Burlington Chiropractic and Physiotherapy Clinic

Treatment for Carpal Tunnel Syndrome

Kevin — Sun, 29 Aug 2010 12:00:52 +0000

Carpal tunnel syndrome occurs when a nerve in the wrist (the median nerve) gets compressed between some bones and soft tissues. The symptoms usually consist of pain, numbness, tingling, weakness and deficits in sensation. Typically, carpal tunnel syndrome is more common in women and often occurs in both hands.

There are many different treatment approaches for carpal tunnel syndrome. For those individuals with significant changes in the hand musculature, an unrelenting symptom pattern and objective confirmation of carpal tunnel syndrome surgery is often indicated. For most people carpal tunnel syndrome can be easily controlled with conservative treatment. At Burlington Sports Therapy we recommend a combination of soft tissue therapy (active release techniques and graston technique) with night splinting. The purpose of the soft tissue therapy is to break-down scar tissue that is impeding the proper function of the median nerve. The night splinting is used to “unload” the nerve and allow it to heal.

Although there is significant evidence supporting night splints for carpal tunnel syndrome, the results of a 2007 paper published in the Archives Physical Medicine Rehabilitation suggest that there may be a right and a wrong way to do this. In this study the authors compared two different approaches for splinting the wrist in patients with carpal tunnel syndrome. Their findings indicated that a splint which keeps a specific segment of the finger extended is more effective, as several studies have shown that this position keeps certain muscles out of the carpal tunnel. Shortening these muscles at night therefore allows the median nerve to have more room in the carpal tunnel without being compressed.

The combination of active release technique, graston technique and night splinting is an effective and evidence based way to conservatively control carpal tunnel syndrome. Keep in mind that there are numerous causes of numbness, tingling, pain and weakness in the wrist and hand. There are other potential entrapment sites of the median nerve and there are other nerves that can create similar symptoms to carpal tunnel syndrome. Ensure that your condition is properly diagnosed by a qualified practitioner; feel free to call our clinic and have one of our doctors examine your condition to see if it is a true carpal tunnel syndrome.

References

Brininger TL, Rogers JC, Holm MB et al. Efficacy of a fabricated customized splint and tendon nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88: 1429-1435.

Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Ann Fam Med 2004; 2: 267-273.

Miedany YE, Ashour S, Youssef S, Mehanna A, Meky FA. Clinical diagnosis of carpal tunnel syndrome: old tests - new concepts. Joint Bone Spine 2008; 75: 451-457.

Ugbolue UC, Hsu WH et al. Tendon and nerve displacement at the wrist during finger movements. Clinical Biomechanics 2005; 20: 50-56.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Exercise for Low Back Pain

Kevin — Sun, 15 Aug 2010 23:09:10 +0000

As mentioned in a previous blog, the transverses abdominis muscle has been shown in the literature to play an important role in controlling the spine (http://www.burlingtonsportstherapy.com/blog/a-strategy-to-prevent-lower-back-injury/). From this, it has been implicated in many instances of low back pain. Although it has yet to be determined whether it is a cause of low back pain or it changes as a result of low back pain, it is relatively safe to say that the literature supports retraining this muscle as a potentially helpful approach to rehabilitation of lower back pain for some patients. A 2010 study published in the Journal of Orthopaedic and Sports Physical Therapy had similar findings to a 2008 study in that athletes with lower back pain could not perform the muscle test for the transverses abdominis as well as those athletes who did not have lower back pain. So what does a finding like this mean? The transverses abdominis is not necessarily the most important stabilizing muscle of the lumbar spine. It is not the only muscle that needs to be trained for patients with lower back pain. Training the transverses abdominis will not guarantee elimination or total prevention of lower back pain. These findings suggest that for some patients with lower back pain, retraining of the transverses abdominis can be helpful in re-establishing control of the spine. This may result in decreased low back pain. Identifying weakness of the transverses abdominis is paramount to the effectiveness of this approach, since we cannot expect targeting this muscle to be helpful if a person already has normal function in this area. If you’ve been experiencing lower back pain and are uncertain whether your transverses is doing its job, give us a call, we’ll help you figure it out!

References

Hides JA, Boughen CL, Stanton WR et al. A magnetic resonance imaging investigation of the transverses abdominis muscle during drawing-in of the abdominal wall in elite Australian football league players with and without low back pain. Journal of Orthopaedic and Sports Physical Therapy 2010; 40: 4-10.

Hides JA, Stanton WR et al. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. British Journal of Sports Medicine 2008; 42: 509-513.

Richardson CA, Snijders CJ, Hides JA et al. The relation between the transverses abdominis muscles, sacroiliac joint mechanics and low back pain. Spine 2002; 27: 399-405.

Treatment for Sciatic Nerve Pain “Sciatica”

Kevin — Sun, 01 Aug 2010 22:37:30 +0000

“Sciatica” is a slang term often used to describe pain in the sciatic nerve distribution. More often than not, this involves symptoms down the back of the thigh below the knee and into the foot. This is caused by an irritation of the sciatic nerve. As we’ve mentioned in previous blogs, sciatica is not actually a diagnosis. One of the more common causes of numbness, tingling, pain or aching in the lower limb (following a sciatic pattern) is lumbar disc herniation. Many people refer to this condition as a “slipped disk”, a “pinched nerve” or a disc bulge. Lumbar disc herniation is an area of considerable interest for researchers as the treatment options range from exercises, clinical treatment (like that from a physiotherapist or chiropractor) to surgery. There is ample evidence supporting each avenue of treatment. For example, a large 2006 study published in the Journal of the American Medical Association found no difference between patients who underwent micro-discectomy (surgery) to a group that were treated with physical therapy modalities and steroidal injections. Another study, published in the Journal of Manipulative and Physiological Therapeutics found that lumbar spine traction, ultrasound and low intensity laser therapy were all effective in the reduction of sciatic nerve pain and the reduction of the size of the lumbar disc protrusion. A third example is a 2006 study published in the journal Physical Therapy. The authors of this paper found that exercise-based management of a patient with lumbar disc herniation not only decreased symptoms after nine weeks, but demonstrated resolution of disc extrusion and relief of the nerve root compression on a follow-up MRI.So what is the best way to treat a lumbar disc herniation? There are many variables that play a role in the decision making process for lumbar disc herniation management. Our clinic usually recommends starting with the most conservative approach that is appropriate for an individual’s symptoms. Occasionally, in severe cases, surgical intervention may be warranted. In the province of Ontario, your medical doctor or your doctor of chiropractic have the ability to diagnose this condition for you. Obviously, a proper diagnosis is the first step for a successful treatment outcome!

As always, we do our best to bring you the most current and accurate information both in our clinic and on our website. References from credible scientific journals are provided below. We encourage your questions or comments!! Want more? Sign up for our complimentary email feed (on the right of the page) which gets sent out every two weeks.

References

Hahne AJ, Ford JJ. Functional restoration for a chronic lumbar disk extrusion with associated radiculopathy. Physical Therapy 2006; 86(12): 1668-1680.

Unlu Z et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics 2008; 31: 191-198.

Weinstein JN et al. Surgical vs. non-operative treatment for lumbar disk herniation: the spine patient outcomes research trial (sport): a randomized trial. JAMA 2006; 296: 2441-2450.

Shoulder Exercises

Kevin — Sun, 18 Jul 2010 19:52:26 +0000

Shoulder pathology is very common among active individuals. Although there are many different causes of shoulder pain, many studies have been published in recent years which link scapular (shoulder blade) position and the activity patterns of the muscles around the scapula to many types of shoulder dysfunction. Among the evidence is the consistent finding of delayed lower trapezius activity in dysfunctional shoulders. Thankfully, we now have some objective evidence that can assist us in choosing the best exercises to retrain this dysfunction. A 2009 study published in the Journal of Orthopaedic and Sports Physical Therapy used EMG analysis to examine muscular timing in the trapezius muscles during various exercises. The results of the study indicate that the prone extension exercise and the prone horizontal abduction (with external rotation) both promote early firing of the middle and lower trapezius muscles (when compared to the other muscles that move the shoulder).

In the prone extension exercise, you simply lie on your stomach (on a bench) with your shoulders flexed to ninety degrees. You then extend your shoulders to achieve the end-position pictured below. (Don’t use a stick as pictured below…it is recommended to use dumbbells).

In the second exercise, you start in the same starting position as the first exercise but you bring your arms out to the side (as pictured below). Finish the exercise with your thumbs pointing up to the ceiling.

As always, we do our best to bring you the most current and accurate information both in our clinic and on our website. References are provided below. We encourage your questions or comments!! Want more? Sign up for our complimentary email feed (on the right of the page) which gets sent out every two weeks.

References

Cools AM, Dewitte V, Lanszweert F et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? The American Journal of Sports Medicine 2007; 35(10): 1744-1751.

De Mey K, Cagnie B, Van De Velde A et al. Trapezius muscle timing during selected shoulder rehabilitation exercises. Journal of Orthopaedic and Sports Physical Therapy 2009; 39(10): 743-752.

Hirashima M, Kadota H, Saraurai S et al. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. Journal of Sports Science 2002; 20: 310-310.

Ankle Sprain Prevention

Kevin — Sun, 04 Jul 2010 22:49:58 +0000

Quite often we hear of patients who repeatedly sprain their ankles. Weeks, months or even years may pass between episodes, but there is a definite pattern of inversion sprain (or “rolling your ankle”) on a specific side. Often times this can be attributed to what we call a functional ankle instability. With functional ankle instability, our body controls the muscles around the affected joint in an altered fashion due to repeated episodes of injury. So what can we do to fix this?

According to some recent research, the peroneus longus muscle has been found to be dysfunctional in many patients who have experienced repeated ankle sprains. Although the specific cause is unknown, this altered muscular activity can be expected to reduce protection against ankle sprain. It is therefore recommended that those patients who have experienced repeated ankle sprains be assessed by a qualified doctor (like a chiropractor) who is familiar with identifying weakness of the peroneus longus muscle. Combined with proprioceptive training (see http://www.burlingtonsportstherapy.com/blog/page/5/) and other common strategies to address ankle dysfunction, targeted strengthening of a weak peroneus longus muscle can be helpful in reducing chronic ankle sprains.

If you have an ankle sprain and are looking for effective treatment, call or email our clinic now to schedule an appointment with one of our doctors…end your ankle pain once and for all!

References

Santilli V, Frascarelli MA, Paoloni M. Peroneus longus muscle activation pattern during gait cycle in athletes affected by functional ankle instability. The Journal of American Sports Medicine 2005; 33(8): 1183-1187.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinics in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractics clinic in Burlington.

Injuries in Soccer Goal Scorers

Kevin — Mon, 21 Jun 2010 00:43:54 +0000

Since the World Cup is on everyone’s mind these days, we thought it would be only fitting to make you aware of a crucial paper published in the American Journal of Sports Medicine which analyzed score-celebration injuries among soccer players.

The authors of the study observed professional and amateur soccer players over the course of two seasons, looking at the incidence and nature of injuries sustained by players during their goal celebrations. Over the study period, 152 players were evaluated for injuries sustained in matches. Of these, 6% (9 players) sustained injuries during their goal celebrations. The pertinent findings were as follows…

7 of the 9 players were male and their average age was between 17 and 29.
The injuries happened on real grass in 8 of the 9 cases.
Most injuries occurred in the second half.
Sliding injuries (on the stomach, back or knees) accounted for 5 cases.
Piling up or over-excited teammates were the other major cause.
Injuries included fractures to the ankle, clavicle and rib. Other injuries included knee ligament sprain, lower back strain, and lower limb muscular strains.
Perhaps the most interesting statistic is that the average recovery time for these injuries was 6.2 weeks! Perhaps enough reason to take it easy when celebrating a goal!

References

Zeren B, Oztekin HH. Score-celebration injuries among soccer players. The American Journal of Sports Medicine 2005; 33(8): 1237-1240.

Whiplash Injury

Kevin — Mon, 07 Jun 2010 00:59:29 +0000

Whiplash injury is a condition that involves damage to both the muscles and joints in the neck after it has been “whipped” backwards. Most commonly associated with rear-end motor vehicle collisions, whiplash is a common yet often complicated condition to resolve. Due to this, a great deal of literature has been published on whiplash and different pieces of the puzzle are slowly being put together.

The cervical facet joint is a joint at the back of the neck that compresses together when the head is extended (like the motion of whiplash). To challenge the right facet joint, we turn the head to the right and extend the neck backward. Likewise, to challenge the left facet joints, we would turn the head to the left and extend the neck backward. A recent study published in the journal Spine investigated the affect of having your head turned when rear-ended and whether or not that made injury to the facet joints (whiplash) worse. Perhaps predictable, this study indeed found that a head-turned posture increases the facet joint injury associated with whiplash. Unfortunately, it is common for drivers to turn their head to the right and look out the rear-view mirror a split second before an impending collision. Of course, we hope that none of us are ever in this situation, but in the unfortunate event of a rear-end collision remember to keep your head straight!

Our Burlington Chiropractic and Physiotherapy Clinic treats many patients with injuries that stem from car accidents. If you’ve been in a car accident it is very important to get examined and diagnosed as quickly as possible. Call or email our clinic today to have your whiplash injury examined by one of our doctors.

References

Lord SM, Barnsley L, Wallis BJ et al. Chronic cervical zygapophysial joint pain after whiplash. A placebo controlled prevalence study. Spine 1996; 21: 1737-44.

Siegmund GP, Davis MB, Quinn KP et al. Head turned postures increase the risk of cervical facet capsule injury during whiplash. Spine 2008; 33(15): 1643-1649.

Sturzenegger M, Radanov BP, Distefano G. The effect of accident mechanisms and initial findings on the long term course of whiplash injury. Neurology. 1995; 242:443-9.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinic in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractic clinic in Burlington.

Laser Therapy and Achilles Tendon Injury

Kevin — Sun, 23 May 2010 16:25:14 +0000

Laser therapy has been used in clinical practice for the treatment of musculoskeletal injuries for over 26 years. As with other healthcare applications utilizing laser technology, knowledge of this modality has grown considerably since its inception. A recent study published in the American Journal of Sports Medicine examined the usefulness of low intensity laser therapy for the treatment of achilles tendon injury. A significant difference was found between the treatment group and the placebo group, with the laser patients healing much faster. Specifically, the laser group achieved the same level of healing in 4 weeks that the placebo group achieved in 12 weeks. (Eccentric strengthening of the tendon was given to both study groups since this has been established in the literature as beneficial for overuse tendon injuries). For those readers seeking a viable treatment approach for their Achilles tendon injury, this recent research supports an approach combining low intensity laser therapy and eccentric exercise.

From a practitioner standpoint, this paper provides some other useful information. The success of laser therapy for various injuries largely depends on the settings chosen by the practitioner. A longer, more intense setting is not necessarily better. Through clinical trials like this one, it has been discovered that the use of certain lower settings for tendon injuries will benefit the patient more. Perhaps another example of how scientific evidence can guide practitioners and patients in choosing the best treatments available. If you have an achilles injury (achilles tendinopathy, achilles tendinosis, achilles tendonitis, achilles rupture, achilles tendon pain) call or email our clinic right away…we can help!

References

Stergioulas A, Stergioula M, Aarskog R et al. Effects of low-level laser therapy and eccentric exercise in the treatment of recreational athletes with chronic achilles tendinopathy. The American Journal of Sports Medicine 2008: 36(5); 881-887.

World Association for Laser Therapy (WALT). Laser dosage recommendations. Available at http://www.walt.nu/dosage-recommendations.html

What is the Q-Angle?

Kevin — Sun, 09 May 2010 18:15:30 +0000

The Q-Angle (quadricep angle) is a measurement used by many health care practitioners to assess patello-femoral alignment. It is often mentioned in running magazines and on different websites because of its apparent ability to identify those persons at risk of certain knee injuries. But is it a valid measurement tool?

The basic premise of the Q-Angle is that a higher angle (such as what might be expected in women with a wider pelvis) would affect the way that the patella (knee-cap) lines up with the lower limb. Some practitioners use it to identify those patients at risk of patella-femoral injury. According to the scientific literature though, the Q-Angle is a measurement which over-simplifies knee biomechanics. It only examines a person in one plane of reference (like a two-dimensional object) and does not take into account the complex forces that occur during running, walking and jumping. Numerous publications in very reputable journals have scrutinized its ability to accurately identify those people at risk of injury. Despite this, many practitioners continue to use it and many magazine articles and websites continue to present it as reliable. Perhaps again, an example of something that’s popular but not validated by science.

References

Duffey MJ, Martin DF, Cannon DW et al. Etiologic factors associated with anterior knee pain in distance runners. Med Sci Sports Exerc. 2000; 32: 1825-1832.

Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clinical Journal of Sports Medicine. 2009; 19(3): 201-206.

Thomee R, Renstrom P, Karlsson J et al. Patellofemoral pain syndrome in young women. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports. 1995; 5: 237-244.

Witvrouw E, Lysens R, Bellemans J et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. American Journal of Sports Medicine 2000; 28: 480-489.

Stress Fracture

Kevin — Sun, 18 Apr 2010 15:20:29 +0000

Our bones are constantly remodeling, a balance between the cells that breakdown and the cells that rebuild bone. When we place excessive demands on an area (from something like excessive running or walking) there can be a net balance of bone breakdown, which can result in a stress fracture. A stress fracture is a painful bone injury that can affect anyone. Common with runners and military personnel, stress fractures are most frequent in the lower extremity. Specifically, the metatarsals (small bones in the foot) and the tibia (the bone in our leg below the knee) are common sites. X-ray is often the first step in diagnosing a stress fracture. Unfortunately, it is not the most sensitive tool for detection. The literature suggests that on average, pain is usually present between two weeks and three months before an x-ray will detect a stress fracture. In addition, 85% of stress fractures are missed on the first x-ray and follow-up x-rays only detect them 50% of the time. Therefore, bone scans or magnetic resonance imaging (MRI) are more useful for detecting stress fractures, but x-rays can serve as a good starting point.

The primary treatment for a confirmed stress fracture is rest. In doing this, the bone is allowed to remodel with the net balance in favour of bone building (instead of breakdown). At present, there are no proven methods for preventing stress fractures in the lower extremities, but there is some research that suggests shock absorbing insoles being potentially helpful. Common sense would perhaps indicate that a gradual progression of mileage and distance for runners and walkers would help the bone in adapting to increased demands.

As always, we do our best to bring the most current and accurate information to our clinic and our website. References are provided below if you are interested in further reading. We encourage your questions or comments! Want more? Sign up for our complimentary email feed (on the right of the page) which gets sent out every two weeks.

References

Arendt E, Agel J, Heikes C et al. Stress injuries to bone in college athletes: a retrospective review of experience at a single institution. American Journal of Sports Medicine 2003; 31(6):959-968.

Moran DS, Evans R, Hadad E. Imaging of lower extremity stress fracture injuries. Sports Medicine 2008; 38(4): 345-356.

Rome K, Handoll HH et al. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev. 2005; 2:CD000450.

Shaffer SW, Uhl TL. Preventing and treating lower extremity stress reactions and fractures in adults. Journal of Athletic Training 2006; 41(4): 466-469.

Yeung EW, Yeung SS. Interventions for preventing lower limb soft-tissue injuries in runners. Cochrane Database Syst Rev. 2001; 3: CD001256.

Yochum TR, Rowe LJ. Essentials of Skeletal Radiology 1996, Williams and Wilkins.