“What is Carpal Tunnel?”

Carpal tunnel syndrome occurs when the nerve (median), which runs from the forearm into the hand, becomes compressed between the displaced bones of the wrist (called subluxation). Nerve signals originate in the brain and follow tracts down the spinal cord through openings between the neck bones (vertebrae). The nerves then travel down the arm and into the hand. At the wrist, a semicircular tunnel allows the nerves to travel through the highly mobile wrist area. The tunnel is a narrow and rigid passageway of ligaments and bones at the wrist and contains the median nerve and tendons. The tunnel deforms when there is sprain or damage to the ligaments allowing the bones to move away from their normal positions.

There are also other causes for compression, such as inflammation. Sometimes, the nerve is more susceptible to compression at the wrist if it is also pinched or irritated at the neck level. When the nerve is compressed or irritated at both the wrist and neck area it is called a double crush injury or syndrome.

Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be pinched. This is why sometimes anti-inflammatory drugs such as aspirin or ibuprofen will decrease the pain in some patients. But these medications really are a no-end kind of treatment that never gets at the cause of why there is inflammation in the first place. They also have significant side effects, especially in older patients where they can cause stomach or intestinal bleeding (ulcers).

The median nerve controls sensations to the palm side of the thumb and fingers except the little finger as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. Pain, tingling and numbness in the hand can be caused by neck problems such as a herniated disk, sprains or subluxations, and arthritis.

When carpal tunnel syndrome strikes, the result may be pain, weakness, or numbness in the hand and wrist. Sometimes, the pain runs from the wrist and back up the forearm. Many patients will also say that they have other bothersome symptoms such as back and neck pain or stiffness.

Many patients believe surgery will help their condition or have had it recommended to them. It is important to make sure  a comprehensive diagnosis is obtained prior to contemplating surgery. Surgery is a very drastic and last resort type of option so one should try conservative treatments first. If the problem is an irritated or compressed nerve in the neck, no amount of wrist surgery will help that type of problem.

A Pill or A Chiropractic Adjustment for My Back?

It’s a good question. We want to do the things that promote and speed healing, and not do the kinds of things that cause more harm or are destructive. A lot of us know that a little rest when we injure the back is ok, but staying in bed for a week might not be a good idea. Studies have shown that bed rest for more than 2 days causes even more pain. Since our goal is to move, then lying down doesn’t seem like a worthwhile step towards that goal.

Some of us know that when the back flares up, ice is better than heat. Some of us still don’t, and instead throw gasoline on the inflammation fire by having a soak in the hot tub.  These things are obvious on the list of do’s and don’ts for the person with low back pain. But pain pills have a downside that a lot of us are not aware. It seems like taking a pill for a few days to help with pain is reasonable enough. Right? Maybe wrong.

For example, certain NSAIDs (e.g. ibuprofen) can make the scar formation in a muscle strain less effective. Instead of the scar being formed properly, it is in a more disorganized or scrambled fashion. If you have a poorer scar, the tissue will not be as strong and could lead to re-injury or a delay in your recovery. We don’t think about it but just not taking pain pills early on would help for a lifetime. Ice can be an effective pain killer and doesn’t come with medication-side effects.

Muscle relaxants are also prescribed for people with back pain. They are consumed by 49% of patients. The theory is that the muscle spasm should be relieved so that there can be less muscle pain. A study of patients who took muscle relaxants showed that these sufferers recovered more slowly. Unfortunately, the muscle spasm is there for good reason: to protect a delicate nerve.

Another thing that you have to consider besides poor scar formation and slowed healing, is the actual purpose of these medications. You have to also ask yourself why your body wants you to feel this pain. The body wants you to protect the area from movement. If you block the pain with medications, you may move too much, or too soon in the healing process, delaying your recovery.  A study that compared chiropractic adjustments to muscle relaxants in patients with low back pain had interesting results. There was also a sham adjustment group and a placebo medicine group. The authors concluded that chiropractic care had superior results.

Dr. Akhavan can help guide you to when you can return to certain work or sports. By gradually integrating exercises into your daily routine as the function of the joints is improved, your injury can heal more naturally.

I’m Waking Up With A Stiff Neck!

Life is stressful enough during the day that it seems truly heartbreaking that many us cannot get the restorative sleep we need each night. Tossing and turning causing insomnia is an epidemic in the U.S., but worse, some of us wake up with actual pain and stiffness. What a way to start the day.

Sometimes it’s the mattress being too soft or unsupportive. Or maybe the too thick hotel pillow has gotten your number. Sleep posture is very critical to spinal health. The neck has a forward arch, and this has to be preserved for there to be maximal relaxation of the spinal cord and nerves. Also the head needs to be supported when turning to side sleeping. The pillow needs to be thick enough so that the head does not fall towards the shoulder, stretching the muscles and delicate nerves on the side of the neck.

You need to rest your spine each night so that the tissues can repair and heal. It is important that muscles are able to relax, and that the bones of the neck are not placed into abnormal postures. Ever fall asleep on an armrest of a sofa, or in a car or plane? Most of us have experienced the stiffness that comes with this. But some of us have spinal bones that are already sprained and displaced from old injuries, which means good sleeping posture is even more critical. Simply a minor change from our usual bed or pillow is enough to make for a stiff neck in the morning. Or perhaps you thought a stiff neck in the morning was normal because it has gone on for years.

One of the more common problems for morning stiffness is neck and body position. Stomach sleeping is a definite no. In this position, the neck will be twisted excessively. The best positions will be side lying with adequate head support, or flat on the back with a proper neck-support pillow. These types of pillows allow the cushion to push upwards into the curve of the neck, while the head is cradled. Usually pillows are simply too thick and these can cause the neck to be in a forward stressed position which stretches the nerves and spinal cord.

If you’re waking up with a stiff neck, then it could be how you’re sleeping or whether your pillow is right for good neck sleeping posture.  In our office, we do carry natural supportive pillow to help our patients hold their adjustments.

“What Jobs Cause a Bad Back and What Can I Do About It?”

Back  problems are commonplace in society. It is important to ask if there might be certain  risk factors for back injury that should be avoided if possible. While we cannot pick our genetic make-up or even our current occupation (for most of us), how we interact with our daily tasks can be the difference between disabling pain and minor aches.

Some of the most strenuous jobs are those tied to the construction industry. Concrete-reinforcement workers and carpenters have more back pain than what is typically seen in office workers. But office workers  can be a greater risk for carpal tunnel symptoms. Each of these jobs has unique characteristics that make certain locations of the spine more affected than others.

Lifting heavy weights (e.g. concrete, lumber), especially  in awkward positions makes the discs in the low back vulnerable to the load, which can exceed the strength of the ligaments. This is called a sprain and in severe cases the disc can bulge or herniate. If the worker can use good ergonomics  (e.g. symmetrical lifting), then the disc can more safely resist the load. It is  also known that the spine is more stiff in the morning, and develops higher pressure in the disc when a worker lifts at this time of day. Taking this into account, one can do more light lifting in the early morning. In almost every case one  should never lift anything, even a light object, by doing a twisting motion. This action is where the spine can easily be damaged. Getting a buddy to help with a lift is a solution that many do not try.

Sitting for prolonged periods can also be damaging to the spine. First there is  the inactivity, which causes muscles to become weak. The spine is designed for movement,  especially walking. An apple a day is good but a walk a day is better.  Sitting also causes increased pressure in the disks of the low back. If you add  vibration (e.g. bus drivers), the sitting seems to be much worse. An anti-vibration seat, frequent walk breaks, along with a chair that provides proper support, are the main counter measures.

Each job has its   own unique ergonomic characteristics and should be assessed accordingly. Proper  spinal posture while working is a key to overall good health and is the best prevention for back injury.

“Why Is It That My Usual Stretches:Don’t Seem To Help My Back Pain Anymore?”

Like most health conditions, low back pain is a chronic problem. Patients with low back pain typically suffer off and on for years. Back pain seems to come on when we overexert or do something out of the ordinary, such as moving boxes or when returning to a sport we have not tried since our high school days.  Most patients will say that stretching seems to prevent problems and injuries from the activities of daily living. Both the weekend warrior and the daily athlete will attest to the benefits of stretching prior to the activity.

But stretching is typically not a good treatment plan when the pain comes on.  Why is that? Why is something so effective for preventing a problem and completely useless as a cure. Some patients are lucky however. Through trial and error,  they may find that the stretching actually causes their back pain to get better.  But over the years its effectiveness diminishes. Some patients will say that                   their normal pre-activity stretches actually make the pain get much worse.

Stretching is designed to lengthen muscles and tendons. But back problems typically affect the ligaments and the discs. And the problem here is that the ligaments are stretched out, allowing the bones to creep into abnormal positions.  So while stretching may help a tight muscle, its affect on ligaments can be detrimental.

Another factor to consider is that the delicate nerves of the lower spine cross the disk areas. With stretching, those nerves can lengthen and become even more irritated.  If you find that your normal stretches seem to have no effect on your pain or even make the pain worse, then that is a sign the ligaments have been damaged. Stretching will not help in this scenario and you will need to consult a chiropractic doctor who will perform an examination of the ligaments and discs.

The adjustments that chiropractors perform are designed to align the bones of the spine so that the ligaments do not remain stretched-out, producing pain. Over weeks, the bones begin to hold their normal position for longer periods of time and gradually the ligaments begin to shorten.

Our office can also advise you on stretches that lengthen the muscles but do not cause further stretch to the already damaged ligaments of the lower spine.

Low Back Pain:Could Your Feet Or Hips Be At Fault?

The body is an interconnected whole and needs to be lookedat as such in order to  get at the root of a spinal problem. We are all familiar with low back trauma, bending   and stooping in awkward positions to lift something from a trunk, or the slip and fall on ice. In these examples, it’s easy to see how the trauma preceded the low back pain.

But sometimes pains in the low back are not so easy to figure out. One area of the spine could be compensating in posture for   another, inhibiting a vertebral joint’s ability to fully recover. Or maybe you’re suffering from the cumulative affects of microtrauma over time. Such is the short leg; about 1/10 people will have an anatomic difference in leg length of up to one centimeter. This short leg causes the pelvis to incline to one side providing an uneven support for the base of your spine. It’s a little like walking with one foot in a small ditch.
The uneven pelvis then causes a lumbar scoliosis, which must be further compensated from above.  But a  short leg can also be functional, due perhaps to a small or collapsed arch of the  foot. This can account for up to 5 mm of leg length difference. Do you have a history of having flat feet or have you ever sprained one of your ankles? The sprained ankle can damage ligaments to such a degree that the normal arch of the foot can no longer be maintained.  Depending on the degree of the problem we may be able to help your low back pain by correcting a problem in the foot. Many in-shoe orthotics are available to correct a fallen arch. If the problem is very severe, you may also need a visit to a podiatrist.

In any case, it’s important to consider the foundation of a spinal problem, and it can be as simple a problem as bad foot posture that is affecting how your low back functions. Also, problems in the sacroiliac joint or hips can affect how the lower spine moves.  So pay attention to where the pain is located,  but also consider that other joints nearby may be affecting your recovery as well.

As a doctor of chiropractic, my office is fully equipped to handle problematic low back conditions that don’t seem to clear up in response to what  you’ve tried in the past. Have your feet been checked? Has someone looked at your postue carefully?

An Ice Pack or the Hot Tub?

Many patients do some self-care when they first hurt their  back, hoping this will keep them out of  a doctor’s office. Home remedies sometimes make the pain go away and sometimes  they don’t. It depends on what you try. When the back is first hurt, it’s often  a sprain/strain typ e of injury with accompanying muscle spasm.  When a nerve in the low back gets pinched or irritated, the body will protect the delicate nerves by keeping you from moving and risking further nerve injury. The easiest way for the body to do this is to cause the back muscles to spasm and splint the injured area.

Muscle pain can be quite severe and heat can sometimes soothe muscle pain. For this reason,  many patients take to the hot water bottle or the hot tub to try and get some relief.    This should be avoided in an acute injury because inflammation is present.  With inflammation, there is increased heat and the additional heat you provide is like adding gasoline to a fire. The results are usually not good.

A better choice with an acute injury is to ice the area, but this also needs  to be done with some caution. The simplest ice pack is ice cubes placed in a plastic bag. While effective, you can cause a frostbite injury if you leave the pack  on for too long. When you first ice the area, you will go through several phases  before some pain relief is achieved. At first the pack will feel cold. The next   phase is a burning sensation and the ice will almost feel hot. This is followed  by an aching or throbbing sensation. Just before the area is numbed, a very   sharp pain will be experienced followed by the relief you desire. This can take from five to ten minutes to go through all of the phases. Once numbness is achieved,  the pack should be removed. You should most definitely not fall asleep while the pack is on.

If this simple procedure does not solve the problem it’s best to get your spine checked by Dr. Akhavan.

What is a Subluxation?

Subluxation means a vertebral joint of the spine is out of its normal position. It’s the same as a sprain because the ligaments are stretched when this occurs. But how does a joint get out of its normal position? Usually, the culprit is some sort of trauma but not necessarily at the level of a high fall or a major car accident (although these trauma do cause problems).

Many times, the spine is injured because it is more vulnerable in awkward positions, such as when we bend forward and add a little twist to a lift. Perhaps it’s putting a baby seat into the back seat, or pulling weeds in the garden.

For many patients, it’s life’s trips and tumbles as a child that set the stage for a problem years later. We can all remember how we thought our spines were once invincible. The reality is something much less. Those jumps from the rooftop did have a consequence.  That small sprain of the ligaments did just enough to make the joints function abnormally. Over time the muscles adapt and our movements become less even. Then some twenty years later, a simple sneeze or less throws our back out. Some patients get back pain when they are under work stress or have to sit for long periods of time.

The important thing is to get subluxations reduced or corrected. The adjustments we perform at the clinic are meant to align the spine and make the movements of spine symmetrical from side to side. This tends to reduce the tensions on ligaments and muscles, and most importantly, makes you feel better.  When your spine moves normally, you may have less pain when you exercise or move the spine in a stressful way.

We can’t make the ligaments perfect, there will always be scar tissue, but we can optimize your life and improve its quality. For many, just working without constant pain can be a real lifesaver. Many patients find their moods improve and they cannot wait to return to the sports or hobbies they once did. This is true wellness, healing not just the body but also the mind. Being in chronic pain is not much fun. While drugs can help many people and get them out of excruciating pain, they do have their limitations. Chiropractic can be a drug-free and natural alternative for health.

Low Back Pain: Fix the Problem First and You Won’t Need to Worry about the Pain

It’s gotten a bit confusing how we sometimes look at our health. When pain strikes the low back we usually think we just got a new problem or injury. But why then was coughing, shaving, or doing the laundry, so different this time? These are things we do everyday. Rarely is a new episode of low back pain brought on by a well-defined injury or trauma. Trauma in most cases is usually quite trivial. We confuse pain as a signal for something that is physically changing each time.

So what is the problem? The problem is joint sprain or subluxation. This is a ligament problem and occurs with small micro traumas over many years, or sometimes with acute events such as car accidents or falls. Over time the ligaments stretch, causing the joints and vertebrae to displace, irritating the delicate nerve fibers. But over a few days or weeks, the pain that accompanies this injury gradually lessens, and in many cases goes away all on its own. But has the problem also gone away? Likely not, because when ligaments are traumatized, the repair mechanism involves scar tissue, which is less elastic than the original, and makes the joint vulnerable to re-injury and sometimes impairs the free and symmetrical motion of the spine. The doctor of chiropractic examines for this type of joint sprain using palpation for tenderness and edema, and x-rays to see the directions the vertebrae have moved towards. These specific analyses can tell us the vulnerable directions and how the vertebrae need to be repositioned to promote good alignment and good posture.

The adjustment is designed to reduce this misalignment, and induce more symmetric motion. When movements are asymmetrical in the spine, they can lead to premature degeneration of the spine and arthritis. This may be why a simple task such as lifting a laundry basket can flare up the back so easily. You may be lifting with good form and posture but with an asymmetrical spine, the loading is very off balance. Sometimes the disks are so damaged that a simple sneeze is enough to cause excruciating pain. So when these trivial events seem to trip you up, it means there is an underlying problem that is not getting corrected.

Low Back Problems and Their Cause

Low back pain for many of us is somewhat of a middle age problem. Lots of sufferers begin to seek chiropractic care in their 30′s and 40′s and wonder how it all happened. Perhaps it was a sneeze, a long drive, or gardening in the yard that set the pain off. But you were always able to do these things before without so much as a chirp from your low back. And now things are different. Even job stress can add to back pain.

So how come your back seems so weak, when it was so strong before? What changed? Not much in fact. The reality is that back problems begin during our youth. With advances in MRI technology we can study changes in the disks of the back to see when these injuries first occur. Spinal degeneration begins to occur at age 10, provided some trauma has occurred, such as from competitive sports or simply goofing off as a child. Rarely is significant pain involved and the child seems to shake off the injury with little future consequence. But having back pain is not the same as a having a back problem, such as a sprain of the disk. When the pain subsides, it does not always mean that symmetrical motion of the joint is restored and the vertebrae are now back in their normal position…but the pain may be much less.

Our bodies have a tremendous capacity to heal on their own without any type of doctor helping out. Mother Nature and innate intelligence is the best doctor. But sometimes recovery and return to full and optimum health is incomplete.

Over time the effects of gravity and daily stresses, cause the joint to become more injured until something as simple as making the bed causes excruciating pain. But was it really the bed making? Probably not because this is something you’ve done every day of your life. A thorough examination by a doctor of chiropractic prior to the onset of pain could have perhaps discovered one of these “silent” injuries. But most people wait until the pain happens before seeking help.

It’s important to be checked after a trauma, even in young children. Properly diagnosing the extent of injury is the first step to getting you the care you may need. The pain often goes away quickly and we often think the problem has also completely healed.

Getting regular check ups to make sure the motions of your spine are fluid and symmetrical is one potential way to avoid bigger problems down the road. We can also advise you on preventive strategies to minimize the risk of injury, such as proper lifting techniques.

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