Most patients will benefit from other aspects of our comprehensive approach, such as specific stretches or exercises and appreciating how our lifestyle choices can also influence symptoms.

While excessive weight is a risk factor for carpal tunnel syndrome (obese and overweight patients have a greater risk for developing carpal tunnel syndrome), there are also other dietary approaches that have been tried to cure or alleviate symptoms. One of these is vitamin therapy, specifically vitamin B6. This is an important vitamin for many complex bodily functions, including maintaining a strong immune system. It also supports glucose or blood sugar functions.

Recent research (Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Canadian Family Physician 2007;53(7):1161-2.), has shown that although the research is weak on the subject, there appears to be modest evidence that supplementing their diet with vitamin B6 can help some patients with carpal tunnel syndrome. This effect has to be balanced against any known risks, which appear to be very rare and not severe. The recommended daily dose is about 100-200 mg and this can be taken for a few months with a gradual reduction in the dose after this time.  Other authorities believe it’s better to take the B vitamins in a complex form rather than one vitamin in isolation. There may be some biochemical synergy to taking the various B vitamin forms together, which is how they are often sold in stores. You can also get B6 from natural food sources such as potatoes, garbanzo beans, and fortified cereals. Older adults and those who consume excessive alcohol can be at risk for developing a vitamin B6 deficiency.

Almost to a person, the answer is: carpal tunnel. But the thing that surprises me more is that the person usually says how much pain they’re still in, despite the brace. Maybe it’s because their work is so stressful on the wrist? Serving tables is hard work and holding a couple of heavy plates with one hand can put a considerable strain on the wrist.

For many patients, the brace can be a life saver, getting us back to work and providing for our families. But for many others, they don’t solve the problem. That’s because simply limiting motion, while good in theory, could make the muscles of the wrist weaker. Also, wrist problems aren’t always just a problem in the wrist. If the wrist and hand pain is actually coming from a pinched nerve in the neck, then the wrist brace will do little to help.

The important thing is to get the problem checked out. Is a small bone of the wrist out of its normal position? Is the mobility of the wrist asymmetrical and uneven? Is there a double-crush problem, with a pinched nerve not just in the carpal tunnel, but also where the nerves exit the neck area?

Our clinic does our best to help the pain of carpal tunnel. Usually a comprehensive approach is needed and we may need to adjust the bones of your neck and wrist to help restore proper alignment. If the vertebrae are twisted in the neck, they can narrow the openings where the delicate nerves emerge and travel down the arm to the hand. Sometimes the posture of the neck is affected and there is a loss of the normal forward curve of the neck. This can cause a stretch to the spinal cord and nerve roots.

If possible, we try to limit the use of braces and instead focus on strengthening the muscles of the forearm, or use deep tissue massage and stretching to increase muscle flexibility.

Moving your neck slowly through all its ranges is key. It is important to do pure movements rather than combinations, rolling the neck around like a ball and socket joint (such as the hip or shoulder) is to be avoided. Instead, flex the neck forward until your chin touches the top of your chest. Then, slowly bend your neck backwards, chin to the sky These movements should not cause pain if they are done slowly and you have no pre-existing injury.

The next movement is side bending and is accomplished by trying to bend either ear towards the shoulder. Do this in front of a mirror so that you keep your head straight looking forward. Note whether you can do this the same amount to each side.

The last movement is rotation. Simply rotate your chin slowly so that you are looking over one shoulder. None of these movements should cause pain or make you dizzy. If they do, then it’s a sign you have a neck injury.

An important aspect of neck function is how the shoulder girdle influences neck posture and motion. Try rolling your shoulders forwards and backwards, stretching slowly, to help ease tension at the neck. General exercises such as fast paced walking or hiking are important for your neck too. Remember, your spine is the core of your body and walking is one of the least “injury-producers,” something you can keep up well into your later years.

Lastly, make sure your neck posture is kept upright when you are talking on the phone, driving, reading, doing other tasks, or sleeping.  A very small pillow is usually best for sleeping and neck support pillows are available to help maintain the normal forward arch of the neck. A small pillow will allow your head to ease back, relaxing the muscles at the back of the neck.

In carpal tunnel syndrome, some of the well-known risk factors are using tools that vibrate or doing work that involves repetitive motions of the hands and wrist. Also workers who have neck and shoulder pains are more likely to get carpal tunnel symptoms in the future.

These obvious factors are easy to understand, but what does this have to do with my excess weight? Carpal tunnel syndrome, like all diseases, has many different causes. All of these potential causes need to be thoroughly considered when approaching a patient’s condition from a holistic standpoint.

Excess weight gain has been problematic in U.S. society for many decades. Two-thirds of adults are now either overweight, or clinically obese. Research has shown that obesity can increase your risk for carpal tunnel syndrome by as much as 75-100%. Why this is the case is not well understood. But understanding this additional risk to being overweight may motivate more of us to do something about it. Weight loss is difficult for anyone, so if there is one more positive thing that can motivate us, such as less hand pain, then this needs to be appreciated.

In some patients, the increasing body size can cause the spine to alter its posture into a sway back with forward head posture. The sway to the low back is easy to see looking at an obese person from the side. X-ray is needed to see the changes in the neck curve. In this sway back position, the spinal cord and nerves of the neck are more stretched. This stretching of the nerves might make them more susceptible to pinch at the wrist, because they were first compromised at the neck.

Another theory is that the changes that come with obesity could create more inflammation generally in the body. This inflammation might make symptoms at the wrist occur if there was already a narrowed space for the nerves.

Obesity can be just one more added stressor to your body that you can do without. Choose a doctor that considers both your nutritional and structural needs when deciding on a health care provider. Prevention is the key to many problems including carpal tunnel syndrome.

The cause of the headaches associated with neck pain and dysfunction is usually due to the compression caused by the tight neck muscles squeezing the upper three nerve roots in the neck region, resulting in radiating pain into the head.  Frequently, light and noise sensitivity, as well as nausea, can accompany a severe headache, which only adds to the activity limitations associated with neck pain. In fact, there are many experts who feel most headaches, even migraines, stem from the neck or are at least are very closely related.  Since neck pain affects approximately two thirds of the population at some point during their lifetime, it becomes clear that headaches, in the absence of neck pain, are quite uncommon.

Another interesting and lesser-known relationship is the jaw (frequently referred to as the TMJ) and its association with neck function, especially the upper cervical vertebrae, as well as headaches.  The muscles that move the jaw/TMJ are largely innervated by the 5th cranial nerve, also called the trigeminal nerve.

Several studies have found that when stimulating structures innervated by the trigeminal nerve, neck and/or jaw pain was created and vise versa.  Similarly, patients with jaw problems (called temporomandibular dysfunction or, TMD) often report neck pain.  When we open our mouth wide, head-neck extension always occurs followed by head-flexion when we close the jaw.  Hence, the neck is always moving when we chew, yawn, talk, and clench our teeth.  In fact, all of these every day activities result in jaw, head, neck motion extending from the base of the skull and first cervical vertebra (occiput-C1) and continues down through the entire cervical spine.

This was investigated in a study where the relationship between neck symptoms, jaw function – specifically active mouth opening, and pressure pain sensitivity in a trigeminal nerve innervated region after a spinal manipulation was applied to the upper neck vertebrae.  Here, 37 female patients with neck pain were randomly assigned to 1 of 2 groups (control and experimental) and, before and after treatment, exams of mouth opening and pressure pain levels were measured.  The group receiving the upper neck manipulation showed a significant increase in active mouth opening motion as well as improved pressure pain tolerance compared to the control/non-manipulation group in a sample of woman with neck pain.

This study is very important as many people suffer from neck pain, headaches and TMD.  In order to properly treat these patients, one must focus on multiple regions, not just the neck area.  It has been demonstrated when we bite down, there is a corresponding tightening of two important muscles in the neck and upper back region.

Similarly, studies show relaxation of muscles in the neck, upper back and TMJ after spinal manipulation to the neck is applied.  Injuries to the TMJ are common but often not pursued by patients as often they’ll say, “my jaw clicks and snaps but I don’t think about it much.”

In the diagram above, the nerves come off the spinal cord.  Those in the neck region go down the arm and those in the low back go down the legs.  The spinal cord is the “highway” that brings information from the nerves in the arms, legs, trunk, etc.,  to the brain where information is processed.  The bony spine houses and protects the spinal cord and skull protects the brain but there is no bony protection for the nerves.  Nerves bring information to the brain allowing us to feel, taste, smell, see, and move our legs and arms to perform complex movements like dancing, running, gymnastics, and so on.  Information is constantly going to and from the brain to allow us to function normally.  The nerve can get “pinched” anywhere along its course, including the wrist (carpal tunnel syndrome), elbow (cubital tunnel syndrome), shoulder (thoracic outlet syndrome), and/or neck (herniated disk and/or arthritis).  This results in a slowing down of information transmission to/from the brain and numbness, pain, throbbing, as well as weakness in strength can occur.

There are two types of conditions that commonly pinch nerves, which generally occur at different times of life – those with a herniated disk (younger > older patients) and those with arthritis (older > younger patients).  A combination of the two conditions producing the pinching effect on the nerve can also occur making the diagnosis process a little trickier.

The nerves exit the spine through holes that can be narrowed if the jelly central part of the disk herniates outward and into the nerve pushing it against the bone that makes up the hole through which it exits the spine. A “bone spur” (as shown in the diagram to the left, coming off the left facet joint) pushing into the nerve  or the thickening of the ligaments that run inside the spinal canal (eg., ligamentum flavum) can also crowd these sensitive nerve structures and cause similar symptoms.

Both of these conditions are commonly treated by Dr. Ali Akhavan at Grande Chiropractic.  If a family member or a friend requires care, we sincerely appreciate the trust and confidence shown by choosing our service.  We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.

This is where the center of the disc (Nucleus Pulposus) has not yet herniated, but is still bulging through the outer containment walls of the disc (Anulus Fibrosis) and is causing nerve pressure…often times on the lumbar nerve roots that form the sciatic nerve. This can lead to sciatica (leg pain) as well as low back pain and dysfunction of varying degrees.

Bulging discs will often times become full blown disc herniations if left untreated.

Spinal Decompression machines are designed and built to reduce disc bulges and disc herniations. They do this by enlarging the disc space, stretching the spinal ligaments, elongating the spine, re-establishing nutrient exchange between the disc and blood stream, and creating a negative pressure in the disc.

The negative pressure pulls the bulging disc fragments, or herniated disc fragments back to the center of the disc where they belong and off of the spinal cord and nerves.

It really is quite amazing…but that’s how it works.

Does it work every single time? NO…just most of the time.

At our clinic, we only accept cases that have a high probability of success. And the patient must be willing to do their part. The treatment protocol is for 20 hour long sessions over 4-6 weeks. There is quite a bit of home care also in the form of exercises, dietary recommendations, hydration, and do’s and dont’s.

The bulging disc patients that get the most from spinal decompression therapy, do their part, keep their appointments, and have a positive attitude about the treatment process…because it is a process.

Lumbar disc bulges can cause severe pain and loss of function…and often times nothing will help as far as medical care. This is when spinal decompression makes the most sense.

So…if you have been diagnosed with a bulging lumbar disc or herniated disc, and feel you have no where to turn…disc decompression with a machine like the DRX9000 just might be a logical next step.

To find out if you are a candidate for the DRX9000 at our clinic, call 604-984-4601 and ask for a complimentary consultation.

As pain continues, we may stop using a keyboard or playing certain sports or hobbies. All of this lack of activity makes muscles weaker and joint function further impaired. This is why it is important to maintain flexibility of your joints and muscles if you have this disorder.

Two good stretches for the forearm and hand involve stretching into flexion, which lengthens the tissues on the back of the wrist and moving your fingers backwards, stretching the palm and the front of the forearm. You can do these two stretches by using your other hand to bend the fingers backwards and pulling the back of the hand forward. If either of these motions causes more pain, then you should avoid them.

Three additional stretches involve the elbow, wrist and neck. For the elbow, extend your arm out, stretching the front of the upper arm. You can also rotate the wrist by twisting it until the thumb points down maximally and outwards maximally. Check to see if you have the same flexibility on both sides; your goal will be to create symmetrical side to side movements.

The shoulder and neck are often neglected in carpal tunnel stretches but are critical because the nerve that goes through the wrist starts in the neck area and passes through the shoulder. Put both hands over your head and “reach for the stars.” You might also rotate your shoulders by moving your arms in large circles. This stretch will also affect the neck. It’s important to do your stretches slowly. Little by little, the nerve will have more flexibility as it courses down the arm and this may help your hand symptoms.

So what does the medical literature actually say? A recent article published in a scientific journal (Adv Tech Stand Neurosurg 2007;32:175-249) may provide some perspective.

The paper is titled, “Carpal Tunnel Syndrome-a comprehensive review.”

Unfortunately, the “comprehensive” review pretty much only discusses the surgical approach to this most difficult problem. The conclusion states, “Surgery for carpal tunnel syndrome requires meticulous attention to history-taking, investigation, counseling, training and surgical technique if unsatisfactory results and complications are to be avoided.”

The authors are to be commended for providing a sober perspective on the potential outcome and pitfalls of surgery for CTS.

The part that makes me feel this review is very incomplete, is that chiropractic care is not discussed. That is too often ‘”to be expected.”

But, patients deserve to be told their many options for care, including alternatives to surgery such as chiropractic care. When all you have is a hammer, everything starts to look like a nail.

So, that is what this Health Update is all about, a chance for you to consider surgical alternatives. No one doctor has all the answers but it’s important to hear the various perspectives so you can make an informed decision.

In our office, I would explain the various types of techniques and modalities we use to address carpal tunnel symptoms. Sometimes the neck is involved, affecting the nerves that go to the hand and wrist. This is called the double-crush syndrome, and is often overlooked by providers who only examine the wrist for the cause of the wrist and hand symptoms. If your neck was injured in a whiplash or sports trauma, this may be one aspect of your health that has not yet been addressed. By adjusting the problem in the neck region, the nerves to the wrist may function more normally. Also commonly the forearm muscles are involved where the median nerve travels along.  We commonly treat that with Active Release Therapy (ART) followed by Low Level Laser Therapy.

If you have questions regarding this, do not hesitate to contact our office at 604-990-6676.

The spine is meant to move a lot, especially the neck. This is so we can quickly look around, above, and below. When the spine cannot be moved without intense pain, it’s a sign of both a joint and nerve problem. The nerve may be pinched or compressed, stretched, or irritated by chemicals from inflammation/swelling. To protect the nerve, the body puts a splint on it with muscle spasm. This keeps you from moving your head.

If the joint injury is reduced, by aligning the bones of the spine, the healing and scar tissue will stabilize the area in alignment. If the joint is left out of alignment or is hypermobile, this can lead to future degeneration. To get the joint moving and functioning normally again, you need to have motion through the joint adjustment, and exercises to keep activated. One study showed that patients who wear foam collars after whiplash, do worse then patients who were actively mobilized without collars. It may at first seem counterintuitive to move when pain is there, but it’s all about moving within your pain tolerances. Usually small motions are still preserved. Instead many patients wear collars or do not move their neck enough. This causes the muscles to become more inflexible and contracted. Overtime it can lead to substantial weakness and even atrophy (wasting away).

So even in the early stages of a whiplash, when the neck can barely move at all, small movements that are not painful are encouraged. The specific adjustment will reduce the irritation to the nerve that is signaling the muscles to spasm. Once the nerve is freed, then the muscle will usually release. Greater ranges of movement will follow as the body allows. This should not be hurried because the nerve and disk is at risk for re-injury in the very early stages of healing.

Medications and surgery will not correct the alignment of the spine. When the joint is sprained, it needs to be re-aligned to reduce the tension on the ligaments and disk. Your doctor of chiropractic can guide you through this process so the range of motion returns quickly.