Our Denver Chiropractor, Dr. Glenn Hyman, thinks this is a great way to improve your posture, prevent knee pain and improve muscular endurance in your quads and glutes. Check with a doctor first!
Short Week Alert. We will have a short week this week in our office, so if you need to get in this week please don’t hesitate to call 303.300.0424 ASAP or reply to this email.
Monday 2/27: In the office
Tuesday 2/28: In the office
Weds 3/1: In the office
Thursday 3/2: Out of the office
Friday 3/3: Out of the office
Coming soon- Win Rockies Tickets!Yep, the Avs ticket giveaways have been so popular that I got Rockies tickets to keep the party going all summer long. Just keep watching for our emails!
Here is this week’s 1-Page Health News.
My friend and fellow Altitude Multisport club member Justin Chester summed up Xterra Beaver Creek perfectly, “That’s harder than a Half-Ironman!” I don’t know about that since I’ve never done a Half-Ironman. But I do know this: Beaver Creek, for such a posh place, serves up one tough off-road triathlon course. For the record, I did the Sprint version.
I’m never too focused to high-five my kids at the bike-run transition!
Overall, I had a good day. My swim was slower than last year, possibly related to my lack of swim training this year. I guess I shouldn’t have taken 7 months out the pool after last season? The bike and run were about the same as last year (maybe a tad slower). Overall I was only 4 minutes off of last year’s time. I’ll take it! Next up is Xterra Indian Peaks at Eldora ski resort this coming Saturday. That’s right, 2 Saturdays in a row.
Weekly Health Update
Week of: Monday, July 22th, 2013
“A healthy outside starts from the inside.”
~ Robert Urich
Mental Attitude: Obsessed With Forbidden Pleasures.
When individuals are forbidden from everyday objects, their minds and brains pay more attention to them. Obsession is not as strong if others are also denied. When an object is forbidden to a group, the allure of the object drops dramatically. This helps to explain why group diet programs can be more successful than dieting alone.
Cognitive, Affective and Behavioral Neuroscience, June 2013
Health Alert: Kids Poisoned.
Every 10 minutes a child in the United States is taken to the Emergency Room because of poisoning from swallowing a prescription or over-the-counter medicine. The most common drugs associated with children’s poisoning include those used to treat diabetes, high cholesterol (statins), pain (opioids), and cardiovascular diseases (beta blockers).
Pediatrics, June 2013
Diet: Soda, Illegal Drugs, and Teeth.
Drinking large quantities of soda can be as damaging to your teeth (tooth erosion) as methamphetamine and crack cocaine use. Tooth erosion occurs when acid wears away tooth enamel. Without enamel, teeth are more susceptible to developing cavities, as well as becoming sensitive, cracked, and discolored. The citric acid present in both regular and diet soda is known to have a high potential for causing tooth erosion. The ingredients used in preparing methamphetamine can include extremely corrosive materials such as battery acid, lantern fuel, and drain cleaner. Crack cocaine is also highly acidic in nature.
General Dentistry, June 2013
Exercise: Quantity Over Frequency?
A study of over 2,300 Canadian adults found that those who exercised 150 minutes over just a few days of the week received the same health benefits as those who spread out 150 minutes of exercise over the entire week.
Physiology, Nutrition, and Metabolism, June 2013
Chiropractic: Success!
A study compared the effectiveness of manual therapy (performed by a Chiropractor), physical therapy (performed by a Physical Therapist), and medical care (delivered by a Medical Physician) for patients with neck pain. The success rate at 7 weeks was twice as high for the chiropractic therapy group (68.3%) compared to the medical care group. Patients receiving chiropractic therapy had fewer absences from work than patients receiving physical therapy or medical care for their neck pain. Manual therapy and physical therapy also resulted in statistically significant less analgesic (pain relief medication) use.
Annals of Internal Medicine, 2002
Wellness/Prevention: Prevent Stress.
Among women who reported stress, 40% had psychosomatic symptoms in the form of aches and pain in their muscles and joints, 28% suffered from headaches or migraines, and 28% reported gastrointestinal complaints. (Note- I’m sure men would have reported even more complaints, as everyone knows women are the tougher gender.)
University of Gothenburg, June 2013
As always, thanks for reading,
Carpal Tunnel Syndrome – Are There Other Tunnels?
Carpal Tunnel Syndrome (CTS) refers to the median nerve being pinched in a tunnel at the wrist. As the name implies, “carpal” refers to the 8 small bones in the wrist that make up the “U” shaped part of the tunnel and “syndrome” means symptoms that are specific and unique to this condition. As we learned last month, CTS can be affected by nerve pinches more proximal to the wrist, such as at the forearm, elbow, mid-upper arm, shoulder or neck.
To make matters more complex, there are two other nerves in the arm that can also be pinched in different tunnels, and the symptoms of numbing and tingling in the arm and hand occur with those conditions as well. This is why a careful clinical history, examination, and sometimes special tests like an EMG/NCV (electromyogram/nerve conduction velocity) offer the information that allows for an accurate diagnosis of one or more of these “tunnel syndromes” in the “CTS” patient. Let’s look at these different tunnels and their associated symptoms, as this will help you understand the ways we can differentiate between these various syndromes or conditions.
Let’s start at the neck. There are seven cervical vertebrae and eight cervical spinal nerves that exit the spine through a small hole called the IVF (intervertebral foramen). Each nerve, like a wire to a light, goes specifically to a known location which includes: the head (nerves C1, 2, 3), the neck and shoulders (C4, 5), the thumb side of the arm (C6), the middle hand and finger (C7) and the pinky side of the lower arm and hand (C8). If a nerve gets pinched at the spinal level (such as a herniated disk in the neck), usually there is numbness, tingling, and/or pain and sometimes, usually a little later, weakness in the affected part/s of the arm and hand (or numbness in the scalp if it’s a C1-3 nerve pinch).
So, we can test the patient’s sensation using light touch, pin prick, vibration, and/or 2-points brought progressively closer together until 1-point is perceived and then comparing it to the other arm/hand. Reflexes and muscle strength are also tested to see if the motor part of the nerve is involved in the pinch. The exam includes compression tests of the neck to see if the arm “lights up” with symptoms during the test.
Next is the shoulder. Here, the nerves and blood vessels travel through an opening between the collar bone, 1st rib and the chest muscles (Pectorals). As you might think, the nerves and blood vessels can be stretched and pinched as they travel through this opening and can cause “thoracic outlet syndrome.” Symptoms occur when we raise the arm overhead.
Hence, our tests include checking the pulse at the wrist to see if it reduces or lessens in intensity as we raise the arm over the head. At the shoulder, the ulnar nerve is the most commonly pinched nerve, which will make the pinky side of the arm and hand numb, tingly, and/or painful. A less common place to pinch the nerves is along humerus bone (upper arm) by a bony process and ligament that is usually not there or resulting from a fracture. Here, an x-ray will show the problem.
The elbow is the MOST common place to trap the ulnar nerve in the “cubital tunnel” located at the inner elbow near the “funny bone” which we have all bumped more than once. Cubital tunnel syndrome affects the pinky side of the hand from the elbow down. The median/carpal tunnel nerve can get trapped here by the pronator teres muscle, thus “pronator tunnel syndrome.” This COMMONLY accompanies CTS and MUST be treated to obtain good results with CTS patients. The radial nerve can be trapped at the radial tunnel located on the outside of the elbow and creates thumb side and back of the hand numbness/tingling.
Any or all of these nerve can get “trapped” by the muscles that run near them. This is where Active Release Techniques (ART) treatment separates itself for other modalities. ART is the only system that trains providers how to check these entrapment spots muscle by muscle. Once identified, the trained and certified ART provider knows how to release the muscles and remove the pressure. This goes way beyond standard chiropractic treatment or basic physical therapy.
So now you see the importance of evaluating and treating ALL the tunnels when CTS is present so a thorough job is done (which is what we do at Denver Chiropractic Center). Try the LEAST invasive approach first – non-surgical treatment – as it’s usually all that is needed!
We’re back in the office Monday 11/27 at 9AM, and are ready to help you. Most deductibles reset on January 1, so if something’s been hurting you, give us a call and get it taken car of now. 303.300.0424
Mental Attitude: Sleep? Just one night of inadequate sleep can detrimentally trigger an increase (by as much as 60%) in brain activity related to anticipating negative emotional events. UC Berkeley, October 2012
Health Alert: Stop Smoking! Female smokers in the UK die 10 years earlier (on average) than non-smokers. However, women who stop smoking by age 30 are 97% less likely to suffer a smoking related, premature death. The Lancet, October 2012
Diet: Grapes! Grape consumption is linked to healthier diet habits and higher intake of nutrients. Individuals who consume products made with grapes also have higher intake of the following: dietary fiber, potassium, calcium, magnesium, vitamin A, vitamin C, and vitamin B6. Grape consumption is associated with higher vegetable, seed, and nut intake, as well as a decreased intake of cholesterol, saturated fat, and total fat, compared with adults who did not consume grape products. Grapes can assist in lowering blood pressure, strengthen blood flow, and lower inflammation in men suffering from metabolic syndrome. Academy of Nutrition and Dietetics Food, October 2012
Exercise: Yoga. Yoga stretches all of the soft tissues of your body such as ligaments, tendons, and the fascia sheaths that surround your muscles. No matter your level of yoga, you most likely will see benefits in a very short period of time. Yoga participants had 35% improvement in flexibility after only 8 weeks. American Council on Exercise, October 2012
Active Release Techniques / Chiropractic: Why Wait? The activities of every day living can cause micro-traumas to the musculoskeletal system. While these injuries may not result in pain, if left untreated they may lead to more serious problems such as back or neck pain (for example). Regular adjustments can help prevent these micro-traumas from becoming bigger problems in the future. In our experience people who come in just once a month for maintenance treatment experience fewer injuries over time. Really.
Wellness/Prevention: Keep Young Drivers Safe. In May 2010, New Jersey implemented Kyleigh’s Law, requiring all 16-20 year old drivers with a permit or intermediate license to display a reflective decal on the front and back license plates of vehicles they are operating. The decal is intended to help police officers enforce laws specific to younger drivers such as those related to night time driving and the number of permitted passengers. Since going into effect, Kyleigh’s Law has decreased car accidents among 16-20 year old intermediate license holders by 9%. Tips for keeping your young driver safe: “[Start] them out in low-risk conditions. Keep the number of passengers to no more than one, limit nighttime driving to before 10 pm, always prohibit cell phone use while driving, and insist on seat belts for every occupant on every drive.” Children’s Hospital of Philadelphia, October 2012
Quote: “Genius comprised: of inspiration 1% percent, of perspiration, 99%.” ~ Thomas A. Edison
Carpal Tunnel Syndrome (CTS) is a condition characterized by pain, numbness and/or tingling in the hand. This includes the palm and the 2nd, 3rd, and half of the 4th finger, usually sparing the thumb. Another indication of CTS is weakness in grip strength such as difficulty opening a jar to even holding a coffee cup. CTS can occur from many different causes, the most common being repetitive motion injuries such as assembly line or typing/computing work.
Here is a PARTIAL list of potential causes of CTS: heredity (a small sized tunnel), aging (>50 years old), rheumatoid arthritis, pregnancy, hypothyroid, birth control pill use, trauma to the wrist (especially colles fractures), diabetes mellitus, acromegaly, the use of corticosteroids, tumors (benign or malignant), obesity (BMI>29 are 2.5 more likely), double crush (pinching of the nerve in more than 1 place such as the neck and the carpal tunnel), heterozygous mutations in a gene (associated with Charcot-Marie-Tooth), Parvovirus b19, and others. Again, repetitive trauma is still the most common cause. Once the cause(s) of CTS has been nailed down, then treatment options can be considered.
From a treatment perspective, we’ve previously discussed what chiropractors typically do for CTS (spinal and extremity joint manipulation, muscle/soft tissue mobilization, physical therapy modalities such as laser, the use of a wrist splint – especially at night, work task modifications, wrist/hand/arm/neck exercises, vitamin B6, and more). But, what about using other “alternative” or non-medical approaches, especially those that can be done with chiropractic treatment? Here is a list of four alternative or complementary treatment options:
In many cases, Carpal Tunnel Syndrome (CTS) results strictly from overuse activities though, as we have discussed previously. Other conditions such as, pregnancy, etc. can also be involved as a contributor and / or the sole cause. When these conditions are present, they must be properly treated to achieve a favorable result. However, the majority of cases are the result of a repetitive motion injury. So, the question remains: What is the role of the patient regarding activity modification during the treatment process of CTS? How important is it?
To answer this question, let’s look at a fairly common type of CTS case. The patient is female, 52 years old, moderately obese (Body Mass Index 35 where the normal is 19-25), and works for a local cookie packing company. Her job is to stand on a line where cookies are traveling down a conveyor belt after being baked and cooled. She reaches forwards with both arms and grasps the cookies, sometimes several at a time, and places them into plastic packaging which are then wrapped and finally removed from the belt and placed into boxes located at the end of the line. Each worker rotates positions every 30 minutes. A problem can occur when other workers fall behind or when there aren’t enough workers on the line, at which time the speed required to complete the job increases.
So now, let’s discuss the “pathology” behind CTS. The cause of CTS is the pinching of the median nerve inside the carpal tunnel or muscles of the forearm, located on the palm side of the wrist. The tunnel is made up of 2 rows of 4 carpal bones that form top of the tunnel while a ligament stretches across, making up the tunnel’s floor. There are 9 tendons that travel through the tunnel and “during rush hour” (or, when the worker is REALLY moving fast, trying to keep up with production), the friction created between the tendons, their sheaths (covering) and surrounding synovial lining (a lubricating membrane that covers the tendons sheaths), results in inflammation or swelling.
When this happens, there just isn’t enough room inside the tunnel for the additional swelling and everything gets compressed. The inflamed contents inside the tunnel push the median nerve (that also travels through the tunnel) against the ligament and pinched nerve symptoms occur (numbness, tingling, and loss of the grip strength). The worker notices significant problems at night when her hands interrupt her sleep and she has to shake and flick her fingers to try to get them to “wake up.” She notices that only the index to the 3rd and thumb half of the 4th finger are numb, primarily on the palm side.
At this stage, the worker often waits to see if this is just a temporary problem that will go away on its own and if not, she’ll make an appointment for a consultation, often at her family doctor (since many patients don’t realize Active Release Techniques Soft Tissue Treatments REALLY HELP this condition). In an “ideal world,” the primary care doctor first refers the patient to the ART provider for non-surgical management. Other treatment elements include the use of a night wrist splint and (one of the MOST IMPORTANT) “ergonomic management.” That means work station modifications, which may include slowing down the line, the addition 1 or 2 workers, and reducing the reach requirement by adding a “rake” that pushes the cookies towards the worker/s. Strict home instructions to allow for proper rest and managing home repetitive tasks are also very important. Between all these approaches, our office is quite successful in managing the CTS patient, but it may require a workstation analysis.
It all starts with the initial examination. Call our office at 303.300.0424 right now to schedule yours.
Our awesome office manager Keri (my kids call her Miss Keri) was run off of the Cherry Creek bike trail and into a concrete half wall this weekend. Another cyclist was going too fast in the other direction, was too far over to his left, and basically forced Keri to choose between colliding with him or scraping the wall.
She chose the wall and this morning is sporting a nasty wound on her right arm. Of course, this guy didn’t bother to stop (maybe he was on his way to do Rocket Surgery). The message- be careful out there. A whole lot of morons are legally loose on our streets.
Of course, Miss Keri is tough as nails and never misses work, so she’s here today- bandaged up & ready to help you.
Here’s this week’s 1-Page Health News.
Mental Attitude: Get Your Sleep! Older adults with poor sleep habits have an altered immune system response to stress that may increase their risk for mental and physical health problems. Stress leads to significantly larger increases in a marker of inflammation in poor sleepers compared to good sleepers; a marker associated with poor health outcomes and death. Poor sleepers report more depressive symptoms, more loneliness and more global perceived stress relative to good sleepers. As people age, a gradual decline in the immune system occurs, along with an increase in inflammation. Heightened inflammation increases the risk for cardiovascular disease, diabetes and other illnesses, as well as psychiatric problems. American Journal of Geriatric Psychiatry, March 2012
Health Alert: Slow Down — You Move Too Fast? People who are considered ambitious, attend the best colleges and universities, have prestigious careers and earn high salaries don’t necessarily lead more successful lives. Ambition has its positive effects (in terms of career success, it certainly does) but ambitious people are only slightly happier than their less- ambitious counterparts and they actually live somewhat shorter lives. Journal of Applied Psychology, March 2012 Diet: Fish Oil. Six weeks of supplementation with fish oil significantly increased lean mass and decreased fat mass in test subjects. International Journal of Sport Nutrition and Exercise Metabolism, October 2010
Exercise: Good Reasons. Exercise helps you maintain proper muscle balance, reduces the rate and severity of medical complications associated with hypertension, helps alleviate menstrual symptoms and lowers your heart rate response to submaximal physical exertion. Surgeon General’s Report on Physical Activity and Health, 1996
Chiropractic: Adjustment or Microdiskectomy for Sciatica? 60% of patients with sciatica (symptoms of unilateral lumbar radiculopathy secondary to lumbar disk herniation at L3-4, L4-5, or L5-S1) who had failed other medical management (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) benefited from spinal manipulation to the same degree as if they underwent surgical intervention. JMPT, October 2010
Wellness/Prevention: Dark Chocolate Good For The Heart. A flavonoid called epicatechin, found in dark chocolate, enhances mitochondria structure in people with advanced heart failure and type 2 diabetes. Mitochondria are cellular structures that provide the energy a cell requires in order to move, divide, and contract. Both heart failure and type 2 diabetes impair these cells, resulting in abnormalities in skeletal muscle. In individuals with diabetes and heart failure, these abnormalities in the heart and skeletal muscle cause decreased functional capacity, resulting in difficulty walking even short distances, shortness of breath, and a lack of energy. Clinical and Translational Science, March 2012
Quote: “Common sense is the collection of prejudices acquired by age eighteen.” ~ Albert Einstein
Carpal Tunnel Syndrome (CTS) is a very common problem. The American Association of Orthopedic Surgeons (AAOS) reported that in 2007, there were 330,000 carpal tunnel release surgeries performed. (WHOA!) The main reason to have the surgery is to “open up” the tunnel. That is, the transverse carpal ligament or “floor” of the tunnel is released so the contents inside the tunnel are able to move more freely, reducing the pressure inside the tunnel.
Essentially, this is the goal of any treatment (surgical or not): improving the depth of the tunnel, thus reducing the pressure from inside the tunnel allowing the tendons to slide better as the muscles on the palm-side forearm contract to move the nine tendons that pass through the tunnel and attach to the fingers and thumb.
However, there are non-surgical methods for reducing the pressure within the tunnel that should be first attempted as surgery is always reported to be the “…last resort” for good reason. There can be surgical complications, the effects may be only partial, and there is an average of 30% grip strength loss following the transverse ligament surgical release. So, the question is, how can chiropractic approaches reduce the pressure inside the carpal tunnel without somehow changing the length of the transverse carpal ligament?
By going beyond traditional chiropractic care and using Active Release Techniques (ART), we can often release the transverse carpal ligament by hand, taking pressure off of the nerve and relieving symptoms. We can also address possible muscular entrapment sites for the median nerve, like the pronator teres muscle. These muscular entrapments mimic Carpal Tunnel Syndrome, but can be easily released with ART treatment. In the last 15 years, we’ve helped literally hundreds of patients avoid carpal tunnel surgery by using Active Release Techniques. We don’t claim to have a 100% success rate, as some cases do require surgery. But we believe it’s best to try us first and see what we can do.
The use of a night splint to keep the wrist in a straight or slightly “cocked-up” position is also highly beneficial as the pressure inside the tunnel goes up as much as 6-8x when CTS is present when the wrist bends.
If you, a friend or family member require care for CTS, we would be happy to help. Just call 303.300.0424 to set up your first appointment.
Because carpal tunnel syndrome (CTS) is technically a tendonitis that happens to be near a nerve (the median nerve), one treatment option for CTS is to manage the tendonitis and by doing so, the pressure on the median nerve will resolve. Also, because the movement of the hand and wrist are controlled by opposite functioning muscles (that is, when we flex the wrist and fingers, the palm side tendons are doing the job and when we extend the wrist/fingers, the back of the forearm and hand tendons are doing the work), these opposite functioning actions need to be balanced. Moreover, if the muscles on one side of the forearm are tight and inflamed, very often so are the muscles on the opposite side.
Therefore, an exercise program for the forearm and hand should include BOTH sides, not just the flexor or palm side of the forearm/hand where the carpal tunnel is located. Perform these exercises multiple times a day for 3-10 second hold times. You can modify #2 and #3 by NOT using the opposite hand to pull but rather, simply make the movement without the opposite hand assisting in the stretch. That way, you can perform BOTH at the same time IF your time is short (such as when performing these during a busy work day, for example).
| 1 | Thumb Stretch | A. Grab your thumb in a fist
B. Bend wrist down to feel the stretch in the thumb & wrist. |
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| 2 | Carpal Stretch | A. Place the palm flat on wall, fingers point down (elbow straight).
B. Reach across and pull the thumb back. Feel pull on palm side forearm. |
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| 3 | Extensor Stretch | A. Make a fist (elbow straight).
B. Reach under and pull back on the fist. Feel the pull on the top forearm. |
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Feel for the stretch where the arrows are pointing – it should be a “good” hurt/stretch!
Active Release Techniques is one of the most effective conservative treatment options for Carpal Tunnel Syndrome. Dr. Hyman has been hired by large corporations to treat and prevent CTS, saving literally hundreds of people from potential surgeries. If you have the symptoms of CTS, call us 303.300.0424. We can help.