The Many Faces of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) was first reported in the late 1800’s and the first
surgery was noted in 1933. In the beginning, CTS surgery was rarely performed,
reportedly because the nerve pinch was present somewhere before the median nerve
reached the wrist or carpal tunnel. In brief, possible compression sites include
the cervical nerve roots (C5-7), the brachial plexus, thoracic outlet, above the
elbow, in the proximal and/or mid forearm, and finally at the wrist / carpal
tunnel.
Estimating the frequency of CTS is challenging due to the fact that the pinch or
entrapment may include more than one area before the wrist resulting in double
and multiple crush syndromes. One European study reported the incidence of CTS
at 5.8% in women and 0.6% in men while another reported 3.4% in the United
States. Even the causation of CTS is all over the board. For example, the annual
incidence of CTS in automobile workers ranges between 1-10%, while in a fish
processing plant, it was reported to be as high as 73%! To make this even more
challenging, the cause of CTS is commonly associated with other conditions such
as diabetes and pregnancy. In diabetics, CTS ranges between 14% and 30% and
those who are pregnant have a 2% incidence. Even harder to report is the
incidence of median nerve pinching proximal to the wrist as this ranges between
as little as 1% to as high as 75% for pronator tunnel syndrome in already
symptomatic women. Gender is also a factor as women are reported to be four
times more likely to develop CTS than men. If there is NO other condition
associated with CTS, the term “idiopathic” is applied, and this reportedly
occurs 43% of the time.
Another issue making CTS a challenge to diagnose is the many risk factors
associated with it, and sometimes studies are published that contradict one
another about the possible risk factors. There are studies that report CTS is
more likely to occur with conditions including: 1) Jobs or activities associated
with wrist flexion or extension; 2) Hysterectomy without ovary removal; 3)
Obesity; and 4) Varicosities in men. Some studies indicate risk criteria such
as: 1) Use of birth control pills; 2) Age at menopause; 3) Diabetes; 4) Thyroid
dysfunction; 5) Rheumatism; 6) Typing; and, 7) Pinch grasping. One study
reported the highest incidence to occur in those with previous wrist fracture
(Colles’ fracture), and common conditions included rheumatoid arthritis,
hormonal agents or ovary removal, diabetes, and pregnancy. Another study
reported obesity and hypothyroid as being risk factors, but not all studies
support that theory. Certain medications have been reported to be associated
with higher CTS risk including: 1) Insulin, 2) Sulfonylureas (diabetes meds); 3)
Metformin; and 4) Thyroxin.
As doctors of chiropractic, we perform a thorough history, examination, and
offer MANY non-surgical, non-pharmaceutical ways of treating CTS. Some of these
approaches include: 1) Joint and soft tissue manipulation of the neck, shoulder,
elbow, forearm, wrist, and hand; 2) Wrist splinting, especially at night; 3)
Vitamin B6 and anti-inflammatory nutrients; 4) Home exercises for the neck, arm
and hand; 5) Work station / ergonomic evaluations; 6) Dietary counseling for
various conditions listed previously; 7) Co-management with primary care,
rheumatology, neurology, orthopedics, and others.
We realize you have a choice in whom you consider for your health care provision
and we sincerely appreciate your trust in choosing our service for those needs. 
If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we
would be honored to render our services.  Visit http://www.olsonchiropracticcenter.com for more information.

The "Aging" Lower Back - Part 1

Low back pain (LBP) can arise from many causes. Nearly everyone has or will
suffer from LBP at some point in time, though it is most common in the
30-year-old to 50-year-old group and it affects men and women equally. However,
what about the elderly population and low back pain? Let’s discuss back pain
unique to the geriatric population…
We’ve all heard of the “wear and tear” factor as it applies to clothing,
automobiles, shoes, and tires, but it affects our bones and joints too! A
condition that none of us can fully avoid is called osteoarthritis (OA). OA is
the “wear and tear” factor on our joints, particularly the smooth covering
called hyaline cartilage located on the surfaces of all moving joints. It’s the
shiny, silky smooth surface that we’ve all seen at the end of a chicken leg when
we separate it from the thigh. Osteoarthritis is the wearing away of that shiny,
smooth surface and it can eventually progress to “bone-on-bone” contact where
little to no movement is left in the affected joint. Bone spurs can also occur
and be another potential generator of back pain. OA is NOT diagnosed by a blood
or lab test but rather by an accurate history, physical examination, and
ultimately, an x-ray. However, when the low back is affected by OA, it may not
even hurt! Yes, in some cases, there may be a significant amount of OA on an
x-ray and that patient may not have significant problems. Or the opposite can
occur and some patients with very little arthritis can have a lot of back
trouble. It’s FREQUENTLY very confusing. The “take-home” message with OA is
that, in and of itself, it does not always generate pain. This is why the
history, physical examination, and the response to treatment (chiropractic
adjustments, exercise, and possibly some lifestyle changes in diet and activity)
are MORE important than the amount of arthritis found on the x-rays. Ultimately,
we will ALL get OA sooner or later. It’s usually a slow, gradual process that
may slowly change our activity level. Ironically, KEEP MOVING is the best advice
we can give to the patient with OA.
There are a number of conditions associated with OA that affect the spine and
respond well to chiropractic treatment. Degenerative disk disease (DDD) is one
of those conditions found in association with OA. In fact, another name for OA
is “degenerative joint disease” (DJD)! The normal anatomy of the intervertebral
disk (IVD) consists of a thick, tough outer layer of fibroelastic cartilage and
a central “nucleus” that is more liquid-like and allows the IVD to function like
a shock absorber. As we age, the water content gradually “dries up” and the
shock absorbing quality is lost.
As chiropractors, we address OA (DJD) and DDD with a number of HIGHLY EFFECTIVE
treatments but most important (in many cases) is the use of spinal manipulation
or adjustments. “Exercising the joint” with manipulation and mobilization
reduces the tightness and stiffness associated with OA and DDD. Exercises are
also important and can give the OA/DDD patient a way of controlling this
condition on their own. Diet, activity modification/encouragement, and periodic
adjustments help a lot! Next month, we will continue this discussion!
We realize you have a choice in whom you consider for your health care provision
and we sincerely appreciate your trust in choosing our service for those needs. 
If you, a friend, or family member requires care for back pain, we would be
honored to render our services. Visit http://www.olsonchiropracticcenter.com for more information.

Chiropractic and Neck Pain in Children | Yankton Chiropractor | Brian Olson SD

Children have been treated by chiropractors for spinal problems ever since
chiropractic was founded in 1895, and neck pain is no exception. Neck pain is
surprisingly common in kids, though not quite as common as it is in adults,
reaching a similar occurrence rate by age 18. Studies conducted in the United
States and in other countries report similar findings, leaving one to conclude
there is a high prevalence of neck pain in kids all over the world. There are
many causes of neck pain with a few being unique to children and some that could
be a warning sign of something dangerous, such as meningitis. But far more
commonly, neck pain in kids is NOT dangerous. Let’s take a look!
Looking at neck and shoulder pain in high-school-aged students, 931 males
between 16 and 19 years of age were surveyed. More than two out of five students
(44.3%) had recurrent neck and shoulder pain more than once a week with an
overall prevalence of 79.1%. THAT’S A LOT! The study reported the student’s
average sitting time was 10.2 hours a day, 59% did NOT sit up straight, and
11.9% reported that they stretched their neck and shoulders regularly throughout
the day. Students with recurrent neck and shoulder pain also reported frequent
fatigue and depressed moods. Looking specifically at 1,122 backpack-using
adolescents, 74.4% were classified as having back or neck pain. When compared to
non- or low use backpackers, there was nearly a two times greater likelihood of
having back/neck pain! Also, females and those with a large body mass index
(overweight) were also significantly associated with back/neck pain. Lastly,
they found when compared to adolescents with no back/neck pain, those with pain
carried significantly heavier backpacks.
Another common cause of neck pain in adolescents is a condition called
torticollis or, “wry neck.” This is basically a muscle spasm of certain neck
muscles that rotate and extend the head from the neutral / normal position,
often described as being “stuck” in this position. Though there are several
types of torticollis, it can be triggered by almost anything including a change
in weather, sleeping in a draft, following an infection like a cold or flu,
maintaining a faulty prolonged posture, certain types of medications, and many
others. Some studies describe torticollis as usually improving within one to
four weeks, but in the hands of a chiropractor, it usually takes two to three
days for the acute pain to subside and one week to completely finish the job! Of
course, this varies depending on the case. Infants can be born with “congenital
torticollis,” which occurs in 0.3 to 2.0% of newborns. Here too, chiropractic is
VERY effective.
We realize you have a choice in whom you consider for your health care provision
and we sincerely appreciate your trust in choosing our service for those needs. 
If you, a friend, or family member requires care for neck pain, we would be
honored to render our services.  Visit http://www.olsonchiropracticenter.com for more
information.

Low Back Manipulation - How Does it Work? | Yankton Chiropractor | Brian Olson DC

Low back pain (LBP) is such a common problem that if you haven’t suffered from
it yet, you probably will eventually. Here are a few facts to consider:  1) LBP
affects men and women equally; 2) It is most common between ages 30-50; 3)
Sedentary (non-active) lifestyles contribute a lot to causation; 4) Too much or
too little exercise can result in LBP; 5) A BMI around 25 is “ideal” for weight
management, which helps prevent LBP; 6) Causes of LBP include lifestyle
(activity level), genetics – including, but not limited to, weight and
osteoarthritis; 7) Occupation; 8) Exercise habits, and the list can go on and
on. Let’s next look at how an adjustment is done.
When spinal manipulation is performed in the low-back region, the patient is
often placed in a side lying position with the upper leg flexed towards the
chest and the bottom leg kept straight. The bottom shoulder is pulled forwards
and the upper shoulder is rotated backwards at the same time the low back area
receives that the manipulation is rotated forwards. This produces a twisting
type of motion that is well within the normal range of joint motion. When the
adjustment is made, a “high velocity” (or quick), “low amplitude” (a short
distance of movement) thrust is delivered often resulting in “cavitation” (the
crack or, release of gases). So, WHY do we do this?
Most studies show that when there is back pain, there is inflammation. In fact,
inflammation is found in most disease processes that occur both within and
outside the musculoskeletal system. We know that when we control inflammation,
pain usually subsides. That is why the use of “PRICE” (Protect, Rest, Ice,
Compress, Elevate) works well for most muscle/joint painful conditions. We have
also learned that IF we can avoid cortisone and non-steroidal drugs (like
aspirin, ibuprofen, naproxen, etc.), tissues heal quicker and better, so these
SHOULD BE AVOIDED! If you didn’t know that, check out:
 http://www.benthamscience.com/open/torehj/articles/V006/1TOREHJ.pdf
Please see our prior discussions on the use of anti-inflammatory herbs and diets
that are MUCH safer than non-steroidal drugs! But what does spinal manipulation
DO in reference to inflammation?
Different things occur physiologically during a spinal adjustment or
manipulation. We know that the mechanical receptors located in muscles, muscle
tendons, ligaments, and joint capsules are stimulated and this results in muscle
relaxation (reduced spasm or tightness), increased measurable range of motion,
and a decrease in pain. A recent study also reported that inflammatory markers
(CRP and interleukin-6) measured in a blood test, NORMALIZED after a series of
nine chiropractic low back manipulations! So, NOT ONLY do spinal adjustments
give immediate improvements in pain, flexibility, and muscle relaxation, they
also REDUCE INFLAMMATION without the use of any pharmaceuticals!
So, let’s review what manipulation does for your low back pain: 1) Pain
reduction; 2) Improved flexibility – now you can put on your socks with less
pain and strain; 3) Improved functions and activities of daily living like
sitting more comfortably, getting in or out of your car, bending over to feed
the cat, etc.; 4) Improved sleep quality; and 5) Faster healing time by actually
reducing the inflammatory markers in the blood! If you have LBP, PLEASE don’t
delay – make that appointment TODAY!
We realize you have a choice in whom you consider for your health care provision
and we sincerely appreciate your trust in choosing our service for those needs. 
If you, a friend, or family member requires care for back pain, we would be
honored to render our services.  Visit http://www.olsonchiropracticcenter.com for more information.

Intersegmental Traction Video | Yankton Chiropractor | Brian Olson DC

http://www.olsonchiropracticcenter.com
605-665-2434

Intersegmental Traction | Yankton Chiropractor | Brian Olson DC

Intersegmental Traction is a particularly useful and effective therapy to treat and help prevent painful muscle spasms and muscle guarding specifically in spinal muscles.

Back Muscles

The back is a marvelous wonder.  There are many muscles in your back used singly or in combination to achieve a tremendous range of motion (forward flexion, lateral flexion, rotation, and extension).   In your core muscles there are small muscles (semispinalis, intertransversarii, interspinus, Rotatores, etc) connecting one vertebrae to the next and there are the muscles of the Erector Spinae (Iliocostalis, Longissimus, and Spinalis) which are longer and connect different sections together.  When fatigued, or affected by accident, injury, or repetitive stress, these muscles can spasm and can lead to chronic muscle guarding.

Vetebral Discs

In between the vertebrae there are shock absorbing structures called vertebral discs.  The outer layer of a vertebral disc (like the dough of a jelly donut) is comprised of multiple layers of annulus fibrosus which is a very tough fiber.  The inside of the disc contains nucleous pulposus (the jelly) which is really very jelly-like and contains about 90% water.
The vertebral discs cushion the vertebrae from movement and act as a shock absorber during more strenuous movements like walking or running.
When Back muscles are tight and spasming they can pull vertebrae out of alignment (because the muscles are attached to the vertebrae and they shorten during a spasm).  When vertebrae are out of alignment they may cause the vertebral disc to be displaced or in severe cases rupture which may lead to mild to severe pain.

Intersegmental Traction

Intersegmnetal traction is a great intervention.  Intersegmental traction is delivered through the use of a traction table.  It is a table that you lay down on (on your back) and there are rollers just underneath the surface of the table.  These rollers are adjusted for your condition and weight to gently and specifically elongate and stretch your spinal joints and muscles.  This benefits in reduction and prevention of muscle spasm and begins to reestablish normal range of motion for your spinal joints (each vertebrae).  When your muscles become more relaxed and vertebrae begin to move normally your vertebral discs now have their normal space and can return to their normal position and functioning.  This also helps to prevent abnormal wear and tear on the vertebral discs and vertebrae which in turn prevent further injury and reduce the arthritis process.  Visit http://www.olsonchiropracticcenter.com for more information.

Why Does My Neck Hurt So Much But My Car Only Got A Dent? | Yankton Chiropractor | Brian Olson DC

Whiplash pain can be much different from other types of injuries. When a car
accident is severe, the pain will come on right away. If the injury produces a
mild or moderate sprain, sometimes it takes a few days for the pain and
inflammation to reach its maximum. Sometimes it is stiffness that is the
prominent symptom and the patient notices this in the first few weeks after the
accident. The delay in pain is often seen in low speed collisions where
typically there is very less damage to the vehicles.
There are a lot of factors that determine the extent of injury following a low
speed whiplash. One of these is the neck posture prior to impact. Was the head
turned? This can occur if the patient was looking at the rear view mirror during
the collision. Low speed collisions can occur in parking lots. If the patient
was turned to see if a space was clear, this can make a simple trauma result in
a significant injury.
Besides the position of the patient prior to the collision, the speed and amount
of vehicle damage are sometimes good criteria for the severity of the trauma.
However, it may not be in many cases because of crumple zones. Cars are built
with crumple zones. These areas are crushed during the collision and absorb the
energy of impact. In some low speed collisions, there is less crumple and more
of the force is transmitted to the occupants. This is but one reason why vehicle
damage won’t always equate with the spinal damage.
Another factor in whiplash is whether the head-rest was properly positioned. A
proper headrest should be close to the back of the head and its high point
slightly above the top of the head. The reason for the high position is that in
a rear-end collision, the patient who is being hit will rise slightly with
impact. If the headrest is too low, then the neck will bend around it like a
fulcrum causing even more injury. The same thing happens if the seat is reclined
too far and the head whips backwards before hitting the headrest.
Because symptoms can come on slowly and minor vehicle damage is not a good
indicator of injury, a thorough examination is required. It is important to be
checked by a competent health care provider after any motor vehicle collision.
Visit http://www.olsonchiropracticcenter.com for more information.