Dr. Dalfino's Non-Surgical Treatment Blog

Whiplash Associated Disorders

Is the speed of a car crash directly proportional to amount of injury sustained to the occupants?  One would expect more injury to occur when the speed of the collision is faster. Sometimes, this is the case – especially when car accidents occur at highway speeds. 

However, what about the cases where a patient ends up in a lot of pain even when the speeds are quite slow, especially when there is little to no damage to the vehicle? , The answer to this seemingly paradoxical relationship has to do with plastic vs. elastic deformity. 

This may be more simply understood if you think of “plastic” as something (in this case, your car) breaking apart vs. “elastic” as bouncing off without deforming or breaking apart. Therefore, in plastic deformity, there is more damage to the vehicle and in elastic deformity, there is little to no damage.  When there is more metal crushing or more vehicular damage (plastic deformity), the G-forces associated with the crash are absorbed by the crushing metal, which in turn, exerts LESS G-forces to the contents inside the vehicle (ie, the occupants), resulting in less injury. On the other hand, in the stiffer, less damaged vehicle, the energy is not absorbed by crushing metal (elastic deformity), resulting in the contents or occupants inside the vehicle being jostled or thrown about to a greater extent (due to the higher G-forces are exerted) and are at a greater risk for a higher degree of injury.

To illustrate this point, let’s say that, we have a car that hits a solid brick wall at 10 mph that crushes in the front of the car 5 inches. In the second scenario, let's keep the car at a speed 10 mph, but because of a different car design (stiffer frame such as a solid bumper-to-bumper chassis), the crush in this instance is only 2 inches.

In the first example, the acceleration is found to be 8 G’s of force. In the second example, acceleration is equals about 20 Gs of force. Thus, a collision with the same velocity, but with a crush amount smaller by 2.5 times will have a resulting G force 2.5 times larger.

Facts such as these are VERY important for you, your family and your doctor to appreciate, especially if there is legal action being taken in the case.  Therefore, it is important for you to choose a health care provider who understands and appreciates the potential impact this information carries when addressing your health related needs and communicating this information to others involved in a case.
Robbins MC. Lack of relationship between vehicle damage and occupant injury. SAE 970494

Please contact our office if you, your family or friends are suffering with Whiplash Associated Disorders or injuries that were sustained in a motor vehicle collision.

Did You Know This About Low Back Pain?

If you have low back pain (LBP), you are certainly not alone. Almost everyone at some point has back pain that interferes with work, daily activities, and/or recreation. Americans spend at least $50 billion each year on LBP.  It is the most common cause of job-related disability and a leading contributor to lost work time. Back pain is second to headaches as the most common neurological condition in the United States.  Fortunately, most occurrences of LBP go away within a few days. Others take much longer to resolve or lead to more serious conditions (1).

There are two types of low back pain – acute and chronic.  Most episodes of acute LBP last from a few days to weeks, are not neurological and usually do not carry a high level of surgical risk. The cause of LBP can be difficult to isolate because often, while the cause is cumulative where multiple events over time, the last activity the patient recalls is “bending over for a pencil.” This, by itself is not likely to cause an acute onset of LBP.  Low back pain can be caused by trauma such as sports injuries, work around the house such as garden work, car accidents, and others. Chronic low back pain, by definition, is LBP that lasts more than 3 months and the cause can be more difficult to identify and is often cumulative and superimposed on a prior condition such as degenerative disk or joint disease.  A real problem is the rate of recurrence or, chronic, recurrent low back pain where pain may subside but returns at various rates of frequency and duration.  This category affects a high percentage of the population and represents the true challenge in spine care management (1, 2).

As people age, their bone strength and muscle stretch, strength and tone usually decreases due to lack of activity. When the disks begin to lose fluid and flexibility, their ability to cushion the vertebrae and function as “shock absorbers” also decreases. Disks can tear, bulge, and/or herniate which results in localized LBP and/or radiating pain that follows the course one or more of the 31 pairs of nerve roots (eg., “sciatica” down the back of the leg).  Soft tissues such as joint capsules and ligaments lose their capacity to stretch and can tear more easily, resulting in a sprain or strain (muscle/tendon injury). Other conditions that either cause or contribute to LBP include arthritis, obesity, smoking, pregnancy, stress, poor posture and/or physical health, and can lead to unsatisfied patients if these co-contributors are not properly identified and discussed.  Less commonly, LBP can be caused by a more serious condition such as cancer, fracture, infection, spinal cord compression, and various internal conditions (3).  Emergency care may be indicated in these circumstances.

 Your doctor of chiropractic will perform a complete examination, consider other contributing causes, and will treat the problem(s) causing the LBP condition.  If needed, working with other allied health care providers will be arranged.  Exercise, dietary recommendations, ergonomic or work modifications, spinal manipulation, and modalities will all be considered to help eliminate or control of the LBP. Methods of self-managing the LBP will be emphasized.

1. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2. http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-and-treatment-options
3. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline. Rockville, Md: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1994.

Could It Be Fibromyalgia?

Fibromyalgia (FM) affects at least 6 million Americans; minimally 4 million of which are women (1).  FM is the third most prevalent rheumatologic disorder (after osteoarthritis and rheumatoid arthritis) and it represents 5% of family practice office visits and 20% of rheumatology visits. Approximately 90% of FM patients are women between the ages of 40 and 60 years, with an average age of 49.  Some physicians feel FM does not exist and offer no therapeutic options while others over diagnose the condition using Fibromyalgia as a “wastebasket diagnosis.” (2, 3).
 FM is a condition characterized by pain in the muscle and soft tissue fibers of the body.  People with Fibromyalgia will experience widespread pain of at least three months duration.  Some people are often unable to continue with their vocations due to this widespread pain.  Other symptoms associated with FM include chronic fatigue (physical or mental), tiring easily, morning stiffness, urinary urgency, anxiety or stress, irritable bowel syndrome (IBS), sleep disturbance, tingling and numbness, excessive menstrual bleeding, gastrointestinal symptoms (2).
 Approximately 75% of Fibromyalgia sufferers experience sleep disturbance, which can range from insomnia to wakefulness, to non-restorative sleep.  The discomfort will be aggravated by extremes in temperature as well as humidity (2, 4).  Some characteristic symptoms of fibromyalgia and associated prevalence (pain symptoms) include widespread pain (98%), pain in the neck (85%), low back (79%), mid back (72%), 15 or more painful sites (56%), headaches (53%), and difficulty with menstruation (41%) (2).
 If you experience tenderness in any number of these locations, it may indicate you suffer from Fibromyalgia.  A chiropractor can recognize and detect these tender points in a person’s body and offer a multifaceted healthcare treatment plan including exercise therapy, stress reduction, nutrition and manual therapies that has shown the most promise for Fibromyalgia sufferers (5).  Other treatments that include drugs such as naproxen, ibuprofen, acetaminophen, etc., and muscle relaxants such as cyclobenzaprine, are often not sufficient to relieve the aching and discomfort.  Unfortunately, drugs only mask the symptoms and carry significant side effects (2, 6).  In a study reported in the American Journal of Physical Medicine Rehabilitation, Chiropractic care scored amongst the most effective measures, more effective than drugs (7).

1.  Soderberg, S., Norberg, A., “Metaphorical Pain Language Among Fibromyalgia Patients,” Scan J. Caring Sci., 1995, 9:  55-59.
2.  Wolfe, F., Diagnosis of Fibromyalgia, J. Musculoskeletal Med 1990: 7(7): pp. 53-69.
3.  Bennett, R.M., Myofacial Pain Syndromes and Fibromyalgia Syndrome: A Comparative Analysis. Man Med 1991; 6(1): pp. 34-45.
4.  Duarte, M., “Primary Fibromyalgia Syndrome and Myofacial Pain Syndrome: Clinical Features and Criteria for Diagnosis. Chiro Tech 1989; 1(3): pp. 97-100.
5.  Cox, James, M., Low Back Pain: Mechanism, Diagnosis and Treatment, Chapter 7, pg. 251
6.  Campbell, S.M., Gatter, R.A., Clark, S., et al. A Double-Blind Study of Cyclobenzaprine versus Placebo in Patients with Fibrositis, Arthritis Rheumatology 1986; 29: pg. 1371.
7.  Waylouis, W.G., Heck, W., “Fibromyalgia Syndrome: New Associations,” Am Journal Phys Med Rehabilitation, 1992; 71: pp. 343-348.

Dr. Roizen Presents

YOU: The Most Important Choices For Making Yourself Younger: #5-10 DHA, ½ A Multi Twice A Day, Vitamin D, Calcium And Magnesium, And Aspirin 

By Dr. Michael F. Roizen
   
Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.  The Owner’s Manual For Extending Your Warranty (Free Press) and YOU: The Owner’s Manual. An Insider’s Guide to Your Body That Will Make You Healthier and Younger (Harper Collins)

Our basic premise is that your body is amazing:  You get a do over: it doesn’t take that long, and isn’t that hard if you know what to do.  In these notes we give you a short course in what to do so it becomes easy for you and then to teach others. We want you to know how much control you have over your quality and length of life

Last month (you did read and memorize all our columns, haven’t you?) we came to the conclusion that the most important tips to Staying Young are:

1. Understand you get a do over and it’s not that hard and it doesn’t take that long if you know what to do.
2. Start with walking.
3. Recruit a buddy and call daily.
4. Learn how to make YOU-turns

Now we want to add six more:

5-10, Pop these Pills:  5, one half a multivitamin morning and night; 6, vitamin D 500 IU, 7, Calcium 600mg,  and 8,  magnesium 200mg, morning and night; 9, DHA –omegaa-3 600mg a day; 10, 162.5 mg of aspirin. 
 
The ½ of a multivitamin morning and evening?  You pee out the water soluble ones in 8 to 16 hours so you need it twice a day.  Since only 160,000 of the over 23 million people who have taken the full nutrition program at RealAge (it’s free at RealAge.com) get the right amount of vitamins and minerals from diet, we believe in taking half a multi twice a day as an insurance policy against a less than perfect diet. As to the specific ones, D, calcium and magnesium: 50 to 87% of Americans are short of vitamin D in published studies—and you need it to help fight cancer (see below), to keep arteries young, and to aid brain function. So make sure you get it measured and take what is needed to keep its level normal. Also vitamin D3 is essential for calcium absorption and incorporation into bone.

When you think about it, much of what we do and use for our health really boils down to protection: helmets to protect us from an accidental brain smoosh, running shoes to protect us from shards of glass, aspirin to protect us from cancer and arterial aging, fluoride to protect against cavities, and Trojans to protect us from STDs. Perhaps the greatest protector of all is the one that you can’t buy in any store or order from any online discount warehouse (though there’s an idea): it’s the p53 tumor suppressor gene, which has the job of recognizing when your cells are at risk of developing into cancer and doing what it can to put a stop to it. Its job— that of biological guard dog and computer spell-checker rolled into one mean gene—is to protect your body and you know what is essential to turn on your p 53 gene—it is vitamin d and since 50 to 80 % of us do not get enough to turn on our spell checker, I feel getting adequate amounts of vitamin D in pill form is essential.

We’ll discuss the rational for other “POP YOU PILLs” recommendations , Tips #6-10, next month.

Mehmet and I have a new book released on November 11th, 2008, entitled YOU: Being Beautiful:  The Owner’s Manual to Outer and Inner Beauty.   Next Month, we will discuss an excerpt from that book and dispel three beauty myths: “Beauty is in the eye of the beholder”, “Don’t judge a book by its cover”, and that “Beauty is only skin deep”, and tell you why we believe beauty is actually precisely perceived, purposeful, and rooted in hard science more than abstract and random opinion.

 Beauty doesn’t as much reflect our vanity as much as it does our humanity and our health. So stay tuned for more tips on Staying Young, and on being more beautiful.

About the author:

Michael F. Roizen, M.D., is a professor of anesthesiology and internal medicine, Chief Wellness Officer, and and chair of the Wellness Institute at the Cleveland Clinic.  Dr Roizen can be heard on over 30 radio stations Saturdays from 5 to 7 pm.   For a listing just email a request to YouDocs@gmail.com 

Headaches and Management Options

Headaches are one of the more common conditions that enter the offices of primary care physicians, including chiropractors.  The standard medical treatment revolves around the use of medications and/or injections.  The standard chiropractic treatment approach includes manual therapies that may include spinal manipulation or adjustments, manual or mechanical cervical traction, mobilization techniques, trigger point therapy, physical agents or modalities such as electrical stimulation, ultrasound, etc., and nutritional counseling.  While both approaches have their pros and cons, there are far less side effects associated with the chiropractic treatment option.
 Headaches can generally be classified as primary or secondary. Primary Headaches include Migraine, Tension, and Cluster. Secondary headaches occur because another condition or injury is present such as after a car accident or slip and fall injury, due an infection, a sinus, jaw, and/or dental condition, a vascular injury such as stroke, a medication side effect, psychiatric disorder and others (1).
Treatment for patients with headaches is dependant on the cause.  Choosing a type of health care service for the treatment of headache can be a difficult choice.  When considering the use of complementary and alternative medical approaches available to patients with chronic tension-type headaches, a recent report revealed that 40% of 110 patients surveyed utilized some form of an alternative/complementary medical approach.  The most frequently utilized was chiropractic (21.9%), followed by acupuncture (17.8%), and massage therapy (17.8%). 

If you find yourself frequently utilizing over-the-counter medications such as an anti-inflammatory drugs (ibuprofen: Advil, Nuprin; Naprosyn such as Aleve) or Tylenol, it is probable that the chiropractic management approach will benefit your headache condition. 

Frequently, in patients with headaches, the vertebrae in the upper neck lose their normal range of motion and the muscles in that region that attach to the base of the skull become overly tight and squeeze or compress the nerves that feed into the head.  This results in radiating pain over the top or around the head, sometimes into the eyes.  Chiropractic care can make it easier for you to move your head and neck forwards, back, rotate or twist, and side bend.  This, in turn reduces the muscle tension and nerve pinching, which reduces headache pain.

References:

1. http://ihs-classification.org/en/
2. Rossi, P.; Di Lorenzo, G.; Faroni, J.; Malpezzi, M.G.; Cesarino, F.; Nappi, G. Use of complementary and alternative medicine by patients with chronic tension-type headache: results of a headache clinic survey.  HEADACHE 2006;  46:(4); 622-31.

Carpal Tunnel Syndrome Is Very Common

Carpal Tunnel Syndrome (CTS) is a very common problem and one of the leading causes of work related injuries.  This is partially due to the advancement in technology and the dramatic increase in the pace of work performance (1). The carpal tunnel is a small space in the wrist made up of wrist bones (carpal bones) and a ligament on top, through which 9 tendons and the median nerve travel into the hand.  
 
 CTS is often times caused by prolonged use of our hands and wrists (repetitive stress).  As a result, there is swelling of the forearm and wrist muscle tendons inside the carpal tunnel, forcing the median nerve upwards against the “roof” of the tunnel (the transverse carpal ligament), pinching it.  Symptoms initially include numbness or tingling, followed later by weakness in the muscles innervated by the median nerve.  This often results in grip and pinch strength loss, dropping of pens, difficulty buttoning a shirt, waking up at night with numbness in the 2nd, 3rd, and 4th fingers of the involved hand and driving induced numbness.
 
 In addition to overuse, there are other causes or contributors to the onset and presence of CTS:
• Age. Our workforce is aging (2).  Kaplan reported people over 50 years of age have a greater risk at failing conservative medical treatment (3). 
• Gender. Women are 3 times more likely to suffer from CTS, with the peak incidence between 45 and 54 years old. (4)
• Other problems/conditions. Obesity, hypothyroidism, diabetes, rheumatoid arthritis, and lupus (5 – Atcheson, et al).  Forty percent of CTS patients were reported to have a metabolic, inflammatory, or degenerative condition that might have caused or at least contribute to the symptoms. Moreover, the authors point out that only 35 patients (11.8%) knew that they had any of these conditions. 
• Nerve Compression. Nerve compression in the neck and/or arm above the wrist can also contribute to CTS (6).

If you would like to schedule a complimentary consultation to see if chiropractic care can befit your health, just give us a call a 203-922-9277 to make an appointment.

1.  Scott, WJ.  The Mechanization of Women's Work.  Scientific American 1982; 247: 162-87.

2.  Donnedly H. Percentage of Aged to Grow Rapidly.  Congressional Quarterly 1981: 2330-2.

3.  Kaplan SJ, Glickel SZ, Eaton RG.  Predictive factors in non-surgical treatment of carpal tunnel syndrome.   J Hand Surg [Br] 1990;15B:106-108.

4.  Stevens JC, Sun S, Beard MC, et al.  Carpal Tunnel Syndrome in Rochester, Minnesota, 1961-1980.  Neurology 1988; 38: 134.

5.  Atcheson S, et al. Other causes of CTS. Archives of Internal Medicine 1998;158:1496, 1506-1512.

6.  Upton ARM., McComas, AJ.  The Double Crush in Nerve Entrapment Syndromes.  Lancet 1973; 2:359-61.

Dr. Roizen Presents

YOU: The Most Important Choices
For Making Yourself Younger:
 “YOU Turns”

By Dr. Michael F. Roizen
   
Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.  The Owner’s Manual For Extending Your Warranty (Free Press) and YOU: The Owner’s Manual. An Insider’s Guide to Your Body That Will Make You Healthier and Younger (Harper Collins)

Our basic premise is that your body is amazing:  You get a do over: it doesn’t take that long, and isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you and then to teach others. We want you to know how much control you have over your quality and length of life

Last month (you did read and memorize that column we wrote, didn’t you?), we came to the conclusion that the most important tips to Staying Young are:

1. Understand you get a do over and it’s not that hard and it doesn’t take that long if you know what to do.
2. Start with walking.
3. Recruit a buddy and call daily.

Now, we want to add another: 4. Learn how to make YOU-turns. What do we mean by that? Well let’s talk about what a buddy does: You and your buddy talk daily to help support each other.  Don’t be judgmental if your buddy tells you she ate 7 of Mrs. Field’s chocolate cookies yesterday. It isn’t saying “tsk tsk” for having those seven cookies. You need to find out what you can do to encourage her, to help her make YOU-Turns in life. Remember, it isn’t the first cookie or even the first seven cookies that are a problem; it’s thinking the rest of the box of cookies looks good.  If you can correct your mistakes early enough, you can make a YOU-Turn and stay on a healthy track. What do we mean by YOU-Turn?

If you’ve ever ridden in a car with a GPS satellite navigation system, you know how it works. Plug in your destination, and the system – using satellites to plot your current and final points – tells you exactly what to do when. Turn left after 400 feet. Stay straight. Get in right lane. But let’s say you make a mistake and miss a turn or turn onto the wrong street. The GPS doesn’t berate you, doesn’t scold you, doesn’t tell you that you might as well drive off a cliff, since you make a mistake and missed First Avenue. Instead, all it says, very politely, is this. “At the next available moment, make an authorized U-turn.” YOU-reka! The GPS recognizes the mistake matter-of-factly and simply guides you back onto the right road. The GPS allows you to make mistakes and tries to help you correct them. That’s the kind of mentality we want you to have and especially for your buddy to have. Your buddy and you are going to make wrong turns. You’re going to turn left at the cookies, make a right at the blueberry pie, and occasionally merge onto the interstate at banana nut pancakes with a side order of sausage patties. Does that mean you should steer off the cliff and onto destructive behaviors? Of course not. Your job as a buddy is to help the other person make that “YOU-turn”: Get back on the right road and get healthy together. And enjoy your passions longer

So the most important tips that we can give anybody are:

1. Understand you get a do over and it’s not that hard and it doesn’t take that long if you know what to do.
2. Start with walking.
3. Recruit a buddy and call daily.
4. Learn how to make YOU-turns.

About the author:

Michael F. Roizen, M.D., is a professor of anesthesiology and internal medicine, Chief Wellness Officer, and chair of the Wellness Institute at the Cleveland Clinic.  Dr. Roizen can be heard on over 30 radio stations Saturdays from 5 to 7 pm.   For a listing, just email a request to YouDocs@gmail.com 

Minimizing Your Risk for Whiplash

While it is hard prevent someone from crashing their car into your car, there are some things you can do to minimize whiplash injuries.

The first preventive measure is making sure your seat is upright and the head rest touches the top of your head. If there is a lot of distance between your head and the rest, it will do little to help in the event of a collision. Also, if the headrest is too low, in can act as fulcrum, leveraging your neck into a worse position, and increasing injury risk.

Another thing we can do minimize injury risk is being in the best possible shape prior to the trauma. Research has shown people with good aerobic fitness seem to be more resilient after whiplash accidents.

If you are aware you are about to be hit, it is probably best to remain in a neutral position with eyes facing forward. People with their head turned prior to impact seem to have worse ligament injuries.

If you can afford it, a larger car will lessen the momentum of your vehicle after a collision. There are now vehicles with whiplash-protection seats (e.g. Saab) that dampen the effects of rear end-accidents. Frontal collisions tend to be less severe to the neck if the speeds are equal because the chin can hit the chest preventing forward motion of the neck. Rear-end and side-impact collisions do not have this benefit.

Unfortunately, there are many simply unavoidable risk factors. Women and children seem to be more vulnerable, possibly because of the increased head to neck size ratio. Also if you've ever had a head or neck trauma before and or have a degenerated disk in the neck, these factors elevate your risk for a more pronounced injury. Other factors that can slow your recovery include wearing a neck brace/collar, taking to bed rest, or getting vertical traction treatments. Inhibiting movements can feel good initially but is not good in the long term because of decreased muscle function and strength. Getting diagnosed as soon as possible can determine the best course of action for getting you to back to a speedy recovery. Just letting things go is rarely a good solution.

If you've been injured in a whiplash and need to discuss your health concerns, just call 203-922-9277 to make a complimentary consultation appointment.

New Research on Strength and Endurance Training for Fibromyalgia

It seems a month doesn't go by when yet another scientific study is published proving the benefits of exercise for fibromyalgia patients. The most recent study from Finland (Valkeinen H, Alen M, Hakkinen A, Hannonen P, Kukkonen-Hariula K, Hakkinen K. Effects of concurrent strength and endurance training on phsyical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial. Arch Phys Med Rehabil 2008;89:1660-1666.) looked at 26 women who were postmenopausal and had fibromyalgia symptoms such as widespread pain and fatigue. The participants were given a supervised 21-week progressive program addressing both strength and endurance exercises.

The results were very encouraging and merit further large-scale studies. The scientists found increases in muscle strength and that fibromyalgia symptoms were also reduced, especially fatigue. The front of the legs (quadriceps) improved significantly in strength over the control group.

What is key to this study is both weight training or resistance types of exercises were used along with aerobic conditioning, which works your heart and lungs. This combination coupled with a weight-loss or sound nutrition program are key adjuncts in getting a patient with fibromyalgia to move again. The addition of chiropractic care rounds out a natural and comprehensive alternative approach. When pain limits your mobility and ability to exercise, chiropractic can help to lessen pain and help you to regain more function.

When research (Athritis Rheum 2006;54:1334, Scand J Rheumatol 2005;34:309)  shows again and again the importance of exercise in treating fibromyalgia patients, it should compel us to take action.  If you can still walk (even it's in a swimming pool), you can begin an exercise program. Just make sure it is doctor-supervised so you don't go too far, too quickly. Since gains are great in the first month and we feel much better, we may progress too quickly with demands, resulting in injury or over-training. Advice as simple as getting enough rest at night, is to recovery and advancing your fitness goals. Also, a sound diet with vitamin and mineral support needs to be considered when you are consuming less calories for weight-loss needs.

If you would like to schedule a complementary consultation to discuss the specific strategies we use to help you regain your natural vitality, just call us at 203-922-9277 to make an appointment.

Carpal Tunnel Syndrome and Its Cause

Research has shown certain work practices and risk factors, such as being overweight, can elevate your risk for developing carpal tunnel symptoms.

As a chiropractor, I often look to the spine when my patients have nerve pain. Many people with carpal tunnel syndrome have a history of a whiplash injury or other neck trauma. But how can a neck injury make me susceptible to carpal tunnel? Simple. When you sprain the ligaments in your neck, this can cause damage and inflammation, which can irritate a nerve where it exits the spinal cord and courses between tiny bones to eventually reach your hand. If the nerve is irritated at the neck region, then this makes it more vulnerable to compression as it passes through the wrist tunnel. Signs that your carpal tunnel pain is a neck problem include shoulder and neck pain and/or a history of a neck trauma.

How can this possibly be fixed “chiropractically”? The first step is to diagnose if you have a primary wrist or neck problem, or a problem with both areas. A thorough examination of the neck, which may include x-rays, is important. The carpal bones of the wrist can be out of alignment or the vertebrae in the neck can be out of normal position. A specific adjustment can help to correct the abnormal posture and restore mobility.

You may also need to do strengthening exercises, especially if the condition is long-standing or you've worn a brace. The muscles of the lower arm are integral to providing wrist support and optimum function

Contractures can develop over time as well, fixating the nerves and not allowing them to glide normally with movements. Deep tissue therapy such as "pin and stretch" and deep massage and break up knots and tight tissues or scarring.

With most patients, alignment is an issue, as is flexibility and strength. I consider the cause of most carpal tunnel symptoms to be multifactorial. Not one exercise, or one pill, or even one adjustment, is right for everyone. However, it's important to consider conservative options first before deciding on invasive surgery. Even rest and taking pain pills is not really exploring all of the potentially conservative options available.

If you would like to schedule a complimentary consultation to see if chiropractic care can befit your health, just give us call at 203-922-9277 to make an appointment.