What can be the root cause of paralyzing heart disease, hypoglycemia, anorexia, neuritis and neuralgia, depression and anxiety? What can cause weakness and fatigue, exhaustion after meals, indigestion and insufficient stomach acid, poor appetite, craving for sweets, noise sensitivity, headaches, insomnia, nervousness, forgetfulness, and mental problems such as severe apprehension and uneasiness, vague or morbid fears, rage and hostility, hallucinations, and a debilitating and constant feeling that something horrible will happen? These are all symptoms of B-complex deficiency syndrome (BCDS).
If you have any of these symptoms, be sure to treat the potential underlying cause first before rushing off for prescription drugs that mask the symptoms but can also cause severe side effects or addiction. Unfortunately, synthetic B vitamins will not resolve the problems. Rather, the whole B-vitamin spectrum from whole foods and extracts is needed.
So if you have these symptoms, please give yourself 3 to 4 months on Cataplex B from Standard Process at a dose of 3 or 4 taken 3 times daily. And if you have kids with these kinds of problems, make sure to give them 2-3 Cataplex B, taken 3 times daily. And if all your symptoms are of the "hyped up" kind (agitation, nervousness, apprehension, and anxiety versus exhaustion, fatigue, depression, etc.), be sure to add 2-3 Cataplex G taken 3 times daily. Cataplex G is weighted more with the calmative portions of the B complex.
Just why synthetic B vitamins don't work is obvious. Lots of foods that kids eat are "fortified" with chemical, synthetic versions of a few B vitamin fractions (the typical "B vitamins"). They do not work. Would you rather get a chemical, synthetic copy of a few fractions of the B-vitamin complex that is made in a pharmaceutical company laboratory, or would you rather get the entire B-vitamin complex, concentrated from condensed, organic, B-vitamin-rich whole foods and extracts?
Real B vitamins like Cataplex B and G come from extracts and concentrates of liver, special yeasts, beets, carrots, wheat germ, adrenal, and more. The foods have to be grown organically, and the processing has to be without heat or solvents to maintain the live tapestry of the nutrients. This is the only way to get the full spectrum of B vitamins, including vitamin B4, which cannot be synthesized. Then consider that the ingredients in a typical bottle of "high potency vitamin B" tablets cost less than the label. You choose.
Suffer the Children
Children suffer greatly from BCDS. Their mental and emotional state is powerfully affected by B vitamins. Unfortunately most kids, especially teens, consume almost no foods rich in real B vitamins. However, many do consume tons of junk such as soda, alcohol, and processed foods-all of which make a B vitamin deficiency worse.
The very first signs of BCDS in kids are mental and emotional instability. These manifest themselves as depression, delusions, and disorientation. These symptoms are also right out of a medical textbook describing a disease that most physicians consider eradicated in the last century-beriberi. Sub-clinical (not full blown) beriberi affects kids mentally. If not resolved before they become adults, it will eventually manifest itself physically in a paralyzing form of heart disease, that if left untreated will eventually cause death.
So if you or your child or grandchild starts feeling or acting strange-and particularly if you or your child starts to live in constant fear that something dreadful is about to happen, think BCDS. Today it is a shocking fact that children by the millions are drugged for mental and emotional symptoms caused by a dramatic, universal, and deadly B vitamin deficiency.
Unfortunately the same can be said for adults. The good news is that in most instances, there is a simple solution. And at the very least, this protocol should be tried first. With any of these problems, always restore your whole, natural, B-vitamin stores with Cataplex B and G before you embark on the world of symptom treatment with all its problems. And please, do this first for the kids.
Whiplash is caused by a sudden movement of the head, usually caused by a motor vehicle collision (MVC) but it can also occur in sports and from slip and fall injuries. The combination of the weight of the head (approximately 15 pounds) and the length and strength of the neck predisposes the neck to be injured when a sudden force is applied. This is also caused by the fact the neck muscles cannot tighten quick enough to prevent injury in these types of injuries. People with slender necks (i.e., women > men) are more prone to injury.
The purpose of this article is to discuss some VERY effective ways to reduce the likelihood of being in a MVC of which the obvious include don’t drink and drive, don’t use your cell phone and drive, and don’t “text” on your phone while driving. Instead, use a hands-free phone or better yet, pull over to talk as you can’t concentrate or fumble around dialing/texting, and still pay proper attention to what you’re supposed to be doing – that is, driving!
According to a study conducted by the University of Utah, the distraction resulting from talking on a cell phone when driving is more significant than being intoxicated (0.08% blood-alcohol). Driving inattentively is estimated to be a factor in 20-50% of all police-reported MVC’s of which 8-13% are caused by driver distractions (cell phones is estimated to be 1.5-5% of that). One study reported both hands-free and hand-held cell phones were similar, reducing the driver response time to about a 40th percentile compared to a “normal driver.”
It’s believed the “cognitive workload” or, the “thinking” part during conversation causes the primary distraction, not the use of the hands. When compared to talking with a passenger, the University of South Carolina reported planning to speak put far more demands on the brain than listening. Talking to other passengers or on a cell phone are not the only or, the most common of the driving distractions.
The two most common causes of distraction-related accidents are “rubbernecking” (looking at outside objects/events) and adjusting the car radio/CD player. Cell phone use was reportedly 8th on that list. The use of a cell phone to text is limited because it is relatively new. However, a preliminary report from the University of Utah found a 6-fold increase in distraction related accidents when texting. The obvious concerns include the eyes off the road and in some cases, the hands off the wheel required for texting/email. Of interest, about 50% of drivers between 16 and 24 years of age compared to 22% of 35-44 year olds have admitted to texting while driving. Some recent highly publicized MCV’s caused by texting drivers include a May 2009 Boston trolley car driver and, the 2008 Chatsworth train collision that killed 25 people.
A July of 2009 Virginia Tech report of video footage of 200 long haul truck drivers who drove over 3 million combined miles, reported 81% of safety critical events involved driving distractions. They found texting had the greatest relative safety risk at 23 times more likely with their eyes being off the road for 4.6 out of a 6 second during a safety critical event. Another significant cause of driver distraction is drowsiness, which increased the driver’s risk of a crash or near-crash by 4 times, reaching for a moving object increased the risk by 9 times, looking outside/rubbernecking = 3.7 times, reading = 3 times, applying makeup = 3 times, dialing a cell phone = 3 times and talking or listening on a hand-held devise = 1.3 times. Eating while driving is also a risk.
As a service to you, we would appreciate it if you would share this information with family and friends so we can all drive more safely and live longer, healthier lives! We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.
Neck pain is a very common complaint that chiropractic has been found to be very effective in treating. There are many causes of neck pain including posture related (such as a forward head carriage) and repetitive strain (such as long static holding of awkward positions). These two causes are very similar as the head weighs approximately 15 pounds and when held in a forward translated position for a lengthy time frame, the muscles fatigue and begin to ache. This is similar to holding a baby in your arms for a long time frame. We soon find ourselves moving the baby to the other arm or against our chest due to the gradual increasing strain placed our upper quarter muscles. Hence, we must similarly change the forward head position when we are working at the computer, listening or talking (especially if the person is not directly in front of you), reading a book, cooking, and so forth.
Another cause of neck pain is trauma. This could be from a car accident, a slip-and-fall injury, sports injury, and more. These injuries are highly variable as no two injuries or accidents are the same and, there are a wide variety of neck sizes in both length and girth and hence, the same trauma may hardly result in an injury in one person and greatly injure a smaller, more petite person. Your doctor of chiropractic will ask you about the “mechanism of injury” as that can give us clues about which tissues are injured. For example, in a motor vehicle collision, if the impact occurs from the side verses the rear end of the car, the tissues in the neck are stretched differently and the management/treatment may vary accordingly.
Other causes of neck pain include a “slipped” or herniated disk. A herniated disk is like a jelly donut where the jelly leaks out and presses against a nerve that travels down the arm. Symptoms often include pain, numb, tingling, burning, weakness, or combinations of these sensations down the course of the nerve. When this occurs, the person is usually quite specific about where the pain is traveling such as, “…it goes down my arm to my 4th and 5th finger.”
Another cause can be related to natural aging process involving the “wearing out” process of the disk, joints, and muscle/ligament attachments. The term, “osteoarthritis” is commonly associated with these findings and is often blamed for neck pain, but this is controversial. First, osteoarthritis (OA) takes years to develop and many people have a significant amount of OA but literally no pain or symptoms while others with only a little x-ray evidence of OA present with an abundance of pain.
So, how do chiropractors manage all of these causes of neck pain? A thorough history, examination, and locating the positions of pain production verses pain relief are “key” to the successful management of patients with neck pain. For one patient, traction/stretching types of manual adjustment techniques work best while for the next, this may not be tolerated at all, which is why we “pre-position” the patient prior to administering an adjustment.
Other treatment considerations may include exercise instruction, physical therapy modalities (electric stim, ultrasound, etc.), the use of ice, re-adjustment of a computer monitor or work set up and nutritional considerations. If you, a family member or a friend require 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 we look forward in serving you and your family presently and in the future.
So you think you may suffer from Fibromyalgia (FM) and you’re trying to find out more information about FM…..but where do you start? Certainly you can “Google” the word “fibromyalgia” and spend the rest of the day, week, or maybe month reading about the symptoms, clinical signs, the many treatment options and the different types of doctors who treat FM patients. You will certainly learn a lot! But you will still most likely remain confused as to what to do about it.
First, what is fibromyalgia? It is a chronic (long standing) painful condition resulting in widespread pain throughout the body and it’s usually difficult to isolate a cause or reason for such significantly disabling symptoms. It is very common, affecting 3-6% of the general population (global) and 6-12 million Americans (2-4% of the US population). Woman are affected more than men (75-90% are women), and it is typically diagnosed between 20-50 years of age. It affects people physically, emotionally, and socially. The symptoms can fluctuate but it never completely disappears. The cause, though still debated, points to the central nervous system in which a “minor” pain signal reaching the brain is somehow magnified and perceived as more intense (this is called “central sensitization”). This makes the FM patient hypersensitive to normal stimulations like a hug or a when hitting a bump in the road with the car.
How is it diagnosed? Prior to 1987, it was not recognized by the AMA as an illness or cause of disability. In 1990, The American College of Rheumatology (ACR) reported the initial criteria for diagnosing FM. There are no blood tests, x-rays, biopsies, EEG’s, EMG’s or other tests for FM. Hence, a thorough history (frequently revealing fatigue, sleep problems, mental fog, depression, headache, and bowel problems) and examination ruling out other disorders is appropriate. Diagnosis includes a history of widespread, chronic pain and the presence of multiple tender points (at least 11 of 18) located all over the body.
What is the treatment? Pain management has been the focus and this can include medication, ice/heat, exercise, lifestyle adjustments, counseling when anxiety/depression are issues, dietary strategies, sleep management, but perhaps most important is education – about FM and how to “live with it.” That is, learning how to “control it” since no one has found the “cure.” Exercise in short durations of time by walking or swimming (not too strenuous). Expect post-exercise soreness so don’t overdo it initially, or you’ll be “convinced” you shouldn’t be exercising. Diet – avoid glutens/grains and emphasize fruits, vegetables, lean meats (grass fed chicken, beef, and fish), and consider nutritional support from a multiple vitamin, calcium/magnesium, fish oil (omega 3 fatty acids), Vit D3, and Co-Q10. Find a good “team” of doctors – chiropractic, family doc, and rheumatologist who YOU are comfortable with and who will work together for you. Don’t expect miracles – it may lead to disappointment.
Carpal Tunnel Syndrome or CTS, has been reported to be the most expensive of all work-related injuries, costing the average CTS patient about $30,000 in medical bills and lost work time over his or her lifetime. CTS is primarily found in adults, is 3x more frequently found in woman, and usually affects the dominant hand first. The pain can be quite severe and disabling. Certain occupations tend to cause CTS more than others, such as manual labor jobs (assembly-line / manufacturing, sewing, finishing, cleaning, meatpacking, food processing and packing occupations). Other jobs like computer work, playing a musical instrument and waitressing can also cause CTS. Certain medical conditions such as diabetes, obesity, pregnancy, the use of birth control pills, inflammatory arthritis and hypothyroidism can predispose patients to CTS. CTS is caused by a pinch to the median nerve that runs down the arm from the neck, through shoulder, elbow and wrist. The pinch can occur in one or more of these locations making it important to obtain a complete evaluation including the neck and upper arm – not just the wrist. There are a total of 9 tendons, ligaments, and blood vessels jammed into the tight confines of the carpal tunnel formed by 8 small carpal bones and the transverse carpal ligament that serves as the “roof” of the tunnel. Symptoms include burning, tingling, aching, and/or numbness primarily into the 2nd to 4th fingers and at times, the thumb. Some sufferers develop weakness in their grip making it hard to open jars, stubborn door knobs, holding onto a newspaper or steering wheel. Waking up multiple times at night is also a common complaint caused by sleeping with the wrist bent, which increases the pressure inside the tunnel, thus pinching the nerve more firmly.
A CTS diagnosis is made by reproducing the symptoms by further compressing the median nerve inside the tunnel. This is accomplished by applying pressure over the tunnel, by bending the patient’s wrists 90 degrees backwards (dorsiflexion) and forwards (palmar flexion), compression over the proximal forearm, at the thoracic outlet (under the collar bone) and / or at the neck. Special tests like an EMG/NCV (electromyogram and nerve conduction velocity) can determine the degree of nerve damage and verify the diagnosis. At times, x-ray or MRI are helpful if arthritis or a bone spur is suspect, or to measure the size of the carpal tunnel. Laboratory blood tests to determine secondary causes, described earlier, can also be of benefit.
Treatment consists of 1. Rest; 2. Modifying the activity or workstation suspected of causing CTS; 3. Using a splint- especially at night and when driving; and 4. Managing any underlying disease condition. Managing inflammation is also important, which can be accomplished by the use of ice of. (Ice massage is very effective. This consists of freezing water in paper cups, tearing off the top half of the cup, and rubbing the ice against the skin for approximately 5 minutes. The sequence of sensations includes cold, burning, aching, and numbness (“C-BAN”). Make sure you quit when numbness is reached, as frost bite is a risk if performed for too long.) Anti-inflammatory medications like ibuprofen, naproxen, or herbal remedies such as ginger, turmeric, boswellia, and/or vitamins like bromelain & papain, vitamin B6, fish oil (omega 3 fatty acids, Vitamin D (2000-5000IU); calcium/magnesium are all potentially helpful. Manual manipulations to the joints of the neck, shoulder, elbow, wrist and hand and soft tissue manipulation to the muscles and tendons of the forearm and hand can also be used. Other non-surgical treatments include exercises and physical therapy modalities such as low level laser therapy, electrical stimulation, ultrasound, and others.
Every season brings unique activities that require us to perform some physical activity we may not want to do but have no choice. In the winter, shoveling snow comes to mind (at least in some parts of the country) while spring, summer and fall may include yard clean up, mowing, and raking. All of these seasonal activities are, “…I have to..” activities of daily living (ADLs), rather than ADLs we want to do. Therefore, let’s talk about shoveling snow since that time of year is upon some of us, though hopefully on its way out! Of course, if snow is not an issue based on where you live, this information can also be applied to gardening, digging a hole or some other yard related shoveling activity.
First, a few facts that help us appreciate why back pain is so common when we shovel: 1. When we bend over, approximately 2/3rds of our body weight is being lifted in addition to what we’re lifting. Hence, a 180# person has to lift 120# of body weight every time he or she bends over. 2. A 5# weight equals 50# to our back when it is held out in front of us – consider the 10-20# weight on the end of a shovel! 3) Our legs are much stronger than our back and arms. If a person can bench press 300#, they can usually leg press 500# - almost 2x more weight. Yet, most of us use our arms, not our legs, when shoveling. 4) Most of us bend over using poor technique, lift the shovel with the arms and back (not the legs), and rapidly extend and twist the back when we throw the substance from the shovel – 3 bad things! 5) Then, this faulty action is repeated many, many times, and on top of that, it is not something we’re used to doing and hence, we’re not physically adapted or “in shape” for shoveling. With all of these “truths,” it’s no wonder why we often can barely move after an hour of shoveling! So what can we do about it?
I suppose hiring the neighborhood kid to do our shoveling makes the most sense but we’re not that smart! We can’t change the fact that most of our body’s weight lies above our waist so that one we’re stuck with and, we’re not going to lose weight in time for shoveling. But, we can certainly put less material on the shovel so the load on our back is less. It’s important to squat down using our strong leg muscles while keeping our back as vertical/straight as possible- DO NOT BEND OVER. Try sticking out your fanny (to keep an inward curve in your back), lift the shovel / load of material straight up with your legs, maintaining that arched back / butt out position. Keep your arms / elbows straight and walk the shovel load over to the dumping location – DON’T try and throw the load a distance by twisting your body. Take multiple breaks and switch sides so you don’t “beat up” the same muscle groups repeatedly.
If you do hurt your back - using an analogy of a cut on your skin –avoid picking at the cut so it can heal. If your back hurts after shoveling, use ice/rest followed by gentle stretching and modified activities – DON’T go back out and shovel (ie, don’t pick at your cut!). Some wise considerations for shoveling include warming up before starting, staying “in shape” by regular exercise throughout the year, maintaining a good nutritional diet and getting enough sleep.
There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain. Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.” But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history. In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today. Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care. Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system (the URL is included for further study):
1) Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437. http://www.chiro.org/LINKS/ABSTRACTS/LBP_of_Mechanical_Origin.shtml
2) Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada. http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml
3) Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR). http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870
4) Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up. British Medical Journal 1995 (Aug 5); 311 (7001): 349–351 http://www.chiro.org/LINKS/ABSTRACTS/Chiropractic_and_Hospital_Outpatient.shtml
5) Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1); 29 (1): 79–86. http://www.ncbi.nlm.nih.gov/pubmed/14699281
Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury. So the question on deck is, which of the health care services best addresses the injured whiplash patient?
This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25). The authors state conventional [medical] treatment utilized in whiplash care, "is disappointing." The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome. The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. They separated patients into one of 3 groups: Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit"; Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement"; Group 3: patients who described "severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."
Group 1
24% Asymptomatic
24% Improved by Two Symptom Grades
24% Improved by One Symptom Grade
28% No Improvement
Group 2
38% Asymptomatic
43% Improved by Two Symptom Grades
13% Improved by One Symptom Grade
6% No Improvement
Group 3
0% Asymptomatic
9% Improved by Two Symptom Grades
18% Improved by One Symptom Grade
64% No Improvement
9% Got Worse
These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2). The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened. The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3). Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.
If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!
There are many conditions that can be attributed to specific causes with a clear origin and means of diagnosis. However, there are also conditions that are obscure and can only be diagnosed by eliminating other, more common conditions. Fibromyalgia (FM) is one of those conditions where the degree of pain and disability can be profound and life quality interrupting, yet all the tests come back negative and there are no other conditions to explain the collection of symptoms. It is at that point when the diagnosis of fibromyalgia is typically made.
FM is typically a chronic (symptoms have been present for at least 3 months) condition where the patient complains of widespread, generalized muscle, ligament and tendon pain accompanied with fatigue and multiple tender points on the body that hurt with only light pressure. To be considered “widespread,” it usually affects both sides of the body and is both above and below the waist. It occurs in approximately 2% of the population in the US and women are 3-4 times more likely to develop FM. The risk of FM increases with age and can be secondary to other physical or emotional trauma, or it can occur all by itself. No obvious pattern usually exists as signs and symptoms can vary depending on weather, stress, physical activity, and even the time of day.
Sleep quality is an issue that seems well agreed upon as regardless of the number of hours in bed, the deep, restorative stages of sleep are seldom reached. Other sleep disorders frequently associated with FM include sleep apnea and restless leg syndrome.
Causation for the most part is unknown but genetics (family traits), infections (can trigger or worsen FM), and after physical or emotional trauma (eg., post-traumatic stress disorder) have been linked to FM. An explanation as to why it hurts so much centers around a theory called “central sensitization.” This is basically a low threshold for pain because of increased sensitivity in the brain to the incoming pain signals. Certain chemical (neurotransmitters) changes in the brain have been identified resulting is hypersensitivity creating an overreaction to pain signals.
The American College of Rheumatology has established two diagnostic criteria that include 1) widespread pain lasting at least 3 months, and 2) at least 11 out of 18 positive tender points using just enough pressure to whiten the fingernail bed. There are no direct blood tests to confirm a diagnosis of FM but other conditions can affect or cause FM can be diagnosed with blood testing. These include thyroid disease (thyroid function blood tests), inflammatory arthritis such as rheumatoid (ESR), and a complete blood count to assess anemia and infection.
Carpal Tunnel Syndrome or CTS, is the most common of the peripheral nerve conditions where the median nerve is compressed or pinched at the wrist. The resulting symptoms of numbness/pain in the wrist, index, third, and forth fingers, multiple sleep interruptions, frequent shaking and flicking of the hand/fingers, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, the inability to perform work duties – especially fast, repetitive work tasks can have a devastating effect on a person’s quality of life.
While treatments traditionally have involved activity modification, night splints, anti-inflammatory medication, and in advanced/severe cases surgery, a recent study comparing different vitamin approaches reports promising results with the use of alpha-lipoic acid (ALA) and gamma-linolenic acid (GLA). This combination was described as a logical early stage treatment aimed at “neuroprotection” or, to limit and correct nerve damage caused by CTS. The doses utilized for 90 days in 112 subjects with moderately severe CTS were 600 mg/day of ALA and 360 mg/day of GLA. This combination was compared against a commonly recommended multiple vitamin B complex that included 150 mg of B6, 100 mg of B1, and 500 mcg of Vit B12 per day for the same 90 day period. Questionnaires regarding CTS symptoms and function and electromyography (EMG) were utilized to track the outcomes in the study. The ALA/GLA treated group was statistically significantly improved when compared to the other B-complex vitamin approach. This included significant improvements in both symptom scores and functional impairment compared to only a slight improvement in the vitamin B group. Similarly, EMG was significantly improved in the ALA/GLA and unchanged in the vitamin B group.
Because there are many contributing causes of CTS, a multi-dimensional treatment plan will usually yield the best long-term results. Because repetitive motion / cumulative trauma are often associated with the onset and perpetuation of CTS signs and symptoms, ergonomic issues must be addressed. This includes perhaps a period of time when slower “light duty” work is necessary and consideration for workstation modifications, when feasible. Because most people do not ‘run to the doctor’ with the early signs of CTS, over time, many CTS patients develop abnormal movement patterns by minimizing hand/wrist motions. Instead, they start to shrug the shoulder and lean the body to one side. Hence, management addressing neighboring joint problems at the elbow, shoulder, and neck is needed. A condition called “double-crush” where the nerve is pinched in more than only at the wrist but also at the elbow, shoulder, and/or neck results in a significantly worse CTS presentation. These patients require treatment at all areas involved, not just at the wrist if long-term, satisfying results are to be obtained.
Metabolic conditions including diabetes mellitus, hypothyroid, obesity, pregnancy, the use of birth control pills, and others also contribute or, can even by themselves cause CTS. Chiropractic has traditionally viewed the body as a whole, treating the person from the ground upwards paying attention to posture, leg length, pelvic tilt, shoulder and head tilt. The use of manipulation of not only the wrist and hand, but also the elbow, shoulder, neck and back has yielded the best results rather than focusing only on the hand/wrist. The traditional use of night splints, work station/ergonomic modifications, as well as diet and exercise are also commonly addressed by chiropractors when managing CTS patients. We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care and we realize there are many healthcare options available. If you, a friend or family member requires care for CTS, we would be honored to offer our services.
1. In a series of recent human volunteer crash tests of low speed rear impact collisions, it was reported that the threshold for cervical spine soft tissue injury was 5 mph (delta V) (1 ref).
2. Other reports have shown that crashed cars can often withstand collision speeds of 10 mph or more without sustaining damage (5 refs). Thus: the concept of "no crush, no cash" is simply not valid.
3. Recent epidemiological studies have shown that most injury rear impact accidents occur at crash speeds of 6 mph to 12 mph (2 refs.) --the majority at speeds below the threshold for property damage to the vehicle.
4. A number of risk factors in rear impact accident injury have now been verified including: rear (vs. other direction) impact (18 refs), loss of cervical lordotic curve (2 refs), pre-existing arthritic changes (5 refs), the use of seat belts and shoulder harness (at slow speeds) (4 refs), poor head restraint geometry (3 refs), non-awareness of the impending collision (4 refs), female gender (4 refs), and head rotation at impact (2 refs).
5. Once thought to suggest minimal injury, a delay in onset of symptoms has been shown to be the norm, rather than the exception (13 refs).
6. Mild traumatic brain injury can result from whiplash trauma. Often, the symptoms are referred to as the post-concussion syndrome. This condition, often denied in the past, has now been well-validated in recent medical literature (4 refs).
7. A recent outcome study of whiplash patients reported in the European Spine Journal found that between one and two years post injury, 22% of patients' conditions deteriorated (1 ref). This second wave of symptoms has been observed by others as well (1 ref).
8. Radanov et al. (1 ref) followed whiplash patients through time and reported that 45% remained symptomatic at 12 weeks, and 25% were symptomatic at 6 months. Other researchers have reported time to recovery in the most minor of cases at 8 weeks; time to stabilization in the more severe cases at 17 weeks; and time to plateau in the most severe categories as 20.5 weeks (1 ref). Thus, the notion that whiplash injuries heal in 6-12 weeks is challenged. (Incidentally, there never has been any real support for this common myth.)
9. Of the 31 important whiplash outcome studies published since 1956 (19 published since 1990) pooling patients from all vectors of collision (i. e., rear, frontal, and side impacts), a mean of 40% still symptomatic is found. For rear impact only, a mean of 59% remain symptomatic long-term.
10 . Although estimates vary, about 10% of all whiplash victims become disabled (79).
If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at this office.
Fibromyalgia (FM) is a complex condition that includes widespread symptoms of muscle and joint pain, where everything seems to ache and is associated with severe exhaustion and fatigue. It affects up to 4% of the population (woman > men), with no known cause or known cure. With these facts, it’s not surprising that many sufferers have turned to diet as a means of trying to improve their quality of life. Unfortunately, there are many conflicting dietary recommendations for FM, some completely contradicting the other, leaving the patient and doctor confused as to who or what to believe.
FM can be primary (of unknown cause) or secondary (caused by a different specific condition). Because many conditions can give rise to FM, it’s not surprising that there is no one diet that works universally for all FM patients. However, many FM sufferers respond from eliminating one or more of several types of foods according to experts interviewed by WebMD, and utilizing these recommendations can prove highly effective. They specifically identified 7 foods to avoid in the management of FM, which include the following:
1. Aspartame (NutraSweet): All of the experts interviewed by WebMD agreed a large majority of FM patients could worsen by eating or drinking foods sweetened by aspartame.
2. MSG (monosodium glutamine) and nitrates: MSG is a common additive to enhance flavor in many processed and frozen foods as well as in some Asian (eg., Chinese) foods. Hence, lunchmeats like ham, bologna and bacon should be avoided.
3. Sugar, fructose, and simple carbohydrates: Though no study has clearly identified that these foods directly worsen the symptoms in FM patients, eliminating foods like cake, white bread and sugar in general, will decrease the risk of developing secondary conditions such as yeast infections that can give rise to FM. Eliminating foods with high levels of fructose corn syrup has been reported to help some FM patients.
4. Caffeine (coffee, tea, colas/soda, & chocolate): After a brief stimulating effect (energy boost), there is a longer lasting sedative affect, which is amplified in FM patients. The good news is that most of the caffeine is out of the body within a week of discontinuing use.
5. Yeast and glutens: These two are not related but are frequently used together in foods like cake, donuts and bread and both contribute to FM symptoms. Yeast gives rise to yeast fungus where an overgrowth may cause or exacerbate FM symptoms resulting in joint and muscle pain. Glutens can cause stomach and other GI problems, which in turn can give rise to fatigue.
6: Dairy: Regardless if its low or high fat, some reports indicate that dairy products, particularly milk can increase the symptoms of FM and avoiding these can help.
7. Nightshade plants: Tomatoes, chili and bell peppers, potatoes and eggplant can trigger flare-ups of FM and various forms of arthritis.
Some GOOD diet approaches include a heart-healthy diet – that is, one that is low in saturated fat and includes lean meats & poultry, fresh fruits and vegetables. This diet improves one’s overall health, thus reducing the risk of secondary FM and allowing the body to better fight off other disease processes. This diet is also anti-inflammatory, the common link found in many health conditions. A vegetarian diet comprised of mostly whole foods was also reported as helpful. High potency vitamin supplement and specifically Omega 3 fatty acids (main ingredients – EPA & DHA) included in fish oil, flax seed, walnuts, some fortified cereals, and eggs also help reduce inflammation. These recommendations are research supported and we can further discuss the nutritional approaches that benefit patients suffering with fibromyalgia.
Have you ever considered how important your hamstrings muscles are in relationship to the low back? Most people do not think about those tight muscles on the back of the upper leg / thigh as having much to do with low back pain (LBP). However, it is one of the most important muscles groups to keep loose both as a means of improving current low back trouble as well as preventing future LBP. Think of the hamstrings as a stabilizing guide wire that keeps us upright. When we bend over with our knees straight, we can feel the hamstrings gradually tighten, often limiting us from reaching our toes. When the hamstrings are too tight, some of us can hardly reach past our kneecaps as we bend over. We then (unconsciously) bend our knees to put slack in the hamstrings so we can easily reach the floor.
The low back is only so flexible and in reality, most of our ability to touch our toes comes from our hip joints. In fact, after scoliosis surgery where metal rods are placed on both sides of the spine, these patients will often make up for the loss of low back movement by increasing hip motion and still be able to touch their toes! This, however, can only be accomplished if the hamstrings are stretched to a point of allowing the hips and pelvis to rotate forwards when bending with the knees straight.
So, what happens if the hamstrings are too tight? Think of a young sapling tree branch versus an old oak branch. When bending the two branches, the young sapling can easily bend, while the old oak branch breaks early into the process. Similarly, as we bend over to lift a box, when the back and leg muscles, ligaments, and tendons are tight, something has to give or “break,” similar to the old oak branch. The “weak link” in the injured person bending over may be a disc that ruptures, ligaments and/or muscle tendons that overstretch and tear. By keeping the hamstrings loose (like the young sapling branch), much less force is placed on the spine because the pelvis can rock forwards during the bending process, thus unloading the spine. Another way to look at it is that when the hamstrings are too tight, something else has to be correspondingly loose to make up for the tight hamstrings or else the task of bending forwards and performing daily tasks will be limited.
Tissues in our back are injured when forces exceed their capacity to withstand the load. By keeping our hamstrings stretched, we reduce the need for our spine to have to make up for the tightness; thus both preventing a new injury, as well as perpetuating a current problem. The best way stretch the hamstrings is to lay on our back in an open doorway with one leg placed on the door jamb (edge of the doorway) and the other leg is kept flat on the floor (knee straight) through the door opening. Scoot as close as you can so that the hamstring muscles are stretched tightly to the point of a “good hurt.” Maintain that position for at least 2 minutes and then switch legs. Because the hamstrings tighten up during sleep, it’s usually best to perform the stretch in the morning. Repeating this multiple times a day may be required to obtain proper hamstring muscle length. Exercise training is a routine part of chiropractic care!
If you, your family, or a friend is struggling with low back pain, sharing this information may be one of the greatest acts of kindness you can give to that person. At this clinic, we strive to provide the highest quality care and follow evidence and “best practice” approaches. We greatly appreciate the trust that our patients place in us and our services as we help them recover as well as teach ways to prevent future LBP episodes.
What Is It? Whiplash is an injury to the soft tissues in the neck including ligaments, joint capsules, muscles and their tendons, and intervertebral disks. It can also involve the nervous system tissues in more severe cases, resulting in radiating arm pain.
How does it happen? During a car crash, most commonly a rear-end collision. The sudden jolt occurs so fast we cannot brace ourselves adequately and the head accelerates back and forth beyond the limits of the ligaments that hold our bones firmly together (often referred to as a “sprain”). Because of the significant range of motion of the neck, the weight of the head, and how is suspended on the neck, the neck is particularly vulnerable to this type of injury (more commonly worse in woman due to a more slender neck).
What are the symptoms? The primary symptom is neck or upper back pain that may develop immediately or be delayed days, weeks, and sometimes months. A partial list of possible symptoms (each injured person’s symptoms are different) include: muscles spasms, loss of movement, headache, dizziness, concentration &/or memory loss, difficulty swallowing, chewing &/or hoarseness, burning or tingling, shoulder/arm/hand radiating pain, and more.
How is it diagnosed? Even when symptoms do not seem significant, a health care provider can diagnose the condition by taking a careful history and performing a physical exam. X-rays showing a change in the curvature or contour of the neck, &/or MRI or CT scan to better assess the disk and nerve roots when pain radiates down an arm may also be indicated. When persistent concentration/memory loss is present, a consult by a neuropsychologist is helpful.
How is it treated? In most cases, non-surgical methods are usually appropriate. If you go to a medical doctor, typical approaches include a wait & watch approach and/or medications such as anti-inflammatory drugs, pain killers, &/or muscle relaxants. MD’s may refer the patient to physical therapy. When these methods fail, referral to a physiatrist may result in injection therapy (epidural steroid, facet injection, trigger point injections). Chiropractic care includes spinal manipulation, mobilization, soft tissue release techniques, exercise training, activity modification training, and physical therapy modality use (electrical stimulation, traction, ultrasound, low level laser therapy – LLLT, TENS unit). Care may also include a mix of provider approaches, when appropriate.
How can it be prevented? The degree of severity of whiplash can be decreased or maybe avoided completely with the following: the use of seatbelts (especially in high speed collisions), placing the headrest close to the head (< 1 inch) and high enough to avoid “ramping” over it. Placing the seat back more vertical/upright can minimize ramping. Do not partake in distractive activities while driving – cell phone use, adjusting the radio, taking your eyes off the road (eye contact during conversation), dosing off, reading a book (this is more common than you think!), and others. Bracing yourself has not been shown to be very helpful – whiplash happens too quickly to voluntarily brace your neck muscles. For athletes, wear appropriate protective gear when engaging in sporting activities and use proper form / technique during the athletic activity.
Important to know! Chiropractors have a unique advantage over other health care providers as spinal manipulation and other manual therapies have been shown to yield the highest levels of satisfaction and faster recovery rates compared to other forms of health care. If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at this office.
There are many treatment options for those suffering from neck pain. There is conventional medical care where the family doctor will usually prescribe a muscle relaxant, anti-inflammatory, and/or pain killer to help patients through episodes of acute neck pain. However, many patients with neck pain have been through the process of treatments associated with medications and simply cannot tolerate the adverse side effects of stomach pain common with anti-inflammatory drugs such as ibuprofen (Advil, Nuprin, Mediprin, etc.), Aleve (Naproxen), or aspirin. Others don’t like the groggy, drunk-like feelings associated with pain killers or the sleepiness associated with muscle relaxants. Therefore, these patients often turn to complementary / alternative care.
As noted in the May, 2009 issue of Consumer’s Report for low back pain, chiropractic was the most sought after form of treatment, but there has been no extensive review of neck pain regarding evidence-based treatment approaches – at least not until February, 2008. An international “team” representing 9 countries screened over 31,000 titles of articles published between 1980 and 2006, reviewed more than 1200 articles and eventually reported on 552 studies in their final report. Their findings included the following:
· In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
· Neck pain was the 2nd most common reason Americans obtained chiropractic care.
· Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
· Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
· Women more commonly obtained care than men for neck/shoulder pain (29% vs. 18% men) over a 4-6 year time frame.
· Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
· For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and “…perhaps acupuncture…” were reported as more effective than no treatment, sham, or other alternative interventions.
· For both whiplash and non-traumatic neck pain, supervised exercise with or without manual therapy was favored over usual medical care or no care.
What does all this mean? Simple! Everyone who is suffering from neck or upper back pain should seek chiropractic care which includes manipulation, mobilization, exercise training, and activity modifying advice, as these approaches have been found to be more effective than usual medical care! Why waste time with a “wait and watch” with or without drug intervention approach when the evidence favors chiropractic related interventions. If you, a friend, or a loved one is struggling with neck or upper back pain, we will properly assess your condition and administer the appropriate care that is required. We will coordinate care with other health care services when necessary. This recommendation may represent one of most significant acts of kindness you can offer those that you truly care about.
Fibromyalgia (FM) has a long reputation for being a controversial diagnosis. Some health care providers (HCPs) feel FM is a legitimate condition that warrants treatment and research while others feel it’s a “garbage can diagnosis” that HCPs throw patients into when they’re not sure what diagnostic label to use for a patient’s condition. Regardless of the personal beliefs of individual HCPs, there have been two general classifications of FM – primary and secondary. Primary FM occurs when there is no underlying health condition participating in the patient’s overall health status and onset of FM. Secondary FM results from an underlying condition that contributes significantly to the patient’s health status, such as irritable bowel syndrome and over time, gives rise to the onset of FM.
Posttraumatic FM belongs to the secondary FM classification when the traumatic related injury results in the patient developing FM. A Canadian study reported that 25-50% of FM patients reported a traumatic event just before the FM symptoms began. This study surveyed different specialty physician groups to determine which issues were most important in causing the onset of widespread chronic pain after a motor vehicle trauma. Five factors were studied to determine how important each was to the HCP in arriving at a FM diagnosis in a case study of a 45 year-old female with a whiplash injury who developed chronic generalized pain, fatigue, difficulties in sleeping and diffuse muscle tenderness. These five factors included:
1. The number of FM cases diagnosed weekly by the HCP
2. The patient’s gender
3. The force of the initial impact
4. The patient’s psychiatric history before the trauma
5. The initial injury severity
Also described as important were the patient’s pre-injury health status, fitness level and psychological health. All HCP groups were reluctant to blame the car accident as causing FM, but rather placed more importance on the patient attitude, personality, and level of emotional stress. The least important of the five points were numbers 3 and 5. The orthopedic group also included “ongoing litigation” as a cause but as a group, they were the least likely to agree on the FM diagnosis (29%) in the 45 year old case study. Rheumatologists were highest at 83%, followed by general practitioners at 71%, and physiatrists at 60%. A most interesting observation was that once the data was analyzed, ONLY the patient’s pre-accident psychiatric history remained in the model of predicting agreement or disagreement with the FM diagnosis.
Posttraumatic FM can result from any type of trauma, not just motor vehicle collisions. Other “secondary” FM causes besides trauma, can include systemic conditions such as irritable bowel syndrome, chronic fatigue syndrome, and other internal disorders that in part, alter the person’s ability to obtain restorative sleep. Hence, an important focus of treatment should be placed on helping the FM patient obtain restful sleep. Chiropractic management strategies have included manipulation, mobilization, soft tissue therapies, physiological therapeutic agents such as electrical stimulation, ultrasound, the training for home use of traction, the use of nutritional counseling and supplementation, and the training of exercise. Many studies support success with this multidimensional approach to treating FM as chiropractic attacks the FM condition from multiple directions, often yielding highly satisfying results. We are committed to help you or a loved one that may be suffering with FM, and sharing this information may be one of most significant acts of kindness you can give.
What is it? Carpal Tunnel Syndrome (CTS) occurs when a nerve on the palm side of the wrist is pinched. It is named after the area of the wrist from where the symptoms occur. The Carpal Tunnel is basically a horseshoe shape made from 8 small carpal bones and the ends of the horseshoe are connected with a ligament thus completing the “tunnel.”
What are the symptoms? CTS symptoms include pain from swelling of the tendons inside the CT. When the nerve pinch occurs, numbness, tingling, or a half asleep sensation into the 2nd, 3rd, and 4th fingers occurs. This is often worse at night due to the wrist being bent when asleep. This often wakes the person and shaking/flicking the hand/fingers is needed to “wake them up.” Grip weakness is also associated with CTS such as difficulty opening jars.
What are the causes? Usually, over use from tasks including repetitive line work (meat/fish/poultry packing, cookie/food packing), typing, sewing, carpentry, waiting tables, and the like. Other “contributors” include hormone related conditions such as hypothyroid, dysmenorrhea, diabetes, and obesity. These fast/repetitive movements cause swelling of the tunnel’s contents (9 tendons and the median nerve) and the nerve is pushed into the ligament connecting the ends of the horseshoe/tunnel.
Who is at risk? Gender is a significant factor as women are 3x more likely to develop CTS than men as the CT may be smaller in woman. The dominant hand is often first affected and more severe. Hormone imbalances as described above also increase risk.
How is it diagnosed? The history of the symptoms as well as physical examination of the hands, arms, shoulders and neck can lead to the proper diagnosis. The exam consists of trying to reproduce the numbness into the fingers by pressing/holding over the CT and other areas where the nerve runs down the arm (including the neck where the nerve originates), tapping over the CT with a reflex hammer, bending and holding the wrists at the extreme endpoints of motion. Also, poking the skin with a sharp object and comparing the 2nd to 4th fingers to other parts of the hand and the opposite side commonly yields differences between the two sides. Questionnaires and hand diagrams completed by the patient are helpful and quantify the degree of severity. Tests used during the course of treatment help track improvements. More sophisticated testing includes an EMG (nerve conduction test) that tests the motor and sensory changes when the nerve is pinched.
How is it treated? Chiropractic approaches include manipulation of the wrist, hand, forearm, shoulder and neck, specifically addressing the areas of greatest restricted motion. Soft tissue therapy includes massage, active release, graston, trigger point, and a host of physical therapy modalities such as light/low level laser, IFC, ultrasound, microcurrent, and low frequency approaches. Exercise training to be repeated multiple times per day is very helpful. Wrist bracing especially at night is also a common treatment approach used by all health care providers. Nutritional counseling and supplementation is also very helpful.
How can it be prevented? Work station assessments, staying in shape (avoid obesity), taking “minibreaks” when doing repetitive work, and proper treatment for conditions like hypothyroid, diabetes, and other disorders associated with CTS.
“I can’t believe how much my low back hurts! I don’t know if I can go to work with it like this!” Does this sound familiar? Have you ever missed work because of low back pain? Well, if you have, you’re certainly not alone! In fact, over 80% of the general population seeks some type of health care provision at some point in life because of low back pain and many of those lose work time. Lost work time is often associated with not being able to tolerate certain positions such as prolonged sitting, standing, bending, twisting, reaching, or combinations of these. Sometimes, just getting to work is next to impossible as the car ride alone may intolerable! There is nothing more depressing than not being able to move due to the sharp knife-like feeling in the back every time you try to change positions.
However, it’s one thing to lose a day or two or even a week of work but what about those that can’t work for longer time periods, like several weeks or even months? This can become life altering as avoidance of moving for fear of that knife-like sensation in the back can quickly lead to muscle weakening, weight gain, lethargy, depression, and a host of other negative residuals. Many articles have been published in the past that tried to identify ways determine early on in the course of back treatment, who might be at greatest risk of not improving or becoming disabled. The term, “yellow flags” has been used to describe such factors and some success in identifying those prone to becoming disabled has been reported. In May 2009, another attempt to identify injured workers who were at risk for becoming disabled or, not being able to return to work for at least 3 months was published. Of the 346 injured workers that were followed for 6 months after the sick leave period began, 47% failed to return to work. There were five questions found to adequately screen those who were not able to return to work or were at greatest risk of becoming disabled. The 5 questions included:
1. Do you expect to return to work within 6 months?
2. How much does the pain interfere in your daily activities?
3. It is not advisable to be physically active?
4. Do you feel generally nervous?
5. Do you feel generally scared?
The good news is that chiropractic manages these types of acute back pain quicker and better than any other form of health care. This is reflected by the highest percentage of consumers seek chiropractic over any other form of alternative health care for back pain relief according to the May, 2009 issue of Consumer’s Report.
We strive to provide the highest quality care and follow evidence and “best practice” approaches at our clinic and look forward to helping our patients through difficult times like this.
A 48-year-old male had left sided neck pain with intermittent left arm tingling, numbness, and aching for 2.5 months. The pain was described as a deep nagging ache on the left side of the neck with a more intense pain in the left shoulder blade that occurred without any specific activity. Also, no particular position of the neck or head changed the symptoms in the neck or left arm. The patient described having periodic episodes of neck and left arm pain/numbness 4 or 5 times over the last 10 years, and he felt that this episode was similar to the previous episodes. He had utilized chiropractic treatment previously with good results and was considering calling for an appointment once again.
Everything "looks and sounds" like a neck condition with an associated pinched nerve causing pain and tingling radiating down the arm - but is it?
After carefully questioning, it was discovered that no specific date of onset could be tied to a trauma (specific injury), over-use activity, or any other identifiable cause. Similarly, he stated that no specific position of the head/neck or arm changed the intensity or length of time the pain lasted. This is unusual for a pinched nerve in the neck as the nerves are stretched when the arm hangs down at the side increasing the pain, and less stretched when the arm is raised over the head resulting in less arm symptoms. Another inconsistent finding was that the whole arm rather than a specific part of the arm was symptomatic. Usually, a pinched nerve follows a specific course down the arm affecting either the 4th and 5th fingers or the thumb side of the hand, but not the whole arm and hand. The physical examination was fairly typical for neck pain sufferers - limited ranges of motion of the neck, neck pain reduction with manual traction and increased with compression tests. However, there were no arm symptom changes during the neck ranges of motion tests, compression tests, or elevating the arm.
These history and examination findings should alert the health care provider of a possible "organic" cause for the symptoms rather than the "pinched nerve" diagnosis. When considering a list of possible "organic" causes, heart disease must be first on the list since it has life threatening potential. In the case presentation above, the patient was indeed having a heart attack where the blood vessels to part of the heart wall were blocked and the blood carrying oxygen to the heart muscle couldn't get through, thus was causing the "referred pain" to the left side of the neck, shoulder blade and down the left arm. It is important to know that this heart related referred pain pattern never involves the right arm - only the left. Other potential symptoms can include left jaw (TMJ) pain, and the more obvious left sided chest pain, even though these were not present in this case.
Unfortunately, this case ended sadly as the patient did not survive the heart attack. This is probably because at this young age of 48, the blood vessels around the heart had not yet developed "collateral circulation" or, new branches that develop as the other arteries around heart gradually close down (atherosclerotic heart disease).
We welcome you to contact our office for a thorough evaluation or to answer any questions concerning you, your loved ones, or friends concerning neck pain, with or without arm complaints. The good news is that it is probably your neck and not your heart that is causing the symptoms. Most importantly, rest assured that we ALWAYS consider all possibilities.