Cold Laser in the treatment of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is caused by the entrapment of the median nerve as it travels through the carpal tunnel in the wrist.  Signs are pain, numbness and paresthesia in the thumb, index, middle and inside ring finger; increased pain and numbness at night due to prolonged wrist flexion; and if long standing, weakness in pinching and grip strength and atrophy of the hand muscles. 

Causes of CTS include inflammatory conditions such as pregnancy, rheumatoid arthritis, hypothyroidism, diabetes, and obesity.  Cumulative trauma from repetitive activities such as typing and guitar playing which puts the wrist into forced flexed positions are also implicated.  History and clinical tests to stress the nerve give a diagnosis, with a nerve conduction study being conclusive. 

Non surgical treatments have included night splints, NSAIDs, cortisone injections, ultrasound and modifying or changing certain activities.  Cold laser, a new treatment now being offered at our clinic, has shown promise in treating CTS to reduce pain and inflammation, as well accelerate healing. Surgical release of the carpal ligament may be indicated if conservative treatment has failed, if so cold laser can also be used post surgically to assist in healing. 

Several recent clinical trials have compared cold laser with sham laser, splinting and ultrasound. Results have shown cold laser to be effective in pain alleviation; reducing the numbness and paresthesia; improving hand grip strength and even improved EMG findings with no side effects, and to be superior to both splinting and ultrasound.   

Sources: The effectiveness of conservative treatment of carpal tunnel syndrome: splinting, ultrasound, and low level laser therapies; Photomed Laser Surg, Feb 2009 and The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome; Electromyogr Clin Neurophysiol; June 2008                                              

Sports Supplements that are Clinically Proven to Work

Athletes may ask about the value of certain supplements to enhance performance or gain muscle strength, but many supplements have more hype than science to support their use. While whey protein in shakes to replace protein loss during workouts is common, creatine, L-glutamine, ornithine and arginine also top the list of legitimate sports supplements. 

Creatine leads to an increase in muscle mass which is thought to occur from increased protein synthesis, this allows athletes to train harder as there is increased energy available for muscle contraction, promoting strength gain.  Creatine can also preserve strength as athletes age, keeping them functional longer. A loading dose of creatine monohydrate crystals is 20-25 grams per day for the first week, and than 10 grams per day for maintenance. 

 L-glutamine has been shown to decrease muscle breakdown during workouts and also reduce the incidence of upper respiratory infections by providing fuel for immune cells.  Optimal dosage of L-glutamine is 1,000 – 2,000 mg per day.

Ornithine and arginine are amino acids that have been shown to increase the release of growth hormone.  As we age, growth hormone declines, facilitating breakdown of lean muscle and bone mass.  Supplementing with arginine and ornithine may not only enhance muscle mass and strength gains, but as it elevates metabolism, it can help reduce body fat too.  Recommended dosage is 500 mg twice a day for five days a week.

So to maximize your athletic performance, consider using creatine monohydrate, L-glutamine, ornithine and arginine at these clinically proven dosages stirred into a glass of juice on an empty stomach.  Happy training!

Author:  James Meschino, DC, MS, ND; Dynamic Chiropractic

Laser Therapy for Shoulder Impingement

A 2011 study published in Clinical Rheumatology compared the traditional treatment of exercise for impingement syndrome of the shoulder to exercise with the addition of low level laser therapy.  Research has shown low level laser therapy to be beneficial in accelerating tissue repair by increasing fibroblast formation and circulation, while also decreasing inflammation and pain.

80 patients were divided into two groups; with neither the participant nor therapist knowing which patients were receiving laser therapy or sham laser.  Treatment consisted of 10 sessions over two weeks.  The intervention group showed significant improvement in both pain and increased range of motion than the exercise group alone.  The results were further strengthened as the same therapist performed all the treatment, eliminating practitioner bias. 

One weakness of the study was that the study did not differentiate only impingement syndrome, but rather lumped it with biceps tendonitis and other rotator cuff pathologies as they commonly occur together.   Strengths of the study were not only the large research group and “gold standard” of being double blinded and randomized, but that the low level laser improved the pain and range of motion, regardless of the underlying musculoskeletal condition. 

 

Manipulation or Exercise for Low Back Pain?

Low back pain affects 80% of the population at some point in their life, costing billions of dollars in lost productivity and health care.  There are many different treatment options available as individual response to care is unique.  A 2011 clinical trial reported in The Spine Journal compared two proven conservative care therapies, spinal manipulation and exercise, in chronic low back pain.

 

300 participants were divided into three groups: supervised exercise; spinal manipulation and home exercise with advice for a 12 week program.  There were equally improved outcomes in all groups, with a 40-50% reduction in pain and disability.  As would be expected, endurance and strength improved in the exercise groups more than the manipulation group.   

Results parallel the 2004 UK BEAM study comparing spinal manipulation and exercise, which found that manipulation and exercise were equally successful in treating low back pain, but that spinal manipulation combined with exercise did better than manipulation or exercise alone.  This supports what chiropractors have been doing for years, keeping the spines of patients functional through manipulation and providing exercise advice and encouragement to strengthen the core to stabilize the spine. 

Managing Pain with Acupuncture

Inflammation is the first phase of healing, but the pain associated with this inflammation may predispose some patients to chronic pain and disability.  If the initial pain experience is severe and continues, central pain hypersensitivity may develop.  Early intervention and prevention remain the best treatment, with rapid pain relief being the key. 

Acupuncture reduces pain via two different mechanisms.  It decreases the stimulation of nerve signals that lead to pain and it also reduces the expression of inflammatory chemicals that stimulate nerve endings that cause pain. 

Acupuncture may provide an analgesic effect by encouraging release of opiate based chemicals in the body and release of serotonin in the central nervous system.  It may also inhibit stimulation of the sympathetic nervous system to regulate inflammation and pain.  Acupuncture also seems to suppress Cox-2 in the spinal cord; Cox inhibitors are commonly used with some NSAIDs. 

If the patient’s pain is desensitized and there is increase tolerance to painful activities and therapy, the patient will hopefully avoid chronic pain syndrome and recover function faster to get their life back!

Piriformis Syndrome - What a pain in the butt!

Piriformis syndrome is referred to as sciatica resulting from compression of the sciatic nerve by the piriformis muscle.  Most patients state that they have buttock pain with numbness and tingling travelling down the thigh and upper leg, less reported is associated low back pain.  Other features include painful sitting; tenderness over the sciatic notch; pain with hip movements that stress the pirifomis (internal rotation) and relief with shortening of the piriformis (external rotation of hip, or walking with the toe pointing out).  The condition must be differentiated from lumbar disc herniation in younger people, and advanced degeneration or tumors that narrows the spinal or lateral canals in the older population. 

It is estimated that 15-20% of the population are predisposed to piriformis syndrome as the sciatic nerve passes through the piriformis muscle body rather than underneath, making it more susceptible to compression.  Other causes of piriformis syndrome include: muscle imbalance of weak hip extensors/abductors and tight hip flexors/adductors caused by prolonged sitting; overuse injuries in a sitting position, such as rowing or biking; stiff sacroiliac joints causing gait changes and shearing of the piriformis; and overpronation of the foot causing the knee to turn inward and piriformis to compensate. 

Conservative treatment will generally resolve the symptoms, and can include: ice, NSAIDS or acupuncture for inflammation and pain control; avoiding aggravating activities (uphill running, biking, rowing); stretching tight muscles and strengthening weak muscles; massage or using a tennis ball to target tight muscles; manipulation to restore SI joint function; gait correction with orthotics; and tissue healing with therapeutic laser. 

How Chiropractic Neurology helped Sidney Crosby

If you follow hockey at all, you would know that its star player, Sidney Crosby, has been sidelined with a concussion since early January 2011.  As with most head injuries, there is no predicting how long recovery would take or if full recovery is possible.  After eight frustrating months, and uncertain if he would ever again play the game he so excelled at, Sidney turned to Dr. Ted Carrick, the father of chiropractic neurology, in a desperate attempt to help with his ongoing balance and spatial orientation problems, caused by a disruption in his vestibular system. 

Dr. Carrick assessed Sidney, and determined that his injury caused him to not be able to tell where his body is in space or where other objects in relation to him were in space, skills which are essential for an elite hockey player.  After determining what his brain dysfunction was, a treatment protocol involving various proprioception exercises to reeducate his brain and develop a new spatial grid were given.   This included eye exercises, balance exercise, multitasking exercises and sessions in a unique device called a gyroscope, which spins you around like a fair ride. 

After a week with Dr. Carrick, Sidney was sent home.  A few weeks later, on September 7^th, a high profile press conference was held to update the public on Sidney’s progress, and Dr. Carrick was at his side, explaining his unique therapy.  On September 17^th Sidney practiced with his team mates on opening day of training camp, without contact and without symptoms.  Sid the kid played his first game on November 21^st, scoring 2 goals and 2 assists, announcing to the hockey public that he was back. 

Currently a 400 person research project is underway at Life University in Georgia to try and validate Dr. Carrick’s treatment protocol, but as many in the field of head injuries would point out, concussions are unique to the individual and as such, so is the treatment prescribed.  Many in mainstream medicine remain skeptical, as they have never heard of Dr. Carrick, chiropractic neurology or his holistic approach to treating brain injuries.  But Sidney and his support team would tell you that it made the difference with getting him back on the ice. 

Source:  http://www2.macleans.ca/2011/11/03/rebuilding-crosbys-brain/