Month of: February 2017
Chad Abramson, D.C.
Low Back Pain
Can Damaged Nerves Regenerate?
Previously, we discussed how herniated disks can resorb all by themselves, especially large
herniated disks. But what about a damaged nerve—can it self-repair too?
First, it’s important to realize that damage can occur when enough pressure is applied to any living tissue. The anatomy of our nerves includes many micro-structures such as the blood vessels that bring needed oxygen to the several layers of the nerve. If the nerve is deprived of oxygen long enough, there can be damage to its infrastructure, similar to a heart attack damaging the heart muscle.
A pinched nerve results in symptoms that include numbness, tingling, weakness, and in some cases, burning sensations. There are three stages of nerve damage that can be simplified into mild, moderate, and severe, and the ability for nerves to regenerate depends largely on the amount of damage and the length of time that has passed before treatment is sought out.
Generally speaking, it has been well reported that the nerves that make up the peripheral nervous system (the nerves outside of the brain and spinal cord) have the ability to regenerate, while those within the central nervous system (CNS) generally do not. However, there is hope. Researchers have begun to identify the molecular mechanisms that can promote axon regeneration in CNS injuries. Much of the knowledge and insight derived from these studies comes from the experimental use of fruit flies, as is referred to as “Drosophila models of axonal regrowth.”
The activation of an important receptor (called “insulin-like growth factor 1 receptor or IGF-1R) appears to be an essential step for axonal regeneration to occur in adult CNS neurons. Studies utilizing Insulin-like Growth Factor-1 (IGF-1) as a form of treatment in animal models after a brain injury found IGF-1 to be “neuroprotective” in the early stages of brain injury, and blood levels are often elevated soon after an injury.
In a study of 45 patients who suffered traumatic spinal cord injuries, researchers detected higher levels of IGF-1 blood serum levels in those who had clinically documented neurological resolution as compared to lower levels that were found in those who did not have neurological remission.
Unfortunately, researchers need to identify some of the missing pieces of the CNS-injury recovery puzzle before a consistent and predictable outcome can be expected for people who have sustained a serious spinal cord injury.
Doctors of chiropractic are trained to identify injuries to peripheral nerves as well as to the spinal cord and they can also work closely with other experts who manage the more significant neurological injuries, all in the quest of getting you back on the road to as much recovery as possible!
Is Your Shoulder Pain Caused By a Rotator Cuff Tear?
One of the most common causes of shoulder pain is a rotator cuff (RC) tear. To
determine just how common this is, one study looked at a population of 683 people regardless of
whether or not they had shoulder complaints. There were 229 males and 454 females for a total
of 1,366 shoulders. (The participants' average age was 58 years, ranging from 22 to 87 years
The research team found 20.7% had full thickness rotator cuff tears. Of those with shoulder pain, only 36% had tears found on ultrasound. Of those without shoulder pain, 17% also had tears! Risk factors for an increased for tearing of the rotator cuff include a history of trauma, the dominant arm (ie your right arm if you're right handed), and increasing age.
In a review of radiologic studies of 2,553 shoulders, researchers found full-thickness rotator cuff tears in 11.75% and partial thickness tears in 18.49% of the subjects for a total of 30.24% having some degree of tearing. In this group, about 40% of tears were found in pain-free shoulders. The researchers concluded that rotator cuff tears are common and frequently asymptomatic.
Both of these studies support the necessity to FIRST consider the patient’s clinical presentation and then correlate that with the imaging results. In other words, the presence of a RC tear on an image (usually MRI or ultrasound) does NOT necessarily mean there is pain (and vise versa)!
So what other things could be causing the shoulder pain? There are many: impingement, tendonitis, bursitis, muscle strain, capsular (and other ligament) sprain, frozen shoulder, and osteoarthritis (the "wearing out" type). Also, rheumatoid arthritis, lupus, polymyalgia rheumatica and other autoimmune types of “arthropathies,” fibromyalgia, a herniated cervical disk, shoulder dislocations, whiplash injuries, and more!
Most importantly, we must NOT forget to include referred pain to the shoulder from an impaired heart (such as coronary heart disease or heart attack), lung, liver, or gall bladder as these problems commonly refer pain to the shoulder and may represent a MEDICAL EMERGENCY!
A Brief Look at Whiplash Injuries
Whiplash is an injury to the soft-tissues of the neck often referred to as a sprain or strain. Because
there are a unique set of symptoms associated with whiplash, doctors and researchers commonly use the
term “whiplash associated disorders” or WAD to describe the condition.
WAD commonly occurs as a result of a car crash, but it can also result from a slip and fall, sports injury, a personal injury (such as an assault), and other traumatic causes. The tissues commonly involved include muscle tendons (“strain”), ligaments and joint capsules (“sprains”), disk injuries (tears, herniation), as well as brain injury or concussion—even without hitting the head!
Symptoms vary widely but often include neck pain, stiffness, tender muscles and connective tissue (myofascial pain), headache, dizziness, sensations such as burning, prickly, tingling, numbness, muscle weakness, and referred pain to the shoulder blade, mid-back, arm, head, or face. If concussion occurs, additional symptoms include cognitive problems, concentration loss, poor memory, anxiety/depression, nervousness/irritability, sleep disturbance, fatigue, and more!
Whiplash associated disorders can be broken down into three categories: WAD I includes symptoms without any significant examination findings; WAD II includes loss of cervical range of motion and evidence of soft-tissue damage; and WAD III includes WAD II elements with neurological loss—altered motor and/or sensory functions. There is a WAD IV which includes fracture, but this is less common and often excluded.
Treatment for WAD includes everything from doing nothing to intensive management from multiple disciplines—chiropractic, primary care, physical therapy, clinical psychology, pain management, and specialty services such as neurology, orthopedics, and more. The goal of treatment is to restore normal function and activity participation, as well as symptom management.
The prognosis of WAD is generally good as many will recover without residual problems within days to weeks, with most people recovering around three months after the injury. Unfortunately, some are not so lucky and have continued neck pain, stiffness, headache, and some develop post-concussive syndrome. The latter can affect cognition, memory, vision, and other brain functions. Generally speaking, the higher the WAD category, the worse the prognosis, although each case MUST be managed by its own unique characteristics. If the injury includes neurological loss (muscle strength and/or sensory dysfunction like numbness, tingling, burning, pressure), the prognosis is often worse.
Chiropractic care for the WAD patient can include manipulation, mobilization, and home-based exercises, as well as the use of anti-inflammatory herbs (ginger, turmeric, proteolysis enzymes (bromelain, papain), devil’s claw, boswellia extract, rutin, bioflavonoid, vitamin D, coenzyme Q10, etc.) and dietary modifications aimed at reducing inflammation and promoting healing.
Carpal Tunnel Syndrome
HOW Do I Know if I Have Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) can be an extremely painful and activity-limiting condition. It
affects many people of all ages and genders, though women are affected more often than men. But
how do you know if what you are suffering from is truly CTS or if it's another condition that's
producing the symptoms in your hand or wrist?
Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through the wrist. However, the median nerve travels out of the neck, through the shoulder, elbow, and forearm before it passes through the wrist and into the hand. Pinching of the median nerve ANYWHERE along its course can give rise to the signs and symptoms of CTS including numbness, tingling, and/or pain into the hand and index, third, and thumb-side half of the fourth digits, and sometimes the thumb. If the pinch is significant enough, weakness can also occur. Sometimes the median nerve can become compressed at both the wrist and other body sites as it travels from the spinal cord to your hand, that's why it's important for a doctor to check for impingements along the entire course of the nerve.
But compression of the median nerve isn't the only thing that can produce symptoms in the hand. Here are a couple of the more common conditions that are often confused with CTS:
- Ulnar neuropathy: This is pinching of the ulnar nerve (at the neck, shoulder, elbow, or wrist)
but this gives rise to a similar numbness/tingling BUT into the pinky-side of the fourth and
the fifth fingers (not the thumb-side of the hand). The most common pinch location is either
at the neck or the inner elbow, the latter of which is called “cubital tunnel syndrome” or
Tendonitis: There are a total of nine tendons that pass through the carpal tunnel that help us
grip or make a fist. Similarly, there are five main tendons on the back side of the hand that
allow us to open our hands and spread our fingers. ANY of these tendons can get strained or
torn, which results in swelling and pain as well as limited function BUT there is usually NO
DeQuervain’s disease: This is really a tendonitis of an extensor tendon of the thumb and its
synovial sheath that lubricates it resulting in a “tenosynovitis.” This creates pain with thumb
movements, especially if you grasp your thumb in the palm of your hand and then bend your
wrist sideways towards the pinky-side of the hand.
Chiropractors are well-trained to diagnose and treat patients with CTS. And if you don't have CTS but another condition listed above, they can offer treatment (or a referral, if necessary) to help resolve it so you can return to your normal activities as soon as possible.
Neck Pain / Headaches
What Is Cervical Spondylosis?
Cervical spondylosis (CS) is another term for osteoarthritis (OA) of the neck. It is a common,
age-related condition that you will probably develop if you live long enough. Or, if you suffered a neck
injury as a youth, it can develop within five to ten years of the injury, depending on the severity.
It is basically caused by the “wear and tear” associated with normal daily living to which some refer to as “the natural history of degeneration.” According to the Mayo Clinic, CS or OA affects more than 85% of people over 60 years old, and that is probably a conservative estimate!
Common symptoms associated with CS/OA vary widely from no symptoms whatsoever to debilitating pain and stiffness. For example, when CS crowds the holes through which the nerves and/or spinal cord travel, it creates a condition called spinal stenosis that can result in numbness, tingling, and/or weakness. In severe cases, this can even affect bowel or bladder control (which is an EMERGENCY)!
CS occurs when the normal slippery, shiny cartilage surfaces of the joint(s) gradually thin and eventually wear away from excessive friction caused by years of repetitive use related to a job, sport, or just time. Bone spurs often form, which results from the body trying to stabilize an unstable joint. In some cases, the spurs can actually fuse a joint, which often helps reduce pain. (Bone spurs can also form if the intervertebral disks or shock-absorbing pads between the vertebrae are injured or become dehydrated due to arthritic conditions.)
Risk factors associated with CS include: aging, injury, years of heavy lift/carry job demands, and jobs and/or hobbies that require the neck to be outside of a neutral position (like years of pinching a phone between the ear and shoulder). Genetics and bad habits (like smoking) also play a role in CS. Obesity and inactivity also worsens the severity of CS symptoms.
The good news is that even though most of us will have CS, it is usually NOT a disabling condition. However, CS may interfere with our normal activities. Depending on its location, pain may feel worse in certain positions, like when sneezing or coughing or with movements like rotation or looking upwards.
Stiffness is a common symptom, which can vary with weather changes. Too little as well as too much activity can be a problem, but the BEST way to self-manage CS is to keep active! Range of motion exercises, strength training, and walking all help reduce the symptoms of CS.
Doctors of chiropractic are trained to identify CS/OA. Gentle manipulation, mobilization, nutritional counseling, exercise training, modalities (and more) can REALLY HELP!
Whole Body Health
How Can I Improve My Sleep Quality?
Here are a few ways to improve your sleep quality in spite of a busy lifestyle:
- SET A SCHEDULE: Set a time for BOTH going to bed AND getting up in the morning, preferably at the same times each day—even on weekends.
- EXERCISE: Try to get 20-30 minutes of exercise every day (but NOT just prior to bedtime). FIRST thing in the morning is often the best time—before we can “talk” ourselves out of it!
- AVOID CAFFEINE, NICOTINE, & ALCOHOL: These stimulate the brain and keep us awake. Caffeine sources include coffee, chocolate, soft drinks, non-herbal teas, diet drugs, and some pain relievers. Smoking promotes light sleep and early morning waking from nicotine withdrawal. Alcohol also interferes with deep sleep and REM sleep—especially when consumed before bedtime!
- RELAX BEFORE BED: Take a warm bath, read (but not an action-packed book), and/or perform relaxation exercises before bedtime, as studies have demonstrated these to help one fall asleep.
- SLEEP UNTIL SUNRISE: Try to wake up with the sun or turn on very bright lights in the morning. This helps “set” the body’s biological clock and exposure to morning sunlight can help people fall asleep later that night.
- GET OUT OF BED: If you can’t sleep, do something like read, watch TV, or listen to music until you feel tired. Anxiety about NOT being able to sleep contributes to insomnia!
- CONTROL ROOM TEMPERATURE: Keep the temperature comfortable. If the room is either too hot or too cold, it may prevent you from both falling asleep and also reaching deep, restful sleep when you do finally clock out.
- SLEEP AIDS: These can include sleep supplements such as valerian root, melatonin, chamomile tea, and/or kava starting with a low dose and gradually increase it as needed.
Other “lifestyle” tips on getting a higher quality sleep include: 1) keep noise and light to a
minimum (use earplugs, window shades, or an eye mask); 2) avoid large meals two hours before
bedtime; 3) avoid afternoon naps; 4) stop mentally taxing tasks one hour pre-bedtime; and 5)
avoid emotional discussions/thoughts right before bedtime.
This list is certainly finite and could go on much longer. The BOTTOM LINE is that if you need help, your doctor of chiropractic can offer a LOT of benefits and when necessary, can work with primary care physicians and sleep specialists—all in the quest of getting you to sleep!
FOR YOUR FREE NO-OBLIGATION CONSULTATION CALL: 425.315.6262
Abramson Family Chiropractic
10222 19 th Ave SE, Suite 103, Everett, WA 98208
This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.