Cause:

Although it was once believed that tension-like headaches were due to muscle tension, it is now recognized that although there are often tender trigger points in the neck and base of the skull, there is no higher incidence of muscle tightness when compared to other headache types.

Evaluation:

There are no diagnostic findings specific to tension-like headaches. It is not unusual to find tender trigger points and tight muscles in the neck, although these are not exclusive to tension-like headache sufferers.

Presentation:

The patient present with a complaint of pain and numbness/tingling in the palm side of hand, usually more towards the thumb and the first and middle fingers. Symptoms may be worse at night, and there may be weakness in grip strength.

Cause:

The median nerve runs through an osteofibrous tunnel created by the transverse carpal ligament and carpal bones. Although direct compression from ganglions, fractures and dislocations are possible, it is more common to have a history of direct external pressure on the tunnel or a history of prolonged wrist use in full flexion or extension. Pressure inside the tunnel increases in these extreme positions. Additional factors may have to do with fluid retention, as in pregnancy, rheumatoid arthritis, diabetes, and connective tissue disorders. Patients may also be deficient in B Vitamins.

Evaluation:

Some simple tests can be done at home to determine if carpal tunnel syndrome causing your hand and finger pain.

 

 

Treatment:

Treatment in our office would first determine if the hand and finger pain is truely a carpal tunnel syndrome, or pain being referred from other areas such as the elbow or neck.

With true carpal tunnel syndrome (CTS) we would recommend rest by avoiding the activties that caused the CTS. We would recommend a B-complex vitamin to rule-out vitamins defeciencies.

Ultrasound therapy to the carpal tunnel would reduce inflammation around the median nerve.

Manipulation to the lunate bone of the wrist is one of the most effective treatments for reducing pressure on the carpal tunnel.

Manipulation and mobilization to the other joints of the hand / wrist / forearm are also benificial.

When conservative treatments are not responsive, surgical release of the retinaculum may be necessary. It is important to note that one study indicated that 5 years following surgery, 30% of patients rated their satisfaction as poor or fair. (JAMA. 1991; 265:1922-1925)

Patients will have a complaint of lower leg pain, either in the front of the shin, or deep within the shin. It is usually caused by running on a hard surface, especially if the patient is deconditioned to running. The pain is a deep ache that is usually worse with weight bearing, or exercise.

Cause

Shin splints are usually a tendonitis, or muscle strain.

Stress fractures may have similar presentation. With stress fractures the pain is more localized and on the tibia itself. With shin splints, X-rays are usually normal. If stress fracture is suspected, a bone scan is warranted.

There are usually several causes to shin splints:

Excessive activity / training

Old Shoes

Shoes that do not fit properly

Faulty foot biomechanics

Treatment:

Rest. Most runners I know will not take this advice, so atleast reduce your mileage and intensity.

Ice is your best freind. Ice for 10-15 minutes after training. I always found a ziploc bag with about six ice cubes and some cold water conforms great to the front of the shins while your feet are proped up.

Stretch. Here is a good video showing how to stretch your muscles involved with shin splints.

If symptoms get worse, or if they are prolonged for more then a couple of weeks then rest is a must, and further evaluation may be needed.

Some treatments in our office would include:

Ultrasound with high voltage combination therapy. This is a deep heat therapy which will help reduce inflammation and spasm in the muscles.

Kinesiotape. Kinesio tape is made of a high elastic quality woven tape that allows it to stretch 30-40% from its resting length. It is designed to simulate the elastic properties of skin. The theory is that it lifts the skin away from the muscle fascia, facilitating blood flow and drainage of fluids by the lymph system. This effect is thought to promote healing and prevent injury to the muscle and joint. The advantage of the tape is that is can be worn for long periods of time, for days or even weeks.

Manipulation to foot and ankles. This will help restore proper foot and ankle biomechanics.

Sole Supports Custom Orthotics. These will also help improve proper foot, ankle, and lower extremity biomechanics.

Have you ever had tight knots in your shoulder muscles? Sensitive trigger points in your trapezious? Of course you have; everyone has. But what causes it? Do you think your muscles just ball up into rock hard knots because you’ve been sitting all day? What about when they go away?
Among different manual therapies aimed at inactivating muscle TrPs, ischemic compression and spinal manipulation have shown moderately strong evidence for immediate pain relief.
New research shows that when you have parts of the spine not moving well, then you’ll have more knots in your muscles. They go hand in hand. Because my neck and ribs weren’t moving well, my muscles got trigger points. This is the body’s innate way of telling you that things need to move better.
Reduction of joint mobility appears related to local muscles innervated from the segment, which suggests that muscle and joint impairments may be indivisible and related disorders in pain patients.
When there’s poor movement in the neck, there’s a reflex that goes from the joints in the spine, to the spinal cord, and back out to the muscles that support the spine. This reflex has the muscles tightening down and guarding the area so it can heal and stabilize itself against further injury. the body perceives poor posture, locked up joints, and achy muscles as injury.
Two clinical studies have investigated the relationship between the presence of muscle TrPs and joint hypomobility in patients with neck pain. Both studies reported that all patients exhibited segmental hypo-mobility at C3-C4 zygapophyseal joint and TrPs in the upper trapezius, sternocleidomastoid, or levator scapulae muscles.
Because chiropractic care restores normal motion that flushes out inflammatory chemicals, and provides a reflex relaxation of the muscles and pain gate, it also helps to break the reflex causing trigger point knots in the shoulders.
There is scientific evidence showing change in muscle sensitivity in muscle TrP after spinal manipulation, which suggests that clinicians should include treatment of joint hypomobility in the management of TrPs.
Quotes taken from Interaction between Trigger Points and Joint Hypomobility: A Clinical Perspective.

A new study added more information to the way we understand how chiropractic adjustments help the brain with pain relief. 13 people with neck stiffness were hooked up to computers that read brainwaves, and were given chiropractic adjustments. When they were adjusted, the machines told them that parts of the brain where pain and suffering occurs has less activity. Adjustments block off pain patterns for pain relief.
This is another study that shows that chiropractic adjustments have more widespread and far-reaching effects on the whole body rather than just in the inflamed part of the spine. Chiropractic adjustments not only relieve back pain, but they also improve dizziness in some patients and other non-spinal problems.
http://www.ncbi.nlm.nih.gov/pubmed/20350670

We had an interesting patient visit our office yesterday. He had acute right shoulder pain, and he could not lift his shoulder above 90 degrees with out severe pain. The pain was not exactly in his shoulder, but in a joint known as the sternoclavicular joint. Where your collar bone attachs to your sternum, or breast bone. He was in so much pain, and he literally could not lift his shoulder. He claimed he didn't do anything to cause this, he just got out of bed quickly, and was in sudden pain.

After a detailed patient history and physical examination, we began treatment on his sternoclavicular joint. Ultrasound therapy for 3 mintues in and around the joint, and a specific manipulation to the joint which removed the adhesions within the joint, and allowing it to return to its normal biomechanical ranges of motion with shoulder elevation. It only took several minutes for the treatment, but his pain was reduced from 9/10 to barely a 1/10. There is some residual inflammation in the area which should subside naturally in the next several days.

Functional neurology is a modality that aims to integrate all of the brain's sensory activities in order to treat a variety of clinical and subclinical symptoms. This modality draws from a number of complementary and alternative health therapies. Advocates claim that correcting neurological problems and restoring functionality in the body may be possible by participating in a variety of exercises whose aim is neurological integration. These exercises involve specific forms of or exposure to movement, scent, sound, light, and touch. Drugs and surgery are not a part of this modality.

Pain and your brain

The perception and processing of pain information happens in your brain. Without your brain you could not have the opportunity to experience pain. Phantom pain is an interesting example of how the brain works. People who have lost a leg, for example, will complain of toe pain on that side, even though they have no toes. How is that possible? All we can say: the area of the brain that represents the pain perception of the toes is activated. Why, we cannot state, at least not in this context. This leads to the subjective experience of pain, even though there are no pain fibers from the toes to the brain.

All sensory information from the periphery, including pain, is channeled through the Thalamus to the cortex. The Thalamus is the main relay for all incoming sensory information.

Pain fibers are always "on" Our brain has two functions with respect to pain perception. One area of the brain receives the incoming pain fibers from the periphery via the Thalamus in order to facilitate the experience of pain. Another area of the brain fires down to the Thalamus to inhibit and dampen that transmission of pain. Here is an important thing to remember: pain fibers, similar to other neurons, fire at all times. This is essential to their survival. If they did not fire, they would degenerate and eventually die.

Brain inhibits pain perception

If it were not for the pain inhibition of the cortex, we would experience pain at all times. The problem arises when normal brain function declines in one or both brain hemispheres. The brain's capacity to inhibit pain perception would decline. This could lead to what we call intractable pain syndromes. The most difficult and frustrating cases for many of us in the health care field are those patients who present with these pain syndromes, with no history of trauma to explain them. These people simply hurt. Medication of varying strength has been used extensively, with less and less effectiveness.

The biggest mistake we all tend to make is to look only at the area of pain. There has to be an explanation for this person's suffering right there. When we cannot find a physical reason, we either give up, or we declare that it must be "psychological", that "it is all in your head". We give it fancy names such as "psychosomatic", etc.

Brain hemisphericity

Most of these names only cover up our helplessness and ignorance as to the true cause of their suffering. Actually, it may well be all "in their head". Besides looking at the area of pain, it is of vital importance to also investigate brain function. Once we understand that normal brain function is designed to inhibit pain perception, we must look for a way to evaluate the person's brain state. A neurological examination by a skilled chiropractic neurologist will easily reveal brain hemisphericity, the relative under-functioning of one brain hemisphere compared with the other.

Brain specific therapy

Once we have determined that there is no pathology in the area of pain, or anywhere else for that matter, we then have to decide how to best increase the function of the under stimulated brain hemisphere. The strongest sensory feedback from the periphery to the brain is via large diameter myelinated nerve fibers (Ia fibers), especially those from joint mechanoreceptors and muscle spindles. Brain hemisphere specific chiropractic adjustments on the side of the body opposite to the brain hemisphericity are exquisite ways to activate the brain function where it is needed. The brain can also be stimulated with light, sound, smell, taste, movement, etc.

For a successful outcome it is vital that all therapies are brain based. Their application must have a sound neurological basis. If you stimulate the "wrong" side, you may end up making the brain hemisphericity worse. This may lead to increased pain perception. From www.drz.org

Two new studies, from researchers at the University of California-San Francisco and the National Cancer Institute, suggest that hospitals may want to cut down on the volume of CT scans. One of the studies estimates that “about 29,000 future cancers could be related to CT scans performed in the United States in 2007 alone.” The researchers’ advice to patients: keep track of how many CT scans you receive, and discuss with your doctor if the CT scan is necessary.  Remember, CT scans are X-rays taken at multiple levels to give a better image of inside your body.  Some CT scans can give you as much radiation as 100 chest X-rays! 

An MRI does not have the radiation issues like a CT scan, but another recent study has shown when there is an increase MRI availability, there is a higher incidence of spinal surgery! This may be bad news for patients, since previous studies have found that increased surgery rates do not improve patient outcomes. “The worry is that many people will not benefit from the surgery, so heading in this direction is concerning,” said senior author Laurence Baker, Ph.D., professor of health research and policy at the Stanford University School of Medicine. 

While volunteering for the Salvation Army Bell Ringing yesterday, I was reminded of a common sign of lumbar stenosis.  I was standing outside of our local Kroger grocery store (it was very cold by the way!) and I noticed a few shoppers walking into the store with an empty shopping cart.  If you look carefully, you will notice their posture while pushing the carts.  They are flexed forward, and leaning on the cart.  This posture, flexion of the lumber spine opens up the spinal canal and allows the nerves that control the lower extremity to work better. 

Ironically, most shoppers that do this, do not even notice that it is their change in posture is what improves their gait.  They assume the cart acts as a "crutch" to help them walk.  

In new patient consults that I suspect lumbar stenosis, I always ask if they walk better with a shopping cart.  I usually get a surprised look of - yes it does, or they have to think about it before they realize that pushing the cart actually does help their gait. 

What we use in our office is a technique called Flexion Distraction which helps open up the spinal canal which is compressed by lumbar stenosis.  Studies have shown an increase of spinal canal area increase by 28%. 

 

Notice in the photo above, the shopper is not just pushing the shopping cart, she is leaning forward and putting some of her body weight on the cart.  This creates an increased flexion posture in the lumbar spine, allowing the nerves to work better in her legs.  This is a common sign of lumbar stenosis that can be helped with chiropractic care using Flexion Distraction technique.