Your Doctor

September 2010

Massey Family Chiropractors

Chiropractic care for carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is characterised by frequent burning, tingling, itching, or numbness in the palm of the hand and fingers. The thumb, index and middle fingers are most commonly affected. Symptoms usually start gradually and are initially more common at night. Patients with CTS often wake up with a hand that feels numb and swollen, and may need to shake or squeeze the hand to regain feeling. As symptoms worsen, affected people might feel tingling during the day or pain that radiates up the arm. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away.

The carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand. Blood vessels, nerves and tendons pass through it into the hand. CTS occurs when the median nerve, which runs from the forearm into the hand, becomes compressed at this site. Some people have a congenital predisposition – the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist, repetitive and forceful movements of the hand, repeated use of vibrating hand tools, fluid retention during pregnancy or menopause. Other possible causes include over activity of the pituitary gland, hypothyroidism, rheumatoid arthritis or the development of a cyst or tumour in the canal.

Physical tests that place pressure on the median nerve are used to help diagnose CTS. If they reproduce the symptoms, CTS is likely. More sophisticated tests include nerve conduction tests that measure the amount and speed of electrical impulses that move through the wrist into the hand.

The chiropractic approach to treating CTS generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms and immobilising the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling. Adjustments and mobilisation of the wrist, elbow, shoulder and especially the upper spine and neck are often useful. Short-term supplementation with vitamin B6 may be helpful to reduce fluid retention. As symptoms improve, stretching and strengthening exercises can also help.

While chiropractic care, along with rest and exercise will be helpful most times, more advanced cases may require medication or even surgery. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.

Pulses provide plenty of protein

Pulses (also known as legumes) including beans, peas and lentils, are the dried seeds of certain plants. They are low in fat and are an inexpensive source of nutrients such as complex carbohydrates, fibre, vitamins and minerals (especially iron). Iron from vegetables is more readily absorbed by the digestive system when eaten with foods rich in Vitamin C such as capsicum and tomatoes.

Pulses are also an inexpensive source of protein. Proteins from plants do not contain all of the amino acids found in animal proteins. Combining different plant proteins can ensure a diet with adequate protein content. Examples include beans on toast, rice with lentils and hummus – a mixture of chickpeas and tahini (sesame paste).

Sprouting some pulses, such as mung or soybeans, will increase their vitamin C

levels. To do this, soak overnight in plenty of water. Pour off the water and cover the container with a piece of light fabric. Keep in a dark place for about three days until sprouts are a few centimetres long. Rinse with fresh water each day. Enjoy raw in salads and sandwiches.

Some people complain of “wind” when eating pulses. This problem may be helped by careful preparation and cooking. Long soaking, preferably overnight, in plenty of cold water helps to make them more digestible and reduces the cooking time. Rinse thoroughly in cold water before cooking in fresh water or stock. Boil vigorously for 10 mins then simmer gently until soft. Split peas and lentils do not need to be soaked before cooking.

Do not add salt or any acidic foods such as tomato before pulses are cooked or they will toughen.

Good Health on the Menu

This dish goes well with a rocket salad which will add fibre and aid digestion.

Chilli Con Carne

(serves four)

1 tsp oil

1 onion, chopped

1 clove garlic, crushed

1 tsp cumin seeds

500g low-fat minced beef

1 green capsicum, chopped

1 large carrot, chopped

120g tomato paste

1-2 tsp chilli powder or crushed chilli

2 cups home cooked or canned kidney beans

Method:

Heat oil then add onion, garlic, cumin seeds and meat and brown, stirring frequently.

Add remaining ingredients except beans. Stir and cook for 30 mins.

Add beans and heat.

Myth & Fact

Myth

Older people should not exercise with weights.

Fact

One of the major health concerns with people in their senior years is osteoporosis. This is a thinning of the bones that is most common in post-menopausal women. People with osteoporosis are more prone to fractures, especially of the hip. An osteoporotic hip fracture in a person over 65 can be a devastating injury. It can lead to cardiovascular and other health problems due to the lack of mobility that follows such an injury. This type of injury is common because older people often have balance problems.

Muscle cells shrink (atrophy) if they are not being used. Strength training such as lifting weights does the opposite, causing the muscle to enlarge (hypertrophy). The increase in muscle size with older people is only small compared to the increase in strength. In one study the average increase in strength was 73% but the increase in muscle size was only 8%.

Strong muscles translate to strong bones. In another study, postmenopausal women were assigned to either a strength-training group or a control group. The strength group gained an average of 1% bone density. Over the same time period, the control group lost 2-2.5% bone density. The strength group also showed improvements in balance and a 27% increase in general activity level.

Ask your chiropractor about a strength program to suit you.

Depression, Anxiety and Brain Asymmetry

Mood disorders such as depression and anxiety are common in society. Within an entire lifetime, major depression will affect 10-25% of women and 5-12% of men. Increased awareness and education has fortunately led to a gradual breakdown of the social stigma that was often associated with these conditions and meant that more people are willing to seek help.

For some time now health practitioners have been aware of the relationship between emotional state and brain function. In the last decade, much of the study in this field has centred on brain chemistry, in particular neurotransmitters in the brain, such as serotonin and dopamine.

Recently researchers have been looking at the effect of brain asymmetry on emotional states. It has been shown that different sides of the brain are dominant for different body functions and emotional feelings.

Put simply, the left-brain is more positive and is related to optimistic and forward moving behaviour. If you are feeling sociable and walk across a room to introduce yourself to someone you don’t know at a party, that is predominately left-brain activity.

The right-brain, on the other hand, is more negative and cautious and related to retreat behaviour. Crossing the road to avoid a suspicious looking person in the street is predominantly a right-brain activity. Research suggests that depression is associated with under activity of the left (moving forward) brain and anxiety states are associated with over activity of the right (holding back) brain.

A person experiencing a significant mood disorder should be under the care of a psychologist or similarly trained professional to ensure proper management and diagnosis. Chiropractors have a role to play because these people will usually have musculoskeletal problems related to their condition, which can become an additional source of stress.

High anxiety patients tend to do better with slow, low force chiropractic techniques that will not over stimulate the right-brain. Listening to calming music, going for walks in nature, Tai Chi and yoga may all be of benefit.

People experiencing depression are likely to do better with faster moving chiropractic techniques. Movement of any sort is important to help depression, to activate and fire up the left-brain.

Proper breathing is important for anyone experiencing stress. When anxious, our breathing tends to be too fast and shallow. When depressed, we may have a shortened breath-out (expiration) phase. In both states, we often breathe with our shoulders and chest rather than our diaphragm. You can engage your diaphragm by ensuring your abdomen and lower ribs expand on the in-breath (rather than the shoulders and upper ribs elevating). Keep your shoulders relaxed and breathe out for longer than you breathe in.

Supplements such as fish oil, magnesium and vitamin D may also be helpful in nourishing the nervous system in times of stress.

Advice from children – proving that we all live and learn

“Never trust a dog to watch your food.” Patrick, age 10

“When your dad is mad and asks you, ‘Do I look stupid?’ don’t answer.” Hannah, 9

“Never tell your mum her diet’s not working.” Michael, 14

“When your mum is mad at your dad, don’t let her brush your hair.” Taylia, 10

“Puppies still have bad breath even after eating a Tic Tac.” Andrew, 9

“Never hold a dustbuster and a cat at the same time.” Kyoyo, 9

“You can’t hide a piece of broccoli in a glass of milk.” Armir, 9

“Don’t wear polka dot underwear and white shorts.” Kellie, 11

“If you want a kitten, start out by asking for a horse.” Naomi, 15

“Felt markers are not good to use as lipstick.” Lauren, 9

“Don’t pick on your sister when she’s holding a cricket bat.” Joel, 10

“When you get a bad grade in school, show it to your mother when she’s on the phone.” Alyesha, 14

6 Steps to Perfect Posture

When thinking of perfect posture, think long and relaxed – like gravity is working gently in reverse through your spine.

Relax your knees – to do this first lock your knees fully, then let go slightly.

Hold and ‘Abdominal Hollow’ – this involves activating the muscles around your waist and drawing them into your spine. This is not forceful, but enough to feel that your deep abdominal muscle (called Transverse Abdominis) is engaged.

Open your chest and lengthen your spine.

Relax your shoulders and allow them to fall easily back.

As you extend through the neck allow your chin to draw back slightly.

Breathe in a relaxed way with your diaphragm – when you do, your lower ribs will expand rather than your shoulders elevating.

The science of chiropractic

Since DD Palmer performed the first chiropractic adjustment way back in 1895, chiropractors have always been interested in the science of the human body. In 1895 leeches were still in common use to rid the body of poisons, so it goes without saying that our understanding of science has come a long way since then.

In the early years, it was postulated that the vertebrae would move ‘out of place’ and compress the spinal cord or nerves exiting the spine. The ‘foot on the hose’ theory was that the hard bone pressing on the soft nerve would interfere with nerve transmission from the brain to the body. This theory gained popular recognition amongst the chiropractic profession because it made sense based on early 20th century anatomy. It was also observed that most people seeing chiropractors seemed to get better. If the outcome is good, the theory must be right?

Despite chiropractors having great success with their patients in most cases, the theory turned out to be wrong. As knowledge of anatomy and neurophysiology has improved, our understanding of the human body has become more sophisticated. It is now widely accepted that in most cases, spinal vertebrae do not ‘go out of place’ and chiropractors do not ‘put them back in’.

When you receive an adjustment from a chiropractor, he/she is not putting vertebrae back in place but stimulating special receptors called proprioceptors that fire nerve messages into the spinal cord and brain to help improve spinal function. The amount of stimulation is controlled, using different techniques and pressures. As it turns out, stimulating your senses really is good for you!