Monday, April 16, 2018

Understanding A "Pinched Nerve" In The Neck


By Dr. John A. Papa, DC, FCCPOR(C)

About two-thirds of people will experience neck pain at some point in their lives.  Occasionally, neck pain can spread to involve other structures such as the upper back, shoulder, and arm regions.  Pain in these regions is often dismissed simply as muscle pain.  However, a “pinched nerve” originating from the neck can radiate pain to these nearby anatomical sites and be a significant source of discomfort.

The “cervical spine” is the medical name given to the region of the neck.  Nerve roots originate from the cervical spine on each side.  These nerves send off various branches that travel to distinct regions in the upper back and arms to supply strength to muscles and provide sensation/feeling.  The term “pinched nerve” is often used to describe a mechanical and/or inflammatory irritation directly affecting any component of the nerve root(s) in the neck/cervical spine.

A “pinched nerve” in the neck can cause symptoms almost anywhere along the nerve pathway.  This may result in neck symptoms only, and/or symptoms that radiate into the chest, upper back, shoulder, arm, hand and finger regions.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and arm muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as movement of the neck or shoulder, prolonged sitting or laying down, lifting, and even coughing or sneezing may aggravate the symptoms.

Below is a brief summary of three common causes of a "pinched nerve" in the neck:

1.     Spinal disc herniation/bulge – Spinal discs separate and cushion cervical vertebra.  Repetitive and cumulative loads or a heavy single load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

2.     Degeneration and Osteoarthritis – The normal aging process causes cervical disc degeneration and osteoarthritis of the cervical joints.  The consequence of these processes is that mechanical irritation from bony spurs on the vertebrae along with inflammation can cause irritation of the nerve root(s).  This most commonly occurs in adults over 50.

3.   Cervical spinal stenosis – This condition may cause “pinched nerve” symptoms due to narrowing of the spinal canal and/or nerve pathways, which puts pressure on the nerve root(s) or spinal cord.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

Other causes of a “pinched nerve” in the neck include: direct irritation of nerve tissue by overlying muscles; direct trauma or injury to the nerve root(s); and mechanical changes in the neck associated with poor postural habits (i.e. head poking forward in the sitting position).  Some common causes of symptoms that act like a “pinched nerve” in the neck include muscular trigger points, ligament sprains and arthritic joints from the neck, upper back, and shoulder regions.

Treatment for a “pinched nerve” in the neck will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis.  A proper medical history, along with physical examination consisting of range of motion, strength, neurological and orthopaedic testing, along with diagnostic imaging (if necessary) should be performed to aid in the diagnosis.  It is extremely important to rule out rare causes of “pinched nerve” symptoms such as spinal tumors, fractures and infections.  Disorders of the esophagus, trachea (windpipe), heart and thyroid can cause symptoms that overlap with those of a “pinched nerve” in the neck.  These potential causes require appropriate medical referral when applicable.

There are natural and conservative treatment options available for those suffering from a "pinched nerve" in the neck.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, acupuncture, ice/heat application, electrotherapy, activity modification, postural education, and rehabilitative exercise.  A qualified health professional can determine the cause of your symptoms and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Monday, April 9, 2018

Nutrients That Support Musculoskeletal Health


By Dr. John A. Papa, DC, FCCPOR(C)


The musculoskeletal (MSK) system includes the muscles, tendons, joints, and bones of the body.  Many nutrients contribute to the healthy functioning and integrity of the MSK system.  Included below is a summary of 5 common nutrients that significantly contribute to MSK health.
 
1. WATER brings vital nutrients to muscle tissue to support movement and decrease the risk of cramps and strains.  Water also eliminates waste products and toxins from the body and helps to protect our joints by providing lubrication and cushioning.  The consequences of inadequate water intake/dehydration include:  muscle and joint pain, cramping, and fatigue.  A general rule of thumb to follow is to consume 0.5-1 litre of water daily for every 50 pounds of body weight.

2.    CALCIUM is best known for building strong bones.  It is also needed for muscular growth and contraction.  A deficiency in calcium status can lead to aching joints, muscle cramps, and osteoporosis.  Foods such as milk, yogurt, and cheese are good sources of calcium but may not be suitable for individuals sensitive to dairy products.  Other healthy foods high in calcium include pinto, navy, red and white kidney beans, sesame seeds, almonds, and dark leafy vegetables.

3.   VITAMIN D is essential for helping bones absorb calcium, keeping them strong, and preventing osteoporosis.  Signs of Vitamin D deficiency may include painful muscle spasms, leg cramps, numbness in the extremities, bony malformations, and arthritic pain.  Vitamin D is naturally found in food sources such as cod liver oil, salmon, mackerel, tuna fish, sardines, and egg yolks.  Sensible and safe sun exposure is also an important natural source of Vitamin D.

4.  VITAMIN C plays a vital role in collagen production and tissue repair.  Collagen is the building foundation for many body tissues and is found in all MSK structures.  There is an abundance of Vitamin C in strawberries, citrus fruits, and vegetables including, red peppers, broccoli, spinach, brussel sprouts and cauliflower.

5.    GLUCOSAMINE SULPHATE is a normal element of cartilage matrix and joint fluid and provides the body with the building blocks necessary to repair joint damage.  As we age, our bodies slow down the production of glucosamine sulphate.  Published research suggests that glucosamine sulphate is beneficial for arthritic patients, particularly for those individuals with mild to moderate osteoarthritis of the knees.  Some glucosamine sulphate supplements also contain anti-inflammatory herbs that can be combined with other nutrients such as Omega-3 fatty acids to help with arthritic pain.

Sensible eating should include nutritional balance with the correct proportion of quality carbohydrates, proteins, healthy fats, and adequate water intake.  Although nutritional supplements can help support MSK health, many nutrients appear to be most effective when consumed in their natural state within whole foods.  For additional information on diet, nutrition, and how you can improve your MSK health, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tuesday, April 3, 2018

Plantar Fasciitis: A Common Source Of Heel Pain


By Dr. John A. Papa, DC, FCCPOR(C)

Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes.  This condition is a common source of heel pain that can be quite disabling.

Plantar fasciitis usually develops gradually, but it can also come on suddenly.  Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic.  Pain and discomfort can also extend into the arch of the foot.  Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity.  If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight-bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.

Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot.  Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed.  This may occur with activities that require running, jumping or prolonged walking and standing.  Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.

Faulty foot mechanics may also contribute to the development of plantar fasciitis.  Individuals with flat feet or those who excessively pronate (role feet inward) will experience added strain on their plantar fascia.  Old lower extremity injuries such as ankle sprains and fractures can increase susceptibility due to altered lower limb movements.  Being overweight is also a risk factor.  Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.

Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.

Plantar fasciitis that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic or laser modalities to assist in healing, manual and soft tissue therapy to supporting structures, therapeutic taping of the heel, and specific rehabilitative  exercises for the muscles and joints of the lower leg and foot.  A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.

It is important to establish an accurate diagnosis of plantar fasciitis.   Other causes of heel pain may include stress fractures, heel fat pad syndrome, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Thursday, March 29, 2018

Cervicogenic Headache


By Dr. John A. Papa, DC, FCCPOR(C)

Cervicogenic headache is defined as a headache which has its origin in the area of the neck.  The source of pain arises from biological tissues such as muscles, ligaments, joints, and nerves that have become injured and/or irritated.  When these structures become stimulated, their nerve endings send pain signals from nerves in the neck to the head.

Cervicogenic headache is a relatively common cause of chronic headache and has symptoms similar to those seen in other well known headache disorders such as migraine and tension type headaches.  For example, both migraine and cervicogenic headaches affect females more than males, with headache symptoms generally located unilaterally (on one side of the head).  These headache sufferers may complain of severe pain, head throbbing, sensitivity to light and sound, and nausea.  Neck pain and muscular tension are also common symptoms in tension headaches, migraine attacks, and cervicogenic headaches.  The problem of symptomatic overlap in these common and frequent headache types makes the accuracy of precise diagnosis difficult.  Furthermore, the fact that an individual may have two or more headache types
co-existing at any one time further elevates the diagnostic challenge.

Cervicogenic headaches are usually unilateral (occasionally bilateral), and can be experienced in several different regions of the head including the base of the skull, the forehead, or behind the eyes.  The intensity of pain may fluctuate from mild to moderate to severe on a daily basis.  Individuals with cervicogenic headache may also exhibit physical signs of altered neck posture and restricted range of motion of the neck.  Headache symptoms can be triggered or reproduced by active neck movements or passive positioning.  Tenderness can also be palpated in the neck and upper shoulder region with muscular trigger points spreading pain upwards into the head.

The cause of cervicogenic headache may be singular or multi-factorial.  This may include a whiplash injury, sports injury, arthritic changes, chronic postural strain, stress, and fatigue.  The evaluation and assessment of headaches should include a proper medical history and physical examination.  Serious causes of headache symptoms must be ruled out before appropriate treatment can be administered.

After a diagnosis of cervicogenic headache is made, the goal of therapy is to minimize headache frequency and diminish levels of pain associated with each episode.  Treatment and management options that have demonstrated effectiveness include: postural correction, joint mobilization and manipulation, acupuncture, soft tissue therapy, and rehabilitative exercises.  Trying a variety of therapies or combination of therapies may be required to find relief.  It should be remembered that many patients who are diagnosed with migraine and tension headaches may also respond to these treatment strategies.

For those suffering from headache symptoms that may be interfering with their activities of daily living, a qualified health professional can prescribe appropriate therapy, rehabilitation, and self-management strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tuesday, March 20, 2018

Repetitive Strain Injury


By Dr. John A. Papa, DC, FCCPOR(C)

Repetitive strain injury (RSI) is a type of disorder that primarily affects muscles, tendons, nerves and joints.  This includes conditions such as rotator cuff and achilles tendinopathy, carpal tunnel syndrome, neck tension syndrome, bursitis, golfer’s elbow, tennis elbow, and plantar fasciitis.

Symptoms of RSI may include restricted mobility, weakness, numbness, tingling, burning sensations, swelling, redness, sharp and/or aching pain.  In its severest form, RSI can significantly limit physical functioning and render people incapable of carrying out even simple tasks.

RSI can affect anyone involved in activities that require rapid and/or repetitive motion of muscles and joints in work, sport, or leisure activities.  It is more likely to happen if these movements are combined with awkward posture(s), excessive or prolonged force, poor technique, and using the wrong equipment or tool.  Physical deconditioning can also make individuals susceptible to RSI.  As a result, RSI can affect a broad variety of people including:  trade workers such as electricians, painters, and carpenters; recreational athletes such as tennis players and golfers; and labourers such as cleaners and assembly line workers.  Video gaming, computer use, holding one's phone between the neck and shoulder, and even hobbies like knitting and playing a musical instrument are associated with RSI.

While most cases of RSI are treatable, it can recur and may become chronic without appropriate management.  Pain in one area of the body may also spread to other areas as the body tries to compensate.  For example, pain in the wrist can move to the forearm, shoulder joint and neck muscles as an individual attempts to avoid pain and symptoms while continuing to perform the offending activities.  Therefore, prevention is key to managing RSI.  This is accomplished through identifying and then altering or eliminating the situations that contribute to the cause of RSI.  This may include making changes to a work station, using the correct tools/equipment, taking breaks to relax overworked muscles and joints, and performing exercises to relieve stress and strengthen the affected parts of your body.

Chiropractors are healthcare professionals skilled in evaluating, maintaining and restoring physical function.  They can provide education to help prevent RSI and offer effective therapy to help relieve symptoms that have already developed.  This may include treatment options such as joint mobilizations, specialized soft tissue therapy, therapeutic laser, acupuncture, and electrotherapy.  In addition, a chiropractor can advise you on modifications to your work environment as well as assist you in improving work habits and postures. Specific rehabilitative exercise prescription that includes strengthening and stretching exercises, combined with aerobic conditioning, may also be part of your treatment plan to help with recovery and prevent recurrence of RSI.

If RSI is affecting your ability to get through the day and keeping you away from your favourite activities, consider chiropractic care.  A chiropractor will assess your symptoms, diagnose your condition, and recommend a treatment plan to put you on the road to recovery.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Monday, March 12, 2018

Bending Forward - A Common Factor In Persisting Low Back Pain


By Dr. R. Greg Lusk, DC

In my last article in January, I discussed the value of applying a "functional" diagnosis to a complaint such as low back pain. To refresh, it is the process of identifying movements and/or activities (i.e. functions) that produce or aggravate symptoms, as well as those that may reduce or even abolish symptoms. Aiming for this better understanding of factors that influence pain offers great value to patients, beyond the anatomical diagnosis, as they can independently modify behaviour and movement to modulate pain, in addition to the traditional approach of receiving a form of treatment to manage and/or mask the symptom of pain.

With respect to neck or low back pain, flexion (i.e. bending forward) is by far the most common direction which produces, aggravates, and perpetuates pain. This is not surprising as most of us have a posture that tends toward slouching versus sitting straight up and many of our activities of daily living involve spine flexion - sitting, driving, computer use, looking down at our phones, washing dishes, putting on socks, etc. Conversely, how many things do you do throughout the day or how much time do you spend in positions that involve bending your spine backward or extending your neck to look up? Not many and not much would be my guesses. If you consider that most clients that present to my office with neck or back pain also report no trauma or specific mechanism resulting in their pain, this points to a more repetitive, cumulative, or sustained source of strain as the culprit.

Ironically, although spine flexion can be implicated as a functional source of pain in many cases, patients will often describe prior relief efforts that have been largely flexion based. For example, for low back pain, I often hear people tell me that they've been bending forward or lying on their back and pulling their knees up to their chest, to stretch the "tightness" in their back. I understand the reasoning that led to this as those positions would stretch the muscles of the back by lengthening them as you bend away. However, other than a temporary sense of relief that is achieved by stretching the tissues, there is often no prolonged benefit noted. Similarly, many patients will report that resting in a recliner-style chair with their legs up is comfortable....until they go to stand up. The common denominator - the low back gets rounded forward in all of these positions and flexion stress can accumulate. I've heard Dr. Stuart McGill, a world-renowned spine researcher, comment previously that if spine flexion is what someone needed to get better then their daily life would simply make them better due to the volume of spine flexion done daily. There is wisdom there that demands considering a different approach.

Practicing "spine hygiene" is a valuable part of that strategy as it involves sparing the spine from aggravating loading patterns, by modifying how we move while bending, rising from a seated or lying position, brushing our teeth, etc. A future article will address these things in more detail so stay tuned. While flexion is commonly not well tolerated, I do want to stress that it isn't bad 100% of the time and will happen naturally during many activities. Sometimes we just do too much of it which results in degenerative changes over time and a sensitization to biomechanical forces in that direction. By limiting this sort of functional intolerance often a longer duration of pain relief can be achieved.

This article is for general information purposes only and is not to be taken as professional medical advice.

Tuesday, March 6, 2018

Knee Pain And Prevention


By Dr. John A. Papa, DC, FCCPOR(C)

Knee pain is often caused by either a one-time acute injury or repetitive motions that stress the knee, particularly as we age.  Included below are some of the conditions that commonly cause knee pain:

·   Osteoarthritis results from the protective layers of cartilage in the knee becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.  This may result in a number of symptoms including:  joint pain and stiffness, decreased ranges of motion, weakness, swelling, inflammation, and instability.

·       Patellofemoral pain syndrome refers to knee conditions that involve the kneecap and/or the structures around it.  Pain can be generated by breakdown of the cartilage under the kneecap, tight or weak tissues around the kneecap, or misalignment of the kneecap.

·       Meniscal injuries directly involve tearing/damage to the cartilage cushioning in the knee.  This type of injury can result from a sporting event or fall where the knee undergoes a sudden twisting motion or impact.  It can also occur in older individuals who develop a chronic tear in a worn meniscus.

·       Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the knee or there is an awkward fall or twisting motion involving the knee.

·      Tendons are strong tissues that anchor muscles to bones, and these structures can become torn or inflamed around the knee joint leading to tendonitis and muscular strains.

·    Bursitis can involve several fluid-filled structures in your knee that help provide more cushioning in the joint.  Certain activities, such as kneeling on the floor, can cause a bursa to become irritated.

Below are some useful tips that can help individuals avoid or minimize the chance of knee pain and injury:

1.    Maintain a healthy bodyweight to decrease the overall stress on your knees.
 
2.    Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.

3.    Prepare your knees for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the thighs and lower legs.

4.    Choose activities that are knee friendly for you.  This may include low impact activities such as walking or cycling.  Remember to start slowly and build up the intensity gradually.

5.    Strength, balance and flexibility exercises can train your leg muscles to better support your knees and avoid injuries.

In the event that you suffer a knee injury that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of knee pain.  For additional information on knee pain and treatment of muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.