To properly answer this question, let’s get familiar with the anatomy of the wrist. There are 2 bones that make up the forearm – the ulna (on the pinky side) and the radius (on the thumb side). Just beyond that, there are two rows of four bones each called the carpal bones for a total of 8 small bones that make up the wrist joint. These carpal bones are arranged in a horseshoe or tunnel shape. When you look down at your wrist and wiggle your fingers quickly, you can see all the movement that occurs on the palm side of the wrist. That’s a lot of movement! You can also see the muscles on the upper half of the forearm moving rapidly as the fingers wiggle.

There are 9 muscle tendons that travel through the carpal tunnel, as well as some blood vessels and most important, the median nerve sits on top of all those moving tendons. Just beneath the floor of the tunnel is a ligament called the transverse carpal ligament. The tendons inside the tunnel are surrounded by lubricating sheaths that make it easier for the tendons to slide back and forth as we wiggle our fingers, grip to open a jar, type on a computer, play a musical instrument, or so on. Without the tendon sheaths, the friction between the rubbing tendons would quickly build up heat, resulting in swelling, pain and numbness. However, in spite of the lubricating function of the sheaths, when we work our fingers and hands too much, swelling and inflammation does occur.

So, why do we have numbness at night when we aren’t working, gripping and moving our fingers repetitively? The answer lies in how we sleep. Since we are asleep, we cannot control where we position our hands and wrists. Most of us curl up in a ball and tuck our hands under our chin or someplace cozy. Normally, when we bend our wrists, the pressure inside the carpal tunnel doubles. However, a carpal tunnel patient already has a higher level of pressure in their wrist. So, when a carpal tunnel patient bends their wrist in the exact same way, the pressure goes up even more – that is, 3, 4, 5, or more times than a normal person without their wrist bent. That is why a wrist “cock-up” splint works so well at night! It keeps the wrist straight so we can’t bend it. Often, this allows the CTS patient to sleep through the night instead of waking up 2, 3, or more times with numbness, tingling, and/or pain on the thumb half of the hand.

Unfortunately, in the real world, no blood test, x-ray, or exam procedure is 100% accurate (sensitive and specific), so even when tests return positive, there can be “false positives” that are caused by many things such as drug induced test alterations and/or other conditions that alter the same test. On the other hand, there are “false negatives,” so even though the test came back negative, it’s still possible that the problem one is present but the test may just not be sensitive (accurate) enough to detect it. FM is one of those conditions where only after a myriad of tests have been run and come back negative, can the diagnosis of FM be made with some degree of confidence.

Essentially, we have to prove that you don’t have something else causing similar symptoms before we can confidently (or at lease more confidently) diagnose you with fibromyalgia. To complicate this further, in “secondary FM,” the cause of FM is known and is due to an underlying condition such as rheumatoid arthritis, lupus, hypothyroid, HIV, cancer, as well as physical trauma such as after a car accident or a work injury. When an accident is involved, the symptoms may be more confined to one area (then called “regional FM”) making the diagnosis even more challenging as the classic 11 of 18 tender points may not hold up in these cases.

Finally, there are doctors out there that simply don’t “believe in” the condition and may say to the FM patient, “…there is no such thing, it’s all in your head, you simply have learn how to live with it. There’s nothing that can be done.” Well, they actually may be partially right – that is, the “…it’s all in your head” part (don’t get mad… just wait!). Another finding that is well-published in peer review literature is the concept called central and peripheral “sensitization.” This occurs when increased incoming sensory information from injured skin, muscles, and/or organs, in a sense bombard areas in the central nervous system (spinal cord and brain) leaving it “sensitized” or, more sensitive to “normal” incoming information. This is because the threshold or tolerance to normal incoming sensory stimuli is reduced and results in increased muscle pain commonly described by patients with FM.

To better illustrate this, hypersensitivity or central sensitization was found in people after a whiplash injury. They recruited 14 whiplash patients and 14 “normals” to compare their responses when stimulating the leg (the non-injured area) as well as the neck (injured area). Theoretically, if central sensitization didn’t exist, the responses to the exact same stimulus on the healthy leg of both the whiplash patients and the normal subjects would be equal. Instead, what was found was that the whiplash patients had significantly lower pain thresholds for 2 of 3 tests (a single electrical stimulus in the muscle, repeated electrical stimulation in the muscle and on the skin, but not from heat when applied to the skin). Each pain threshold was measured at the neck and leg before and after local anesthesia was applied to the painful, sore neck muscles. In the whiplash cases, the lower pain threshold was found when stimulating both skin and muscles at the healthy leg and at the injured anesthetized neck equally. That proves that the central nervous system (brain and spinal cord) has a “pain memory” which lowers the threshold so the whiplash patients feel pain more intensely and quicker than the non-injured people. This can help patients understand the answer to the question, “…why won’t this pain go away?” This pain memory or hypersensitization is similarly found in FM patients.

Dr. Patten

http://ericpattendc.com/

This is a time when it’s good to prioritize our life and to understand what we can change, what we should change and what we must change.  Diet, exercise, smoke cessation, going to church all seem to top the lists made this time of year.    I suggest you write everything down in three categories:

1. I want   ___
2. I need   ___
3. I Must   ___

Write about 5 items for each of the above and put them in order of importance (TO YOU).  We’re working on YOU, not someone else.  Don’t forget that.  Now, put a start date and use realistic goals.   Pick one of each and do it.

The key to this is a very boring word:  MODERATION.  That is the key to just about everything, particularly in the medical field.  Over-abundance and under-nourishment are completely different when it comes to eating, but both have poor end results.  The same is true with just about anything because you will become burned out, unhappy and feel like you can never reach your goals.

So…  The word for the year is Moderation.  Have Mcdonald’s if you absolutely have to, but just once in a while.  Work out hard, but give yourself adequate rest.  Get on a weight loss program, but remember if you’re losing more than 2 lbs per week after the first week you need to settle down.

Ultimately my advice is this:  Make your resolutions according to what is absolutely necessary, what will effect your happiness.  The resolutions should be long-term, might as well make your resolutions for next year while your at it so you know where you’re going.

If back pain, neck pain or anything else I work with at the office is bothering you, come get it fixed now.   Why wait?  I would personally rather see you get better in 3 visits now than 12 visits 6 months from now.

Finally…  Throw out the dang scale.  Forget the BMI chart.  They are worthless in reality.  Have your body fat tested to measure progress.

Dr. Patten, Chiropractor in Gulfport, MS

PattenFamilyChiropractic.com

EricPattenDC.com

There are many causes of CTS. Most commonly, CTS occurs in people whom perform fast, repetitive motions including (but not limited to): typing on a computer keyboard, using a computer mouse, sewing, driving, assembly line work, painting, writing, use of hand tools, sports such as racquetball or handball, and playing musical instruments. Many of these tasks involve bending or twisting of the wrists (think of a violin or flute player and you get the picture). CTS most often occurs in people 30-60 years old, affects women more than men and, can be either caused or contributed by other conditions such as fracture/trauma to the wrist or hand, arthritis of the wrist, diabetes, alcoholism, hypothyroid, kidney failure and dialysis, menopause, premenstrual syndrome (PMS), and pregnancy, infections, obesity, rheumatoid arthritis, SLE, and others.

Symptoms most commonly include numbness or tingling in the thumb-side palm, thumb, 2nd, 3rd, and thumb half of the 4th fingers. The symptoms can extend to the elbow or higher to the neck or shoulder, can affect both hands (but one is usually worse than the other), and can interfere with daily activities such as buttoning shirts, opening jars, holding onto the steering wheel, riding a bike, working with the hands, etc.

During an initial examination, a Doctor of Chiropractic exam will often check your sensation with a sharp pointed object, percuss over the palm-side wrist, ask you to hold your hands back to back and palm to palm while counting the seconds to numbness, test grip strength, and also check the neck, shoulder and elbow as these areas refer pain back and forth. Sometimes, he or she will order an EMG to test the nerve’s damage. Conservative chiropractic treatment is highly effective and DEFINITELY should be done FIRST, before injections, medications, or surgery!

The study consisted of 6 female patients diagnosed at a university hospital with FM, which by the way, means all other conditions that create similar symptoms have to be “ruled out” or, considered first. Therefore, many tests are typically run to make sure there isn’t some other serious underlying condition hiding behind the symptoms associated with FM. As a background, the authors describe FM as “…a chronic syndrome with no cure.” Because of this, they state, “…a thorough understanding of the illness experience is therefore key in the palliative care of patients…” They acknowledge that care givers of FM patients often include chiropractors and other manual therapists and knowledge of the “…meaning and reality of living with this condition” is reported as being ESSENTIAL for all health care providers who manage FM patients. The focus of the study was to carefully look at the personal, occupational, and social impact of the condition on patients’ lives and their views about the future. Structured interviews with each participant were analyzed.

Results showed that FM impacted all aspects of life with 4 main themes arising from the data: 1) Personal life impact; 2. Occupational life impact; 3. The forecasted impact on future life; 4. Social interaction impact. Specifically, most of the participants had stopped working and felt useless. Leisure activities were greatly affected, as many described opting to not participate in various leisure oriented activities (such as going for walks, shopping, attending social events). FM was described as altering family bonds with some being made stronger while others were destroyed, resulting in separation and/or divorce. FM patients were reported to be “relieved” when a diagnosis was “finally” made, as it marked an end to a period of uncertainty. The participants were often ambivalent to interaction and despite some positive points, frustration prevailed from “perceived incomprehension” or, not really understanding why they feel the way they do. At times, this made it hard to discuss their symptoms and personal experiences. This study reveals the negative impact of FM and how complex and individual that is.

What is important about this study is that it alerts those of us who treat FM that we need a more efficient diagnostic process and we need to be better educated so that we can provide a multifaceted treatment option approach as each FM patient’s needs vary because of how each patient “deals with” the condition. We need to really listen to the patient to determine what treatment goals they are interested in and we must create treatment plans that center around those needs and desires, possibly including checklists so everyone stays on task as it’s quite easy to become distracted by the symptoms of FM. We are sharing this information with you so that you can feel comfortable approaching us with the many concerns and issues that surround FM.

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

A recent November 2011 study begs to differ. Researchers took 58 patients with a diagnosis of “sinus headache” made by their primary care physician and asked them the following questions:

1. Have you had a previous diagnosis of migraine or tension-type headache?
2. Is their clinical evidence of a sinus infection during the past 6 months?
3. Is there the presence of “mucopurulent secretions” (that’s the “not so pretty stuff” when we blow our nose)?

All 58 patients clearly seemed to have chronic sinusitis with an acute flair up and were given complete thorough examinations by a neurologist and an ears, nose, throat specialist (otolaryngologist) on a monthly basis for 6 months during treatment. The surprising results showed that final diagnosis in these 58 cases were 68%, 27% and 5% of the patients really had migraine, tension-type headache and chronic sinusitis with recurrent acute episodes, respectively. Treatment during the 6 months included antibiotic therapy in 73% of the patients with tension-type headache and 66% with migraine. Sinus endoscopy (taking a look up the sinuses with a scope – ouch!) was performed in 26% of the patients, and therapeutic nasal septoplasty (surgery!) was performed in 16% of the migraine patients and 13% of patients with tension-type headache (a pretty BIG mistake, wouldn’t you say?). The conclusion was that many patients with self-described or primary care physician diagnosed “sinus headaches” have no sinonasal abnormalities but instead, met the criteria for migraine or tension-type headache.

So, what does this mean? Well, for one thing, too many antibiotics are prescribed for tension-type or migraine headaches and have no place in the treatment process of these two common headache categories. Side effects of antibiotics include (but are not limited to): stomach and intestinal irritation, nausea, and if one is allergic to the antibiotic, a potentially life-threatening condition call anaphylactic shock. Let’s not forget to mention that sinus surgery was performed in 29% of the cases where the sinuses were NOT causing the headaches and we all know the risks of undergoing anesthesia and surgery can include death and infections, among other problems.

Chiropractic was reported to be a wise choice in the treatment of headaches by several publications, one of which provided a large review of the literature on the “Effectiveness of manual therapies: the UK evidence report,” released in 2010 (http://chiromt.com/content/18/1/3). In this report, both migraine and cervicogenic-type (headaches that start in the neck) headaches were found to have strong research support for manipulation or, chiropractic adjustments. In this day and age, you can be very confident that choosing chiropractic services for headache treatment is a wise, safe, and very cost-effective approach for a very disabling condition.

Dr. Patten

http://www.pattenfamilychiropractic.com

• It is more common to have a delay in the onset of whiplash symptoms. Symptoms may start about two hours after the initial injury or it may take days, weeks, or months before you feel anything.
• For whiplash caused by car accidents, the severity depends on the force of the impact, the way you were seated in your car, and if you were properly restrained using a shoulder and seat belt.
• Tests show the soft tissues in your neck sustain injury at a threshold of 5 mph. That means if you’re rear-ended at 5 mph or slower, you have a lower chance of getting whiplash. However, most rear-end car accidents happen at speeds of 6-12 mph.
• If you’ve been in a car accident, it’s a good idea to be evaluated even if your car didn’t get damaged and you don’t feel any pain.
• Although whiplash is most often associated with car accidents, you can also get whiplash from sports such as snowboarding, boxing, football and gymnastics.
• The concept of “no car damage = no injury” is COMPLETELY false. Most cars can withstand collisions of up to 10 MPH and as pointed out above, only in collisions < 5 MPH are you less likely to be injured. Collisions that occur between 6-12 MPH cause the highest percentage of whiplash injuries (which is below the threshold of car damage in most cases). Also, the energy of the impact is transferred to the contents inside the car when there is no vehicular damage (that means you).
• Mild traumatic brain injury (MTBI) can occur in motor vehicle collisions even if the head does not hit an object inside the car, although it’s more common when there is a head strike. The symptoms associated with MTBI are often referred to as “Post Concussive Syndrome.”
• Approximately 10% of whiplash injured patients become totally disabled.
• Of the studies published since 1995, over 60% of whiplash patients required long-term medical care.
• Risk factors for long-term symptoms associated with WAD include: rear impacts, loss of the cervical lordosis curve, pre-existing degenerative arthritis, use of seat belts & shoulder harness (low speed impacts only), poor head restraint position or shape, non-awareness of the impending collision, female (especially long slender neck), head rotation at impact.

Improve your Posture

Greek ergon, meaning “work”, and nomos, meaning “natural laws.” By definition, ergonomics means, “…the study of efficiency in working environments.” Wikipedia describes it as, “…the study of designing equipment and devices that fit the human body, and its cognitive abilities.” The International Ergonomics Association offers this definition: “Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”

The study of ergonomics is not new as it dates back to Ancient Greece with substantial evidence that, in the 5th century BC, ergonomic principles were applied to tool design, jobs and workplaces. Examples include Hippocrates giving surgeons recommendations on how to arrange their table and tools during surgery.

Some ergonomic concepts we can employ on a daily basis include:

1. Take frequent breaks, every half-hour if possible, but at least every 60 to 90 minutes. Get up, stretch and walk around. If nothing else, perform stretches while sitting in your work chair.
2. Maintain “good posture” (tuck in the chin and hold the retracted position).
3. Evaluate your workstation: proper sitting position, how you hold the phone, keyboard/monitor positions, type & position of the mouse, reaching requirements, avoid twist/bending the wrists.
4. When grasping/gripping, use the whole hand – not just the fingers or thumb tips alone.
5. Keep cutting instruments sharp (scissors, knives, etc.) and maintain locks on hinged knives.
6. Consider modifications if tools are too heavy, buttons too high, too much required force, etc.
7. Stay in shape as obesity is a risk factor for carpal tunnel syndrome.
8. Rotate job tasks rather than continuing with one task until finished (less repetition)!
9. Communicate with your supervisor and HRO person about improving the workplace.

The key to this connection can be found in looking at the anatomy of the neck. There are 7 vertebrae that make up the cervical spine and 8 sets of nerves that exit this part of the spine and innervate various parts of the head, neck, shoulders and arms, all the way to the fingers. Think of the nerves as electric wires that stretch between a switch and a light bulb. When you flip on the switch, the light illuminates. Each nerve, as it exits the spine, is like a switch and the target it travels to represents the light bulb. So, if one were to stimulate each of the nerves as they exit the spine, we could “map” exactly where each nerve travels (of course, this has been done). When we look specifically at the upper 3 sets of nerves that exit the spine (C1, C2, and C3), we see that as soon as they exit the spine, they immediately travel upwards into the head (the scalp). Like any nerve, if enough pressure is applied to the nerve, some alteration in nerve function occurs and usually a sensory change is noted (numbness, tingling, pain, burning, etc.). If the pressure continues, these symptoms can last for a long time. These types of headaches are often called “cervicogenic headaches” (literally meaning headaches that are caused by the neck). These can be caused by the nerves getting pinched by tight muscles through which they travel as they make their way to the scalp.

Another connection between the neck and headaches includes the relationship between 2 of the 12 cranial nerves and the first three nerves in the neck described above. These types of headaches usually only affect one half of the head – the left or right side. One of the cranial nerves is called the trigeminal nerve (cranial nerve V). Because the trigeminal nerve innervates parts of the face and head, pain can also involve the face. Another cranial nerve (spinal accessory, cranial nerve IX) can also interact with the upper 3 cervical nerve roots, resulting in cervicogenic headaches. People with cervicogenic headaches will often present with an altered neck posture, restricted neck movement, and pain when pressure is applied to the base of the skull or to the upper vertebrae. Other than a possible numbness, there are no clinical tests that we can run to “show” this condition, though some patients may report scalp numbness or, it may be found during examination.

Though medication, injections, and even surgical options exist, manipulation applied to the small joints of the neck, especially in the upper part where C1-3 exit, works really well so why not try that first as it’s the least invasive and, VERY EFFECTIVE! In some cases, a combination of approaches may be needed but many times, chiropractic treatment is all the patient needs for a successful outcome.

I’m often asked about detoxification.  When should I do it?  How do I do it?  Should I move the TV into the restroom for a few days?    I’ll go ahead and answer the third first – keep all appliances out of the restroom.  Ok, moving on…  Detoxification is much different when compared to Purification.  Although the two words are used interchangeably (spell check said it was right), don’t do this.  Detoxification is preparation for purification.  Here’s an analogy:  You want shiny tires on your car, you have your soap, brush, water and armor all.  What do you do first?  You clean the tire, then you shine the tire.   So, Detoxification and purification really makes a two-part process.

When should I do it (detoxification)?

It really depends on how you feel and how your body works.  However, detoxification has been shown to be helpful with:

• Chronic Conditions (Fibromyalgia, Chronic Fatigue, arthritis, unexplained aches, recurrent infections
• Cognitive issues (memory/forgetfullness)
• Food sensitivities & allergies (bloating/gas/constipation/IBS/diarrhea)  Note:  food sensitivities are problems with foods that you may have that do not show up on a typical allergy test.
• Endocrine Issues:  (hormone issues:  Female/male, adrenal (Amazingly common in the stressed), Thyroid, Pancreas, etc…

How do I do it? (Detoxification)

Gut reconditioning.  Don’t go to Wal-Mart or GNC and get some detoxification package that will guarantee results in 5 days.  Not happening.  It takes at least 30 days to complete, anything less just makes you sit on the toilet.  I don’t enjoy sitting there: it’s boring.  Might as well avoid what you can avoid.  So, back to it.  You can follow one of below.

1. The Melvin Page diet (boring boring boring)
2. The Garden of Eden Diet – No white foods, no packaged foods containing hydrogenated or partially hydrogenated oils, Just imagine what would be available in the Garden of Eden and eat away.
3. The modified Detox diet (done under doctor supervision)

The modified Detox diet

Ok, this is no joke.  Really works.  You will drop weight fast, you will detoxify your body and you will hate me (just a little bit).  Remember, this is DOCTOR supervised:

• Eat twice as much vegetables as fruit, 50% raw or over VERY low heat/steam
• Go organic
• No hydrogenated oils, nothing in a box, can, container, plastic wrap, from gas station, etc…
• Fats are IMPORTANT!!!  Fish oil, olive, coconut (unless blood type A), grape seed or almond.  No others, especially veggie oil, canola, peanut oil
• Sweet potatoes are beneficial
• Beets are important – at every other day because the make the liver happy.
• No Corn, bananas, white potatoes, corn syrup (nothing high-glycemic – search the web and you’ll find a huge list)
• Drink lots of water!!  At least 1/2 of your body weight in ounces, drink mostly in between meals.  NO DISTILLED
• Eat frequently, 5/6 times per day.
• NO alcohol, tobacco, stimulants.  If you need your coffee get some dandelion coffee or green tea.
• Protein comes from Ocean fish – Salmon, Cod, etc…  Organic Chicken/turkey is permissible.  No lake fish, nothing fried.

Important!!!

1. Doctor’s supervision on all of this.  I’ll do it, blame me (or the front desk staff, rather) if you choose to take on this endeavor.
2. Arthritis patients should avoid:  Nightshades (tomatoes, potatotes, all peppers, eggplant and citrus.
3. Chronic Fatigue/Fibromyalgia patients MUST avoid citrus fruits.  Get the acid out, just don’t do it.

Part 2:  Purification.  Shining the tires, dropping the weight, learning what your body feels like when it works.

The modified detox is courtesy of the International foundation for Nutrition and Health. Most of this post if things I’ve learned from them INFH.org

http://www.Pattenchiropractic.com