Carpal Tunnel Syndrome and Head Forward Posture.

Carpal Tunnel Syndrome, we have all heard about it and many of you reading this may in fact have been diagnosed with it. I’ve even read articles from some angry neurologists angry in fact that people have even suggested that there may be another way to deal with it other than surgery.

Chiropractors have been helping people with Carpal Tunnel Syndrome very successfully for many years. Some better than others but there you go. As Dad used to say “There are more muskrats than minks out there son.” I think this is true in every discipline and yet I believe most practitioners are doing the best they can for people some are just better than others.

The nice thing about the Chiropractic approach is that should it fail you, the surgery is still an option for you. Where if you have the surgery first the Chiropractic method may still help but…. Hey…. You just had surgery for nothing.

No I’m not saying we are better than the other guys, just less invasive and more often than not successful at helping people with these issues. Not only that but our treatment is far less expensive too though many insurance companies won’t pay for this type of care. I do however think its worth checking out prior to jumping on the surgery band wagon.

The following are quotes from an article talking about something we Chiropractors have known for years. I like to think it’s a huge advance to see the other side even talking about it, let alone researching it. You go guys, its about time you get on board.

J Orthopaedic & Sports Physical Therapy 2009 (Sep);   39 (9):   658—664 Ana I. De-la-Llave-Rincón, César Fernández-de-las-Peñas, Domingo Palacios-Ceña, Joshua A. Cleland

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.

STUDY DESIGN: Case control study.

OBJECTIVES: To compare the amount of forward head posture (FHP) and cervical range of motion between patients with moderate carpal tunnel syndrome (CTS) and healthy controls. We also sought to assess the relationships among FHP, cervical range of motion, and clinical variables related to the intensity and temporal profile of pain due to CTS.

BACKGROUND: It is plausible that the cervical spine may be involved in patients with CTS. No studies have investigated the possible associations among FHP, cervical range of motion, and symptoms related to CTS.

METHODS: FHP and cervical range of motion were assessed in 25 women with CTS and 25 matched healthy women. Side-view pictures were taken in both relaxed-sitting and standing positions to measure the craniovertebral angle. A CROM device was used to assess cervical range of motion. Posture and mobility measurements were performed by an experienced therapist blinded to the subjects’ condition. Differences in cervical range of motion were examined using the nonparametric Mann-Whitney U test. A 2-way mixed-model analysis of variance (ANOVA) was used to evaluate differences in FHP between groups and positions.

RESULTS: The ANOVA revealed significant differences between groups (F = 30.4; P<.001) and between positions (F = 6.5; P<.01) for FHP assessment. Patients with CTS had a smaller craniovertebral angle (greater FHP) than controls (P<.001) in both standing and sitting. Additionally, patients with CTS showed decreased cervical range of motion in all directions when compared to controls (P<.001). Only cervical flexion (rs = -0.43; P = .02) and lateral flexion contralateral to the side of the CTS (rs = -0.51; P = .01) were associated with the reported lowest pain experienced in the preceding week. A positive association between FHP and cervical range of motion was identified in both groups: the smaller the craniovertebral angle (reflective of a greater FHP), the smaller the range of motion (r values between 0.27 and 0.45; P<.05). Finally, cervical range of motion and FHP were negatively associated with age in the control group but not in the group with CTS.

CONCLUSION: Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion. However, a cause-and-effect relationship cannot be inferred from this study. Future research should investigate if FHP and restricted cervical range of motion is a consequence or a causative factor of CTS and related symptoms (eg, pain).

In other words, to those of us who have been treating people with  forward head posture for years, it is CLEAR to us that Forward Head Posture is in fact a major causative factor in people with Carpal Tunnel Syndrome. Its amazing to me that research on this issue has been this late in coming.

Historically speaking, Chiropractors (And not all of them for that matter.) have been working at correcting head forward posture for years. Don’t you think this should be the starting point if you are suffering with Carpal Tunnel Syndrome as opposed to the treatment of last resort ?

Chronic pain… what do I do ?

Sometimes my patients tell me things. Often I have to scratch my head as per who’s helping whom in these situations.

Recently the concept of communication came up and it was opined that I ought to go into my website and change a large percentage of my message as apparently many people don’t comprehend what I’m talking about so here goes an attempt to clear up some confusion.

I often talk about postural correction and have been told lately people don’t understand what that is or the why one would do it. It was suggested I talk about “Chronic Pain” instead. Yes that’s the crux of this biscuit all right.

An enormous percentage of my patients present with pain syndromes that have been constant for more than three to six months or… in many cases off and on for a few years duration. Often they have tried drugs or other types of typical intervention to no avail. In fact many times they come in as a treatment of last resort and I often think to myself they could have saved time, aggravation and pain had they started with me.

These conditions are often accompanied by the comment “I carry my stress in my shoulders,”  “I have migraines often times daily or weekly,” and “I rarely have more than a few months without low back pain.”

These comments are also accompanied by statements like “I slept funny and woke up with this pain with no apparent cause” and or “I bent over to pick up a feather and… .”

Could these chronic headaches or pains be caused by the nocturnal gymnastics while unconscious or the adverse mechanical stresses placed on the body by that feather. No not likely.  More often than not it’s the adverse mechanical stresses of poor posture affecting both the muscles and nervous system.

There is an MD of note by the name of Alf Brieg. He’s a Nobel Prize winner and neurosurgeon located in Sweden. The sort of lazy slouch you’d expect to virtually disappear in the medical literature.

His pet issue was posture and how it stretches nerves beyond their normal capacity to do what they need to do. He dare I say it…. Recommends postural correction and is credited with the following statements.

“Pressing on a nerve stretches the nerve; stretching the nerve reduces its ability to carry nerve impulses (conductivity); and if the nerve is not damaged, taking the stretch off the nerve will relieve the symptoms and restore normal nerve function.”

“What presses on these nerves is usually a spinal column that does not have proper structure and posture.”

“Eighty percent of the people studied with chronic pain syndromes, have a postural component that has to be corrected for them to fully recover.”

What this premise begs you to ask yourself is, do you have the proper spinal posture?  If you suffer chronic headaches, store your stress in your shoulders or have intermittent recurring low back pain of more than a years duration, chances are that the answer is no! This can be very unhealthy. Most people don’t even know how to go about implementing positive changes in their posture.

There are two reasons posture changes: The first is plastic deformation of tissue, the I got in an accident, fell down the stairs, or engage in sports with repetitive falls such as skiing, snowboarding and windsurfing. Yeah…  that sounds like many of us doesn’t it?

The second method of change is visco-elastic deformation of tissue. Viscosity is the relative thickness of a fluid. The human body is 70% water. Yes we are fluid creatures and flow into the positions we hold ourselves in for hours at a time.

Think of the using of a laptop for hours at a stretch or perhaps reading for hours like people who study or prepare reports do as the culprits of visco-elastic deformation of tissue. Sound like anyone you know?

Suffice it to say most of us fit one or all of the above and therefore the alteration of posture is rampant in modern society and needs to be addressed to truly relieve many of these chronic pain syndromes.

Here are some choices available to you, and in combination, they are much more effective than doing any one alone.

(1) Chiropractic care – Helps to improve posture, balance, and function of the nervous system and the entire body. Chiropractic is very successful in managing posture, particularly when traction is applied to correct the alteration, which sadly is absent in most Chiropractic approaches.  Yes it’s somewhat medieval but it really works.

(2) Preventative lifestyle – Helps to insure that you will lead a healthier and more productive life as you enter into your later years. This includes raising your computer monitors, taking care to avoid falls and other injuries and proper diet.

(3) Muscular strengthening and stretching – This will allow proper function and balance in the musculoskeletal system, as well as affecting spinal posture in a positive way.

I hope this explains a little better how CHRONIC PAIN SYNDROMES can be affected by posture.

As always, thanks for reading and feel free to contact me in my office at 415 922-2225 if you have any questions or concerns about your posture.

Yours in Health, Dr. Camp