Village Family Clinic Blog

Researchers in Spain and the United States report that “Patients who received physical therapy consisting of manual techniques for carpal tunnel syndrome” achieved results comparable to outcomes for patients who had surgery for this condition. Physical therapy patients saw faster improvements at the one-month mark than did patients treated surgically.

For three weeks, the therapy patients received weekly half-hour manual therapy sessions - meaning therapists only used their hands. The therapists focused on the neck and the median nerve. They also applied manual physical therapy to the shoulder, elbow, forearm, wrist and fingers. The Physical Therapist also instructed the patients on how to perform neck-stretching exercises at home.

After one month, the therapy group reported greater daily function and greater "pinch strength" between the thumb and forefinger compared to the surgery patients. After three, six and twelve months, however, improvements were similar in both groups. All participants experienced similar reduction in their pain, but the physical therapy group showed faster improvement.

Carpal Tunnel Syndrome, is typically caused by compression of the Median nerve in the palm facing area of the wrist. This can cause symptoms such as numbness and tingling typically of the thumb, index, middle and thumb side of the ring fingers. In more advanced cases of carpal tunnel there can be constant pain, decreased hand strength and loss of sensation in the hand. This overtime can cause a loss of ability to use the hand for work and everyday activities.

Possible causes of Carpal Tunnel:

Include repetitive maneuvers related to work, hobby or home activities. It can also be brought on by pregnancy because of edema, or fluid retention. Other possible causes are underlying inflammatory diseases, degenerative, and rheumatoid arthritis, hypothyroidism, or an underactive thyroid or diabetes. Trauma, such as dislocation or fracture of the wrist or structural problems in the wrist joint, lesions in the wrist, a cyst or tumor in the carpal tunnel.

How is Carpal Tunnel Syndrome Diagnosed:

Patient’s subjective history of thumb and finger numbness, tingling, pain and strength loss of the affected hand.

Observation of atrophy (loss of muscle mass) in the palm region just below the thumb along with marked loss of strength with grip testing

Tinel's test, or Tinel's sign: The doctor taps the median nerve at the wrist lightly to see whether the patient feels numbness or tingling in one or more fingers.

Phalen's test for wrist-flexion: The patient presses the backs of the hands against each other so that the wrist is bent. If tingling or numbness occurs within one minute, there may be damage to the median nerve.

Electromyography: A fine needle is inserted into the muscle. Electrical activity on a screen can reveal whether there is any median nerve damage, and if so, how severe it is.

Blood tests: Blood tests can detect an underlying condition that can be related to carpal tunnel syndrome, including hypothyroidism, rheumatoid, arthritis, or diabetes.

Imaging scans: An x-ray can show whether there is a fracture or some other disorder, such as rheumatoid arthritis and an ultrasound scan can check the structure of the median nerve. Studies have found that MRI scans are not useful in diagnosing carpal tunnel syndrome.

Study co-author Joshua Cleland, a professor with the physical therapy program at Franklin Pierce University in Rindge, N.H. stated "Manual physical therapy may be just as beneficial in improving function and symptom severity as surgery despite the severity of their condition," he also noted that 38 percent of those in the therapy group had "severe" carpal tunnel syndrome. Cleland went on to state "Surgery is necessary when there is muscle weakness or atrophy from the nerve being compressed at the wrist." However, operations can have complications, said Cleland. He cited a previous research finding that "approximately 25 percent of individuals undergoing surgery for carpal tunnel syndrome experience treatment failure with half of those requiring an additional surgical procedure."

So based on the findings of this study if you considering surgery for your “Carpal Tunnel Syndrome” physical therapy can be considered a first line option with just as effective results and less complications. J Orthop Sports Phys Ther. 2017 Mar;47(3):151-161. doi: 10.2519/jospt.2017.7090. Epub 2017 Feb 3.The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial. Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C.

Our warmest Holiday wishes from the entire team here at Village Family Clinic. Calendar year 2018 was, and continues to be, a truly remarkable year and we take this moment to recognize the joy that each and every one of you has brought to our personal and professional lives. We exist because of your faith and trust in us.

As calendar year 2019 approaches, we reflect upon the foundational recognition that your success is our success. Our New Year’s wish for 2019 is to nurture our positive and ever strengthening partnership and to deliver ever increasing value to you and your business through the entirety of 2019.

Throughout this Holiday season may you be blessed with health and surrounded by friends and family. All the best! Cheers!

What is the rotator cuff?

It is the tendinous attachment of 4 muscles that start from the Shoulder blade (Scapula) to attach to the top of the Shoulder (Humeral head).
• Tendons attach muscle to bone and allow the muscle to move/control the joint.
• Tendons can sustain tears as a result of trauma (fall, accident etc.) or because of wear and tear (aging, sport or work demands).

Signs & Symptoms of Rotator Cuff Problems:

Pain and stiffness around the top of the shoulder, pain on the outside of the upper arm, pain at night that interferes with your sleep, pain, and difficulty or inability to lift your arm overhead and weakness of the arm.

How are Rotator cuff tears diagnosed?

Subjective History, Fall onto an outstretched arm or directly onto the shoulder, Decreased ability to raise the arm overhead, Pain with lowering the arm from above head level, Age > 55, Night pain

Imaging: X-rays and MRI

With a history of trauma X-ray and MRI are warranted to rule in or out other serious pathology, (fracture, dislocation, labral lesions) as well as checking the integrity of the Rotator Cuff

In the case of a Non-Traumatic onset X-rays and MRI have limited predictive value and should be held until a course of conservative care has been undertaken. (exceptions are patients with a history of cancer or a know metabolic disease

Do Tears Progress?

Several studies indicate that larger full-thickness tears (> 1.5 cm) will progress about 50% of the time over a 5 year period and become more symptomatic

About 35% of partial tears will increase in size over 5 years follow up but most remain less symptomatic then full-thickness tears.

Tears that are more anterior and involve tears into the ‘Cable” region are usually more symptomatic and typically require surgical repair vs conservative care.

Conservative Care?

May include a short period of rest in the case of traumatic injury

Management of pain with either prescription or over the counter NSAIDs or Tylenol (Opioid medication is not indicated)

Management of pain/inflammation via Cortisone Steroid Injection(CSI) tends to be short-term relief of 4-8 weeks but may allow the patient to tolerate other interventions.

Physical Therapy to address, shoulder mobility, control, strength and load tolerance ( recommended timeframe is 8-12 weeks) Exercise for rotator cuff tendinopathy – A systematic review of contextual factors and prescription parameters Littlewood et al (2015. International Journal of Rehabilitation Research)

Significant outcomes can be achieved when programs are prescribed by physical therapists, Patients of varying age, duration of symptoms and severity of pain and disability can achieve significant outcomes, Pain production or pain avoidance during exercise does not appear to matter.

Village Family Clinic offers proven conservative care such as Physical Therapy, Chiropractic care, Nutritional counseling, and Acupuncture. If you are having shoulder area pain and problems we offer care to help you get back to the activities and life you want to have!.

Should you have any questions regarding this information please feel free to contact us.

Things in the world of Hip region pain are changing. So here is a quick synopsis of 4 of the more common hip issues.

1. Femoral Acetabular Impingement (FAI): This is one of the newest hip problem diagnosis. It has come about because of the ability to perform much better imaging (X-rays & MRI) of the hip region. The problem is a developmental change in the either the shape of the Ball (Femoral head) or Socket (Acetabulum) which causes increased stress in the hip joint which can cause irritation to the joint surfaces or damage to the cartilage ring (Labrum) , all the way to early joint (articular) cartilage damage. There are 3 types of changes typically seen CAM the ball has an abnormal shape, Pincer there are spurs at the edge of the socket or Mixed both a CAM and Pincer change.

   Treatment ranges from the use of NSAID’s, Education on avoiding aggravating activities and motions, Physical Therapy and either Hip Arthroscopic or Open surgery. This condition is most commonly seen in the younger 15 to 35-year-old active population. The pain can be felt deep in the groin, outside of the buttock and upper and mid-buttocks. In some cases there is “clicking”, “catching” and a sense of “locking”. There is still a fair amount of controversy on what is the best treatment approach. Currently, the standard for diagnosis and care recommendation comes from the Warwick Agreement on FAI published in the British Medical Journal 2016.
   
   https://bjsm.bmj.com/content/50/19/1169 Warwick Agreement

2. Gluteal Tendinopathy (Lateral hip pain): This can be considered the hip’s version of the shoulder Rotator Cuff issues. The past was used to describe this problem was Greater Trochanter Bursitis but again better quality imaging and research are showing that the tendons of the Gluteus muscles (Buttock muscles) are actually the culprits. The pain is typically felt along the outside of the hip, mid-buttock and occasional down the outer or inner thigh. The pain is worse with activities that increase forces about the affected hip such as walking, running, going up stairs, getting up from a chair, getting into or out of a car and lying on the painful side.

   There have been two recent major research papers that show that a Physical Therapy program of guided exercise program of progressive loading levels, education in proper loading and reducing aggravating habits during the reactive phase has a much better outcome within 8 weeks Vs. injection of the area or simply waiting for the problem to self-resolve. The typical patient population is post-menopausal women, runners or people who have suddenly changed their activity level.
   
   https://www.bmj.com/content/361/bmj.k1662 (LEAP trial)
   https://www.ncbi.nlm.nih.gov/pubmed/25969366

3. Hip Dysplasia: Is the term used for a group of joint disorders which most commonly involves a “shallow” socket which fails to fully cover the femoral head (ball of the uppermost thigh bone). When this lack of coverage occurs the hip joint becomes unstable and usually leads to early onset of joint osteoarthritis. Common symptoms of hip dysplasia include:

   Pain in the groin or side of the hip, the sensation of “catching” or “popping” with activity, worsening pain with sitting, walking or running, limping, and increased difficulty with strenuous activities.

   Hip dysplasia can be congenital or developmental and can range from mild to severe and be diagnosed at all ages. Diagnosis is usually made by the patient’s reported history and imaging ranging from X-ray, MRI and CT scan. Because moderate to mild dysplasia can mimic other hip issues it sometimes takes the failure of conservative care measures before the diagnosis is confirmed. Treatment can range from bracing, exercise, surgical procedures such as osteotomy and Total Hip Replacement in advanced cases. Hip Dysplasia is more common in females and occurs more frequently in the left hip (64%).

   Hip Osteoarthritis (OA): Is the onset of degenerative wear of the highly specific “hyaline” cartilage that covers the head of the femur (ball) and pelvis acetabulum (socket). Causes of hip OA are increased age >55, family history of OA, Previous hip injury, Obesity, and the already discussed hip dysplasia. Treatment can range from minimizing aggravating activities, switching from high-stress activities such as tennis or running to swimming or cycling and weight reduction. Physical therapy to help maintain joint and soft tissue flexibility and strengthening affected muscles of the lower limb. Temporary or long-term use of assisted devices such as canes, crutches and reaching devices. Medications such as NSAIDs, Acetaminophen, and Corticosteroids can help with pain associated with OA flare-ups. End-stage disease surgical options are Total Hip Replacement (THR). There are now two predominate surgical approaches, 1. Posterior and 2. Anterior approach. Both have been found to be highly successful. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759198/ : Comparison of 3 types of surgical approaches

Village Family Clinic offers proven conservative care such as Physical Therapy, Chiropractic care, Nutritional counseling, and Acupuncture. If you are having hip area pain and problems we offer care to help you get back to the activities and life you want to have!.

Should you have any questions regarding this information please feel free to contact us.

While chiropractic care can fix headaches by correcting subluxations in the spine, there are other temporary treatments that help reduce aches. With help from chiroone.net, we have listed 7 holistic, natural ways to relieve headaches.

1. Chamomile tea, a mild sedative, acts as an anti-inflammatory and relaxes muscles and depresses the nervous system, providing a calming effect.
2. Heat can be applied to the neck, a common source of headaches when tightness or tension is present. Cold can be used on the temples or the forehead for headaches that are pulsing and hot.
3. Peppermint oil mixed with coconut oil and applied to the shoulders, temples, forehead, back, or neck is a soothing topical treatment that can reduce the pain of a headache, improve blood circulation, and relieve tension.
4. Water is the most important remedy. Most headaches are the result of dehydration. Whether you replenish your water supply with celery or watermelon, you should be drinking water throughout the day!
5. Massages can improve blood flow and relieve tension when massages focus on the temples and the neck area. Gentle pressure is very effective for headache pain and massages in 30-minute increments can reduce and eliminate headache symptoms
6. Feverfew is an herbal tea that has been widely-used for centuries to treat headache pain. Its active ingredient parthenolide is an anti-inflammatory and widens vessels, preventing vessel constriction in the head and relieving muscle spasms.
7. Black coffee, although it can be addictive and in turn make headaches worse, is a treatment that should be used sparsely to constrict blood the blood vessels in your head and relieve pain.

Did you recently go to the gym and bruise, sprain, or strain something? What do you do when you are faced with a painful injury, bruise, or swelling? Do you go for the heat compress or the ice pack to reduce pain? In this blog post, we will set the record straight for what heat and ice are useful for and which one you should go for depending on your condition.

Heat

Heat is associated with relaxation: hot yoga and hot stones used in massages are two examples of this. Heat opens the blood vessels and increases blood flow to an affected area. Heat is not only soothing for aches and pains such, but it is also good for repairing damaged tissue because blood flow stimulates healing. Stiffness and tension are two conditions that benefit from heat application. When choosing to use the heat method, apply an even amount of heat for 15-20 minutes.

You should not use heat near bruises, open wounds, or swelling, as heat will worsen these conditions. If you have heart disease or hypertension, you should also be weary of using heat therapy and contact your doctor with questions or before serious use.

Ice

Generally, ice is the best treatment for injuries and inflammation because coldness restricts blood flow and therefore reduces swelling and inflammation. Bruises, strains, and sprains, and any other condition where there are underlying bleeding issues, should all be treated with ice because it will slow blood flow and slow bleeding. Ice therapy is used in the immediate aftermath of an injury as well as during rehabilitation.

In the immediate aftermath of an injury, ice is beneficial because it prevents stiffness in affected area. Long-term rehabilitation with ice treatment prevents pain and spasms and restores normal functioning.

Chiropractic

While these two treatments can be affective, the ultimate treatment is chiropractic. A healthy musculoskeletal system is critical to healing and affects how the whole body functions. Chiropractic may be the answer to unrelenting pain and the best way to completely rehabilitate in a natural, drug-free way.

A healthy, balanced diet is essential for overall health, especially long-term. The devastating effects that a poor diet has on the body can lead to the breakdown of fundamental bodily processes. No matter where you are, it is important to establish healthy eating and exercise practices whether that be cutting out meat once a week, sugar once a week, or dairy once a week, little steps can make a big difference. In this blog post, we are going to focus specifically on the Paleo Diet and design a one-week meal plan to encourage you to give this diet a try.

The goal of the Paleo Diet is to eat that which is found naturally on the Earth. Sometimes, this diet is called the “caveman diet” because researchers believed that cavemen ate exclusively whole foods, which is what someone on the paleo diet is allowed to eat. Many find that this diet contributes to weight loss without calorie counting and to a clear mind.

The following are allowed on the Paleo diet: fruits, vegetables, eggs, meats, fish, nuts, seeds, herbs, spices, healthy fats and oils.

The following are not allowed on the Paleo diet: processed foods, sugar, soft drinks, grains, legumes, dairy products, vegetable oils, artificial sweeteners, margarine, trans fats.

Below is a sample of a one-week Paleo meal plan by healthline.com:

Monday

• Breakfast: Eggs and vegetables fried in coconut oil. One piece of fruit.
• Lunch: Chicken salad with olive oil. Handful of nuts.
• Dinner: Burgers (no bun) fried in butter, with vegetables and some salsa.

Tuesday

• Breakfast: Bacon and eggs, with a piece of fruit.
• Lunch: Leftover burgers from the night before.
• Dinner: Salmon fried in butter, with vegetables.

Wednesday

• Breakfast: Meat with vegetables (leftovers from night before).
• Lunch: Sandwich in a lettuce leaf, with meat and fresh vegetables.
• Dinner: Ground beef stir-fry with vegetables. Some berries.

Thursday

• Breakfast: Eggs and a piece of fruit.
• Lunch: Leftover stir-fry from the night before. A handful of nuts.
• Dinner: Fried pork with vegetables.

Friday

• Breakfast: Eggs and vegetables fried in coconut oil.
• Lunch: Chicken salad with olive oil. Handful of nuts.
• Dinner: Steak with vegetables and sweet potatoes.

Saturday

• Breakfast: Bacon and eggs with a piece of fruit.
• Lunch: Leftover steak and vegetables from the night before.
• Dinner: Baked salmon with vegetables and avocado.

Sunday

• Breakfast: Meat with vegetables (leftovers from night before).
• Lunch: Sandwich in a lettuce leaf, with meat and fresh vegetables.
• Dinner: Grilled chicken wings with vegetables and salsa.

For more information on healthy living and healthy lifestyles, contact Village Family Clinic.

Hey everybody! Here’s a simple video about what to do when you're having neck pain. So we have a lot of patients in the clinic with neck pain so we’re here to give you a little explanation about neck pain, tell you some things that to do that might help out with neck pain.

So you got a spine here, we got a bunch of bones, vertebrae in the spine, and there's three distinct reasons for this being part of the spine. We've got the neck which we call that cervical, the middle back, and lower back we call lumbar. So in our example here the purple bones are the neck bones are there are seven of them, the cervical vertebrae c1 through c7. That's not really important for you to know that's our job to know but most neck pain comes out of the bones in the neck. So we get tight muscles but most of the studies showed most neck problems are coming out of the bones in the back of the neck.

So what can happen is you can get tight muscles, get stressed, working on our computer all that stuff adds up. It puts some stress on the bones or vertebrae. Well it causes a lot of real bad neck problems or headaches due to pulling the muscles back here. A lot of the reason for that is these nerves in the neck may be getting pinched so they got the bones or vertebra here can come out of alignment. The muscles are pulling it really tight and pinching the nerve in there.

So the most common causes of neck pain, the good news is for patients, you don't need an MRI or an x-ray. Usually we can diagnose that right in the office. We have advanced technology called “surface electromyography by mile vision”. It's NASA develop technology. We can take readings of the nerves to see if there might be a pinched nerve. In this non-invasive test we can find out if you have a pinched nerve.

If that's what you're having trouble with, we've been doing this for over 15 years to resolve pinched nerves. We treat patients every day who come into the clinic with neck pain, so if you have any pain in the back of the neck, any shooting pain, numbness, burning, or tingling you may have a pinched nerve in the neck. It is something you should have checked out right away because they can get worse over time. Give us a call.

How's it going everyone, this is dr. Carlock over at Village Family Clinic here today to talk about how Advil is not as great as you think.

So a lot of people coming in here with backpain, neck pain, and other aches and their first response is usually to pop some Advil. While Advil may take the edge off a little bit, what it's doing is temporarily decreasing the inflammation there on your nerves. It’s only temporary relief.

Chiropractors are trained to find those exact spots in your spine where pressure is being put on the nerves and we correct that permanently. So it's better than taking Advil which has bad side effects. Extended use is not good for your stomach among other things. So if you're having aches and pains come on in and let us check you out now.

Hi everybody, Dr. Miller here at Village Family Clinic. Today I want to talk to you about how to sit at your desk all day for eight hours without having back pain.

A lot of people have jobs where we have to sit all day. It's a big source of back pain. We have a chair here, so I'm going to do some demonstrations. A lot of people work at a computer desk, so, the first thing you want to do is to make sure you're standing up nice and tall. Get a chair with nice support. If it's real flat in the back and you kind of feel like you're slouching, a little good lumbar support will help that out a lot.

Another thing to do is you want to stand up sit up nice and tall. Keep your knees at 90 degree angles. That's going to drive your back forward. It's going to cause a lot of pressure in here so you want to bring your knees up. Keep them at a good 90 degree angle. You want to keep your arms also at a 90 degree angle so you want to have a good nice posture here.

I tell people always get up and walk around the office. If you want to, go get some water. Go chat with somebody. It doesn't take much time, just take a five minute break. I know it's tough when you're working a desk and you got a lot to do, you got deadlines, you really get stuck into a rut. You're really working, working, working, so what we want to do is get up move around a little bit.

There's also some stretches you can do. Uou just kind of rotate your back every once a while. Just hold that Stretch. The big point here is to keep moving. Get yourself up every once in a while. Don't always sit. If you're there for more than an hour at a time it's gonna cause problems of your lower back.

So there's some good tips here. I’m Dr. Miller at Village Family Clinic with some tips on how to keep yourself from getting back pain when you have to work at a desk all day long.