US Chiropractic Directory Presents:
Shoulder-Arms-Hand Problems
Shoulder, arm and hand problems aresignificant issues that effect people worldwide. Chiropractic has been safely and effectively helping patents with pain in the neck for over 100 years and The US Chiropractic Directory has create a forum of information involving the entire healthcare and scientific community to bring the public evidenced and researched based answers on how and why chiropractic works to help those with shoulder, arm and hand pain/problems.
A report on the scientific literature
Frozen shoulder syndrome (FSS) is a common condition presenting to a variety of health care practitioners including chiropractors, osteopaths, medical doctors, and physical therapists. Also referred to as adhesive capsulitis, FSS remains one of the most poorly understood shoulder conditions, with its cause most of the time, unknown. Recently, a consensus definition of FSS was reached by the American Shoulder and Elbow Surgeons to be a condition characterized by functional restriction of both active (while moving) and passive (while still) shoulder motion for which x-rays of the shoulder are usually negative. It occurs usually between 40 and 60 years of age, is 3 to 7 times more prevalent in women than men and it is characterized by sudden onset, night pain along with a painful restriction of numerous motions of the shoulder. Common traditional medical treatments include nonsteroidal anti-inflammatory drugs, steroid injection, and shoulder surgery.
Children with Tremors and Conversion Disorder
A Possible Chiropractic Solution
Reporting a Limited Case Study
A report on the scientific literature
by Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Chiropractors and chiropractic has been treating children safely for over 110 years for a host of maladies. In December, 2008, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, released findings on Americans and the use of complementary and alternative medicine (CAM). "The findings are from the 2007 National Health Interview Survey (NHIS), an annual in-person survey of Americans regarding their health- and illness-related experiences. The CAM section gathered information on 23,393 adults aged 18 years or older and 9,417 children aged 17 years and under" (National Center for Complementary and Alternative Medicine, 2008, http://nccam.nih.gov/news/camstats/ 2007/camsurvey_fs1.htm). They found that 11.8% of children in the United States have undergone CAM therapies, indicating that children aren’t obtaining the desired outcomes and their parents are looking for solutions.
CAM is a term applied to any healing discipline that does not fall into the category of traditional medicine or any health care that traditional medicine must govern over, such as nursing or physical therapy, rendering those as secondary health care providers and not allowing them to care for patients unless under the supervision of a medical doctor. Chiropractic is considered part of CAM simply because doctors of chiropractic are not medical doctors or secondary providers requiring supervision by a medical doctor.
Miller reported in 2010 on 2,645 children that were treated in the outpatient clinic of the Anglo-European College of Chiropractic from 2006-2010 for various maladies. Of these children, 87% were under the age of 5 and 13% were between 5 and 13. 34% were seen for musculoskeletal problems such as neck pain and postural issues, 30% were treated for infant colic/excessive crying, 16% for feeding disorders and the balance for various other issues. Every child had been seen by at least one medical practitioner and some by many medical providers. Of the 2,645 children referred to the chiropractic clinic, 83% were referred by their medical physicians.
Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results.
The pediatric related conditions that were reported to be cared for by chiropractors were the following:
Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
Conversion Disorder according to Heruti, Levy, Adunski and Ohry (2002) has been previously labeled Hysterical Neurosis, Somatisized Disorder, Anxiety Hysteria and Hysterical Personality. Today's proper accepted nomenclature has been the simple use of Hysterical Neurosis, where Conversion Disorder is lumped together with Dissociative Disorder. This disorder, according to the authors is "disability to a psychological mechanism in people with physical impairment secondary to trauma without evidence of organic etiology (deviation or disruption from any internal organ, part or system)" Page 327.
Alcantara and Adamek (2012) reported "that an 11 year old girl with presented with complaints of uncontrollable tremors of both arms and right leg. Conversion Disorder was diagnosed following negative examination findings of an organic etiology. Prior to institutionalization, her parents requested a second opinion from a clinical psychologist who referred her to a chiropractor. Care was provided using spinal manipulation to sites of spinal and cranial dysfunctions. With subsequent visits the patient's tremors improved. Following 12 chiropractic visits the patient's symptoms resolved. Long-term follow-up revealed continued resolution of the symptoms of tremors." (page 89)
Although this is one case as reported in a limited case study, it adds to the growing body of the results chiropractic care. It also adds to the growing list of conditions chiropractors care for. Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in both the pediatric and adult population with minimal to no side effects.
References:
National Center for Complementary and Alternative Medicine. (2008, December). The use of complementary and alternative medicine in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm\
2.Miller, J. (2010). Demographic survey of pediatric patients presenting to a chiropractic teaching clinic, Chiropractic & Osteopathy,18(33), Retrieved from http://www.chiroandosteo.com/content/pdf/1746-1340-18-33.pdf
3.Marchand, Aurelie (2012) Chiropractic Care of Children From Birth to Adolescence and Classification of reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors, Journal of Manipulative and Physiological Therapeutics, 35 (5) 372-380
4. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
5.Heruti R., Levy, A., Adunski A. and Ohry A., (2002) Conversion Motor Paralysis: Overview and Rehabilitation Model, Spinal Cord, 40, 327-334
6. Alcantra J., Adamek R., (2012) The chiropractic care of a child with extremity tremors concomitant with a medical diagnosis of conversion disorder, Complementary Therapies in Clinical Practice, 18, 89-93
Children/Pediatric Utilization of Chiropractic Care
A report on the scientific literature
by
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
83% of children under 3 years old were referred by their medical practitioners
Children have been under chiropractic care for almost 100 years according to my 30 years of rendering chiropractic care to children and the 2 generations of my instructors and mentors that taught me how to care for children. While there is a growing body of evidence of the efficacy of chiropractic care and childhood maladies, the amount of children under care and being referred to chiropractors by pediatricians and other medical doctors is growing.
In December, 2008, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, released findings on Americans and the use of complementary and alternative medicine (CAM). "The findings are from the 2007 National Health Interview Survey (NHIS), an annual in-person survey of Americans regarding their health- and illness-related experiences. The CAM section gathered information on 23,393 adults aged 18 years or older and 9,417 children aged 17 years and under" (National Center for Complementary and Alternative Medicine, 2008, http://nccam.nih.gov/news/camstats/ 2007/camsurvey_fs1.htm). They found that 11.8% of children in the United States have undergone CAM therapies, indicating that children aren’t obtaining the desired outcomes and their parents are looking for solutions.
CAM is a term applied to any healing discipline that does not fall into the category of traditional medicine or any health care that traditional medicine must govern over, such as nursing or physical therapy, rendering those as secondary health care providers and not allowing them to care for patients unless under the supervision of a medical doctor. Chiropractic is considered part of CAM simply because doctors of chiropractic are not medical doctors or secondary providers requiring supervision by a medical doctor.
Miller reported in 2010 on 2,645 children that were treated in the outpatient clinic of the Anglo-European College of Chiropractic from 2006-2010 for various maladies. Of these children, 87% were under the age of 5 and 13% were between 5 and 13. 34% were seen for musculoskeletal problems such as neck pain and postural issues, 30% were treated for infant colic/excessive crying, 16% for feeding disorders and the balance for various other issues. Every child had been seen by at least one medical practitioner and some by many medical providers. Of the 2,645 children referred to the chiroprctic clinic, 83% were referred by thier medical physicians.
According to Jandial, Myers, Wise, and Foster in 2009, 21% of all medical practitioners, including pediatricians, had no confidence in treating musculoskeletal issues and only 53% had "some" confidence in treating musculoskeletal issues in children. Considering the "self-rated" format of this study, there are no interpretation issues of the results. Miller (2010) also reported in the study that 83% of the children under 3 years of age were referred by medical practitioners, underscoring the need for this type of care and the efficacy of the care for children. In a limited study, Alcantara and Davis (2010) reported improvement with chiropractic treatment in children with attention deficit hyperactivity disorder (ADHD) as well as various other limited and case studies. While significantly more research is required for children and chiropractic care, the growing body of recognition by the medical and chiropractic communities and the public gives evidence to the results of chiropractic care in the pediatric population.
REFERENCES
1. National Center for Complementary and Alternative Medicine. (2008, December). The use of complementary and alternative medicine in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm
2. Miller, J. (2010). Demographic survey of pediatric patients presenting to a chiropractic teaching clinic, Chiropractic & Osteopathy,18(33), Retrieved from http://www.chiroandosteo.com/content/pdf/1746-1340-18-33.pdf
3. Jandial, S., Myers, A., Wise, E., & Foster, H. E. (2009). Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. Journal of Pediatrics, 154(2), 267-271.
4. Alcantara, J., & Davis, J. (2010). The chiropractic care of children with attention-deficit/hyperactivity disorder: A retrospective case series. Explore, 6(3), 173-182.
Tennis (Golf) Elbow and Chiropractic Care
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
"Tennis elbow [or lateral epicondylitis] is a painful condition that happens when tendons in your elbow are overworked, usually by repetitive motions of the wrist and arm" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/tennis-elbow/DS00469/DSECTION=symptoms). Tennis elbow is also called "golfer's elbow" and according to Owens, Wolf, and Murphy (2009), "...has been demonstrated to occur in up to 50% of tennis players. However, this condition is not limited to tennis players and has been reported to be the result of overuse from many activities. Lateral epicondylitis is extremely common in today's active society" (http://emedicine.medscape.com/article/1231903-overview).
Owens, Wolf, and Murphy (2009) go on to explain, "Any activity involving wrist extension [upward bending] and/or supination [twisting] can be associated with overuse of the muscles originating at the lateral epicondyle [outer elbow]. Tennis has been the activity most commonly associated with the disorder. The risk of overuse injury is increased 2-3 times in players with more than 2 hours of play per week and 2-4 times in players older than 40 years. Several risk factors have been identified, including improper technique, size of racquet handle, and racquet weight [and the same holds true for any sport or activity]. For work-related lateral epicondylitis, a systematic review identified 3 risk factors: handling tools heavier than 1 kg, handling loads heavier than 20 kg at least 10 times per day, and repetitive movements for more than 2 hours per day...Patients present complaining of lateral elbow and forearm pain exacerbated by use. The typical patient is a man or woman aged 35-55 years who either is a recreational athlete or one who engages in rigorous daily activities" (http://emedicine.medscape.com/article/1231903-overview).
In tennis, the USTA (United States Tennis Association), and in golf, the PGA (Professional Golf Association), along with almost every professional sports team in the United States and internationally, now employ chiropractors as part of their medical staff. They recognize the competitive edge that it gives their players in both avoiding and treating injuries. Professional sports are a big business and the owners want to protect their investments, the players. On a daily basis, as highlighted above, many of us are exposed to the negative effects of lateral epicondylitis.
According to Fernández-Carnero, Fernández-de-las-Peñas, & Cleland (2008), the application of a cervical spine thrust manipulation (chiropractic adjustment) produced an immediate bilateral increase in pain pressure thresholds, or less pain at the elbow in patients with lateral epicondylitis and an increased pain free grip on the affected or painful side. The implication in sports and everyday life is that lateral epicondylitis, tennis elbow, golf elbow, packaging elbow or any other name attached to the activity causing this problem, has been clinically proven in randomized clinical trials to have positive outcomes with chiropractic care.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with lateral epicondylitis. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References
1. Mayo Clinic Staff. (2010, Obtober 21). Tennis elbow, symptoms. MayoClinic.com. Retrieved from http://www.mayoclinic.com/health/tennis-elbow/DS00469/DSECTION=symptoms
2. Owens, B. D., Wolf, J. M., & Murphy, K. P. (2009, November 3). Lateral epicondylitis. emedecine from WebMD. http://emedicine.medscape.com/article/1231903-overview
3. Fernández-Carnero, J., Fernández-de-las-Peñas, C., & Cleland, J. A. (2008). Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. Journal of Manipulative and Physiological Therapeutics, 31(9), 675-681.
Children and Chiropractic:
A Study in Adverse Effects
Chiropractic adjustments were found safe for young children and adolescents
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
For over 100 years, parents have been taking their children for chiropractic care for various reasons. Clinically, chiropractic has been effectively treating numerous childhood ailments, from asthma to scoliosis to attention deficit disorder to sports-related injuries as well as other symptoms, conditions and diagnoses. This article is not about the efficacy of chiropractic caring for those types of disorders. It is limited to a single topic the safety of the chiropractic adjustment for children.
Having cared for children for 30 years in clinical practice for various diagnoses and wellness care, the safety of the adjustment has been the most asked about by parents. When asked if it was safe, my answer has always been based on my personal clinical experience, which resulted in me answering, "Yes." As with medicine and any other healing discipline, the results have to be verified with science over time to prove that assertion to be true.
Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
In clinical practice, having successfully cared for children with scoliosis, attention deficit disorders, hearing loss, bedwetting, ear infections, eczema, headaches, cerebral palsy, whiplash, low back pain, neck pain and many other conditions, I cannot recall one instance of a child having an adverse reaction. It is also of importance to note that approximately 100% of the patients had visited their pediatrician or other medical subspecialists prior to seeking chiropractic care as their "last alternative" to get help. These weren’t patients who needed convincing on a philosophy or religious beliefs. They were desperate for help. This is not an indictment against medicine and pediatrics. It is an endorsement for having the right care available when the correct diagnosis is rendered. Often chiropractic should be the first choice and not the last, after expensive and sometimes dangerous testing and treatment is performed.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for parents seeking safe care for their children. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
Carpal Tunnel Syndrome and Chiropractic
A report on the scientific literature
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
When people experience pain in the wrist, the common assumption is that it is carpal tunnel syndrome. The wrists are made of 2 rows of 4 bones called the carpal bones. When you flip your hand over with the palm facing the sky, there is a covering over those bones at the wrist. To the side of this covering is where you can take your pulse. One of two major nerves that go to the hand travel between this covering and the carpal bones. The nerve travels with the tendons, which connect muscle to bone, of nine muscles that flex the wrist or bring your fingers toward you. The nerve is named the median nerve, so carpal tunnel syndrome is the compression of the median nerve between the carpal bones and the covering of the tunnel at the wrist. This causes numbness and tingling in the thumb, index finger and ½ of the middle finger because that is where the median nerve goes. Numbness or tingling in any other finger or the palm is not due to carpal tunnel and may be coming from the elbow, shoulder or neck.
There are a few common reasons for carpal tunnel syndrome, the primary one being inflammation or swelling in the tunnel. This can be due to direct trauma like a wrist injury or a result of a car accident involving your hands twisting on the steering wheel. Other causes can be overuse, like typing too much on a keyboard, fine movements at work or weakness and overuse of the forearm muscles. The mild and moderate symptoms can generally be controlled and treated with conservative therapy. More severe cases often require surgery and can only be quantified with a neurological test. Surgery, although necessary in some cases, is a last resort since scar tissue can result from the surgical incision and over time can result in the return of compression of the median nerve in the carpal tunnel. In the cases of the mild or moderate symptoms, they may be due to improper mechanics of the 8 bones of the wrist. In these cases, chiropractic management, using the chiropractic adjustment administered to this area, has been shown to be effective in a recent study.
In this study the authors stated, “From a mechanistic viewpoint, manual therapy techniques designed to release tissue adhesions and increase the range of motion (ROM) of the wrist may alleviate the mechanical compression of the median nerve without the need for surgical interventions" (Burke et al., 2007, p. 51). They also state, "Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks" (Burke et al., 2007, p. 50). "The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions” (Burke et al., 2007, p. 50).
The authors related the following statistic, “The American Academy of Neurology and 40% of neurologists in the Netherlands recommend conservative management of CTS before surgical intervention" (Burke et al., 2007, pp. 50-51). An important perspective to have on surgical intervention was also included and the authors stated, “In addition, of patients with failed primary surgical interventions, up to 12% may require a secondary surgical procedure. Persistent symptoms after a secondary surgical procedure ranged from 25% to 95%" (Burke et al., 2007, p. 51). Therefore, we see that the American Academy of Neurology recommends holding off on surgery until other options are explored.
In conclusion, the paper reports, “Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS" (Burke et al., 2007, p. 59). In the end, it was the management of carpal tunnel syndrome by a doctor of chiropractic that was the most important factor; the individual techniques did not matter.
If you are experiencing numbness and tingling into hands or fingers, please discuss this with a doctor of chiropractic. Conservative care is recommended by the American Academy of Neurology.
References:
1. Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), 50-61.
Elbow Pain (Tennis Elbow, Golf Elbow) and Chiropractic
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Tennis elbow, golf elbow, shooter’s elbow "is a condition where the outer part of the elbow becomes sore and tender. It is commonly associated with playing tennis or other racquet sports, though the injury can happen to almost anybody. The condition is also known as lateral epicondylitis ("inflammation of the outside elbow bone"), a misnomer as histologic studies have shown no inflammatory process. Other descriptions for tennis elbow are lateral epicondylosis, lateral epicondylalgia, or simply lateral elbow pain...The peak incidence is between 30 and 60 years of age historically" (Wikipedia, 2010, http://en.wikipedia.org/wiki/Tennis_elbow).
Symptoms include pain on the outer part of the elbow (lateral epicondyle), point tenderness over the lateral epicondyle – a prominent part of the bone on the outside of the elbow, gripping and movements of the wrist hurt, especially wrist extension and lifting movements, activities that use the muscles that extend the wrist (e.g. pouring a pitcher or gallon of milk, lifting with the palm down) are characteristically painful, and morning stiffness.1
In December of 2008, a research article reported on the effects of chiropractic cervical manipulation (adjustment) on the pain pressure threshold, or the minimal amount of pressure to cause pain, along with grip strength, or the amount of strength in the hand. The results of the research concluded that the application of a cervical spine adjustment produced an immediate bilateral (both sides) increase in pain pressure threshold (decreased pain) and an immediate pain free grip on the affected side.2
This is one of the reasons that both professional golf and tennis organizations maintain chiropractors at high profile events as it is reported that the scores of the players have improved with chiropractic care. However, this also explains why chiropractic has been helping in work and at home in everyday life with a similar diagnosis.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to elbow pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.com and search your state.
References:
1. Wikipedia, The Free Encyclopedia. (2010, August). Tennis elbow. Retrieved from http://en.wikipedia.org/wiki/Tennis_elbow
A report on the scientific literature
|
Condition
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Responded to Chiropractic
|
Research Paper and Date
|
|
Shoulder Impingement Syndrome
|
YES
|
Pribicevic and Pollard 2005
Gleberzon 2005
Pribicevic and Pollard 2004
Smith 2000
Williams and Brockhohn 1994
Shrode 1994
Plezbert and Nicholson 1994
Kampschroder et al 1990
|
|
Thoracic Outlet Syndrome
|
YES
|
Rimbey 2005
Vernon 1982
|
|
Elbow Pain
|
YES
|
Konczak 2005
Coppieters et al 2004
Annis 2003
Kaufman 2000
Tchoryk 2000
Lawrence and Humphery 1997
Greenly and Bergmann 1990
Woo 1988
|
|
Frozen Shoulder Syndrome
|
YES
|
Valli 2004
Donahue et al 2003
Kazemi 2000
Harmeyer 1995
Ferguson 1995
Polkinghorn 1995
Feeley 1992
|
|
Separated Shoulder
|
YES
|
Kiner 2004
Stoddard and Johnson 2000
|
|
Swimmer’s Shoulder
|
YES
|
Kurtz 2004
|
|
Shoulder Instability
|
YES
|
Moreau and Moreau 2001
|
|
Rotator Cuff Tear
|
YES
|
Kazemi 1999
Buchberger 1993
|
|
Shoulder Tendonitis
|
YES
|
Gimblett et al 1999
Nia 1994
|
|
Scapular Winging
|
YES
|
Horrigan et al 1994
|
|
Chronic Bursitis
|
YES
|
Hammer 1993
Volstad 1983
|
|
Wrist Pain
|
YES
|
DeSantis 2004
Russell 2003
McDermott 2003
|
|
Carpal Tunnel Syndrome
|
YES
|
Davis 2004
Brunarski et al 2004
Pringle et al 2003
Brown et al 1999
Petruska 1997
Buchberger et al 1996
Valente and Gibson 1994
Mariano et al 1991
|
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