Carpal Tunnel

As a chiropractor in the Woodbridge, Dale City Virginia area  I see all sorts of joint and nerve complaints.  A very common one is people complaining of wrist and hand pain.  With all the computer use these days it is becoming even more common.  Carpal Tunnel or CTS is one of the more common surgeries performed at this time.  Here is some basics you should know and you should consult a chiropractor as well as orthopedic surgeon.

CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.

What Is CTS?

CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.

What Are the Symptoms?

Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.

Why Does CTS Develop?

Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause.

How Is It Diagnosed?

CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.

Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome.  The most common are:

Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.

Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.

 Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. With these tests, small electrodes, placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your doctor of chiropractic to this diagnosis.

What Is the CTS Treatment?

Initial therapy includes:

Resting the affected hand and wrist

Avoiding activities that may worsen symptoms

Immobilizing the wrist in a splint to avoid further damage from twisting or bending

Applying cool packs to help reduce swelling from inflammations

Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.

Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.

Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

How Can CTS Be Prevented?

The American Chiropractic Association recommends the following tips:

Perform on-the-job conditioning, such as stretching and light exercises.

Take frequent rest breaks.

Wear splints to help keep the wrists straight.

Use fingerless gloves to help keep the hands warm and flexible.

Use correct posture and wrist position.

To minimize workplace injuries, jobs can be rotated among workers. Employers can also develop programs in ergonomics—the process of adapting workplace conditions and job demands to workers’ physical capabilities.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Jaw Pain

Jaw pain is a common complaint that I see in my Woodbridge, Dale City Virginia chiropractic office.  It is sometimes noted with patients complaining of headaches.  Most of the time my chiropractic patients don’t realize the two may be connected.  There are several other things that can be contributed to jaw pain.  Here is a check list from the ACA today that can help people with their jaw pain.

Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the jaw muscle, cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do your jaws make noises loud enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/locked as you open it?

If you answered “yes” to some of these questions, you may have a temporomandibular joint disorder, or TMD. TMD is a group of conditions, often painful, that affect the jaw joint.

Signs may include:

Radiating pain in the face, neck, or shoulders;

Limited movement or locking of the jaw;

Painful clicking or grating when opening or closing the mouth;

A significant change in the way the upper and lower teeth fit together;

Headaches, earaches, dizziness, hearing problems and difficulty swallowing.

For most people, pain or discomfort in the jaw muscles or joints is temporary, often occurs in cycles, and resolves once you stop moving the area. Some people with TMD pain, however, can develop chronic symptoms. Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.

What Causes TMD?

Researchers agree that TMD falls into three categories:

Myofascial pain—discomfort or pain in the muscles of the jaw, neck, and shoulders;

A dislocated jaw or displaced disc;

Degenerative joint disease—rheumatoid arthritis or osteoarthritis in the jaw joint.

Severe injury to the jaw is a leading cause of TMD. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively or chewing on one side of the mouth too frequently, may cause TMD.

Both physical and emotional stress can lead to TMD, as well. The once-common practice of sitting in a dentist's chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today’s dentists also screen patients for any weaknesses in the jaw structure that would make physical injury likely if they keep their mouths open very long. In that case, they may use medications during the procedure to minimize the injury potential, or they may send the patient to physical therapy immediately after treatment.  In less severe cases, they instruct patients in exercises they can do at home to loosen up the joint after the visit.

While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMD.

Some conditions once accepted as causes of TMD have been dismissed—moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve the prolonged opening of the mouth, as mentioned above), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.

Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, posture and higher heels.

TMD Diagnosis and Treatment

To help diagnose or rule out TMD, your doctor of chiropractic (DC) may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problems while doing these things, then the problem is not likely to be TMD. Your DC can then look for signs of inflammation and abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.

If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. In most cases, your doctor’s first goal is to relieve symptoms, particularly pain. If your doctor of chiropractic feels that you need special appliances or splints (with the exception of the “waterpack” and other guards against teeth grinding), he or she will refer you to a dentist or orthodontist for co-management.

In addition to treatment, your doctor of chiropractic can teach you how to:

Apply heat and ice to lessen the pain. Ice is recommended shortly after the injury or after your pain has started. In the later stages of healing, you need to switch to heat, especially if you are still experiencing discomfort.

Avoid harmful joint movements. For example, chomping into a hard apple is just as bad as crunching into hard candy (some hard candies are even called “jawbreakers”—for good reason). And giant sandwiches can cause the mouth to open too wide and have a destabilizing effect on the jaw.

Perform TMD-specific exercises. Depending on your condition, your DC may recommend stretching or strengthening exercises. Stretching helps to loosen tight muscles and strengthening helps to tighten muscles that have become loose. Special feedback sensors in the jaw can be retrained, as well, if needed.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Stress relief

With all the stresses of life it is hard to find ways to let go.  I hear it in my Woodbridge, Dale City Virginia chiropractic office all the time.  We all wind up picking of different stresses throughout that eventually beat us down.  Be able to let go of those stresses help you spiritually feel better which in return can physically make you feel better.

Through asanas (postures), meditation, relaxation and breathwork, yoga helps students deal with fear, change, uncertainty and other factors underlying their stress, anxiety and depression, increasing their coping ability. By focusing on the present moment and not on the mistakes of our past or the potential problems ahead in our future, yoga encourages us to accept change and uncertainty as necessary elements that take us to the next step in our evolution. We experience fear when we don't trust that things will work out, but as we go through life, we learn that things do work out...even if not in the way we expected. We also learn to love and appreciate ourselves—and to trust ourselves. Yoga teaches us to notice our unique personal gifts and contributions to this world and to accept them as features that distinctively make us who we are.

Asanas for Relief of Stress, Anxiety and Depression: 

Consider incorporating one or a few of these postures into your daily routine to assist in relieving distress.

Legs Up the Wall (Viparita Karani) helps calm anxiety and release depressing thoughts.

- Sit sideways with one hip touching the wall. You can sit on a bolster or folded towel or blanket for back support.

- On an exhale, roll onto your back and extend both legs up the wall.

- Flex the feet and press through the heals, drawing your feet toward the ceiling. 

- Push down through the hips and pull the hips toward the floor.

- Draw the backs of the thighs toward the wall.

- Soften the throat and draw the base of the skull away from the neck, creating space. You can place a rolled-up washcloth at the base of the skull.

- Allow the arms to relax, palms facing up at the sides of the body or overhead. 

- To exit the posture, gently roll the legs to one side and lift the upper body from the floor.

Standing Forward Bend (Uttanasana) calms the central nervous system.

- Stand tall with feet hip distance apart. Inhale to reach the arms and crown of the head toward the ceiling.

- Exhale, and reach forward through the arms and crown. 

- Draw the shoulder blades down the back, and draw the belly toward the thighs – heart towards the knees.

- Reach the palms around the legs to the backs of the ankles or shins. Bend elbows to draw the upper body in toward the lower body.

- Let the head and neck relax and hang.

- With each inhale, draw the hips into the air and the crown of the head toward the floor. 

- With each exhale, use the bent elbows to pull the upper body toward the lower body. Work to stretch the legs.

- To exit the pose, draw your hands to your hips, stretch the spine, and lift the head forward and up with a flat back.

Child’s Pose (Balasana) provides a feeling of security and calming in the mind.

- Drop onto the hands and knees and let your hips glide back over your heels. For extra padding, place a blanket or towel under the knees or between the thighs and calves.

- Gently lower the forehead to the floor.

- Allow the arms to walk back beside the body so the palms face up near the feet.  Let gravity pull the fronts of the shoulders toward the floor.

- Stay in the posture for 30 seconds to several minutes, slowly inhaling and exhaling.

- Notice any thoughts or feelings that come up, and allow yourself to sit with them.

- To exit the pose, use the strength of the back to gently lift your torso away from the floor.

Happy Baby (Ananda Balasana) – In addition to opening the back, this posture releases stress and encourages calming. Smile as you roll from side to side in the posture for a playful approach to relaxation.

- While lying on your back, pull the knees in and to the sides of the rib cage. 

- Reach the palms of the hands under the feet and grasp the soles of your feet with your hands.

- Flex the feet, and simultaneously press the heels into the palms as the hands pull down on the soles of the feet.

- Extend the hips and crown of the head away from the body.

- Draw the base of the skull away from the neck, stretching the neck and spine

- Breathe for 30 to 60 seconds.

When selecting a yoga teacher or class, take the time to determine what you are looking for. Depending on your personality and approach to handling stress, the following types of yoga may be beneficial:

Yin yoga – Often considered the moon phase or calming side of yoga, it focuses on holding postures for a longer period to stretch and exercise the bone and joint areas of the body and allow for emotional release.

Restorative yoga – A nurturing approach to yoga that draws from Yin and typically uses many props to ensure comfort, relaxation and release during practice.

Yang yoga – Often considered the sun phase or energetic side of yoga, it includes practices such as vinyasa, power or ashtanga. The focus is on alignment as you move more quickly through a series of postures stimulating muscle and building strength. While this is not traditionally considered a gentle or relaxing approach, it may provide an outlet for excessive energy.

Yoga therapy draws on a mix of yoga philosophy and psychology to assist students in identifying and dealing with deeper issues. Yoga believes that we hold many emotions and feelings in our body, which often leads to pain or discomfort, and that by working through the physical practice, we can find and confront the emotions that are causing such problems.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Softball season is over now on to bowling!

Softball season is over and now time for the next weekend warrior activity… Bowling.  As a chiropractor in the Woodbridge, Dale City Virginia area we see lots of weekend athlete injuries.   I was looking for some chiropractic articles on bowling which is very popular in the Woodbridge, Dale City VA area.  I came across the ACA’s relationship with the PBA and thought it was an interesting read.

After more than a decade in hiatus, the ACA Sports Council (ACASC) rekindled its professional relationship with the Pro Bowlers Association (PBA) in February 2014, when a contingent of ACASC doctors of chiropractic (DCs) attended to the medical needs of nearly 500 bowlers competing in the 2014 United States Bowling Congress (USBC) Masters held at Brunswick Zone Carolier Lanes in North Brunswick, N.J. In addition to making history, when Australia’s Jason Belmonte became the first bowler in nearly 50 years to successfully defend a USBC Masters title, the highly competitive and nationally televised event featured a field of 468 bowlers from 15 countries vying for $315,000 in total prize funds.

Chiropractic Services

Having worked numerous PBA competitions more than a decade ago, Dr. Ira A. Shapiro, a two-time member of the United States Olympic team medical staff, admitted his admiration for both the sport and its participants after being named one of the ACASC DCs to the Masters tournament. “It’s a wonderfully rewarding feeling to help these athletes overcome any number of injuries and then see them go out and dramatically increase their performances,” said Dr. Shapiro. “Since most of these bowlers are responsible for their own care, many of them came to us for treatment immediately after arriving at the lanes. Once the word spread, we were actively busy offering applications ranging from spinal manipulation and kinesiology taping to soft-tissue and cold-laser therapies to participants from all over the world.”

During the course of the competition, this support included working with the bowlers, who were in a minimum of three five-game sets and rolled as many as 1,000 balls throughout the week. As a result of competing in tournaments for years, many of the bowlers were very responsive to working with the sports chiropractors to alleviate chronic side effects of the overuse injuries that commonly accompany pain and swelling in the shoulders, forearms and lower back.

“The chiropractic services offered during the USBC Masters were amazing,” said Mike Fagan, PBA player representative and the current tour leader, who has competed or coached in more than 20 countries around the world. “The doctors were able to give the players much-needed help for all of their new, nagging and reoccurring issues. We were very grateful for the services provided and hope to have an on-site chiropractor at all of our future events.”

Joining Dr. Shapiro at the Masters were Drs. Len Ershow, Victor Dolan and William Bonsall, who not only actively worked to service the medical needs of the tournament’s bowlers but also alongside Dr. Shapiro worked with the other chiropractic professionals who were relatively new to the sport. Among these ACASC professionals were Drs. Veera Gupta, Robin Lin ster, Julie Scarano and Michael Stewart.

“After working the Pro Bowlers Tour 20 years ago in New Jersey, it was good to come full circle again,” offered Dr. Bonsall. “Dr. Shapiro and I were the only doctors with international experience treating professional bowlers. Subsequently, we worked with our fellow doctors to share our evaluations and treatment techniques related to the most common bowling injuries. Utilizing manipulation, Active Release Techniques, FAKTR, rock tape and laser therapy, the top bowlers all reached for care from us,” he added. “Watching the scores go up after treatment also quickly saw our utilization go up dramatically over the course of the five days.”

World Games

Prior to this event, both Dr. Shapiro and Dr. Bonsall were among 35 sports chiropractic specialists from 13 countries selected by the International Federation of Sports Chiropractic (FICS) to treat over 1,500 international athletes competing in 40 different sports at the 2013 World Games in Cali, Colombia. The World Games is held every four years for the sports federations, such as bowling, that do not compete in the Olympics.

“During the games, I was asked as president of FICS to meet with the heads of the Bowling Federation because they were so pleased with the treatment their athletes received from the FICS doctors,” said Dr. Sheila Wilson. “There was interest in working with FICS to provide care at future bowling events, specifically the Pro Bowlers Association tour in the United States. When FICS is contacted to provide sports chiropractors for a national event, we contact our member association for that country, in this case the ACA Sports Council, so their individual members can be used to staff the event.

“Drs. Ira Shapiro and Bill Bonsall from the ACA Sports Council were the DCs on the FICS team who worked with the bowlers in Colombia. I recommended Dr. Shapiro as the ACA Sports Council’s network coordinator for the PBA, and in return he has done an outstanding job organizing care at the events held so far this year. I’m very proud of the work FICS is doing to bring more events to our members around the world and of those members who always do a great job representing chiropractic in the United States,” added Dr. Wilson.

More PBA Support

As for the future, ACASC president, Dr. Sherri Lashomb, confirmed her association’s excitement about supporting the PBA once again. “The ACASC and FICS have a long history of working together to offer our members the opportunity to work various sporting events, both in the United States and internationally,” stated Dr. Lashomb. “This is a win-win-win situation for three organizations. I am very proud of all the doctors who provide chiropractic care for these athletes. I know the time and commitment that is necessary to volunteer at these events. Our members are to be commended for their dedication and service to the public and our profession.”

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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