All posts by sikorskychiro

Can Inversion Table help lower back pain?

Inversion Table for stretching and pain relief.

A question I get all the time is: do Inversion tables help with back pain?

This study finds that Inversion tables can help lower back pain & spinal traction. Spinal Traction is a form of stretching. Inversion table provides pain relief in your lower back. An inversion table is not for everyone.

The 2-year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years). It was also lower than the surgery rate in the other 2 control groups. [Conclusion] Inversion therapy relieved symptoms and avoided surgery.

Lower back pain can be treated by a variety of treatment. Chiropractic, physical therapy, medication, home exercise. Inversion tables might also be part of your treatment. It can’t hurt and might help you improve your pain.

INVERSION LOWERS DISC SURGERY RATE BY NEARLY HALF 

Mendelow AD, Gregson BA, Mitchell P, Schofield I, Prasad M, Wynne-Jones G, Kamat A, Patterson M, Rowell L, Hargreaves G. Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls. Journal of Physical Therapy Science. 2021;33(11):801-8. Link 

Fat Stacks = Back Pain?

Can a wallet or a purse cause back pain?

“Purses are for girls, and back pockets are for boys.”

If you grew up with this train of thought for how to carry your wallet, then you might also know it’s a tough habit to break. 

Yet, despite being taught that wallets go into our bags or back pockets, we weren’t told that stashing our stuff could be bad for our backs or joints.  Who knew that sitting on a bunch of folded bills or stashing coins and lip balm in a shoulder bag can wind up causing aching shoulders, back, and neck pain?

Rather than teach us how to live better, we had consumerism marketing masquerading as advice.  The result: new purses were bought to help alleviate shoulder pain, and new jeans were purchased whenever the back pocket wore out.

How does using a purse or sitting on my wallet affect me? 

Carrying heavy shoulder bags, sitting with a wallet in your back pocket, and even heavy backpacks have one major consequence in common: lopsided posture.  Slipping your wallet into the back of your jeans or into your shoulder bag (which can also carry emergency bandages, spare pens, and the weight of a thousand other things to do) causes uneven weight distribution on the spine, hips, and shoulders.  Sitting with one hip higher than the other due to the bulk of a wallet creates a lopsided tilt of the pelvis or the sitting bones.  Something similar happens with a heavy purse: lopsided weight is consistently carried on one shoulder, weighing down one side compared to the other.  

The result is a person sitting lopsided with a rounded, banana-shaped spine.  This hunch-like position puts more stress on the back and spine and can even cause a slouchy posture with slumped shoulders.   Muscles work harder to compensate, and joints become stiff and achy.  

Sitting on a wallet or carrying a shoulder bag can also affect the nerves of our body.  Carrying a heavy bag over the shoulder can strain the muscles and nerves of the neck in an area called the brachial plexus.  Pinched nerves in this area can result in tingling and numbness down the arm, into the hand, and down to the fingertips. 

A similar effect happens from sitting on a wallet: the sciatic nerve gets pinched between your wallet, your gluteal muscles, and your hip. Even after a short time, the sciatic nerve can become irritated, causing discomfort that ‘zings’ down the back of the leg and into the heel.  This condition is so commonplace that it has earned the nickname, “wallet neuritis,” describing the inflammatory response that happens to the sciatic nerve due to sustained compression.

Even the thinnest wallet and lightest of shoulder bags can create these symptoms.

What can I do about it?

If you love your wallet or carrying a bag, however, all is not lost!  Some simple changes in your daily routine will help you keep using your cute clutch, nifty clip, or the leather wallet you received as a birthday gift.

If you must carry a bag, keep it to just the essentials: pare down your carrying case to make it more lightweight.  If you can, invest in a bag with a wide-banded strap that crosses diagonally over the torso.  This design helps balance weight between your shoulder blades, chest, and pelvis, and even helps prevent theft by making your bag harder to steal.  Consider switching to lighter gauge materials such as nylon, long-strand cotton, or canvas that are also durable with wear and functional to use.  At the very least, alternate shoulders to prevent one side from maintaining the bulk of the weight.

Waist bags (or fanny packs as some call them) are fantastic to avoid the shoulder region altogether.  Plus, there are many fashionable styles that are also functional!

For wallet users, your best bet is to remove it from your back pocket entirely before you sit down or get in your car.  You could switch your wallet to your front pocket – but be warned that prolonged use of a wallet in this position can also pinch a nerve between the thigh and torso, especially when you’re in a car.  This can create discomfort as well. 

While at work, place the wallet in your desk, locker, or somewhere safe. You should also avoid anything bulky and stick to slim wallets or money clips that hold only the essentials.

The bare minimum advice is to alternate back pockets to carry your wallet if you must use the back pocket to carry your wallet (or a similar object) at all.  This helps evenly distribute the lopsidedness when sitting as well as wear-and-tear on your pants.

What if that’s not enough?

We can take care of you at Sikorsky Chiropractic and Fitness. We perform a detailed history of your injury, followed by a functional movement assessment and examination.

If you have been carrying a purse or sitting on your wallet for many years, this may be a cause of shoulder pain, low back pain, and even pelvic imbalances. We recommend scheduling a chiropractic visit to evaluate any muscle aches, imbalances, or joint problems you may have.  We can help identify postural compensations or spinal fixations that result from wallet and shoulder bag ergonomics and provide other alternatives to keep you functioning, feeling great, and your belongings safely stowed where you need them.

References

1. Siddiq, M., Jahan, I., & Masihuzzaman, S. (2018). Wallet Neuritis – An Example of Peripheral Sensitization. Current rheumatology reviews, 14(3), 279–283. 

2. Lutz, E.G. Credit-card-wallet sciatica. JAMA. 1978;240(8):738.

3. Viggiani, D., Noguchi, M., Gruevski, K.M., Carvalho, D.D., and Callaghan, J.P. The Effect of Wallet Thickness on Spine Posture, Seat Interface Pressure, and Perceived Discomfort During Sitting. IISE Transactions on Occupational Ergonomics and Human Factors. 2014;2:83–93.

4. “Heavy backpacks and children.” Southwest Scoliosis Institute. Retrieved from https://scoliosisinstitute.com/heavy-backpacks.

5. Rempel, D.M., and Diao, E. Entrapment neuropathies: pathophysiology and pathogenesis. J. Electromyogr. Kinesiol. 2004;14(1):71–75.

6. Mwaka, E.S., Munabi, I.G., Buwembo, W., et al. Musculoskeletal pain and school bag use: a cross-sectional study among Ugandan pupils. BMC Res Notes 7, 222 (2014).

7. Amyra Natasha, A., Ahmad Syukri, A., Siti Nor Diana, M. K., Ima-Nirwana, S., & Chin, K. Y. (2017). The association between backpack use and low back pain among pre-university students: A pilot study. Journal of Taibah University Medical Sciences, 13(2), 205–209. 

Want to live longer? Have strong hands.

In a previous blog posting , I posted about the association between handgrip strength and Morbidity (the rate of disease in a population) and mortality(the number of deaths in a population during a given time or place ).

I have this same tool for myself. I use it almost all day every day.

Here are three more studies that show the link between hand strength and disease.

The first study shows the link between hand strength and sickness and death. The first study showed there was sufficient evidence that hand strength was a predictive link all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. That’s a pretty impressive list

The second study used a dynamometer(handheld testing tool) to test hand strength. The authors of the study found that patient with greater differences from side to side shows an increased morbidity risk. The greater the difference the greater the risk.

The third study showed: Assessing hand grip strength asymmetry, as another potential biomarker of impaired muscle function, may provide novel insights for predicting instrumental activities of daily living limitations. Future research should continue examining how strength asymmetries, and other aspects of muscle function beyond maximal strength, factor into the disabling cascade.

Grip Strength: An Indispensable Biomarker For Older Adults

Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans – PubMed (nih.gov)

Handgrip Weakness and Asymmetry Independently Predict the Development of New Activity Limitations: Results from Analyses of Longitudinal Data from the US Health and Retirement Study

What is Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes.

Having metabolic syndrome increase your chances of getting heart disease. Heart disease includes coronary heart disease it is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. This buildup can partially or totally block blood flow in the large arteries of the heart

To have the diagnosis of metabolic syndrome. A patient has to have 3 out of 5 of these following conditions.

  1. Elevated waist circumference Men greater then 40 inches.
  2. Elevated Triglycerides: greater then 150
  3. Reduced HDL cholesterol: less than 40mg/dl for men and less than 50mg/dl for woman
  4. Elevated Blood Pressure: greater then 130/85 mm Hg
  5. Elevated Fasting Glucose: greater then 100 mg/dl

I like this diagram, it puts together how many diseases can link together to cause another condition.

The relationship between adiposity, inflammation, insulin resistance and athleroschlerotic vascular disease. Image Credit: (Boden, 2009) T2DM(diabetes) dyslipidemia ( abnormal

How do you treat Metabolic syndrome? It’s hard to but easy to answer. Get Healthy

  1. Start to exercise. Walking 30 minutes a day is great way to start.
  2. Get adjusted to ensure your body is functioning the best it can.
  3. Improve your diet. Eating plenty of vegetables, fruits, lean protein and whole grains. A Purification Program is a great way to jump start your weight loss. I like the Purification Program from Standard Process.
  4. Learn how to cook health meals.
  5. Limiting saturated fat and salt in your diet
  6. Lose weight
  7. Drink water instead of soda or fruit juices
  8. If you smoke, stop.
  9. Reduce alcohol consummation. Start with a 30 day alcohol free challenge and go from there.

Do you want to be fit and healthy at 80? 2.0

Can you be fit and healthy at 80? The answer is yes.

So how can you be fit and healthy at eighty? So what exercise should I do? What type of exercise will help me stay healthy or will help me become more healthy? You’re going to find out.   

The type of exercise will depend on what the end goals are. If you’re going to run a marathon it will be different than if you want to be a bodybuilder. This article will discuss exercising in the context of health and improving one longevity. 

Generally, speaking exercise can fall into two broad categories: Cardiorespiratory fitness and Strength/muscle mass. Both of these play the role of improving life span. The scientific literature shows that morbidity and mortality risk increase as fitness levels decline with age. Sarcopenia is associated with adverse health outcomes. 

Now for some definitions.

What are morbidity and mortality? Morbidity is the condition of suffering from a disease or medical condition. Mortality is the state of being subject to death. 

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory (heart and associated blood vessels) and respiratory (Lungs) systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. Mitochondria are inside most cells and they make energy.

Muscular strength can be defined as the ability to exert force to overcome resistance In other words the ability to pick up or move objects around. 

Muscle mass is the amount of muscle in your body, including skeletal muscles, smooth muscles, and cardiac muscles. 

Loss of muscle mass and strength is known as Sarcopenia.  

Let’s talk about cardiorespiratory fitness

Cardiorespiratory fitness is measured in VO2 max. VO2 max, or maximal oxygen consumption, refers to the maximum amount of oxygen that an individual can utilize during intense or maximal exercise.  

Have you ever gone up a flight of stairs ran for the bus and got out of breath? You just tested your VO2 max. The better your VO2 max the better you’re able to exchange oxygen (O2) in the body. 

Here’s a study association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. The study found “The adjusted mortality risk of reduced performance on exercise treadmill test was comparable to, if not greater than, traditional clinical risk factors (eg, coronary artery disease, smoking). Importantly, there was no upper limit of the benefit of increased aerobic fitness”. So having poor cardiorespiratory fitness is as dangerous as smoking for your health and life span.  That right having low cardiorespiratory fitness is as dangerous as smoking.  The study broke down the participants into low, below average, average, high, elite. Going from just being low to being below average is a 50% reduction in mortality over a decade. If you then go from low to above average it’s about 60%  above average, it’s about a 60% or 70% reduction in mortality.   

How can we improve VO2 max? 

Well, it’s cardio. Any type of cardio, walking, rowing, or riding the bike. Any exercise that gets your heart rate up. You don’t have to do a bone-crushing workout every day to improve or keep your VO2. About 20 minutes once a week would be a good amount. So if walking is your form of cardio find a big hill and do hill repeats (walk up the hill quickly) and then walk down, let your heart rate recover, and do it again. The same principle can go for riding a bike. Go hard for 1 minute and then recover and repeat. Do that once a week and that will help your V02 max and improve your oxygen exchange.

Doing this type of cardio once a week is great for your health. Some tips start slow, no need to do 20 hill repeats the first time out. 

Start with 3-5 reps and build from there. If you feel any chest pain or thing that does not feel normal a call your doctor or heart doctor (Cardiologist). If the discomfort is too bad go to the ER. 

Now the other days you train, your cardio should be different. You should be training Zone 2. Zone 2 is steady training just coming above the easy zone, It’s not moderate or anything above. The main benefit form zone 2 heart rate or zone 2 power is that it builds an aerobic base and endurance. The best formula to figure out Zone 2 heart rate is the following;

(Your age)-180= Target heart rate.

I’m 48 years old so my target heart rate is 133. (180-47=133)

The benefits of Zone 2 training are, increased mitochondria (the power plant of the cell), increased mitochondrial efficiency, lower heart rate, lower blood pressure, and finally help with insulin resistance.

So doing both types of cardio will help you balance your cardiorespiratory fitness. A good ratio is 80% zone 2 and 20% hard. 

Strength/Muscle mass

Sarcopenia, or the decline of skeletal muscle tissue with age, is one of the most important causes of functional decline and loss of independence in older adults. An average person can lose 1-4% of their lean mass (muscle) and year. 

Figure 9. Strength loss with aging in literature (Keller and Engelhardt, 2013).

If you have low muscle strength, then you have probable sarcopenia. 

As we age we replace our muscle fibers with fat and connective tissue. 

So the muscle loses its ability to contract (contractile function) and muscle metabolic function. Muscles need lots of energy, so they use a lot of blood glucose (sugar). If a person has less muscle then they use less sugar/blood glucose leading to insulin resistance and then type 2 diabetes

Two ways to see how well you’re doing are the sit-to-stand test and grip strength test. This study Strength, But Not Muscle Mass, Is Associated With Mortality in the Health, Aging and Body Composition Study Cohort.  The authors used sit-to-stand test and grip strength test, in their study to see how strength affects Mortality.

 Low muscle mass did not explain the strong association of strength with mortality, demonstrating that muscle strength as a marker of muscle quality is more important than quantity in estimating mortality risk. Grip strength provided risk estimates similar to those of quadriceps strength.  

The ability to get out of a chair without using your arms is very important. This movement is a squat. If you trip over a sock while going to the bathroom at night you need the strength in your leg to prevent you from falling and potentially hitting your head or breaking a bone when you fall.

30-second Chair Stand test is a great way to test how strong your legs are.  Try it out and see if you’re at risk for falling.  If you are get to work and improve your muscle strength in your legs.

 Fall death rates in the U.S. from 2007 to 2016 for adults aged 65 and older. (CDC)

Fall death rates in the U.S. from 2007 to 2016 for adults aged 65 and older. (CDC)

From 2007 to 2016, 10 years, we saw the deaths per 100,000 in the United States as a result of falls go from about 46 to 60 (That’s a 30% increase). At this rate, by 2030, we’re going to see seven fall deaths every hour

The other day I slipped on some clothes my kids left on the stairs. What stopped me from falling down the stairs? Grip strength, the ability to grab the railing and stop my fall.

Fall death rates in the U.S. from 2007 to 2016 for adults aged 65 and older. (CDC)

Fall death rates in the U.S. from 2007 to 2016 for adults aged 65 and older. (CDC)

From 2007 to 2016, 10 years, we saw the deaths per 100,000 in the United States as a result of falls go from about 46 to 60 (That’s a 30% increase). At this rate, by 2030, we’re going to see seven fall deaths every hour

The other day I slipped on some clothes my kids left on the stairs. What stopped me from falling down the stairs? Grip strength, the ability to grab the railing and stop my fall.

Grip strength.

Grip strength is harder to test but it is still important. So, start working on hand strength by carrying heavy objects or get yourself a hand gripper. Carrying heavy objects for a workout is called a farmer’s carry. Farmer carries are good for your core as well as your hand/grip strength.

Get a Grip! – YouTube https://youtu.be/NXaQcKYeloY

Pushing, Pulling, Squatting & More! – YouTube (Farmer’s Carry)

So as we age it’s critical to work on maintaining muscle mass and strength to improve the quality of our lives. The stronger we are the more muscle we have the lower the morbidity and mortality. It’s never too late to start. It’s better never to stop building muscle.  

Figure 15. Paddon-Jones Curve.

A lot of people think that there’s a linear or gradual decline in muscle mass or muscle size as we age. The reality is that it’s a lot more staggered as you get into older age…if you’re injured or if you’re bedridden, for example, that accelerates the decline.

Much like saving money the more you have when you retire the more you have to withdraw from.  So start now and build as much muscle as possible.  Your life could depend on it.

So where to start:

  1. Get off the couch, the hardest lift is lifting yourself off the couch.
  2. Get outside and walk. It’s easy and free. 
  3. Find a big hill and walk up and down it once a week.
  4. Start lifting weights. A gallon of milk/water is a great start. If you need an idea on what to do go over to our YouTube page.
  5. Start doing Chair squats. Here’s a link to show how to do them
  6. Find something heavy and do farmers carries or static holds till you feel the burn.
  7. Anything is better than nothing.
  8. Come in or Call I would love to help.  Dr. Steve

Is sitting bad FOR YOUR health?

You probably hear that sitting too much can be harmful. Sitting is the new smoking, is another catchy phrase going around.  The average American spends almost eight hours sitting each day. This study found: Higher levels of total daily sitting time are associated with an increased risk of cardiovascular disease and diabetes, independent of physical activity.

So why is sitting harmful to one’s health. How bad is sitting for your health? Can you Conter act sitting with exercise? Let’s try to answer these questions.

How does sitting effect your health?   When a person is sitting or lying down for that matter, they use their muscles less. Muscle have more than the function of moving our bones. The health risks from more sitting (or being less active in general) seem to correlate with reduced levels of muscle contractions, which affect both the muscles themselves and whole-body energy metabolism.   

1. When we use our muscle it affects cardiac (heart) output and blood flow. Sitting all day make us use our heart less. INCREASEING THE CHANCE OF HEART DISEASE. Another way muscle effects heart health is by lipoprotein lipase (LPL) (a protein important for controlling plasma triglyceride breakdown, HDL cholesterol, and other metabolic risk factors. Reduce lipoprotein lipase activity causes, impair lipid (fat) metabolism increase one risk of heart disease.

2. Sitting requires less muscle activation. Skeletal muscle constitutes 40% of body mass and takes up 80% of a glucose from the blood. The less we use our muscle the less glucose it taken out of the blood and put into the muscle. This will cause the blood sugar to rise over time and could lead to insulin resistance.

During sitting, muscular passivity increases insulin resistance and influences the transport and oxidation of fatty acids in muscular tissue


One of the first series of controlled laboratory studies providing translational evidence for a molecular reason to maintain high levels of daily low-intensity and intermittent activity came from examinations of the cellular regulation of skeletal muscle lipoprotein lipase (LPL) (a protein important for controlling plasma triglyceride catabolism, HDL cholesterol, and other metabolic risk factors).

The health risks from more sitting (or being less active in general) seem to correlate with reduced levels of muscle contractions, which affect both the muscles themselves and whole-body energy metabolism.   
Sedentary behaviors reduce lipoprotein lipase activity, muscle glucose, protein transporter activities, impair lipid metabolism, and diminish carbohydrate metabolism.
 Furthermore, it decreases cardiac output and systemic blood flow while activating the sympathetic nervous system, ultimately reducing insulin sensitivity and vascular function.
It also alters the insulin-like growth factor axis and the circulation levels of sex hormones, which elevates the incidence of hormone-related cancers.
Increased sedentary time impairs the Gravito stat, the body’s weight homeostat, and weight gain, adiposity, and elevated chronic inflammation caused by sedentary behavior are risk factors for cancer.
Sedentary behaviors have wide-ranging adverse impacts on the human body including increased all-cause mortality, cardiovascular disease mortality, cancer risk, and risks of metabolic disorders such as diabetes mellitus, hypertension, and dyslipidemia; musculoskeletal disorders such as arthralgia and osteoporosis; depression; and cognitive impairment.
Therefore, reducing sedentary behaviors and increasing physical activity are both important to promote public health.

Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks (nih.gov) Why is excessive sitting a health risk? – PubMed (nih.gov) Lipid metabolism, exercise and insulin action – PubMed (nih.gov) Sitting Time, Physical Activity, and Risk of Mortality in Adults – PubMed (nih.gov)

Another reason for arm and hand pain and numbness

PRONATOR TERES SYNDROME


Do you have arm or hand pain or numbness in the hand? Do you have a painful forearm or weird sensations in your thumb and pointer finger? Maybe your forearm, wrist, and elbow have been aching. A quick online search for symptoms yields dozens of results for painful hand, wrist, and elbow conditions, making fact-finding confusing. Your pain and discomfort may partially match common wrist complaints like carpal tunnel syndrome, hand tendonitis, elbow pain, and other related conditions, or your symptoms don’t seem to fit any single situation — making it hard to tell what exactly is going on with yourself. One lesser-known condition that causes finger tendon and forearm discomfort is called pronator teres syndrome, and this culprit for finger, hand, wrist, and forearm pain lies close to the elbow. Pronator teres syndrome imitates other conditions; however, it is discernable.

Pronator Teres compress this nerve

But what exactly is pronator teres syndrome, and how can you tell pronator teres syndrome from other related wrist and hand conditions? What is pronator teres syndrome?

The elbow is a structure connecting bones, ligaments, connective tissues, the elbow joint, several muscles, bursa (fluid-filled sacs designed to absorb forces), and nerves. Repetitive or excessive movement causes injury and damage to these structures.

1) With this syndrome, a specific muscle is the victim: the pronator teres muscle of the forearm.

2) Excessive or repetitive movement can have many causes: carpentry, assembly line work, basketball, plumbing, weightlifting, mechanic work, or any repetitive movement that causes the wrist to bend and the forearm to go palm-down.

These excessive movements contribute to stress and strain on the pronator teres. This muscle lives in the upper forearm and has two ends or heads. When it becomes swollen or inflamed, it can affect other structures nearby, such as the median nerve of the forearm and wrist. Additionally, the median nerve can also be compressed by a local ligament coming off the bicep muscle: the lacertus fibrosis.

The median nerve is one of three nerves that supply our upper extremity. This nerve begins in the upper arms and extends into the wrist and fingers. When the pronator teres muscle compresses this nerve, it creates aching in the forearm and wrist, possible muscle weakness, and changes in sensation to the thumb and index finger.3 Pronator teres syndrome is like carpal tunnel syndrome, defined as compression of the median nerve at the wrist.3,4 However, pronator teres syndrome affects both the hand and the forearm, whereas carpal tunnel syndrome largely affects the wrist and hand only.

Common signs that the median nerve is being entrapped at the elbow include the following3,4:

  • Aching discomfort in the forearm and tenderness on palpating (pressing) into the pronator teres muscle
  • Tingling sensation in the forearm, palm, and/or fingers (including the thumb)
  • Numbness in the forearm, hand, and/or fingers (including the thumb)
  • Pain and discomfort in the forearm, hand, and/or fingers (including the thumb)
  • Muscle weakness in the forearm, wrist, and/or fingers (including the thumb)

With pronator teres syndrome, there may not be a history of trauma or injury associated with symptoms. Instead, the symptoms may come on gradually and worsen over time.3,4

Who gets pronator teres syndrome?

Several factors can put people at higher risk of developing pronator teres syndrome. (4) These include:

• People employed in occupations that increase the bulk of the pronator teres muscle such as mechanics, plumbers, and athletes in weightlifting or racket sports

• People with a history of trauma to the elbow resulting in restrictive bands of scar tissue or fibrous tissue in the forearm

The typical age of onset is in the fifth decade, and the condition is more common in women than men. Patients with metabolic disorders like diabetes, alcoholism, or hypothyroidism are predisposed to this condition.5

How do I know if I have pronator teres syndrome?

Symptoms of pronator teres include aching pain and discomfort on the volar (front) side of the forearm with sensory disturbances along the thumb, pointer finger, and even the palm of the hand. The pain may span the lower arm. You may notice discomfort when turning your wrist to go palm-down (pronation), or this maneuver may make your pain and changes in sensation worse.2,3,4 Is pronator teres syndrome essentially the same thing as carpal tunnel syndrome? Not really. Although the symptoms may be similar, the causes are very different and require different treatment approaches. Compression of the median nerve causes carpal tunnel syndrome by inflamed tendons where the wrist meets the hand; pronator teres syndrome is compression of the median nerve near the elbow due to hypertonic (tight) muscles, muscle adhesions, and/or the presence of scar tissue or fibrous tissue that compress the nerve.2,3 How is pronator teres syndrome treated? For mild to moderate cases of pronator teres syndrome, conservative treatments like chiropractic care and rehabilitation are the first line of defense to attempt resolution of the condition.

These non-surgical methods may include one or more of the following:

  • Chiropractic care
  • Manual therapy
  • Rest from the inciting activity
  • Anti-inflammatory pain medications
  • Forearm splinting to prevent rotating
  • Targeted exercises and rehabilitation.
  • Severe cases may require a minimally invasive surgical intervention to relieve the pressure on the median nerve.

Thankfully, most cases don’t need it.

Call Sikorsky Chiropractic Clinic for an appointment today.

 References

1. Chumbley EM, O’Connor FG, Nirschl RP. Evaluation of overuse elbow injuries. Am Fam Physician. 2000 Feb 1;61(3):691-700.

2. Plancher KD, Peterson RK, Steichen JB. Compressive neuropathies and tendinopathies in the athletic elbow and wrist. Clin Sports Med. 1996 Apr;15(2):331-71.

3. Posner MA. Compressive neuropathies of the median and radial nerves at the elbow. Clin Sports Med. 1990 Apr;9(2):343-63.

4. Howard FM. Compression neuropathies in the anterior forearm. Hand Clin. 1986;2:737-745.

 5. Tetro AM, Pichora DR. High median nerve entrapments. An obscure cause of upper-extremity pain. Hand Clin. 1996;12:691-703. 6. Dididze M, Tafti D, Sherman Al. Pronator Teres Syndrome. [Updated 2021 Aug 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526090

Where is her Foot pain coming from?

Thanks to this patient for being a case study

Where is the pain coming from? Sometimes the problem is above or below where the patient is experiencing the pain.

This patient is having pain on the inside of her right foot. She reports it hurts to walk and stand for moderate periods.

Watching a patient walk and examine how the patient stands can help you find out where the problem is coming from. Standing and walking can give you clues into what causes the patient pain.

Look at the stickers on the patient foot and knee. See anything? There is an increase angle in the shin bone (tibia bone). It’s also called a valgus knee or knocked knee. Having this can cause increased load on the inside of the knee and foot/ankle.

When we are not symmetrical or vary off from normal, we will cause changes in the body. Some time we can deal with these changes and never develop any problems or pain. Other time these changes off can lead to break down and pain. Tissue in the body can breakdown when they fail to heal. Failed repair leads to tendonitis, tears, stress fracture, muscle strains and even disc herniations

In this patient she has developed pain on the inside of her right arch and plantar fascia. She has also developed tendonitis in a muscle called tibialis posterior.

Now to the video. The patient gait is even more telling. Patient has a very narrow gait, a kicking type leg swing and too much rocking of the hips and upper body. Her feet are turned outward or extrenally rotated

A narrow gait can lead to all types of problem, here just a few. Hip, knee and ankle/foot pain.

Weakness in the Glutes can cause a narrow gait along with a kicking type gait. The quadriceps are muscles in the front of the legs and can become dominant if the glutes become very weak.

Do you want to be fit & healthy at 80?

Age is nothing but a number, you can be fit at ANY age!

Can you be fit and healthy at 80? The answer is yes.

So how can you be fit and healthy at eighty? So what exercise should I do? What type of exercise will help me stay healthy or will help me become more healthy? You’re going to find out.   

The type of exercise will depend on what the end goals are. If you’re going to run a marathon it will be different than if you want to be a bodybuilder. This article will discuss exercising in the context of health and improving one longevity. 

Generally, speaking exercise can fall into two broad categories: Cardiorespiratory fitness and Strength/muscle mass. Both of these play the role of improving life span. The scientific literature shows that morbidity and mortality risk increase as fitness levels decline with age. Sarcopenia is associated with adverse health outcomes. 

Now for some definitions.

What are morbidity and mortality? Morbidity is the condition of suffering from a disease or medical condition. Mortality is the state of being subject to death. 

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory (heart and associated blood vessels) and respiratory (Lungs) systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. Mitochondria are inside most cells and they make energy.

Muscular strength can be defined as the ability to exert force to overcome resistance In other words the ability to pick up or move objects around. 

Muscle mass is the amount of muscle in your body, including skeletal muscles, smooth muscles, and cardiac muscles. 

Loss of muscle mass and strength is known as Sarcopenia.  

Let’s talk about cardiorespiratory fitness

Cardiorespiratory fitness is measured in VO2 max. VO2 max, or maximal oxygen consumption, refers to the maximum amount of oxygen that an individual can utilize during intense or maximal exercise.  

Have you ever gone up a flight of stairs ran for the bus and got out of breath? You just tested your VO2 max. The better your VO2 max the better you’re able to exchange oxygen (O2) in the body. 

Here’s a study association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. The study found “The adjusted mortality risk of reduced performance on exercise treadmill test was comparable to, if not greater than, traditional clinical risk factors (eg, coronary artery disease, smoking). Importantly, there was no upper limit of the benefit of increased aerobic fitness”. So having poor cardiorespiratory fitness is as dangerous as smoking for your health and life span.  That right having low cardiorespiratory fitness is as dangerous as smoking.  The study broke down the participants into low, below average, average, high, elite. Going from just being low to being below average is a 50% reduction in mortality over a decade. If you then go from low to above average it’s about 60%  above average, it’s about a 60% or 70% reduction in mortality.   

How can we improve VO2 max? 

Well, it’s cardio. Any type of cardio, walking, rowing, or riding the bike. Any exercise that gets your heart rate up. You don’t have to do a bone-crushing workout every day to improve or keep your VO2. About 20 minutes once a week would be a good amount. So if walking is your form of cardio find a big hill and do hill repeats (walk up the hill quickly) and then walk down, let your heart rate recover, and do it again. The same principle can go for riding a bike. Go hard for 1 minute and then recover and repeat. Do that once a week and that will help your V02 max and improve your oxygen exchange.

Doing this type of cardio once a week is great for your health. Some tips start slow, no need to do 20 hill repeats the first time out. 

Start with 3-5 reps and build from there. If you feel any chest pain or thing that does not feel normal a call your doctor or heart doctor (Cardiologist). If the discomfort is too bad go to the ER. 

Now the other days you train, your cardio should be different. You should be training Zone 2. Zone 2 is steady training just coming above the easy zone, It’s not moderate or anything above. The main benefit form zone 2 heart rate or zone 2 power is that it builds an aerobic base and endurance. The best formula to figure out Zone 2 heart rate is the following.

(Your age)-180= Target heart rate.

I’m 48 years old so my target heart rate is 133. (180-47=133)

The benefits of Zone 2 training are, increased mitochondria (the power plant of the cell), increased mitochondrial efficiency, lower heart rate, lower blood pressure, and finally help with insulin resistance.

So doing both types of cardio will help you balance your cardiorespiratory fitness. A good ratio is 80% zone 2 and 20% hard. 

Strength/Muscle mass

Sarcopenia, or the decline of skeletal muscle tissue with age, is one of the most important causes of functional decline and loss of independence in older adults. An average person can lose 1-4% of their lean mass (muscle) and year. 

Figure 9. Strength loss with aging in literature (Keller and Engelhardt, 2013).

If you have low muscle strength, then you have probable sarcopenia. 

AS we age we replace our muscle fibers with fat and connective tissue. 

So the muscle loses its ability to contract (contractile function) and muscle metabolic function. Muscles need lots of energy, so they use a lot of blood glucose (sugar). If a person has less muscle then they use less sugar/blood glucose leading to insulin resistance and then type 2 diabetes

Two ways to see how well you’re doing are the sit-to-stand test and grip strength test. This study Strength, But Not Muscle Mass, Is Associated With Mortality in the Health, Aging and Body Composition Study Cohort.  The authors used sit-to-stand test and grip strength test, in their study to see how strength affects Mortality.

 Low muscle mass did not explain the strong association of strength with mortality, demonstrating that muscle strength as a marker of muscle quality is more important than quantity in estimating mortality risk. Grip strength provided risk estimates similar to those of quadriceps strength.  

The ability to get out of a chair without using your arms is very important. This movement is a squat. If you trip over a sock while going to the bathroom at night you need the strength in your leg to prevent you from falling and potentially hitting your head or breaking a bone when you fall.

30-second Chair Stand test is a great way to test how strong your legs are.  Try it out and see if you’re at risk for falling.  If you are get to work and improve your muscle strength in your legs.

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Figure 13. Fall death rates in the U.S. from 2007 to 2016 for adults aged 65 and older. (CDC)

Figure 13. Fall death rates in the U.S. from 2007 to 2016 for adults aged 65 and older. (CDC)

From 2007 to 2016, 10 years, we saw the deaths per 100,000 in the United States as a result of falls go from about 46 to 60 (That’s a 30% increase). At this rate, by 2030, we’re going to see seven fall deaths every hour

The other day I slip on some clothes my kids left on the stairs. What stopped me from fall down stairs? Grip strength, the ability to grab the railing and stop my fall.

Grip strength.

Grip strength is harder to test but still important. So start working on hand strength by carrying heavy objects or get yourself a hand gripper. Carrying heavy objects for a workout is called a farmer’s carry. Farmer carry are good for your core as well as your hand/grip strength.

So as we age it’s critical to work on maintaining muscle mass and strength to improve the quality of our lives. The stronger we are the more muscle we have the lower the morbidity and mortality. It’s never too late to start. It’s better never to stop building muscle.  

Get a Grip! – YouTube

Pushing, Pulling, Squatting & More! – YouTube (Farmer’s Carry)

Figure 15. Paddon-Jones Curve.

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A lot of people think that there’s a linear or gradual decline in muscle mass or muscle size as we age. The reality is that it’s a lot more staggered as you get into older age…if you’re injured or if you’re bedridden, for example, that accelerates the decline.

Much like saving money the more you have when you retire the more you have to withdraw from.  So start now and build as much muscle as possible.  Your life could depend on it.

So where to start:

  1. Get off the couch, the hardest lift is lifting yourself off the couch.
  2. Get outside and walk. It’s easy and free. 
  3. Find a big hill and walk up and down it once a week.
  4. Start lifting weights. A gallon of milk/water is a great start. If you need an idea on what to do go over to our YouTube page.
  5. Start doing Chair squats. Here’s a link to show how to do them
  6. Find something heavy and do farmers carries or static holds till you feel the burn.
  7. Anything is better than nothing.

Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims

I treat a lot of patient who have seen other doctors before walking into my office. Lots of them have had lots of testing (MRI’s, C.T’s, EMG/NCV) before they even see me. Many of times these tests are a waste of time and money. This study shows if patients see a chiropractor first they would have less testing and in turn save money . This study found patients who did not see a chiropractor first had 2x risk of escalation. This means being sent for  imaging, injection, emergency room, or surgery. A simple rule of thumb to follow is chiropractic first, medicine second and surgery last. A high quality exam will direct care and must be done first. Here’s the study.

Chiropractic FIRST, Medicine SECOND, Surgery LAST.

The Study: Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims

Results

The sample was 55% women, with a mean age of 44 years (range, 18-103). Treatment escalation was present in 42% of episodes overall: 2448 (46%) associated with other care and 876 (26%) associated with spinal manipulation. The estimated risk of any treatment escalation was 2.38 times higher in those who received other care than in those who received spinal manipulation (95% confidence interval, 2.22-2.55, P = .001).

Conclusion

Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation. In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain.