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Common Conditions

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition caused by the compression of the median nerve, typically within the carpal tunnel in the wrist, however there are two other places in the arm this compression can occur like the pronator teres muscle and bicipital aponeurosis. This compression can lead to sensory and motor deficits, affecting the hand and fingers. CTS affects a significant portion of the population, with occurrences ranging from 3% to 16%.

Factors that increase the risk of CTS include repetitive wrist movements, prolonged wrist flexion or extension, and extended use of smartphones or exposure to vibrations. Occupations involving repetitive manual tasks, such as assembly line work, are at higher risk for CTS compared to desk jobs.

Underlying health conditions such as diabetes, hypothyroidism, rheumatoid arthritis, and vitamin deficiencies also contribute to CTS. Trauma, fluid retention during pregnancy, and certain anatomical factors are also known to cause CTS

More severe cases are often linked to factors like vitamin B12 deficiency and obesity. The syndrome is more common in the dominant hand and can sometimes affect both hands. Understanding the various risk factors and mechanisms behind CTS is crucial for both prevention and management.

References

  1. Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. The Journal of hand surgery. 2001 May 1;26(3):460-6. Link

  2. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. Jama. 1999 Jul 14;282(2):153-8. Link

  3. Upton AM, Mccomas A. The double crush in nerve-entrapment syndromes. The Lancet. 1973 Aug 18;302(7825):359-62. Link

Discogenic Neck Pain

Discogenic pain refers to discomfort or dysfunction originating from the intervertebral discs in the neck, specifically the six discs between the C1 and T1 vertebrae. These discs have a strong outer layer of annular fibers and a gel-like inner core made of water, proteins, sugars, and collagen.

When the outer fibers are damaged, the disc may bulge or herniate, pressing on nearby nerves. Symptoms may include pain, pins and needles, numbness, or weakness in the hands, shoulders, or upper back. Early disc damage may not cause symptoms since only the outermost fibers have nerve endings. However, disc issues are common, especially as we age.

Most disc herniations occur at the C5-6 or C6-7 levels in the neck. These issues usually develop gradually due to age-related changes and repetitive stress, such as poor posture, heavy lifting, or excessive smartphone use. Reduced neck curvature can increase the risk of disc problems. Understanding these factors can help in managing and preventing disc-related pain.

References

  1. Healy JF, Healy BB, Wong WH, Olson EM. Cervical and lumbar MRI in asymptomatic older male lifelong athletes: frequency of degenerative findings. Journal of computer assisted tomography. 1996 Jan 1;20(1):107-12. Link
  2. Constantoyannis C, Konstantinou D, Kourtopoulos H, Papadakis N. Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks. Journal of manipulative and physiological therapeutics. 2002 Mar 1;25(3):188-92. Link
  3. Kramer J. Intervertebral Disk Diseases. Causes, Diagnosis, Treatment and Prophylaxis. George Thieme Verlag, Stuttgart Year Book, Medical Publishers Inc; 1981.

Chronic Ankle Instability (CAI)

A lateral ankle sprain is a common sports injury, but 40-46% of people who sprain their ankle may develop chronic ankle instability (CAI). This condition leads to frequent ankle sprains, reduced ankle function, and even arthritis. Children with CAI often have weaker legs, poor balance, and lower physical activity levels, which could impact their long-term health.

CAI is common among athletes, especially those in sports like basketball, soccer, and gymnastics. The condition often arises from repeated injuries to the ligaments on the outer side of the ankle, particularly the anterior talofibular ligament (ATFL), which is most common.

CAI can cause ongoing instability and increase the risk of other injuries, including knee and hip problems. Understanding CAI is essential for preventing further damage and maintaining overall mobility.

References

  1. Hertel J, Corbett RO. An updated model of chronic ankle instability. Journal of athletic training. 2019 Jun;54(6):572-88. Link

  2. Lin CI, Houtenbos S, Lu YH, Mayer F, Wippert PM. The epidemiology of chronic ankle instability with perceived ankle instability-a systematic review. Journal of foot and ankle research. 2021 Dec;14(1):1-1. Link

  3. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–40. Link

Chronic Low Back Pain

Chronic low back pain (CLBP) is typically defined as lasting for three months or longer. Unlike acute back pain, which is often linked to a specific injury or strain, CLBP can continue despite treatment and may not have a single, clear underlying cause. This condition massively reduces quality of life, and can lead to long-term disability. Factors contributing to CLBP include poor posture, repetitive stress, underlying health conditions, and even psychological factors. Managing CLBP often requires a multidisciplinary approach to address both the physical and psychological aspects of the condition. In our practice we find that chronic low back pain responds best to adjustments, rehabilitation of deep spinal muscles, and lifestyle changes that disrupt the cycle of pain or the negative feedback loop.

References

  1. coming soon

Dysfunctional breathing (lack of ribcage expansion)

This is arguably one of the most important conditions we screen for during your initial visit. Too much upper rib cage elevation with very little abdominal expansion, or lower ribcage expansion is problematic for 2 reasons.

1. The accessory breathing muscles like the SCM and scalene muscles are too active and can become chronically shortened causing neck pain or stiffness.
2. Lack of lower ribcage control can lead to poor stabilizing patterns and poor mechanics which increases your risk of injury.

Proper breathing involves a wave-like expansion of the rib cage. This expansion begins in the abdomen and should be symmetrical, with equal movement on both sides of the rib cage. We often lose the proper stabilization pattern through poor workstation mechanics, sedentary lifestyles, vanity reasons, mouth breathing, etc.

References

  1. coming soon

Femoroacetabular Impingement (FAI)

Femoroacetabular impingement (FAI) often affects young, active individuals, particularly athletes. It typically involves a dull, achy pain in the front of the hip or groin, which may spread to the side of the thigh or hip. This discomfort is often aggravated by activities like prolonged sitting, stair climbing, or movements that involve hip flexion and rotation.

FAI may initially present as clicking or popping in the hip, with pain worsening over time. Certain tests are used to identify this condition in the office.

Patients with FAI often show limited range of motion, especially in flexion and internal rotation, and may have altered walking and squatting patterns.

Conditions such as lumbopelvic stiffness, pubic symphysis issues, and abnormal hip structure may also contribute to hip pain and are not always resolved with surgery.

References

  1. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clinical orthopaedics and related research. 2009 Mar 1;467(3):638-44. Link
  2. Tijssen M, van Cingel R, Willemsen L, de Visser E. Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012 Jun 1;28(6):860-71. Link
  3. Schmerl M, Pollard H, Hoskins W. Labral injuries of the hip: A review of diagnosis and management. Journal of Manipulative and Physiological Therapeutics. 2005 Oct 1;28(8):632-e1. Link
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