Interestingly, pain doesn’t occur where you “feel” it or believe it to exist. In fact, pain really isn’t a “thing”. Pain is a perception triggered by the activation of certain areas in the brain. These “pain centers” (the neurology can get quite complex, so I’ll keep it simple) in the brain receive signals from specific nerves that have pain receptors (nociceptors) on them. So in the case of low back pain, for instance, the nociceptors harbored in the spinal joints, muscles, etc. get stimulated which then send nerve transmissions to be interpreted by the brain as pain. It’s because of this reason that “nerve blocks” work; basically blocking the signal to the brain. Now, what do we do about pain (other than a nerve block)?

Well, that of course depends on the type of pain you’re talking about. You see, nociceptors can get stimulated in different ways. Specifically, they respond to mechanical forces, inflammatory chemicals, and temperature changes.

As far as mechanical forces go; compression or stretching of a nerve(s) causes the stimulation of nociceptors, and results in the perception of pain. This can be caused by any number of structural imbalances, whether acute or chronic. The treatment for this type of “pain” stimulation is to balance muscle and joint function in order to eliminate the compression or stretching of the nociceptor. Furthermore, balancing muscle and joint function results in the stimulation of nerves that harbor mechanoreceptors (sensitive to light touch, vibration, position-sense, etc.) which actually act to: a) directly block the transmission of nociceptor signals to the brain, and b) travel faster to the brain in order to allow for the perception of something other than pain. By the way, “a” and “b” are the reason we rub an area of pain in order to relieve it.

Chemical pain, on the other hand, results from the stimulation of nociceptors via various inflammatory mediators/chemicals. So why do inflammatory mediators get released? Simple, because of tissue damage. This can certainly result from a structural abnormality that causes damage; in addition to a “chemical assault” that results in inflammation such as a food allergen or sensitivity, infection, toxin, or nutritional deficiency. All of the above can (and usually do) cause an inflammatory reaction. The chemicals involved include the likes of histamine, prostaglandins, thromboxanes, leukotrienes, etc.. As a result, these chemicals need to be kept at bay in order to prevent pain from being perceived. This is the reason why you may still sometimes feel pain after a chiropractic treatment. The treatment is designed to balance the structural components of dysfunction, however if there are still inflammatory chemicals circulating in response to tissue damage, the pain will persist. Once the healing begins, the pain should diminish and ultimately resolve. Chemical mediators of pain can be controlled by balancing muscle and joint function in order to prevent further damage, in addition to being controlled by nutritional substances that assist in healing and reducing inflammation.

Thermal or temperature-related pain… To relieve this…take your hand off the stove and don’t play with matches!

This idea of mechanical and chemical-mediated pain can be of extreme importance in diagnosis. Let me explain. If the pain experienced can be fully relieved by holding your body in a certain position, then your pain is solely caused by mechanical insults. However, if there is no position you can get into that relieves the pain, your problem most definitely has an inflammatory chemical component to it. And of course, if a certain position relieves some of the pain but not all of it, then there is both a mechanical and chemical component involved (this is most often the case). Whenever there is a chemical component to the pain, your doctor needs to have methods that can easily determine why you are inflamed. Remember, this can be the result of the normal repair process from structural damage, a chemical toxin, a food allergen or sensitivity, and/or a nutritional deficiency.

Several decades ago, it was found out that the mind cannot be separated from the body (through the field of psychoneuroimmunology). Now, if we were to dismiss the chemical component of pain, we’d basically be trying to separate the body from the body. Hopefully this helps to explain why your doctor may ask you to avoid certain foods, change your diet altogether, and take supplements even though your primary complaint is “physical” pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

some information in this article was sourced from: Chris Astill-Smith, DO, DIBAK – metabolics.com

Symptoms

The main symptom of plantar fasciitis is pain on the sole of the foot, especially on the heel. Additionally, it tends to hurt the most just after stepping out of bed in the morning, and may get better as the day goes on. However, it may also get worse with walking.

Causes

The primary cause of plantar fasciitis is overpronation of the foot; which is also referred to as “flat feet” or “fallen arches” in lay terms. If you think of the foot and its (plantar) fascia as a bow and arrow, the fascia would be the string and the bow would be the bones of the foot. In a biomechanically-sound foot, an arch is present which gives it the bow-like structure. Now, imagine if the arch (or bow) “dropped” (or straightened) as in overpronation; then picture what happens to the string on the bow (i.e.: the fascia). Essentially, it will have to stretch to accommodate the “flattening out” of the bones of the foot. It is this stretching and excessive tension of the fascia that can lead to the painful condition known as plantar fasciitis. Other factors that can contribute to plantar fasciitis are excessive pounding on the foot (as in jogging or jumping) and a tight achilles tendon or calf muscle.

Treatment

Conventional treatment can include the use of orthotics, anti-inflammatory medication, and stretching exercises.

Chiropractic and applied kinesiology treatment consists of correcting the cause of the problem. If this relates to overpronation, the muscles and joints of the foot and lower leg need to be evaluated and treated appropriately. Certain muscles may need stretching and lengthening, while others need strengthening and shortening. Also, joint motion will most likely need to be restored in the foot and ankle with chiropractic adjustments. The integrity of the ligaments may need to be supported through specialized applied kinesiology treatment and possibly through nutritional supplementation. Also, supplements to assist with quelling inflammation and to speed healing may be warranted. If necessary, orthotics may be prescribed to assist in maintaining the structural integrity of the foot. Whether or not orthotics need to be used permanently depends on the severity of the problem. Most importantly, a treatment plan needs to be designed to fit each individual’s needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

The rotator cuff is a group of four different muscles that help stabilize and move the upper arm bone (humerus). Specifically, the rotator cuff helps stabilize the ball-and-socket (or gleno-humeral) joint of the shoulder to prevent a dislocation; as well as help raise and rotate the arm. The muscles of the rotator cuff include the supraspinatus, infraspinatus, subscapularis, and teres minor. Usually, injuries to the rotator cuff involve a tear or degeneration of the tendon(s), most often the supraspinatus tendon.

The supraspinatus tendon is tucked under the (acromio-clavicular or AC) joint formed between the collarbone and the tip of the shoulder blade (acromion). This joint is on the top of the shoulder where the strap of your bag may rest. The supraspinatus tendon often becomes compromised during activities that include prolonged overhead movements; such as in sports like baseball, volleyball, tennis, acrobatics, etc.. Essentially, the tendon continuously gets damaged (possibly leading to a tear) from being “impinged” under the AC-joint. This can result in pain, weakness, and/or limited range of motion of the arm. There are other ways that injuries to the rotator cuff muscles occur, but impingement is a common one.

Now, when an injury involves damage to the rotator cuff muscle(s), they are usually deemed to be the problem. Conventional treatments are often directed at exercises for rehabilitating the rotator cuff, therapeutic ultrasound, oral or injected anti-inflammatories, or surgery in severe cases.

My approach to rotator cuff syndrome is a bit different. I usually find that injuries to the rotator cuff muscles and tendons often do not stem from an inherent problem with the rotator cuff. Instead, I usually find that the main problem lies within the larger muscles of the other shoulder joints that help to prevent the humerus from “impinging” under the AC-joint; and that help stabilize the shoulder blade and collarbone. Usually, when I get the other, larger muscles firing properly and restored to their normal length, the rotator cuff muscle(s) will not become compromised and then allowed a chance to heal and function properly. Additionally, I evaluate the joints and correct the movement of the shoulder blade, collarbone, and humerus when necessary. Specialized treatments for ligaments, tendons, connective tissue (fascia), and even skin may also be employed. Lastly, evaluating the cervical spine for joint dysfunction is critical, as the nerves that exit the cervical spine control the muscles of the shoulder. Eventually, a rehabilitative program targeting the appropriate muscles causing the problem is undertaken. This is aimed at preventing a recurrence of the problem and a return to normal activities.

So even if you’ve been diagnosed with rotator cuff syndrome or impingement syndrome; it would be prudent to have your entire shoulder complex and cervical spine evaluated for dysfunction to determine the ultimate cause of the problem.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

This condition has often been found to be instigated by a cold breeze on the face (such as sleeping or driving with a window open), shaving, chewing, brushing your teeth, extreme opening of the mouth (such as in yawning), or sometimes for no known reason. Other, more serious problems like multiple sclerosis and tumors may be a cause. The more common reasons for changes in the function of this nerve have been deemed to be due to inflammation from an infection or pressure of a muscle or blood vessel.

The standard medical treatment for this condition is typically anti-convulsants, muscle relaxers, or maybe antibiotics (if it’s secondary to an infection). If medication doesn’t work, surgery may be the next step in conventional treatment.

My personal approach to this disorder is to restore proper motion and function of the cranial bones that this nerve passes through. This would include gentle cranial bone and cervical spine adjusting, in addition to balancing the muscles of the head, neck, and TMJ. Other factors affecting the alignment of the cranial bones, cervical spine, and TMJ would definitely need to be considered as well; which may include correcting the biomechanics of the pelvis and feet.

Nutritional considerations might include supplements that help control inflammation, reduce muscle spasms, and/or up-regulate the immune system. The most important thing to consider is that we are all individuals and treatment is based on your specific needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

sources: http://www.icakusa.com/ + http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446

Symptoms of TMJ dysfunction typically include the following: jaw pain, clicking or popping in the joint, decreased mouth opening, headaches, neck pain, tinnitus (ringing in the ears), and vertigo or dizziness. However, because of its large representation in the brain, I check it in on almost all my patients. Other than musculoskeletal complaints, endocrine gland imbalances can also result. This is because the “master” endocrine glands, the pituitary, hypothalamus, and pineal reside in the skull. And because structure determines function, these glands can dysfunction (and affect other glands they control) if the cranium is distressed due to muscular imbalances in the TMJ. Symptoms can vary and include but are not limited to: infertility, insomnia, hypo/hyperthyroidism, adrenal stress syndrome, PMS, increased or decreased appetite, digestive disturbances, etc..

Causes of TMJ dysfunction include muscular imbalances in the head and neck, faulty posture, malocclusion (irregular contact of the upper and lower teeth), grinding or clenching the teeth, chewing on only one side, pelvic imbalances, and even over-pronation in the feet.

Treatment of the TMJ generally includes leveling the head on the neck through chiropractic adjustments to the cervical spine, in addition to balancing the muscles of the neck and jaw. However, as stated above, the pelvis and feet can play a role in TMJ function as well.

The TMJ usually becomes dysfunctional because of other areas of the body that affect it; unless there has been direct trauma to it, as in boxing or a head injury. Therefore, I rarely go straight to the TMJ. But it is certainly worth checking no matter what the patient suffers from.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

The sciatic is a bundle of nerves composed of nerves from the lower spine (~levels L4-S3) and usually runs it course under the piriformis. Interestingly, it is believed that in roughly fifteen percent of the population, the sciatic nerve actually goes through the piriformis muscle.

Piriformis syndrome occurs when the piriformis is overly contracted, shortened, or tight and puts pressure on the sciatic nerve. The result of this is typically (the proverbial) “pain in the butt” and possibly down the back of the thigh, and sometimes pain that radiates into the low back.

Now, the question remains: “Why is the piriformis overcontracted, shortened, or tight in the first place?”. Well, realize that there are basically two muscles that cross and thus stabilize the sacroiliac (or pelvic) joint on either side. These are the gluteus maximus (or buttock muscle) and the piriformis. Typically when I encounter a patient with piriformis syndrome, I find the gluteus maximus to be under-functioning; i.e.: neurologically inhibited. As a result, the piriformis seems to be left to do the job of stabilizing the sacroiliac joint on its own. Obviously, by design, it was meant to have the help of the gluteus maximus muscle, and without it the piriformis may reflexively over-contract or shorten to give the most support possible. The result is then excessive pressure or irritation to the sciatic nerve. Bear in mind that there can certainly be other causes of piriformis tightening or contraction, however the example just mentioned seems to be the norm in what I’ve encountered.

Standard treatment is generally aimed at stretching the piriformis, in addition to deep massage and perhaps anti-inflammatory medication.

Typically, I’ll look to the reasons behind gluteus maximus muscle inhibition if I find that is the major cause of the tight piriformis. This can include pelvic joint dysfunction, ligament laxity in the pelvic joints, lumbar (low back) and sometimes cervical (neck) spine joint dysfunction, lower extremity (hip, knee, ankle, and/or foot) dysfunction, and in some instances nutritional deficiencies.

I aim to address the cause of the piriformis dysfunction in the first place. I have many patients who do not stretch their piriformis and still do not have piriformis syndrome; so we can be certain that the cause of piriformis syndrome is not a lack of stretching. If it was, everyone who didn’t stretch that muscle would have piriformis syndrome. Don’t get me wrong, stretching is often indicated, however my point is that the cause of the tightness needs to be addressed or this problem will generally recur and perhaps cause other complications.

There may also be a problem with an inhibited priformis on the opposite side or inhibited internal hip rotators contributing to or causing the problem. Because of the inter-relatedness of all parts of the body, there can be any number of primary causes for this condition. This article is meant to be a general introduction into the problem, so I’ll leave it there.

All in all, the muscles that support the pelvis should be evaluated for dysfunction. And the alignment and motion of the pelvic joints and lumbar spine need to be restored. Specialized treatment for ligaments, tendons, and fascia (connective tissue) may also be required. A home stretching and strengthening program may be given to help support the treatment, while helping prevent a future recurrence. Nutritional supplements designed to increase healing and reduce inflammation may also be of benefit.

Strangely enough, doctors used to doubt that piriformis syndrome even existed, but that thinking seems to be obsolete now . Dr. Janet Travell, John F. Kennedy’s doctor certainly believed in the occurrence of piriformis syndrome; as she has been reported to say that it was more common than spinal disc herniations (or “slipped disc”) as a cause of back pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Signs or symptoms
Swelling, bruising, and pain are typical after an ankle sprain.

Causes
Again, this can be caused by a sudden twisting of the ankle if your foot lands on the ground the wrong way. But if this happens during everyday activities, there was mostly likely an imbalance in the coordination of the ankle muscles to begin with.

Standard Treatment
Generally this includes rest, ice, and elevation of the ankle during the immediate or acute stage. Additionally, taping the ankle and anti-inflammatory medications may be used. After the acute stage calms down a patient may go through a physical therapy regimen of stretching and strengthening, and proprioceptive training such as the use of a balance or wobble board. If there is a complete tear of any ligament(s), surgery would be warranted.

Applied Kinesiology Treatment
Restoring proper muscle function is paramount in achieving immediate and lasting results. Usually the muscles on the outside of the lower leg (the peronei) are injured and neurologically inhibited or “weak”. Getting these muscles to function appropriately is essential, as it is often the initial reason the ankle got sprained in the first place. This can be done through treatment directly to the muscles as well as through restoring normal ankle joint function. Additionally, the skin overlying the ankle very often requires treatment; as the stretching of it during the injury causes the neurological receptors in the skin to adversely affect the function of the adjacent muscles. After the inhibited muscles have been treated, it is often necessary to correct imbalances in muscles that have reflexively tightened or shortened as a result of compensation. This is done through specific techniques that address trigger points in muscles. Foot, ankle, knee, hip, pelvis, and spinal joints should then be evaluated to ensure proper motion. Joint dysfunction is corrected through standard chiropractic adjustments. Techniques to help restore ligament function and integrity may also be warranted. And lastly, nutritional support to aid in healing and help control inflammation may be indicated.

As you can see, there are a number of different techniques that can be employed to treat people with this condition, and what is used will depend on the individual. In my experience working with patients, many people re-sprain the same ankle multiple times. This is usually because the original sprain was never treated effectively. Please understand that being out of pain does not mean that optimal function has been restored. So don’t ignore an old (or new) injury.

Before I finish, I’d like to share a case about a patient with an old ankle injury. A gentleman in his mid-40′s came in because of a lumbar (low-back) disc herniation he suffered from chopping wood. He couldn’t stand up straight because of the pain. After several treatments he was out of pain, however, he still wasn’t standing up straight. We continued treating him, but his posture just would not budge. Again, he was out of pain, but he really was like the crooked man living in the crooked house. At some I decided to look further; specifically to his feet. At that point he remembered having suffered a sprained ankle some twenty years earlier. I immediately addressed his ankle biomechanics and he finally straightened up. In fact, because his ankle had been distorted for so long, he needed a heel lift inserted in his shoe as well. It may have been possible to help him without a heel lift, but it would have taken quite a while to reverse the compensations that had set in after twenty years. I would have went for the “crutch” of a heel lift as well if I couldn’t stand up straight!

It’s very common to see old injuries cause problems later in life.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Signs or Symptoms
Pain or discomfort in the Achilles tendon with up or down movement of the ankle and foot; as in walking, running, and climbing stairs. Quite often, pain is also elicited by simply touching or applying pressure to the tendon. A decrease in range of motion will usually result due to the pain; and swelling may be noted in severe cases.

Causes
Overuse of the calf muscle as in long distance running, or running up hills can often result in Achilles tendonitis (bear in mind that overuse can sometimes mean insufficient recovery). Direct trauma to the tendon, perhaps from being kicked while playing sports may also be a cause. Poorly fitting shoes should be considered, especially if there is undue pressure being exerted on the tendon itself. Structural misalignments or abnormalities like dysfunction in the joints of the foot and ankle (including over-pronation), or a short leg can also be a cause. However, the most common cause is an over-contraction of the calf muscle which attaches to the Achilles tendon. (I’ll address this at the end of the article)

Standard Treatment
Generally, rest, ice, stretching, and anti-inflammatory medications are recommended. Other physical therapy modalities such as therapeutic ultrasound or electric muscle stimulation may be used. In some circumstances, a heel lift may be used.

Applied Kinesiology Approach
The focus of applied kinesiology treatments for any musculoskeletal complaint is proper muscle balance. In the case of Achilles tendonitis, I would consider a weakness in the muscles that act as synergists or antagonists to the calf muscle. This might explain why the calf muscle is over-contracted, or tight and shortened in the first place. Joint alignment, whether in the lower extremity, spine or pelvis should also be considered as aggravating factors, and corrected with standard chiropractic adjustments.

The most common cause I see is inhibited muscles in the lower leg (known as the peronei). This tends to be the primary reason for a tight calf muscle. In addition, nutritional factors may need to be considered. And, as always, a specific treatment plan for each individual is recommended.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Source: International College of Applied Kinesiology

Causes of snapping hip syndrome

The snapping sensation results from the movement of a muscle or tendon over a bony structure. In the hip, one most common site is over the outer portion of the upper leg where a band of tissue, the iliotibial band, passes over the thighbone. Additionally, the gluteus medius tendon can also rub over the outside of the thighbone.

Other common areas are on the inner leg where the adductors or psoas become shortened. Here the snapping sound occurs when the leg is rotated outwards as in sitting cross-legged on the floor or in a yoga pose.

If the iliotibial band is involved, it is too tight and rubs against the leg bone. This occurs because when the hip is straight; the band is behind the trochanter of the femur or thigh bone. When the hip bends, the band moves over the upper leg bone so that it is in front of it. Because the leg bone is shaped with a bend in it, it juts out and the movement of the band across it creates the snap you hear.

If the adductors are too short and tight it can cause dysfunction in the hip joint itself, resulting in a snapping of the hip.

If the psoas is too short and tight it can rub or snap over one of several bony prominence known as the anterior inferior iliac spine (on the pelvic bone), lesser trochanter (on the inside of the femur), or the iliopectineal eminence.

A tear in the cartilage or some bone debris in the hip joint can also cause a snapping or clicking sensation. This type of snapping hip usually causes pain and may be disabling. A loose piece of cartilage can cause the hip to catch or lock up

Complication of a snapping hip

The complications of this, if the underlying conditions are not corrected, are tendonitis, bursitis and hip joint degeneration. Tendonitis is an inflammation of the tendons of the muscles, those that attach to the iliotibial band
as well as the muscles that hold the leg in the hip socket and those that control the motion of the hip and leg.  Bursitis is a thickening and inflammation of the bursa, a fluid-filled sac that allows the muscle to move smoothly over the bone.

Any chronic contraction of a muscle or misalignment of the normal forces that pass through a joint will eventually lead to arthritic changes.

Diagnosis

The most important information is exactly what motion causes the snapping. This helps to isolate the muscles and tendons that have shortened. This is only part of the answer. For every short muscle, there is usually at least one weak muscle that is not doing its job. The weak muscles cause changes in muscle function that adversely affect the function of the joint.

Other common causes are a dropping of the arch (or overpronation) in the foot that causes twisting or torque of the lower leg that again distorts the forces coming up the leg. Pelvic imbalances will cause changes in weight distribution down the leg.

Range of motion of the leg should be tested and all the related muscles should be tested for proper functioning.

Treatment

Treatment involves correcting the structural changes that have changed the way the weight is transferred up and down the leg. This might include the use of orthotics, exercises for the muscle of the lower leg, pelvic corrections and changes in the way you walk. Locally, the muscles that have shortened will need to be elongated using appropriate therapy. The muscles that have weakened and caused the shortening need to be identified and the reasons for the weakness corrected.

Many times, you will have to do home stretching or massage to aid in the elongation of the shortened muscles and strengthening exercises if the opposing muscles have weakened and/or atrophied.

As most people with this problem have lower leg/foot problems that are a part of the underlying cause, you may have to change your footwear, use orthotics or exercise the muscles of the foot and ankle to provide proper support.

Finally, there are usually changes in the small muscles that control hip rotation. These are similar to the rotator cuff muscles in the shoulder. Imbalances in these muscles need to be identified and corrected.

While a snapping hip seems like a minor problem, it can lead to severe problems like hip joint degeneration and possibly hip replacement later in life.

Source: Education Materials of the International College of Applied Kinesiology

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

“Carpal” refers to the bones in the wrist. There are eight small “carpal” bones that lie between the lower forearm and the bones of the hands. Now picture them forming a sort of oval tunnel with the help of other tissues in the wrist. A nerve (called the median nerve) and nine different tendons that are part of the finger and thumb muscles go through the carpal tunnel. Carpal tunnel syndrome occurs when the roof of the tunnel (so to speak) drops or narrows due to muscle or ligament dysfunction resulting in a narrowing inside the tunnel. If this occurs, pressure may be applied against the median nerve and result in weakness and changes in sensation of the hand (particularly the thumb, index, middle and ring finger). Sensations can vary but include, pain, numbness (or no sensation), tingling, burning, and temperature changes. Degenerative changes in the tendon(s) can also cause the median nerve to become compromised. Additionally, swelling can occur in the carpal tunnel, again causing increased pressure on the nerve. Swelling can be the result of a systemic problem like “water retention” and even go as far as hypothyroidism. I find those to be the extremely rare exception though. The National Institution of Neurological Disorders and Stroke say this: “contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal.”

Typically, this condition is thought to be the result of repetitive use of the hand as in typing, etc.. However, an article on MSNBC had this to say: “A 2001 study by the Mayo Clinic found heavy computer users (up to seven hours a day) had the same rate of carpal tunnel as the general population. Harvard University headlined a 2005 press release “Computer use deleted as carpal tunnel syndrome cause.””

Now I’ll discuss how I treat people with carpal tunnel syndrome. Obviously, (as with most conditions) I’ll start with a head-to-toe evaluation of the patient. This approach can (and often does) uncover other sources of imbalance that may be contributing to carpal tunnel syndrome or symptoms that resemble carpal tunnel syndrome. For example, I always consider it prudent to evaluate the elbow, shoulder, neck, pelvis, and (sometimes) the feet with this. The median nerve travels from the neck, down the arm, and then into the hand. This is is why I evaluate the elbow, shoulder, and neck, which is basically “following” the nerve along it’s path to see if there is a compromise in the nerve between the neck and the wrist. Because of this nerve pathway, a person can have symptoms of carpal tunnel syndrome while the source of the pain is actually coming from somewhere other than the wrist. These are certainly the “failed surgery” cases. As mentioned, I also evaluate the supporting muscles and joints of the pelvis and feet, as they can both be sources of reflexive muscle tension in the neck.

That considered, let me now talk more about particulars focusing on treatment to the actual wrist. One very important muscle attaches to the bones of the forearm, the radius and ulna, just above the wrist. This muscle, the pronator quadratus, acts to essentially turn the palm downward, in addition to holding the radius and ulna firmly together. So, it serves to keep the ends of the radius and ulna from “separating”. Now imagine that the ends of those bones are “widened”. This would essentially “flatten out” that area and possibly cause a “stretching” of the tissues just before the “entrance” to the carpal tunnel. Picture a rubber band glued to two pencils while allowing for the rubber band to maintain a ring-like shape. Now, if you pull the pencils away from one another, that ring will become compromised and “flatten out”. Very often the pronator quadratus is inhibited in its function usually from repetitive stress and micro-trauma. As a result, this can cause the muscle to lose its tone and function, thus compromising the wrist. Treatment would be directed to restoring normal muscle function and perhaps doing very simple rehabilitation to regain any lost strength. By the way, ligament laxity (usually from adrenal stress) in the wrist can also cause a problem similar to that of a dysfunctional pronator quadratus.

Next, the carpal bones can get “jammed” (or lose proper mobility) potentially causing undue tension on the median nerve and tendons that pass through the tunnel. This aberration cannot be overlooked in my opinion, because any tension on the tendons can cause them to hypertrophy (or get larger) and often compromise the median nerve due to pressure. A simple, painless chiropractic adjustment can “fix” this.

Also, cold laser therapy directed at the carpal tunnel can often be helpful in eliminating very stubborn conditions. There really is not much more to say about treatment directed at the wrist. It is very straight forward. By the way, I almost always have to look to the elbow and neck to “fix” dysfunction there that usually contributes significantly.

From a “chemical” standpoint, vitamin B6 is almost considered “the” carpal tunnel nutrient because of its “anti-swelling/fluid balancing” effect. Many studies have shown that is has helped, though I can’t say I’ve found it very useful. I usually opt for nutrients that may help nerve damage, like Omega 3 and 6 essential fatty acids, and antioxidants. Also, collagen-building nutrients can be helpful in cases where there is damage to connective tissue(s).

In conclusion, don’t forget that it might be a good idea to get a second opinion if the only treatment you’ve been offered is surgery. And, in my experience and opinion, anything can cause anything and perhaps result in symptoms of carpal tunnel syndrome. I have yet to see a case of carpal tunnel syndrome that does not respond favorably to conservative care.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology