ACTIVE P.T. SOLUTION S ...BECAUSE LIFE SHOULD BE ACTIVE APTS Monthly Office Hours: VOLUME VI, ISSUE IX SEPTEMBER 2016 Monday - 8:00am - 5:30pm Tuesday - Wrist Problem or Neck Problem? 8:00am - 7:00pm Wednesday - Carpal tunnel syndrome is one of the and arm pain or tingling. There are When the shoulders round and the most common nerve entrapments of some that get temporary relief but the head shifts forward, the muscles in 8:00am - 5:30pm the upper extremity. It occurs when problem recurs frequently with symp- the neck and shoulders compress Thursday - the median nerve is compressed in toms of higher intensity. Other pa- the nerves that course from the the wrist. However, it is not uncom- tients develop symptoms similar to neck to the hand. The hand re- 8:00am - 5:30pm mon for compression of the median carpal tunnel syndrome following neck quires a stable base at the neck and nerve to occur in several different injury. They may not have had a wrist shoulders in order to function Friday - sites in the forearm. Over the course injury but still experience pain in the properly. Weakness caused by 8:00am - 4:00pm of time, the general population has hand. inactivity and poor posture ulti- come to accept that hand and wrist mately causes the hand and fore- Location: pain, numbness, or tingling adds up to Since the body is a complex network arm muscles to be overworked. carpal tunnel syndrome. In fact, hun- of joints, nerves, ligaments, muscle, This results in “double crush syn- 91 Columbus Street dreds of people each year have wrist and fascia, it is possible that a symp- drome” or nerve compression in Auburn, NY 13021 decompression surgery in hopes of tom from one area of the body may be the neck and shoulders proximally relieving these symptoms. The prob- caused by a problem located in a dif- while also causing compression P: (315) 515-3117 lem with this thought process is that ferent part of the body. This approach distally in the hand and forearm. there are many causes of numbness, to healing is more holistic as opposed This results in tingling, pain or tingling, and/or pain in the hands and to the isolationist approach. Recent numbness in the hand, wrist and fingers. research demonstrates this to be the arm. INSIDE THIS case in patients experiencing symp- ISSUE: Symptoms specific to carpal tunnel toms of carpal tunnel syndrome. Some Before you accept a diagnosis of syndrome most often occur in the studies indicate that it is not uncom- carpal tunnel syndrome, ask your- thumb, index finger, middle finger, mon for symptoms of carpal tunnel self some simple questions: Did Wrist Problem or 1 and half of the ring finger. If you have syndrome may be caused by muscle anyone examine my neck? Was I Neck Problem? symptoms in your fingers but your stiffness in the neck and shoulders given an explanation why my neck little finger is fine, this may be a sign resulting in poor posture, tense mus- was not a cause of my hand symp- Exercise of the 2 that you have carpal tunnel syn- cles, nerve compression, and pain toms? Should I get a second opin- Month: Wrist drome. There are two other periph- traveling down the arm and into the ion? Does the diagnosis of carpal Stretches eral nerves that supply the hand. The hand. tunnel syndrome make sense? ulnar nerve supplies the little finger, Were metabolic causes of carpal Muscle Cramping? It 2 while the radial nerve supplies the While we have created a technologi- tunnel syndrome ruled out, such as Could Be Your Meds backside of the thumb, index and cally advanced society, these advance- diabetes, thyroid disease, and even middle fingers. Nerve roots from the ments have accelerated the aging proc- pregnancy? neck or cervical spine (C6, C7, C8) ess creating chronic postural distor- The Downtown 2 control a different pattern of sensa- tions in even our youngest members. Generally speaking, there are many Auburn Mile 2016 tion in the hand with some overlap. Previous articles in this column were options for the treatment of pa- This is what makes the diagnosis of a focused on “iPosture” and the “effects tients experiencing carpal tunnel- cervical spine problem versus true of sitting”. I would recommend that like symptoms. Do your homework Carpal Tunnel 3 carpal tunnel syndrome so challeng- you read these to complete this arti- and work with healthcare providers Syndrome ing. It is also why it is so important to cles content. In a given day, it is not that share your goals and expecta- answer questions about your symp- uncommon for the majority of the tions. As the patient, it is your right APTS Recipe Box: 3 toms as specifically as possible. The population to go from a car to a desk to choose a physical therapist with Crockpot Dessert diagnosis will sway one way or an- and computer, back to a car, and fi- whom you feel most comfortable Stuffed Apples other based on the answers you nally to a La-Z-Boy. discussing all aspects of your care. provide. Nutrition 101: Health 4 This lack of movement creates a dom- Article by Dale Buchberger, Benefits of Apples Many people who have undergone ino effect, and most relevant to carpal DC, PT, CSCS surgery for carpal tunnel syndrome tunnel syndrome is the rounding of the continue to experience hand, wrist, shoulders and forward head posture. P A G E 2 Exercise of the Month: Wrist Stretches

This month’s exercise features “bottom” (palm) side of the you may already feel a stretch two stretches for the wrist that forearm. Stand with your palm just by getting into this position. will help prevent or relieve pain on the table, fingers pointing To increase the stretch, keep in the wrist, elbow, and fore- behind you, and the elbow fully the back of your hand on the arm, especially for those people extended. You may already feel table, elbow extended, and that perform a lot of repetitive a stretch in this position. If not, wrist down, and then lean back motions with their hands. For keep your palm on the table slightly to feel more of a stretch each of these stretches, you’ll and your elbow extended and in the forearm. want to find a table high enough lean back slightly to feel a Hold each stretch for 30 sec- to rest your hand on comforta- stretch in the forearm. onds and perform one stretch bly with your elbow straight. If The second stretch is for the three different times a day to you can’t find one high enough, “top” side of the forearm. Stand keep your wrist, forearm, and you can stack books on a table with the back of your hand on elbow loose and less painful. until you reach a comfortable the table, fingers once again height to perform the exercise. pointing behind you, and the Wrist flexor stretch The first stretch is for the elbow fully extended. Again, (top), wrist extensor stretch (bottom).

Muscle Cramping? It Could Be Your Meds Muscle cramps We hear it all the time in our office: “I’ve (used to treat high blood pressure, conges- calcium, stretching properly before exercise, been getting leg cramps a lot lately. Why? tive heart failure, and edema); beta blockers taking a bath with Epsom salt, and icing or And what can I do about them?” Muscle (used to treat high blood pressure and warming the muscle. In most cases, these self- can have many cramps can have many possible causes, abnormal heart rhythm); statins and fibrates care measures are sufficient. But if you con- including dehydration; poor blood circulation (used to treat high cholesterol); beta-2 tinue to experience cramping frequently and possible causes, in the legs; overexertion of the leg muscles agonists (used to treat COPD); ACE inhibi- for no apparent reason, you should talk to while exercising; insufficient stretching; tors (used to treat high blood pressure and your doctor as they could be a sign of a including exercising in the heat; muscle fatigue; CHF); angiotensin II-receptor blockers (used medical problem that requires evaluation and pinched nerves in the neck or back; sitting to treat CAD or heart failure); antipsychot- treatment. If your cramps are medication- medication-related for too long; standing on hard surfaces for ics; Aricept (used to treat Alzheimer’s based, you should consult with your doctor too long; wearing uncomfortable shoes or disease); Evista (an osteoporosis treatment); about the possibility of adjusting the dosage of causes and non- shoes with elevated heels; diabetes; edema in asthma medication; and Tasmar (used to your medication or changing to another type the legs; or a vitamin deficiency, such as treat Parkinson’s disease). of medication or treatment. magnesium, calcium, and/or potassium. They The treatment of muscle cramps not brought Article by Carolyn Collier, PTA medication-related could even be caused as a side effect of some on by medications is as simple as staying drugs, including, but not limited to, diuretics causes. hydrated, eating foods high in magnesium and Downtown Auburn Mile 2016 Downtown The 39th Annual head count of 315 finishers. of under 9 minutes! A.T. Auburn Downtown Auburn Leon Atkins crossed the Walley’s did a fantastic job Mile First Mile sponsored by Ac- finish line first (left) with a with the after party, as well. Place tive Physical Therapy time of 4:31.05! Wow, A huge thank you goes out Finisher Solutions was a success! that’s fast! Dr. Dale to Laura Clary and the Au- Leon Atkins We had a beautiful Buchberger participated burn YMCA for organizing summer evening on this year, and crossed the this event! We’ll see you Friday, August 26 for finish line 130th with a time next year! the race, with a total of 7:34.17, beating his goal

APTS MONTHLY VOLUME VI, ISSUE IX P A G E 3 Carpal Tunnel Syndrome

Symptoms usually start gradually, with be smaller in women than in men. The domi- frequent burning, tingling, itching, or numb- nant hand is usually affected first and produces ness in the palm of the hand and the fingers, the most severe pain. Carpal tunnel syndrome especially the thumb and the index and usually occurs in adults. Patients under the age middle fingers. Some patients state that their of 40 are more likely to experience CTS symp- fingers feel useless and swollen, even though toms due to inflammation of the tendon linings little or no swelling is visible. The symptoms and repetitive compression of the nerve itself. start in one or both hands during the night, Patients over the age of 40 are more likely to since many people sleep in a fetal position develop CTS symptoms from degenerative with their wrists and fingers flexed. A per- changes (arthritis) of the wrist joints and/or son with CTS may wake up needing to degenerative thickening of the flexor tendons "shake out" the hand or wrist. As symptoms in the carpal tunnel. worsen, tingling occurs during the day. Just because a Carpal tunnel syndrome (CTS) continues to Decreased grip strength makes it difficult to be a label commonly given to anyone ex- form a fist, grasp small objects, or perform The risk of developing CTS is not confined to patient periencing pain, numbness, and/or tingling in fine movements. In chronic cases, the mus- people in a single industry or occupation, but is his or her hands. While carpal tunnel syn- cles at the base of the thumb atrophy. Some common in assembly line workers - manufac- drome is one cause of hand symptoms, it is people are unable to differentiate between turing, sewing, finishing, cleaning, and meat, experiences not the only cause; however, it continues to poultry, or fish packing. In fact, CTS is three- hot and cold by touch. be the popular cause. times more common among assemblers than median nerve among data-entry personnel. A 2001 study by Carpal tunnel syndrome is often the result the Mayo Clinic found heavy computer use (up Carpal tunnel syndrome occurs when the of a combination of factors that compress to 7 hours a day) did not increase the risk of symptoms median nerve, which runs from the shoulder the median nerve in the carpal tunnel, developing CTS. through the forearm and into the hand, rather than a problem with the nerve itself. doesn’t mean becomes compressed at the wrist. The Contributing factors include trauma or median nerve controls sensations to the injury to the wrist that cause swelling, such The non-surgical treatment of CTS involves palm side of the thumb, first two fingers and as sprain or fracture; mechanical problems manual therapy such as Active Release Tech- that he or she half of the third finger (but not the little in the wrist joint; work stress; repeated use niques (ART) or Instrument Assisted Soft finger), as well as small muscles in the hand. of vibrating hand tools; fluid retention dur- Tissue Mobilization (IASTM) applied along the has carpal We need to remember that just because a ing pregnancy or menopause; or the devel- entire course of the median nerve. Splints may patient experiences “median nerve symp- opment of a cyst or tumor in the canal. In be used at night for symptom relief allowing for toms” doesn’t mean he or she has CTS. The some cases, no structural cause can be uninterrupted sleep. Once the symptoms tunnel median nerve can become entrapped at one identified. In these cases, the cause is en- reduce, the brace should be abandoned as long of six common places from the shoulder to trapment at another site along the path of term use of bracing increases the tightness that syndrome. the wrist. the median nerve. Symptoms in all five contributed to the problem in the first place. fingers are not usually caused by a problem Patients over the age of 40 are more likely to The carpal tunnel itself is a narrow, rigid in the carpal tunnel and are more commonly require surgical release of the carpal tunnel to passageway of ligaments and bones at the associated with shoulder instability or tho- decompress the median nerve. Patients under crease of the hand. It houses the median the age of 40 are more likely to recover with racic outlet syndrome. nerve and finger flexor tendons. Sometimes, physical therapy that includes the above- thickening from irritated tendons or other mentioned manual therapy techniques. If you swelling narrows the tunnel compressing the There is little clinical data to prove that are experiencing CTS symptoms, you may want median nerve. The result may be pain, repetitive computer work causes CTS. to discuss manual therapy treatment as an weakness, or numbness in the hand and Repeated motions performed in the course alternative prior to pharmaceutical or surgical wrist, radiating into the fingers or up the of normal work or other daily activities can treatment. arm. result in repetitive motion disorders such as bursitis and tendonitis. Women are three Article by Dale Buchberger, DC, PT, times more likely than men to develop CTS, CSCS perhaps because the carpal tunnel itself may

APTS Recipe Box: Crockpot Sugar Detox Dessert Stuffed Apples

September is the perfect time for apple cream concentrate or homemade coconut coconut and sunbutter mixture into each recipes! If you’re on a sugar detox, butter, melted; 1/4 cup sunbutter, un- apple all the way to the top. Top off each you’re allowed green apples in modera- sweetened (or other nut butter); 2 table- apple with a bit more cinnamon and tion. If you’re not on a sugar detox, use spoons (or more!) cinnamon; pinch of shredded coconut. Cook for 2-3 hours whatever kind of apples you may pick nutmeg; pinch of salt; 3-4 tbsp unsweet- on low. The longer your cook it, the from the orchard (or the grocery store). ened shredded coconut; 1 c water. softer the apple will be. The best part about these dessert apples Instructions: Mix together coconut butter, These would even be delicious with nuts is that they turn into applesauce if you sunbutter, cinnamon, nutmeg, and salt. or dried fruit mixed in. Get creative! cook them long enough. Place your cored apples (with bottoms still Source: paleomg.com/crockpot-sugar- Ingredients: 4 green apples, cored, with in place) in the crockpot and pour water in detox-dessert-stuffed-apples/ bottom still in place; 1/2 cup coconut the bottom. Use a spoon to scoop the At Active Physical Therapy Solutions, we utilize the most cutting edge treatment and management techniques available. Our goal is to deliver the best possible healthcare in Active P.T. Solutions a friendly, caring, and well-organized 91 Columbus Street environment. Our staff is here to Auburn, NY 13021 provide active solutions to achieving Phone: 315-515-3117 Fax: 315-515-3121 your personal goals! E-mail: [email protected] website: www.activeptsolutions.com ...BECAUSE LIFE SHOULD BE Get Well...Get Active...Be Active ACTIVE! Newsletter Edited by Carolyn B. Collier, PTA Nutrition 101: Health Benefits of Apples

Other than being an easily portable, grab-and-go leads to heart Protect against cancer. The consumption of snack, here are 10 facts about apples that you disease and flavanol-rich apples could help decrease your risk might— or might not have—known: diabetes. Re- of pancreatic cancer by 23%. Researchers at Cor- Nutrition. Four grams of fiber and 95 calories search has found nell University have identified several compounds per medium-sized apple makes them a filling that people who called triterpenoids that are found in the peel and snack. (Five grams of fiber are found in a large eat apples are have potent anti-growth activities against cancer apple.) One medium apple counts as one serving less likely to cells in the colon, liver, and breast. Additionally, of fruit, too. Apples also contain vitamin C, B- have symptoms the National Cancer Institute has recommended complex vitamins (such as riboflavin, thiamine, of metabolic consuming high amounts of fiber to help prevent and B-6), phytonutrients, calcium, potassium, and syndrome, in- colorectal cancer. phosphorus. cluding lower levels of C-reactive protein, which is Neutralize irritable bowel syndrome. an inflammatory marker whose presence in the Weight loss. Some researchers believe that the Whether you can’t go to the bathroom or you blood suggests and increased risk of heart disease or can’t stop, the fiber found in apples can pull water antioxidants and pectin (a type of fiber) in apples diabetes. Additionally, one study showed that people plays a role. And since apples are high in fiber, out of your colon to keep things moving along who eat 3 servings of apples a week had 7% lower when you’re backed up or absorb excess water to they will help to fill you up without costing too risk of developing type 2 diabetes. many calories. slow things down. The fiber can also help prevent Exercise extender. Eating an apple before working straining too much when going to the bathroom, Heart health. Antioxidants found in apples out may boost your exercise endurance. An antioxi- therefore averting hemorrhoids. helps prevent LDL cholesterol from oxidizing dant called quercetin, a flavanoid, is found in apples An apple a day keeps the doctor away, but and inhibits inflammation. Apples are associated and it aids endurance by making oxygen more avail- with a decreased risk of death from coronary not the dentist. Because apples are fairly acidic, able to the lungs. Quercetin can also help to boost they can be up to four times more damaging to artery disease and cardiovascular disease. Some and fortify the immune system. other research suggests that apple eaters have a the teeth than carbonated drinks. Snacking on lower risk of having a thrombotic stroke. After Preventing dementia. A study found that includ- acidic foods throughout the day is most damaging, just six months, one study showed that older ing apples in your daily diet may protect neurons while eating them at meal times is much safer. women who ate apples everyday had 23% less against oxidative stress-induced neurotoxicity and And, most importantly, apple seeds should not be “bad” cholesterol (LDL) and 4% more “good” may play an important role in reducing the risk of consumed as they contain cyanide, a powerful cholesterol (HDL). neurodegenerative disorders such as Alzheimer’s poison! disease. Protect against metabolic syndrome. Meta- Article by Carolyn Collier, PTA bolic syndrome is a cluster of symptoms that