From Dr. Natalie Meiri’s Clinical Pearl Stories:

Chiropractic Adjustments for Foot Pain from Metatarsalgia

 

This was a 45 year old patient who had a chief complaint of pain on the bottom of the foot, specifically at the sole. To be HIPAA compliant, I will call her Beatrice instead of her real name.  Beatrice had treated with another chiropractor prior to seeing me.  She had foot problems he wouldn’t address.  He would only work on her spinal complaints.  

 

Beatrice’s History

Beatrice worked all day on her painful feet.  Moreover, she didn’t know how she developed this problem.  There was no trauma. Beatrice went to a podiatrist with no relief.  He told her she had metatarsalgia.

However, the podiatrist did tell her the culprit could be the improper shoes she often wore.  Beatrice’s high heels transferred extra weight to the front of her feet.  And this could have caused metatarsalgia. Beatrice also wore shoes with a narrow toe box. 

Beatrice started wearing athletic shoes with a lot of support and padding, but her feet continued to hurt. Even the orthotics she got at the podiatrist didn’t help.  She didn’t want a cortisone shot or surgery. The podiatrist had prescribed NSAIDS (Non-steroidal anti-inflammatory drugs) which gave her very little relief.  

 

 

What is Metatarsalgia?

Metatarsalgia is defined as pain and inflammation in the ball of the foot. It can have varied causes. Typically, the pain is experienced in the padding directly below the toes. The metatarsals are the five long bones in the midfoot. They are located between the tarsal bones and the phalanges.

 

Metatarsalgia pain can consist of numbness, shooting pain, and/or soreness, especially when flexing the toes. Indeed, injuries to the balls of feet are common in athletes.  Also, metatarsalgia is a repetitive injury. It is prevalent in those who spend a lot of time on their feet.  Metatarsalgia is a very common foot problem.

 

Causes of Metatarsalgia

There are a lot of reasons for Metatarsalgia.  Some may be related to gait mechanics (how you walk), foot anatomy, and/or foot and ankle deformity/malformation (e.g. hammer toes, pes planus (low arch) or pes cavus (high arch).

 

Furthermore, chronic stretching of the transverse ligaments may be an underlying reason. These ligaments run across and connect together the heads of all the metatarsal bones.

 

Firstly, excessive weight or repetitive activity may injure these ligaments. Secondly, direct trauma from jumping or landing on the toes with running or jogging can be a cause.  Thirdly, standing for long periods of time in high-heeled shoes is definitely a contributing factor.  Fourthly, shoes with too narrow a toe box will also cause compression and pain. Lastly, your feet may have a chiropractic subluxation of the metatarsal heads.

 

Beatrice’s Examination and Imaging

Upon examination, there were positive tests for Beatrice’s feet for Metatarsalgia. The x-rays she brought in from her podiatrist’s office showed degenerative osteoarthritis of both her feet. 

 

Beatrice’s Treatment

Beatrice was given instructions on the use of a metatarsal pad placed just proximal (next) to the metatarsal heads.  And room was left after placement of the pad for the first and fifth metatarsal heads.  The pad was only utilized during the beginning (acute stage) of her care.

Chiropractic adjustments were performed to the metatarsal restricted joints and associated regions.  Associated regions that were adjusted were her other foot joints and ankles that were restricted.  Beatrice was also adjusted full spine to keep her aligned and functioning optimally.

Next, Soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) and modalities (cold/heat therapy and electric muscle stimulation) were administered as needed.

Finally, she was given therapeutic exercises to continue her treatment at home.

 

Beatrice’s Outcome

The outcome for Beatrice was excellent! She started feeling better immediately from the first few visits.  By the end of 12 visits, she was pain-free and her feet were functioning optimally. Beatrice returned for as needed care for her feet. 

 

Chiropractic Adjustments restore joint mobility and function, resolves joint inflammation and reduces the patient’s pain.  Do you know someone who is in need of chiropractic care for Metatarsalgia?  Contact  Meiri Chiropractic today at 561-253-8984 to learn more about  Chiropractic Adjustments for Foot Pain from Metatarsalgia or to schedule an appointment.

 

 

                                           Video /vlog

 

From Dr. Natalie Meiri’s Clinical Pearl Stories:

Computer and Video Game Injuries in Kids: Chiropractic Care is Effective

 

This is my clinical pearl story about Computer and Video Game Injuries in Kids: Chiropractic Care is Effective. Arnold was a 10 year old child who liked playing video games and spent many hours on his computer a day.  His chief complaint one day in the office was that his thumbs, neck and mid back hurt from playing video games continuously for 4 hours. This was double the amount of time he normally spent daily!  His mom brought him in the next day.  I will call him Arnold instead of his real name to be HIPPA compliant. 

 

Arnold’s Examination

Upon examination, Arnold tested positive for his neuromusculoskeletal injuries: Myalgia (muscle pain) in his mid back and strain in his neck and thumbs.

 

Computer and Video Game Injuries: Repetitive Trauma

It is common to have a postural problem for individuals who work at desks. Prolonged sitting at a desk combined with the repetitive activity of typing or using the mouse for your computer causes postural problems and/or repetitive motion injuries. Furthermore, we are texting (ie. Text neck) and looking on smart phones with a forward neck position. 

This sedentary lifestyle which eliminates a variety of movements cause pain and dysfunction. Moreover, Kids and teenagers can also develop a slumped posture due to heavy back packs, hunching over homework or video games.   

 

Prevent computer and video game injuries

By correcting ergonomic issues and limiting these types of repetitive injuries, long term damage can be avoided.    Indeed, excessive gaming in front of a screen can result in postural stresses from lack of movement.  Additionally, it can cause eyestrain, wrist, arm, elbow, hand, thumb strain and even carpal tunnel syndrome.

 

Some Tips (what to do) to Avoid Repetitive Injury at the computer and while video gaming

 

• Taking frequent short breaks and doing stretching exercises while working or gaming. Also, switch up the activity.
• Sit at an adjustable desk that is specially designed for computer use
• Having the computer screen at eye level or slightly lower
• Ensuring your keyboard is at a height that allows your elbows to rest comfortably at your sides.
• Ensuring your forearms are nearly parallel to the floor and at the same level as the keyboard.
• Using an ergonomic chair that is designed to prevent the spine from losing its natural curve while sitting
• Adjusting your chair such that your feet are always resting flat on the floor, or using a footstool

Kids should be interested in a variety of hobbies, and activities.  And especially physical activities like sports.  Simply sitting all day can lead to obesity and even problematic emotional or aggressive behavior.  Kids should have a limit. Sensible time for playing could be a maximum of 1-2 hours a day for computer and video games with lots of breaks during these sessions.  Getting the right keyboard, mouse and furniture that is suitable for your child’s height is essential.

Arnold’s Treatment and Outcome at  Meiri Chiropractic:

 

Firstly. Chiropractic manipulation or mobilization of the cervical (neck) and thoracic (mid back) spinal joints and both thumbs/hands.

Secondly, soft tissue manipulation to the muscles involved.

Thirdly, exercises focusing on stretching tight muscles and strengthening weak muscles.

Fourthly, recommendation on redesign of work environment and ergonomics.

Fifthly, postural advice/ recommendation of frequent breaks with stretching.

Finally, after the first visit, Arnold started feeling better!  And within a few visits, he was completely healed.

 

Computer and Video Game Injuries in Kids: Chiropractic Care is Effective

Most children and adolescents regularly experience physical injuries from ordinary play and sports. However, with the increasing popularity of computer and video games, some kids are now feeling the same kind of pains and aches that adults get from sitting behind their desks all day. Chiropractic care can help to offset the postural stresses and lack of movement linked to gaming and sitting at a computer all day. 

Are you experiencing pain due to poor posture or repetitive motion injury?  Chiropractors can help posture problems and repetitive motion injuries for you and your family. Call 561-253-8984 today for an appointment.

 

Do you have pain, weakness, and paresthesia (tingling, numbness or “pins and needles”) in your arm/forearm (below the elbow)?  You may have dull, sore achiness in the extensor muscles (muscles that extend wrist/hand) below your elbow. The pain may be more prominent at night and after use. These are all symptoms of Radial Neuropathy/Entrapment below the elbow. Read on to learn about Elbow and Forearm Pain Due to Radial Neuropathy: Chiropractic Can Help.

 

Anatomy of the Radial Nerve

The radial nerve is the terminal (end) continuation of the posterior (back) part of the brachial plexus. And the brachial plexus is a bundle of nerves that originate from nerve roots in the cervical (neck) and upper thoracic (torso) sections of the spinal cord (C5-T1). Ultimately, the brachial plexus creates a network that connects to the nerves in the arm. Therefore, the radial nerve contains fibres from nerve roots C5 – T1.

It arises from the axilla and exits the axilla inferiorly (below).  Next, it supplies branches to the long and lateral heads of the triceps brachii muscle.

The radial nerve then descends down the arm.  It travels in a shallow depression within the surface of the humerus (long upper arm bone), known as the radial groove.

To enter the forearm, the radial nerve travels anterior (front of) to the epicondyle of the humerus, through the cubital fossa of the elbow. The nerve then ends by dividing into two branches:

• Deep branch (motor) – innervates (supplies) the muscles in the posterior (back) compartment of the forearm.
• Superficial branch (sensory) – contributes to the cutaneous (skin) innervation of the dorsal (back) hand and fingers.

 

Compression of the Radial Nerve from Elbow to the Wrist

The Radial nerve divides into its two major branches, the posterior interosseous and the superficial radial nerve at the level of the radiocapitellar joint (elbow joint).  Above the elbow the radial nerve innervates the brachioradialis and extensor carpi radialis longus and brevis.  Therefore, entrapment below the elbow joint does not affect these muscles. 

Posterior interosseous nerve compression depends on where the compression occurs. There may be involvement at the radial tunnel, causing what is known as the radial tunnel syndrome or along the distal course of the nerve (including the radial tunnel) in which case it’s called the posterior interosseous nerve syndrome.

 

Radial Tunnel Syndrome aka Resistant Tennis Elbow:

If you have what appears to be tennis elbow, but is resistant to therapy, it could actually be radial tunnel syndrome.  And you may have unremitting pain around the lateral epicondyle (bump on outer side of elbow) of the elbow.

 

What is radial tunnel syndrome?

This is a compressive neuropathy of the posterior interosseus nerve (PIN) branch of radial nerve in the radial tunnel. The radial tunnel is about 2 inches long. It goes from the capitellum (rounded knob-like structure at end of humerus where meets elbow) of the humerus (long bone of upper arm) and the radial head of radius to the supinator muscle. 

The boundaries of the radial tunnel is formed by the supinator (broad muscle in the posterior compartment of the forearm, curved around the upper third of the radius), extensor carpi radialis longus/extensor carpi radialis brevis (both muscles in forearm extend hand a wrist), and brachioradialis ( muscle of the forearm that flexes the forearm at the elbow).

 

Locations of compression within the Radial Tunnel

Locations of compression within the radial tunnel include:

–fibrous bands over the anterior (front of) radial head and capsule (of elbow joint) at the the entrance to the tunnel

-a recurrent fan of blood vessels that supplies the brachioradialis and the extensor carpi radialis longus, the ulnar half of the tendon and fascia of the extensor carpi radialis brevis muscles

–under the fibrous arch at the proximal edge of of the supinator called the arcade of frohse and below the fascial arcade at the distal lateral border of the supinator muscle. 

The arcade of frohse seems to be the most common area of entrapment in this area.  Researchers stated that in 10% of patients with lateral epicondylitis (tennis elbow) there is a co-existent radial tunnel syndrome due to radiocapitellar bursitis (inflamed bursa at elbow).

 

Causes of Radial Tunnel Syndrome

Radial tunnel syndrome is caused by direct compression by anatomic structures as mentioned above.  Additionally, in athletes by vigorous contraction of the extensor musculature can trigger it. Furthermore, it can occur with one very strenuous effort.  However, more often it is due to repetitive pronation and supination (rotating palm downward or upward), although wrist extension can aggravate it.  The syndrome is found especially in athletes who lift weights, golf, swim and participate in racquet sports. 

 

Posterior Interosseous Nerve Syndrome:

Radial tunnel syndrome refers to a rare compressive neuropathy of the posterior interosseous nerve (PIN) as it passes through the radial tunnel as described above.  So radial tunnel syndrome has pain without motor or sensory dysfunction. And with the PIN compression syndrome, a more severe compressive neuropathy occurs. Ultimately, with PIN there is wrist extensor muscle  weakness as well as pain. Again, the PIN is a branch of the radial nerve at the elbow.  It supplies motor innervation to the dorsal (top) extensor compartment of the forearm and sensory innervation to the dorsal wrist.

Causes of Posterior Interosseous Nerve Syndrome (pins)

The main site of compression is at the arcade of frohse at the elbow.  Other causes can be vascular anomalies (abnormalities), synovitis, edema, ganglion, bursa or lipoma. Of course, overuse such as repetitive pronation and supination are culprits as well.

 

Treatment at Meiri Chiropractic for Radial Neuropathy:

Firstly, soft tissue techniques will be rendered to the contracted fibrotic muscle and collagen at entrapment sites.

Secondly, Chiropractic adjustments (chiropractic manipulative therapy) to the elbow, wrist, and associated restricted joints.  This would be along the kinetic chain  and spine which is important.

Thirdly, Therapeutic exercise will be given for stretching and strengthening.

Fourthly, if trauma or swelling is involved, ice, compression, elevation, and physical therapy modalities is utilized to reduce swelling. Ergonomic recommendations to change the inciting activity is necessary.

Are your suffering from elbow or forearm pain from Radial Neuropathy?

We offer excellent Chiropractic care for Radial Neuropathy. At Meiri Chiropractic, we spend the time necessary to examine, diagnose and treat every neuromusculoskeletal condition and various ailments you have. Indeed, Chiropractic is a holistic and natural way to not only treat shoulder and arm pain, but to keep your body in its best working condition. We have been offering effective chiropractic care in West Palm Beach since 2006. Many of our patients reviews note our excellence. Call us today at 561-253-8984 to make an appointment or to find out more about Elbow and Forearm Pain Due to Radial Neuropathy: Chiropractic Can Help.

From Dr. Natalie Meiri’s Clinical Pearl Stories:

Chiropractic Care for Cervical Radiculopathy

 

This was a 68 year old patient who had neck and left hand numbness and pain. To be HIPAA compliant, I will call him Wallace instead of his real name.  Wallace had treated with another chiropractor prior to seeing me.  He had gone to physical therapy for his lower back which was much better.  However, Wallace’s orthopedist thought his cervical spine (neck) condition was a surgical case.  After trying another chiropractor and acupuncture, he presented to my office.

Wallace worked as a handyman for 30 years and attributed some of his neck problems to his daily work activity.  However, he really didn’t know why this had occurred.  What really bothered him was the constant numbness in his last 2 fingers (4^th and 5^th digits) and weakness in his left hand. 

Wallace had been prescribed NSAIDS (Non-steroidal anti-inflammatory drugs) which gave him very little relief.  

 

Wallace’s Examination and Imaging

Upon examination, there were positive tests for his cervical spine (neck) as well as the left hand-4^th and 5^th finger symptoms giving the diagnosis of C8 radiculopathy. 

I ordered X-rays of Wallace’s cervical spine. The findings in his x-rays were a reversal in the natural lordotic curve and moderate to severe osteoarthritis (wear and tear arthritis). 

I would order a M.R.I. if he wasn’t improving in a month or 12 visits. 

After that, I explained his diagnosis (radiculopathy of C8 nerve root and osteoarthritis), prognosis and treatment plan.

 

 

Wallace’s Treatment

Firstly, Wallace’s chiropractic treatment for C8 radiculopathy consisted of chiropractic manipulation/ adjustments of the cervical spine (at levels above the C8 nerve root) and associated regions.  Associated regions that were adjusted were his thoracic and lumbar spine (low back) which were misaligned (subluxations or intersegmental dysfunctions).

Secondly, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) and modalities (cold/heat therapy and electric muscle stimulation) were administered as needed.

Thirdly, he was given therapeutic exercises to continue his treatment at home.

Fourthly, Wallace was given recommendations on his activities of daily living (ergonomics on posture etc) at home and work. 

Lastly, his visits started at 2-3 times a week for 4 weeks and than 1-2 times a week thereafter for 3 months. 

 

What is a radiculopathy?

Cervical radiculopathy is a neurologic condition resulting from compression or inflammation of the cervical nerve roots (initial segment of nerve leaving central nervous system). The nerve compression is caused by narrowing of the neural foramen (opening in spine for nerve exit) due to cervical spondylosis (osteoarthritis), disc (small rubbery cartilage between spinal vertebrae) herniation, trauma, or an abnormal curve of the spine. The majority of cases of cervical radiculopathy stem from degenerative disease (osteoarthritis) in the cervical spine.

In Osteoarthritis, your disk desiccates (drying out) over time.  This can lead to decreased disk height, hypertrophy of the uncinate joint (joint becomes bigger), foraminal stenosis (nerve exit gets smaller) and cervical radiculopathy occurs.  Finally, disk degeneration and herniation trigger a pro-inflammatory cascade causing further nerve root irritation.

Indeed, trauma or swelling can contribute to symptoms.  Cervical radiculopathy can less commonly be caused by tumors, infection, or changes in blood flow. 

 

Wallace’s Outcome

The outcome for Wallace was excellent! He started feeling better immediately from the first few visits.  Moreover, after a few weeks of continued care his function improved. His range of motion greatly improved and he gained the strength back in his hands.  By the end of his 3 months of corrective care, he was pain-free and functioning optimally. Wallace returned for once a month supportive/maintenance care after this.

 

Chiropractic Care for Cervical Radiculopathy at Meiri Chiropractic

So Cervical radiculopathy is a medical condition where there can be symptoms of pain, weakness, and/or numbness as a result of a pinched or irritated nerve in the neck.  Cervical radiculopathy will cause loss of function and/or symptoms in one or both arms.  And Chiropractic Adjustments restore joint mobility and function, resolves joint inflammation and reduces the patient’s pain.

Do you know someone who is in need of chiropractic care for cervical radiculopathy? Contact Dr. Natalie Meiri of Meiri Chiropractic today at 561-253-8984 to learn more about Chiropractic Care for Cervical Radiculopathy or to schedule an appointment.