News - Kinetic Edge Physical Therapy
Wednesday July 10, 2019

Is Tingling in My Arm a Pinched Nerve or Carpal Tunnel Syndrome?

July Newsletter 2

Dr. Troy Vander Molen, PT, DPT

July 2019

In our May newsletter and blog post (https://www.kineticedgept.com/is-the-kink-in-my-neck-a-pinched-nerve/), I asked the question, “Is the kink in my neck a July Newsletter 1pinched nerve?” If you were paying attention, you will remember that the answer essentially was, “Probably not.” While a kink in the neck is always accompanied by localized stiffness, soreness, and difficulty moving the neck, a pinched nerve typically involves symptoms – numbness, tingling, and/or pain – that travel down the arm.

 

The natural follow-up questions, then, are these:

 

If I have numbness, tingling, and/or pain down the arm, does that mean that I have a pinched nerve? Or is it carpal tunnel syndrome?

Good questions!

Technically, the answer to the first question is “yes.” Because nerves carry motor information from the brain to the body and sensory information from the body to the brain, symptoms of numbness and tingling in the arm are likely due to compression of nerve somewhere.

So, the ultimate questions are: What things can compress a nerve? And where does that compression occur?

Back in May, I included this statement in my blog post:

Nerves can potentially be compressed either centrally as they exit from the spine or peripherally by structures like tight muscles that exist external to the spine. Spine-related issues that can put pressure on a nerve as it exits the spine (i.e. central causes) include herniated disks and other arthritis-related changes like narrowing of the disk space, disk degeneration, and bone spurring.

Numbness and tingling in the arm can be caused by compression on a nerve in multitude of areas and from a multitude of sources. The compressive force is not necessarily coming from the neck and may, in fact, be coming from multiple areas.

What structures external to the spine can compress a nerve and cause numbness and tingling?

There are many structures that can compress a nerve as it travels from the brain to the terminal body part. Compression from one or more of the structures along the pathway of the nerve can contribute to a variety of arm symptoms.

There is a condition called double crush syndrome. With this condition, there is increased nerve symptom intensity due to distinct compressive forces along the pathway of the nerve at two or more locations. Double crush syndrome can lead to diagnoses like carpal tunnel syndrome (CTS) or thoracic outlet syndrome (TOS), which don’t fully explain the root cause of the problem and can lead to expensive and often ineffective treatments.

Because of double crush syndrome, treatment of arm numbness and tingling must be comprehensive. If you have been told that you have carpal tunnel syndrome, you may have been led to believe that you have pressure on your nerve at the carpal tunnel of the wrist. You may even have gone through a diagnostic test of nerve conduction velocity (i.e. NCV or EMG) that “proved” that you have pressure on the nerve at the wrist.

But, in the words of ESPN football analyst Lee Corso, “Not so fast, my friend!”

The key to successfully treating any condition that is causing numbness and tingling in the arm is to assess and correct any of the structures that can place a compressive force on the nerve throughout its entire pathway.

Here are the primary culprits that must be cleared to ensure that you eliminate peripheral nerve compression and numbness/tingling in the arm.

July Newsletter 2SCALENE MUSCLES

As the nerves pass from the neck to the fingers, they pass through many structures. At the origin of the nerves, this bundle of nerves (known as the brachial plexus) passes through the scalenes, which are muscles that run from the upper part of your neck to the first rib. Tightness of this muscle group will compress the nerve bundle, which can manifest as numbness and tingling down the arm.

COLLAR BONE

When the scalene muscles are tight, the first rib may elevate, which further compresses the nerve bundle. Furthermore, a forward head/rounded shoulders posture (see pec muscle information below) and weight gain can further increase the mechanical compressive forces in this area.

PECTORAL MUSCLES

Our chest muscles are comprised of the more superficial (and visible) pec major and the underlying pec minor. These muscles travel from the sternum and the front of your rib cage and connect on a bone that projects forward from your shoulder blade (the coracoid process).

As the nerve bundle and accompanied blood vessels travel distally down the shoulder into the arm, branches of these nerves are positioned beneath the pec minor. You will typically know that the pec minor is tight because you will see that the shoulder is rounded, or hunched. This problem, by the way, can also cause shoulder problems because of increased compressive forces on the rotator cuff tendons and a bursa in that region

For a great summary of how to manage this issue, click on this link from Cirque Physio (https://www.cirquephysio.com/this-little-muscle-might-be-sabotaging-your-circusshoulder/).

If you are concerned about numbness and tingling in the arm and have wondered whether you have carpal tunnel syndrome or thoracic outlet syndrome, I encourage you to take advantage of our free injury screens. Take a test drive for FREE by scheduling a brief and complimentary 20-minute consultation with one of Kinetic Edge’s movement experts, and you can get simple answers to your musculoskeletal problems. Call 866-588-0230 today to claim one of our few open slots.

Saturday June 1, 2019

YOUNG GIRL WITH AUTISM BENEFITS FROM OCCUPATIONAL THERAPY

Vivian Turner Occupational Therapy

by Marketing Specialist Lindsey Klyn

Vivian Turner Occupational TherapyOn July 6, 2015, Jack and Megan Turner welcomed their fourth child, a little girl named Vivian, into the world. For the first year of her life, Vivian seemed to be hitting all her milestones and growing right along. But once her first birthday came and went, her parents began to notice that she wasn’t behaving like other one-year-old kids.

The differences were small. Vivian wasn’t saying words or babbling. She didn’t make eye contact and didn’t seem to be playing with toys like she should. After they continued to notice these small differences, the Turners sought out their family doctor. Their doctor recommended bringing Vivian to be evaluated at the University of Iowa’s developmental department, so the Turners did.

The evaluation lasted for most of the day, ending with a sit down with a specialist. That was the moment the Turners learned that Vivian was diagnosed on the autism spectrum, along with a speech and developmental delay.

“Truthfully, I don’t think I heard much after that,” shared Vivian’s mom Megan. “We left and when I got in the car, I sat and cried thinking, ‘What in the world do I do for autism?’ Knowing there isn’t a ‘cure’ for autism was the scariest thing to me.”

The Turners faced a lot of fear and unknown after this diagnosis. They wondered if Vivian might grow out of this or if there would be medicine that could help. Their world looked bleak, and they feared how this diagnosis would impact their sweet little girl.

Despite how they felt, the Turners were committed to doing all they could to help Vivian. The doctors suggested starting speech therapy and occupational therapy. After hearing about the occupational therapy team at Kinetic Edge Physical Therapy from a few people, the Turners called to set up an evaluation for Vivian.

Occupational Therapist Elise Spronk performed Vivian’s initial evaluation. She discovered that Vivian was struggling with her fine motor skills, as well as not really playing with toys. Vivian preferred to line toys up rather than play with them. In addition, Spronk noticed Vivian’s social interaction, her ability to dress herself, and her ability to eat with utensils could all use work.

“At the start of therapy, our goal was to just have Vivian attend long enough to an activity to participate in play without quickly going from one activity to the next,” shared Occupational Therapist Elise Spronk. “As this improved, we were able to focus more directly on her skills so that she’d be able to participate in other play and self-care skills.”

After a year of weekly occupational therapy, the Turners notice a drastic change in their almost four-year-old daughter. Vivian used to hate the feeling of any wet texture and now plays with items like wet sand and shaving cream, an indication of improved sensitivity to stimuli.

Pella Sensory Play at Kinetic Edge“This little girl who couldn’t even put a finger in something like that is now putting whole hands and arms in,” Megan exclaimed. “After seeing these changes happen week after week, I started telling myself this is happening and is real. It has been a huge life changer! Kinetic Edge has been nothing short of a God-send really.”

Life now looks a lot different for the Turners than it did three years ago when they got Vivian’s diagnosis. Thanks to help from therapies, school, and home life, Vivian now says words and babbles all the time. She even enjoys getting into messy things. While Vivian still show signs of delay, the Turners outlook on this diagnosis completely changed as they’ve been filled with hope.

“I believe Vivian will live a full, self-functioning life when she gets older,” said Megan. “We have a cheerful and happy-go-lucky daughter who shines light on our lives every day! I wouldn’t change anything for the world.”

Kinetic Edge’s mission is to transform lives and restore hope through movement. Vivian is another one of the stories that attribute how they’re bringing hope to individuals of all ages in Iowa. A  child with delays in developmental milestones, abnormal sensory preferences, trouble with reflex integration, or difficulty with visual perception can benefit from pediatric occupational therapy. These symptoms sometimes occur for no apparent reason and other times can be the result of a specific diagnosis. To find out more about occupational therapy at Kinetic Edge, call 866-588-0230.

Thursday May 9, 2019

KINETIC EDGE PHYSICAL THERAPY COMING TO WAUKEE

Sportplex West, located in Waukee
Sportplex West, located in Waukee
Sportplex West, located in Waukee

Kinetic Edge Physical Therapy is opening their seventh clinic across Iowa in Waukee on June 3. This opportunity came about after Sportplex West, an indoor sports and recreation complex, promoted their interest in a physical therapy partner on Facebook back in January.

CEO and Doctor of Physical Therapy Troy Vander Molen reached out to Jake Shandri, one of the partners at Sportsplex West, to find out more about their vision after seeing the post on Facebook. He quickly discovered their vision was very compatible with that of Kinetic Edge.

“The Sportsplex West and D1 Training teams that operate out of this facility in Waukee are leaders in the field of sports and athletic development,” shared Vander Molen. “Kinetic Edge focuses on enhancing comfort and performance through movement which blends well with the performance enhancement and athletic fundamentals training performed by Sportsplex West and D1 Training.”

Kinetic Edge Physical Therapy, formerly Work Systems Rehab & Fitness, opened in 1998 in Pella, Iowa. Their corporate office is still based out of Pella, with five additional clinic locations throughout central Iowa. In March of 2015, the company rebranded to Kinetic Edge Physical Therapy. Since then, they’ve experienced unapparelled growth as a company.

Their recent success increased their interest in finding new markets to serve. This interest in growth, however, is not simply to add pins to the map. They desire to influence people and communities with their mission to transform lives and restore hope through movement.

“After interviewing and meeting with several physical therapy groups from the Des Moines area, D1 Training Team decided Kinetic Edge was the right physical therapy group to bring the expertise that would best serve our clients and facility needs,” said Managing Partner of Sportsplex West Jake Shandri.

Both companies quickly realized that a partnership would provide a winning solution for everyone involved – Sportsplex West, D1 Training, the Waukee community and surrounding areas, and Kinetic Edge. Initially, Kinetic Edge of Waukee will be open Mondays, Wednesdays, and Fridays, with plans to extend hours as demand increases. Physical Therapists Patrick Ford and Kaity Hall will operate this location.

Physical Therapists Kaity Hall & Patrick Ford
Physical Therapists Kaity Hall & Patrick Ford

“Patrick is a young therapist with an athletic background,” commented Vander Molen. “He will relate exceptionally well to the clients we will serve there. Kaity Hall’s background as an athletic trainer, in addition to her physical therapy skills, make her an extremely versatile option for the athletes there as well.”

Kinetic Edge has a 20-year history of restoring health to people with musculoskeletal problems quickly. They provide the care people need when they need it using evidence-informed techniques, which has proven to be very effective. Plus, as an independent provider of physical therapy, their lower costs generally result in lower costs to any client that has to pay a co-pay or co-insurance for each date of service. They look forward to opening and serving the community of Waukee and surrounding areas soon!

Friday May 3, 2019

IS THE KINK IN MY NECK A PINCHED NERVE?

Neck-pain-2

Is the Kink in My Neck a Pinched Nerve?

By Dr. Troy Vander Molen, PT, DPT

By far the most common type of neck pain that people experience, especially among those of you who are younger, is described as a “kink” or “crick” in the neck. Often times, that localized area of pain makes it difficult to turn your neck one way or the other. It is, quite literally, a pain in the neck!

neck_pain

Over the years, I’ve had many people consult with me reporting that they have a pinched nerve in the neck, and then they proceed to describe the typical kink in the neck that makes neck movement difficult and painful. While those symptoms are not pleasant, this common type of neck pain is not a pinched nerve.

To be sure, there are nerves that travel through small openings that exist between each vertebral body in the cervical spine (and each set of spine segments traveling down the back). However, if you have a condition that compresses one of those nerve roots, you will likely have distinct symptoms that are different from a kink in the neck.

What causes a kink in the neck?

Most medical providers suggest that a painful kink in the neck is the result of muscle spasms. A leading expert in this type of pain, Dr. Robert Maigne, a French medical doctor, described common neck pain as “painful intervertebral dysfunction.” The intervertebral joint consists of several structures: the disk, the vertebral bones above and below the disk, ligaments that provide structural stability, and the facet joints, which are located both on the left and the right where one vertebral bone connects to the neighboring vertebral bone. Irritation of any of these structures can cause a painful kink and possibly headache pain.Neck-pain-2

In my many years of experience as a physical therapist, I’ve found that the facet joint is often the primary culprit. When a facet joint gets irritated, which can happen from time to time if you move wrong, posture yourself awkwardly, or have some arthritic changes in the neck, a signal is sent to the brain, and the brain will unconsciously respond by telling the muscles around the joint to spasm. This unconscious response is a natural protective mechanism for the irritated joint.

It is important to know that a kink in the neck, though painful, is not dangerous. Most people can relieve the discomfort by modifying the aggravating postures, movement, or activities and applying ice and/or heat. If the pain lasts for more than a few days, consider seeing a physical therapist trained in evaluating and treating neck dysfunction. Early intervention usually results in a short course of care, and you will feel better very quickly in most cases.

What kind of distinct symptoms are present with a pinched nerve?

Our nerves carry critical information between the brain and the body. Some of this information is sensory, which travels from the body to the brain and includes our senses of pain, numbness, tingling, burning, temperature discernment, and pressure sensitivity, among others.

Some of the information carried via the nervous system is motor, which travels from the brain to the body and helps us create voluntary and involuntary muscle actions.

Nerves can potentially be compressed both centrally as they exit from the spine and peripherally by structures like tight muscles that exist external to the spine. Spine-related issues that can put pressure on a nerve as it exits the spine (i.e. central causes) include herniated disks and other arthritis-related changes like narrowing of the disk space, disk degeneration, and bone spurring.

 Interestingly, if you are experiencing a pinched nerve, you may not even experience neck pain at all. Some do; others don’t. What you most definitely will be feeling, however, is pain, numbness, and/or tingling that extends into your arms and even your hands. Sensory changes in the arm are typically the earliest symptoms you will notice with a pinched nerve in the neck.

 Like a kink in the neck, a pinched nerve is not necessarily serious. Most pinched nerves result in sensory changes only and can be easily managed conservatively. I would recommend you seek professional consultation if you experience these types of symptoms. A well-trained physical therapist can help determine the source of the nerve compression and determine a plan of care that will help you eliminate the symptom and restore your function.

If you experience changes in muscle function in your arm and/or hand, like a loss of pinch or grip force or other signs of muscle weakness, the compressive forces on the nerve(s) are more substantial and potentially need more advanced care. Our physical therapists typically refer people with these advanced symptoms to a physician or spine specialist for diagnostic testing to determine the extent of the problem.

If you are experiencing any arm symptoms or simply have a kink in the neck, I encourage you to take advantage of one of our free injury screens. A brief and complimentary 20-minute consultation with one of Kinetic Edge’s movement experts can yield a bounty of solid advice that will put your problem to rest. Please call 866-588-0230 today to claim one of our few open slots.

Wednesday May 1, 2019

PHYSICAL THERAPIST VOLUNTEERS TWO WEEKS IN AFRICA

Carol Kelderman with school kids - Copy

by Lindsey Klyn, Marketing Specialist at Kinetic Edge

Carol Kelderman with school kids - CopyFor years, Carol Kelderman looked for an opportunity to use her skills as a physical therapist on a mission trip in a foreign country. She always felt a pull towards Africa, and she even researched organizations to volunteer with there over the last couple of years. For some reason, none of the opportunities she came across ever felt quite right. So, when the pastor at their church mentioned a trip to Tanzania, she inquired more to see if her skills as a physical therapist might be useful.

“I was met with a positive response so I started to prepare for this possibility with an open heart,” shared Kinetic Edge Physical Therapist Carol Kelderman. “I want more than the ‘Christian version of the American dream’, so if I have an opportunity to serve, I want to be ready and willing.”

So with an open heart, Carol boarded a plane for Tanzania on March 15 with plans to spend two weeks serving the people of Africa. After 48 hours spent traveling (22 of those hours on planes), the team of five arrived at Hope of the Nations in Kigoma, Tanzania.

Carol spent most of her time working alongside a Tanzanian nurse and Linda Verhoef, a nurse on her team. The three of them assessed and treated a wide variety of people with all sorts of conditions. Donations from Kinetic Edge Physical Therapy and Mahaska Drug allowed them to make medical kits for Hope of the Nations’ boat ministry, college, primary school, staff members, and the general community. Carol and Linda also spent time training staff at the primary school and teaching schoolkids about germs and hand sanitation.

Abu with some of his family
Abu (on lap) with some of his family

A highlight of Carol’s trip came when she met seven-year-old Abubakari, “Abu”, only a few days in to the trip. Abu contracted yellow fever when he was just days old. The yellow fever caused severe seizures and difficulty breathing, and due to limited treatment options, Abu became essentially paralyzed, unable to control his muscles or body position or communicate. This reality puts quite a strain on his family, including his mother who is pregnant with her fifth child when she and Carol met.

The team quickly realized that the right kind of chair would enable Abu to sit up and greatly help him and his mom. If Abu lived in the United States, he’d likely have a properly fit wheelchair along with physical therapy, occupational therapy, and speech therapy. But in Africa, limited resources and the scarcity of medical care meant the team had to get inventive.

Abu sits  on his own in his newly created chair
Abu sits on his own in his newly created chair

“We were able to construct a chair using parts of our suitcases and help from the ladies in the sewing training center,” said Carol. “The chair provided adequate support and safety for Abu so he could remain in the main family living area where interaction with family and neighbors could happen more naturally. This also freed up mom’s hands as she is preparing for a new baby in the home.”

Carol noted that it was difficult to not be able to help to the extent she would have liked with Abu and others she met while on her trip. However, she was thankful to be reminded that much like in her hometown, education empowers and provides hope, something she and her team at Kinetic Edge Physical Therapy are quite passionate about.

“God is teaching me to be ready to serve, even outside of my comfort zone,” concluded Carol. “You never know what impact you can have on the people you encounter.”