Chiropractic is a drug free way to help treat
the symptoms of RSD/CPRS. Our resident expert, Dr Leprich , DC,
who treats RSD patients, explains his approach to treatment.
ABOUT DR. LEPRICH
Dr David Leprich graduated from the Canadian Memorial Chiropractic
College in 1977 and commenced practice in St. Catharines in 1978,
After serving as President of the Niagara Chiropractic Society
and as a Director of the Ontario Chiropractic Association, he
was elected as President of the Canadian Chiropractic Association
(CCA) in 1998. He currently serves as Chairman of the Board of
Governors of the CCA. He is the theatre chiropractor for the Shaw
Festival Theater in Niagara-on-the-Lake and is a chiropractic
disability consultant to the St. Catharines General Hospital and
the Medical Assessment Center of Ontario.
ALTERNATIVE TREATMENT OPTIONS
by Dr David J Leprich DC
What a miracle of engineering! The human body is perfectly designed
to handle the special functions and stresses placed on it throughout
life. The newborn skeleton contains all of the structures needed
during life. Amazingly, these structures can handle the rigors
of childbirth and then adapt as the demands place on them change.
The flexible cartilaginous bones of the infant become the strong
support structure of the young adult. The greatest miracle of
human design and function is the nervous system.
It has been said that the human brain is so complex that we will
never be capable of understanding its full function. How ironic;
the brain will never be able understand itself! Just as intriguing,
the remainder of the central nervous system (the brain stem and
spinal cord) and the peripheral nervous system somehow manage
to convey information from the outside world to the brain and
send the appropriate response messages to the body. Most of this
happens without conscious effort. In fact, until problems arise,
most people have little awareness of what is taking place. The
importance of a healthy nervous system and the relationship between
the nervous system and skeletal systems will become more apparent
Like any other complex system, the human nervous system is susceptible
to malfunction and breakdown. Some of these problems are well
understood. For example diabetic neuropathy is the systematic
breakdown of neural tissue which results from an increase in blood
sugar. The symptoms of carpal tunnel syndrome can include numbness
and tingling of the affected hand and is due largely to the compression
of the neuromuscular bundle which passes through the tunnel formed
by the carpal bones and the flexor retinaculum. Perhaps the most
common example of nerve dysfunction is the paresthesia (numbness
and/or tingling) which occurs in your hand when you lay on it
during sleep. Many mistakenly assume this is due to impingement
of blood vessels with a resulting loss of blood flow. In fact,
whenever numbness or tingling occur, you are experiencing a disruption
of normal nerve function. Other conditions affecting the nervous
system are less well understood.
Multiple sclerosis is a potentially serious condition which affects
the nervous system. It involves slow degeneration of the fatty
tissue (myelin) which surrounds and protects the nerve and spinal
cord. The resulting loss of conductivity of the nerve may lead
to paralysis. The exact cause of this condition remains unknown
and this limits treatment options. Reflex Sympathetic Dystrophy
(RSD) shares some characteristics with both simple nerve impingement
and the more complicated neuropathies.
Other authors have described well the mechanisms of injury and
resulting pathology and dysfunction relative to RSD. I will simply
say that RSD is generally the result of injury to a nerve or surrounding
soft tissue which does not follow normal healing patterns. One
of the key features of RSD is pain and stiffness of a greater
magnitude than would be expected from the initial injury. following
the onset of RSD, stimulation of the skin by any light touch may
elicit pain. Repetitive stimulation may produce increasing pain.
Often there will be tender points within the affected muscle which
trigger pain in other areas when touched. One of the few features
of RSD which seems to be universal is that it often occurs after
trauma. This may be a one time soft tissue injury such as a sprain,
strain or a direct injury. For example the first patient I attended
to who was experiencing RSD reported that the initial injury occurred
when a large tin of fruit juice dropped onto her foot. The current
thinking is that RSD is the result of prolonged and/or continuous
response to the trauma by the sympathetic nervous system. The
element of RSD which is of interest to me as a chiropractor (and
could be of great value to those who suffer RSD) is that it often
appears as a component of some other condition. For example, RSD
may appear as a component of degenerative disc disease, carpal
tunnel syndrome, or may follow trauma to the spine such as whiplash.,
As a result, treatment of RSD may be more effective it if includes
treatment directed at the coincidental condition. One of the keys
to treatment of RSD is restoration of function and mobility of
the affected part. In these situations, chiropractic treatment
can be very effective.
The main component of chiropractic is spinal manipulation. This
gentle, hands-on treatment is intended to restore normal function
to the small facets joints of the spine, the larger sacoriliac
joints, and often, the peripheral joints as well. These articulations
can become hypomobile\ (too stiff) or hypermobile (too loose).
These conditions can be the result of trauma, repetitive strain
or postural abnormalities. Even undue stress can affect spinal
joints by creating muscular tightness, particularly in the upper
back and neck. When the small joints of the spine begin to function
abnormally, the body responds. This response may include muscle
spasm and soft tissue inflammation and swelling. This, in turn
may affect the spinal nerves as they exit the small openings between
the vertebrae. Chiropractors refer to these malfunctions of the
spinal joints as subluxation. This can produce a variety of symptoms
including local pain and stiffness, referred pain (pain experienced
in an area remote from the site of the problem) and irritation
of the spinal nerve roots. When the nerves becomes involved, the
symptoms can include pain, numbness and/.or weakness in the area
supplied by that nerve.
Chiropractic treatment will often include advice on lifestyle
modifications such as sleeping and sitting posture and exercises
specific to each patient. Recommendations may be given for changes
in diet or the proper use of nutritional supplements.
Most new patients in my clinic present with one or two major
complaints, usually low back or neck pain, or headache. After
concluding the treatment program, they report a significant or
complete resolution of the problem and more. It is not uncommon
to hear patients describe improvements in sleep patterns, increases
in energy, and a generally better sense of well being. All of
these benefits can help the RSD patient.
While there are many more questions than answers regarding RSD,
it is known that it affects the nervous system RSD may be the
result of overstimulation of the sympathetic nervous system and
if often initiated by an injury to the voluntary system. In any
case, maintaining proper nerve function can help to reduce symptoms
of RSD. A thorough chiropractic assessment will reveal possible
areas of spinal dysfunction. A complete consultation will provide
information about the possible presence and root cause of RSD.
for patients who are diagnosed with RSD, a course of chiropractic
treatment can at the very least improve the level of function
of the spine and nervous system and at best, can help to reduce
the symptoms and complications of RSD.
For more information about chiropractic, or for
advice on how to find a chiropractor near you, please visit the
web sites of the Canadian Chiropractic Association (www.ccachiro.org)
or the Ontario Chiropractic Association: (www.chiropractic.on.ca).
UPDATE: Dr Leprich was a guest
speaker at the RSD International Conference held on July 27-29,
2000 in Toronto Ontario Canada. A videotape of his lecture is
available in section Conference 2000.
FURTHER READING: Muir JM Vernon
H Complex Regional Pain Syndrome and Chiropractic J Manip Physiol
Ther 2000 Sep23;(7):490-7 PMID 11004654.