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 FOR RSD
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 shortly.
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.