Dr. Jessica Hong Wing Lee, DC – Hong Kong Chiropractor

Information and Thoughts About Chiropractic, Health, and the Human Body.


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My finger is stuck!

Recently, a few of my patients have experienced the problem of one of their fingers seemingly stuck then suddenly… unstuck. What’s going on?

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Trigger finger is a condition where your fingers seem stuck when bending or straightening and then suddenly releases and pops back. It is commonly called “trigger finger” because of the similarity to pulling the trigger of a gun. It can involve any finger including the thumb, and may affect more than one finger or more than one hand at a time. The ring finger is the most commonly affected.

Initially, people with trigger finger usually notice soreness at the base of the finger or thumb. Some people report the problem started with a painless clicking when moving the fingers. Finger stiffness is often experienced, especially in the morning, and may occur when firmly grasping an object or when straightening the finger. There may be difficulty in fully straightening or bending the finger. As the condition gets worse, the finger locks in a bent or straight position and often needs to be aided with the other hand. People will commonly say that they feel a painful clicking or popping when bending or straightening the finger. This sensation of the finger getting stuck is worse when not moving for a prolonged period of time but seems to be better with movement. Some people notice a bump at the base of the affected finger. Eventually the finger will not be able to fully bend or straighten and is usually stuck in a contracted position. Over time, due to avoiding the painful triggering, there may be the development of secondary contractures and generalized finger stiffness. Symptoms may be aggravated by hand use at work, home, gardening, and playing sports.

This condition occurs due to irritation of the tendon sheath of the finger. Tendons attach muscle to bone. The muscles that control the movements of the fingers and thumb are located in the forearm above the wrist. These tendons travel from the forearm through the wrist to the small bones of the fingers and thumb. Each tendon is surrounded by a protective tendon sheath and there is a pulley system that keeps the tendon in place next to the bones. When you bend or straighten your finger, the tendon slides through the tendon sheath and pulleys. Due to some reasons such as overuse or injury, the tendons can become irritated and thicken, forming nodules that make its passage through the pulley tunnels more difficult leading to a clicking sensation. When the tendon becomes momentarily stuck at the opening of the tendon sheath tunnel, when you are trying to bend or straighten your finger, then suddenly slips through the tight area is when you may feel a pop and the finger will suddenly shoot straight out or bend. Usually the fingers are stuck in a bent position because the tendons of the finger that control bending are strong enough to overcome the restrictive and narrowed tendon sheath while the tendons that control straightening are not.

Trigger finger reportedly happens more to people whose work or hobbies require repeated and strong gripping actions such as farmers, industrial workers, and musicians. However, studies have not found any definite association between trigger finger and the workplace, so the cause is probably due to multiple factors. The condition tends to be found more in women and those between the ages of 40 to 60. It is more common in individuals who have diabetes, rheumatoid arthritis, renal disease, hypothyroidism, amyloidosis, etc. It may be a complication associated with surgery for carpal tunnel syndrome. Sometimes it can happen after a hand injury. In many cases the condition has no known cause and is insidious.

Trigger finger can be diagnosed with a physical exam of the hand and fingers. Lab tests and x-rays are usually not necessary unless ruling out other differential diagnoses. If you notice that there is stiffness, catching, numbness, or pain in a finger joint or you are unable to straighten or bend a finger then make an appointment with a health professional. You may notice that the finger is swollen or there is a bump over the joint. For self-care at home you may try resting, applying heat, applying ice, stretching, and modifying your activities that involve repeated gripping. Chiropractors may manage this problem with modalities such as ultrasound and/or electric stimulation, Graston, wax therapy, rehabilitation exercises, adjustments, splinting, etc. For chiropractic therapy, the goal is to decrease the swelling and get rid of the locking to allow full, painless movement of the fingers. If these conservative measures don’t work then surgery may need to be considered where the pulley at the base of the finger is cut open to allow the tendon to glide more freely.

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7 Exercises to Try for Trigger Finger:

  • Lay your palm down on a flat surface. Lift each finger one by one and hold in the lifted position for 2 seconds before returning to the original position. You may use your other hand to pull the fingers to increase the tension. Repeat 10 times each finger.

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  • Wrap a rubber band around your fingers. Open and close hand against the resistance. Repeat 20 times each hand.

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  • Touch each finger to your thumb. Repeat for 2 minutes.

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  • Hold a therapy ball in your palm. Squeeze for 5 seconds then release. Repeat 10 times.

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  • Fold your fingers down together joint by joint until you make a fist, then straighten your fingers. Repeat 20 times.

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  • Massage the joint and area affected by the trigger finger for 3 minutes.

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  • Place a towel on a table. Place your palm on the towel. Grab the towel with your fingers and scrunch it while applying pressure on your fist. Maintain this position for 5 seconds then straighten fingers slowly. Repeat 15 times.

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Can Ankle Sprains Lead to Back Pain??

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As a chiropractor, ankle sprains are one of the most common complaints that my patients have. Often these are due to sports injuries, but I have seen many that were due to walking on uneven surfaces or just missing a curb. Immediately after the sprain, there is usually swelling and pain that can affect your daily activities. After 4-6 weeks, the soft tissues will have mostly healed, but I have seen many cases that have lasted for months or even years where the original ankle sprain has led to problems in the pelvis or lower back due to compensation. Most people don’t realize that even minor ankle sprains can lead to long-term consequences.

First of all, the ligaments that are damaged during the sprain lose their elasticity and functionality due to build up of scar tissue. This is why after jogging or long walks especially on uneven ground you may notice increased ankle pain or stiffness. The ankle ligaments also become overstretched from the sprain when the ankle is suddenly turned past its normal range of motion. Once these ligaments are overstretched they will not return to their original shape and this results in decreased stability in the joint. Both of these problems lead to increased chances that you will sprain your ankle again. These issues also change the way the ankle moves and may lead to problems in the parts of the body above this joint including the knees and the spine.

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The sprained ligaments also lose the ability to effectively communicate with the brain leading to decreased coordination of the ankle. This leads to poor balance, and again, you are more likely to twist your ankle repeatedly. This makes walking on uneven surfaces or playing sports more dangerous because our brain is having trouble telling our body how to make small adjustments to avoid injury. Decreased coordination also changes the way you walk leading to torsion or strain in the lower back.

If an ankle sprain is not properly treated it may lead to chronic stiffness. This means that the ankle may have trouble moving in certain directions such as the toes moving upwards and turning the foot outwards. This loss of ankle motion will cause changes in how the body moves during walking. Since the heel is not contacting the ground properly, the muscles of the pelvis and leg regions will not work efficiently and lose strength, leading to an alteration of normal gait that in turn can lead to problems such as lower back pain.

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Even minor ankle sprains can have a big effect on your body. With proper treatment, improvements can be made quickly even with chronic cases. If you have an old ankle sprain then you may need chiropractic therapy to help you achieve full range of motion and complete your rehabilitation. An examination of the structures that have been affected since that time may be necessary including the hips and lower back. Some chiropractors will perform special techniques on the ankle to help promote healing and increase the ankle’s range of motion. Chiropractic treatment can help to prevent chronic and recurrent problems. If you have ankle, knee, hip, or back pain, your chiropractor will perform a careful case history and examination to determine the actual cause of the problem and remedy it accordingly.


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Is the Weather Giving You Pain?

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Ever since I broke my finger in the 8th grade, I have had the ability to sense when it is going to rain or become quite cold.  However, as I got older, I realized that large amounts of people have this ability and that it is not unique.  It is very common for people to blame weather for increased pain in their joints.  We all know someone who say things like “my knees are hurting more than usual today, it must mean that tomorrow is going to rain”.  It is a phenomenon that is most often associated with cities that experience extremely cold weather, but it happens to many people in Hong Kong too possibly due to the humidity and precipitation.  Even in a city like San Diego where the temperature is always mild and never gets too hot or too cold, people report a great sensitivity to weather changes.

 

So what is it that brings on increased joint pain with weather changes?  Currently, there is no full agreement among scientists that weather causes pain, and the exact mechanism is not known, but there are several plausible theories.  Although people blame the cold, wind, rain or snow, research suggests that barometric pressure is what affects people the most.

 

Barometric pressure is the weight of the atmosphere that surrounds us.  Imagine the tissues surrounding the joints to be like a balloon.  Barometric pressure normally pushes against the body from the outside and keeps the tissues from ballooning out or expanding.  Usually before bad weather starts, the barometric pressure of the environment decreases.  Because there is less air pressure pushing against the body, this allows the tissues surrounding the joints to expand and this leads to more pressure on the joints.  If the joints have arthritis already, this increased pressure may lead to more pain.  When people have chronic pain, often the nerves are already more sensitive due to injury, inflammation, adhesions, and scarring.  In these people, even very minor changes in barometric pressure can lead to pain. 

 

Cold weather can affect joint fluid thickness so that there is less lubrication in the joints that leads to more pain.  When the temperature is cold outside, the tissues of the body contract and this pulls on the nerve endings that can lead to increased sensitivity or pain.  So when the barometric pressure drops when it is cold, again there will be less air pressure pushing against the tissues and this inflamed tissue will expand leading to more pain.

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There are many methods to alleviate weather related joint pain.  One of the most effective strategies is to keep active.  Exercise helps to lubricate the joints to prevent pain.  Try some low impact aerobic moves that are easy on the joints such as walking, Yoga, or Tai Chi, which enhances the range of motion.  Stretch in the mornings and evenings to stay flexible and decrease tension.  Swimming in a heated pool can help alleviate back and joint pain.  You can also try applying a heating pad onto your painful joints to let the muscles relax and sooth the joint pain. 

 

As a chiropractor, I have seen first hand how this regular therapy can help these patients.  Many of my patients complain of increased joint pain with poor weather.  After undergoing a treatment plan where the movement of their joints improves significantly, their weather related pain dissipates.  Now these patients no longer have joint pain with damp or cold weather.   


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Is Crossing the Legs Good or Bad for Your Spine?

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“Sit properly! Cross your legs! Be more ladylike!” Many of us ladies were scolded by our mothers growing up to sit with our legs crossed at the knee.  Nowadays, most men and women usually cross their legs due to comfort and habit rather than for manners.  Often when we cross our legs now, one of our friends will exclaim “don’t cross your legs, that’s bad for you!”  Ever wonder why?  Well, this position can lead to an unbalanced pelvis or even contribute to pelvis, lower back, and hip discomfort.

The pelvis needs to be balanced for the spine to be balanced.  The pelvis consists of 3 bones: the two hip bones and the triangular sacrum in between.  If the hips are level and the hips and sacrum are aligned, the legs will be able to sit evenly into their sockets and the spine can be straight.

How can crossing the legs lead to pelvic imbalance?

The bones of the body are held together by tendons and muscles, which run from one bone to the next.   These keep the bones in the right place so that every joint can move properly.  Each muscle has a specific length and when they are all in their ideal range of length, everything is held in perfect alignment.   However, if you habitually adopt a slightly different position, slowly over a long time the muscles adapt and become permanently longer or shorter leading to the chance that your joints will move out of place.

Constantly crossing your legs eventually makes the outer thigh muscle longer and the inner thigh muscle shorter.  When the posterior hip muscles shorten, it can lead to tightness and discomfort in the lower back and hips.  Over time, this additional pressure on the hip muscles and the sciatic nerve can throw off your sacroiliac joint and pelvis leading to sciatica and back pain.

Sometimes your pelvis may be already out of alignment for other reasons such as accidents, falls, poor posture, etc.  In this case, the body may try to alleviate the discomfort by crossing the legs.  Crossing one of the legs will lessen the discomfort by taking the pelvis out of a neutral position to adapt to the imbalanced pelvis; however, this will just create more problems over time if the original issue is not corrected.

When is there a problem with crossing legs?

 Crossing the legs is acceptable if you cross both sides approximately for the same amount of time and switch regularly as this is just a position switch that can relieve your body when sitting for long periods of time

It becomes a concern if:

  1. You notice that you feel more comfortable with one leg crossed over the other
  2. You always cross only one side over the other
  3. You find that crossing one way has more hip range than the other side.
  4. You notice that when you walk it seems like you have two different length legs
  5. You get regular low back or pelvis pain
  6. Feel like one leg is becoming weaker or heavy
  7. If your lower back, hips, or pelvis feel uncomfortable when you sit properly

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If you experience these problems you need to seek a qualified professional to assess your pelvis and spine, and to check the nerves.  Chiropractors are highly experienced in balancing the spine and nervous system.

How should you sit?

Find a supportive chair with good low back support that allows you to sit with feet flat on the floor, knees and hips close to 90 degrees.  Your weight should be placed evenly across both bones of the bum and make sure there is a natural arch in the lumbar spine.  The most important point is to remember to take breaks often from sitting at least one time every hour and get moving!


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Help! My Child’s Feet are Flat!

Recently, a mother brought her 3-year-old child to my office very concerned that he has flat feet.  Another practitioner told her that he requires orthotics immediately.  This is a common concern of many parents out there so let’s get our facts straight.

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It is normal for babies and infants to have the appearance of flat feet due to a fat pad that is in the arch region and also because the arch hasn’t fully developed yet.  The longitudinal arch of the foot begins to develop around the age of 2.  Children’s bones and joints are quite flexible so at a young age, their feet tend to flatten when they stand.  It takes time for the muscles, tendons, ligaments, and bones to grow strong to form an arch.  Having the child go barefoot more often on varying terrain can help with arch development.  By the age of six or seven, the feet become less flexible and the arches become fully developed.    


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Are Backpacks Harming Your Child?

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When was the last time you weighed your child’s backpack? If the backpack is 15% or more of your child’s body weight, they have an increased chance of experiencing neck and back pain due to backpack induced poor posture.  If your child feels a need to lean forward while carrying the backpack, it is a sign that the bag is too heavy.  Many Hong Kong parents are very concerned about how heavy backpacks are affecting their child’s health; here are some tips!

Backpack Shopping Tips:

  1. Is the bag made of lightweight material?
  2. Does the bag have a padded back?
  3. Are there individualized compartments to separate items?
  4. Are there two padded, wide, adjustable shoulder straps?
  5. Is there a waist belt to redistribute the weight of the backpack?
  6. If your child often needs to carry a heavy backpack, have you considered a rolling backpack?

(All of these answers should be “yes”)

Backpack Habits:

  1. Is your child using both shoulder straps?
  2. Is your child’s posture straight with the backpack or are they leaning forward while walking?
  3. Are the heaviest objects packed in first so they are lower and closer to the body?
  4. Is your child only carrying what is needed and leaving unnecessary items at home or at school?
  5. Does your child clean out their backpack at least once a week?
  6. Is the backpack within 10-15% of your child’s body weight?
  7. Does your child lift the backpack using their leg muscles rather than their back?
  8. Are the straps adjusted so that the backpack fits snugly to your child’s body?
  9. Is the bottom of the backpack approximately 2 inches above the waist, and the top of the backpack just below the base of the skull?

(All of these answers should be “yes”)

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Tips for Parents:

  • Observe if your child has difficulty putting on and taking off their backpack.
  • If the backpack is too heavy for your child, remove some items from the bag and have your child hug them in front of their body
  • Communicate with your child regularly regarding any neck pain, back pain, or numbness and tingling in their arms and legs
  • If your child or teenager reports neck or back pain, take them to a chiropractor immediately
  • Choose the smallest and lightest backpack that will suit your child’s needs
  • If your child experiences discomfort carrying their backpack, reduce the weight right away

Chiropractors are health professionals that can provide further advice regarding proper postures in young people to improve their spinal health and avoid future injury.  If your child has pain from backpack use, or you notice them developing a hunchback or forward head posture, it is time to consult your family chiropractor.  The sooner these issues are dealt with, the less problems they will lead to in the future.  Kids need a healthy spine for a healthy life!


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Is your neck too straight?

forward head postureLook into a mirror when you are standing sideways and draw an imaginary line from your ear hole to the shoulder.  If your head is forward of the line then you have forward head posture.  Forward head posture means a loss of the curve of the neck, which is needed to function properly.  The vertebral column has 4 spinal curvatures that are important for balance, flexibility, shock absorption, and force distribution.  If these spinal curvatures deviate too much from normal limits, it can lead to issues such as pain, muscle tightness, and can even affect your spinal nerves.

It is not unusual that so many people suffer from forward head posture.  With the advances in technology, there is frequent usimage-400x275e of devices such as computers and smart phones that have made us very vulnerable to postural problems.  Our bodies were not designed to spend hours hunched in front of a computer, looking down at a phone to text, playing portable video games, or watching shows on tablet devices.  Consider how many years you have been doing this.  The youth of today have been doing this for basically their entire lives and now many more are suffering from postural health issues.  Due to this technological lifestyle, postural problems have become an epidemic.

When the head sits properly on top of the spine the weight of the head is evenly balanced.  When your head is forward of your body’s centre of gravity, this causes the structures of your neck to undergo unnecessary strain.  For every inch of forward head posture, the weight of your head increases by an additional 10 pounds.  If this faulty position perpetuates, the bones in your neck will move out of alignment and will not function as they should.  Furthermore, retaining a particular position for even 3 hours can result in scar tissue being laid down in and around the joints, which will ultimately reduce the neck’s range of motion and nerve function.  A mound of soft tissue at the base of the neck may develop due to the compressive loads upon the upper thoracic vertebrae known as a “Dowager’s Hump”.  The added pressure on the spinal cord, nerves, and discs can cause neurological issues such as headaches, disc herniation, and pinched nerves leading to numbness or tingling in your hands or feet as well as fatigue and a weakened immune system.  Over time, poor neck posture can also lead to long-term complications such as osteoarthritis.  In fact, forward head posture may actually promote accelerated aging of the spinal joints resulting in early degeneration.  There are even more far reaching effects of anterior head carriage.  Posture also affects bodily functions from breathing to hormonal production such as mood, blood pressure, pulse, and lung capacity.

Correcting anterior head carriage cannot be accomplished overnight.  It takes time for the body to revert to a correct position.  The first step is to see a chiropractor to obtain a diagnosis and receive treatment to relieve your neck from joint and muscular problems.  Once the neck structures are functioning well, corrective exercises will be prescribed to restore and maintain proper posture.  Also, many lifestyle changes need to be made, for example, the set up of your office workstation and the amount of time spent using devices.  It is also important to maintain an active lifestyle to prevent early degeneration and posture associated injury.  Forward head posture has serious impacts on your health. It will only become worse with time if not corrected.

Suggested Exercises for Improving Posture

lateral flexionLateral Neck BendsMove your ear towards your shoulder on the same side.  Use your hand to pull your head farther until you feel a stretch.  Hold for 20 seconds and repeat on the other side.  Perform 10 times each side.

 

shoulder rollsShoulder RollsRoll your shoulders backwards in a circle.  Perform for 2 minutes.

 

chin tucksChin TucksMove your head straight backwards to make a double chin.  Hold this position for 10 seconds.  Perform 20 times.