Dr. Jessica Lee – Hong Kong Chiropractor

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


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Is Your Blackberry Giving You a Health Condition? The Dreaded Blackberry Thumb!

(Aka Cell Phone Thumb, iPhone Thumb, Text Messaging Thumb)

In recent years, it seemsyou can’t go anywhere without seeing people on their smartphones.  In the elevator everyone is looking down at his or her phone and texting.  At dinner with friends, everyone is texting.  In the subway, everyone is texting. 

A relatively new condition has surfaced called “Blackberry Thumb”. This condition is not solely limited to the handheld device named Blackberry.  It may occur with any device that primarily uses the thumb for typing.  Blackberry Thumb is a catchall phrase used to describe a repetitive strain injury (RSI) of the thumb that is caused by irritation of the muscles and tendons of the thumb used to press the buttons on smart phones, PDA’s, and other devices.  These RSI have existed for a long time in the desktop and laptop computer users, and is now spreading to the mobile handheld device community.

This is reminiscent of the 80’s and 90’s when a condition called “Nintendoitis” or “Gamer’s Thumb” appeared when kids complained of pain in their thumbs after hours of nonstop video gaming.  It is no wonder that some console systems now have health disclaimers stating that when playing video games there may be occasional discomfort in the hands, arms, shoulder, neck, and other parts of the body.  They also warn that if one experiences persistent or recurring symptoms of discomfort, pain, throbbing, aching, tingling, numbness, burning, or stiffness, to seek a qualified health professional in a timely manner.

How Common Is This Issue?

Currently, there are no statistics as to how many people suffer from this type of thumb issue, but clinicians have reported an increase in related cases.  In January of this year, the American Society of Hand Therapists issued a consumer alert stating that handheld electronics are causing an increasing amount of carpal tunnel syndrome and tendinitis.  There is definitely the potential for this issue to become extremely widespread as these devices gain popularity.  There has been a substantial increase in cell phone text usage in the past few years that suggests this issue has the potential to affect a large amount of the population in the future.

Why Does Blackberry Thumb Develop?

The thumb is one of the least dexterous fingers and it was not meant to be used so rigorously for activities such as touch-typing at high speeds.  This is why on computer keyboards, we only use the thumb for the spacebar!  Blackberry Thumb is a repetitive strain injury, which often occurs when a person’s activities require prolonged and constant use of a specific muscle group.  Instead of a single traumatic event, RSI occur due to repetitive demands.

When the tendons and ligaments become mechanically tired, there are small tears created in the connective tissue.  Usually this takes time to heal.  But often we don’t give our bodies enough recovery time, so then the same tissues get put under stress again and this effect cumulates. When the tissue damage is significant enough and passes a certain threshold, then physical symptoms begin to emerge including pain and dysfunction.

RSI can affect basically any part of the body that is subjected to repetitive stress.  Over the long term, RSI can sometimes lead to premature arthritis.  Blackberry Thumb may progress in some people to other conditions such as deQuervain’s Tenosynovitis, Carpal Tunnel Syndrome, and Trigger Finger.

How Do I Know If I Have Blackberry Thumb?

Blackberry thumb often presents as an achy and throbbing pain located at the base of the thumb, in the thumb web space, or in the space between the wrist and the thumb, which may continue even when the thumb is at rest.  Some people may experience pain in the other fingers and wrist as well.  There may be some tingling, coldness, or loss of sensation in the region of complaint.  In more advanced cases, a loss of grip strength, weakness or fatigue may be noted as well.  Blisters on the fingers may also be present.

Also associated with handheld device use is postural strain from the typical cell phone texting pose where one’s neck is bent forward and down, the shoulders are rounded, the elbows are bent and elevated, and the thumbs are typing away.

How is Blackberry Thumb Treated?

Most people are quite addicted to their mobile devices so giving them up would not be an option; however, ultimately, decreasing usage or eliminating the use of this type of mobile device for texting may be necessary.  The most common self-treatment methods include icing, rest, and use of over-the-counter pain medications.  Some people have been advised to wear a splint.  Blackberry Thumb massage has begun to crop up around town.  Several spas have developed massage sessions geared towards dealing with this issue.

Speaking with your chiropractor or medical doctor is a good strategy.  Chiropractors often use manual therapy to restore joint motion and to loosen the soft tissues in the area and also create a rehabilitation protocol to prevent relapses.  In extremely severe cases, management may include corticosteroid injections or surgery.

Can I Prevent Blackberry Thumb From Happening?

There are definitely strategies you can employ to prevent Blackberry Thumb: 

  • Abstain from using the Blackberry for lengthy typing tasks.  If this is something you find you have to do often, try switching to a desktop computer for tasks like these, or consider a plug-in keyboard for your device.
  • Try to use other fingers to press buttons on handheld devices and vary the fingers that are being used.
  • Take frequent breaks while using your handheld device.
  • Hold the device properly so that your wrists are in neutral position.  If possible, place a pillow in your lap so your wrists are in an upright position.
  • Activate the autotype feature on your device that anticipates the word you are typing so that you can use less keystrokes.
  • Switching to a smaller device where the span for the keypad is not so large may help to decrease the strain on your thumbs.
  • Use shortcut features to reduce the need to scroll with your thumbs
  • Make sure your workspace ergonomics are appropriate so that no extra stress is being put on your thumbs and hands.
  • Consider using a speech to text program so that you can talk into the phone rather than typing.
  • Perform regular stretching and strengthening exercises for your thumb, fingers, hands, and wrists.
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Our Love Hate Relationship with Uggs

In the recent years, girls and women of all ages have fallen in love with… Uggs!  Uggs with their suede exterior and sheepskin lining, so comfortable, so easy to slip on and off, so warm, so cushioned, aaaaand they match all of your outfits.  However, many people notice foot, ankle, knee, and hip pain with prolonged wear of Uggs and its imitators.  So… are Uggs bad for your feet?

On average, we take 3000 to 5000 steps everyday. With each of these steps we have to carry our entire weight on our feet.  Also putting into consideration activities such as running or sports, we add even more stress to our overworked feet.  It is no surprise that a large portion of the population suffers from pain in their feet and ankles, all the way up to their knees, hips, and lower back.

Many factors influence if a person is predisposed to foot and ankle pain such as flat or overpronated feet, walking mechanics, footwear, activities, demands, etc.  One factor that we can control is footwear.  The best type of shoes are usually semi-rigid that is not too flexible and has a small heel.  Shoes should be supportive for your foot type.  Some people may require motion control while others may require more cushioning.  With the popularity of “bad” footwear such as flip-flops, flats, and Uggs, healthcare practitioners have seen a rise in the number of women who experience toe deformities, backache, and foot pain.

What’s Wrong With Uggs?

It has been stated that as little as 6 months of wear can lead to a lifetime of foot deformities, backache, and pain in their feet. Uggs are known to be for comfort and not performance footwear.  Although these shoes apparently have a reinforced heel and “cushioned” insoles, they don’t offer the motion control, cushion, or support that is necessary for prolonged walking or standing especially on the tough surfaces that we most often walk on (concrete, asphalt, industrial flooring).  This is why people who spend lots of time with their Uggs may notice that their foot arches hurt, their feet feel very tired, or there may be pain on the outside of their ankles.  The symptoms may not even show up until later as the shoes feel so comfortable during wear.

We’ve all heard about the arches of the feet.  These arches are important to help the foot absorb shock as we walk and do our normal activities.  Bad shoes with poor arch support can lead to overuse injuries.  This means that the muscles, tendons, ligaments, and bones in the foot and ankle have to overwork.  Low arch or flat-foot people who consistently wear loose-fitting boots like Uggs have their ankles roll inwards with every step. The structures around the foot and ankle need to compensate for this and over time, this can lead to sprain/strain injuries.  Studies have shown that there is a relationship between a flat arch and issues with the knee, hip, and back.

Some doctors suggest that people with high arches have quite stable feet that could benefit from footwear that is more shock absorbent and cushioned so Uggs may not be so bad for them.  However, other doctors are anti-Uggs for everyone as whether you have a low arch or a high arch, there are issues.  These boots just don’t have enough support under the foot, or around the ankle joint and Achilles tendon.

“If you look at the wear pattern of most Uggs, it collapses around the medial malleolus area and it starts to bunch.  That means not enough support and pronators will continue to over-pronate. If you pull out the inside fluffy insole, you’ll see that it is very flat.  There is no shape to it, so there really isn’t much support.  However, it is overlooked because the fluffy fur on top still makes it very comfortable.  Also, the shape of the Ugg boot is a “J”; there is no contour to support the ankle area.  The suede extends through the whole boot area, and the side stitching isn’t enough to give adequate support to ankle”– Dr. Nancy Wan

“Uggs are horrible for your arches.  They provide no support for the arches of your foot; therefore, the arches collapse and can increase risk for strains and sprains” – Dr. Tracy Ho

Another issue with wearing Uggs is that they are loose-fitting.  So with each step we take, our feet will slide around inside.  There is a term for the gait of Ugg wearers called the “shuffle” where people start walking lopsided and pigeon-toed to keep their shoes on while they walk.  As you walk with Uggs, the foot slides around and the force when walking ends up more on the inside of the foot leading the foot to splay.  When your foot splays, the arch of the foot flattens and again this will lead to the joints and muscles of the feet, ankles, knees, hips, and back overworking.

Performing everyday movements such as prolonged walking, standing, and daily activities in Uggs can lead to both temporary and long-term effects.  Symptoms may start off as just a minor pain in the arch or heel pain.  As the muscles, joints, tendons, and ligaments have to start working differently to compensate for not enough support, this long term stress can lead to long term problems such as bunions, hammertoes, arthritis, inflammation of the tendons, knee pain, hip pain, and lower back pain.

So …do we break up with our Uggs?

Keep it casual with your Uggs.  They’re fine to wear at out for short times or when you know you won’t be doing any prolonged walking, prolonged standing, or major activities.  If you already have aches and pains from wearing your Uggs, it could be time to stop and find something more supportive.  Many foot and ankle issues arise due to improper footwear.  There is a company that offers sheepskin-lined orthotics that may help provide a bit more support or adding custom/pre-made supportive insoles may help as well; however, even with this, the actual structure of the shoe is not great for people who need more foot and ankle support.  Just as we should not wear flip-flops for prolonged periods of walking or activity, it is wise to keep Ugg boot wearing to a minimum.

If you start noticing pain in your feet and ankles, it is time to head for the nearest chiropractor and get assessed, and to also have your knees, hips, and back checked as well.


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“You can do it grandma!” – Exercises to Improve Walking speed in the Elderly

Picture this.  You’re in your car stopped at a red light at an intersection and you see an elderly lady crossing the street.  As she’s slowly chugging along, you take a look at the pedestrian light and it’s starting to flash.  She’s not even halfway across the street.  Your heart starts racing and you think “Come on grandma, you can do it… it’s just a little bit farther. SUMMON YOUR STRENGTH!”  The traffic light is about to turn green…

As we age, an aspect of walking that changes is gait speed.  To walk, more than 1000 muscles need to be working properly to move 200 bones around 100 movable joints (Clark 1995).  Age-associated decrease in gait speed is typically noticeable when a person hits their 60’s.  Once you hit the 70’s, normal gait speed decreases about 12-16% per decade and 20% per decade for fast gait speed (Judge 1996). Normal walking speed is about 1.2-1.4m/s. Once walking speed slows to about 1.0 to 1.2 m/s geriatrics will tend to have trouble crossing the street safely before the traffic light changes (Langlois et al 1997).

Why do older people walk so slow??          

There are several different reasons as to why there is a decrease in gait speed over time.  Some of these factors are:

  • Changes in how big your steps are (stride length),
  • May walk slower to feel more stable
  • Painful joints may hurt when walking so a slower walking speed limits the force absorption at those joints
  • Decreased range of motion from degenerative changes such as osteophytes, etc. in the joints leading to changes in how you walk (motor pattern changes)
  • Decrease in muscle strength due to loss of motor neurons, muscle fibers, and aerobic capacity (ability to use oxygen) leading to decreased mechanical power production
  • Changes in the joint moments and powers so that there is an increase at the hip and decreases at the knee and ankle. [Peak ankle dorsiflexion displacement (moving ankle so toes point to the sky) during gait has been found to be a key discriminating factor between low-performing and high-performing groups of older people living independently.]
  • During normal walking speed, the elderly consume significantly more oxygen (decreased aerobic capacity) for a given distance compared to the younger population, even though the elderly walk significantly slower (Waters et al.)

So what’s so important about Gait Speed anyways? 

It turns out that walking speed has been shown to predict mortality, risk of falls, functional decline, and nursing home placement.

A decrease in gait speed of as little as 0.1 m/s will change a person’s ability to perform their activities of daily living by 10%.  Geriatric people with a walking speed of less than 0.25 m/s are more likely to be dependent on others for 1 or more activities of daily living.  A slowed walking speed may also increase the risk of falls, which can lead to a loss of independent living. Walking speed also has relationships with overall aerobic capacity so it can also be linked to heart health.

An increase in the normal walking speed over a 1-year period strongly predicts survival in the following 8 years.  In this case, there is an almost 60% decrease in relative risk and almost 20% decrease in the absolute risk of death.  This is a big deal as it has been found that this survival benefit still applies even after adjusting for other medical, functional, and psychosocial factors that are known to affect survival, and this effect is very consistent across many different subgroups of people.

What are some exercises to improve gait speed? 

Lower extremity exercises can help to improve muscle force and flexibility, upright balance, and aerobic fitness.  Things like yoga and flexibility training don’t help to increase walking speed, but can increase stride length and hip extension displacement to improve walking in general.

Here are some sample exercises you can try out! [Consult your family physician/chiropractor if you have an existing condition]

RANGE OF MOTION:

Leg Swings 1. Start with left side about 2 feet away from a wall.2. Reach sideways, and place your left hand on the wall for balance.3. Kick your left leg backward and forward repeatedly, balancing on your right foot.

4. Repeat the exercise with your right leg, facing in the opposite direction.

5. Next, face the wall, and place both hands on it for balance.

6. Kick your left leg inward, crossing in front of your right leg, and then outward. Switch legs and repeat.

Knee Sliding 1. Lie down with legs straight and about hip-width apart.2. Bend one knee and slide it along the floor towards the buttock.3. Hold the knee at the maximum range of motion.

4. Return to starting position.  Switch legs and repeat.

Ankle Alphabets
  1. Sit in a chair with your back straight.
  2. Raise your foot slightly off the ground and “write” the ABCs in the air using only your foot and ankle.
  3. Repeat on other side.

STRETCHING:

Calf Stretch
  1. Sit on a flat surface and place a towel around your foot, keeping the leg straight.
  2. With the ends of the towel in each hand, pull your foot so your toes point towards you.
  3. Hold stretch and repeat on other side.
Quadriceps Stretch
  1. Stand and hold a stationary object for balance.
  2. Grasp your ankle or foot from behind
  3. Pull your ankle or foot to your buttocks.  Keeping your thighs parallel
  4. Hold stretch and repeat on other side.
Hamstring Stretch
  1. Sit on a flat surface with one leg straight and one leg bent.
  2. Reach forward to touch your toes on the straight leg. 
  3. Hold stretch and repeat.

STRENGTHENING:

Side Lying Leg Raises 1. Lie on your side with the top leg slightly behind the bottom one.2. Lift your top leg up to about 30 degrees keeping your toes pointed straight ahead.3. Return to start position and repeat.  Switch legs.
Wall Slides 1. Stand with your buttocks and back against the wall.2. Bring feet to 1 foot from the wall, keeping your back against the wall.3. Lower down until your knees are bent to about 60 degrees.

4. Rise back up to starting position. Repeat.

Heel Raises

  1. Stand with your feet apart, hands resting on a chair for support.
  2. Slowly raise your heels off of the floor, keeping your knees straight.
  3. Hold then slowly lower your heels to the floor. Repeat.

These exercises need to be performed on a long-term basis.  Changes won’t be noted right away, but over time you will notice increase in strength and flexibility.  Visiting your chiropractor will help also to improve joint motion so you can perform these exercises and your activities optimally.  A chiropractor can also give you advice on more exercises that you can perform that are customized for you and your goals.

Final Words

Who knew that walking speed is so important?  So teach these moves to your parents, grandparents, great-grandparents, and relatives.  And if you see another elderly lady crossing the street slowly giving you anxiety, give her some tips so she can beat her street crossing time!


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“You already asked that… 5 times…” Alzheimer’s Disease and Chiropractic

Everyone notices that as we get older, there is a decline in our memory abilities.  Suddenly, we forget to buy certain items at the grocery store, we can’t remember where the heck we put our glasses, and what was the name of that person you just met??  While a certain amount of memory decline is expected with age, there is a condition affecting many people nowadays called “Alzheimer’s Disease”.

I recently attended a talk regarding Alzheimer’s Disease that was mainly geared towards understanding what a person with Alzheimer’s may be experiencing and being prepared financially for chronic diseases.  Dr. Lisa Genova, author of “Still Alice” described what it feels like to undergo the disease during the presentation as well.  It made me recall my own grandmother who suffered from Alzheimer’s towards the end of her life and how my mom and sister found it quite tough to care for her.

As this condition is becoming quite common, I have compiled some quick information about it.

What is Alzheimer’s Disease?

Alzheimer’s disease is a brain condition that leads to significant memory loss, making it very difficult for these people to communicate with others.  The circuitry in the brain becomes blocked with clumps of protein called amyloid plaques and neurofibrillary tangles.  It is the most common form of dementia and there is currently no cure.  There are medications available to slow the disease, but nothing that will reverse the damage.  It usually develops after the age of 65; however, there is a genetic type of the disease where people can get it between 30 and 60.  It is much more common in females (72% of cases), and the prevalence is expected to be quite high in the coming years.

Early warning signs include forgetfulness (more than usual and quicker than typical aging), severe feelings of depression, severe mood swings for no reason, confusion, and inability to think and process things as before (such as paying bills).  Other signs include difficulty performing familiar tasks, problems with language, disorientation in time and place, problems with abstract thinking (such as counting), poor or decreased judgment (such as dressing inappropriately), misplacing things in unusual locations (such as watch in the fridge), changes in personality, and loss of motivation.

As a chiropractor, one symptom we may notice of regular patients is a loss of body mass over time.  There is evidence that the loss of BMI in the elderly may clinically predict the development of Alzheimer’s Disease.

There are other conditions that present with dementia as well, so it is important to get checked out early if some of the signs are noticed in order to rule out other causes.

So what are some things we can do to prevent or slow down Alzheimer’s Disease?

  • Long-term physical activity – exercise helps to slow the protein buildup in the brain
  • Engaging in mentally stimulating activities
  • Maintaining social networks and social involvement
  • Don’t smoke!
  • Eat foods rich in antioxidants
  • Eating fish and omega-3 fatty acids
  • Taking heart health boosters such as garlic, coenzyme Q10 and folate

How can your chiropractor help? 

Chiropractors are great at helping you perform at your best.  We can make sure that you are able to exercise and perform your activities without pain and to your fullest ability.  It is important during exercise that your joints and muscles are moving properly in order to prevent injury.  Providing care for any aches and pain that emerge and promoting better body awareness is another role we play.  Acupuncture treatment has been suggested to help with cognitive function, and nutritional advice is something we would be happy to give.

It has been found by Robert Vassar of Northwestern University that when the brain doesn’t get enough of the energy source that it needs, changes occur that leads to the clumps of protein that are the hallmark of Alzheimer’s Disease.  He suggests that improving blood flow to the brain may be an effective therapy to prevent Alzheimer’s Disease.  Based on this information, some chiropractors have suggested that chiropractic neck adjustments may improve the blow flow to the brain and thus, may help prevent/slow this condition.  However, as this correlation has not been studied, we have to be careful before jumping to conclusions and to take this hypothesis with a grain of salt.

For those of you who have a family member suffering from Alzheimer’s Disease, please remember to take care of yourselves as well.  It becomes extremely difficult to watch someone deteriorate in mind and body, so make sure you get the help and therapy you need and to take a rest sometimes.  There are many support groups out there for patients and their caregivers as well.