Carpal Tunnel Syndrome

By Dr. Jason Slagel | September 26th, 2022

Almost all things work best when they are done in a particular order.  When you go out of that order with most things, then they either don’t work as well, or it don’t work at all.  Some easy quick examples: you poop and then you wipe.  If you go in the opposite order, you are in trouble.  A less gross example is if you shower and then you dry you are good to go.  But if you dry off and then you shower it just doesn’t work well.  A final example is tying your shoes.  If you type your laces in a particular way, and a particular order, then your shoes stay tied and you don’t get knots in them.

Now, with some things the order doesn’t matter.  However, these things are the exception, not the rule.  For example, it doesn’t matter if you take off your right shoe and then your left shoe.  You could also do your left shoe and then your right shoe.  With a few people it is going to matter, but to most people it doesn’t.  It makes a difference in what order you do things when one thing impacts the other.  

When we look at the human body, the human body very much functions in this way, where the order of operations is extremely important.  The human body works neurologically from the top down and then mechanically from the bottom up. What I mean by that is that the brain and brainstem are at the top and control everything neurologically.  After that, the feet and hips control everything mechanically from the bottom up, because everything sits on top of the feet and the hips. Many people make the mistake of skipping the neurological part from the top down.  This is a mistake because the feet and hips will not be crooked unless there is a neurological problem.  Because there is a sense of hierarchy in which the body works then we must work with that hierarchy.  When we go about fixing things with the body, if we go in the wrong order or in the opposite order that the hierarchy is in, then we either don’t get the results that we want or we get underwhelming results.  It just doesn’t work as well.  So, if you are looking to truly fix a problem you must start neurologically from the top down. After this you can work biomechanically from the bottom up.  When you do this, that’s when you truly fix problems.

I am going to give you two examples of this in the human body.  One of them is low back pain and the other one is carpal tunnel. Now, when we look at low back pain, most of the low back pain is from altered biomechanics.  This means that the hips aren’t leveled, the legs aren’t even, and/or the upper body is tipped to one side or the other. These things can cause disc bulges, pulled muscles, knots, spasms, and all kinds of things. To fix all of this first you must look at the body neurologically from the top down.  Here at Structural Spinal Care, we look at the very top of the spine, where the brainstem is.  If the head and neck, through some type of accident, injury, or trauma, get shifted out of place and are putting pressure on brainstem, there will be a neurological impact on the body.  The very edges of the brain stem control the muscle tone of the body side to side. So, if the head and neck shift out of place and the top bone in the neck is putting pressure on the side of the brain stem, this will alter the muscle tone in the body side to side.  One side of the body will squeeze down more than the other side of the body.  This will create a certain posture pattern where the shoulders are unlevel, the hips unlevel, the hips off centered, the legs uneven, and that strain is going to result in pain somewhere, most likely the low back. So, if somebody has low back problems, what you first need to do is get the pressure off the brainstem.  Then the body is neurologically clear from the top down.  

This is what we do here at Structural Spinal Care. We take the x-rays to measure, and after we correct the brainstem pressure, we take x-rays to make sure the pressure is off the brainstem.  We also measure the posture pattern to make sure the muscle tone is now balanced from side to side.  When we see these changes, we know that this person will get better.

At that point, once the body is neurologically taken care off from the top down, we can investigate from the bottom up mechanically to see what is left over. For example, if a person’s hips have been uneven from that neurological problem for years, the sometimes that femur is not going to be sitting in the joint correctly.  After we get the strain off the body and we correct the neurological component from the top down, then sometimes we must go back in to loosen up a hip that is still jammed up.  That is a mechanical thing that we do from the bottom up.

Now we wouldn’t try to fix a muscle spasm above the hips before we reset the hips because mechanically the body works from the bottom up AFTER neurologically from the top down.  So, after we work neurologically from the top down, we must examine things from the bottom up mechanically and clean up whatever is left over.  When we do this, we can get rid of backpain, and we can make it a permanent fix because we are not fighting against neurology by skipping it and going straight to the mechanics of the hips or low back.

We can also look at this when talking about carpal tunnel.  Most people that have had carpal tunnel surgery on their wrist find the tingling and numbness comes back within a year. The actual statistic is 80%.  Why is that? It seems ridiculously high. The reason for this is when you do surgery on the wrist you are not working with the body the way that the body works.  Here at Structural Spinal Care what we do is we trace the entire median nerve, the nerve that gets caught in the carpal tunnels and creates that carpal tunnel syndrome, all the way from where it comes out of the neck, past the first rib, past the collar bone, past the shoulder joint, though the muscles in the upper arm, through the elbow, through the muscles and bones of the lower arm, and the forearm, and then though the wrist.  We trace it though the whole pathway down, top-down, because it is a nerve.  So, we do top-down neurologically.  Once we correct the head and neck back into the correct position and all the pressure is off the median nerve coming out of the neck, then we can look at the first rib and the collar bone, making sure they are in the correct position and moving freely.  Then we can look at the shoulder joint, make sure that the muscles are working properly, and it is moving freely in the correct position.  Then we just keep working down.  We can look at the biceps and triceps, we look at the elbow joint, we look at the forearm, then we look at the wrist.

When we go through that whole pathway and clear out that median nerve, by the time we get to the wrist and we get the wrist released, relaxed, and moving correctly, then that carpal tunnel syndrome can go away and stay away. It is so incredibly common for people to have multiple points of compression on that median nerve that there is a term for it, called double crush syndrome, or double crush phenomenon.  This is where there is pressure on the median nerve at the wrist, which is where the carpal tunnel is, and then there is also median nerve pressure either in the forearm, the elbow, the upper arm, the shoulder, the collar bone, the first rib, or the neck. If you neglect all these areas and only take care of the wrist then 80% of the time that carpal tunnel syndrome, that tingling and numbness of the hand, will come back.  So, only 20% of the time is the carpal tunnel syndrome coming from just the wrist. This means that when we work from the top down, neurologically, we get much better results and almost always we can get rid of carpal tunnel, as long as someone hasn’t had too much damage done through surgery or injury.  Most of the time we can get rid of the carpal tunnel syndrome permanently because we are just working with the body the way the body works; neurologically from the top-down.  Following that nerve path and making sure that every step along the way the nerve is free and clear.

Those are two examples of working with the body in the way the body works.  The body works primarily neurologically from the top-down and secondarily mechanically from the bottom-up.  When you are working with the body in this way you can fix things in a much more permanent way.  We examine every patient in our office this way, primarily neurologically from the top-down and then secondarily mechanically from the bottom-up.  Patients in my office will recognize the phrase brainstem pressure because we talk about it so often. This is because we try to clear the body neurologically from the top-down then after we do that and the body is clear neurologically, the muscle is balanced outside to side, and everything is all balanced, then we look at the body mechanically from the bottom-up.  In my office we call this the collateral issue phase.  When your body is stuck in a certain posture pattern for some time, collateral issues will start to develop, such as hip joints being jammed up, that type of stuff, so when we work neurologically from the top-down and release that brainstem pressure then we work with the body mechanically from the bottom-up on the collateral issues, people get better.

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