What is Carpal Tunnel Syndrome?

What is Carpal Tunnel Syndrome:
Carpal Tunnel Syndrome (CTS) is one of the most common entrapment syndromes. Patients often complain of 'pins and needles' affecting the thumb, index, middle and half of the ring finger. CTS is noted most commonly in persons whose occupation or avocation requires substantial use of the hands. Patients may also complain of pain which may radiate up the arm to the shoulder. I will discuss the causes of CTS later on.

The Symptoms:
Patients complain of awakening from their sleep at night with 'pins and needles' affecting their fingers as mentioned above. Relief is most commonly brought on by simply "shaking their hand(s) out. The feeling of pins and needles dissipates and they can then return to sleep. Patients with severe cases may have to go through this routine several times a night.

The Cause(s):
CTS is caused by a compression of the "median nerve" at the wrist. The median nerve runs the length of the arm to the hand and distributes into the thumb, index, middle and half of the ring finger, starting at the neck/cervical spine. As a practicitoner, it is my job to investigate whether the pain in the hand is caused by an entrapment of this nerve in the carpal tunnel in the wrist or due to an impingement in the neck. Treatment would then be administered accordingly.
The most common causes or associations of CTS are:
-Idiopathic (arising from an unknown cause)
-Trauma to the wrist
-Fibrosis (the formation or development of excess fibrous connective tissue)
-Pregnancy
-Rheumatoid Arthritis
-Diabetes
-Hypothyroidism

The Treatment:
The treatment is determined by the severity of the symptoms. Being a chiropractor, I will always look to take a conservative approach first. If this is ever unsuccessful I would then refer the patient back to their GP for referral onto possible surgical intervention if deemed necessary.
Conservative treatment would consist mainly of the following:
-Carpal (wrist) manipulation/mobilisation - practitioner
-Cervical (neck), upper back, shoulder and elbow manipulation/mobilisation - practitioner
-Soft Tissue (muscle) release - practitioner
-PIR stretches for the forearm - practitioner
-Tendon gliding exercises - patient
-Median nerve mobilisation - patient
-Passive self stretching - patient (see pictures)
-Cock-up slints

All 'homework' given to the patient will be fully explained during the treatment session.


Passive self stretching of the forearm muscles of the wrist can be done numerous times a day. Placing the forearm between the thighs (picture 1) allows control of the stretch and frees the other hand to stretch the thumb (picture 2). Slowly squeezing the thighs together increases the stretch of the fascia overlying the carpal tunnel. Each stretch should be held for 30 seconds.



Well I hope that has given you a bit more of an insight into what CTS is all about and what can actually be done to relieve any symptoms. Should you have any questions on this subject please do not hesitate to get in contact and I would be very happy to discuss this in person. Come if for a 15 minute consult for only £5.

Hip replacement! Is it always necessary?

Here at the Chiropractic Clinic we see a lot of patients who come to us for a second opinion as to whether they actually need to undergo hip replacement surgery. Nearly all patients who ask this question are very unsure and often worried about such an undertaking. Surgical intervention should always be the last resort if all other avenues have been exhausted. There will be times when surgery is the only option and following an orthopaedic consultants' advice is the best bet and it is highly unlikely that we would intervene in such cases.

However, if you have been told that you have osteo-arthritis (OA) in the hip and that nothing can be done for you apart from surgery, I would strongly recommend that you seek a second opinion first. Conservative care can be just as productive and a lot less intrusive. I regularly treat patients with painful hip restrictions due to OA and they usually respond very well. A combination of treatments such as soft tissue work to the musculature of the hip joint, buttocks and upper legs along with heat therapy, manipulation, distraction techniques and home exercises can have a profound effect in restoring movement back into the area. A process a lot of patients find much more acceptable.

For example, a friend's Aunt spoke with me (just on a casual basis) regarding her hip problem saying that she had been advised by her GP that she would need replacement surgery to fix the problem. She then showed me her x-ray findings which simply showed there to be some moderate degeneration (OA) in the hip in question. However, she said she had days when she could walk without any pain and after talking to her more it became clear to me that surgery was a route she did not really need to take. This was later confirmed by her orthopaedic consultant (actually the following day).

I believe she is now seeing a local osteopath for her care and I wish her all the best for a speedy recovery. If you have any further questions about how we might be able to help, why not book in for a £5 consult with us.

Treating the GB softball team

For the last 11 years I have played on the GB Softball team and when not actually playing softball, I am inundated with requests for treatment.

Softball is a sport that believe it or not, puts an enormous amount of stress through the body and this is especially true when you are batting. Going from a standing still position to then rotating your body through over 180 degrees in a split second can have a serious impact on your lower back. Fortunately however, due mostly to effective warm up routines this is not an area I have to deal with very often.

One of the most common injuries I have to deal with on a regular basis is sprained/twisted ankles. This occurs mainly when the athletes are running the bases. The ankle has to withstand a huge amount of force as you "corner" the bases, and if there is any weakness or even fatigue in the muscles in this area, then the inevitable often happens..... an inversion sprain!! This is where the the ankle literally collapses in on itself and the outer ligaments that support the ankle are stretched too far. An inversion sprain is the most common ankle injury.

If the sprain is only minor, reinforcing it with strapping (see picture) can allow the athlete to carry on with the game immediately, but the after care is vitally important in order to allow the athletes to continue playing/training without interruption. On the other hand, if there is immediate swelling and inability to weight bear without pain then we have to be certain that the damage is not just over stretching of the ligaments but actual tearing of such structures. If this is the case then stopping the athlete from continuing is paramount and rehabilitative care and treatment is required straight away. This will consist primarily of what is known as RICE - Rest, Ice, Compression and Elevation, followed by proprioception retraining and strengthening of the musculature in and around the ankle joint.

Obviously, ankle injuries such as the inversion sprain can happen in all walks of life, but we are well equipped to deal with them through our treatment and rehabilitative plans here at all the clinics.

Another Patient Testimonial for Brett

Another recently left testimonial from a patient at The Chiropractic Clinic Liverpool for Dr Gibbens:

''I came due to severe back, neck and pelvis pain all exacerbated due to pregnancy. I can't recommend Brett and Chiropractic treatment enough as years of several courses of physiotherapy have never yielded any results.

I can't believe the difference this treatment has made to my pregnancy and will continue once baby is here to improve my ongoing back condition''

Christine O'Brien

Pregnancy very often causes low back and sciatic leg issues, due to the changes in loadings upon the lumbar spine. symptoms can occur at any point during pregnancy, and in fact quite commonly a patient will experience no symptoms at all until after the birth and then all of a sudden they experience low back, backside or leg pain. This is often because the body takes time to respond to change, and if change happens quickly,.....is obviously in the case of having a baby, often muscles, joints and other tissues are unable to adapt fast enough to cope.

Chiropractic is very effective in treating low back and leg problems, and at The Chiropractic Clinic we have a wealth of experience at treating Pregnancy related symptoms. We have even treated a patient at 3 weeks over due! (towels and hot water on standby!)

Another recent testimoial for Brett in Liverpool

Here's another recent treatment review for Dr Brett Gibbens from a patient at The Chiropractic Clinic Liverpool:

''I have suffered from lower back pain for years and tried everything - but regular visits to see Brett at The Chiropractic Clinic have benefited my entire health immensely. I have now learned to manage my ongoing back problem with lower pain - now only intermittent bouts.

Thankyou so much.''

Dawn Hinton

At The Chiropractic Clinic, low back pain is obviously our bread and butter. It is by far the most common thing that we treat, and there are very few presentations of it that we are unable to help with to some degree if not resolve completely.

However, if because of the nature of your problem it is not possible to remove your symptoms entirely,....as in this case,.....there are many things that Brett and the other chiropractors are able to do, primarily to ease the direct symptoms, and ensure that you are equipped to manage and minimise them if and when they do re-occur.

For any more info just give the clinic a bell, or have a look at our website back pain page: www.thechiroclinic.co.uk/back.html

Consult Dr Gibbens for only £5

At The Chiropractic Clinics in Liverpool and on the Wirral we are offering the opportunity to consult Dr Brett Gibbens BSc(hons) MSc(Chiro) DC for only £5.

It is available so that you can come into the clinic, have a chat to Brett, ask any questions about what we do to get a good idea if and how he can help with your problem.

It usually takes about 15 to 20 minutes, and Brett will have a look at the area that you are suffering with, and based on his experience and what he sees, he will give you a good idea of what it might be able to do for you, and of course how long it might take.

We think it is a really great opportunity to dip your toe in the water and find out what we can do. Just give the clinic a call to book your slot.


Liverpool: 0151 4275000 http://www.thechiroclinic.co.uk//liverpool.html
Wirral: 0151 6485000 http://www.thechiroclinic.co.uk//wirral.html

Merry Christmas from The Chiropractic Clinic