What is a “Double Crush Syndrome”?

Often times when a patient is suffering with hand or leg pain I not only examine the part that hurts I will also examine the entire nerve pathway up to the spine. Similar to telephone wires, nerves which are affect at one spot may not be felt at the injured location, instead it may hurt where the nerve ends.

Hand Pain/Carpal Tunnel Syndrome

All hand pain is not Carpal Tunnel Syndrome (CTS). When someone suffers with hand IMG_1597pain, the first thought is CTS; so what actually is carpal tunnel syndrome? There is a small tunnel located in your wrist, which is where the median nerve passes through. If any structures (bone, ligament, cartilage etc.) that make up that tunnel are injured, squeezed or inflamed the tunnel will tighten putting pressure on the median nerve. Theses symptoms may be any adverse sensations felt in the thumb, index and middle fingers. Hypotrophy may also exist in the thumb muscle if CTS has been around for a while. All other hand symptoms are from something other than CTS. This is why we need to look at all the tunnels and spaces the nerves transverse through and ultimately terminate in your hand. The nerves start in the neck, work though the shoulder, the elbow and into the wrist and ending in the hand. Proper evaluation will help any nerve that may be entrapped along the pathway.

Sciatic and Foot Pain

Similar to hand pain nerves that transverse from the lower spine may create foot pain if irritated along its pathway. Sciatica is a catchall diagnosis, which really is a symptom of nerves, impinged in the lower spine. Depending on which nerves are affected, pain may be experienced in the front, side or behind the leg. Discomfort may also be felt into the groin as well as the feet. It is very common to have a herniated lower back disc yet no back pain, only pain in the calf or foot. This can be confusing for the patient but well understood if examining the neurology.

So what is Double Crush Syndrome?

We have already talked about the numerous tunnels and pathways nerves may travel, and if one of those tunnels is affected, nerve pain (or neuralgia) may develop. So what happens if two tunnels are affected impinging the nerves? This is actually a very common event that requires both areas to be treated to effectively offer the patient relief. This also explains why someone may be receiving treatment for a specific aliment, thinking it would help his or her problem, yet the pain doesn’t resolve. It is important to not only treat the primary tunnel, but also the secondary tunnel. Double crush means two tunnels are closing in (or crushing) on a particular nerve. Can this happen in three or more tunnels too? Yes it can!

If you are suffering with hand pain, foot pain or sciatica call the office give the office a call at (201) 825-6601 for an evaluation.

Until Next Time,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino

“I’ve Tried Everything for My Back Pain……”

Have you really tried everything? When patients enter my office, most of them never heard of spinal decompression. They are most likely recommended or “talked into coming” by a friend who is one of our success stories. Once they are in the office there is either a high level of skepticism or a high level of hope….. either way we treat each person the same.

Patients who we will treat with the DRX9000 are either suffering with a lower back disc injury, sciatica or a chronic lower back condition. This treatment is not for the casual person with a stiff low back. Everyone is put through a thorough examination including an evaluation of past history and previous treatments. All prospective candidates will be explained what spinal decompression is all about, as well as given material to read once they leave the office.

The DRX9000 treats patients by decompressing the injured disc or spinal segment. This opening up of the disc space creates an internal negative pressure, which is a natural vacuum that brings the injured structure back together. It also causes a rush of nutrition to the injury while allowing metabolites, lactic acid and other negative chemicals out of the area. Treatment lasts approximately 30 minutes, and then patients are place on interferential stimulation for another 15 minutes. The typical treatment schedule is set for 20 visits, which may take more or less visits depending on the severity of your injury and your body’s ability to heal. Sometimes other therapies may be needed to compliment the decompression; such as soft tissue manipulation, ultrasound or IASTM to name just a few.

The objective is for the entire treatment to begin as passive for the patient, and active for the doctor. As treatment progresses it becomes equal with the patients doing exercises at home so when treatment ends it becomes all active for the patient with a full exercise program to keep the back strong and prevent the need for future treatment.

If you are suffering with chronic lower back pain or sciatica it doesn’t hurt to have an evaluation. Should you be deemed a candidate for decompression treatment, it will ultimately be your choice to move forward with it or not.

Give the office a call at (201) 825-6601 for an evaluation; remember you can’t say you’ve tried everything if you haven’t visited the office.

Until Next Time,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino

Instrument Assisted Soft Tissue Manipulation – it’s not just “scraping”

Tight muscles, taut tendons or other stubborn soft tissue conditions can all be helped with Instrument Assisted Soft Tissue Manipulation (IASTM). In our office we regularly treat athletes to seniors and everyone in between with IASTM. No other treatment method allows the doctor to reach deep into the muscle bed and break up adhesions, trigger points and boggy knots.

IASTM involves the use of various tools, most look like a dull knife. The edges of the tools are rounded and dull, so patients are never contacted by any sharp edges. The doctor identifies the soft tissue in question and will first perform a scan with the tool along the affected area. Once found these muscles or tendons will feel “gritty” to the doctor. He or she will begin a series of instrument-assisted techniques that stroke the area. The treatment may be a little uncomfortable, as we are working on sensitive areas, but generally right after the therapy relief is felt. There is also some short-term redness found on the skin area where the treatment is performed.

Treatment with IASTM breaks down scarring, adhesion and fascial restrictions in a way that your body is unable to achieve, then it accelerates the healing process. A lubricating cream is first place on the skin, which allows for a smooth sweep of the instrument over the area in question. The cream’s only function is to allow for instrument gliding without friction. The instrument itself is creating very small below the surface micro-trauma, which in turn allows for new healing to begin.

After the treatment, the patient is usually instructed on stretching exercises, which will encourage healing and align the cells so they follow correct physiological function. IASTM treatment is usually performed twice a week, and some form of positive improvement is generally felt after just one session.

If you suffer with any chronic muscle, tendon or a chronic musculoskeletal condition that is not getting better, give our office a call at 201-825-6601.

Until Next Time,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino

Starting Back Up……

As the season changes and people start to come out from quarantine, albeit using all COVID-19 safety precautions, it is important to ease back into your physical routine. I am assuming athletes have found a way to train at home, so I am not really speaking to them. The larger representations are of those who may have been very active, attended a gym or in fact did any level of daily activity no matter how big or small.

When returning to that daily route you may find it slow going at first. While gyms and most recreation facilities have been closed for two months, many do not realize the lack of regular activity could negatively impact your body. This lack of activity could be stiffness, decreased ability for your muscles to work or even decreasing the ability of your heart, longs or circulatory system to respond from their mid-March activity levels.

It is always best to start out slower rather than pull a muscle or worse affect your overall well being. I have been recommending to my patients that they create a 2-week program to get back to their March fitness levels, especially if they haven’t been out that much. It is important to listen to your body during this time.

Fitness is not only for the athletes but also for everyone to be mindful. If your daily routine consisted of visiting the store, the post office or similar types activities prior, but now have been very sedate, your body will probably not be accustom to returning so quickly. The same scenario exists if you regularly went to the gym for exercise your body may not have the same stamina or strength.

You should start out slow and follow that 2-week return to fitness routine. This may included doing some stretching exercises, even mild ones. Add some walking or anything to bring your physical stamina back up. Believe it or not, but someone who goes from a basic routine to not doing anything for two months, will in fact change their body’s rhythm. I created a You Tube video of some stretches (above) for my hometown that may be helpful in getting your spine stretched and ready to move again.

Movement, exercise, breathing fresh air and using your full lung capacity are very important. Unfortunately while in quarantine many have reversed their overall fitness and need to get their bodies back into shape, regardless of what that shape was. We’ve all heard the stories of how people pulled their neck muscle or strained their back by just picking something up, or doing some other benign activity. By working right and getting yourself back into your routine carefully you can avoid being one of those horror stories.

Until Next Time,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino

“It Hurts to Move My Shoulder”

A common occurence is when shoulder injuries develop into what is called “Frozen Shoulder” or more clinically named “Adhesive Capsulitis”. This is when the shoulder, during the healing process has less and less range of motion. The arm itself may decrease its full motion capacity or even be in a position stuck against your side. Sometime as the shoulder healed, motion was not introduced into the joint, which may have left it tight, or created soft tissue scarring.


Fig 1

The shoulder is a very complex joint, but for our purposes we will keep it relatively simple. Understanding why one gets frozen shoulder you would need to understand the basics of the joint. The shoulder is considered a “shallow ball and socket joint”. The articulation is between the head of the humerus and the glenoid, hence glenohumeral joint. (see figure 1) The anatomy of this joint allows for the arm to lift and turn in many positions from behind the back to over the head as well as rotate inwards and out. Keeping the joint stable are many muscles and tendons.


Fig 2

The prominent shoulder structural muscles are the three deltoid and four rotator cuff muscles. (see figure 2) When the shoulder moves anywhere above 90 degrees, the articulation separates and the joint is held together entirely by the shoulder muscles and tendons.

If an injury occurs, regardless if it is a blunt force trauma, a workout injury or something as minor as reaching wrong, part of the rehabilitation must include range of motion exercises. Depending on the type of injury and the recommendation of your doctor, rest may be necessary at first. After this acute phase, stretching exercises are necessary to prevent these muscles and tendons from becoming stiff. Stretching exercises such as pendulum, wall walking, cross body towel stretch and behind the back towel stretch can kick start the shoulder to move once again. The important thing in frozen shoulder prevention is to introduce motion, gently and at the appropriate time.

The shoulder is a very complex joint, and what I touched on is dealing with one aspect, yet a very common aliment. In our office we include everything talked about above as well as utilizing passive range of motion, therapy and instrument assisted soft tissue manipulation. The object is to restore the shoulder back to its normal movement and doing so without pain.

Until Next Time,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino


photos courtesy of WebMD

Limiting Quarantine Cabin Fever!

We are living in very stressful times. Within 4-weeks many have lost their jobs, others have had their income cut, all of us in one way or another are locked in our homes and there is great fear of catching a horrible virus. The world is experiencing an unprecedented historical period that is breaking new grounds for survival. Over the past 60 years there have been catastrophic national emergencies, each in its own way required a constant level of fighting persistence.

If true mental illness, depression, anxiety or substance abuse is what you or a loved one is suffering with there are professionals ready to help by calling 1-800-662-HELP (4357). If you generally do not suffer with a mental wellness crisis, the events of today are affecting almost everyone’s essence. Below are some suggestions that may help ease some of our blues:

Take a Walk. The weather is beginning to break, we are enjoying more hours of natural light while the sun is getting warner with the season. Sunlight has shown to help recurrent depression, relieve stress, improve sleep and be a great source of Vitamin D. The fresh air will help invigorate your state of mind. Although most parks in New Jersey are presently closed, put on a mask and safely walk your neighborhood streets. This will also give you some time away from your home and an ability to look at and enjoy stimuli other than your living room, television or kitchen.

Shower, Shave, fix your Hair and Dress for the Day. The daily grind of living in sweats will affect your psyche. If you are working from home or are not working at this time, go through the habit of repeating your traditional morning routines. Positive habits have demonstrated that they put us on a pathway to starting the day with a bright outlook.

Don’t Spend all Day Watching the News. Yes you should know what is going on in the world, but leaving your TV on to the news all day long and being bombarded by an overload of negativity will affect your psyche, this includes living on social media platforms like Facebook. Times are stressful you do not need different people telling you over and over again how things are presently bad.


Dr. G enjoying a Zoom chat

Use Technology to Communicate. There are things we can learn from the youth. I see my kids doing it regularly; enjoying Skype card games with friends, having group get-togethers on Face time and exercising with pals on Zoom. You can communicate and see each other, why not spend some time with your friends? As we say, “we are all in this together”, they are probably just as stressed as you. Set up some time to see and chat away…..even better do it while sitting on your porch outside!

While we are shuttered at home we are finding each hour becomes a day and each day becomes a week; like Bill Murray’s “Groundhogs Day” every day seems the same. We need to find a way to break these patterns to create differences in our perception and changes our monotony. Humans are social beings by nature, please take some of these suggestions and add them to your day, and if you can think of other things that make your day more dynamic then go ahead and add them to your list!

Until Next Time and Stay Safe!

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino

During this emergency Dr. Guadagnino is still seeing patients. If you wish to be seen please call the office first as patients are being distance scheduled so the waiting room will remain empty.

We are Here to Serve

During this unprecedented time in our history, health and well being has become the priority. The most important thing we can do is to protect one another, and ourselves from this virus.  It is also extremely important that we do not over run our healthcare system – particularly our hospitals during this time of emergency.

Chiropractic is rightfully considered an essential service, so our office will remain open unless directed by higher authorities. We are concentrating our efforts to keeping people out of pain, away from hospitals, off over-the-counter medications and not to visit pharmacies. The goal is also to keep people healthy by not having to resort to painkillers, opioids or other toxic remedies.

As we help our patients we are taking extreme measures to keep everyone safe.

Waiting Room to Remain Empty:  Through proper scheduling we are not allowing people to congregate in the waiting room. As you know the space is often a place for conversation and pleasantries. During this emergency we are not allowing anyone to hangout in the room and are distant scheduling so patients will not share time in the waiting room. When patients arrive we are placing them in a treatment room immediately.

Cleaning rooms and surfaces: After each patient is treated each room is being thoroughly cleaned down with Lysol and alcohol. This includes all tables and equipment as well as doorknobs and surfaces. The office has smelled like Lysol for the past few weeks, which is something we need to get use to.

All staff and doctor wearing gloves:  Thankfully we have a supply of gloves that have offered further protection between patients and staff. This is new territory and in an effort to prevent contact no one will be treated or exchanged anything with the front desk without gloves.

As well as repeated hand washing and using Purell, there is a container of Purell in the waiting room for patients, if they so wish to use. All laundry is removed daily and washed. Other precautions such as wearing a mask when appropriate have been implemented.

These are trying times, but as we work in the health care field to prevent overriding the system we are doing everything to keep people safe.  Within time society will return to normal and the office will be that happy friendly place people have come to enjoy visiting.

If you have any questions please feel free to call the office.

Until Next Time, and Looking Forward to Better Times Ahead,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino

Help Your Immune System to Function at Its Highest Capacity!

During these trying times it is always best to build up your immune system to its fullest potential. This will help you prevent any microscopic invaders, as well as enable you to fight off any infections you may encounter. Now more than ever is the best time to strength that perfect machine that is the human body.

Foods:  There are many foods you can ingest that will help build up your body’s line of defense.  Citrus foods are loaded with vitamin C, which is necessary for the growth, development and repair of all body tissues. These include oranges, grape fruits and lemons just to name a few.  Red bell peppers are also filed with Vitamin C, even more so than citrus fruits. Other fruits include kiwi, papaya and strawberries. Helpful vegetables other than peppers are broccoli and spinach, which contain vitamins A, C and E as well as many antioxidants. Almonds and sunflower seeds are rich in vitamin E that helps to control and fine-tune your immune system.  Ingredients you could cook with that boost the immune system include turmeric and ginger.

Exercise:  This is something I talk about all the time, but moving your body is great for the immune system. Exercise keeps your heart pumping and moving the blood through out your body; this forces your lymph nodes to clean and remove the toxins.  The increase and deep breathing from exercise allows any bacteria and toxins to be expelled. Exercise causes a change in your white blood cells and allows these soldiers in the fight against infection to circulate more rapidly throughout your system. Exercise also helps to combat stress, where it has been shown that stress is inhibits your immunity.

Sleep:  This may be a cliche, but a full nights rest does wonders for your body. Your brain and immune system is given enough time to rest, repair and rejuvenate.  People walking around tired are risking their health in many ways.

Sunlight and fresh air:  Sunlight allows you to receive your Vitamin D from the natural source…the sun. As the weather starts to break, take some time to sit in the sun and soak in those rays. Fresh air has also shown to boost the immune system by not only supplying you with a dose of “un-stale air” but by getting you away from all those microorganisms that have been collecting indoors all winter.

Getting Adjusted: Chiropractic adjustments have shown to boost the immune system. US News and World Report published an article breaking down how an adjustment positively affects the nervous system which is linked together with the endocrine and immune systems. By correcting segmental dysfunctional in the spinal column there is a  correction that boosts both of the other two systems.  Article sited below as well as other studies have been published.

The immune system is a fascinating part of our bodies; there are many facets to it while it takes on the role of our line of defense. Improving its function can only benefit us as we deal with these issues in this very unusual time. Take control of your body, and give it every opportunity to function at is highest working capacity.

Until Next Time,

Dr. Michael Guadagnino

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino



Is Fresh Air Actually Good for Your Healh

How to Safely Get Vitamin D

How To Boost Your Immune System

15 Foods That Boost the Immune System

7 Impressive Ways Vitamin C Benefits Your Body

Surprise: Chiropractic Can Treat 5 of These Conditions

Immune Response To Spinal Manipulation

The Aches and Pains of Working Out

Those that exercise regularly know the feeling of constantly being sore.  It is a distinct feeling to have tight pecs, sore quads or achey triceps. But every once in a while we may get flair ups of our shoulders, elbows or hips?

Before we go any further it must be said that any tissue that can continue to be damaged will need rest and proper treatment; this goes without say.  A trained professional should make the determination as to what needs to be rested and what you can work through. In this discussion we are talking about the body part that hurts but a doctors says you can work through it.

It is important to stretch prior to all workouts. This includes making sure you warm-up all muscles that you will be training on any particular day. Proper mechanics when exercising are also important as well as to properly pick up any weights or dumbbell you may be moving around the weight room.  Injuries can occur from improperly yanking dumb bells off the rack or twisting to put plates on the bar.  Everything you do in the room needs to have complete present time consciousness as you move anything you touch.

Keeping all this in mind, yes bouts of tendinitis, knots in muscles and chronic soreness can occur.  In fact it is quite common for people who train regularly to have some sort of aliment, but is a daily reminder that something is just not right.  A big part of my practice is to help athletes and exercise enthusiasts move through these complaints.

No matter how much you warm-up, cool down and watch your mechanics, a tendon or muscle could respond not as intended. Human tissue is dynamic, we may mean for some fibers to elongate, but they may not lengthen as much as we wanted and a knot could develop, or some inflammation may settle in to a contracted muscle. These things happen, but it is not cause for alarm.


In our office the most common tools we use to help these aches are the percussionmassager and IASTM techniques. We will also utilize other adjunctive therapies as well as chiropractic adjustments to help those training get through their injuries, get back to their full work out schedule and become pain free. Often times we allow our patient to train while we tailor exercises that will not further injure what ails them.

If you suffer with constant pain in the elbows, hips or shoulders, which are three such examples, do something about it.  Exercising is an important part of living which includes weight training, running or circuit training. Each of these, like anything else, can cause aches and pains; but doing something about it will enable you to continue on with your exercise program and reach your developmental goals.

Until Next Time,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino


Pathway to Health?

What is health? How can I be healthy? These are the forever questions we are always looking to answer.  Putting aside genetic programming or environmental exposures there is a pathway we can follow to be the healthiest our DNA code will allow.

Jumping right in, diet or better said “what you put into your body” is the first building block as to how you can best express health. I recommend to eat as close to a plant base diet as you can. The benefits of eating this way have been well documented including getting your protein straight from the source as opposed through the “middle man”; the animal. Our bodies are much more conducive to eating plants than animals. We should also try to stay away from processed food, rather eating as fresh as possible. Like they say with computers, garbage in – garbage out; it’s the same with your body.

We should exercise regularly. There are many forms of exercise, many pathways to take and various degrees of intensity. How ever you slice it, we need to move, to get our blood circulating and our lungs expanding. Exercise has shown to have a strong immune system boost, it keeps our bones strong and has a positive hormonal effect on our entire body. If you haven’t exercised in a while or if you have never exercised, start simple with some walking. As you start to train you will find your body and mind want more where the natural progression will be to pick up the intensity.


Never take for granted to importance of rest which not only includes sleep but plain old down time. Your psyche needs to just “chill”, this allows your adrenal glands to rest keeping you out of the constant flight or fight pattern we are always experiencing. A new study stated that Americans get on average 5 1/2 hours of sleep every night, yet science has said we need 8 hours.  This means in a regular work week an average American is depriving themselves out of 12 1/2 hours of sleep. Sleep has also been shown to help the brain heal and rest. The brain controls all the body functions, so a well rested brain will improve all aspects of metabolism and immunity.

Speaking of your brain, it needs exercise too. This would mean reading, doing puzzles or watching “smart TV” such as documentaries or other programs that require thinking. There have been studies that link the slowing of dementia and reading daily. We need to work those neuronal connections so they stay sharp.

These are just a few of the important points to staying health naturally. It doesn’t take just one element, but when all are included it can help you reach your level of optimum daily and long term health.

Until Next Time,

Dr. Michael Guadagnino

Chiropractic Physician

To reach Dr. Guadagnino at his Ramsey, NJ office: DrMGuad@gmail.com and follow him on Instagram @Dr._Guadagnino