Knee Pain and Running – Are They Related?

10 Jan

Knee pain is a common complaint that will affect about 30% of the general population at some point in adulthood. Since running has a reputation for causing knee pain due to “wear and tear”, the question frequently arises as to whether or not running accelerates knee problems. So, what does the current body of research say?

In a 2018 study published in The American Journal of Sports Medicine, Dr. Christopher Bramah and colleagues reported that the most frequent injuries in runners include the knee (50%), the foot (39%), and the lower leg (32%). Sounds like running is bad, right?

In a small pilot study that included six healthy runners aged 18-35, researchers analyzed blood and knee joint synovial fluid samples before a 30-minute run, immediately after their run, and after a 30-minute rest. To the surprise of the research team, the inflammatory markers that are associated with conditions like osteoarthritis (OA) were higher before the run and lower in the two timeframes following the run. This suggests running may be protective against OA.

Due to the small number of subjects tested, the authors are quick to point out that they plan to run a larger scale study and will test the inflammatory marker levels at a week or longer after running to see how long this “protection” lasts. Critics have also stated that a 30-minute run is relatively short and cite a study of marathon runners (26.2 miles, or 42.2 km) that found changes in the cartilage that could suggest potential for injuries that persisted for three months after the marathon.

Another study compared data concerning recreational runners, competitive runners, and non-runners from several prior studies (a “meta-analysis”) and found that recreational runners had a LOWER occurrence of OA than participants in the other groups.

A study that compared 1,207 UK male soccer players vs. 4,085 men from the general population (all around age 60) showed that soccer players were twice as likely to have knee pain (52% vs. 27%, respectively). Furthermore, approximately 28% of the soccer players vs. 12% of non-soccer players had radiographically diagnosed knee OA, and the athletes were three times more likely to have received a total knee replacement.

In summary, it appears that short distance leisurely running on healthy knees is safe and even perhaps preventive against OA. On the other hand, engaging in more high-intensity activity may increase the risk for problems with the knee. If a person has OA, walking may be the safer option, but this must be individually determined.

Research has shown that problems elsewhere in the body, such as the ankle and hips, may place added strain on the knees, which can elevate the risk for problems in that region. This is why it’s important to evaluate the whole patient when they present for care for a condition like knee pain, as a satisfying outcome may not be achieved if contributing factors are not addressed.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Can a Job Cause Carpal Tunnel Syndrome?

7 Jan

Every career has its pros and cons when it comes to physical exertion, stress, work hours, the physical environment (temperature, cleanliness, etc.), and more. But when a worker develops carpal tunnel syndrome (CTS), is it the job that’s the culprit or is there something else responsible for the patient’s symptoms?

Since we spend about a third of our time each week at work, it only makes sense that certain jobs are more likely to cause or exacerbate CTS. The current research shows that jobs that include the following factors have an elevated risk for repetitive stress injuries, like CTS: highly repetitive tasks; exposure to vibratory/percussive forces; and little-to-no down time or rest breaks.

Examples of careers associated with such factors include auto repair, landscaping, garment work, computer work, dental hygiene, hair dressing, music, retail, radiology, meatpacking, massage therapy, and carpentry, just to name a few.

One’s risk for developing the symptoms associated with CTS can also be raised by factors outside of work such as having conditions like diabetes, hypothyroid, obesity, and arthritis (rheumatoid and osteoarthritis, most commonly); hormonal changes associated with birth control pills and pregnancy; and musculoskeletal dysfunction elsewhere along the course of the carpal tunnel. If someone who may already have an increased risk for CTS takes on a vocation that requires repetitive and forceful movements with few breaks, then the chances they develop pain, tingling, and numbness in their hands and wrists may be even higher.

The good news is that in many cases, a worker can recover from CTS and return to their job of choice (that is, not have to change careers) with reasonable work modifications (better ergonomics, more breaks, changes to the tools used), better management of health conditions associated with increased CTS risk, night splinting, dietary modifications to reduce inflammation and promote healing, and conservative care to address any musculoskeletal issues that are present (of which chiropractic care is a fantastic choice).

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

A Less Obvious Cause of Back Pain?

3 Jan

Multiple studies have shown that hyper-pronation (HP), or too much rolling-inwards of the ankle, can have effects on the body far beyond the foot. For example, abnormal motion of the ankle can lead to slight changes in how the knees and pelvis move as you carry out your normal daily activities, placing added strain on these structures and increasing the risk of injury in both the short and long term. These faulty movement patterns can also lead to improper motion and a higher risk for injury above the hips, including in the lower back.

In one study that involved patients with low back pain (LBP), researchers found that improving both ankle pronation (with foot orthotics) and lower limb weakness (with exercise) resulted in improvements in knee, hip, and low back function.

Foot orthotics often include a lateral heel wedge to correct the rolling-in effect of the ankle. One study measured the effects that a 5º heel wedge had on the lower limb up to the thorax, noting significant 3-dimensional kinematic changes occurred on the hip, pelvis, and thorax. However, over-correction (at 10º), had detrimental effects on proper motion elsewhere in the body, which underscores the importance of getting an accurate prescription when fitting foot orthotics. Likewise, other studies have demonstrated that a forefoot orthotic may also be required to ensure proper biomechanics while walking.

A study that included 213 high school and college cross country runners (107 male, 106 female) found that 37 (17.4%) wore foot orthotics. Of the 37 orthotic users, 17 (54.8%) wore them for exercise-related leg pain, of which 15 of the 17 reported benefits. Another study compared the load on the Achilles tendon during running both with and without foot orthotics and reported that running with foot orthotics was associated with significant reductions in Achilles tendon loading compared to running without orthotics.

These studies clearly support the MANY benefits foot orthotics have on the whole body or structure, which facilitate both the short- and long-term management of conditions like low back pain! Doctors of chiropractic frequently fit foot orthotics for lower extremity complaints, as well as LBP.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The Link Between Breathing and Posture…

20 Dec

If someone said that suboptimal breathing patterns and problems associated with posture and trunk stability are related, what would you say? Sounds pretty far-fetched, doesn’t it?

There are many factors that can result in both faulty respiration and poor posture including poor exercise tolerance (being “out of shape”), dyspnea (shortness of breath), poor chest expansion, poor neuromuscular control of core and pelvic floor muscles, diaphragm issues (hernia, muscle shortness, poor pressure output), increased lumbar lordosis, and low back pain. This is because several of the muscles that help control posture and stabilize the core—such as the thoracic diaphragm, transverse abdominus, and the pelvic floor muscles—are also involved in the breathing process.

One of the most critical and overlooked factors is the ability to maintain an optimal zone of apposition (ZOA) of the diaphragm. This refers to the dome, or “umbrella” part, of the diaphragm and its attachments to the lower rib cage. The ZOA is important because it is largely controlled by the abdominal muscles and plays a role in how much air you can take in while breaking, or maximal respiration.

When the ZOA is decreased or not optimum, the result is inefficient breathing (less air in and out) and reduced activation of the transverse abdominus muscle (important for BOTH respiration and low back stabilization). A suboptimal ZOA can be the result of a combination of increased curve in the low back (hyperlordosis), long abdominal muscles (a large belly), long hamstring muscles (forward pelvic tilt), and/or a weak pelvic floor.

The following is a therapeutic exercise that promotes optimal posture and finely tunes the neuromotor control of the deep abdominals, diaphragm, and pelvic floor: 1) Lie on your back and put your feet on a wall with both the knees and hips bent at 90 degrees. 2) Place a small (4-6 in, or 10.16-15.24 cm) ball between your knees. 3) Place your right arm above your head and place a balloon in your mouth with the left hand.  4) INHALE through the nose and simultaneously perform a posterior pelvic tilt (flatten your low back into the floor/mat) while pulling downward with your heels (as if to bend the knees – don’t push into the wall) and gently squeeze the ball with your knees.  5) Inhale through the nose and exhale or blow slowly into the balloon, then pause for three seconds by pressing the tongue to the roof of the mouth (to prevent blowing into the balloon). 6) Without pinching the neck of the balloon and while keeping your tongue placed on the roof of the mouth, inhale again through your nose (without the balloon deflating).

Relax and repeat the sequence four more times. When blowing into the balloon, do not strain your neck or cheeks. After the fourth breath in, pinch the balloon neck and remove it from your mouth and let the air out of the balloon.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Whiplash Can Even Happen in Low-Speed Collisions

17 Dec

Though whiplash injuries can arise from any sudden jar, like a slip and fall or sports injury, they are most commonly associated with motor vehicle collisions (MVCs), even those that occur at low speeds. To best understand how someone can become injured in cases where little to no vehicular damage has occurred, we need to discuss elastic and plastic deformity, as well as the various characteristics involved in MVCs.

When you hear the term “plastic,” think breaking apart or crumbling.  In a car crash, crushing metal absorbs energy. That’s an example of plastic deformity. The greater the damage, the more energy is absorbed by the crushing metal and LESS energy is transferred to the occupants (until a certain speed is reached).

In elastic deformity, little to no damage occurs, and most, if not all, of the energy passes onward. In the context of an automobile collision, a low-speed impact may not crumple the bumper or damage the rear structure of the car, and the force of the impact will continue on to the contents of the vehicle—which includes the driver and their passengers!

There are several variables that exist in car crashes that can also affect the degree of injury, such as the size of the vehicles involved, the angle of impact, the design of the vehicle, the position of the headrest, the angle of the seat, and the vehicle’s safety equipment (seat belt; air bag quantity, location, and design; breakaway seats; automated head rests; and more).

If you have a child, be sure to properly install their infant or booster seat. This includes positioning the seat on the right side of the car. The following guide from the National Highway Traffic Safety Administration can help: https://www.nhtsa.gov/equipment/car-seats-and-booster-seats

Though in most cases, the whiplash process can occur much faster than we can voluntarily brace for it, if you do see an impending collision, you may be able to reduce your risk of injury by looking forward as opposed to having your head turned at the moment of impact.

Should you experience a whiplash injury, the current research supports chiropractic care as an appropriate treatment option for reducing both pain and disability.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Chiropractic Care for Headache Relief?

13 Dec

Headaches have a significant impact on quality of life in both adults and children. Approximately 13% of patients who sought chiropractic care over the last decade did so for headache relief. Several studies have found that manual therapies, such as spinal manipulation and mobilization, can provide significant benefits for patients with both tension-type and migraine headaches—even better than standard medical care, in some cases.

In 2011, Canadian researchers reviewed data from 21 published studies to develop specific recommendations for chiropractic management of headaches. For episodic or chronic migraine and cervicogenic headaches (those caused by specific neck problems), they recommended spinal manipulation and other manual interventions, such as massage. Additionally, researchers noted that joint mobilization and strengthening exercises for the deep neck flexor muscles may also improve symptoms associated with cervicogenic headaches.

For episodic tension-type headache, the investigators did not find enough published evidence to support the use of spinal manipulation. They stated that, at the current time, “a recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache” (CTTH). However, they did report that low-load craniocervical mobilization “may be beneficial for longer term management of patients with episodic or chronic tension-type headaches.”

In contrast, following a randomized clinical trial of 80 patients with chronic tension-type headaches, Dutch researchers reported that “Manual therapy is more effective than usual [general practitioner] care in the short- and longer term in reducing symptoms of CTTH.”

Chiropractors utilize many types of manual therapies as a primary form of care for several complaints and conditions, including headaches.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
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