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Common Shoulder Sports Injuries

10 Aug

With many sports requiring overhead movements that can place the shoulder at the extreme end of its range of motion, it’s not surprising that shoulder injuries are so common among athletes. For instance, up to 50% of NCAA college football players have some history of shoulder injury, which comprises about 10-20% of total injuries in the sport. When looking at collegiate quarterbacks, one study found that shoulder injuries accounted for more than half of injuries among players in the position. When it comes to sport-related shoulder injuries, these are the three most common (and to complicate matters, they often co-occur):

1) SLAP (or labrum) tears: Superior (top) Labral tear from Anterior (front) to Posterior (back) tear is a term used to describe a torn piece of cartilage located along the rim of the socket. The labrum adds depth to the cup, which helps to stabilize the ball in the socket. Individuals with a SLAP tear will often report a loss of motion and power, a feeling like their shoulder could pop out of socket, and a deep ache that is hard to pinpoint when attempting overhead movements.

2) Shoulder instability or dislocation: With contact sports, there’s the opportunity for a collision that can dislocate the ball of the shoulder joint (the end of the humerus bone) from the shoulder socket. Because the muscles in the front of the shoulder tend to be larger and stronger, the dislocation will more often occur in that direction. Symptoms can include a severe, sudden initial pain followed by short bursts of pain as well as swelling and a noticeable deformity in the appearance of the shoulder.

3) Rotator cuff tears (RCTs): This is common in sports that require repetitive overhead motion like baseball (especially among pitchers), swimming, and tennis. Symptoms include a deep, hard to locate ache, weakness, and reduced range of motion (especially overhead or to the back).

In general, early/prompt care yields the best results. While there are instances when a prompt surgical procedure is warranted, treatment guidelines typically emphasize non-surgical therapies first with surgery only after all other options have been exhausted. Chiropractic management of these conditions will often involve a multi-modal management approach that includes manual manipulation and mobilization to the shoulder’s multiple joints, the neck, and the mid back; specific shoulder exercise instruction; physical therapy modalities (ice, electrical stim, ultrasound, laser, pulsed magnetic field, and more); and nutritional recommendations.

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.

Footwear Changes for the Knee Osteoarthritis Patient

20 Jul

Osteoarthritis (OA) is the leading cause of knee pain and disability in the elderly population. While treatment to address knee OA will often focus on the knee itself, a patient may also need to change their footwear. Why is that?

During normal walking, joint loading is NOT evenly distributed, and the distribution most often greatest on the medial (inner) side of the knee. This greater load can cause  wear and tear over time and lead to thinning of the smooth, slippery cartilage surfaces on the medial side of the joint, which eventually leads to bone-on-bone contact, the end-stage of OA. By changing where joint loading occurs on the knee, it’s possible to slow this process and potentially delay or even prevent the need for a knee joint replacement.

This can be accomplished through either a change in footwear or adding an insole or orthotic to an existing shoe. On the footwear front, an OA patient may need to avoid clogs, barefoot shoes, high heels, and extra-rigid/stiff shoes. Rather, walking or running shoes or, for more formal occasions, a shoe with a shock-absorbing sole and padded collars that’s not too rigid may be a better choice. A well-trained employee at a specialty shoe store can help identify which shoes will work best for your situation.

One study investigated the use of lateral wedges both with and without custom arch supports for people with medial knee osteoarthritis (OA) and pronation (rolled in feet). Each of the 26 participants wore one or the other for two months and switched to the other option after a two-month “washout” or rest period. The researchers concluded that the lateral heel wedge WITH foot orthotic/arch supports provided the best benefit to the participants with respect to performance on a timed stair climb test. Another study found that adding a mobility shoe reduced medial joint loading to an even greater degree.

For the knee OA patient, chiropractic treatment may also include specific exercise training, weight management/nutrition, manual therapies, modality use (electrical stim, magnetic field, laser, ultrasound, and more), and the use of a knee brace—all in the effort to reduce pain and improve mobility.

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.

Non-Surgical Care for Rotator Cuff Tears

17 Feb

While the anatomy of the shoulder allows for a wide range of motion and movement, it comes at the cost of a less stable joint, especially for those who routinely perform activities that require lifting the arms. This is likely why shoulder pain is one of the leading reasons patients seek chiropractic care, trailing behind low back and neck pain. The most common cause of shoulder pain is from tearing of the rotator cuff muscles (RCMs), particularly muscles that rotate the shoulder outward.

The “typical” rotator cuff tear patient is typically over 50 years of age with shoulder pain that has slowly worsened over time. A 2018 study found that as many as 96% of people over age 50 have RCM abnormalities, of which MANY are asymptomatic or non-painful. The study also reported that 24% of a random sample of 46 young people with an average age of 23 years old with no symptoms and no history of past injury, had degenerative changes in the RCMs. This finding supports the notion that rotator cuff injuries may occur early in adulthood and progress slowly until the symptoms drive a patient to seek care.

In a study involving 167 patients with rotator cuff tears, researchers observed no difference in outcomes one year after participants received either conservative care or surgery. This led the authors to recommend that non-surgical care, such as chiropractic care, should be considered as the PRIMARY method of treatment for rotator cuff tears of non-traumatic origin.

One study looked at impingement syndrome in a case series of four patients who received multimodal chiropractic care that included shoulder manipulation, shoulder girdle exercises, and ultrasound. In all four cases, the patients reported complete resolution of their shoulder pain and disability with five treatments. When researchers followed up with the patients four to eight weeks later, the participant’s symptoms had not returned.

A systematic review of data from 200 articles found evidence for the following non-surgical treatment options—which are commonly provided in chiropractic clinics—for shoulder pain: exercise training (specific favored over general), manual therapy, laser, extracorporeal shockwave, pulsed electromagnetic field (PEMF), transcutaneous electrical nerve stimulation (TENS), myofascial trigger point therapy, acupuncture, and microwave and light therapy. For a patient with a rotator cuff tear, conservative chiropractic care is an excellent option for reducing pain and improving function in the affected shoulder!

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.

Running and the Knees

9 Jan

Running is one of the most popular forms of exercise, largely because it can be done almost anywhere at any time and it doesn’t require much in the way of equipment (other than a pair of running shoes). While there is a common belief that running always leads to osteoarthritis (OA) of the knee, the current research suggests that running may reduce the risk for knee OA and it can also improve pain and disability in patients who have developed the condition. Here are four tips for reducing the risk of experiencing a running-related injury so that you can reap all the benefits this activity has to offer…

Tip #1: Practice good form. Avoid running like you’re on a tight rope or balance beam (crossover gait). Practice walking, and then slowly run while keeping your feet apart (about the width of your pelvis). A crossover gait is bad because it increases foot/ankle pronation (rolling in), knee valgus stress (knock-knee affect), hip internal rotation (turns in), hip adduction stress (pulls on the outer thigh and impinges the hip), and low back extension (too much arching)—ALL of which can lead to injury in multiple body regions, including the knees!

Tip #2: Wear the “right” shoes for your foot. Dip your foot in water and look at your footprint on the floor. If your foot looks wide, you have a flat, pronated foot and a “motion control” shoe (designed for the low or no arched foot) is recommended. Avoid stiff soled shoes as they reduce the ability to feel the ground, leading to new or further injuries. If your footprint looks skinny, a “cushioned” shoe designed for the high arched foot is ideal as it absorbs the shock caused by the lack of pronation. If your footprint is between skinny and wide, a “stability” or “neutral” shoe designed for the normal arched foot is ideal. If you’re not sure, consult with a representative at your local running store. Many businesses that cater to runners have equipment on site to help identify the best shoe for you. Also, remember to replace your shoes every 250 miles REGARDLESS of your foot and shoe type!

Tip #3: Avoid progressing too fast. The tendency is to want to get into shape NOW! This can lead to overtraining and places too much stress on the body, which can result in injury.  Practice the 10% rule. If you ran ten miles in total last week and you want to increase your total distance, try adding 10% to each run so you achieve a total of eleven miles this week.

Tip #4: Strengthen your legs and hips with these exercises: 1) Posterior lunge – Stand and reach back with your left leg while squatting down as if to touch your left knee to the floor while bending your right knee (arms out front for balance). Go as far down as you COMFORTABLY can, keeping the right knee behind your toes. Repeat on the other side. Go slow, start with a half or quarter lunge to avoid injury!  2) Advanced Clam – Lie on your side, raise the upper leg and rotate the hip in and out slowly. 3) Side Plank Leg Raise – Lie on your side, legs straight (advanced) or bent (easier), and raise the pelvis off the floor (elbow under the shoulder), then raise the upper leg toward the ceiling.

If you feel as though running is causing pain or worsening existing pain, then consult with your doctor of chiropractic. He or she can examine your body and mechanics and provide conservative treatment to help make sure your next run is as pain free as possible.

 

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.

Hip-Related Injuries in Athletic Kids

12 Dec

The hip is a very important region of the body, especially since our upright, weightbearing activities rely on a properly functioning hip joint.  With the expansive growth of youth athletic programs, the incidence of hip-related injuries and the associated disability has markedly increased.  But is there a difference between young male and young female hip injuries?

We’ve all observed the rapid rate of growth that occurs from age five to age seventeen, with bone growth reaching maturity around age sixteen for females and eighteen for males.  Prior to skeletal maturity, the growth plates remain open in the long bones of the body, which adds to the complexity and challenge in diagnosing and treating hip injuries in this age group.

Studies show that hip injuries account for approximately 5-9% of all athletic injuries. According to a study that looked at data from 121,047 pediatric visits at a sports medicine clinic between 2000-10, the most common hip injuries for males were labral tear (23.1%), avulsion fracture (11.5%), slipped capital femoral epiphysis (11.5%), dislocation (7.7%), and tendonitis (7.7%). For females, the leading hip injuries included labral tear (59.0%), tendonitis (14.8%), snapping hip syndrome (6.6%), strain (4.9%), and bursitis (4.9%).

The five most common sports that caused hip injuries were dancing/ballet (23.0%), soccer (18.4%), gymnastics (9.2%), ice hockey (8.1%), and track and field (6.9%).  Among adolescents (age 13–17 years), the data show that hip injuries were significantly more common in females than males. Studies have shown that young female athletes, especially in post-puberty ages, exhibit different landing and pivoting movements than males, which may help explain why adolescent females may be more at risk for hip injuries than teenaged boys.

Doctors of chiropractic are trained to diagnose and treat musculoskeletal injuries—including those of the hip joint—in patients of all ages. The key is to manage such conditions as early as possible to help patients get back to sporting activities and reduce the risk for future injuries in the hip and neighboring regions of the body.

 

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.

Scapular Stabilization for Shoulder Pain

14 Nov

The shoulder is one of the largest and most complex joints in the body. It’s actually three joints—the AC or acromioclavicular joint (the collar bone/acromion of the shoulder blade joint), the glenohumeral joint (the ball-and-socket joint), and the scapulothoracic joint (the shoulder blade/rib cage “joint”)—all of which involve the scapula to some degree.

The rotator cuff is made up of four muscles, three of which sit on the back side of the scapula and rotate the arm outward (external rotation) and one in front that rotates it inward (internal rotation). The trapezius muscle is made up of three parts: the upper part pulls the shoulder blade up and in, the middle portion pulls the shoulder inward, and the lower section of the muscle pulls the scapula down and inward. The chest muscles rotate the arms inward. There is also a “bursa” or a fluid-filled sac that cushions, lubricates, and protects the rotator cuff tendon attachments. The “labrum” attaches to the rim of the “socket” or cup, to give it more depth and stability for the ball to sit in.

While this arrangement gives the shoulder a wide range of motion, it also makes it less stable and more vulnerable to injury. There are many injuries that can affect the shoulder, with one of the most common being tearing of the rotator cuff tendons (called “tendinitis” or “tendinopathies”), which often lead to a bursitis, or swelling of the bursa sac, resulting in shoulder impingement (pain raising the arm). In fact, over half of people in their 80s have tearing of the rotator cuff.

There are many exercises that help return function to the shoulder in both non-surgical and post-surgical cases. Exercises are aimed at restoring motion, strengthening weak muscles, and stabilizing the shoulder. However, studies show that the best results are achieved when scapula stabilization exercises are included in the treatment process.

One GREAT exercise for stabilizing the scapulae is called the Push-Up Plus (PUP). This is performed by positioning yourself into a push-up position (either toes or knees—you choose based on strength) with your hands shoulder width apart, elbows locked straight, and the fingers pointed outward (thumbs at 12 o’clock). Instead of dropping the chest to the floor, PUSH the middle of the back upward toward the ceiling. Hold the position for three seconds and SLOWLY return to the start position. Repeat five to ten times and gradually increase reps as you’re able.

There are several variations of this. For example, rotating your fingers inward increases activity in the rotator cuff muscles (the most important muscle group for shoulder stabilization) and reduces activity in the chest muscles (pectoralis major) and scapula elevators (levator scapula). You can also alter this by raising your feet to different heights, as the higher the feet, the greater the serratus anterior muscle activity! Your doctor of chiropractic can advise you on which shoulder stabilization exercises may provide the most benefit for your unique case.

 

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.