Archive | Joint Pain RSS feed for this section

What is Hip Impingement? Can Chiropractic Help?

14 Mar

Femoroacetabular impingement (FAI) is a pathological hip condition found in 17% of the population, and it’s caused by abnormal contact between the ball of hip and the socket. To be more precise, it’s the head-neck junction that impinges against the rim of the acetabulum. There are three types of FAI: cam, pincer, or a combination of the two. The cam deformity (also called “pistol-grip”) is from too much bone at the head-neck junction and is found in 65-75% of FAIs (often active young men 20-30 years old). The pincer deformity is from too much bone off the front of the acetabular rim (like a spur), and it is often seen in middle aged, active women. Less than 10% have both cam and pincer deformities together.

In some cases, FAI can arise without either a cam or pincer deformity and occurs as a consequence of extreme hip movements like those associated with ballet, gymnastics, or weight lifting (squatting). There are actually several types of impingement syndromes in the spine-pelvic region, but we will focus on that which occurs at the hip joint specifically, the FAI syndrome.

The pain associated with FAI results from repeated abutment, or contact, between the two bones leading to injury of the adjacent cartilage and/or labrum, which is a crescent-shaped band of cartilage that stabilizes, lubricates, and cushions the hip joint. Over time, repeated trauma can lead to hip joint osteoarthritis (OA). In fact, in a large population study, researchers observed cam and/or pincer deformities in 71% of males and 37% of females with hip OA.

The clinical presentation of FAI is usually found in healthy, active adults between 20-50 years in age. In older patients, it’s frequently accompanied by hip OA. Anterior FAI presents with pain in the front of the hip, groin, pubic bone, and/or anterior thigh and often arises from activities that include running/sprinting, kicking sports, hill climbing, and prolonged/repeated sitting in low chairs – any activity where the hip flexes forward (knee-to-chest positions).

Impingement from pincer deformities can also give rise to posterior FAI, or pain in the back of the hip joint. When this occurs, pain in the buttock and sacroiliac joint (SIJ) have to be differentiated from pain arising from the low back and/or SIJ. Repeated hip hyperextension such as from fast walking and hiking downhill are common causes.

So, can chiropractic help? Short answer – YES! The current research shows that non-surgical care for FAI should include avoiding activities that impinge the hip (discontinuing or modifying a sport or daily activity), reducing inflammation, and exercising to stretch the hip flexors and strengthen hip extensors. Once a proper diagnosis is made, your doctor of chiropractic can advise you on the best ways to manage your FAI.

 

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.
Advertisements

What Do Chiropractors Do for Shoulder Pain?

14 Feb

When people think of chiropractic care, they usually imagine back pain, neck pain, and headaches, as research STRONGLY supports chiropractic treatment for these complaints. But what about chiropractic care for shoulder pain?

In 2010 and again in 2014, the United Kingdom government published landmark studies that reviewed previously published research on various forms of treatment for MANY conditions, both musculoskeletal and non-musculoskeletal (like asthma). These reviews noted there is favorable scientific evidence for the use of chiropractic treatment with regards to shoulder-related conditions including shoulder girdle pain/dysfunction, rotator cuff pain, and adhesive capsulitis (frozen shoulder).

When doctors of chiropractic approach treatment for patients with shoulder pain, care typically focuses on restoring shoulder range of motion using various manipulative and mobilization techniques directed at the three joints of the shoulder: the glenohumeral (the ball & socket joint), the acromioclavicular (AC) joint (clavicle & scapula), and the scapulothoracic joint (shoulder blade & rib cage). Chiropractic care may also include exercise training focused on restoring motion, strength, and stability to the muscles and soft tissues surrounding the shoulder region. A host of physical therapy modalities are also utilized as adjunctive procedures in many chiropractic settings at various stages of healing following shoulder injury. The goal of care is to return patients to their normal level of everyday function.

But what about shoulder pain AFTER surgery? Can chiropractic still help? A 2018 study found that post-surgical patients who received mid-back (thoracic spine) manipulation experienced significant increases in shoulder movement (flexion and abduction) and increased subacromial space measurements (in neutral and external rotation). The authors cited other studies that reported similar improvements in shoulder mobility as well as shoulder blade (scapular) kinematics (movement & stability).

Another study looked at changes in shoulder pain, disability, and perceived recovery after two sessions of upper thoracic and upper rib manipulation in patients with shoulder pain. Here too, participants reported significant improvement in all parameters tested that persisted for up to three months.

Given the solid research support of manual therapies directed at not only the shoulder but also to the neck, upper, and mid-back spinal regions, chiropractic care for patients with shoulder pain is simply a must!

 

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.

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.

A Weak Core May Contribute to Hip Pain

10 Dec

When people think of hip pain, they generally turn to hip-specific exercises as a self–help strategy.  However, recent evidence shows there’s a correlation between poor core stability of the trunk and injury to the lower extremities, which includes the hips.  In March 2018, Belgian researchers reviewed data from nine previously published studies with a focus on the importance of core stability and its relationship to lower extremity musculoskeletal injuries in a healthy athletic population. The investigators reported that core strength, core proprioception (balance), and neuromuscular control (coordination) of the core are directly linked to the likelihood of lower extremity injuries.

Let’s take a closer look at three specific core strengthening exercises that can be done relatively fast and are highly effective (you can view several demonstration videos on YouTube if you search for “stuart mcgill’s big-3 core exercises”).

1) The Curl-Up (abdominal strength): STEP 1 — Lie on your back, straighten your left leg, and bend your right leg, placing the right foot next to the left knee.  STEP 2 — Tuck your hands under your low back to prop up the lumbar curve (so it does not flatten out).  STEP 3 — Curl up by lifting your head, neck, and shoulders only a few inches off the floor (keep your chin tucked).  STEP 4 — Hold for 7–8 seconds (or work up to this).  STEP 5 — Slowly lower your trunk back to the ground.  Repeat five times with the right leg bent and five times with the left leg bent, while keeping the opposite leg straight.  This exercise helps reduce low back disk compression, which is significant when performing a conventional sit-up exercise.

2) The Bird-Dog (core, back, and gluts):  STEP 1 — Kneel on all-fours (hands and knees).  STEP 2 — Keeping your back flat, lift and straighten out the LEFT arm and RIGHT leg parallel to the floor. STEP 3 — To further activate the core muscles, draw a square with the arm and leg while bracing the abdominal muscles (firm up your abs, as if to brace for being punched in the stomach). STEP 4 — Return to the starting position and repeat on the opposite side (repeat STEP 3 again).

3) The Side-Bridge (obliques): STEP 1 — Lie on your side, elbow directly under your shoulder and bend your knees 90°. To increase the difficulty, keep the legs/knees straight. STEP 2 — Lift your hips off the ground so you are holding your weight with your elbow and knees (or feet). STEP 3 — Hold the “Up” position for as long as possible. STEP 4 — Repeat steps 1-3 on the opposite side.

Doctors of chiropractic are trained to evaluate the entire person from the feet up to the head to identify issues elsewhere in the body that may contribute to or even cause the patient’s chief complaint. For many patients, managing hip-related conditions may involve treatment to address issues in the core (as described in this article), the lower back, and even the feet or knees!

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.

What Is Frozen Shoulder?

15 Nov

Adhesive capsulitis (also known as “frozen shoulder”) is the end result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the humeral head or “ball” part of the ball and socket joint. Adhesive capsulitis dramatically reduces the range of motion of the affected joint, which can severely impact one’s ability to carry out their normal daily activities. A frozen shoulder may or may not be associated with shoulder pain and tenderness. Though all movements are affected, raising the arm to the side is often the most impaired movement of the shoulder.

Conditions such as tendinitis, bursitis, and rotator cuff injury can lead to adhesive capsulitis, especially if the person refuses to move the shoulder for an extended length of time. Diabetes, chronic inflammatory arthritis (such as rheumatoid) of the shoulder, and chest or breast surgery are known risk factors for adhesive capsulitis.

The condition is diagnosed following a review of the patient’s history for prior trauma caused by over reaching/lifting or from repetitive movements. The examination will look for severe loss of shoulder range of motion (ROM), both active and passive. X-ray, blood tests for underlying illnesses, and other imaging approaches may also be required to make a final determination for adhesive capsulitis.

Treatment for adhesive capsulitis has classically included an aggressive combination of anti-inflammatory medications, cortisone injections, manual therapies (such as joint manipulation, mobilization, and traction), exercise training, ice (if painful), heat (if no pain), and physiotherapy modalities such as ultrasound, electric stimulation, laser, etc.

Exercises performed by the patient are also highly important for achieving a satisfactory outcome. The patient can begin immediately with pendulum-type exercises, long-axis traction (while sitting, grip the chair seat and lean to the opposite direction while relaxing the shoulder muscles to open up the ball-and-socket joint), and eventually strengthening exercises (TheraTube, TheraBand, light weights, etc.).

A recent study involved 50 patients with frozen shoulder (20 males, 30 females, ages 40-70 years) who underwent chiropractic care for a median time frame of 28 days (range: 11-51 days). Researchers looked at patient-reported pain on a 1-10 scale and their ability to raise the arm sideways (abduction). Of the 50 cases, 16 resolved completely (100%), 25 showed 75-90% improvement, 8 showed 50-75% improvement, and 1 experienced less than 50% improvement.

 

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.

Knee Pain – Do I Need a Replacement?

22 Oct

About a quarter of adults experience frequent knee pain, which results in limited function, reduced mobility, and impaired quality of life.  Osteoarthritis (OA) is the most common cause of knee pain in those over 50 years of age, and it is the #1 reason for total knee replacement (TKR). The rate of TKR in the United States and the United Kingdom has increased substantially in recent decades, which many have written off as a consequence of our aging populations. But is that really the case?

One study reviewed long-term data from the National Health and Nutrition Examination Surveys (NHANES) and the Framingham Osteoarthritis (FOA) study. The research team concluded that advancing age is indeed a factor behind the increase in TKR since the 1970s, but it doesn’t tell the whole story. The researchers also found that obesity is a risk factor for symptomatic osteoarthritis of the knee, and as you know, obesity rates have skyrocketed in the last four decades.

So, what can be done to reduce your risk for a total knee replacement? There isn’t anything you can do about getting older, but there’s a lot you can do to maintain a healthy weight. Begin by switching to a more anti-inflammatory diet such as the Mediterranean diet or the Paleo diet. You don’t have to change everything you eat all at once. Start by eating an extra serving of vegetables and one less serving of processed food a day. As you notice yourself starting to feel better, it will give you the confidence to make further dietary modifications.

Because the primary way for the cartilage in your joints to get nutrients is through movement, you’ll need to become more active. Increase the number of steps you take per day and raise the intensity over time. You should also engage in balance and strength training exercises.

Of course, you’ll also need to ensure your knee isn’t subjected to abnormal movements both above and below that can compromise the tissues that make up the joint. For example, ankle pronation can overload the medial compartment of the knee. Similarly, a problem in the hip, pelvis, or lower back can also place stress on the knee, which can impair its function. That’s why doctors of chiropractic evaluate the whole patient to identify any and all contributing factors to a patient’s chief complaint. Otherwise, the patient may not experience a satisfactory outcome.

 

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.