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Deep Gluteal Syndrome – What Is It?

17 Sep

The term deep gluteal syndrome (DGS) describes a condition that causes pain in the buttock that may travel down the back of the leg when the sciatic nerve is irritated. There are various structures that can result in sciatic nerve entrapment within the gluteal space which include the following: the piriformis muscle; fibrous bands containing blood vessels; the gluteal muscles; hamstring muscles, the Gemelli-obturator internus (muscle) complex, vascular (blood vessels) abnormalities; and space-occupying lesions.

Unique features within a patient’s history and physical examination can help to differentiate and define the specific site of sciatic nerve entrapment. It is common for patients with sciatic nerve entrapment to have a prior history of trauma, symptoms when sitting, and radiating pain from the low back and/or hip with tingling into the affected leg. If the nerve becomes damaged, diminished reflexes and/or muscle weakness can occur.

Because of the relationship between the lumbar spine (lower back) and the hip, it’s important to examine both regions in order to rule out a lumbar spine pathology as either the cause or a contributing factor to a patient’s symptoms. Failure to do this on a timely basis can lead to chronic pain and reduce quality-of-life based on an inaccurate diagnosis and treatment.

In one study, researchers found that a tight piriformis muscle plays a role in the majority of cases of DGS. The piriformis muscle can be stretched from a seated position. First, cross the leg, grasp the knee of the crossed leg, and pull toward the opposite shoulder (i.e., right knee toward left shoulder and vice versa). Next, arch the low back during this process and twist the trunk to the crossed knee side. Lastly, move the crossed knee in a circular manner to “work” the entire muscle. Do this for 30-60 seconds per side, multiple times a day.

The key to successful management is a prompt, accurate diagnosis followed by conservative care. While conservative treatment approaches to stretch the piriformis muscle and to reduce any pressure on the sciatic nerve are usually enough to reduce pain and improve function in patients with the condition, in some cases more invasive treatments such as injections or surgery may be necessary.

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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What Causes Shoulder Pain?

13 Aug

Each year, Americans make 7.5 million doctor visits related to shoulder/upper arm pain. After neck and back pain, shoulder pain is one of the top reasons patients seek chiropractic care. So, why are shoulder injuries so prevalent?

Though there are many possible explanations that address this question, there’s a simple answer: anatomy. There are essentially three joints that make up the shoulder: 1) scapulothoracic joint, 2) the glenohumeral joint, and 3) the acromioclavicular joint. These joints work simultaneously and in harmony to carry out the many tasks we throw at our upper extremities from swimming to swinging a tennis racket or even reaching up to hang a curtain or change a light bulb. The overall structure of the shoulder favors mobility over stability and as a result, there is a greater chance for injury. So, what can we do to prevent shoulder injuries?

Perhaps the most important strategy is to think before you act; that is, don’t take unnecessary chances such as over-lifting in especially awkward positions. Try asking someone else for help instead. Also, use proper form and stay conditioned. Research shows that a strong core (back and belly) can help prevent shoulder injuries.

Common shoulder conditions include (but are not limited to): inflammation (bursitis and tendinitis), instability (“sloppy” joints), arthritis (bone/cartilage injury/wear), fracture, and nerve injuries. Injuries can be acute (from an obvious cause) or more commonly, they can be chronic from wear and tear and can occur gradually over time (from no obvious, single cause).

It’s important to understand that a shoulder complaint may be the end result of dysfunction throughout the body, just as a knee problem can place added stress on the hip (or vice versa). So in addition to direct treatment of the shoulder, your doctor of chiropractic may identify and treat problems elsewhere in the body (forward head carriage, poor core strength, leg length deficiency, etc.) that likely contribute to your shoulder pain complaint. In order to promote a speedy recovery, your chiropractor may also recommend certain food or vitamins/supplements with the aim of reducing inflammation.

 

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 Chiropractic Help Prevent a Hamstring Injury?

12 Jul

Sports that require rapid acceleration and deceleration, cutting left and right, agility, jumping, and bending pose a unique risk for injury to the lower limbs. Hamstring injuries are the most prevalent injury in Australian rules football, afflicting 16% of players, causing an average of 3.4 missed matches per injury, accounting for the most time lost due to injury, and having the highest recurrence rate once players return to the active roster. Moreover, a player’s performance can be highly diminished by hamstring injuries.

In a 2010 study, researchers randomly assigned 57 male Australian football players to either a control group that received the current best practice medical and sports science management or an intervention group that received the same care with the addition of a sports chiropractic manual therapy injury prevention program that included manipulation/mobilization and/or soft tissue therapies to the spine and lower extremities. Both groups received a minimum of one treatment per week for six weeks, one treatment every two weeks for three months, and one treatment per month for the remainder of the season (three months).

At the close of the season, the researchers found that the group receiving the chiropractic injury intervention program reported significantly fewer primary lower-limb muscle strains and weeks missed due to no-contact knee injury than the other group. Though lower-limb injury prevention was the primary focus of this study, the players in the chiropractic group also experienced fewer episodes of back pain.

Because dysfunction in one area of the body can place added stress elsewhere, it’s important to examine the whole patient in order to identify other issues that may either be the cause or contribute to the patient’s chief complaint. Likewise, preventative care focused on maintaining proper motion in the joints throughout the body can lead to a reduced risk for injury, as was demonstrated by this study.

 

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.

Shoulder Pain – What Are My Treatment Options?

14 May

The shoulder is not just one joint but rather four: the sternoclavicular (collar bone/breast bone), acromioclavicular (the “roof” of the ball & socket joint), glenohumeral (the ball & socket joint), and scapulothoracic joints (shoulder blade/rib cage joint). There are also many structures in the vicinity that can mimic shoulder pain—namely, the cervical spine (neck), the upper half of the thoracic spine (upper back), and the rib cage.

The most common area that most shoulder pain sufferers point to is the top of the shoulder—between the neck and upper arm/shoulder joint. This may indicate dysfunction in the neck, since it can refer pain to this area. When patients point to their upper arm, the shoulder “could be” the pain generator, but more information is necessary before their doctor can make a firm diagnosis. If raising the arm above the horizontal plane (90°) hurts, it could be an impingement caused by a swollen bursa (“bursitis”), tendon (“tendinitis”), and/or a tear of the rim of the socket (“glenoid labrum tear”).

Specific orthopedic tests exist that help to differentiate between the possible causes or diagnoses but often, an MRI may be necessary to nail down a diagnosis. Unfortunately, an MRI can also show too much information, such as normal age-related changes, “silent” abnormal findings (like tears and frayed tissue that are not pain generators), which can actually make it more difficult to be sure what is causing the patient’s current shoulder pain.

When it comes to treatment, there is evidence to suggest conservative approaches, like exercises, are just as effective as surgical approaches. One review found the following:

  • Subacromial impingement syndrome: Exercise is as effective as surgery at one, two-, four-, and five-year follow-ups (at a fraction of the cost of surgery).
  • Rotator cuff partial thickness tears (<75%): Exercise is as effective as surgery (at a fraction of the cost).
  • Atraumatic full thickness rotator cuff tears: Exercise significantly reduces the need for surgery (75%).
  • Subacromial impingement syndrome: Exercise significantly reduces the need for surgery (up to 80%).

So if you suffer from shoulder pain, don’t jump to surgery as your first treatment option. Conservative treatments offered by doctors of chiropractic—such as manual therapies, exercise training, and the use of modalities—can help improve motion in the shoulder and the surrounding structures at a much lower cost and without the risks that come with more invasive procedures. Also, regardless of the treatment option you choose, keep in mind that it can take three, six, nine, or even twelve months to reach a satisfying end-point in treatment for these types of injuries.

 

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 Can Be Done for Kneecap Pain?

19 Apr

Patellofemoral (PF) pain (or pain in the area of the knee cap) is a very common problem, especially in women because they naturally have a wider pelvis. A wider pelvis can cause a “knock-knee” effect, which can be exacerbated by flat feet and ankle pronation (rolling in at the ankles). The net result is that outward pressure increases on the patella, which can be quite disabling and interfere with weight bearing activities. So, what can be done for individuals with patellofemoral pain?

Because we cannot change the width of the pelvis, the focus must shift to the foot/ankle and hip/knee muscle balance. A 2014 study set out to prove (or disprove) that exercises that target BOTH the hip and knee vs. the knee only would yield better long-term outcomes.

Here, researchers randomly assigned 31 women with PF pain to one of two treatment groups: Group A participated in BOTH hip & knee exercises for eight weeks and Group B engaged in ONLY knee exercises for eight weeks. Following the completion of each eight-week exercise program, the researchers examined each participant, followed by a re-examination three months later. The investigators found that patients in Group A experienced greater improvements with regards to pain and function.

The authors of the study concluded, “An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.”

The “take-home” message here is that patients obtain the best results when treatment—in this case, exercise—is applied to more than just the area of complaint. Chiropractic care includes assessment of the whole person, not just a localized area where the patient feels pain. Perhaps this is why chiropractic almost always scores highest in “patient satisfaction” surveys when compared with other healthcare delivery systems.

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.

Common Hip Injuries

19 Mar

Hip pain is a very common cause for lost time in sports, and it can also interfere with one’s daily activities—including work! So, what are some of the more common injuries of the hip?

MUSCLE STRAINS: This is probably the most common injury to the hip and groin because of the weight bearing “job” the hips have when running, cutting, jumping, climbing, twisting, etc. Strains occur more often with “eccentric” muscle contractions (when the muscle lengthens) vs. when the muscle shortens. Examples of eccentric muscle contractions include the lowering of a weight during a biceps curl, running DOWN a hill or steps, or lowering a bar to the chest in a bench press.

BURSITIS: A bursa is a fluid-filled sac located where muscles attach to bone to help lubricate muscles and tendons as they slide back and forth on each other during activity. We have bursae in several joints but especially in the hip, shoulder, elbow, and knee. Injury to the bursa can be the result of overuse, a trauma, or a post-surgical complication.

CONTUSIONS: A direct blow to the hip and/or pelvis can bruise the area, which is called a “contusion.” This is a common cause of bursitis and when located on the side of the hip, it is often called a “hip pointer.”

STRESS FRACTURE: These are usually seen in long distance runners and in women more often than men. Individuals with a nutritional deficiency (like those with an eating disorder) and older athletes—especially those with poor bone density—also have an elevated risk for stress fracture.

LABRAL TEAR: The labrum is a thick, fibrous ring that borders the hip socket adding depth and support to the hip joint. If the labrum tears, a patient may experience pain, stiffness, and mobility issues.

FEMOROACETABULAR IMPINGEMENT: When bone spurs form on the rim of the hip joint socket (acetabulum), they can cause pinching as the hip is moved to its end-ranges of motion. This can lead to osteoarthritis and is often due to a torn labrum and/or capsule.

OSTEITIS PUBIS: Repetitive pulling of muscles that attach to the pubic bone often seen in runners, soccer, and hockey players. Childbirth can also result in osteitis pubis.

SPORTS HERNIAS: These injuries are frequently seen in athletes from sports that require repetitive twisting/turning at high speeds (like hockey players) and are thought to be caused by an imbalance between strong thigh muscles and weaker abdominal muscles.

 

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.