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Dynamic Stretching for Hip Pain

10 Jun

As we grow older, stretching becomes a more important part of our routine, especially when hip pain is present. Whether you are about to engage in a sport, a job, weight lifting, or errands, it’s best to prepare your muscles for activity. With that said, stretching can be broken down into two main types: static (or passive) and dynamic (or active) stretching.

The available research notes that static stretching (stretching while holding one position, like reaching for your toes) has recovery benefits and is most effective at the end of a workout/competition. However, it can reduce performance when done beforehand, as it relaxes muscles, reduces blood flow and muscle strength, and decreases central nervous system (CNS) activity.

Active warm-ups or dynamic stretching have the opposite effect—they boost blood flow and activate the CNS, which enhances strength, power, and range of motion (ROM) resulting in BOTH immediate and long-term benefits. A 2014 systematic review of 31 studies reported that dynamic stretching that included sprints and plyometrics (movements against resistance) enhanced power and strength performance when compared to static stretching—which did not reduce strength. In a 2010 systematic review of 32 studies investigating active warm-up before engaging in a sport, researchers found that an active warm-up improved performance by 79% across all criteria investigated.

But what about the hip? A 2019 study compared static stretching vs. dynamic stretching of the hip joint with no-load (DSNL), with a light-load (DSLL, 0.25kg), and with a heavy-load (DSHL, 0.5kg) in an elderly population (63.2 ± 7.13 years). Participants stood sideways behind a chair (for balance), and swung one leg, as able. Researchers measured hip flexion and extension range of motion before the test, immediately after, and 60 minutes later. Compared to static stretches, all three types of dynamic stretches improved hip ROM more effectively at all time points, with DSNL being the most effective.

Here are a few hip-specific dynamic stretch options: 1) Standing Hip Circle: Stand on one leg, raise the opposite knee to 90º (thigh parallel to the floor); move the knee outward (open your hip), and make wide circles for 30 seconds/side or to fatigue (start gradually). 2) Lunge: Step forward with the right foot, lower the back knee toward the floor (as able); pause and repeat on the other leg. 3) Half Squat: From standing, slowly bend the knees until the thighs are parallel to the ground while bracing the core and maintaining a neutral low back curve.

 

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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Where Is This Shoulder Pain Coming From?

9 May

When people say, “My shoulder hurts,” they often point to different areas in the vicinity of the shoulder such as the base of neck, the collar bone, the scapula (shoulder blade), the chest, and/or their arm. The challenge with the shoulder is that it’s anatomically comprised of three joints: the glenohumeral joint, or GHJ (ball-and-socket); the acromioclavicular joint, or ACJ (collar bone and scapula); and the scapulothoracic joint, or STJ (shoulder blade and rib cage). Some researchers even argue that the sternoclavicular joint, or SCJ (collar bone and sternum), should also be considered part of the shoulder.

From a musculoskeletal standpoint, the list of conditions that can cause shoulder pain is quite lengthy (and NOT all-inclusive): avascular necrosis (the bone dies due to lack of blood flow), nerve injury (neck and/or peripheral), thoracic outlet syndrome, fractures in/around the shoulder, bursitis, shoulder dislocation, frozen shoulder, impingement, arthritis (several types), rotator cuff injury, sprains, tendinitis or rupture, and labral tears (cartilage rim around the socket).

One of the most common causes of shoulder pain is impingement, which may occur with many of the above-mentioned conditions. This is technically referred to as “subacromial impingement” (SAI), which is essentially a reduction of the normal gap between the ball and socket, thus limiting the amount of room the joint has to function. Classic symptoms include pinching and pain when trying to put a coat sleeve on or raising the arm horizontally.

To complicate matters, conditions elsewhere in the body can also refer pain to the shoulder. In 2018, a study noted instances in which athletes failed to respond to routine treatment for shoulder pain but experienced improvements in pain and function when treatment addressed dysfunction in the cervical spine. Non-musculoskeletal conditions can also result in shoulder pain, such as gall bladder disease, which classically refers pain to the right scapula/shoulder blade. Other abdominal organ conditions that can refer pain to the shoulder include pancreatitis, an ovarian cyst, an ectopic pregnancy, as well as post-surgical referred pain. A heart attack classically refers pain to the left shoulder and left arm but may also include the abdomen, jaw, and/or mid-back. A lung condition such as a blood clot (pulmonary embolism), infection (like pneumonia), or lung cancer or tumors may also refer pain to the shoulder.

Doctors of chiropractic are trained to evaluate the whole patient and identify contributing factors for the patient’s chief complaint. In instances in which a non-musculoskeletal issue is suspected, the patient may be referred to the appropriate healthcare provider. However, a combination of manual therapies (manipulation/mobilization), exercise, ergonomic modifications, nutritional counseling, and physical therapy modalities can result in a satisfying outcome in most cases of shoulder pain.

 

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 Patellofemoral Pain?

15 Apr

While chiropractic care commonly focuses on improving function in the spine to reduce neck pain and back pain, in many cases achieving a successful outcome is only possible when treatment addresses conditions elsewhere in the body. For example, ANY painful condition of the knee can alter one’s gait pattern, which can result in abnormal movement in the ankle, pelvis, and lower back, potentially leading to musculoskeletal pain in those areas as well. In this article, we’ll focus on patellofemoral (PF) pain, or pain that arises in the region of the knee cap, as it’s one of the more common knee conditions.

The anatomy in and around the patella is unique in several ways. First, the patella is the largest “sesamoid” (free-floating) bone of the body. The role of all sesamoid bones is to improve the function of the muscle/tendon connecting to the sesamoid bone by optimizing the angle of action. In effect, it acts like a pulley, which significantly improves the strength and force of the muscle. The quadriceps muscles attach above at the pelvis and below at the upper pole of the patella. The patella then glides in a grove, or track, located in the distal femur (thigh bone) and a tendon then attaches the lower pole of the patella to a bony prominence located just below the knee on the proximal tibia, or upper “shin bone.”

When we flex and extend our knee, the patella slides up and down in the track as the quadriceps contract and relax. This occurs automatically when walking, running, climbing, etc. Of the four muscles that make up the quadriceps, three (rectus femoris, vastus lateralis, and vastus intermedius) pull the patella up and out when we extend or straighten the knee and only one (vastus medialis) pulls the kneecap up and inward. To compensate for this disadvantage, the vastus medialis normally fires first during knee extension, which allows for proper patellar tracking and normal function.

A 2018 study published in the Archives of Medicine and Rehabilitation looked at the “neural drive” of the four quadriceps muscles in 56 women with or without PF pain. Subjects were asked to sustain an isometric, or static knee, extension contraction at 10% of their maximum effort for 70 seconds. Specialized nerve testing tools measured the average firing rates at various time points during muscle contraction.  In the non-PF pain subjects, the vastus medialis fired at higher rates vs. the largest muscle (the vastus lateralis) that pulls the patella up and out. This was the opposite case in the women with PF pain, which investigators suspect may cause and/or perpetuate PF pain.

This finding has led to the recommendation of isolating the vastus medialis with a specific strengthening exercise. This is accomplished by emphasizing the last ten degrees of full knee extension by completely locking or straightening out the knee in extension followed by only a slight bend. This is repeated 10-20 times with or without weight, depending on the degree of injury, pain, and muscle weakness. Your doctor of chiropractic can help train you in performing this exercise properly, as well as offer other highly effective exercises and treatments for knee pain.

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 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.

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.