Archive | Joint Pain RSS feed for this section

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.

Exercise Can Help Knee Osteoarthritis

17 Oct

In the face of musculoskeletal pain, it’s common to restrict activity. Unfortunately, doing so can weaken the muscles and joints in the affected area, which can prolong pain and elevate the risk for future injury. Patients with osteoarthritis of the knee often fall into this trap. So, what type of exercises are best for improving knee strength in the presence of knee osteoarthritis?

First, let’s define two types of muscle activity that can occur during exercise: eccentric and concentric. During a bench press, when you’re pushing the barbell upward, the muscles in the chest shorten in a concentric motion. As you lower the bar downward, your pectoralis muscles lengthen, which is an eccentric motion.

A 2019 study that involved 54 seniors with knee osteoarthritis investigated which of the two phases builds better strength for the knee – the concentric/muscle shortening phase or the eccentric/muscle lengthening phase of muscle activity. The participants were split into three groups: CNC RT (concentric resistance), ECC RT (eccentric resistance), or CON (control group – no exercise/wait-list group). The two exercise groups received four months of supervised exercise training using traditional weight machines with proper set-ups and instructions that emphasized the concentric or eccentric phase of the exercise.

Each week, participants completed questionnaires to measure knee pain and disability. The researchers also recorded the maximum weight each subject could lift with respect to knee flexion, knee extension, and the leg press.

The results showed that BOTH exercise groups experienced strength increases in comparison to the control group, with the eccentric resistance group achieving greater gains on the leg press and knee flexion exercises, but not for knee extension. Both exercise groups also reported less pain and disability than the control group. The authors concluded that both types of resistance training effectively improved leg strength, pain, and function, and they recommend that the mode an individual emphasizes should be based on personal preference, goals, tolerance, and equipment availability.

This study is a great example of the many benefits that exercise can offer for an elderly population suffering from knee osteoarthritis. Doctors of chiropractic often prescribe exercises for patients with knee pain in addition to providing manual therapies, modalities, orthotics (knee braces and foot orthotics), as well as dietary and nutritional counselling for inflammation reduction and pain management purposes. Before throwing in the towel and jumping to a total knee arthroplasty (replacement), you owe it to yourself to seek less invasive management strategies FIRST.

 

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 Problem, Back Problem, or Both?

12 Sep

Musculoskeletal conditions drive millions of patients to doctor’s offices each year, with back and hip pain being among the most common. Because the hip and low back neighbor one another in the body, these conditions often overlap, with only one of the two being diagnosed. This can lead to inadequate treatment, unnecessary costs, and unsatisfying outcomes for the patient with prolonged pain, disability, and mental health distress.

In some cases, a problem elsewhere in the body can refer pain to another region. For example, dysfunction in the upper neck could result in symptoms in the wrist and hand that could appear to be carpal tunnel syndrome. Or an issue in one area, like the foot, can change a patient’s gait and lead to a problem with the knee. It’s possible that the patient may only seek care for their knee pain, as their foot may not have obvious symptoms for concern. With the hip and low back, both scenarios can occur, which is why it’s important to focus on the whole patient and not just the area of chief complaint.

That’s why doctors of chiropractic consider the whole patient when they present for conditions like hip pain or back pain, starting with a thorough patient history. This includes asking the right questions, in which we frequently use the acronym LMNOPQRST, which stands for: Location, Medical History (or Mechanism of injury), New, Other Symptoms (or, Onset), Provoking/Palliative, Quality, Radiation, Severity, and Timing. These questions MUST be asked for each complaint.

The remaining history of Past, Family, and Social histories and, a Review of Systems allows the doctor of chiropractic to consider other potentially important aspects of the patient’s past such as prior injuries, accidents, surgeries, current medications, genetics, social aspects (smoking, drinking, exercise habits, sleep quality) and more, which can give clues to the current presenting complaints. The use of pain diagrams and questionnaires helps quantify the amount of suffering and serve as good outcome tools to determine treatment success.

The examination includes observing the patient walk and move (with or without distress), their posture, and their affect (is their condition all-consuming); palpating or feeling for painful structures and performing movements that both increase and relieve their pain; measuring patient’s range of motion; determining what position is favored or “best” vs. “worst”; and nerve function tests to look for impairments with regards to sensation, strength, and reflexes.

Each part of the examination is considered in order to arrive at the correct diagnoses so that treatment can accurately focus on healing and improving the function of the ailing parts.

 

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.

Osteoarthritis of the Shoulder

15 Aug

Osteoarthritis (OA) is the most common form of arthritis and is caused when the smooth cartilage surface of an articulating/moving joint wears away until there is bone-on-bone contact that results in both loss of movement and pain. Although OA most commonly affects the joints under the greatest load (the hips and the knees), it can occur in any moving joint, including those that make up the shoulder.

Because cartilage lacks a direct blood supply, it relies on a process called diffusion in which nutrients are absorbed into cartilage when it’s compressed by movement. Anything that restricts the movement of the joint (like inflammation or injury) can slow or cut off its supply of nutrients, placing the tissue at risk for injury and degeneration.

When a patient presents for care involving OA of the shoulder, chiropractic treatment will generally focus on improving the motion of the affected joints with manipulation, mobilization, manual traction, manual massage, active release techniques, acupuncture, physical therapy modalities (such as ultrasound or electronic stim), nutritional counseling, and home-based exercises.

Here are some additional ways to self-manage osteoarthritis of the shoulder:

  1. Stay Active: Movement/exercise is the BEST way to keep joint cartilage nourished and healthy. Many people can manage the pain often without medication by simply pacing themselves and by staying active.
  2. Eat a Healthy Diet: Keep your diet balanced and emphasize foods that reduce inflammation or swelling like omega-3 fatty acids (fish oil), ginger, turmeric, Boswellia, and more.
  3. Reduce the Load on the Joints: This includes losing weight, as well as modifying job/lifestyle activities that routinely place force on the affected joints.
  4. Get Plenty of Sleep: Several studies show that getting too little or too much sleep each night can lead to poor outcomes. Aim for seven to nine hours of restful sleep.
  5. Use Hot/Cold Packs: This is a great way to reduce inflammation.
  6. Supplements: Consider glucosamine and chondroitin.

Generally, the more advanced the case, the longer it will take to achieve a successful outcome, if at all. That’s why it’s important to seek care sooner rather than later when you experience pain in the shoulder or any other part 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.

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.

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.