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Exercises for Hip Pain

14 Dec

There are two types of muscles that help facilitate motion in our hips and lower extremities: tonic and phasic.

Tonic (postural) muscles are always working or contracting to keep us upright. Therefore, these muscles tend to be tight and short. When we sleep, they contract or shorten and are taut upon waking and need to be stretched on a regular basis.  Examples of tonic muscles include the hamstrings and the iliopsoas or hip flexors muscles. Here are two great stretches for these muscles:

Iliopsoas stretch: 1) Stand and take a step forward with the left leg into a front straddled position.  2) Rotate the left side of the pelvis forward so that it becomes square with the right side of the pelvis. 3) Perform a posterior pelvic tilt by flattening the curve in the low back while rocking the pelvis forward to create a strong stretch in the left groin/front of the hip. 4) Lean backward to the right to further increase the left groin/hip stretch.  Hold for five to ten seconds and repeat this on the opposite side. Practice these stretches multiple times a day.

Hamstrings stretch: 1) Lie on your back and place the left leg on a door jam with the right leg flat on the floor extending through the opening of the doorway.  2) Push the left leg into the door jam and hold for three to five seconds and then scoot closer to the door jam to stretch the hamstring.  Hold for one to two minutes and repeat this on the opposite side, multiple times a day.

Phasic muscles, on the other hand, only work when needed and tend to be weak. These require strengthening, not stretching. Examples of phasic muscles include the abdominal and buttock muscles. Here are two great strengthening exercises for these muscles:

Abdominal strengthening: 1) Lying on the floor, place your hands behind your low back. Bend one knee/leg while keeping the other straight. 2) Lift your breastbone toward the ceiling one to two inches (2.54 to 5.08 cm) and hold for ten seconds. Repeat multiple times until the abdominal muscles are fatigued.

Buttocks strengthening: 1) Squeeze your buttocks together multiple times a day when sitting or standing. 2) Lie on your back with your knees bent and your feet flat on the floor. Raise your buttocks so it lines up with your trunk while pushing your heels into the floor. Hold for ten seconds and repeat five to ten times.

Depending on the nature of your hip pain, your doctor of chiropractic may recommend further exercises that you can perform at home as part of your treatment plan.

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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Shoulder Pain – What Exercises Are Best?

13 Nov

The shoulder is a unique joint because it has a great range of motion. Unfortunately, that benefit is negatively balanced with poor stability. This is likely why between 20-25% of the population is afflicted with shoulder pain at some point in life.

One of the greatest challenges in managing shoulder pain of musculoskeletal origin (it can also be a referred pain from a visceral organ like the gall bladder or from the heart) is its slow recovery rate. Some studies show that only about 50% of all new episodes of shoulder complaints have a complete recovery within six months. Add in the aging process, conditions that can slow recovery (like diabetes), and hobbies and jobs that increase the risk of re-injury and it’s understandable why it may not be possible for some patients to make a full recovery.

So, what can doctors of chiropractic do to help those with shoulder pain? The use of manipulation, mobilization, and modalities such as class IIIb and class IV laser (and others) can help a lot. But most importantly, exercise training is the KEY to a successful outcome.

Because of the slow recovery time for shoulder injuries, it is IMPORTANT to gradually introduce exercises at the correct time. In the initial acute stage, the following are appropriate:

Pendulum exercises: Like the pendulum of a clock, let the arm hang freely and gently swing while grasping a light weight (2.5-5 pounds, or 1.13-2.27 kg) – DO NOT try to lift the weight!

Finger walks up a wall: Face a wall and slowly walk your fingers up the wall but STOP at the point of pain. Remember, the first goal is to restore pain-free motion.

Once pain levels have improved and range of motion has been restored, resistance exercises are necessary to regain full function. TheraTube or TheraBand exercises are very practical, as you can travel with these and perform them anywhere. Here is a sample protocol: https://youtu.be/HKdm-2WYxDQ

Start with only three repetitions for each of these movements and SLOWLY release the tubing to help build coordination. If the protocol is too difficult, move toward the anchor point/door to reduce the tension on the tube. Be patient with your progress. It’s a slow but a consistent routine that will get you to your desired goals.

 

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.

The Origin of Knee Pain – The Medial Compartment

12 Oct

The four compartments of the knee (anterior/front, medial/inside, posterior/back, and lateral/outside) are like dominos. Meaning, when one is injured, the others “start to fall.” This is due to compensatory changes in function—when one compartment is problematic, this places added strain or stress to another compartment(s). Hence, managing knee conditions often requires work on multiple compartments.

The medial/inside compartment of the knee includes muscle, tendon, ligament, and medial meniscus, or “cartilage” attachments. These attachments connect to the top of the tibia/shin bone and/or the end of the femur/thigh bone. The ligaments are strong, non-elastic bands that hold the joint together while the muscles and their attaching tendons move the joint.

Movements of the knee joint include primarily flexion and extension (bending and straightening the leg at the knee). When something “blocks” the knee from fully straightening, an individual may change their gait pattern, possibly walking with a noticeable limp. The meniscus, or fibroelastic cartilage, lies between the ends of the femur and tibia, and when torn or frayed, it can cause the inability to “lock” the joint or to fully extend.

The medial compartment includes the medial collateral ligament, which “checks” the joint from moving excessively inward. Injuries occur when the force is directed to the outside of the knee, such as when a football player is tackled from the side with his foot planted on the ground. Because some of the medial meniscus attaches to the medial collateral ligament, a tear occurring in one often involves a tear of the other.

Moving to the middle of the knee joint, the two ligaments that “check” the joint from front to back are called the cruciate ligaments—specifically, the anterior (front) and posterior (back) cruciates. Injuries to these often occur when excessive force occurs from the front or back of the knee, such as a Due to the intimate relationship between the four compartments, most knee injuries affect multiple structures. For example, the classic tackle from the side can not only tear the medial collateral ligament, but the medial meniscus and anterior cruciate ligament can be injured as well.

Due to the intimate relationship between the four compartments, most knee injuries affect multiple structures. For example, the classic tackle from the side can not only tear the medial collateral ligament, but the medial meniscus and anterior cruciate ligament can be injured as well.

Doctors of chiropractic manage many knee conditions using a combination of joint manipulation, mobilization, different modalities, bracing, and exercise training.

Hip Pain and Iliotibial Band Syndrome

14 Sep

WHAT IS IT? Iliotibial band syndrome (ITBS) is one of the most common causes of hip and/or knee pain among athletes. The pain is caused from swelling or inflammation of a muscle group (including the tensor fascia lata or TFL, gluteus medius, and minimus muscles), the tendons that attach muscles to the knee or hip, and/or the bursa that surrounds the attachments at the hip and/or knee.

How common is it? Experts estimate that the prevalence of ITBS may be as high as 12% among participants in sports that involve running. This is also common during basic training—with ITBS reported by between 5.3% to 22.2% of United States Marine Corps recruits.

What is the clinical presentation? Typically, ITBS presents with a history of pain with activity (walking, running, cycling, etc.), with soreness at the outside of the knee just above the joint. Pain can radiate up or down and include the hip and/or ankle. Climbing steps and running downhill are common irritating activities. Rest can help alleviate symptoms in the short term but isn’t a long-term remedy.

What are some physical exam findings? ITBS patients may exhibit an abnormal gait or walking pattern in which knee flexion (bending) is avoided. They may also have tenderness to touch above the knee joint on the outside and/or along the iliac crest (where the TFL inserts). Squatting can reproduce pain, and lying on the side with the leg extended backward and dropped toward the floor from a bench often reproduces pain (called “Ober’s Test”).

Treatment Options: Because these are “overuse” injuries, changing the frequency, intensity, and/or duration of the sport or injury-causing activity is often necessary. Consider changing up your routine by cross training. If your athletic shoes are worn down, replace them and stay within the rated mileage of the shoe.

For those with ankle pronation (where the ankle shifts inwards), a foot orthotic with a measured rearfoot post can “make or break” a successful, long-term outcome. Similarly, if one leg is measurably shorter compared to the other, a heel or heel-sole combination lift is also very helpful.

If the muscles that move the hip are weak or if there is altered/abnormal muscle activity, then proper exercises to improve the neuro-motor pattern and/or strengthen the weak muscle group are a must! The inclusion of a gait/walking and running assessment can also reap great benefits for long-term success. Your doctor of chiropractic can help you with this assessment.

Chiropractors are trained to evaluate and treat ITBS and other hip/knee conditions, whether they are sports-related or not.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

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

14 Aug

Shoulder pain can arise from a multitude of places—from joints, muscles, tendons, and bursa in and around the shoulder region as well as from more distant locations like the neck, upper back, or even referred pain from the gall bladder. The onset of shoulder pain is highly variable as it can arise without an obvious cause or be related to a specific mechanism of injury such as a work or sports injury. Shoulder pain can also occur as a result of repetitive trauma over time, such as a job requiring overhead reaching. Neurological injuries such as stroke or a pinched nerve in the neck can cause shoulder pain as well. Experts estimate that as much as half of the population experiences shoulder pain each year, though many people often decide to “just live with it” and therefore, don’t seek treatment. However, shoulder and neck disorders do account for 18% of disability payments for MSK pain.

These following factors contribute to shoulder pain, either alone or in combination with each other:

  • Inflammatory conditions: Tendonitis, bursitis (the bursa are the fluid-filled sacs that lubricate the surrounding tissues), osteoarthritis (the “wearing out” kind), and rheumatoid arthritis (the autoimmune kind). Inflammatory conditions are a common cause of shoulder impingement (see below).
  • Excessive Motion: Instability can arise from tearing of the joint capsule, tendons, and/or ligaments that become lax after healing. The terms “strain” and “sprain” refer to tears of muscles and/or tendons (strains) vs. ligaments (sprains). Trauma typically results in instability in one direction vs. congenital (or “born with”) problems where instability can be multi-directional. This can result in a subluxation and/or a dislocation of the shoulder.
  • Limited Motion: This occurs when the joint capsule and ligaments are tight and restrict freedom of movement. This can happen after prolonged immobilization (use of a sling) and can result in impingement and/or “frozen shoulder” (adhesive capsulitis).
  • Muscle Weakness/Imbalance: The muscles in front, on top, behind, and those that connect from below must be in proper balance for the ball and socket joint of the shoulder to function properly. Weakness in any of these muscles can alter the normal balance and result in shoulder pain due to poor, inefficient shoulder motion. A common example of this is forward head posture with shoulder protraction (forward, rounded shoulders) that many of us “suffer” from as a result of using electronics (smartphones, computers, television). Overtraining of any of these muscles (like the chest muscles), stroke, or pinched nerves can also alter muscle balance.

Impingement is a common cause of shoulder pain that arises from swelling or inflammation of the tendons and/or bursae. Here, the ability to raise the arm is limited. Chiropractors are trained to diagnose and treat shoulder conditions using the standard approaches like mobilization, exercise, ice, job modifications, and anti-inflammatory measures (modalities and nutritional approaches), as well as those unique to chiropractic such as shoulder joint manipulation, which can reduce impingement.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

The Relationship of the Hip, the Low Back, and Knee

12 Jun

The hip is a very unique joint. The depth of the socket, the strength of the muscles and ligaments surrounding it, and the way it functions in weight bearing activities is unlike any other joint in the body. The focus this month is on the relationship between the hip and the rest of the body.

The hip joint is a synovial joint, meaning it moves freely. It is a ball-and-socket joint that is made up of the femoral head (the “ball”) and the acetabulum (the “socket”). The ball is largely contained within the cup or socket, though there are genetic and cultural differences with regards to the depth and shape of the hip joint in any one individual.

The relationship between the hip and the surrounding joints is intimate in that each joint affects the next. For instance, ankle pronation—or the inward rolling of the foot and ankle—results in a knocked knee, which can then shift the hip outwards. The pelvis then drops down on that side, the tailbone or sacrum becomes unleveled or sloped, and the lower spine curves to compensate with the ultimate goal of keeping your eyes level. Hence, when your hip hurts, your doctor of chiropractic will examine and treat the ENTIRE lower kinetic chain—the foot, ankle, knee, hip, pelvis, and spine—as ALL are so closely related to each other. When it comes to managing you and your hip pain, be prepared for management of any of the following:

  • Ankle pronation: This is the inward rolling of the ankle often associated with a flat foot. When viewing someone with ankle pronation from behind, the angle from the Achilles tendon to the ground will lean inward when it normally should be perpendicular. A valgus correction in a “rear foot post”—a heel wedge thicker on the inside—of a foot orthotic (customized arch support) is needed to correct this.
  • Knocked-knees: Ankle pronation can result in “knocked-knees” (genu valgus) which overloads or jams the outer knee joint, over-stretching the inner knee joint and ligaments. The knee cap (patella) then rides excessively hard on the outer surface of the femoral groove in which it glides as one bends and straightens their knee, causing knee cap pain.
  • Hip inward angulation (or coxa vera): As the knee shifts inward or knocks, the head of the femur moves outward, leaving the joint less stable. Leg length deficiency (LLD)—or a short leg—occurs when the pelvis drops on that side further destabilizing the lower kinetic chain.

Once ankle pronation is properly corrected with a rear foot post and the hind foot is repositioned back to neutral (if LLD persists) a heel lift can be placed under the foot orthotic to corrective this imbalance. ONLY then will the pelvis become level and stable so it can properly serve as a strong foundation for the spine the rest of the body to rest on!

We haven’t touched the subject of muscle imbalance, strengthening of commonly weak hip extensor muscles, or stretching of overly tight hip flexors and adductor muscles—topics for another day! The good news—doctors of chiropractic can help you with this common problem!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

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.