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Running and the Knees

9 Jan

Running is one of the most popular forms of exercise, largely because it can be done almost anywhere at any time and it doesn’t require much in the way of equipment (other than a pair of running shoes). While there is a common belief that running always leads to osteoarthritis (OA) of the knee, the current research suggests that running may reduce the risk for knee OA and it can also improve pain and disability in patients who have developed the condition. Here are four tips for reducing the risk of experiencing a running-related injury so that you can reap all the benefits this activity has to offer…

Tip #1: Practice good form. Avoid running like you’re on a tight rope or balance beam (crossover gait). Practice walking, and then slowly run while keeping your feet apart (about the width of your pelvis). A crossover gait is bad because it increases foot/ankle pronation (rolling in), knee valgus stress (knock-knee affect), hip internal rotation (turns in), hip adduction stress (pulls on the outer thigh and impinges the hip), and low back extension (too much arching)—ALL of which can lead to injury in multiple body regions, including the knees!

Tip #2: Wear the “right” shoes for your foot. Dip your foot in water and look at your footprint on the floor. If your foot looks wide, you have a flat, pronated foot and a “motion control” shoe (designed for the low or no arched foot) is recommended. Avoid stiff soled shoes as they reduce the ability to feel the ground, leading to new or further injuries. If your footprint looks skinny, a “cushioned” shoe designed for the high arched foot is ideal as it absorbs the shock caused by the lack of pronation. If your footprint is between skinny and wide, a “stability” or “neutral” shoe designed for the normal arched foot is ideal. If you’re not sure, consult with a representative at your local running store. Many businesses that cater to runners have equipment on site to help identify the best shoe for you. Also, remember to replace your shoes every 250 miles REGARDLESS of your foot and shoe type!

Tip #3: Avoid progressing too fast. The tendency is to want to get into shape NOW! This can lead to overtraining and places too much stress on the body, which can result in injury.  Practice the 10% rule. If you ran ten miles in total last week and you want to increase your total distance, try adding 10% to each run so you achieve a total of eleven miles this week.

Tip #4: Strengthen your legs and hips with these exercises: 1) Posterior lunge – Stand and reach back with your left leg while squatting down as if to touch your left knee to the floor while bending your right knee (arms out front for balance). Go as far down as you COMFORTABLY can, keeping the right knee behind your toes. Repeat on the other side. Go slow, start with a half or quarter lunge to avoid injury!  2) Advanced Clam – Lie on your side, raise the upper leg and rotate the hip in and out slowly. 3) Side Plank Leg Raise – Lie on your side, legs straight (advanced) or bent (easier), and raise the pelvis off the floor (elbow under the shoulder), then raise the upper leg toward the ceiling.

If you feel as though running is causing pain or worsening existing pain, then consult with your doctor of chiropractic. He or she can examine your body and mechanics and provide conservative treatment to help make sure your next run is as pain free as possible.

 

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-Related Injuries in Athletic Kids

12 Dec

The hip is a very important region of the body, especially since our upright, weightbearing activities rely on a properly functioning hip joint.  With the expansive growth of youth athletic programs, the incidence of hip-related injuries and the associated disability has markedly increased.  But is there a difference between young male and young female hip injuries?

We’ve all observed the rapid rate of growth that occurs from age five to age seventeen, with bone growth reaching maturity around age sixteen for females and eighteen for males.  Prior to skeletal maturity, the growth plates remain open in the long bones of the body, which adds to the complexity and challenge in diagnosing and treating hip injuries in this age group.

Studies show that hip injuries account for approximately 5-9% of all athletic injuries. According to a study that looked at data from 121,047 pediatric visits at a sports medicine clinic between 2000-10, the most common hip injuries for males were labral tear (23.1%), avulsion fracture (11.5%), slipped capital femoral epiphysis (11.5%), dislocation (7.7%), and tendonitis (7.7%). For females, the leading hip injuries included labral tear (59.0%), tendonitis (14.8%), snapping hip syndrome (6.6%), strain (4.9%), and bursitis (4.9%).

The five most common sports that caused hip injuries were dancing/ballet (23.0%), soccer (18.4%), gymnastics (9.2%), ice hockey (8.1%), and track and field (6.9%).  Among adolescents (age 13–17 years), the data show that hip injuries were significantly more common in females than males. Studies have shown that young female athletes, especially in post-puberty ages, exhibit different landing and pivoting movements than males, which may help explain why adolescent females may be more at risk for hip injuries than teenaged boys.

Doctors of chiropractic are trained to diagnose and treat musculoskeletal injuries—including those of the hip joint—in patients of all ages. The key is to manage such conditions as early as possible to help patients get back to sporting activities and reduce the risk for future injuries in the hip and neighboring regions 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.

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.