Archive | Joint Pain RSS feed for this section

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.
Advertisements

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.

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.