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Can Chiropractic Help Prevent a Hamstring Injury?

12 Jul

Sports that require rapid acceleration and deceleration, cutting left and right, agility, jumping, and bending pose a unique risk for injury to the lower limbs. Hamstring injuries are the most prevalent injury in Australian rules football, afflicting 16% of players, causing an average of 3.4 missed matches per injury, accounting for the most time lost due to injury, and having the highest recurrence rate once players return to the active roster. Moreover, a player’s performance can be highly diminished by hamstring injuries.

In a 2010 study, researchers randomly assigned 57 male Australian football players to either a control group that received the current best practice medical and sports science management or an intervention group that received the same care with the addition of a sports chiropractic manual therapy injury prevention program that included manipulation/mobilization and/or soft tissue therapies to the spine and lower extremities. Both groups received a minimum of one treatment per week for six weeks, one treatment every two weeks for three months, and one treatment per month for the remainder of the season (three months).

At the close of the season, the researchers found that the group receiving the chiropractic injury intervention program reported significantly fewer primary lower-limb muscle strains and weeks missed due to no-contact knee injury than the other group. Though lower-limb injury prevention was the primary focus of this study, the players in the chiropractic group also experienced fewer episodes of back pain.

Because dysfunction in one area of the body can place added stress elsewhere, it’s important to examine the whole patient in order to identify other issues that may either be the cause or contribute to the patient’s chief complaint. Likewise, preventative care focused on maintaining proper motion in the joints throughout the body can lead to a reduced risk for injury, as was demonstrated by this study.

 

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 Are My Treatment Options?

14 May

The shoulder is not just one joint but rather four: the sternoclavicular (collar bone/breast bone), acromioclavicular (the “roof” of the ball & socket joint), glenohumeral (the ball & socket joint), and scapulothoracic joints (shoulder blade/rib cage joint). There are also many structures in the vicinity that can mimic shoulder pain—namely, the cervical spine (neck), the upper half of the thoracic spine (upper back), and the rib cage.

The most common area that most shoulder pain sufferers point to is the top of the shoulder—between the neck and upper arm/shoulder joint. This may indicate dysfunction in the neck, since it can refer pain to this area. When patients point to their upper arm, the shoulder “could be” the pain generator, but more information is necessary before their doctor can make a firm diagnosis. If raising the arm above the horizontal plane (90°) hurts, it could be an impingement caused by a swollen bursa (“bursitis”), tendon (“tendinitis”), and/or a tear of the rim of the socket (“glenoid labrum tear”).

Specific orthopedic tests exist that help to differentiate between the possible causes or diagnoses but often, an MRI may be necessary to nail down a diagnosis. Unfortunately, an MRI can also show too much information, such as normal age-related changes, “silent” abnormal findings (like tears and frayed tissue that are not pain generators), which can actually make it more difficult to be sure what is causing the patient’s current shoulder pain.

When it comes to treatment, there is evidence to suggest conservative approaches, like exercises, are just as effective as surgical approaches. One review found the following:

  • Subacromial impingement syndrome: Exercise is as effective as surgery at one, two-, four-, and five-year follow-ups (at a fraction of the cost of surgery).
  • Rotator cuff partial thickness tears (<75%): Exercise is as effective as surgery (at a fraction of the cost).
  • Atraumatic full thickness rotator cuff tears: Exercise significantly reduces the need for surgery (75%).
  • Subacromial impingement syndrome: Exercise significantly reduces the need for surgery (up to 80%).

So if you suffer from shoulder pain, don’t jump to surgery as your first treatment option. Conservative treatments offered by doctors of chiropractic—such as manual therapies, exercise training, and the use of modalities—can help improve motion in the shoulder and the surrounding structures at a much lower cost and without the risks that come with more invasive procedures. Also, regardless of the treatment option you choose, keep in mind that it can take three, six, nine, or even twelve months to reach a satisfying end-point in treatment for these types of injuries.

 

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 Can Be Done for Kneecap Pain?

19 Apr

Patellofemoral (PF) pain (or pain in the area of the knee cap) is a very common problem, especially in women because they naturally have a wider pelvis. A wider pelvis can cause a “knock-knee” effect, which can be exacerbated by flat feet and ankle pronation (rolling in at the ankles). The net result is that outward pressure increases on the patella, which can be quite disabling and interfere with weight bearing activities. So, what can be done for individuals with patellofemoral pain?

Because we cannot change the width of the pelvis, the focus must shift to the foot/ankle and hip/knee muscle balance. A 2014 study set out to prove (or disprove) that exercises that target BOTH the hip and knee vs. the knee only would yield better long-term outcomes.

Here, researchers randomly assigned 31 women with PF pain to one of two treatment groups: Group A participated in BOTH hip & knee exercises for eight weeks and Group B engaged in ONLY knee exercises for eight weeks. Following the completion of each eight-week exercise program, the researchers examined each participant, followed by a re-examination three months later. The investigators found that patients in Group A experienced greater improvements with regards to pain and function.

The authors of the study concluded, “An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.”

The “take-home” message here is that patients obtain the best results when treatment—in this case, exercise—is applied to more than just the area of complaint. Chiropractic care includes assessment of the whole person, not just a localized area where the patient feels pain. Perhaps this is why chiropractic almost always scores highest in “patient satisfaction” surveys when compared with other healthcare delivery systems.

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.

Common Hip Injuries

19 Mar

Hip pain is a very common cause for lost time in sports, and it can also interfere with one’s daily activities—including work! So, what are some of the more common injuries of the hip?

MUSCLE STRAINS: This is probably the most common injury to the hip and groin because of the weight bearing “job” the hips have when running, cutting, jumping, climbing, twisting, etc. Strains occur more often with “eccentric” muscle contractions (when the muscle lengthens) vs. when the muscle shortens. Examples of eccentric muscle contractions include the lowering of a weight during a biceps curl, running DOWN a hill or steps, or lowering a bar to the chest in a bench press.

BURSITIS: A bursa is a fluid-filled sac located where muscles attach to bone to help lubricate muscles and tendons as they slide back and forth on each other during activity. We have bursae in several joints but especially in the hip, shoulder, elbow, and knee. Injury to the bursa can be the result of overuse, a trauma, or a post-surgical complication.

CONTUSIONS: A direct blow to the hip and/or pelvis can bruise the area, which is called a “contusion.” This is a common cause of bursitis and when located on the side of the hip, it is often called a “hip pointer.”

STRESS FRACTURE: These are usually seen in long distance runners and in women more often than men. Individuals with a nutritional deficiency (like those with an eating disorder) and older athletes—especially those with poor bone density—also have an elevated risk for stress fracture.

LABRAL TEAR: The labrum is a thick, fibrous ring that borders the hip socket adding depth and support to the hip joint. If the labrum tears, a patient may experience pain, stiffness, and mobility issues.

FEMOROACETABULAR IMPINGEMENT: When bone spurs form on the rim of the hip joint socket (acetabulum), they can cause pinching as the hip is moved to its end-ranges of motion. This can lead to osteoarthritis and is often due to a torn labrum and/or capsule.

OSTEITIS PUBIS: Repetitive pulling of muscles that attach to the pubic bone often seen in runners, soccer, and hockey players. Childbirth can also result in osteitis pubis.

SPORTS HERNIAS: These injuries are frequently seen in athletes from sports that require repetitive twisting/turning at high speeds (like hockey players) and are thought to be caused by an imbalance between strong thigh muscles and weaker abdominal muscles.

 

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.

Why Is Shoulder Pain So Common?

12 Feb

Shoulder pain is common. If fact, it’s highly likely that many of you reading this currently have or have had a shoulder injury, as studies suggest that about 90% of us will tear our rotator cuff, labrum, and/or capsule at some point in time during our lives. So why is this so common? More importantly, what can be done about this?

The reason for the high prevalence of shoulder pain is due to the anatomy of the shoulder. The shallow “socket” allows for the shoulder’s great range of motion, but with this excellent mobility comes a decrease in stability, as a joint can’t be BOTH stable AND highly mobile. So from a prevention standpoint, consider the following: 1) Don’t reach into the back seat to lift your heavy briefcase or purse to the front seat. 2) Take “mini-breaks” when working overhead. 3) Follow an exercise program that maintains strength in your shoulders. 4) Get help when you know the task you’re about to attempt is going to be a challenge. This list could go on and on but the last point is crucial: don’t feel insecure about asking for help with difficult tasks! As the saying goes, “An ounce of prevention is worth a pound of cure.”

An important goal regarding recovery from a shoulder injury involves restoring the joint space between the ball and socket joint and the “roof” of the shoulder or acromion process (or “acromiohumeral distance”, or AHD). A shoulder impingement injury typically occurs when this space is reduced, resulting in a tighter fit that pinches pain-sensitive structures when one attempts to raise their arm up over their head.

To reduce impingement, try the popular “pendular exercise” by holding a 5-15 lbs (2.26-6.80 kg) weight so that the arm swings loosely like the pendulum of a clock. The weight pulls the shoulder joint open, reducing impingement. Another exercise is gripping the seat of a chair while leaning to the opposite side (focus on relaxing the shoulder while leaning) to open or separate the joint. The joint can also be opened using elastic therapeutic tape. A 2017 study found that taping over the front and back deltoid muscle from insertion to origin worked best to open the AHD to reduce impingement. Doctors of chiropractic can also utilize manipulation and mobilization to open the AHD.

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.