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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
856 Century Drive, Suite C
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.

Have You Tried These Movements Before Considering Shoulder Surgery?

11 May

If you suffer from shoulder pain, here are some exercises you can do at home that really work to improve flexibility and strength. Just remember to ALWAYS stay within reasonable pain boundaries and work BOTH sides of your body, NOT just the injured shoulder!

For flexibility, start with the “Codman” Pendulum exercise. Stand or sit and lean forward so that your arm can swing like the pendulum of a clock while holding a light weight (2-5 lbs, or .9-2.26 kg initially). Move the weight in a clockwise, counter-clockwise, left-to-right, and/or forward-backward ALLOWING the shoulder to RELAX. DO NOT shrug your shoulder upward—let the shoulder go. This is usually comfortable and therefore can be done MANY times a day!

Another great beginning exercise is the Finger Wall-Walk. Stand in front of a wall and slowly walk your fingers up a wall staying within a comfortable range. Go slow and repeat several times. As you improve, rotate your trunk or stand with your body 45º, 60º, and later, 90º to the wall.

To perform the Crossover Arm Stretch, relax your shoulders and gently pull your arm across your chest using the uninvolved arm/hand to assist in the movement. Hold for up to 30 seconds and repeat with the other arm.

The Passive Internal Rotation (stick behind the back) and External Rotation (stick in front) requires a broomstick held parallel to the floor. Grip the stick with both hands held shoulder width apart and allow one arm to move the relaxed arm inward and outward. Do this as two separate exercises. Hold the end-range for up to 30 seconds each, repeat one to three times, as tolerated.

For Strengthening, the use of Thera-Tube or Band works well when anchored into the hinged side of a door. Pretend you are standing on a clock (12, 3, 6, and 9 o’clock positions) and SLOWLY pull and release the tubing three times in each of the four “clock positions,” ALWAYS staying in the pain-free range.

Your “ultimate guide” for advancing in reps, sets, and type of exercise is the comfort factor – AVOID sharp, lancinating painful movements/exercises or those that leave you sore for more than 24-48 hours afterwards. Track your recovery time after exercising to determine safety.

 

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

Dr. Brent Binder
856 Century Drive, Suite C
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.

Is a Labral Tear Causing Your Hip Pain?

13 Mar

One of the structures that is frequently blamed for hip pain is called the labrum—the rubbery tissue that surrounds the socket helping to stabilize the hip joint. This tissue often wears and tears with age, but it can also be torn as a result of a trauma or sports-related injury.

The clinical significance of a labral tear of the hip is controversial, as these can be found in people who don’t have any pain at all. We know from studies of the intervertebral disks located in the lower back that disk herniation is often found in pain-free subjects—between 20-50% of the normal population.  In other words, the presence of abnormalities on an MRI is often poorly associated with patient symptoms, and the presence of a labral tear of the hip appears to be quite similar.

For instance, in a study of 45 volunteers (average age 38, range: 15–66 years old; 60% males) with no history of hip pain, symptoms, injury, or prior surgery, MRIs reviewed by three board-certified radiologists revealed a total of 73% of the hips had abnormalities, of which more than two-thirds were labral tears.

Another interesting study found an equal number of labral tears in a group of professional ballet dancers (both with and without hip pain) and in non-dancer control subjects of similar age and gender.

Another study showed that diagnostic blocks—a pain killer injected into the hip for diagnostic purposes to determine if it’s a pain generator—failed to offer relief for those with labral tears.

Doctors of chiropractic are trained to identify the origins of pain arising from the low back, pelvis, hip, and knee, all of which can mimic or produce hip symptoms.  Utilizing information derived from a careful history, examination, imaging (when appropriate), and functional tests, chiropractors can offer a nonsurgical, noninvasive, safe method of managing hip pain.

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

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

 

Is Your Shoulder Pain Caused By a Rotator Cuff Tear?

13 Feb

One of the most common causes of shoulder pain is a rotator cuff (RC) tear. To determine just how common this is, one study looked at a population of 683 people regardless of whether or not they had shoulder complaints. There were 229 males and 454 females for a total of 1,366 shoulders. (The participants’ average age was 58 years, ranging from 22 to 87 years old.)

The research team found 20.7% had full thickness rotator cuff tears. Of those with shoulder pain, only 36% had tears found on ultrasound. Of those without shoulder pain, 17% also had tears! Risk factors for an increased for tearing of the rotator cuff include a history of trauma, the dominant arm (ie your right arm if you’re right handed), and increasing age.

In a review of radiologic studies of 2,553 shoulders, researchers found full-thickness rotator cuff tears in 11.75% and partial thickness tears in 18.49% of the subjects for a total of 30.24% having some degree of tearing. In this group, about 40% of tears were found in pain-free shoulders. The researchers concluded that rotator cuff tears are common and frequently asymptomatic.

Both of these studies support the necessity to FIRST consider the patient’s clinical presentation and then correlate that with the imaging results. In other words, the presence of a RC tear on an image (usually MRI or ultrasound) does NOT necessarily mean there is pain (and vise versa)!

So what other things could be causing the shoulder pain? There are many: impingement, tendonitis, bursitis, muscle strain, capsular (and other ligament) sprain, frozen shoulder, and osteoarthritis (the “wearing out” type). Also, rheumatoid arthritis, lupus, polymyalgia rheumatica and other autoimmune types of “arthropathies,” fibromyalgia, a herniated cervical disk, shoulder dislocations, whiplash injuries, and more!

Most importantly, we must NOT forget to include referred pain to the shoulder from an impaired heart (such as coronary heart disease or heart attack), lung, liver, or gall bladder as these problems commonly refer pain to the shoulder and may represent a MEDICAL EMERGENCY!

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

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

What Happens When a Knee Injury Occurs?

12 Jan

Have you ever wondered what actually happens when a player on your favorite sports team has a knee injury? Why is this so common, and why is the knee more vulnerable than the ankle or hip?

One reason is simple anatomy. Unlike the hip, the knee doesn’t have a deep socket, meaning there is less stability and they don’t have the added side protection the ankles enjoy. The knee is more like a hinge with little protection when impacts occur from any direction.

In a classic football tackle from the side (or in a “clip”), the runner’s foot is planted with the lower leg rotated inward as the player is cutting a corner when WHAM, a hit occurs. When the tissues in the knee are stretched beyond their limits, they can tear. The order in which the tearing occurs and the amount or degree of the tear is dependent on the exact mechanism of injury or the direction and force of the impact.

The anterior cruciate ligament (ACL) is the innermost structure while the MCL and lateral collateral ligament (LCL) is found on the outside of the joint. If the hit is from the front, the ACL may bear the brunt of the blow while a hit from another direction may first affect the medial collateral ligament (MCL). The meniscus is a C-wedge shaped piece of cartilage that absorbs shock between the joints of the femur and tibia with one on the inside (medial) and outside (lateral meniscus). The meniscus is among the most common of knee injuries, often associated with a twist or torsional stress. This is commonly referred to as a “torn cartilage.”

In one study of 100 consecutive patients with recent ACL tears, there were also 53 MCL, 12 medial, 35 lateral, and 11 bilateral meniscus injuries. The cause included 59/100 injuries due to contact sports, 30/100 in downhill skiing, and 11/100 in other recreational activities, traffic accidents, or at work. It is estimated that there are 100,000 anterior cruciate surgeries in the United States each year!

Doctors of Chiropractic are trained to identify, treat, and rehab knee injuries both pre- and post-surgically. They frequently work with other allied healthcare professionals to optimize outcomes as quickly as possible.

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

Dr. Brent Binder
856 Century Drive, Suite C
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

A Pain in the Hip?

12 Dec

When you ask people to point to their hip joint, it’s very interesting to see the vast number of places where people point—the low back, side of the pelvis, front of the pelvis, in the groin, and more! If one were to draw a line between the back and front pocket, that’s basically the hip joint.

So keeping the hip joint in mind, picture the squat exercise. According to Dr. Stuart McGill, director of the Spine Biomechanics Laboratory at the University of Waterloo, Ontario, Canada, to safely perform a squat, one must FIRST consider genetics and the role it plays, especially in performing a deep squat.

Genetics, according to Dr. McGill, helps us to determine whether the hip joint can handle squatting. For example, genetically shallow hip sockets predispose people to hip dysplasia (arthritis). The highest rate of hip dysplasia in the world is in Poland as individuals of Polish descent are genetically predisposed to be develop shallow hip sockets. However, because of these shallow sockets, the range of motion of their hips (prior to dysplasia, of course) is greater and also more powerful in the deep squat position.

Hence, it should not be surprising that the great Olympic weight lifters come from Poland, Bulgaria, and Ukraine due in part to this uniquely shaped and shallow hip socket (called the Dalmatian hip). In contrast, the shape of the hip in those of Scottish descent is deep, which has a great advantage for walking, standing, and rotation power, but the deep sockets are terrible for producing power at the bottom of a deep squat.

Similarly, Celtic and French populations have deep sockets, and that is the most logical reason why exercises that require a wide range of motion, like yoga, can result in impingement pain in a high percentage of people of such ancestry.

So, how does this relate to hip pain? Depending on your genetic makeup, if you are of the descent where shallow hip sockets are common, it might be best to avoid deep squats and/or occupations that require a lot of weight-bearing and bending over, especially those with heavy lifting. Even though you might win a squatting competition due to less hip impingement, the shallow sockets tend to wear out faster.

Bottom line, when engaging in an exercise class, running, cycling, or the like, if there is pain (a “bad” or sharp lancinating pain), DON’T DO THAT EXERCISE! Stay within “reasonable pain boundaries” and you should generally be safe. DON’T try to keep up with the person next to you, as they may be genetically “better matched” for the activity that you’re engaging in.

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

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org