Pain Relief Chiropractic

Non-surgical, conservative care to address shoulder pain, especially when caused by shoulder impingement syndrome (SIS), is one of the most common reasons patients visit a chiropractic office. Doctors of chiropractic often manage the condition with a combination of manual therapies and exercises targeted on the shoulder joint.

The scientific literature is rich with studies showing the benefits of shoulder exercises to address SIS, and a poorer outcome is more likely without exercise. Manual therapies applied to the shoulder have also been demonstrated to benefit the SIS patient, and it’s common for chiropractors to use both specific exercise and manual therapies in combination when managing the condition.

Two recent studies suggest that incorporating spinal manipulative therapy can lead to even better outcomes for the SIS patient.

In one study, researchers assigned participants (half of whom had SIS) to either a treatment (thoracic spine thrust manipulation) or a sham treatment group. Before and after treatment, participants performed an arm raise test to assess scapular kinematics and note their current pain levels. The SIS patients in the treatment group reported improvements in their shoulder pain; however, there was no observed improvement in scapular kinematics among any participants.

The other study took a similar approach, except it assessed shoulder joint range of motion in addition to shoulder pain. In this study, the research team observed that mid-back thrust manipulation led to immediate improvements in both shoulder pain and shoulder range of motion in the SIS patients.

Both studies demonstrated that spinal manipulation applied to the mid-back can lessen shoulder pain (and improve shoulder joint range of motion) without administering any treatment directly on the shoulder. This suggests mid-back dysfunction may play a role, however small, in many cases of SIS and that patients with shoulder issues should receive a thorough examination to identify all possible contributing factors to the patient’s musculoskeletal pain and disability, even those outside the area of chief complaint, something which doctors of chiropractic are trained to do when assessing a new patient.

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 Baker’s cyst is a swelling located in the back of the knee that can be either asymptomatic or bothersome, especially when bending the knee. Researchers estimate that up to 94% of popliteal (back of the knee) cysts are associated with an intra-articular disorder, most commonly meniscus (“cartilage”) tears, as well as osteoarthritis, inflammatory arthritis (like rheumatoid), and ACL tears.

In about 50% of healthy adult knees, there is a valvular opening located high on the inside of the knee joint that connects the joint capsule to a bursa (a fluid filled sac that functions to lubricate muscle attachments). It is thought that when there is an effusion or swelling inside the knee joint, the excess fluid flows one way to the inner knee joint bursa (called “pes anserine bursitis), which reduces pressure from inside the joint. Although there are other causes of popliteal cysts, this is the most common.

So, what can chiropractors do for the patient with a Baker’s cyst?  Chiropractic management includes both passive and active care approaches that focus on the knee joint and surrounding soft tissues to help reduce pain and swelling and improving function, as well as home exercise instruction to maintain the health of the knee joint. Such exercise recommendations can include the following:

1. Standing calf stretch: stand upright grasping a chair or wall for balance; step back with the involved leg and flatten the heel to the floor with toes pointing as straight as comfortably possible; slowly straighten the bent knee until you feel a firm stretch behind your knee; hold for five to ten seconds and repeat five to ten times or until the muscle feels less tight; repeat on the opposite leg.
2. Heel lift: sit with your feet flat on the floor with your knees bent 90°, lift one heel keeping the ball of the foot on the floor; push down on the knee and slowly lower the heel to its starting position; repeat ten times as tolerated and switch sides, gradually increasing reps and sets, as tolerated.
3. Sitting hamstring stretch: sit on the ground with one leg straight out, keeping the heel on the floor; bend the ankle and bring your toes toward you; arch your low back until you feel a strong stretch in the back of the thigh and knee; lean forward as tolerated for a greater stretch; repeat five to ten times with  a three to five second hold, as tolerated.
4. Heel Slides: lie on your back, legs straight; slowly bend one knee while sliding the heel toward your buttocks; repeat five to ten times, as tolerated, and repeat on the opposite side.
5. Wall squats: stand with your back against a wall and slide down slowly, keeping the toes well in front of the knees; only squat down as far as you can; repeat five to ten times, as tolerated.
6. Side-steps: place a loop or resistance band around your ankles; partially bend the knees; step sideways, alternating between the left and right foot, stepping wide enough to always keep tension on the band.

Your doctor of chiropractic can train you in these exercises and provide care to address any musculoskeletal issues that may contribute to your knee pain.

A Baker’s cyst is a swelling located in the back of the knee that can be either asymptomatic or bothersome, especially when bending the knee. Researchers estimate that up to 94% of popliteal (back of the knee) cysts are associated with an intra-articular disorder, most commonly meniscus (“cartilage”) tears, as well as osteoarthritis, inflammatory arthritis (like rheumatoid), and ACL tears.

In about 50% of healthy adult knees, there is a valvular opening located high on the inside of the knee joint that connects the joint capsule to a bursa (a fluid filled sac that functions to lubricate muscle attachments). It is thought that when there is an effusion or swelling inside the knee joint, the excess fluid flows one way to the inner knee joint bursa (called “pes anserine bursitis), which reduces pressure from inside the joint. Although there are other causes of popliteal cysts, this is the most common.

So, what can chiropractors do for the patient with a Baker’s cyst?  Chiropractic management includes both passive and active care approaches that focus on the knee joint and surrounding soft tissues to help reduce pain and swelling and improving function, as well as home exercise instruction to maintain the health of the knee joint. Such exercise recommendations can include the following:

1. Standing calf stretch: stand upright grasping a chair or wall for balance; step back with the involved leg and flatten the heel to the floor with toes pointing as straight as comfortably possible; slowly straighten the bent knee until you feel a firm stretch behind your knee; hold for five to ten seconds and repeat five to ten times or until the muscle feels less tight; repeat on the opposite leg.
2. Heel lift: sit with your feet flat on the floor with your knees bent 90°, lift one heel keeping the ball of the foot on the floor; push down on the knee and slowly lower the heel to its starting position; repeat ten times as tolerated and switch sides, gradually increasing reps and sets, as tolerated.
3. Sitting hamstring stretch: sit on the ground with one leg straight out, keeping the heel on the floor; bend the ankle and bring your toes toward you; arch your low back until you feel a strong stretch in the back of the thigh and knee; lean forward as tolerated for a greater stretch; repeat five to ten times with  a three to five second hold, as tolerated.
4. Heel Slides: lie on your back, legs straight; slowly bend one knee while sliding the heel toward your buttocks; repeat five to ten times, as tolerated, and repeat on the opposite side.
5. Wall squats: stand with your back against a wall and slide down slowly, keeping the toes well in front of the knees; only squat down as far as you can; repeat five to ten times, as tolerated.
6. Side-steps: place a loop or resistance band around your ankles; partially bend the knees; step sideways, alternating between the left and right foot, stepping wide enough to always keep tension on the band.

Your doctor of chiropractic can train you in these exercises and provide care to address any musculoskeletal issues that may contribute to your 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.

Chronic hamstring strains are more difficult to diagnose because the pain (in the hip region and deep in the buttocks and upper thigh) comes on gradually and is aggravated by repetitive activities like running, rowing, or biking and worsens with prolonged sitting. Hamstring injuries become chronic when a damaged or torn tendon fails to properly heal, often caused by returning to the sport too quickly and/or from mismanagement. Chronic tendonitis can lead to degenerative changes resulting in a weaker tendon, which can lead to long-term pain and disability.

Non-surgical care for chronic high hamstring tendinopathy is often challenging because the usual treatment approaches for acute hamstring strains are less responsive. It’s not unusual for a prolonged recovery of three to six months, with many only partially recovering with a high recurrence rate. Treatment may include:

1. Rest (time away from a sport), though cross training of a different body region during this time can combat the psychological stress associated with chronic injuries.
2. Ice and heat (ice packs, baths, and ice massage is initially recommended to reduce pain and inflammation) applied for ten to twenty minutes, every two to four hours each day. Contrast therapy includes alternating between ice and heat to create a “pump” as heat vasodialates blood vesicles and draws in fluids, which loosens fibrotic scar tissue and relaxes muscles, while ice vasoconstricts and pushes out fluid (inflammation).
3. Because lack of flexibility is “the norm” for chronic high hamstring tendinopathy, regular stretching will be necessary for recovery. Stretches can include lying on the back, pulling the bent knee toward the chest, and slowly straightening the knee; the popular “hurdler” stretch, or sitting with one leg straight on a bench or ground and slowly trying to lock the knee straight while reaching for the toes; or from standing, placing the heel on a chair seat followed by an anterior pelvic tilt (arch the low back by tilting the buttocks upwards).
4. A mix of concentric (resistance as the muscle shortens, such as bringing the heel toward the buttocks) and eccentric (resistance during the opposite of concentric or the straightening of the knee during a hamstring curl) strengthening exercises will typically benefit patients with chronic high hamstring tendinopathy.

Your doctor of chiropractic can guide you in the treatment process as well as address musculoskeletal issues, such as low back pain, that may have preceded the hamstring injury. As is typical with musculoskeletal injuries, the sooner a patient seeks care, the more likely they will achieve a satisfactory treatment outcome.

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 instability (SI) occurs when the soft tissues (joint capsule, ligaments, and labrum) that hold the humerus in the shallow ball-and-socket glenohumeral joint become stretched, torn, or detached. When these tissues are damaged, the resulting shoulder instability is characterized as structural. If instability is caused by abnormal muscle activity that places too much or too little stress on the shoulder joint, the condition is described as functional instability.

In teenagers and young adults, shoulder instability is typically the functional variety, and it can affect up to 2.6% of this population. The most common variety of functional SI among these individuals is posterior positional functional shoulder instability (PP-FSI).

Patients with PP-FSI experience disabling shoulder pain during mid-range movement of the shoulder joint, caused by a muscle imbalance where the external rotator cuff muscles and the posterior deltoid are under-active and the internal rotator muscles are hyperactive. There is also an altered balance of the periscapular muscles. Using functional MRI, researchers have observed that the brain of a PP-FSI patient may send abnormal signals to the shoulder muscles during movement, similar to an infant who hasn’t developed fine motor skills or a recovering stroke or brain injury patient.

The conservative treatment approach to PP-FSI involves manual therapies to help restore proper motion to the shoulder joint, specific exercises to strengthen the muscles that have become inactive, ice and nutritional recommendations to address inflammation, modalities like electronic muscle stimulation to retrain the muscles, and activity modifications to reduce the risk of re-injury during the initial phase of the healing process. Over time, the patient can begin to resume their normal activities, provided movement doesn’t lead to sharp, lancinating pain in the shoulder.

Other musculoskeletal injuries in the shoulder, arm, neck, or upper back that may have preceding or developed following the PP-FSI injury will also need to be addressed in order to return the patient to their normal activities. While surgical intervention may be advised as a first course of treatment for some PP-FSI patients, treatment guidelines typically recommend utilizing non-surgical methods first, of which chiropractic care is an excellent choice.

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.

When it comes to a condition like chronic knee pain, there are many treatment options available to reduce pain and improve function, including chiropractic care. However, there are cases when a patient may opt for total knee arthroplasty (TKA). In some instances, they may be able to resume their everyday activities, but a segment of patients may not achieve a satisfying outcome. What can we learn from these patients that can inform us on when to and when not to consider surgery for knee pain?

In one study, researchers examined TKA patients one year after their procedure to assess their progress with respect to knee range of motion and function, as these are important for performing activities of daily living (ADLs) such as the ability to put on shoes and socks, squat down to pick things up off the floor, get up and down from sitting, climb and descend steps, etc. The research team found that patients with poor range of motion before surgery, as well as those with poor knee alignment (the tibial-femoral angle), were less likely to have a satisfactory outcome.

Several studies have demonstrated how hyperpronation of the ankle can affect the alignment of the knee, placing added stress on the joint, as can impaired hip function. These issues should be addressed before considering TKA. This is why it’s important for doctors to assess the whole patient for a musculoskeletal condition because the cause or contributing factors for the issue could be from outside the area of chief complaint. In many cases, a combination of manual therapies and specific exercises provided by a doctor of chiropractic can restore proper motion to the affected hip or ankle, which can then benefit the knee.

Manual therapies can also break up adhesions and scar tissue that may affect knee range of motion. When the knee can move as intended, the pressure from normal movement can help provide nutrients to the remaining cartilaginous tissue, reducing inflammation and pain. 

The take-home message is that there may be a time when a TKA is the only option available to a patient with knee pain, but if the knee is poorly aligned or its range of motion is restricted, then TKA may not be the answer. Luckily, these are issues that can be addressed with chiropractic care, which may delay or even reduce the need for an eventual surgical procedure.

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 pain is a common complaint that can arise from many different sources including the spine, pelvis, and the knee. Greater trochanteric bursitis or gluteal tendonitis (GT) is a condition that occurs five-times more often in women than men, affecting one-in-four women over 50 years of age.

Patients with GT experience pain in the region from the side of their hip toward the buttocks, which can make finding a comfortable sleeping position difficult. This condition can be as painful and disabling as an osteoarthritic or a worn-out hip joint.

The traditional medical approach for GT is a cortisone injection. However, the results are not impressive in the medium-term, and the long-term results are similar to patients who took a wait-and-see approach. More recently, a treatment regimen that includes specific exercise programs with load-management and education to reduce the load on the injured tendon during sustained postures and activities has gained attention due to its significant medium- and long-term benefits. Better still, it’s non-invasive.

A 2018 study found that GT patients treated with a combination of exercise with education and load management experienced a higher success rate after one year (78.6%) than those given a cortisone injection (58.3%) and those who received no treatment at all (51.9%).

The education, load management, and exercise treatment protocol consisted of fourteen sessions over eight weeks plus a daily home exercise program that included four to six exercises, while keeping a weekly diary. Advice on tendon care was included and exercises included functional retraining, targeted strengthening (especially the hip abductors), and dynamic control during function. A pain-guided approach was used that allowed up to a 5/10 pain intensity level when exercising, provided the pain promptly stopped if activity ceased.

Exercises included the following (partial list):

Static hip abduction: a) Supine: place a belt around the lower thighs with feet slightly wider than hip width, put a pillow behind the knees and gently and slowly push outward while tightening the belt. b) “Imaginary splits”: stand, feet slightly wider than hip width, and pretend you’re doing the splits (sideways)—again, slowly and gently.  

Supine Bridges: a) Double leg bridge: bend knees, feet flat, draw in the abdominal muscles, press the heels into the floor and lift the buttocks SLIGHTLY—only as high as comfortable. b) Offset Bridge: bring one foot closer to the buttocks and lift buttocks up using mostly that leg slowly (three to four seconds up then, three to four seconds down). Another bridge includes lifting one leg up and straightening the knee. These can be held statically or with movement up/down to the floor. Additional exercises included partial squats, step-ups, and sideways floor slides.

If you have been diagnosed with or suspect you have GT, your doctor of chiropractic can guide you in how to perform these exercises and provide additional care to aid in the recovery process.

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.