Pain Relief Chiropractic

The shoulder joint is really four joints—glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular—that all work in a coordinated manner to maneuver the upper arm. The shoulder blade, or the scapula, is an important player in normal shoulder movement because important muscles and related tissues are anchored in this bone. However, an issue with the scapula is easy to miss when diagnosing a patient seeking care for shoulder pain.

The main reason the scapula is overlooked is that when its position or motion is affected—a condition referred to as scapular dyskinesis—the patient may not initially experience pain or discomfort. However, though the condition may start in an asymptomatic manner, abnormal scapular movement can affect the motion of the rest of the shoulder, which can lead to the type of painful condition that drives a patient to their medical doctor or chiropractor’s office.

Indeed, the available research shows that patients with rotator cuff tears, glenohumeral instability, impingement syndrome, and labral tears often have scapular dyskinesis as well. One review found that between 67% and 100% of athletes with shoulder injuries have scapular dyskinesis. The same review noted that 54% of athletes in sports that require overhead motions had scapular dyskinesis.

Researchers have also observed abnormal scapular kinematics in sedentary, non-athletic individuals due to poor posture that places excessive strain on the upper back and neck to keep the head upright.

What can be done if a patient with shoulder pain exhibits scapular dyskinesis? First, treatment in a chiropractic setting might focus on manual therapies to restore normal motion to the affected joints. A doctor of chiropractic may also provide recommendations with heat and ice or nutrients to reduce inflammation. The patient will also be encouraged to perform at-home exercises as part of the recovery process.

A good starter exercise is to sit up tall by holding the head in line with the thorax (retract the chin), and “kiss” the scapula together followed by rolling the shoulders forward to separate the scapula WITHOUT shrugging the shoulders upward. Repeat this slowly, initially in front of a mirror, and concentrate on moving both sides rhythmically and equally. Eventually, do the same while on all fours or from a push-up position for something more difficult. Exercises that address forward head posture may also be recommended to reduce the load on the scapula caused by slouching.

As with many musculoskeletal conditions, the sooner a patient seeks care, the more likely they will achieve a successful treatment outcome—often in fewer visits—using conservative treatment approaches like chiropractic care.

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.

According to medical historians, the first artificial total hip arthroplasty (THA) was performed in Germany in the early 1890s. Since then, there have been many advancements in the design of the artificial hip and how the procedure is performed, even to the point of the introduction of the minimally invasive total hip arthroplasty, or miTHA, which offers similar long-term outcomes but involves only a small incision size results in less pain and disability in the surgical recovery period. An individual with pain or mobility issues associated with hip dysfunction may wonder if a hip replacement is in their future, but how would they know?

It’s estimated that more than half of hip fractures occur at the femoral neck or the angled bony stem that connects the thigh bone to the “ball” of the hip. Several studies have shown that when a femoral neck fracture does not initially lead to a hip replacement, there is a high risk for osteonecrosis, or the death of the bone due to reduced blood supply, which would need to be addressed with THA. Hence, individuals with a history of hip fracture and progressively worsening pain may be a THA candidate.

But what about those without a history of hip fracture? At the end of the 20^th century, most THA patients were over 60 years old, and the advice from clinicians was to wait as long as possible before undergoing the procedure. In recent decades, that advice has shifted with some patients opting for THA in middle age.

However, one reality about surgery is that it can’t be undone if it doesn’t resolve the problem, and there is always the risk of complications. That’s why treatment guidelines often recommend exhausting non-surgical options before consulting with a surgeon. For the patient with hip pain and disability, chiropractic care may be a non-surgical approach worth considering.

Depending on examination findings, treatment may involve the application of manual therapies, modalities, and specific exercise recommendations to restore normal motion to the hip joint. Additionally, a doctor of chiropractic will look for potential issues elsewhere that may be placing added stress on the hip, such as the knees, ankles, and lower back. In many patients, there may be several contributing causes to the patient’s chief complaint, and each will need to be managed to achieve an optimal 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.

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.