Femoroacetabular Impingement (FAI), or hip impingement syndrome, is a painful hip condition that limit a person’s activities and can inhibit an athlete’s ability to perform. Many times people can function just fine with an FAI, depending on their activity, but many times it’s necessary to get surgery to correct the problem. After surgery though, proper rehabilitation is necessary so as to reduce scar tissue buildup in the hip joint region. There are 3 types of FAI and each one can cause significant problems. Continue Reading →
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Oct 2017
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22
Jun 2017
Elbow Pain…What The Heck Is The Issue?
The elbow…well, it certainly isn’t the ‘funny/crazy bone’ when we hurt it.
The elbow…when it hurts, it certainly isn’t so ‘funny’ or ‘crazy’.
We treat a LOT of elbow problems in our office. Why is this? Well, we have an active patient base and most all we do affects the musculature in our elbows. It used to be that when you had medial, or inside, elbow pain, that would be called ‘golfer’s elbow’ and when the pain was on the lateral side, or outside, that was called ‘tennis elbow.’ Well, needless to say, times have changed and people in many sports get medial and lateral elbow pain and they certainly are not playing golf or tennis. For that matter, not all golfers get medial elbow pain and tennis players lateral elbow pain anyway…sometimes, it’s the opposite. As as far as that ‘funny bone’ issue we’ve all heard about, that occurs when we bang a certain part of the elbow that the ulnar nerve runs through. The sensation we feel is irritation to the nerve and the distally affected tissues feel ‘funny.’ Continue Reading →
13
Apr 2017
Golf: Hip Rotation And Its Effect On Early Extension
As a certified Titleist Performance Institute (TPI) level 3 medical provider, I get the honor of treating a lot of golfers. As golfers will tell you, the game is like a heroin addiction…but it’s actually more expensive! A golfer will do just about whatever it takes to improve his/her game. From shoes to gloves to clubs to lessons to whatever, nothing is too much if it will shed a few strokes off each round. Whether the golfer is a 20 handicap or scratch or better golfer, improvements can always be made. As is the case with any sports activity, proper stability and mobility are important and for a precision game like golf, they’re vital.
One major movement fault that many people and golfers alike have is a lack of internal hip rotation. Proper hip mobility is not only vital for back health, but it is vital for proper swing mechanics. I’d say, in my experience, that about 80% of golfers suffer from this issue. It can be on the either side and depending which side it is on, the fault affects the backswing or the follow-through. Regardless of which one it is, it must be corrected to improve that score and lower the risk of musculoskeletal injuries…mostly, the force transmission into the low back. This is one of the major reasons why so many golfers get low back pain. Continue Reading →
23
Mar 2017
The Achilles and Two Reasons Why It Might Be Hurting You
Figure 1.: The Calcaneal Bursa Sacs, picture from WebMD
The Achilles tendon is a rather avascular (lacking blood) thick tendon that is made up of two of your major back side calf muscles: the gastrocnemius and the soleus. The tendon attaches into a part of your heel bone, the calcaneus, and this part is called the calcaneal tubercle. We have to major bursa sacs (bursa sacs are pockets that only fill with fluid when they are inflamed), the subcutaneous calcaneal bursa and the retrocalcaneal bursa (see figure 1 right). The subcutaneous bursa seldom presents as an issue, but the retrocalcaneal bursa can be a major headache. Continue Reading →
13
Mar 2017
Why Your Back Might Not Be Getting Better
There are many reasons as to why people develop back pain and luckily, conservative treatment can help most all of them. Only in the rarest of instances is surgery needed. The problem with treating back pain is that all too often the practitioner focuses so much on the pain that he/she doesn’t actually address what is causing the pain. We’ve all been guilty of this!
I could write volumes on contributing factors to back pain but this blog was written to address one common problem that we are seeing more and more: a hypermobile sacroiliac joint (SIJ). Now, the naysayer will try to suggest that this does not occur, but with over 18 years of treating sports and back injuries, I can assure you that it does, and it does with frequency. I’ve seen this problem in active kids to my professional athlete clientele base. It is usually not properly diagnosed as few practitioners know how to assess it. Continue Reading →
20
Feb 2017
The Truth About Plantar Fasciitis and How To Treat It
Plantar Fasciitis (PF) can be a rather debilitating condition. It doesn’t matter if you have flat feet (pes planus) or high arches (pes cavus). If there is added stress to the bottom of the foot that occurs quickly, it can result in plantar fascial pain.
What exactly is the plantar fascia? Consider the plantar fascia to be similar to a ligament. It runs from the heel (the medial calcaneal tubercle) to the heads of your metatarsals (point at about where you see the webbing of your toes). Despite what you might have been told, its function is NOT to hold the arch of the foot. Rather, the PF more-so holds the muscles under it together so that they can suspend your arch. Continue Reading →
06
Feb 2017
The Dreaded DCO and What It Means To You and Your Shoulder!
DCO, or Distal Clavicular Osteolysis, is a rather bad shoulder condition that all too many athletes suffer from.
DCO occurs when we have damage to our AC (acromioclavicular) joint and it goes unattended to for a period of time. More-so than that, additional damage is done with further activity and the bones that make up the joint get significant damage.
The AC joint is made up of where the distal clavicle bone meets the acromion process of the scapula (see photo below). A sprain of the AC joint tends to involve a macrotrauma (one significant injury) such as a bad fall or other form of side shoulder impact. The AC joint tends to get hypermobile (or move too much) easily as it is not a very stable joint to begin with. When the joint is injured, or sprained, care is needed to stabilize the joint and allow for it to heal. In-office treatments can significantly reduce recovery time and this is important as a healing AC joint sprain is susceptible to further injury. Continue Reading →
11
Jan 2017
The Major Reason Why Your Knee Hurts and What You Can Do About It
As a sports rehabilitation doctor, I get the benefit of seeing all types of sports injuries. One of more common injuries I see is a ‘knee tracking’ issue. I’ll go as far as saying about 75% of all people presenting with knee pain have this condition as either a primary issue or issue that is causing a more serious situation. So, what exactly is this funny sounding condition?
As humans, we are the ONLY animal to be upright and on two legs as a primary means of ambulation. Although our evolution has allowed us to do this, it is not without issues. It just so happens that the muscles on the outside of the thigh tend to get stronger/tighter than the muscles on the inside. Now, it’s a bit more complex than this but this should help give us a general idea of what is occurring. Continue Reading →
16
Feb 2016
Slouching Population Part 1 of 3: Good Posture Goes Beyond Just Looks!
Over the weekend, I met some new friends, and the topic turned to posture very quickly once they found out that I was a chiropractor, and when I found out that they were IT specialists. They began to make fun of themselves about the ridiculous positions in which they sit while working at the computer. Until that moment, I had just visualized poor posture as sitting with the head forward, rounded shoulders, and hunched upper back. After speaking with this group, a new picture popped into my head regarding bad posture. One demonstrated leaning so far back in his chair with his leg propped up on a waste basket he may has well have been lying down. Another was slanting to the side and turning in a way that only a contortionist could have achieved. How you position yourself with your posture, comfortable or not, you may be taking years off your life….or just making those years a bit more painful. Continue Reading →
06
Jul 2015
Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling
We have covered a lot of information about Dry Needling in our last 3 blogs. We discussed the Radiculopathy Model, the Trigger Point Model, and the Spinal Segemental Sensitization and Pentad Model. Already, we can clearly see how Dry Needling can help to break down myofascial trigger points (MTrPs) and reduce pain. The fourth model will discuss another reason as to why Dry Needling can help you.
Central Model
Our final model, the Central Model, covers information about how Dry Needling and other physical interventions (including manipulation, massage, mobilization, etc…) affect the spinal cord and brain. This is a rather basic but powerful model. The premise is that input stimuli will affect tracks in the spinal cord that will carry that information up to the brain. The deeper the treatment, the more information that will be conveyed. The hypothalamus will then take the stimuli and communicate with the pituitary gland and affect other endocrine functions.
In regards to the hypothalamus, it has three primary functions: 1. It supplies input to the brainstem, thus affecting autonomic regulation, 2. It controls endocrine function, and 3. It exerts influence on posture and locomotion.
With the Central Model, MTrPs along the spine will likely cause more autonomic issues (please click to read more about autonomic issues on the Trigger Point Blog). Dry Needling causes an anti-inflammatory response that emanates from the hypothalamic-pituitary-adrenal axis. This is deep stuff!
If we assume that the hypothalamus is directly or indirectly adversely affected by MTrPs, then we can conclude that such MTrPs create autonomic and endocrine problems in addition to postural and movement issues (this means it affects the way you work inside and outside). Certainly, we would want to rid our bodies of such noxious stimuli, and since Dry Needling can eliminate such MTrPs, then this makes it a great option for restoring proper function of not only the musculoskeletal system, but also the autonomic and endocrine functions that are affected by an improperly functioning musculoskeletal system.
Any way you slice it, Dry Needling can help you to function better. From simple pain and dysfunction to autonomic concomitants, Dry Needling offers a viable option for the treatment of trigger points and pain due to musculoskeletal causes.
Let’s take a look at some studies supporting the application of Dry Needling…there are a few here but many more in print:
We will start with the grand-daddy of them all…the landmark study performed by Karl Lewit, MD published in 1979. This study broke down the effects of trigger point injections to determine if the analgesic/steroid that was the agent that helped the patient, or was it the needle alone that contained all the magic! Please read study, and if you would like the full study (versus just the abstract), please let us know.
The Needle Effect In The Relief of Myofascial Pain
And the other studies…
Dry Needling Having Anti-Nociceptive (anti-pain) Effects
Probable Mechanisms of Needling Therapies for Myofascial Pain Control
The Influence of Dry Needling of The Trapezius Muscle on Muscle Blood Flow and Oxygenation
Dry Needling and Exercise for Chronic Whiplash – A Randomized Controlled Trial
Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players
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