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Elbow Pain…What The Heck Is The Issue?

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 →

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Golf: Hip Rotation And Its Effect On Early Extension

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 →

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The Achilles and Two Reasons Why It Might Be Hurting You

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 →

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Why Your Back Might Not Be Getting Better

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 →

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The Truth About Plantar Fasciitis and How To Treat It

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 →

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The Dreaded DCO and What It Means To You and Your Shoulder!

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 →

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The Major Reason Why Your Knee Hurts and What You Can Do About It

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 →

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Slouching Population Part 1 of 3: Good Posture Goes Beyond Just Looks!

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 →

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Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

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 at Myofascial Trigger Spots of Rabbit Skeletal Muscles Modulates the Biochemicals Associated with Pain, Inflammation, and Hypoxia

The Effect of Dry Needling in the Treatment of Myofascial Pain Syndrome: A Randomized, Double-Blinded Placebo-controlled Trial

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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Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

In our last two blogs, we went over models that help explain how Dry Needling works.  These two were the Radiculopathy and the Trigger Point Models.  The topic of this blog will involve the third model, or the Spinal Segmental Sensitization and Pentad Model.  As we have with the last two discussions, we will try to explain any difficult terminology or ideas.

Spinal Segmental Sensitization and Pentad Model

The Spinal Segmental Sensitization (SSS) and Pentad Model was proposed by the late Andrew Fischer, M.D. (Physiatrist…pain management and rehabilitation medical doctor).  This is a good time to discuss this model as it really incorporates both of the first two models.  Dr. Fischer proposed that the SSS is a ‘hyperactive’ state of the dorsal horn of the spinal cord that is caused by damaged tissue sending nociceptive (pain) input into the spinal cord.  This information then causes the over-sensitivity of the associated spinal level dermatome (skin), pain sensitivity of the associated spinal level sclerotome (bone, ligaments, joints), and Myofascial Trigger Points (MTrPs) in the associated spinal level muscles.  All this occurs because the nerve coming from the spine is over sensitized, and by being in this pathological state, it stimulates these changes listed above.  In effect, we have a pretty vicious cycle of pain and dysfunction. Continue Reading →