Meralgia Paresthetica aka Roth’s Disease aka Lateral Femoral Cutaneous Nerve (LFCN) syndrome is a condition we see from time to time. The patient tends to present with pain in the lateral thigh that almost feels like an itchy feeling. The discomfort can be anything from burning pain to tingling. The pain is not a deep pain but is superficial. This means you only feel it on the outside of the thigh vs. deep in. It can be very bothersome and it is certainly annoying enough that people will go to find a solution. Left untreated, it tends to get worse with time. Continue Reading →
11
Jul 2017
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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 →
13
Feb 2017
I Have Disc Problems and I Cannot Run…Will I Be Able To Run Again?
We treat a lot of patients who suffer from disc pathologies, be they bulges or herniations. Most of these people are active and want to continue to be active. The problem they encounter is that they get pain in the low back with activity that many times goes into the gluteal region (on one side or another…or both) and sometimes goes down the leg(s) into the feet. This makes it hard for them to partake in sport. Continue Reading →
09
Jan 2017
Dr. Manison is now Selective Functional Movement Assessment (SFMA) Certified
Doctors learn how to assess and treat based on their specialization. Chiropractors are taught how to diagnose neuromusculoskeletal problems and how to properly treat them. If a patient presents with a condition that a chiropractor cannot handle, then an appropriate referral should be made.
Dr. Manison has acquired skills in most of the highest level treatment approaches in his field. In fact, he now teaches part of the Certified Chiropractic Extremity Practitioner (CCEP) program nationally. This program, developed by Dr. Kevin Hearon, is regarded in the field as the highest level program on the assessment and treatment of extremity injuries. Continue Reading →
08
Jul 2016
Dr. Manison now TPI (Titleist Performance Institute) Medical Level 3 Certified Provider
Golf is a sport that many consider to be an addiction: players will go through great lengths to improve their swings, ball distance, fitness, conditioning, etc… all in the name of lowering that handicap. Along with the need to have a good teaching golf professional to work with, players at all levels need a proper assessment to see if their bodies are even capable of doing what they are asking it to do and proper personnel to help them ‘move’ as they should. Fixing a golf swing is not as easy as simply saying ‘you need to rotate more.’ The body is quite complex and the golf swing relies on so many joints and muscles that even a slight bio-mechanical issue can cost the golfer many strokes! Continue Reading →
20
May 2016
Slouching Population Part 2 of 3: Good Posture and Children
Have you recently witnessed a child sitting hunched over with their head down staring at a smartphone, ipad, or tablet on a table or on their lap? I would venture to guess that you see this picture multiple times per day if you have, or are around, children. I would also go as far as to assume that most, if not all, children have been told multiple times to “sit up straight” by teachers, parents, and/or grandparents. However, even with the constant reminders, it seems that kids have been slumping more and more with the passing of each decade. One of the worst postures I have seen to date is a preteen who developed a point in his mid-back where there should be a smooth curve.
What is causing our youth to have worsening poor posture? Are they having an undeclared slouching contest with the previous generation, are they trying to be cool, or are they just a product of their environment with the vast surge in the use of technology? I get it. Even we adults need to be told to sit-up properly, especially when we are working at a computer, texting, or using a tablet. And you know what? Children hate being corrected as much as we do. With that said, it is hard enough to get adults to follow instructions, so how do we get children to change their habits, and understand the lifelong repercussions of sitting and standing in bad posture? 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
04
Jun 2015
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 →
14
May 2015
Dry Needling Support Models (2 of 4): The Trigger Point Model
In the last blog, we discussed the first model (The Radiculopathy Model) that helps explain why Dry Needling works. Now we will continue with the second of four models. This one is probably the most well-known one and there is a plethora of medical literature supporting it. Again, we will try to explain any concepts that are a little difficult to understand. These models really shed light into how our bodies work and they are great to learn about.
The Trigger Point Model
Myofascial Trigger Points (MTrPs, or TrPs for Trigger Points) are defined as ‘hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band’ (Travell and Simons). The resultant pain/discomfort that one gets due to such points is referred to as myofascial pain syndrome (MPS). Simply put, MPS is defined as ‘sensory, motor, and autonomic symptoms caused by myofascial trigger points’ (Travell and Simons). Sensory symptoms refer to what you feel, motor symptoms refer to how the muscles work, and autonomic symptoms refer to the things that you do not realize. This seems a little odd, but consider what happens when you bang your arm really hard. You will feel the pain (sensory), the muscle might be painful and not contract properly (motor), and your heart rate goes up as does your respiration due to the ‘adrenaline rush’ (autonomic) of the injury. Continue Reading →
15
Dec 2014
Oxidative Stress and Low Back Pain
A new study in the high impact orthopedic journal Spine discusses what we have seen for some time with patient care but have not been able to validate in the literature: oxidative stress contributes to low back pain.
This is a topic of huge importance. As our patients know, we use a Raman Spectrometer (Biophotonic Scanner), not unlike the one Yale uses in their studies, to determine the oxidative stress of our patients through means of a dermal carotenoid scan. The Raman Spectrometer (RS) has been determined in many studies to offer clinicians the optimal way to analyze oxidative stress as the test is not costly to perform, is not invasive, and it makes it easy to track changes in diet/nutrition/supplementation. This is important for all healthcare providers. Being a sports chiropractor, I find the RS to be an absolute necessity for all of us who work in the neuromusculoskeletal fields. Simply put, if we cannot assess oxidative stress, we have no idea if our patients are healthy and this directly affects clinical outcomes. This is not only limited to low back pain. We are not what we eat, but what we absorb. Working with unhealthy patients reduces the effectiveness of our treatments and we should know this before we commence treatment. This is only fair to the patient. They need to know if they have hindered healing ability or not.
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