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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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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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Dr. Manison is now Selective Functional Movement Assessment (SFMA) Certified

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 →

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Slouching Population Part 2 of 3: Good Posture and Children

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 →

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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 →

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Dry Needling Support Models (2 of 4): The Trigger Point Model

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 →

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Dry Needling Support Models (1 of 4): The Radiculopathy Model

Dry Needling Support Models (1 of 4): The Radiculopathy Model

We get a lot of questions about Dry Needling and the next few blogs will address several theories that support the treatment.  There is currently a good amount of medical literature supporting Dry Needling and this is great, but the theories behind Dry Needling are fascinating and interesting to discuss.

The 4 models are as following:

1.  The Radiculopathy Model
2.  The Trigger Point Model
3.  The Spinal Segmental Sensitization and Pentad Model
4.  The Central Model

Each of the next 4 blogs (including this one) will discuss one of these theories as it relates to Dry Needling.  We hope this gives you a better understanding as to why Dry Needling works so well.  We are aware that the models tend to use medical terminology and can be a little hard to follow, so we will try to explain things as we go to make the explanations easier to understand. Continue Reading →