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 →
02
Oct 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 →
30
Jan 2017
It’s Not Your Neck Silly, It’s Your First Rib! It’s My What?
Many people seek care from a chiropractor for neck pain. After all, it’s one of the most common conditions we treat. Sometimes, however, the reason your neck hurts is not due to the neck itself but rather something else close by: the first rib.
The first rib is just that…it’s the rib that is highest up and close to your neck. It goes from the T1 vertebra (the vertebra just below the ‘cervical’, or neck, vertebrae) to the upper portion of the sternum, on the front side. The clinical importance of the first rib (in this case) is that it has two very important muscles that attach on it. Those muscles are the anterior and middle scalenes muscles. 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 →
01
Jun 2016
Do You Want Your Brain To Function Better?
As a sports chiropractor, my training involves learning how to best treat the body to effect changes in many ways for dysfunctional joints, muscles, ligaments, cartilage, fascia, and more. We know that chiropractic adjustments alter neurological pathways that change joint mechanics and alter muscle tone and tension, allowing for a change in biomechanics at local and more global regions. This is great and it works well, but what about all the ‘holistic’ training we receive? Chiropractors are supposed to take care of the whole body, inside and out, but most of us do not do that when we only treat the body from the outside. This approach is not complete and it does not allow us to fully help our patients. 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 →
15
Dec 2015
‘Leaner and Meaner’: How Much Protein Do You Need?
There has always been a debate about how much protein an athlete needs. ‘You need one gram per kilogram of weight’ or you need ‘one gram per pound of weight’ and some other somewhat random numbers are usually used to determine how much protein resistance training athletes need. As a healthcare provider who works with athletes, I need to make sure my athletes have enough protein to ensure healthy soft tissue function and reduce the likelihood of injury. Without proper protein consumption, an athlete will not achieve his/her fitness goals, and if there’s an injury, the athlete will certainly need extra protein during the recovery phase to get better. I won’t discuss the subject of sarcopenia in this blog but this topic too is a major crisis in our country. So, how do we know where to really start?
A literature review study from 2014 in the International Journal of Sports Nutrition and Exercise Metabolism gives us a good formula for determining the range of protein needed for caloric restricted, resistance trained athletes. Before we go any further, we should define who these athletes are…. they are…you and me. If you work out, want to look good, and want a high level of lean muscle mass (highly desirable for good health), then this formula applies to you. In fact, if you just work out and wish to have healthy muscle, this formula will help you achieve your goals. The bottom line is that athletes tend to ingest less protein than they need and this is a major concern. Not only that, but they also are unlikely getting the best quality protein they can. Oh, this study also mentions that total fat consumption should not go below 20% of total calorie intake. So what are we looking at? A sensible caloric restricted diet with adequate micronutrient ingestion and the proper ratio of macronutrients. So, you want to be ‘lean and mean’?…here’s how to achieve it… 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 →
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