Patients often ask me what they can do to prevent future episodes of low back pain. My answer, almost always is physical exercise. While patients sometimes respond with a groan, frankly there is no good substitute for exercise. An anonymous physician was once quoted saying “if exercise could be capsulated in pill form, it would be the #1 prescribed drug.”
One of the benefits of exercise appears to be the conditioning effect that exercise has on the muscles that support the back. If your trunk muscles are strong, have good blood supply and demonstrate good endurance capabilities they are better able to resist the negative effects of poor posture and strains of everyday activities that cause injuries to occur.
Some form of exercise should be part of every management plan for low back pain since risk of developing recurrent back pain is as high as 80%. Recurrence is very drastically reduced if regular exercise is performed.
What type of exercise is best? Research has shown that yoga, tai chi, aerobics, aqua fitness, and pilates can greatly benefit those with low back pain. Unfortunately, science does not yet give answers to which form of exercise is best. Benefits appear to depend on the specific needs of the individual. For example, while yoga may be great for you, stretching may be better for your friend with back pain.
How can you know what type of exercise will help you? Any clinician (doctor, chiropractor, physiotherapist, massage therapist) that knows your low back pain will consider your particular needs and be able to recommend a type of exercise that would work best for you. If you do not have a reliable source to ask, it is okay to experiment with different types of exercise to figure out what works for you.
Monday, September 1, 2008
Friday, August 1, 2008
Do You Suffer From Chronic Ankle Pain or Weakness?
The last article discussed what to do in the event that you sprain an ankle to ease the pain and promote proper healing. But what can you do about old ankle sprains that never quite healed as they should have? Fortunately, there are things you can do and treatment you can get to improve the ankle and prevent recurring injuries.
If a sprained ankle doesn’t heal as it should, the ankle can be less stable causing the ankle to feel weak and increase susceptibility to re-injury. Other signs of an inadequately healed ankle include stiffness, pain, and reduced range of motion due to excessive scar tissue formation.
When the body repairs damaged parts it uses scar tissue to do the job. Scar tissue formation is a necessary part of the healing process otherwise minor tears would develop into large tears and our bodies would literally fall apart after injury. Problems with scar tissue occur when excessive amounts are laid down in one area or between different structures. Because scar tissue is less flexible than the tissue it replaced, range of motion can be impaired and it can create a feeling of stiffness. Scar tissue also has nerve endings in it which can make it more sensitive than the tissue it originally replaced.
What could cause excessive scar tissue to lay down in response to healing a sprained ankle? Completely immobilizing the ankle after a sprain would cause scar tissue to form excessively around the damaged areas and could restrict range of motion. Guiding the ankle through normal ranges of motion without putting weight on the ankle, helps direct where scar tissue is to form (and where it shouldn’t form) so as to heal while retaining range of motion that is necessary for the joint to work properly. See the previous article for recommendations on moving the ankle after an acute sprain.
What can YOU do in the case of an already healed ankle sprain?
To improve stability of the ankle or reduce the weakness of the ankle that is common after the ankle has healed is to train the muscles around the ankle to react quickly and protect and strengthen the ankle.
Practice balancing on one foot to train the muscles around the ankle to provide stability. Start by standing on one foot with your eyes opened for 15 seconds. As your ankle gets stronger, increase time to 30 seconds, then 1 minute. Once you feel strong and comfortable doing this exercise, practice balancing on one foot with your eyes closed. A realistic goal is balancing on one foot with the eyes closed for 30 seconds.
Get treatment to get rid of excessive scar tissue formation
In our office we use a treatment called Active Release Technique (ART) which works to get rid of excessive scar tissue formation that results after the healing of a damaged part. ART is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including muscles, ligaments, fascia and nerves. ART is highly successful in dealing with ankle problems because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues. By locating and treating the scar tissue with ART, it allows the doctor to 1) break up restrictive adhesions, 2) reinstate normal sliding of the soft tissues, and 3) more completely restore flexibility, strength, and balance to the foot and ankle. If you have an old ankle sprain that gives you problems, ART may be able to help. More information about my office and ART can be found on our website at http://www.fallriverchiropractic.ca/.
If a sprained ankle doesn’t heal as it should, the ankle can be less stable causing the ankle to feel weak and increase susceptibility to re-injury. Other signs of an inadequately healed ankle include stiffness, pain, and reduced range of motion due to excessive scar tissue formation.
When the body repairs damaged parts it uses scar tissue to do the job. Scar tissue formation is a necessary part of the healing process otherwise minor tears would develop into large tears and our bodies would literally fall apart after injury. Problems with scar tissue occur when excessive amounts are laid down in one area or between different structures. Because scar tissue is less flexible than the tissue it replaced, range of motion can be impaired and it can create a feeling of stiffness. Scar tissue also has nerve endings in it which can make it more sensitive than the tissue it originally replaced.
What could cause excessive scar tissue to lay down in response to healing a sprained ankle? Completely immobilizing the ankle after a sprain would cause scar tissue to form excessively around the damaged areas and could restrict range of motion. Guiding the ankle through normal ranges of motion without putting weight on the ankle, helps direct where scar tissue is to form (and where it shouldn’t form) so as to heal while retaining range of motion that is necessary for the joint to work properly. See the previous article for recommendations on moving the ankle after an acute sprain.
What can YOU do in the case of an already healed ankle sprain?
To improve stability of the ankle or reduce the weakness of the ankle that is common after the ankle has healed is to train the muscles around the ankle to react quickly and protect and strengthen the ankle.
Practice balancing on one foot to train the muscles around the ankle to provide stability. Start by standing on one foot with your eyes opened for 15 seconds. As your ankle gets stronger, increase time to 30 seconds, then 1 minute. Once you feel strong and comfortable doing this exercise, practice balancing on one foot with your eyes closed. A realistic goal is balancing on one foot with the eyes closed for 30 seconds.
Get treatment to get rid of excessive scar tissue formation
In our office we use a treatment called Active Release Technique (ART) which works to get rid of excessive scar tissue formation that results after the healing of a damaged part. ART is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including muscles, ligaments, fascia and nerves. ART is highly successful in dealing with ankle problems because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues. By locating and treating the scar tissue with ART, it allows the doctor to 1) break up restrictive adhesions, 2) reinstate normal sliding of the soft tissues, and 3) more completely restore flexibility, strength, and balance to the foot and ankle. If you have an old ankle sprain that gives you problems, ART may be able to help. More information about my office and ART can be found on our website at http://www.fallriverchiropractic.ca/.
Wednesday, July 2, 2008
How to Self-Treat an Ankle Sprain
As people get more active at this time of year, it is inevitable that risk of ankle sprains will rise. Ankle sprains are an injury that people often to treat themselves without the guidance of a doctor or therapist. The typical approach people take to recover from an ankle sprain is to restrict movement of the ankle, ice it, take anti-inflammatory medication and allow time to heal the ankle on its own. This approach however, does not guarantee that the ankle will heal properly. It is important to know what to do in the event that you sprain your ankle to guide proper healing as the consequences of poor healing include chronic stiffness, pain, and recurrent ankle sprains.
Ankle sprains occur when the person suddenly rolls over on the outside of the ankle and the ligaments that provide support to the ankle are stretched beyond their natural range. Tearing of the ligament fibres occur which immediately signals the inflammatory system to begin the job of healing the damaged area. The result of inflammation is the swelling, redness, heat and pain that is associated with a sprained ankle. Inflammation is of course, necessary for the healing process to occur. Your body will heal itself, but how you treat yourself will affect the quality of the healing process and will affect the future health of your ankle.
Provided below is a step by step approach of what you should do to treat an ankle sprain. Consult your trusted practitioner (family doctor, chiropractor, physiotherapist) for guidance on how to manage any injury properly if symptoms do not subside within a couple days or if you suspect severe damage has been done.
The first phase of treatment is to minimize soft tissue swelling and manage pain -72 hours
In the first 72 hours after an ankle sprain, the main objective is to minimize soft tissue swelling and manage pain associated with inflammation and regain some range of motion.
1) Apply a covered ice pack to the injured area for 20 minutes. Ice should be applied every 2 hours during hours that you are awake for the first two days. Ice will help control internal bleeding and minimize tissue swelling.
2) Apply a compression wrap over the ice.
3) Elevate the ankle.
4) When the foot is elevated with ice, passive range of motion exercises can be performed. To do this, place a strap around the ball of the foot and gentle pull the foot towards your body. Move the foot forward and back using the strap to guide the movement.
5) It is important to use crutches when walking to keep weight off the ankle. Some drug stores will rent crutches out to the public.
6) On the third day, introduce active range of motion by moving the foot towards and away from your body without the strap.
7) On the third day trace the alphabet with the big toe. Gentle movements of the foot helps promote proper healing of the ankle ligaments so that range of motion is not compromised.
The second phase of treatment is to improve range of motion and re-strengthen the ankle- to be done after pain and swelling subsides.
1) Heel cord stretching: Stand on the edge of a step on the balls of your feet. Lower your heels off the step to allow for a gentle stretch of the heel cord. Hold stretch for 30 seconds. Repeat 3 times.
2) Toe raises: Stand on the edge of a step on the balls of your feet. Raise on toes and hold for 3 seconds. Slowly lower the heel for a mild stretch and raise up on your toes again for 3 seconds. Repeat 10 times.
The third phase of treatment to improve ankle stability and return to activity- to be done when the ankle tolerates weight
1) Once your ankle tolerates weight bearing, practice standing on the injured foot to improve balance. The ultimate goal is to be able to balance for 20 seconds.
2) Stand on the injured foot and lift the heel off the ground then slowly lower it. Repeat ten times for three sets.
3) Once you are able to put your full weight on the ankle normally with no pain, you are encouraged to gradually begin increasing your activity.
4) If you are a runner begin running for short distances on a flat surface. You may have to ice the ankle after the first attempts at running. Once you are able to run for 20 minutes, you may return to usual activity.
Provided are detailed guidelines for what to do to promote proper healing of an ankle sprain. It is important to self manage ankle sprains properly to prevent future problems with the ankle.
Ankle sprains occur when the person suddenly rolls over on the outside of the ankle and the ligaments that provide support to the ankle are stretched beyond their natural range. Tearing of the ligament fibres occur which immediately signals the inflammatory system to begin the job of healing the damaged area. The result of inflammation is the swelling, redness, heat and pain that is associated with a sprained ankle. Inflammation is of course, necessary for the healing process to occur. Your body will heal itself, but how you treat yourself will affect the quality of the healing process and will affect the future health of your ankle.
Provided below is a step by step approach of what you should do to treat an ankle sprain. Consult your trusted practitioner (family doctor, chiropractor, physiotherapist) for guidance on how to manage any injury properly if symptoms do not subside within a couple days or if you suspect severe damage has been done.
The first phase of treatment is to minimize soft tissue swelling and manage pain -72 hours
In the first 72 hours after an ankle sprain, the main objective is to minimize soft tissue swelling and manage pain associated with inflammation and regain some range of motion.
1) Apply a covered ice pack to the injured area for 20 minutes. Ice should be applied every 2 hours during hours that you are awake for the first two days. Ice will help control internal bleeding and minimize tissue swelling.
2) Apply a compression wrap over the ice.
3) Elevate the ankle.
4) When the foot is elevated with ice, passive range of motion exercises can be performed. To do this, place a strap around the ball of the foot and gentle pull the foot towards your body. Move the foot forward and back using the strap to guide the movement.
5) It is important to use crutches when walking to keep weight off the ankle. Some drug stores will rent crutches out to the public.
6) On the third day, introduce active range of motion by moving the foot towards and away from your body without the strap.
7) On the third day trace the alphabet with the big toe. Gentle movements of the foot helps promote proper healing of the ankle ligaments so that range of motion is not compromised.
The second phase of treatment is to improve range of motion and re-strengthen the ankle- to be done after pain and swelling subsides.
1) Heel cord stretching: Stand on the edge of a step on the balls of your feet. Lower your heels off the step to allow for a gentle stretch of the heel cord. Hold stretch for 30 seconds. Repeat 3 times.
2) Toe raises: Stand on the edge of a step on the balls of your feet. Raise on toes and hold for 3 seconds. Slowly lower the heel for a mild stretch and raise up on your toes again for 3 seconds. Repeat 10 times.
The third phase of treatment to improve ankle stability and return to activity- to be done when the ankle tolerates weight
1) Once your ankle tolerates weight bearing, practice standing on the injured foot to improve balance. The ultimate goal is to be able to balance for 20 seconds.
2) Stand on the injured foot and lift the heel off the ground then slowly lower it. Repeat ten times for three sets.
3) Once you are able to put your full weight on the ankle normally with no pain, you are encouraged to gradually begin increasing your activity.
4) If you are a runner begin running for short distances on a flat surface. You may have to ice the ankle after the first attempts at running. Once you are able to run for 20 minutes, you may return to usual activity.
Provided are detailed guidelines for what to do to promote proper healing of an ankle sprain. It is important to self manage ankle sprains properly to prevent future problems with the ankle.
Saturday, June 21, 2008
Three Reasons Why Crocs May Be Good For Your Feet
You either love them or hate them, but it appears that the infamous foam clog is here to stay. Patients are constantly asking me if Crocs are a good or bad choice of footwear. My general opinion of Crocs is that they are a reasonably good shoe. Since it appears that Crocs have outlived the fad, I’ve done some homework for you to support my opinion. Coordinating them with your outfit is truly up to you!
There is no question that what you wear on your feet is extremely important. Your feet are your foundation for walking and standing. If your foundation is not good, you will likely develop problems in the feet, knees, hips or low back. How long it takes for problems to develop depends on how well your body compensates for mechanical strain.
I have provided three reasons why Crocs may be good (orthopedically speaking) for your feet.
1) Stability is Good
Crocs provide a wide base of support which in turn provides good stability to the foot. Stability is important for balance and may help prevent rolling over on the ankles.
2) Good Cushioning Support
Crocs do a good job of distributing pressure throughout the foot. The foot provides shock absorption for the entire body with each step that you take. Many people have structural foot problems (and don’t realize it) that result in poor shock absorption. Poor shock absorption causes strain to accumulate in the joints and soft tissues of the feet, knees, hips or spine which can result in various injuries. High pressures on a diabetic’s foot can cause ulceration to occur which can have disastrous consequences if the person fails to notice due to loss of sensation. A shoe with good cushioning support can help to distribute pressure throughout the foot.
3) Medial Arch Support and Small Heel
Crocs have a decent medial arch support and a slightly lifted heel which helps prevent excessive collapse of the arch. Excessive collapse of the arch, known as over-pronation is extremely common and the main reason people are prescribed orthotics. Over-pronation is seen in people of all ages from children to the elderly. Keeping the arch supported helps minimize physical strain on the body.
It is not known whether wearing Crocs will prevent mechanical problems or injuries from developing. I would not recommend them in place of orthotics or orthopaedic shoes but they have certainly earned their place on my list of “good” shoes.
There is no question that what you wear on your feet is extremely important. Your feet are your foundation for walking and standing. If your foundation is not good, you will likely develop problems in the feet, knees, hips or low back. How long it takes for problems to develop depends on how well your body compensates for mechanical strain.
I have provided three reasons why Crocs may be good (orthopedically speaking) for your feet.
1) Stability is Good
Crocs provide a wide base of support which in turn provides good stability to the foot. Stability is important for balance and may help prevent rolling over on the ankles.
2) Good Cushioning Support
Crocs do a good job of distributing pressure throughout the foot. The foot provides shock absorption for the entire body with each step that you take. Many people have structural foot problems (and don’t realize it) that result in poor shock absorption. Poor shock absorption causes strain to accumulate in the joints and soft tissues of the feet, knees, hips or spine which can result in various injuries. High pressures on a diabetic’s foot can cause ulceration to occur which can have disastrous consequences if the person fails to notice due to loss of sensation. A shoe with good cushioning support can help to distribute pressure throughout the foot.
3) Medial Arch Support and Small Heel
Crocs have a decent medial arch support and a slightly lifted heel which helps prevent excessive collapse of the arch. Excessive collapse of the arch, known as over-pronation is extremely common and the main reason people are prescribed orthotics. Over-pronation is seen in people of all ages from children to the elderly. Keeping the arch supported helps minimize physical strain on the body.
It is not known whether wearing Crocs will prevent mechanical problems or injuries from developing. I would not recommend them in place of orthotics or orthopaedic shoes but they have certainly earned their place on my list of “good” shoes.
Sunday, May 25, 2008
Why Increasing Omega 3 Fats May be Good for Your Health
Increasing omega 3 fats in your diet may protect you from today’s most common chronic diseases such as heart disease, diabetes, arthritis and some types of cancer.
Research shows that because these diseases have an inflammatory component, omega 3 fatty acids which are anti-inflammatory in nature, can play a tremendous role in prevention and as part of a management strategy to keep disease under control by blocking inflammation.
Truth is that the typical Canadian diet does not deliver enough omega 3 fatty acids to the body but favours the omega 6 fatty acids which actually promote inflammation. While both are essential to the body to provide the building materials for cell development and function, the average person gets 10-30 times more omega 6 fats, creating what doctors and scientists call an Inflammatory State in the body. Studies suggest that ideally people should only be getting 1-3 times more omega 6 fats than omega 3 to maintain keep chronic inflammation in the body under control.
Why is there such an imbalance between omega 3 and omega 6 fatty acids in the diet of most Canadians? Increased consumption of vegetable oils such as sunflower oil, safflower oil, corn oil, cottonseed oil and meats that were fed grains high in omega 6 fatty acids account for much of the imbalance. There is no question that it is much easier to get omega 6 fatty acids in the diet than it is to get omega 3. Omega 3 fatty acids are found in canola oil, olive oil (also high in omega 9, which also inhibits inflammation-that’s another story for another day) soybean oil, fish oil, flaxseeds and flaxseed oil, tuna, salmon, walnuts, green leafy vegetables.
The good news is that because cells are constantly renewing themselves, even small changes in your diet can make big changes in promoting a better cellular environment in your body.
What Can You Do To Increase Your Omega 3s?
1-Know Your “Good”and “Bad” Oils
Choose the "good oils" canola, olive and soybean oils over the "bad"oils- sunflower, safflower and cottonseed oils. Keep in mind that soybean oil has a mix of both omega 3 and 6 fatty acids.
2-Limit Packaged or Processed Foods
Most packaged foods use oils that favour high omega 6 content. When you must select packaged foods, check the ingredient list and choose those made with “good” oils. I have noticed that many manufacturers are starting to use olive or canola oils in foods such as salad dressings and mayonnaise.
3-Read Labels
I cannot emphasize how important it is to read labels and know what is in the food that you buy. Certain foods such as tuna and walnuts are known to be naturally good for their omega 3 content. However, if the tuna is packed in sunflower oil, or the walnuts are brushed with corn oil, the omega 3s that your body will absorb is compromised. Always be skeptical of claims that a food is supplemented with omega 3. Most food manufacturers have good intentions to make their food more healthy, but just because a food is supplemented with omega 3s does not necessarily make it a healthy choice. Always read the labels before you buy. Some labels also list the omega 3 versus omega 6 content. The omega 3 content should be equal to or greater than the omega 6 content.
4-Disguise Food with Omega 3 Rich Sources
Add ground flax to baking, yogourt, oatmeal or your cereal. Add flax oil to fruit shakes, add lots of green leafy vegetables to your stirfry, lasagna, or homemade soups. You can also add tuna to your salad or eat walnuts as a mid-day snack.
5-Supplementation
If you are not prepared to make drastic changes to your diet, then supplementation is probably your best bet. How much is enough? The jury is still out on how much is enough to actually fight or prevent disease. The National Academy of Sciences’Institute of Medicine advises that the daily intake is 1.1 g/day for women and 1.6 g/day for men. The Heart and Stroke Foundation in Canada recommend that fatty fish be consumed twice a week. Speak to your family physician before beginning supplementation if you are being treated for any medical condition.
Research shows that because these diseases have an inflammatory component, omega 3 fatty acids which are anti-inflammatory in nature, can play a tremendous role in prevention and as part of a management strategy to keep disease under control by blocking inflammation.
Truth is that the typical Canadian diet does not deliver enough omega 3 fatty acids to the body but favours the omega 6 fatty acids which actually promote inflammation. While both are essential to the body to provide the building materials for cell development and function, the average person gets 10-30 times more omega 6 fats, creating what doctors and scientists call an Inflammatory State in the body. Studies suggest that ideally people should only be getting 1-3 times more omega 6 fats than omega 3 to maintain keep chronic inflammation in the body under control.
Why is there such an imbalance between omega 3 and omega 6 fatty acids in the diet of most Canadians? Increased consumption of vegetable oils such as sunflower oil, safflower oil, corn oil, cottonseed oil and meats that were fed grains high in omega 6 fatty acids account for much of the imbalance. There is no question that it is much easier to get omega 6 fatty acids in the diet than it is to get omega 3. Omega 3 fatty acids are found in canola oil, olive oil (also high in omega 9, which also inhibits inflammation-that’s another story for another day) soybean oil, fish oil, flaxseeds and flaxseed oil, tuna, salmon, walnuts, green leafy vegetables.
The good news is that because cells are constantly renewing themselves, even small changes in your diet can make big changes in promoting a better cellular environment in your body.
What Can You Do To Increase Your Omega 3s?
1-Know Your “Good”and “Bad” Oils
Choose the "good oils" canola, olive and soybean oils over the "bad"oils- sunflower, safflower and cottonseed oils. Keep in mind that soybean oil has a mix of both omega 3 and 6 fatty acids.
2-Limit Packaged or Processed Foods
Most packaged foods use oils that favour high omega 6 content. When you must select packaged foods, check the ingredient list and choose those made with “good” oils. I have noticed that many manufacturers are starting to use olive or canola oils in foods such as salad dressings and mayonnaise.
3-Read Labels
I cannot emphasize how important it is to read labels and know what is in the food that you buy. Certain foods such as tuna and walnuts are known to be naturally good for their omega 3 content. However, if the tuna is packed in sunflower oil, or the walnuts are brushed with corn oil, the omega 3s that your body will absorb is compromised. Always be skeptical of claims that a food is supplemented with omega 3. Most food manufacturers have good intentions to make their food more healthy, but just because a food is supplemented with omega 3s does not necessarily make it a healthy choice. Always read the labels before you buy. Some labels also list the omega 3 versus omega 6 content. The omega 3 content should be equal to or greater than the omega 6 content.
4-Disguise Food with Omega 3 Rich Sources
Add ground flax to baking, yogourt, oatmeal or your cereal. Add flax oil to fruit shakes, add lots of green leafy vegetables to your stirfry, lasagna, or homemade soups. You can also add tuna to your salad or eat walnuts as a mid-day snack.
5-Supplementation
If you are not prepared to make drastic changes to your diet, then supplementation is probably your best bet. How much is enough? The jury is still out on how much is enough to actually fight or prevent disease. The National Academy of Sciences’Institute of Medicine advises that the daily intake is 1.1 g/day for women and 1.6 g/day for men. The Heart and Stroke Foundation in Canada recommend that fatty fish be consumed twice a week. Speak to your family physician before beginning supplementation if you are being treated for any medical condition.
Tuesday, May 20, 2008
Sports Injury 101: Shoulder Tendonitis
Shoulder pain and injuries are extremely common in athletes and individuals involved in activities that require a lot of pushing, pulling, or overhead use of the arm. Of these shoulder injuries Rotator Cuff Tendinopathy (also known as shoulder tendonitis, or shoulder impingement syndrome) is among the most prevalent and most frustrating for the patient or athlete. In many cases,the condition seems to come out of nowhere and usually fails to go away with rest or stretching. To better understand this injury and why it is often slow to heal lets look at what actually happens with this injury.
The rotator cuff consists of a group of four small muscles that run from the shoulder blade to the top of the arm, or humerus. This group of muscles is very important because the anatomy of the shoulder joint makes it susceptible to injury. The shoulder joint consists of the round head of the humerus making a connection with the flat surface of the shoulder blade. As a result of this round on flat relationship the head of the humerus has a tendency to slip and slide on the joint during arm movements. This is where the rotator cuff comes in. The rotator cuff must contract during all arm movements in order to hold the humeral head in place tightly against the shoulder blade. Over time the rotator cuff muscles can actually become fatigued and will begin to become strained. At this stage the shoulder is not yet painful but overtime this strain can accumulate and develop into a repetitive strain injury of the muscle and tendon. As injury develops there is usually a pain on top of the shoulder that is aggravated by lifting the arm overhead or on the day following strenuous activity.
Unfortunately, rotator cuff teninopathy does not usually get better on it’s own. In fact, unless it is properly treated it will often get worse and may even progress into a more serious injury such a muscle tear. The good news is that the majority of tendon injuries are greatly helped with a combination of Active Release Techniques (ART) and specific home stretches and exercises. When treated in the early stages before it is allowed to progress to a more serious injury most rotator cuff tendinopathies are able to fully heal and the individual is able to fully return to their respective sports without any long-term consequences.
The rotator cuff consists of a group of four small muscles that run from the shoulder blade to the top of the arm, or humerus. This group of muscles is very important because the anatomy of the shoulder joint makes it susceptible to injury. The shoulder joint consists of the round head of the humerus making a connection with the flat surface of the shoulder blade. As a result of this round on flat relationship the head of the humerus has a tendency to slip and slide on the joint during arm movements. This is where the rotator cuff comes in. The rotator cuff must contract during all arm movements in order to hold the humeral head in place tightly against the shoulder blade. Over time the rotator cuff muscles can actually become fatigued and will begin to become strained. At this stage the shoulder is not yet painful but overtime this strain can accumulate and develop into a repetitive strain injury of the muscle and tendon. As injury develops there is usually a pain on top of the shoulder that is aggravated by lifting the arm overhead or on the day following strenuous activity.
Unfortunately, rotator cuff teninopathy does not usually get better on it’s own. In fact, unless it is properly treated it will often get worse and may even progress into a more serious injury such a muscle tear. The good news is that the majority of tendon injuries are greatly helped with a combination of Active Release Techniques (ART) and specific home stretches and exercises. When treated in the early stages before it is allowed to progress to a more serious injury most rotator cuff tendinopathies are able to fully heal and the individual is able to fully return to their respective sports without any long-term consequences.
Monday, April 21, 2008
Anatomy 101: What is a Nerve Entrapment?
A nerve entrapment occurs when a nerve is "stuck"to adjacent structures or not sliding properly along its course due to acquired scar tissue adhesions. Symptoms of a nerve entrapment include numbness, tingling, pain, weakness and tightness. You are probably familiar with Sciatica and Carpal Tunnel Syndrome; they are the most common nerve entrapments. These are familiar terms to the general public but most don't know what causes a nerve entrapment and that there are new treatment methods that are effective in managing them.
Nerves arise from your spinal cord and travel out of the spinal column like long telephone wires. They are sandwiched between your muscle groups as they course their way to send information to and from your muscles and joints. The Sciatic Nerve, the most well-known nerve, originates from the spinal cord at your lumbar spine and forms a thick nerve tract roughly 2cm wide and takes a course from your back and down the back of each leg. Chiropractors and physicians are taught in school that sciatica is caused by inflammation resulting from a nerve being compressed at the spinal disc level. Research is now showing however, that this traditional emphasis on the inflamed nerve root as always being the primary cause of leg pain is not only inaccurate but ignores the fact that the sciatic nerve can be entrapped anywhere along its length.
Conventional Therapy
Conventional treatments focus on relieving inflammation or blocking pain associated with a nerve root impingement through drug therapy, joint manipulation or physiotherapy. Surgery is another route of treatment which has been discredited as being an effective management strategy for most patients.
How do Nerve Entrapments Develop?
Unfortunately, in the case of sciatica, these therapies are often not enough to manage pain or improve activity intolerances. Nerve entrapments develop as a result of chronic compression the nerves by tight muscles through which the nerve travels or repetitive rubbing or sliding of the nerve against adjacent structures. Friction between the nerve and adjacent structures results in tissue damage which triggers the onset of inflammation to repair the damage; scar tissue is the result of the inflammatory response.
How does Scar Tissue Contribute to Onset of Symptoms?
Over time, scar tissue will build up and accumulate into what we call adhesions. Adhesions affect the normal health and function of the muscles resulting in pain, tightness, stiffness, restricted joint motion and diminished blood flow. Poor posture, prolonged sitting, previous injury and physical deconditioning set the stage for muscles to become chronically tight and can lead to continuous compression on nerve tissue, essentially damaging the nerve itself.
What is Active Release and How Does it Work?
The good news is that a new procedure in Active Release Techniques (ART) called Peripheral Long Tract Nerve Release is one of the most significant advances in treating sciatica and other nerve entrapments conservatively. The primary focus of this new technique is to move the nerve through the tissue. In these procedures, the doctor uses their hands to tension the soft tissues involved and then performs procedures that enable the nerve to be pulled through the soft tissue structure, thereby releasing the nerve from surrounding adhesions. The true power of this procedure is that the doctor can actually feel the scar tissue causing the restriction and actually feel the nerve pull through any site of entrapment, alleviating symptoms of nerve compression. Both Drs. Jason and Stephanie Gray are certified to treat these conditions and have integrated these procedures into clinical practice.
Nerves arise from your spinal cord and travel out of the spinal column like long telephone wires. They are sandwiched between your muscle groups as they course their way to send information to and from your muscles and joints. The Sciatic Nerve, the most well-known nerve, originates from the spinal cord at your lumbar spine and forms a thick nerve tract roughly 2cm wide and takes a course from your back and down the back of each leg. Chiropractors and physicians are taught in school that sciatica is caused by inflammation resulting from a nerve being compressed at the spinal disc level. Research is now showing however, that this traditional emphasis on the inflamed nerve root as always being the primary cause of leg pain is not only inaccurate but ignores the fact that the sciatic nerve can be entrapped anywhere along its length.
Conventional Therapy
Conventional treatments focus on relieving inflammation or blocking pain associated with a nerve root impingement through drug therapy, joint manipulation or physiotherapy. Surgery is another route of treatment which has been discredited as being an effective management strategy for most patients.
How do Nerve Entrapments Develop?
Unfortunately, in the case of sciatica, these therapies are often not enough to manage pain or improve activity intolerances. Nerve entrapments develop as a result of chronic compression the nerves by tight muscles through which the nerve travels or repetitive rubbing or sliding of the nerve against adjacent structures. Friction between the nerve and adjacent structures results in tissue damage which triggers the onset of inflammation to repair the damage; scar tissue is the result of the inflammatory response.
How does Scar Tissue Contribute to Onset of Symptoms?
Over time, scar tissue will build up and accumulate into what we call adhesions. Adhesions affect the normal health and function of the muscles resulting in pain, tightness, stiffness, restricted joint motion and diminished blood flow. Poor posture, prolonged sitting, previous injury and physical deconditioning set the stage for muscles to become chronically tight and can lead to continuous compression on nerve tissue, essentially damaging the nerve itself.
What is Active Release and How Does it Work?
The good news is that a new procedure in Active Release Techniques (ART) called Peripheral Long Tract Nerve Release is one of the most significant advances in treating sciatica and other nerve entrapments conservatively. The primary focus of this new technique is to move the nerve through the tissue. In these procedures, the doctor uses their hands to tension the soft tissues involved and then performs procedures that enable the nerve to be pulled through the soft tissue structure, thereby releasing the nerve from surrounding adhesions. The true power of this procedure is that the doctor can actually feel the scar tissue causing the restriction and actually feel the nerve pull through any site of entrapment, alleviating symptoms of nerve compression. Both Drs. Jason and Stephanie Gray are certified to treat these conditions and have integrated these procedures into clinical practice.
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