Dr.Crystal Draper

A condition that is a real pain in the butt is Piriformis Syndrome.  Piriformis Syndrome is a set of symptoms that occur when the sciatic nerve is trapped or compressed by the piriformis muscle.  This is a type of nerve entrapment syndrome.  For all of this to make sense, we need to talk anatomy.

Anatomy of Piriformis Syndrome

The piriformis muscle is located in the buttock region, attaching to the sacrum (the bony structure at the base of the spine that is connected to the pelvis) and the greater trochanter (the bony prominence on the outer portion of the hipbone).  Its main function is to externally rotate the hip (rotating the hip outward), however it also plays a role in hip abduction (lifting the hip out to the side) and hip flexion (flexing the hip up towards the chest).  The piriformis muscle provides stability of the hip while walking and standing.

The piriformis muscle lies on top of the sciatic nerve, which is the longest, thickest and largest nerve in the body.  The sciatic nerve starts in the lower spine and runs down the back of each leg (where it splits into the tibial and common fibular nerves), all the way to the feet.  The sciatic nerve is responsible for supplying the muscles of the back of the thigh, all the lower leg and foot muscles, and most of the skin of the leg and foot.  When the piriformis muscle becomes short and tight, it can cause compression and irritation of the sciatic nerve causing pain along its course.  This pain is called ‘sciatica’.

Two types of Piriformis Syndrome…

Primary

The primary type of Piriformis Syndrome is caused by anatomical abnormalities of the piriformis muscle and/or the sciatic nerve.  This type accounts for fewer than 15% of the cases.

Secondary

The next, and most common type of Piriformis Syndrome is secondary.  This means the piriformis muscle and sciatic nerve are irritated due to a precipitating cause such as a fall to the buttocks, overuse of the muscle from long distance running or walking, or direct compression from sitting on hard surfaces.

Who is affected by Piriformis Syndrome?

Piriformis Syndrome most commonly occurs in people 40-50 years of age and affects women more than men.  And, because Piriformis Syndrome can be attributed to either too much sitting or too much running, it affects people of all occupations and activity levels.

Symptoms of Piriformis Syndrome…

Piriformis Syndrome is characterized by pain in the hip and buttock, especially over the piriformis muscle, and sometimes in the low back.  Symptoms can present with sudden or gradual onset, but are associated with spasm of the piriformis muscle and irritation of the sciatic nerve.  Sciatic nerve pain varies widely causing a dull ache, pain, tingling or a burning sensation from the sacrum into the buttock and down the back of the leg.  This nerve pain can cause weakness in the affected leg causing difficulty walking, and numbness in the foot.  These symptoms are aggravated after sitting for longer than 15-20 minutes, especially on hard surfaces with a wallet in the back pocket, which is called “wallet neuritis” (bet you didn’t know there was a scientific name for that!).  Additional aggravating factors include rising from a seated position and motions that increase tension in the piriformis muscle, therefore causing compression on the sciatic nerve.  Pain can also occur with bowel movements due to the location of the piriformis muscle.

Piriformis Syndrome has a similar presentation to pathologies of the low back such as lumbar radiculopathies, degenerative disc disease, compression fractures, spinal stenosis, and dysfunction of the sacroiliac joint.  Therefore, a complete history and thorough examination needs to be conducted for a proper diagnosis to be made.

How is Piriformis Syndrome diagnosed?

Piriformis Syndrome is usually diagnosed based on symptoms and clinical presentation.  Your chiropractor or healthcare provider will gather a detailed history and perform a thorough physical examination including neurological, muscle, sensory and orthopedic testing.

Electromyography (which evaluates the numbness, tingling and/or muscle weakness in the legs and feet), CT, and magnetic resonance imaging (MRI) may be beneficial in determining what anatomical structure is causing the neurological symptoms, and the state of the piriformis muscle, respectively.

What is the Treatment for Piriformis Syndrome?

1. First and foremost is education.  Know your symptoms, what aggravates them, and what your treatment options are.
2. Next, you want to ‘active rest’.  This means decreasing or modifying any activities that aggravate your symptoms and pain, such as repetitive traumas like running or prolonged sitting.
3. Stretching and Strengthening is an important component to treatment.  While you do not want to aggravate your symptoms, you do want to engage in a rehabilitation program that will stretch the offending piriformis muscle and strengthen the abductor and adductor muscles (of the hip).
4. Ice is helpful to control any pain and inflammation in the area.
5. Assessing and correcting biomechanical alterations (such as poor posture) to reduce the incidence of Piriformis Syndrome.
6. Conservative treatments including chiropractic care and acupuncture help to reduce pain and increase function.
7. If these conservative treatment options are unsuccessful, anti-inflammatory medications, trigger point injections, and surgical decompression are alternatives.

If you are suffering from low back, buttock or leg pain, please talk to your Chiropractor or healthcare provider to establish an appropriate treatment plan for you.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Benzon, H.T. Piriformis Syndrome; Anatomic Considerations, a New Injection Technique, and a Review of the Literature. Anesthesiology. 2003; 98: 1442-1448.

Boyajian-O’Neill, L.A. Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach. Journal of the American Osteopathic Association. 2008; 108(11): 657-664.

Hopayian, K. The Clinical Features of the Piriformis Syndrome: A Systematic Review. European Spine Journal. 2010; 19: 2095-2109.

Moore, K.L. Clinically Oriented Anatomy. 5^th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

Smoll, N.R. Variations of the Piriformis and Sciatic Nerve with Clinical Consequence: A Review. Clinical Anatomy. 2010; 23: 8-17.

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You are experiencing pain in your knee.  You go to your healthcare provider, explain your symptoms, and they complete a physical examination.  They diagnose you with Patellofemoral Pain Syndrome (PFPS), which is just a medical way of saying you have pain in your knee.  Not very helpful, so you ask, what does PFPS really mean?

Patellofemoral Joint Anatomy

The patellofemoral joint is one of two joints in the knee.  The first joint is between the femur (thigh bone) and the tibia (shin bone), called the tibiofemoral joint.  The second joint, and the one of significance in PFPS, is between the thigh bone and the patella (kneecap), called the patellofemoral joint.  Within this joint there are multiple points of contact between the two structures as well as several forces acting upon it to ensure its stability and optimal functioning.

Attaching to the patella is the quadriceps muscle, which is the large muscle group on the front of the thigh that is responsible for straightening/extending the knee.  The quadriceps ultimately attaches to the shin bone via the patella and the patellar tendon.

What are the symptoms of PFPS?

Symptoms of patellofemoral pain syndrome include pain under or around the kneecap that occur with activity, and worsen when going down steps or down hills.  The pain is also worse after sitting for long periods of time, also known as “movie-goer’s sign”.  This is because of the extra pressure the joint endures during prolonged knee flexion (knee bent).  PFPS is especially common in runners.

The pain of PFPS should not be confused with pain that occurs directly on the patellar tendon, which is patellar tendonitis or patellar tendinopathy.

What causes the pain in PFPS?

The pain of patellofemoral pain syndrome has many different causes.  The first one is overuse.  Due to the function of the knee, flexing and extending (bending and straightening), there is repetitive contact and movement between the two structures of the kneecap and thigh bone.  It is this repetitive movement and increased pressure in the joint with bending the knee that can lead to overuse, and ultimately to pain.  However, it is thought that overload (due to increased pressure within the joint) is a more appropriate explanation because although PFPS usually targets runners, it can also affect those that are inactive.

Muscular dysfunction is a large contributing factor for PFPS.  It can include muscular weakness or imbalance.  The muscle usually to blame is the quadriceps.  Due to its attachment to the kneecap, if there is any imbalance or weakness, it can quickly create abnormal tracking and patellar movement.  Other possible culprits are the muscles of the hip, which are responsible for movement of the thigh bone.

Biomechanical problems are another cause of PFPS.  This includes structural changes such as ‘pes planus’ or flat feet (which occurs in patients who lack the supportive arch causing their ankle to roll inward – refer to aside picture), or ‘pes cavus’ or high arched foot (which is more rigid and less shock absorbing with less ground contact).  These structural changes cause compensatory changes in the biomechanics of the lower limb and upset the tracking and mechanism of the patellofemoral joint.

These are a few of the causes of PFPS.  Despite the numerous causes, it is unlikely that one single cause will be identified.  In most cases of PFPS, the cause is multifactorial.

What is the treatment for PFPS?

The treatment for PFPS should be just like the cause, multifactorial!

1. First and foremost is education.  Know your symptoms, what aggravates them, and what your treatment options are.
2. Next, you want to ‘active rest’ because of the overuse/overload mechanism of this syndrome. This means decreasing or modifying any activities that aggravate your knee pain.  Because the symptoms of PFPS are aggravated with activity, consider a temporary change to non-impact aerobic activity (such as swimming or elliptical training).  If you are experiencing movie-goer’s sign, straightening your leg or walking as needed is helpful.
3. Stretching and Strengthening is a key component of treatment.  While you do not want to aggravate your symptoms, you do want to engage in a rehabilitation program that will strengthen the offending muscles.  To date, quadriceps strengthening is considered the gold standard of treatment.  Begin a rehabilitation program targeting the offending muscles, such as the quadriceps and hip muscles (abductors, external rotators, extensors and flexors).
4. Ice to help control any pain and inflammation in the area, especially after activity.
5. Have your footwear evaluated to ensure quality and fit, and consider the use of arch supports and custom orthotics to assist biomechanical problems (by preventing loss of arch or providing a broader base of support for example).
6. Knee taping can help reduce friction within the patellofemoral joint and aid in optimal patellar tracking providing short-term pain relief.  This treatment option is helpful to use on a short-term basis to allow completion of pain-free exercises.
7. Patellar bracing and knee bracing are similar to knee taping in that they are used to facilitate proper alignment and tracking for short-term pain relief.  They are also used on a short-term basis to perform pain-free exercises.
8. If these conservative treatment options are unsuccessful, anti-inflammatory medications and surgery are alternatives.

Overall, you want to select treatments that improve the tracking of the patella, and reduce the mechanical stress to the patellofemoral joint to reduce pain and improve functioning.  Please talk to your chiropractor or healthcare provider to establish an appropriate treatment plan for you.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Bolgla, L.A. An Update for the Conservative Management of Patellofemoral Pain Syndrome: A Systematic Review of the Literature from 2000 to 2010. The International Journal of Sports Physical Therapy. 2011; 6(2): 112-125.

Chiu, Joseph. The Effects of Quadriceps Strengthening on Pain, Function, and Patellofemoral Joint Contact Area in Persons with Patellofemoral Pain. American Journal of Physical Medicine and Rehabilitation. 2012; 91(2). 98-106.

Juhn, M.S. Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment. American Family Physician. 1999; 60(7): 2012-2018.

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Snapping Hip Syndrome (SHS, sometimes called coxa saltans or dancer’s hip) is a condition where you hear a ‘snapping’ sound or feel a ‘snapping’ sensation in your hip.  It occurs during movement; when walking, running, standing from seated position, or swinging your leg around.  Most people experience only the annoyance of the ‘snapping’ sound without any pain.  But for others, like dancers or athletes, symptoms can include pain and weakness that hinders performance.

What makes the ‘snapping’ sound?  In most cases, the ‘clicking’, ‘snapping’ or sometimes ‘clunking’ sound is caused by a muscle or tendon moving over a bony prominence in the hip.  This is called the ‘extra-articular’ type because the sound is coming from outside of the joint.  Within the extra-articular type of SHS, there are sub-types, commonly referred to as the ‘external’ and ‘internal’ type.

Outside the Joint…

External type – This type of SHS involves the muscles and tendons on the outer portion of the hip, namely the iliotibial band, tensor fascia lata or the gluteus maximus.  These muscles are the most common culprits of the musical sounds of SHS.  They create the ‘clicking’ or ‘snapping’ sound when the hip is moved in certain directions.  It is their thickened tissue sliding over the bony prominence on the outer portion of the hipbone (greater trochanter) that makes the snapping sound.

Internal type – This is the other offender of SHS occurring outside of the joint.  In this case it is the main flexor of the thigh, the iliopsoas, which slips over the bony prominence on the inner portion of the hipbone (lesser trochanter).  This jingle is also heard with certain movements of the hip.

Those are the common sources of extra-articular SHS.  The remaining snapping hip cases are ‘intra-articular’, meaning the sound is coming from within the joint.

Within the joint…

The ‘snapping’ sound in the intra-articular type comes from pieces of broken cartilage or bone, also known as ‘loose bodies’, in the joint space of the hip.  Sounds very unpleasant, doesn’t it?  Especially when these free-floating nuisances cause problems and an annoying “catching” in the joint.  To diagnose, X-rays, CT and MRI are beneficial because they can visualize the loose bodies that occur within the hip joint.    

Treatment

Despite the different culprits and sources of SHS, both Outside the Joint and Inside the Joint cases follow similar treatment plans:

1. First and foremost is reassurance!  It is important to know that SHS is a common occurrence and is a variation on normal anatomy.  The ‘snapping’ sound may be unsettling, but is not indicative of future hip problems.
2. Next, you want to ‘active rest’.  This means decreasing or modifying any activities that aggravate your hip and cause pain or discomfort.
3. Stretching and Strengthening.  This is a key component of treatment.  While you don’t want to aggravate your symptoms, you do want to engage in a rehabilitation program that will strengthen and ultimately protect the area from future injury.
4. Ice to help control any pain and inflammation in the area.
5. If these conservative treatment options are unsuccessful, corticosteroid injections and surgery are alternatives.  The majority of cases that do require surgery commonly have an associated problem within the joint.

Overall, most people do not experience pain with SHS, just the annoying sound.  For those that do suffer from a painful snapping hip, please talk to your chiropractor or healthcare provider to establish an appropriate treatment plan for you.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Byrd, J.W.T. Evaluation and Management of the Snapping Iliopsoas Tendon. Techniques in Orthopaedics. 2005; 20(1): 45-51.

Choi, J.E. External Snapping Hip Syndrome: Emphasis on the MR Imaging. Journal of the Korean Society of Radiology. 2010; 62: 185-190.

Macintyre, J. Groin Pain in Athletes. Competitive Sports and Pain Management. 2006; 5: 293-299.

Smith, D.V. Hip Injuries in Young Athletes. Current Sports Medicine Reports. 2010; 9(5): 278-283.

WebMD. Snapping Hip Syndrome. Online. <www.webmd.com>

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Ever wake up in the middle of the night with the urge to shake your hands to wake them up?  If so, you may be experiencing a condition known as Carpal Tunnel Syndrome (CTS).  CTS is caused by pressure on the median nerve.

Anatomy of Carpal Tunnel Syndrome

The median nerve passes through the carpal tunnel, which is a passageway under the muscles, tendons and ligaments on the front of the wrist.  This nerve supplies feeling and movement to the thumb-side of the fingers (including the thumb, index, middle and half of the ring finger) and hand.  The tunnel is narrow, so any swelling in the area or irritation to the surrounding tendons can put pressure on the median nerve. Pressure leads to symptoms such as numbness, tingling, weakness, muscle damage or wasting in the affected hand, fingers and occasionally the forearm.  When you experience these symptoms you have CTS.  These symptoms can be experienced in one or both hands, but most commonly affects the dominant hand.

Causes of Carpal Tunnel Syndrome

CTS is caused by swelling and pressure on the median nerve.  Conditions that contribute to swelling, and thus can lead to CTS are:

• Diabetes mellitus
• Rheumatoid arthritis
• Hypothyroidism
• Hormonal imbalances
• Obesity
• And pregnancy.

CTS can also be experienced after local traumas such as a wrist injury or fracture.  However, with the majority of CTS cases, the cause remains unknown.  This is called “idiopathic carpal tunnel syndrome”.  In these ‘unknown origin’ cases, there is often a correlation with the type and amount of work a person does.  Activities that irritate the median nerve are repetitive motions and fixed positions of the hand and wrist.  Unfortunately these movements are ones we are required to do on a daily basis usually at work or during hobbies, such as:

• Typing on a computer
• Writing
• Driving
• Sewing
• Assembly line work
• Use of tools (especially hand-held vibratory tools)
• Sports (racquet sports or handball)
• Or playing musical instruments.

The symptoms of CTS are usually more intense for several days after we have overused our wrists; for example, after a long day at the office or overtime at band rehearsal.

Who is affected by Carpal Tunnel Syndrome?

CTS is the most common hand problem, affecting as many as 1 in 20 adults.  It most commonly occurs in people 40-60 years of age and affects women more than men.

How is Carpal Tunnel Syndrome diagnosed?

CTS is usually diagnosed based on symptoms.  Your chiropractor or healthcare provider will gather a detailed history and perform a physical examination including neurological, muscle, sensory and orthopedic testing.  General observation of the hand is also useful to determine if any muscle wasting has occurred.  Nerve conduction studies (which evaluate the numbness and tingling and/or the muscle weakness in the hand and fingers) and electromyogram (which evaluates the electrical activity of the muscles in the hand and fingers), can also be done to confirm the CTS diagnosis.

What is the treatment for Carpal Tunnel Syndrome?  

The first treatment for CTS is to avoid, reduce or modify any aggravating movements or positions.  A good rule of thumb is, if it hurts, don’t do it!  To do this, most people wear a night splint to keep the wrist in a rest position and avoid irritation during sleep.  This helps with the nightly awakenings due to numb hands, and most people notice a decrease in symptoms within days.

The next thing you need to address is your workstation.  Simple ergonomic changes can be made to reduce the stress placed on your wrist and therefore, your median nerve.  For example, if you are typing a lot at work, investigate special devices such as typing pads, keyboard drawers, cushioned mouse pads, different types of mouses, etc.  If these changes are not sufficient, a wrist splint can be worn during the day as well.  Additionally, take lots of breaks during the day to interrupt the repetitive cycle!

Physical therapy such as heat, yoga, acupuncture and chiropractic treatments including wrist mobilizations and nerve gliding are alternative treatments for CTS.  These conservative care options are possibilities for those with mild to moderate CTS symptoms or people who are poor surgical candidates.  Talk to your chiropractor or healthcare provider to discuss if these treatment options are appropriate for you.

Prescription medications, such as anti-inflammatory drugs, and corticosteroid injections into the carpal tunnel area are also a common option for people experiencing CTS.  Even though symptoms often improve with treatment (conservative and pharmacological), more than 50% of cases eventually require surgery.  The surgery is considered if the symptoms remain unresponsive to conservative treatment.  The surgery for CTS is called carpal tunnel resection, and involves cutting/releasing the ligament (transverse carpal ligament) that is pressing on the median nerve.  This surgery is usually successful, however, full healing and recovery may take months.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Carpal Tunnel Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke. 2002. Online. <http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm>

Carpal tunnel syndrome. Median nerve dysfunction; Median nerve entrapment. A.D.A.M. Medical Encyclopedia. 2010. Online. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001469/>

Luchetti, R. Carpal Tunnel Syndrome. Springer Berlin Heidelberg. 2007. Online. <http://www.springerlink.com.proxy.lib.uwaterloo.ca/content/978-3-540-22387-0/contents/>

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You love your heart. Exercise shows your heart just how much you love it. But how fast should your heart be beating as you exercise?

The Canadian Physical Activity Guidelines recommend at least 150 minutes of moderate to vigorous physical activity per week. Anything lasting more than 10 minutes counts – walking the dog, shoveling snow or taking the stairs at work.

When exercising you should aim for your target heart rate - between 60-85% of your maximum heart rate (MHR).  Your maximum heart rate (for a minute) is:

Men: MHR = 220 – age
Women: MHR = 226 – age

To get your target heart rate simply multiply your maximum heart rate by 60 – 85%.  This gives you a range from the low end of your training zone to the high end.  If your pulse is below your target heart rate you should pick up the pace to adequately work your heart muscle.  If your pulse is too high, take a breath and slow down.

Remember, these calculations are just guidelines.  Everyone has different fitness levels.  If you are starting a new exercise program, consult a healthcare provider to ensure you are reaching your heart health goals.

References
Canadian Physical Activity Guidelines. For Adults – 18 – 64 years. Online. <www.csep.ca>
Cleveland Clinic. Your Pulse and Your Target Heart Rate. Online. <www.cchs.net>
Physical Activity Line. Target Heart Rate Zones.Online. <www.physicalactivityline.com>

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Most of us have had that uncomfortable and painful experience of stepping the wrong way or missing a step and rolling over on our ankle.  A sprained ankle is a common cause of ankle pain, and is the most common sports and physical activity related injury.  So what is it?  An ankle sprain is a joint injury where some of the fibers of the supporting ligament are ruptured, but the continuity of the ligament remains intact. The severity of a sprain is graded as I, II or III, ordered from least severe to most severe ligament damage.

The most common type of ankle sprain is an inversion sprain (lateral ligament sprain).  This means that the ankle rolls inward with your weight placed on the outside (lateral aspect) of your foot.  An inversion sprain causes injury to the ligaments on the outside of your ankle (most commonly the anterior talofibular ligament).  The other type of sprain is an eversion sprain (medial ligament sprain), which is rare.  This sprain means that your ankle rolls the other way, so outwardly, injuring the ligaments on the inside of the ankle (deltoid ligament).  Most times, this type of sprain is associated with a fracture of the bone on the inside of the ankle (fibula, medial malleolus, talus).

So what can you do if you suffer an ankle sprain?  A variety of options have been available in the past for the treatment of ankle sprains depending on the severity.  These include surgical repair, plaster cast or splint immobilization or functional/rehabilitation treatment.  Of these options, rehabilitation has been shown as the preferred method.  This treatment type usually consists of an early mobilization program that is frequently combined with the use of an elastic bandage or brace.

In addition to these treatment options, basic guidelines for ankle sprains exist.  These include the immediate use of R.I.C.E.:

• Rest: to prevent further tissue damage
• Ice: to reduce pain and inflammation
• Compression: to help with swelling and inflammation
• Elevation: to allow gravity to influence drainage and reduce swelling

These guidelines are vital in the beginning/acute stages of the injury.  But, in order to regain stability in your injured ankle, rehabilitation needs to occur.

Rehabilitation is one of the most important aspects of treatment with any injury.  This is because once the pain of a muscle, joint or ligament injury dissipates; residual weakness, instability and functional limitation to the tissues may still be present, making them more susceptible to further injury.  To bring it back to ankle sprains, research shows there is a two-fold increase in risk for reinjuring your ankle after the initial sprain.  This happens because the receptors in your ankle responsible for balance and “proprioception” (the body’s awareness and sense of position of its limbs in space) are affected.  When this awareness is compromised, you decrease your body’s ability to balance, creating instability, and therefore, subjecting your ankle to re-injury.  With ankle rehabilitation, you strengthen the compromised tissues and retrain the proprioceptive mechanism to generate a stable healthy joint.  To determine an appropriate rehabilitation program for you, please talk to your chiropractor or other qualified healthcare provider.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Davenport, T.E. Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial. BMC Complementary & Alternative Medicine. 2010; 10: 59.

Hing, W. Comparison of multimodal physiotherapy and “R.I.C.E.” self-treatment for early management of ankle sprains. New Zealand Journal of Physiotherapy. 2011; 39(1): 13-19.

Janssen, K.W. Ankles back in randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomized controlled trial. BMC Musculoskeletal Disorders. 2011;12: 210.

Kemler, E. A Systematic Review on the Treatment of Acute Ankle Sprain. Sports Medicine. 2011; 41(3): 185-197.

Ross, B.L. Proprioceptive exercises balance ankle stability and activity: The combination of exercises may reduce the change of recurrent ankle sprains and reinjury. BioMechanics. 2006. Online. <http://doeatc.k12.hi.us/pnfankle.pdf>

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­­­­Before we can start talking about how the shoulder can cause us pain, let’s first discuss its anatomy.  The shoulder (glenohumeral joint) is a ball-and-socket joint made up of the upper arm bone (humerus) and the part of the shoulder blade (scapula) called the glenoid.  This ball-and-socket joint allows our shoulder extreme mobility in all ranges – forwards, backwards, up, down, and to the sides.  However, mobility and stability are balanced by muscles of the rotator cuff and other surrounding muscles.

So, why should you learn about the rotator cuff?  Rotator cuff injury is the most common cause of pain and disability in the shoulder.  It is also the most common shoulder condition that patients seek treatment for.

The rotator cuff (RC) is made up of four muscles easily remembered as SITS: Supraspinatus, Infraspinatus, Teres minor and Subscapularis.  It is separated from the bone, ligament and muscle covering the RC by a structure called a bursa.  A bursa is a sac that secretes slippery synovial fluid, which can be thought of as the oil for the joints.  Like oil used for your car, the bursa has the primary function of lubricating the joint, minimizing friction and wear.

Now that we know what structures make up the shoulder joint and rotator cuff, the next question to answer is; what causes injury to the RC?  Unfortunately the most common answer is the wear and tear of aging.  Sometimes the injury comes from the bursa’s inability to fulfill its role (which occurs outside of the joint).  When the bursa doesn’t function optimally, this allows friction to occur causing damage to the RC tendons as they move over the bone.   Other times the injury comes from inside the shoulder joint (where the bones connect).

In approximately two-thirds of RC tears, the individual does not suffer from any pain or other symptoms.  The remaining one-third diagnosed with a RC tear experience pain and/or weakness in the shoulder region as the tendons degenerate and tears develop.  Even though all of the muscles of the RC (SITS) are susceptible to this injury, most often it is the supraspinatus tendon that is torn.

This pain of a RC tear is usually experienced during daily activities such as brushing your teeth, combing your hair, or lifting overhead to open a cupboard.  Often the pain is aggravated while sleeping on the affected side and moving your shoulder in certain directions, specifically during overhead activities.  These symptoms and aggravating movements are key to the diagnosis of a RC tear and should be relayed to your healthcare professional.

Treatment of rotator cuff injuries should begin with a trial of conservative treatment before surgical approaches are considered. Conservative treatment includes physical therapy to strengthen the rotator cuff and stabilizing muscles.  Additional treatment options include acupuncture, anti-inflammatories (including non-steroidal anti-inflammatory medications) or surgical repair.  Consultation with a chiropractor or other qualified health care professional is recommended to determine which treatment options are appropriate for you.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Coghlan, J.A. Surgery for rotator cuff disease.  Cochrane Database of Systemic Reviews.  2008. 1 (CD005619).

Hanchard, N. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder.  V.1.5. ‘Standard’ physiotherapy.  2011. eBook. <www.csp.org.uk/skipp>.

Myers, J. Rotator Cuff Tear. Sports Health. 2007; 25: 30.

Yamamoto, A. Factors involved in the presence of symptoms associated with rotator cuff tears: A comparison of asymptomatic and symptomatic rotator cuff tears in the general population.  Journal of Shoulder and Elbow Surgery. 2011; 20 (7): 1133-1137.

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Dr. Stuart McGill, a professor of Spine Biomechanics at the University of Waterloo, demystifies the common low back myths.  These include the following myths:

1) Back injuries are rare

2) You need a flexible back

3) To avoid injury you need a strong back

4) Bend your knees when you lift

5) Suck in your belly to work your core

Go ahead and test your healthy back knowledge!  Are these true or false?  Watch the video below (click on the link) to see if you are right.

Also, watch Dr. McGill review proper ways to strengthen your core and demonstrate proper lifting technique.  This is a must see to ensure a healthy back!

Dr. Stuart McGill – Low Back Myths

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Low back pain.  It is a condition that almost 85% of the population will experience in their lifetime and is considered to be one of the most common causes of chronic sickness and disability in many populations.  Despite these significant statistics, there are many misconceptions as to what makes a healthy back.

Before we can discuss the misunderstandings, we need to address what a healthy back is.  A healthy back is one that has a strong stabilizing core.  The core muscles consist of the abdominal, trunk, and pelvic musculature.  It is these muscles that protect the spine from potentially injurious forces by providing stability to the spine during movement.

Now, onto the misconceptions.  It is generally understood that stretching the back and increasing the range of motion decreases back problems. However, research shows that individuals with greater ranges also have greater risk for future back troubles.  As they say ‘too much of one thing is good for nothing’, well this saying is relevant in this situation as well.  There needs to be a balance of both mobility AND stability to make a healthy back.

The other predominant back health belief is that people must strengthen their back, following the ‘no pain-no gain’ philosophy.  This thought usually inflicts injury to the back during the strengthening process. Most times it is because the exercises chosen to strengthen the back replicate a forceful injury mechanism and results in high loads on the spine.  Instead of performing high-load, low repetition tasks, you want to perform more repetitions of less demanding exercises while maintaining a neutral spine position (for example, the plank position as depicted here).

So, how do we stabilize the back without causing injury?  The answer is muscle endurance.  Muscle endurance differs from strength, as endurance allows you the persevering ability to withstand stress and therefore, has more protective value for the spine than strength.

Examples of exercises that illustrate endurance-focused core stabilizing include the cat-camel motion, curl-up, plank, side-plank, and bird-dog.  For more information and pictures demonstrating these exercises, please visit Enhancing Low Back Health through Stabilization Exercise (by Dr. Stuart McGill) and for video demonstration, please visit Core Values (by Dr. Stuart McGill).

Remember that everyone’s needs are different, and that there is no ideal set of exercises for all individuals.  So, to determine an appropriate ‘healthy back’ routine for you, please talk to your chiropractor or health care professional.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References:

McGill, S. Enhancing Low Back Health through Stabilization Exercise. ACE Certified News. 2003.

Martin, C.W. Low Back Pain at the Workers’ Compensation Board of British Columbia. The Evidence Based Practice Group, Clinical Services, Program Design Division. 1987-2001.

Sampsell, E. Rehabilitation of the Spine Following Sports Injury. Clinical Sports Medicine. 2010; 29: 127-156.

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