Scoliosis affects about 5-7 million people in the U.S., scoliosis is a lateral curvature of more than 10 degrees in the spine. A person with scoliosis will have a C- or S-shaped curve in their spine. It can appear at any age, but it often presents from the age of 10 to 12 years, or during the teens, but infants can sometimes have symptoms. The reasons for the change in shape are not usually known, but some cases are linked to cerebral palsy, muscular dystrophy, spina bifida, or a birth defect.
A structural curve is permanent, and may be due to another condition. A nonstructural curve is temporary and it is likely to disappear with time. A very small number of patients with scoliosis may require surgery. Complications of scoliosis include chronic pain, respiratory deficiencies, and decreased exercise capacity.
What are the Symptoms of Scoliosis?
The most common form of scoliosis appears in adolescence. It is known as adolescent idiopathic scoliosis. It can affect children from the age of 10 years.
Idiopathic means that there is no known cause. Symptoms can include:
The head is slightly off center
The ribcage is not symmetrical – the ribs may be at different heights
One hip is more prominent than the other
Clothes do not hang properly
One shoulder, or shoulder blade, is higher than the other
The individual may lean to one side
Uneven leg lengths
Some types of scoliosis can cause back pain but it is not usually very painful. Back pain is not uncommon in older adults with long-standing scoliosis.
If scoliosis is left untreated, problems can arise later in life, such as impaired heart and lung function.
What are the Causes of Scoliosis?
Neuromuscular conditions: These affect the nerves and muscles and include cerebral palsy, poliomyelitis, and muscular dystrophy.
Congenital scoliosis (present at birth) This is rare and occurs because the bones in the spine developed abnormally when the fetus was growing inside the mother.
Specific genes: At least one gene is thought to be involved in scoliosis.
Leg length: If one leg is longer than the other, the individual may develop scoliosis.
Osteoporosis: This can cause secondary scoliosis due to bone degeneration.
Other causes: Bad posture, carrying backpacks or satchels, connective tissue disorders, and some injuries.
What are the Types of Scoliosis?
There are a number of ways to differentiate between the various forms of scoliosis, but the most common method for classification is based on etiology, or the underlying cause for the condition. The American Association of Neurological Surgeons (AANS) suggests there are three categories into which the different forms of scoliosis fit: idiopathic, congenital, and neuromuscular.
Most types of scoliosis are idiopathic, which means that the cause is unknown or that there is no single factor that contributes to the development of the disease.
Congenital forms of scoliosis typically result from a spinal defect present at birth, and are therefore usually detected at an earlier age than idiopathic forms of scoliosis.
Neuromuscular scoliosis is spinal curvature that develops secondary to some kind of neurological or muscular disease, such as muscular dystrophy or cerebral palsy. This form of scoliosis tends to progress much more quickly than others.
What is the Treatment for Scoliosis?
As a Chiropractic Physician, I will do a physical examination, postural analysis, and take x-rays. I design an individualized treatment plan that will focus on pain management and postural fixation. Spinal manipulation, therapeutic exercises, and other treatments may also come into play. Initial treatment usually lasts 4-8 weeks and I then recommend my patients to follow up every 1-2 months to monitor the curve of the spine in clinic.
The following factors will be considered by the doctor when deciding on treatment options:
Sex: Females are more likely than males to have scoliosis that gradually gets worse.
Severity of the curve: The larger the curve, the greater the risk of it worsening over time. S-shaped curves, also called “double curves,” tend to worsen over time. C-shaped curves are less likely to worsen.
Curve position: A curve that is located in the center part of the spine is more likely to get worse compared with curves in the lower or upper section.
Bone maturity: The risk of worsening is lower if the person’s bones have stopped growing. Braces are more effective while bones are still growing.
What About Braces?
If the patient has moderate scoliosis and the bones are still growing, I may recommend a brace. This will prevent further curvature, but will not cure or reverse it. Braces are usually worn all the time, even at night. The more hours per day the patient wears the brace, the more effective it tends to be.
The brace does not normally restrict activities of daily living. If the patient wishes to take part in physical activity, the braces can be taken off.
When the bones stop growing, braces are no longer used. There are two types of braces:
Thoracolumbosacral orthosis (TLSO) – the TLSO is made of plastic and designed to fit neatly around the body’s curves. It is not usually visible under clothing.
Milwaukee brace – this is a full-torso brace and has a neck ring with rests for the chin and the back of the head. This type of brace is only used when the TLSO is not possible or not effective.
One study found that when bracing is used on 10-15 year olds with idiopathic scoliosis, it reduces the risk of the condition getting worse or needing surgery.
Forward head posture, sometimes called “Scholar’s Neck”, “Text Neck”, or “Reading Neck”, refers to a posture where the head appears to be positioned in front of the body. It is a very common condition that I see in the office almost on a daily basis.
Technically speaking, forward head posture means that the skull is leaning forwards, more than an inch, over the atlas (which is the first vertebrae in your neck). Forward head posture is considered to be the most common postural deformity, affecting between 66% and 90% of the population.
With a few simple exercises, posture awareness and workstation modifications and you can start correcting this posture!
How Do You Know if You Have Forward Head Posture?
Stand with your back towards a wall with your heels positioned shoulder width apart
Press your buttocks against the wall and ensure that your shoulder blades are in contact with the wall.
So, What’s the Problem with This Posture?
Forward head posture doesn’t just affect the neck and shoulders; the center of gravity of your entire body is also altered, which affects your torso and every joint in your body.
Your body tries to adapt to these positional changes be altering the balance control mechanisms of the body, which actually decreases your ability to balance when engaging in different activities throughout the day, and increases your risk of injury.
The changes that occur with forward head posture can lead to persistent and abnormal pressure in the muscles, tissues, and nerves of both the neck and shoulders, which can lead to rounding of shoulders (increased thoracic kyphosis) and herniated discs in an effort to compensate, which results in a higher load being placed on the back and shoulder muscles (Like Trapezius).
When you combine all of these changes, you’ll eventually end up with a condition called “tension neck syndrome” – symptoms of this condition can mimic tension headache.
Forward head posture is the result of a variety of factors, including:
Weakness of your neck muscles
Previous neck strains or sprains
Sleeping with your head elevated too high on pillows
Frequently sleeping on a sofa with your head propped on the arm rest
Extended computer use
Extended cellphone use (“text neck”)
Incorrect breathing habits
Carrying heavy backpacks
Participating in sports that involve the dominant use of one side of the body (i.e. golf, tennis, hockey, baseball, etc.)
Certain professions are more at risk due to repetitive movements of the body (i.e. hair stylists, massage therapists, writers, computer programmers, painters, etc.)
What is the treatment for Forward Head Posture?
Practicing good posture while performing your daily activities, combined with stretching and strengthening the muscles involved in forward head posture, can put you on the right path towards correcting this postural abnormality. Below, there are some good exercises that can help with forward head posture.
Neck Flexion (Suboccipital Stretch)
This will stretch the back of your neck muscles including the Suboccipital muscles.
First, tuck your chin in using 2 fingers of one hand.
Place your other hand on the back of your head and apply a gentle force down as you pull your head towards your chest.
When you feel a stretch at the back of your neck, hold the position for 20 to 30 seconds.
Repeat this stretch 3 times.
** Keep your chin tucked as you do this stretch
Chin Tuck Exercise
This exercise will activate and strengthen your deep cervical muscles (front of the neck muscles).
Place 2 fingers at the bottom of your chin.
Gently tuck your chin in and retract your head backwards. At the same time, use your fingers to keep the chin tucked in the entire time.
Hold the end position for 3 to 5 seconds.
Relax your neck for a moment (Let the neck come forward).
Aim for 2 to 3 sets of 10 repetitions.
** Your eyes should stay level and you should feel like the back of your neck is lengthening or “pulling up”.
Doorway Pectoralis Stretch
Position your elbows and hands in line with a doorframe.
Step through the door slowly, until you feel a stretch.
Hold this end position for 15 to 20 seconds before returning to the starting position.
This exercise will activate and strengthen your low and mid back muscles.
Position your feet and knees slightly wider than your hips and slightly rotated outwards.
Maintain a chin tuck and raise your chest up, allowing your spine to be in a neutral position.
Rest both of your arms down by your sides.
Now bring your arms back and externally rotate them so that your thumbs are pointing backwards.
Hold this position for 5-10 seconds and release.
Aim for 2-3 sets of 10-15 repetitions.
* Breathe normally as you do these reps.
Lastly, Proper Ergonomics are very important when it comes to forward head posture. If you sit at a computer for extended periods of time, the single most important thing you can do to improve your workstation is to ensure that your computer monitor is positioned properly to allow your neck to remain in a neutral and relaxed position while you work.
Ensure that the top third of your screen is at eye level
Your monitor should be between 18 and 24 inches away from your face.
What is a Whiplash Injury? Whiplash, also called neck sprain or neck strain, is an injury to the soft tissues of the neck. Whiplash injuries occur in sports where a forceful impact (commonly from behind) causes an athlete’s head and neck to snap forward and back in an abrupt, violent motion. It is commonly seen in car accidents, but some contact sports, such as football, can lead to whiplash injuries.The sudden force stretches and tears the muscles and tendons in your neck.This causes movement of the structures within the neck changing the normal curve of the upper back and neck. The sudden backward movement (extension) and forward movement (flexion) can cause the joints of the neck to be injured and can also cause the muscles and ligaments of the neck and upper back to be over-stretched. The neck is particularly vulnerable to this type of injury because of its ability to move in many directions.
Symptoms of Whiplash The primary symptom of whiplash is neck or upper back pain. The pain can start immediately or develop days, weeks, or sometimes even months later. Symptoms can vary widely among individuals. Some may only suffer minor discomfort while others experience one or more of the following:
Tightness or spasms of the muscles the neck or upper back
Pain with movement of the neck, headache and dizziness (symptoms of a concussion)
Abnormal sensations such as burning or tingling
Upper back pain
Severe whiplash can also include injury to the intervertebral joints, discs, ligaments, cervical muscles and nerve of the neck or upper back. Fortunately, with time, the vast majority of people who have had a whiplash injury fully recover.
How is Whiplash Diagnosed? Even if your neck pain is only mild, you should be examined by a health professional such as a Chiropractor as soon as possible. X-rays may be done to rule out any bone fractures. A CT scan or MRI may also be done if there is concern you have a herniated disc or significant ligament injury. These tests are better able to identify soft tissue injuries than plain radiographs.
Treatment Options Most cases of whiplash are treated using conservative methods such as:
Encouraging the patient to remain as active as possible.
A cervical collar should be used for only a very short period of time (less than a week). Ice or heat can be used to control pain, muscle spasm, and inflammation.
A course of spinal manipulation or mobilization can help in restoring normal positioning of the muscles and joints.
Chiropractic and/or Physical therapy helps to increase circulation, restore range of motion, and promote healing.
The use of modalities such as ultrasound and electrical stimulation should only be used in the early stages of treatment to reduce pain and assist in getting an active therapy program started.
Prevention Tips Since most cases of whiplash occur as a result of rear-end car crashes, the best way to protect yourself on the road is to wear your seat belt correctly and on every ride. Also, make sure the headrest in your vehicle is not too low and avoid driving in an overly reclined position.
For Athletes and Sports Enthusiasts if you participate in sports (especially contact sports), make sure you wear appropriate equipment and always use good technique to avoid neck injuries.
While it may be impossible to avoid some injuries, maintaining good overall health can help speed recovery if one occurs. This includes getting regular exercise, eating healthy foods, and not smoking. If you are experiencing neck or upper back pain, visit us at SHC for a complete evaluation.
Stress affects us all in one way or another. There’s no escaping it…Sorry! The important thing to understand is that not all stress is bad stress. The kind of stress that is good for us is the sort that occurs when we are facing imminent danger. In this case, the age-old fight or flight response kicks in. Just as when cavemen used to run away from hungry meat-eating saber tooth tigers, the fight or flight response releases a surge of adrenaline into our system. This results in our heart beating faster, our muscles tensing, and our breath coming in short, rapid bursts. All of this is designed to help us escape as fast as possible or to fight the danger facing us.
It is when stress becomes chronic and long-term that it can become detrimental to our health. Some signs of chronic, long-term stress include:
Increased irritability or irritation experienced on a daily basis
Feelings of anger or frustration
Insomnia or loss of appetite
Loss of sex drive
Skin conditions: like eczema and psoriasis
We do not yet understand why long-term stress affects us this way both physically and emotionally. What we can do is address the causes of stress so that we reduce or eliminate them from our lives.
One very simple yet effective way to reduce the way stress affects us in our lives is to practice deep breathing. Take a deep breathe into your abdomen instead of into your chest. This helps to calm you immediately so that you can cope with a situation that may normally cause a great deal of stress.
Changing our perspective on how we view situations can also help tremendously with our stress and how we let it affect us. When we allow outside circumstances to dictate our inside world it causes us to overreact to certain triggers.Instead give this a whirl: STOP, CHALLENGE, CHOOSE.
STOP- before you respond in anger or frustration stop take a deep breathe.
CHALLENGE-ask yourself “is this reaction going to empower me or add more stress?”
CHOOSE- choose the empowering one.
The more you practice this, the more you will train yourself to respond differently to situations and not sweat the small stuff. In other words it will result in positive feedback that boosts self-esteem and further reduces long-term stress.
There are also a number of small lifestyle changes that we can easily make that will have an immediate impact on our levels of stress. By simply including a daily half-hour walk in our lives it has been shown that we can boost our overall emotional and physical health. The opportunity to get away from daily irritations and problems and simply enjoy and experience the benefits of nature is, in itself, enormously beneficial. In addition, the cardiovascular benefits of daily exercise undertaken at a reasonable pace help to counteract the detrimental effects of raised blood pressure, increased heart rate and muscular tension that so often accompany long-term stress.
Some other lifestyle changes to consider would be undergoing a Chiropractic care for stress relief. As I mentioned in the beginning of the article, when we are under chronic stress it can manifest physically in our bodies with symptoms like: Headaches, Neck and shoulder pain, and back pain. Chiropractic care can help relieve the tension that gets built up from ongoing stress. A Chiropractor can detect and address the areas of tension and relieve those areas that stress is affecting. They do so in various ways using different techniques and modalities.
If you are suffering with any of these symptoms of stress then I strongly recommend getting an evaluation to see if Chiropractic care can help you kick it to the curb!
It is vital to understand that, unless long-term stress is identified and eliminated, its negative effects will build up over time. This, in turn, leads to a cumulative negative effect on our health and well-being. Stress is not some 21st-century badge of honor. It is a real disease and should be treated as such. If you are suffering from long-term stress it is time to take an objective look at your lifestyle to work out what needs to change.
Hope these tips help you start on your path to stress less!
To schedule an appointment for a Chiropractic evaluation Call (201) 746- 6577.
Why do so many athletes from a broad range of sports rely on Chiropractic Care? Well, there’s no doubt that seeing a Chiropractor regularly has many benefits not just for athletes, but for everyone who commits to treatment.
However, athletes tend to experience much larger stresses in a shorter period than the average person day-to-day as they train rigorously to try and set themselves apart from the rest.
This is where staying aligned, preventing injury and maintaining good health become extremely important for an athlete, all of which can be accomplished by Chiropractic care!
Don’t take our word for it though. Here’s a list of some of the world’s most well-known athletes of the past and present who have counted on Chiropractic care as an important piece of the puzzle when it comes to staying healthy and at the top of their respective game.
Michael Jordan – Basketball
One of the all-time greats of basketball – if not THE greatest – was a firm believer in the results of Chiropractic care and attributes part of his success to the care he received. Drafted by the Chicago Bulls in 1984, Michael went on to win six NBA championships and was named the league’s MVP five of those times.
Today, Jordan is the majority owner of the NBA’s Charlotte Hornets and is an incredibly successful businessman with multiple brand endorsement deals throughout the sporting goods world. This is what he said about Chiropractic care: “Since I’ve been in Chiropractic, I’ve improved by leaps and bounds both mentally and physically.”
Tiger Woods – Golf
Tiger may not be in his prime in recent years, but what he accomplished as a pro golfer in the past was unheard of. He finished number one in 10 major professional golf competitions before the age of 30 including the 1997 Masters, 1999 PGA Championship and 2000 U.S. Open to name a few.
Tiger has often spoken about seeing his Chiropractor through the years and how it has been an instrumental part of his success. He’s said himself, “I’ve been going to Chiropractors for as long as I can remember. It’s as important to my training as practicing my swing.”
Evander Holyfield – Boxing
Evander was one of the toughest and most successful professional boxers of his era. With 47 wins and 10 losses over a 27-year boxing career, he reigned as the undisputed champion in both the cruiserweight (less than 200 pounds) and heavyweight (more than 200 pounds) divisions and is the only ever four-time world heavyweight champion.
Evander believes that it helped him maintain his edge in competition, and found that going to see a Chiropractor three times a week helped him improve his performance. He also said that, “I have to have an adjustment before I go into the ring. The majority of boxers go to get that edge,” regarding Chiropractic adjustments.
Barry Bonds – Baseball
Barry Bonds is often considered as one of the best baseball players of all time. In 22 seasons with the Pittsburgh Pirates and San Francisco Giants, he earned several MLB hitting records including the most career home runs (762), a record he holds to this day.
Following an injury had during his career, he sough Chiropractic care for treatment and was impressed. He said, “I just saw my Chiropractor. I feel 100 percent better.” Another time in interview with Dr. Alan Palmer, a Chiropractor in the United States, Bonds made a remarkable statement, “I think it should be mandatory to see a Chiropractor and massage therapist,” regarding athletes.
Arnold Schwarzenegger – Body Building
Arnold may just be the most recognizable professional athlete of them all. The Austrian-American began his incredibly successful life as a professional body builder and powerlifter, winning Mr. Universe at the age of 20 and going on to win Mr. Olympia seven times. Apart from acting, he also is / was an author, businessman, filmmaker, philanthropist, politician and investor over his life time.
Arnold has given huge credit to Chiropractic care as part of his success in professional sports. Here’s a few quotes he’s said over the years:
“What you [Chiropractors] do is really powerful”
‘You Chiropractic doctors are really miracle workers”
“I found out the best way of going, is to use Chiropractors, not only after injury, but also before injury”
“He [the Chiropractor] adjusts my wife, my kids, me, everybody. And we always feel great when he leaves”
Tom Brady – Football
Tom Brady is an all-American professional player who is one of only two players to ever win five NFL Superbowl championships. He is also the only player in the league’s history to do it with the same team. Without a doubt, Tom is the centerpiece of a dynasty team who’s been without a doubt the most successful in the NFL’s recent history.
Tom Brady astutely believes in Chiropractic Care as an integral part of keeping him atop his game. He says, “Chiropractic just makes you feel so much better. When I walk out of the clinic, I feel like I’m about three inches taller and everything’s in place. As long as I see the Chiropractor, I feel like I’m one step ahead of the game.”
Joe Sakic – Hockey
Joe Sakic was one of hockey’s all time greats, as shown by his induction into the Hockey Hall of Fame in 2012. He won the Stanley Cup Championship twice during his illustrious career and was given several awards ranging from the Conn Smythe Trophy to the NHL All-Star Game MVP.
This is was Joe has to say about Chiropractors: “I see the chiropractor on a regular basis. I find that after my treatments I have better flexibility and improved range of motion. I recover quicker from injuries. I have more “jump” in my game and it improves my performance.”
Joe Montana – Football
Another proclaimed professional footballer in the NFL is Joe Montana. He won four Super Bowl Championships and was named the Super Bowl MVP three of those times. During his career, Joe suffered a serious injury, of which he recovered fully and went back to optimal performance afterwards.
When asked about it, he said, “I’ve been seeing a Chiropractor and he’s really been helping me out a lot. Chiropractic’s been a big part of my game.” If Chiropractic care can work for Joe, it can work for you!
Christine Brinkley – Model
Beginning her successful life as a model in the late 1970’s for Sports Illustrated, Christine went on to become the face of CoverGirl for 25 years (she holds the record for retaining the longest running cosmetics contract for any model – ever). She has been named as one of the most attractive woman of all time by Allure and Men’s Health magazines.
Here’s what Christine said about Chiropractic Care: “Chiropractic makes me feel a few inches taller each time I come out.” Even super models are seeing their Chiropractors to maintain their overall health and general sense of well-being!
Wade Boggs – Baseball
Wade Boggs was a 12-time All-star professional baseball player who spent 18 years of his MLB career with the Boston Red Sox. With 118 home runs, 3,010 total hits and an 80 percent safety percentage, he was inducted into the National Baseball Hall of Fame 2005.
After suffering from severe back pain for almost a decade, he was provided Chiropractic Care by Dr. Craig Newman, DC, and made a complete recovery. He went on to say, “Last year I found Dr. Newman (Chiropractor), and I have been seeing him ever since. I have been pain-free and feeling terrific. I swear by it. Now, it is just maintenance and keeping in line so the nerves don’t touch.”
Chiropractic is Not What You Think: The Science & Art of Healing
A Parent’s Story
by Ed Arranga, guest author
“Chiropractic did not originate to treat pain: it originated to promote health.” — Anonymous
Chiropractic is known around the world. There are chiropractors in over 100 countries and 90 of those countries have national associations. The American Chiropractic Association estimates that the nation’s roughly 77,000 chiropractors care for more than 35 million Americans every year. But there seems to be a disconnect when it comes to the general public’s understanding of how they can help us improve our health.
Everyone has a cousin or friend or knows someone who hurt their neck or back and went to a chiropractor to get help. That’s about the extent of interaction the general population has with the profession.
You see chiropractic offices tucked away in strip malls next to laundromats and liquor stores. They are largely invisible, never seen or talked about anywhere.
The sales pitch sounds like a bad marketing campaign from the 1950s — “health and wellness” — carrying with it the same promissory weight as the term “beauty salon.”
The profession has been around for more than 120 years. Sure, if you slip and fall and twist your back, you’ll think about finding a chiropractor. You remember they helped your cousin that one time. What more do you need to know?
And then one day, your son develops a chronic, debilitating cough that won’t go away…
A Growing Problem
My son, Jarad, developed a cough a few years ago, and my concern heightened as the cough became more frequent. The cough was almost constant and getting worse. We tried many healthful items like cups of tea with honey, a vaporizer, and decongestants, but this did not slow the cough’s trajectory.
We saw many different doctors: ear, nose, and throat specialists; neurologists; an allergist; and a gastroenterologist. None of their prescriptions worked.
We knew it wasn’t postnasal drip, asthma, gastroesophageal reflux, chronic bronchitis, chemical irritation, whooping cough, or a host of other possibilities, but we still didn’t know what it actually was.
The hacking was continual and, at this point, it had been going on for more than 2 years.
I didn’t know how my son’s throat could withstand the irritation of the sometimes very strong coughing. Several of the doctors began suggesting it was in my son’s head — a psychosomatic disorder.
It was time to move away from naysayers and find answers.
A Different Paradigm
“Look well to the spine for the causes of disease.”— Hippocrates
A friend advised me to bring my son to a local chiropractor. The initial intake assessment and exam were remarkably quick. The chiropractor placed Jarad on an upper-leaning adjustment table, grasped his head in his hands, and gently rotated his head in one direction and then the other, with the characteristic cracking noise (the cracking sound you hear is not bone, it’s gas — synovial gas — escaping from the joint) occurring each time.
The chiropractor had Jarad turn over and lie on his stomach, feeling along his spine and putting pressure on the T5 vertebrae, in the thoracic area (the upper back.) The head turning along with the popping sound was repeated with both adjustments, and he tolerated the process well. In fewer than 3 minutes, we were done. An hour later, Jarad coughed.
It was the first time in over 2 years he went more than a minute without coughing. Jarad didn’t cough again the rest of the day. After 3 visits, his cough was 90 percent gone!
What had just happened? Why didn’t I know about this sooner?
It brought me back to a time 20 years ago when I was told there was no hope for helping my son’s autism. The “experts” told me to give up and move on, “Autism is now and forever, and there’s nothing you can do to help.”
That wasn’t true then, and it wasn’t true now. The coughing was NOT a figment of my son’s imagination.
Today, 53 to 54 percent of children suffer from a chronic illness. There is an explosion of neurodevelopmental disorders that include autism, PDD-NOS, OCD, and ADHD.
Behaviors exhibited in children diagnosed with ADHD (attention-deficit / hyperactivity disorder), specifically the inability to pay attention and being in constant motion, are manifestations of chronic stress.
An acute injury is very painful and needs immediate attention, but a chronic condition often sneaks up on someone unexpectedly. The joints send stress signals to the brain, and the brain releases stress hormones.
With this type of condition there is no pain, but the body is sick and will continue to send stress signals until all the conditions associated with chronic stress begin to manifest themselves in the body.
Spinal joints that are out of alignment will not move properly, will begin to degenerate, and will cause inflammation. Being chronically out of alignment will cause a chronic stress response. One might think it would be painful, but it’s not. That’s a misconception and major difference between acute and chronic illness.
When subluxations occur in the spine, these misalignments cause tension in the spinal cord or the nerves exiting from the spine. This causes an interference or imbalance in the nervous system messages to the various organs, tissues, glands, and cells.
This means the brain cannot communicate with the body nor the body with the brain as efficiently or effectively as nature intended, which leads to various dysfunctions and symptoms.
The Havoc of Stress
Understanding the basic stress response of the body provides the building blocks behind the art and science. When a person is placed in a stressful situation, the brain releases stress hormones, such as adrenaline, cortisol, norepinephrine, and others. The heart rate and blood pressure increase to send the hormones everywhere in the body.
The body enters a state of upregulation, which is the process of increasing the ability to respond to stress. Catabolic processes begin breaking down complex compounds and molecules to release energy. There is an increase of cholesterol, blood-clotting factors, blood sugar, and fatty acids in the blood.
Catabolic activity is metabolically expensive, requiring that anabolic activities (healing, growth, and repair) are put on hold. The immune system is downregulated, which is the process of reducing or suppressing a response to a stimulus. Cell-modulated immunity is decreased. There is a decrease in factual memory and learning capability.
During an acute stress response, the senses of sight, sound, smell, touch, and taste are heightened. The body is adapting to the situation and these varied responses are intelligent.
Survival depends on the ability of the body to properly respond to stressful changes in the environment.
The dangers arise when the acute stress response becomes chronic. The decrease in healing; growth; repair; memory; and brain-, organ-, and immune-function, is no longer temporary — it becomes permanent. The increase in cholesterol, blood glucose, fatty acids, and insulin is off the charts.
The increase in insulin downregulates the production of HGH (human growth hormone), the hormone responsible for longevity, anti-aging, healing, growth, and repair. Excessive insulin then prevents the production or proper utilization of magnesium, the mineral which is responsible for relaxing both skeletal and smooth muscles, the arteries, and the heart.
How Chiropractic Works
Chiropractors study physiology — the branch of biology that deals with normal functions of living organisms and their parts. Medical doctors study physiology too, but then focus mostly on pathology — the study of the origin, nature, and course of diseases.
Chiropractic returns healthful motion to the spine, which returns healthful motion to the body.
D.D. Palmer, chiropractic’s founder, defines chiropractic as, “a philosophy, science and art of things natural; a system of adjusting the segments of the spinal column by hand only, for the correction of the cause of dis-ease.”
Palmer also said, “Chiropractic is a restorative healthcare profession that focuses on the inherent healing capacity of the body and the fact that the nervous system is the primary system involved in that healing and repair.”
Steve Tullius, a pediatric chiropractor in San Diego stated, “Chiropractors are specifically trained to locate and gently correct these structural imbalances in the spine, known as vertebral subluxations, and by doing so, restoring balance and function to the nervous system.”
Chiropractic care adjustments facilitate health and function.
Chiropractic and the Immune System
A very important part of keeping our immunity strong is the lymphatic system. It consists of a network of lymph nodes, ducts, and vessels that move the lymph (a fluid made of white blood cells and chyle) from various parts of the body into the bloodstream. The lymph nodes are responsible for making immune cells that help to fight infections.
The better the lymph is able to travel through the body, the more it is able to carry the infection-fighting cells to every part.
The lymphatic system is connected to both the central nervous system and the musculoskeletal system. A chiropractic adjustment helps the central nervous system by removing subluxations that prevent proper communication throughout the body. The musculoskeletal system transports the lymph through the body as we move and contract our muscles.
Adjustments allow for more movement in the muscles, which increases movement of the lymph.
A Learning Experience
After examining Jarad’s spine and nervous system, Dr. Holland explained that he had found areas in Jarad’s spine that were misaligned — specifically vertebral subluxations at C1 (cervical or neck area) and T5.
Dr. Holland began a series of gentle adjustments to restore normal movement and function to the spine, allowing the body to communicate more effectively. As a result, we saw Jarad’s cough disappear.
The source of the problem were the misalignments which were not allowing Jarad’s lymph glands to operate as they should.
His lymph glands were overflowing, causing Jarad to cough and swallow continuously in an attempt to clear them.
Jarad’s schedule consisted of 2 adjustments a week (generally Monday and Friday), for 6 weeks, during the corrective phase, dropping down to 1 adjustment a week during the support phase, for 6 weeks. Going forward, I plan to take Jarad once a month to help keep him subluxation free.
As a parent, I’m grateful to chiropractic for restoring Jarad’s health, and grateful to the chiropractic doctors who soldier on, rarely being given the recognition they deserve, while routinely performing some of the most extraordinary reversals of health fortunes in the healthcare industry.
American Chiropractic Association – www.acatoday.org
Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Doctors of chiropractic—often referred to as DCs, chiropractors or chiropractic physicians—practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. In addition to their expertise in spinal manipulation/adjustment, doctors of chiropractic have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.
What conditions do chiropractors treat?
Doctors of chiropractic care for patients of all ages, with a variety of health conditions. DCs are especially well known for their expertise in caring for patients with back pain, neck pain and headaches with their highly skilled manipulations, or chiropractic adjustments. They also care for patients with a wide range of injuries and disorders of the musculoskeletal system, involving the muscles, ligaments and joints. These painful conditions often involve or impact the nervous system, which can cause referred pain and dysfunction distant to the region of injury. The benefits of chiropractic care extend to general health issues, as well, since our body structure affects our overall function. DCs also counsel patients on diet, nutrition, exercise, healthy habits, and occupational and lifestyle modification.
How is a chiropractic adjustment performed?
Chiropractic adjustment or manipulation is a manual procedure that utilizes the highly refined skills developed during the doctor of chiropractic’s intensive years of chiropractic education. The chiropractic physician typically uses his or her hands—or an instrument—to manipulate the joints of the body, particularly the spine, in order to restore or enhance joint function. This often helps resolve joint inflammation and reduces the patient’s pain. Chiropractic manipulation is a highly controlled procedure that rarely causes discomfort. The chiropractor adapts the procedure to meet the specific needs of each patient. Patients often note positive changes in their symptoms immediately following treatment.
Research Supporting Chiropractic
A growing list of research studies and reviews demonstrate that the services provided by chiropractic physicians are both safe and effective. The evidence strongly supports the natural, whole-body and cost-effective approach of chiropractic care for a variety of conditions. To read excerpts from relevant studies, visit www.acatoday.org/research.
Doctors of chiropractic—who are licensed to practice in all 50 states, the District of Columbia, and in many nations around the world—undergo a rigorous education in the healing sciences, similar to that of medical doctors. Because of the hands-on nature of chiropractic, and the intricate adjusting techniques, a significant portion of time is spent in clinical training.
The course of study is approved by an accrediting agency which is fully recognized
by the U.S. Department of Education. This has been the case for more than 25 years. Before they are allowed to practice, doctors of chiropractic must also pass national board examinations and become state-licensed.
This extensive education prepares doctors of chiropractic to diagnose health care problems, treat the problems when they are within their scope of practice, and refer patients to other health care practitioners when appropriate. To learn more about how chiropractic education compares to medical education, visit www.acatoday. org/education- events.
Why is there a popping sound when a joint is adjusted?
Adjustment (or manipulation) of a joint may result in the release of a gas bubble between the joints, which makes a popping sound. The same thing occurs when you “crack” your knuckles. The noise is caused by the change of pressure within the joint, which results in gas bubbles being released. There is usually minimal, if any, discomfort involved.
Is chiropractic treatment appropriate for children?
Yes, children can benefit from chiropractic care. Children are very physically active and experience many types of falls and blows from activities of daily living, as well as from participating in sports. Injuries such as these may cause many symptoms, including back and neck pain, stiffness, soreness or discomfort. Chiropractic care is always adapted to the individual patient. It is a highly skilled treatment, and in the case of children, very gentle.
Are the services provided by doctors of chiropractic safe?
Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints. Although chiropractic has an
excellent safety record, no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small. Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness or aching, just as they do after some forms of exercise. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours. Learn more at www. acatoday.org/patients.
Is chiropractic treatment ongoing?
The hands-on nature of the chiropractic treatment is essentially what requires patients to visit the chiropractor a number of times. To be treated by a chiropractor, a patient needs to be in his or her office. In contrast, a course of treatment from medical doctors often involves a pre-established plan that is conducted at home (i.e. taking a course of antibiotics once a day for a couple of weeks). A chiropractor may provide acute, chronic, and/or preventive care, thus making a certain number of visits sometimes necessary. Your doctor of chiropractic should tell you ahead of time the extent of treatment recommended and how long you can expect it to last.
For more information on prevention and wellness, or to find a doctor of chiropractic near you, visit ACA’s website at www.acatoday.org/patients.
AMERICAN CHIROPRACTIC ASSOCIATION .,, WWW.ACATODAY.ORG
The Bergen County Baseball Tournament is Almost Here…
Dr. Michael O’Reilly, DPT
Baseball may be America’s favorite pastime, but is the throwing motion we all know so well actually detrimental to your body? It does not have to be! Trust me, I would like to preface this article by stating you would be hard pressed to find a more avid baseball fan than myself. As a 2008 NJ Group 3 Baseball State Champion, with a younger brother who is a pitcher at the collegiate level, I feel as if the sport of baseball is part of my DNA. I have recently returned to the Northern New Jersey area as a Doctor of Physical Therapy, and although my lifelong passion for the sport remains strong, I cannot help, but to cringe when I look at the biomechanics associated specifically with the upper extremity necessary to meet the high demand required to produce an explosive high velocity throw. Unfortunately, within the last decade there has been a significant rise in baseball injuries specifically involving a pitcher’s throwing elbow. According to Yankees team physician Dr. Christopher Ahmad and Glenn Fleisig, the leading authority on pitching biomechanics, pitchers began suffering ligament damage as far back as Little League. High-pressure travel teams, increased velocity among elite pitchers, high-intensity inning totals and insufficient arm conditioning, have contributed to a flood of shredded elbows, they contend (Fortenbaugh D, Fleisig GS, Andrews JR.). In addition, from Jeff Roberts’ 2014 article, staff writer from NorthJersey sports, “Matt Harvey believes his own youth odometer played a role in his injury. He said his surgeon, noted orthopedist Dr. James Andrews, agrees the injury may date back to high school.” Furthermore, a study by Dr. Romeo at Rush University Medical Center and others finds that 15- to 19-year-old athletes make up nearly half the number of injuries requiring Tommy John Surgery. Another jaw dropping statistic: the amount of high school athletes requiring the Tommy John procedure increases by 10 percent each year. At this time, one may reflect on the data I have presented thus far and truthfully ask themselves, is it even possible to maintain the health of my arm or is the prolonged health of my arm more like winning the lottery?
One can briefly define the throwing motion as a complex and coordinated body movement that essentially culminates with a violent ballistic movement pattern of the upper extremity with the propulsion of a ball towards a target. Through this specific movement pattern an athlete is exposing and challenging his muscular structures to endure physiologic kinematic loads well beyond their natural capacity. An intricate relationship between the dynamic stabilizers of the upper extremity, predominantly including the four muscles of the rotator cuff (subscapularis, supraspinatus, infraspinatus, teres minor), pectoralis major, serratus anterior, and latissimus dorsi, and the static stabilizers which are composed of tendons and ligaments, is required to simultaneously supply the range of motion, force, and stability of the glenohumeral joint. Frequently, the overhead athlete presents with shoulder pain secondary to the repeated tensile overload instilled upon the posterior structures of the glenohumeral joint capsule. Interestingly enough, the shoulder joint also known as the glenohumeral joint, allows for the most degrees of range of motion to occur versus any other joint in the human body. Since the throwing motion occurs almost exclusively at ninety degrees of shoulder abduction, the inferior glenohumeral ligament and capsule act as the primary static anterior restraint. The deltoid muscle functions to lift the humerus while the rotator cuff adjusts the position of the humeral head on the glenoid. Are we still only talking about the shoulder here? Yes, but as we take a deeper look into the composition of our body and the existing synergistic relationships associated with performing the throwing movement pattern, it should not come as a surprise that the entire kinetic chain is responsible for performing a throw. According to recent literature, Kibler and Chandler calculated that a 20% decrease in kinetic energy transfer from the lower extremity and trunk to the throwing arm required a 34% increase in rotational velocity at the shoulder in order to generate the same amount of force at the hand. Thereby concluding, more force is required at the shoulder to achieve peak velocity during a throw if the kinetic chain is in any way disrupted. On the other hand, optimization of the kinetic chain has the potential to lessen the demand at the shoulder while continuing to increase the peak velocity of the pitch. Assess the whole body!
Let us briefly breakdown the biomechanics associated with traditional phases of pitching, according to evidence based literature (Seroyer ST. Nho SJ, Bach BR, et al.):
Wind-Up: The windup phase positions the pitchers lower extremity and trunk for the most effective performance of the kinetic chain. During the windup, the pitcher keeps his center of gravity over his stance leg for as long as possible to allow for max generation and transfer of momentum and force to the upper extremity. The lower extremity and trunk serve as the main force generators of the kinetic chain.
Stride and Early Cocking Phase: Stride length allows for longer time for trunk motions to occur which allows for increased energy production for transfer to the upper extremity. During this phase, the pitcher’s pelvic rotation reaches maximum velocity and is immediately followed by the upper trunk rotation. Pelvic rotation may be limited secondary to the landing of the stride foot too far closed in front of the stance foot. The abdominal obliques fire eccentrically here to prevent excess lumbar hyperextension during torso rotation and flexion. The stance leg during this phase is providing pelvic and trunk stability via the concentric firing of gluteus maximus. As the upper extremity rotates, the throwing shoulder is experiencing a moment of external rotation. The serratus anterior and scapular retractors position the glenoid in upward rotation and retraction to provide a stable base allowing the humerus to rotate.
Late Cocking Phase: During this phase the pelvis reaches its maximum point of rotation, but the trunk continues to rotate. Increased maximum external rotation within the throwing shoulder allows for more elastic energy transfer to the ball during acceleration because this phase enables the accelerating forces to act over the longest distance. Maximum shoulder internal rotation torque occurs just before maximum shoulder external rotation is achieved. At this point of late cocking, maximum valgus torque is experienced at the elbow. The flexor and pronator muscles of the forearm generate a counter varus torque. In addition, the scapula must upwardly rotate to allow for 90-100 degrees of humeral abduction to occur without impingement at the shoulder. Eccentrically, the subscapularis, latissimus dorsi, and pectoralis major are firing.
Acceleration: the pitchers subscapularis, pectoralis major, and latissimus reach maximum concentric activity producing violent internal rotation of the throwing shoulder.
Deceleration: During the deceleration phase the teres minor, posterior deltoid, and infraspinatus are responsible for dissipating the extreme internal rotation forces as the throwing arm continues to internally rotate and adduct. This is a common theory as to why glenohumeral joint internal rotational deficits are seen in overhead throwers. Furthermore, at this time the upper and middle trapezius, rhomboids, and serratus anterior are firing to stabilize the scapula. This is known to be the most violent phase of the throwing cycle resulting in the largest amount of joint loading. It is the job of the external rotation musculature to dissipate these violent internal rotation forces.
Cutting edge evidence based literature specifically relevant to our baseball community suggests baseball players are prone to present with acute losses in multiple movement patterns involving their throwing dominant upper extremity. Immediately after throwing a baseball, the research indicates at the upper extremity responsible for throwing, there has been found to be approximately a ten degree acute loss of shoulder internal rotation, with additional range of motion reductions noted including elbow flexion and extension, and shoulder cross body adduction (DiGiovine NM, Jobe FW, Pink M, Perry J.). The restricted movement patterns have been found to be associated with an accumulation of eccentric trauma to the musculature responsible for controlling the high intensity angular forces and velocities necessary to light up the radar gun and throw with authority across the diamond. Furthermore, glenohumeral joint anterior capsule laxity combined with posterior capsule tightness, and bony adaptations, limit the functional mobility of the overhead athlete. Unfortunately, as the range of motion continues to develop further into restricted patterns, the body is forced to compensate elsewhere throughout the kinetic chain to combat the overwhelming forces and high demand required for the athlete to perform the throwing movement pattern. For example, a range of motion deficit at the elbow has the potential to increase the demand at the wrist and the shoulder in order for the upper extremity to achieve the required movement pattern necessary to perform a throw.
*Hint, hint, the majority of pitchers who are coming into the clinic with elbow pain present with ipsilateral scapular dyskinesia (your shoulder blade is not moving the way it should be!)…coincidence? Did you develop elbow pain from prolonged scapular dyskinesia?
This is where our athletes delve into the dangerous zone of either seeking appropriate skilled manual therapeutic treatment, recovering properly, and successfully making his next scheduled start at a physically optimal level, or “toughing it out,” developing poor biomechanics which ultimately become adopted and habitual, eventually leading to an increased injury rate. For our dedicated athletes who truly aspire to compete at the next level, and are always seeking that competitive edge, what would you do? Do you want to roll the dice on something that you tirelessly work at, day in and day out?
Do you know when your throwing mechanics begin to fail you? How does fatigue truly play a factor in a pitcher’s mechanics? Let’s take a look at what some of the experts are saying:
“We know that when you pitch, you’re 36 times more likely to become injured if you pitch when you’re tired, when you’re fatigued,” according to Dr. James Andrews, inventor of Tommy John Surgery and founder of the American Sports Medicine Institute (ASMI), and Kevin Wilk, lead physical therapist at ASMI (Hartigan, Matt).”
With fatigue, pitchers tend to become more upright with their trunk, achieve less maximum shoulder external rotation, and decrease their knee flexion at ball release. Their mechanics ultimately CHANGE which leads to a change in the distribution of forces on the body and an alteration in the kinematic chain. Inefficiency throughout the kinetic chain as we have already mentioned, can increase the kinetic requirements of the shoulder to maintain top velocity and performance (Seroyer ST. Nho SJ, Bach BR, et al.). As a Physical Therapist it is not only important to notice these subtle changes in the pitching motion, but we need to continue to educate our athletes on the significance of endurance training followed by implementing a plan of care SPECIFIC to the athlete to keep our athletes healthy and performing at their optimal level.
What should you do after you pitch? Poles, Ice, Tempo-Runs, Rest? As previously discussed, there is no exact formula every single pitcher can use to expedite the recovery process. However, there are a few items I would like to shed some light on based upon recently published research. Ice still works; the literature continues to support from a neurophysiological standpoint in the acute phase, that ice is beneficial for recovery for a multitude of reasons. As we transition away from the world of modalities, I am an advocate for dynamic cardiovascular conditioning. Ultimately, the main goal of an aerobic based conditioning program for the baseball pitcher who walks into my clinic, is to elicit a parasympathetic response from the Autonomic Nervous System to enhance his body’s ability to recovery more efficiently. Chronic adaptations to the body from a consistent aerobic exercise regimen include an increase in the oxidative capacity of musculature via a proliferation of mitochondria in both number and size, improved capillary density, and an increased presence of oxidative enzymes (Burkhart SS, Morgan CD, Kibler WB). Furthermore, there is an improved transfer of body heat within the body due to a larger plasma volume and an improved efficiency of thermoregulatory processes. Although the benefits from aerobic conditioning are clear cut, it is essential to avoid neglecting the anaerobic component of the conditioning program, because if you think about it, when you pitch your body is utilizing both aerobic and anaerobic systems, right? The answer is yes.
Although, evidence based research suggests existing tendencies and links between sport specific movement patterns, and the development of physical impairments, the anatomical composition of each athlete is completely different. As a Physical Therapist it is essential to develop and utilize skilled manual therapeutic techniques specific to the athlete, while maintaining proper knowledge of the sport and position. To optimize the physical potential of ten pitchers, there will have to be ten different manual therapeutic regimens developed and effectively utilized. Every athlete has their unique physiologic limitations which should not be stretched past; there is no room for “cookie cutting” in this profession, and as an athlete you should demand the best for your body. The key to properly addressing my overhead athlete includes a simple yet effective phrase: assess, and reassess. I open up my Doctorate of Physical Therapy “toolbox” and apply the manual therapeutic technique in which my athlete’s body based upon my professional assessment, will respond optimally to. Just like in any other profession, success is determined by: Results, results, results. My job is to optimize the physical potential of my athlete, incorporating theories of length-tension relationships, neurophysiologic responses, impairment minimization, and movement restoration, among others, and I love my job. I am not a pitching coach, nor do I pretend to be, because I find learning and staying within the scope of practice of your profession to be a fundamental pillar for the success of the athlete.
The goal of Physical Therapy for our baseball players here at The Spine and Health Center, typically revolves around enhancing our athletes sport specific movement patterns. Physical Therapy addresses the soft tissue mobility of our athletes through a multitude of the most modern skilled manual therapeutic techniques supported by evidence based literature. As our athletes are approaching the midpoint of their season, the key for them is to MAINTAIN not GAIN. What I mean by this is, at this time in the season it is most important for our athletes to go into the weight room and train with consistent sets, repetitions, and weight, versus trying to achieve personal bests. Save the personal best competitions for the off-season. It is key for the overhead athlete to maintain the full range of motion specifically, but not only, at the shoulder joint, to the exact degree on a consistent and daily basis. Participating in skilled Physical Therapeutic manual treatment is essential to successfully maintain a pitcher’s proper biomechanics throughout the duration of a grueling season, especially in Bergen County, New Jersey, where our climate occasionally influences a pitcher’s recovery timetable. Physical Therapy is an invaluable resource to the preservation of the health of all of our athletes.
The Take Home Message for all of the athletes reading this article:
Would you rather pitch in “X” amount games this season fluctuating between 55-90% of your physical potential, or would you rather prepare for success properly and pitch in “X” amount of games this season at 100% of your physical potential every single time you toe the rubber? Allow Physical Therapy to optimize your physical potential.
Advice: Avoid overuse and actively engage in proper baseball specific recovery programs which include: Nutrition, Quality of sleep, and Skilled Manual Therapy (Reinold, M).
Side Note: I would like to encourage every athlete reading this to quickly assess their shoulder mobility EVERY SINGLE time before they throw a baseball. The idea here is to essentially prevent gradual loss of range of motion through self-assessment.
What does your self-assessment say about the quality of your movement pattern and your range of motion?
How can you self-assess?
Supine with knees bent to prevent lumbar hyperextension, “squeeze your core and bring your thumbs up and overhead to the floor” (Reinold, M)
Recently discussed items within the clinic relevant to the baseball community:
How does your thoracic vertebrae play a role in your velocity?
Can ankle hypomobility be related to this recent onset of shoulder soreness at my throwing shoulder?
How does your body pH and temperature play a role in the recovery of your arm after you pitch?
Why is the appropriate balance between mobility and stability at your scapula-thoracic joint essential for pain free success on the mound?
In order to light up the radar gun with explosive velocity, is strength training the best option for me?
Reinold, Mike. Inner Circle Dashboard. Webinar Archives: How to Assess Overhead Shoulder Mobility, How to Perform and Advance Rhythmic Stabilization Drills, 5 tweaks to Make Shoulder Exercises More Effective, 4 Keys to Staying Healthy During the Baseball Season. https://innercircle.mikereinold.com/. Accessed 3/13/2016.
Seroyer ST. Nho SJ, Bach BR, et al. The Kinetic Chain in Overhand Pitching: ITS Potential Role for Performance Enhancement and Injury Prevention. Sports Health: A Multidisciplary Approach. 2010; 2 (2): 135-146.
Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part I: pathoanatomy and biomechanics. Arthoscopy. 2003; 19 (4):404-420 (PubMed)
DiGiovine NM, Jobe FW, Pink M, Perry J. An eletrocmyographic analysis of the upper extremity in pitching. J shoulder Elbow Surg. 1992; 1(1):15-25(PubMed)
Kibler WM, Chandler J. Baseball and tennis. In: Griffin LY, editor., ed. Rehabilitation of the Injured Knee. St. Louis, MO: Mosby; 1995:219-226
Gowan ID, Jobe FW, Tibone JE, Perry J, Moynes DR. A comparative electromyographic analysis of the shoulder during pitching: professional versus amateur pitchers. Am J Sports Med. 1987;15(6):586-590 (PubMed)
Reinhold MM, Gill T.J. Current Concepts in the Evaluation and Treatment of the Shoulder in Overhead Throwing Athletes, Part 1: Physical Characteristics and Clinical Exanination. Sports Health: A Multidisciplinary Approach.
Fortenbaugh D, Fleisig GS, Andrews JR. Baseball Pitching Biomechanics in Relation to Injury Risk and Performance. Sports Health: A MultiDisciplinary Approach. 2009; 1(4): 314-320.
It has been reported that approximately 1 in 10 individuals will develop chronic heel pain with nearly 2 million Americans affected annually. Furthermore, tendinopathies of the Achilles tendon affect 2% of the general adult population. The typical report of pain presentation of plantar heel pain includes excruciating pain with the first few steps after waking up in the morning, prolonged sitting and with prolonged weight bearing activity. These symptoms often reduce throughout the day as compared to first thing in the morning, but lead to significant functional limitations and even prolonged disability.
Identifying the Problem
A tendon is an anatomical structure that connects muscle to bone, examples include the Patella tendon and Achilles tendon. A tendon is an inherently strong tissue; however, just as with muscular injuries, tendons are subject to overuse. Overuse injuries to tendons often occur with constant and repetitive loading in biomechanically flawed positions. Characteristic changes occur in the tendon structure, resulting in a tendon that is less capable of sustaining repeated tensile load (Cook JL, Khan KM, Kiss ZS, et al). Tendon injuries can occur in the mid-tendon, which is often the case in Achilles tendonitis/osis; however, most tendon pathology arises from the insertion of the tendon to the bone such as with patellar tendonitis/osis.
Tendonitis, Tendonosis, and Tendinopathyathy
The suffix “itis” implies acute (of recent onset/new) injury with inflammation. Different from acute injury with inflammation, tendon”osis” implies chronic (long term) pathology or degeneration without inflammation. Finally Tendon”opathy” simply refers to a disease of a tendon.
Can Exercise Improve Tendon Function?
Research suggests that eccentric exercise affects both the tendon structure as well as pain by increasing collagen production in abnormal tendons with both short and long term. Furthermore, recent research has added that exercise with a combination of manual therapy (hands on approach to treatment) provides greater clinical benefits in terms of function than just exercising and using modalities such as heat, ice, ultrasound, electric stimulation etc.
Eccentric, Concentric and Isometric Contractions
When you consider a muscular contraction, you may think of a simple motion such as a heel raise. During the initial part of the heel raise your triceps surae (calf muscles) are concentrically contracting (or shortening); however, what about the second portion of the exercise? During the descending portion of the heel raise, the triceps surae must control the decent of the weight being held or else your heel would simply drop towards the ground. Here, these muscles are contracting eccentrically, meaning contracting while simultaneously lengthening. On an unrelated note, isometric contractions involve a static muscle activation without associated movement. Consider the same heel raise exercise; however, after raising heels from a neutral position, your heel maintains in the same position for approximately 45 seconds, here your triceps surae muscles are active as to maintain the heel off position, but are not causing physical movement of a structure.
Physical Therapy Protocols for Achilles Tendinopathyathy
The exercises listed below are helpful in preventing and improving tendon pathologies; however, they should not be performed without proper evaluation by a physical therapist in order to determine proper dosage and prescription. To find out more contact us now!
Plantar Fascia Rolling
Why focus on the bottom of the foot for pain in the back of my ankle you ask? Understanding anatomy is key! The plantar fascia inserts to the dorsal aspect of the calcaneus, which happens to also be bone in which the Achilles tendon attaches to (more posteriorly and superiorly). If your plantar fascia is tight, it certainly will affect the kinetic chain by increasing passive tension on the Achilles tendon. Rolling this structure is not “fun”, plain and simple, it hurts for most, but has a drastic impact on foot and ankle health!
Intrinsic Muscle Activation
The intrinsic foot muscles help to stabilize the arch of your foot and improve the biomechanical forces dispersed through the foot with simple activities such as walking to more complex activities such as running, cutting and jumping. Strengthening and activating these muscles will help to improve pain by improving functional movement patterns, thus reducing risk for re-injury.
Self Plantar Fascia Massage
Taking rolling to the next level, massaging the bottom of the plantar fascia will be imperative for the improvements of kinetic chain mobility. While doing so, observe the distal (far) attachment of the plantar fascia to the digits, this means that flexing and extending your toes passively with your non massage hand will sensitize the massage in order to create the best response to treatment.
Triceps Surae Foam Rolling
As always, rolling is imperative prior to stretching, rolling relaxes tissue prior to stretching the tissue out. This is important because stretching a tonic or tight muscle can actually cause more pain in an irritated irritable musculotendonus structure.
Gastrocnemius and Soleus Muscle Eccentric Activation (Heel Raises)
Properly performing this exercise depends on the location of pain, for mid belly Achilles tendon pathology, perform on a step. Start by raising your heels up in the air to the top of motion and slowly lower yourself back down below parallel. This exercise will help to strengthen the posterior lower leg muscles and reduce recurrent pathology.
Gastrocnemius and Soleus Stretching
The gastrocnemius is the large posterior lower leg muscle that crosses both the knee and the ankle joints, as seen below. What this means is that in order to effectively stretch this muscle both the knee and the ankle need to be taken into consideration (extended). To stretch the soleus muscle, the knee is slightly flexed secondary to this muscle not crossing the knee joint. Flexing the knee will eliminate some of gastrocnemius’ tension allowing for a deeper and more effective stretch.
O’Brien M. e anatomy of the Achilles tendon. Foot Ankle Clin 2005; 10(2): 225–38.
Cook JL, Khan KM, Kiss ZS, et al. Asymptomatic hypoechoic regions on patellar tendon ultrasound: a 4-year clinical and ultrasound follow-up of 46 tendons. Scand J Med Sci Sports 2001; 11: 321–7.
O’Neill, S, Watson PJ, Simon, B. Why are eccentric exercises effective for Achilles tendinopathy. The International Journal of Sports Physical Therapy 2015; 10: 552-63.
Cleland JA, et al. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: A multicenter randomized clinical trial. Journal of Orthopedic and Sports Physical Therapy 2009; 39: 473-86.
Cook, JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 2009;43:409–416.
According to the American Pregnancy Organization and the International Chiropractic Pediatric Association, women who seek chiropractic care during pregnancy report 24% shorter labor and delivery times and have fewer complications and 75% of women who received chiropractic care during their pregnancies stated they found relief from pain. Due to the increased hormone called relaxin that is secreted during pregnancy, a woman’s ligaments are more flexible and often any areas of weakness in the alignment of the spine are made worse. This can result in lower back pain and sciatica, neck pain and headaches, pubic symphysis pain and sacroiliac discomfort. The sooner you begin care the more likely you are to avoid the common pains and discomforts many women experience during pregnancy.
One of the most important roles of a chiropractor in prenatal care is to establish pelvic balance and alignment, not only to reduce the mother’s discomfort but also to allow the baby to be in the best position for delivery. When the pelvis is misaligned it may reduce the amount of room for the developing baby to be comfortable and they may seek out a less than optimal positioning for birth. A specialized treatment called the Webster Technique can be performed by a certified chiropractor if the baby is in the breech position during the final weeks of pregnancy. This technique is performed to safely turn the baby into the ideal position for delivery and has an 85 percent success rate when performed before 39 weeks. Common pregnancy complaints such as heartburn, insomnia, carpal tunnel syndrome and even swelling in the hands and feet can be relieved with chiropractic care.