Author: Dr. Robert Speirs DC
Snapping Hip. Not as horrific as it sounds.
The muscle responsible for flexing your hip toward your trunk, is called the Psoas. This muscle begins on your lower spine and passes through your pelvis to attach onto the top of your femur (thigh bone). Along this course, the muscle travels across the front of your hip socket and over several bony prominences. If the muscle is too tight, its tendon may rub over these “bumps”. This occasionally produces an audible snapping sound, hence the moniker, “snapping hip”, aka “psoas tendinopathy”.
The tendon can be irritated by an acute injury, but more commonly from overuse- particularly repeatedly flexing your hip toward your trunk. The condition is also known as “dancer’s hip” or “jumper’s hip”, as movements associated with these activities are known culprits. Likewise, the condition is frequently seen in athletes who participate in rowing, track and field, hurdling, running (especially uphill), soccer, and gymnastics.
Your symptoms may include a “snapping” sound or sensation when you flex and extend your hip- although many cases are silent. Repeated rubbing causes inflammation and subsequent deep groin pain that can radiate to the front of your hip or thigh. Long-standing problems can trigger weakness or even limping.
The diagnosis of snapping hip is frequently overlooked. In fact, some studies show that identification is often delayed more than two years, while other potential causes are pursued. Fortunately, your problem has been recognized, and our office has several treatments to help you recover.
Psoas problems often start when one group of muscles is too tight, while another is too loose. Your home exercises will help to correct this problem. Depending upon the severity of your condition, you may need to avoid certain activities for a while. You should especially avoid repetitive hip flexion. Prolonged seated positions can encourage shortening of your hip flexors so be sure to take frequent breaks. Patients with fallen arches may benefit from arch supports.
Biceps Tendon Injury. The “suns out, guns out” injury.
Your biceps muscle attaches to your shoulder through two strong fibrous bands called “tendons.” The term “biceps tendinitis” means that one of these bands has become painfully irritated from strain or degeneration. Sometimes the tendon may be strained by an accident or lifting injury. Biceps tendinitis more often results from repeated pinching of the tendon beneath the bony part of your shoulder
from a condition called “impingement.” Repeated overhead activity, like throwing, swimming, gymnastics, and racquet sports are known culprits. Biceps tendinitis is often accompanied by other conditions, like rotator cuff tears or injuries to the cartilage around the rim of your shoulder joint. Factors that make you more likely to develop biceps tendinitis include: improper lifting techniques, inflexibility, poor posture, or repetitive overloading.
Your symptoms likely include a deep, throbbing ache over the front of your shoulder. The pain often refers toward the outside of your arm. The main job of your biceps muscle is to flex your elbow and turn your palm up, so overhead movements or activities that require flexion of your elbow may cause pain. Patients often report increased discomfort when initiating activity. Night time symptoms are common, especially if you lie on your affected shoulder. Be sure to tell your doctor if you notice popping, catching, or locking during movements, as this may suggest an additional problem. A painful, loud “pop” followed by relief with a visible bulge in your biceps (Popeye deformity) suggests that your tendon has ruptured.
Surgery is rarely required for biceps tendon problems unless you are a young athlete or worker who performs exceptionally heavy physical activity and have completely ruptured your tendon. The most effective treatment for the majority of biceps tendinitis patients is conservative care, like the type provided in our office. Initially, you may need to avoid heavy or repetitive activity, (especially overhead activity and elbow flexion) as returning to activity too soon may prolog your recovery. You should specifically avoid military presses, upright rows, and wide grip bench presses until cleared by your doctor. You may use ice over your shoulder for 10-15 minutes at a time each hour. The exercises described below will be a very important part of your recovery and should be performed consistently.
CTS Warning Signs
Headaches are REALLY common! In fact, two out of three children will have a headache by the time they are fifteen years old, and more than 90% of adults will experience a headache at some point in their life. It appears safe to say that almost ALL of us will have firsthand knowledge of what a headache is like sooner or later!
Certain types of headaches run in families (due to genetics), and headaches can occur during different stages of life. Some have a consistent pattern, while others do not. To make this even more complicated, it’s not uncommon to have more than one type of headache at the same time!
Headaches can vary in frequency and intensity, as some people can have several headaches in one day that come and go, while others have multiple headaches per month or maybe only one or two a year. Headaches may be continuous and last for days or weeks and may or may not fluctuate in intensity.
For some, lying down in a dark, quiet room is a must. For others, life can continue on like normal. Headaches are a major reason for missed work or school days as well as for doctor visits. The “cost” of headaches is enormous—running into the billions of dollars per year in the United States (US) in both direct costs and productivity losses. Indirect costs such as the potential future costs in children with headaches who miss school and the associated interference with their academic progress are much more difficult to calculate.
There are MANY types of headaches, which are classified into types. With each type, there is a different cause or group of causes. For example, migraine headaches, which affect about 12% of the US population (both children and adults), are vascular in nature—where the blood vessels dilate or enlarge and irritate nerve-sensitive tissues inside the head. This usually results in throbbing, pulsating pain often on one side of the head and can include nausea and/or vomiting. Some migraine sufferers have an “aura” such as a flashing or bright light that occurs within 10-15 minutes prior to the onset while other migraine sufferers do not have an aura.
The tension-type headache is the most common type and as the name implies, is triggered by stress or some type of tension. The intensity ranges between mild and severe, usually on both sides of the head and often begin during adolescence and peak around age 30, affecting women slightly more than men. These can be episodic (come and go, ten to fifteen times a month, lasting 30 min. to several days) or chronic (more than fifteen times a month over a three-month period).
There are many other types of headaches that may be primary or secondary—when caused by an underlying illness or condition. The GOOD news is chiropractic care is often extremely helpful in managing headaches of all varieties and should be included in the healthcare team when management requires a multidisciplinary treatment approach.
He barely hit me; why does it hurt?
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You may have heard the comment, “If there’s no damage to the car, then there’s no injury.” Unfortunately, that does not always seem to be the case.
There are MANY factors that affect the dynamics of a collision and whether or not injury occurs. A short list includes: vehicle type and design, speed, angle of collision, momentum, acceleration factors, friction, kinetic and potential energy, height, weight, muscle mass, seat back angle and spring, head position upon impact, etc.
Consider Sir Isaac Newton’s Third Law of Motion: “For every action there is an equal and opposite reaction.” This law applies to a car accident at any speed. Using the analogy of hitting a pool ball into the corner pocket straight on, when the cue ball stops, its momentum is transferred to the target ball which accelerates at the same speed…hopefully into the corner pocket!
This example is not quite the same as an automobile collision because the energy transfer is very efficient due in part to the two pool balls not deforming (crushing or breaking) on impact with one another. If either ball did deform, more energy absorption would occur and the acceleration of the second ball would be lower.
In fact, in the United States, vehicle bumpers are tested at 2.5 mph with impact equipment of similar mass with the test vehicle’s brakes disengaged and the transmission in neutral. National Highway Transportation Highway Safety Administration (NHTSA) vehicle safety standards demand that no damage should occur to the car in this scenario.
However, energy transfer occurs very quickly and with a greater amount of force when there is no vehicle deformation (damage). As a result, a greater amount of energy (described as G-force) is directly transferred to the occupants inside the vehicle—increasing the risk of injury. A 1997 Society of Automobile Engineers article provided an example in which the same 25 mph (12 m/s) collision resulted in a five-times greater force on the occupants of the vehicle when the crush distance of the impact fell from 1 meter to .2 meters.
So be aware that even low-speed impacts can still place quite a bit of force on your body, even if the bumper of your car doesn’t have a scratch on it.
What is a Migraine? What can I do about them?
A “migraine” is an intense throbbing headache that may be accompanied by nausea, vomiting, and sensitivity to light or noise. Adult women are three times more likely than men to experience migraines. The frequency of migraine headaches usually peaks between age 30 and 40, and attacks decrease thereafter. The onset of a new migraine headache after age 50 is rare.
Migraine headaches are caused by a combination of nerve irritation and enlargement of the blood vessels in your brain. Migraines tend to run in families and sufferers have inherited a sensitive nervous system from their parents. Patients who are overweight or have other vascular risk factors are more likely to suffer from migraines.
Migraines are set off by “triggers” and the headache occurs when the number of triggers reaches a critical threshold. This can be likened to a glass of water that overflows at a certain point. Known triggers include: neck tightness, stress, smoking, strong odors (i.e. perfumes), bright or flickering lights, fluorescent lighting, too little or much sleep, head trauma, weather changes, motion sickness, cold (ice cream headaches), lack of activity or exercise, overexertion, fatigue, eyestrain, dehydration, hunger, fasting, and hormonal changes, including menstruation and ovulation. Certain medications, including hormones or oral contraceptives are known triggers. A detailed list of foods that trigger migraines is provided below.
About 20-33% of people who get migraines have warning symptoms, called an “aura”, before their actual headache attack. Aura symptoms develop slowly over five to 20 minutes and can last up to an hour. The most common aura is a band of absent vision with an irregular shimmering border. Some patients report numbness or tingling in their arms or face. Be sure to tell your doctor if you experience any confusion or decreased consciousness with your headache. Other signs to watch for include: abrupt headaches that develop and peak very quickly, headaches that develop following a head injury, light-headedness, dizziness, difficulty speaking, difficulty swallowing, difficulty walking, fever, rash, or any “new” headache that is significantly different from your prior headaches.
Many patients benefit from the types of treatment provided in this office. Research has shown a “significant reduction” in migraine frequency and intensity through chiropractic care. Your home management will focus on avoiding “triggers” and stress. You should begin keeping a headache diary to help you track and eliminate triggers. Patients who experience migraines are more susceptible to other types of cardiovascular disease, like heart attack and stroke. Be sure to choose a “heart healthy” diet (i.e. limit sodium and fats) and keep your weight controlled. Eat at regular intervals and stay well-hydrated as hunger and dehydration are known triggers.
Your doctor may talk to you about supplements like Feverfew (125mg/ day), Riboflavin (400mg/ day), Magnesium (400-600mg/ day) and Co-enzyme Q10 (100mg 3x per day) that have been helpful in preventing headaches for some migraine sufferers. The American Headache Society recommends that patients avoid overuse of medication to control their headaches, (no more than 2 doses per day, 2 days/week) as this can lead to more frequent “rebound” headaches. Do not begin or discontinue any new vitamins or medications without talking to your doctor first, especially if you are nursing or pregnant.
Another tunnel injury? Seriously?
Your radial nerve begins in your neck and travels past your elbow en route to its final destination in your hand. Just beyond your elbow, this nerve passes through a 2-inch area on the back of your forearm called the “Radial tunnel”. “Radial tunnel syndrome” means that your radial nerve has been compressed or irritated within this space-leading to forearm pain or hand weakness.
Radial tunnel syndrome is thought to result from muscular overuse, especially prolonged or excessive wrist extension or rotation. The most common cause of compression comes from excessive tightness in a muscle called the “Supinator”. Workers whose jobs require heavy or repetitive wrist movements are at an increased risk for this disorder. Occasionally, the radial nerve can become irritated from direct compression by a tight band or brace. The condition may be more common in those who have diabetes or thyroid problems.
Symptoms from irritation of the radial nerve depend upon which specific nerve fibers are irritated. The most common symptoms include pain, numbness, tingling or decreased sensitivity along the top of your forearm radiating toward your hand and thumb. The symptoms often mimic those of “tennis elbow.” When the nerve fibers that control muscle function become compressed, you may experience weakness when trying to extend your fingers, hand or wrist. Seventy percent of radial tunnel patients also have problems in their neck or upper back.
Conservative treatment of radial tunnel syndrome is generally successful. Fixing the problem means limiting excessive or repetitive wrist movements, especially extension and rotation. In severe cases, a splint may be necessary to limit your motion. Try to avoid compression of your forearm, particularly from tight bands or braces. Use of a tennis elbow brace will likely aggravate your symptoms. You may find relief by applying ice or ice massage to the area for 10-15 minutes at a time.
Home Gym Essentials
So you want to build your own home gym but you have no idea what kind of equipment to buy. There are two main limiting factors in outfitting a workout area in your house or apartment—space and budget—but with proper planning, you can design an exercise studio perfectly tailored to your needs. Simply start with the essentials, and then branch out to more specialized equipment as you need it. Below are a few of the essentials that can get your started on your home gym journey.
Quality Mats
No matter what your plans are for your home gym a good quality floor mat is key. You can opt for the single mat for stretching and floor work or go shoe hog with an entire flooring system but be sure to go with a high quality, durable product. Rogue Canada has some great products in this (and most) category from floor mats to olympic lifting platforms, as do spots from Fitness Experience to Home Depot.
Suspension Trainer
Maximizing use of space and finding tools with multiple uses are keys when designing your home gym. One of the best pieces of equipment for both those concerns are suspension trainers. The TRX Home2 System is one of the best purchases you can make for your home gym. It includes the latest TRX Suspension Trainer for homes, as well access to the TRX app. (With more than 80 workouts designed by world-class trainers, the app will keep you busy.) While the Home2 System costs less than $200, it is one of the bigger purchases on this list. What makes it worthwhile is that Suspension Training offers a full-body workout that can be modified for any fitness level.
Resistance Bands
Easy to store, easy to use, easy to afford and easy to scale. Resistance bands are a great addition to any home gym. From stands of tubing to elastic loops and heavy resistance with handles, resistance bands come in many shapes and sizes and can be used to add to any fitness routine. Depending on your fitness goals, resistance tubing can be your main source of muscle building or an add oil that enhances lifts. They are a rehab essential as well when working through those nagging injuries that we all get from time to time and a key part of training for pliability as shown in the TB12 method. Every major fitness retailer has dozens of options for you and can help you decide on what you need based on your goals.
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This list is a great start for your home fitness journey but isn’t all inclusive by any means. Everyone’s goals are different, require different levels of equipment and different levels of motivation. The key with any of them is to get committed, get started and get moving!
Can Carpal Tunnel Be Prevented?
Carpal Tunnel Syndrome (CTS) is a VERY common condition where the median nerve is compressed or squeezed as it passes through the wrist. One reason that it’s so common is because MANY daily activities require fast, repetitive use of the fingers, hands, and arms, and the friction of the rapidly moving muscle tendons inside the tunnel results in swelling and compression of the nerve. So, can CTS really be prevented?
There are many factors associated with CTS, and some risks can be prevented. For example, some conditions like diabetes, rheumatoid arthritis, and IBS increase the risk of CTS. Therefore, it would be safe to assume those who better manage such conditions would have a lower risk for developing CTS.
Due to the many factors associated with CTS, there is no “one size fits all” when it comes to treatment and prevention of CTS. With that said, here are some VERY effective methods:
1) Ergonomic workstation modifications: Altering the work space (monitor height, keyboard/mouse style, different chair, chair/desk height, etc.) to reduce the number and speed of movements needed to perform commons work tasks.
2) Rest periods: Insert “micro-breaks” into a busy task. Combine breaks with stretching exercises of the wrist/hand/fingers and vary job tasks between fast and slow repetitive types.
3) Exercise: Shake the fingers and hands, lean back in a chair with the arms/shoulders stretched back (“Brugger’s Exercise”), move the neck (chin tucks, rotations, etc.), bend the hand/wrist backwards on a wall or the desk’s edge, self-massage and deep tissue release of the forearm and hand muscles. Do regular aerobic exercise (walking, swimming, biking, etc.) several times each week.
4) Posture: Sit up straight, elbows about 90° on height-adjustable arm rests or comfortably at the sides, forearms parallel to the floor; knees level or slightly lower than the hips, feet flat on the floor or on a footrest or box, if needed. Place typing materials at eye level / avoid prolonged head/neck rotation. Use a wrist rest for the keyboard and mouse, and use a headset when on the phone.
5) Reduce hand tool forces: Choose a tool that allows the wrist to remain neutral. Avoid side to side and flexion/extension wrist positions—especially if they’re prolonged! Tool handles should NOT dig into the palm of the hand or the wrist, and should not have sharp edges. A textured handle can improve grip. Minimize vibration from power tools. Wear shock absorbing gloves. Avoid cold work environments and cold tools.
6) Diet: Cut down on caffeine and smoking. Avoid obesity—a known risk factor of CTS! Consider an anti-inflammatory diet (Paleo, Mediterranean).
7) Splints: A wrist cock-up splint at night prevents prolonged faulty positions and REALLY helps!
This is a partial list of preventative measures that can REALLY help. Doctors of chiropractic treat the WHOLE person and can teach you the right exercises, ways to modify your diet, offer manual therapies and modalities, and help guide you in your self-management of CTS, as this can be a lifelong affliction. A multi-modal treatment approach generally works best!
Aberdeen Chiropractic 