Chronic Pain

A weak lateral chain will stop you in your tracks.

~ Dr. Robert Speirs DC ~ Leave a comment

One very important job of your hip muscles is to maintain the alignment of your leg when you move. One of the primary hip muscles, the gluteus medius, plays an especially important stabilizing role when you walk, run, or squat. The gluteus medius attaches your thigh bone to the crest of your hip. When you lift your left leg, your right gluteus medius must contract in order to keep your body from tipping toward the left. And when you are standing on a bent leg, your gluteus medius prevents that knee from diving into a “knock knee” or “valgus” position.
Weakness of the gluteus medius allows your pelvis to drop and your knee to dive inward when you walk or run. This places tremendous strain on your hip and knee and may cause other problems too. When your knee dives inward, your kneecap is forced outward, causing it to rub harder against your thigh bone- creating a painful irritation and eventually arthritis. Walking and running with a relative “knock knee” position places tremendous stress on the ligaments around your knee and is a known cause of “sprains”. Downstream, a “knock knee” position puts additional stress on the arch of your foot, leading to other painful problems, like plantar fasciitis. Upstream, weak hips allow your pelvis to roll forward which forces your spine into a “sway back” posture. This is a known cause of lower back pain. Hip muscle weakness seems to be more common in females, especially athletes.

You should avoid activities that cause prolonged stretching of the hip abductors, like “hanging on one hip” while standing, sitting crossed legged, and sleeping in a side-lying position with your top knee flexed and touching the bed. Patients with fallen arches may benefit from arch supports or orthotics. Obesity causes more stress to the hip muscles, so overweight patients may benefit from a diet and exercise program. The most important treatment for hip abductor weakness is strength training. Hip strengthening is directly linked to symptom improvement. Moreover, people with stronger hip muscles are less likely to become injured in the first place. The exercises listed below are critical for your recovery.

Bryan Cobb RMT.

~ bryancobb ~ Leave a comment

Since 2005, Bryan has been dedicated to helping all people with chronic and acute pain caused by soft-tissue damage.

His training and experience make him uniquely qualified to treat a wide variety of pain and dysfunction and to give instruction on prevention and self-care.

Bryan is the only Massage Therapist in Manitoba — and one of the few in Canada — to be certified by the Certification Board for Myofascial Trigger Point Therapists (CBMTPT).

Bryan holds a degree as an Advanced Remedial Massage Therapist (ARMT) from the Massage Therapy College of Manitoba.  Course work at MTCM includes
• over 2,000 hours of practice, as well as
• intensive course work,
• a supervised clinical practicum, and
• community outreach placements.

MTCM has a credit transfer affiliation with the University of Winnipeg, ensuring that its courses are held to the highest level.  When Bryan studied at MTCM, the college was the only massage therapy college in western Canada accredited by the Commission on Massage Therapy Accreditation.  Today, the college is a member of the Canadian Council of Massage Therapy Schools.

Bryan is a member in good standing of the Natural Health Practitioners of Canada.

Bryan also has a background in Anatomy, Exercise Physiology, and Sport Sciences from the University of Manitoba, and he has worked as a personal trainer and fitness leader.

He is an avid natural bodybuilder and fitness enthusiast, and has a blue belt in Brazilian jiu-jitsu.

Trigger points in the Quadratus Lumborum muscle.

~ bryancobb ~ 1 Comment

The quadratus lumborum muscle is a commonly overlooked source of low back pain and is often responsible for “pseudo disc syndrome”. This muscle originates on the inferior border of the 12th rib and lumbar transverse processes. It inserts on the iliac crest and iliolumbar ligament. The q.l.’s main actions are extension and lateral flexion of the spine. It also acts as a stabilizer of the lumbar spine. Trigger points in this muscle refer pain into the sacroiliac joint and the lower buttock. Pain can also spread anteriorly along the crest of the ilium into the lower abdomen and groin and to the greater trochanter.

Want a fancy new hip? Start with this!

~ Dr. Robert Speirs DC ~ Leave a comment

A “joint” is an area where two or more bones come together. These bones have a slick rubbery protective covering, called “cartilage,” on the areas where they meet. This cartilage serves as a friction reducer and shock absorber, thereby prolonging the health of our joints.

Osteoarthritis, or simply arthritis, occurs when your joint cartilage degenerates as a result of repetitive stress.

Over time, this cartilage can thin and crack, eventually wearing away, leading to a painful “bone on bone” situation. Thinning of your joint cartilage is often accompanied by the development of “bone spurs” and/or joint deformity further disrupting your joint function.

Hip arthritis is common, affecting up to one-third of the population. The likelihood of you developing osteoarthritis increases as you age, and appears to be at least partially inherited from your parents. It is more common if you have been overweight and if you were subjected to repetitive injury, including occupations & sports requiring prolonged standing or heavy physical exertion.

An early symptom of Hip OA is prolonged stiffness upon arising in the morning and following periods of inactivity. You might complain of the inability to put your socks on, shave your legs or climb stairs. Groin, thigh and buttock pain are common. In some cases the pain can radiate into your lower leg. Cracking and popping of your hip when moving is possible.

It is sometimes difficult for doctors to differentiate between hip osteoarthritis and lower back problems that can also cause hip pain. Your doctor will likely X-ray your hip to determine the extent of your arthritis (graded 1-4 based on severity).

Arthritis cannot be cured, but your symptoms can often be relieved. Treatment of hip arthritis may include exercises, especially water-based programs like “water-aerobics.” Your doctor may use physical therapy modalities and will likely stretch and manipulate your hip, as this has been shown to be effective at relieving symptoms.

Your doctor may recommend that you avoid aggravating activities, especially those requiring you to rotate your hip internally (i.e., pigeon toed” movements), and to maintain a healthy weight. You will be taught home stretching and strengthening exercises to help you recover. Taking 1500 mg of Glucosamine and chondroitin has been shown to help some arthritis sufferers.

In more severe cases, you may need to use a cane (in the opposite hand) to take weight off the arthritic hip. If conservative treatment fails to relieve your pain, your doctor might recommend consultation with an orthopedic hip specialist to consider joint replacement.

Chondromalacia Patellae; sounds dramatic, usually isn’t.

~ Dr. Robert Speirs DC ~ Leave a comment

The term “Chondromalacia Patellae” (CMP) describes painful damage to the cartilage behind your kneecap. CMP may begin at any age and is commonly found in teenagers. The likelihood of developing CMP increases with age, and the condition is more common in females. You are more likely to develop CMP if you are overweight or have had a prior knee injury.
One of the most common causes of CMP is an imbalance between the muscles that help to guide your kneecap and its “V-shaped” groove at the end of your thigh bone. Repeatedly flexing and extending a misaligned kneecap leads to pain, swelling, and eventually cartilage damage. Misalignment of the kneecap (patella) is often secondary to problems in your hip and foot, especially weakness of your gluteal muscles or flat feet.

CMP causes a dull pain behind your kneecap that is aggravated by prolonged walking, running, squatting, jumping, kneeling, stair climbing, or arising from a seated position. The pain is often worse when walking down hill or down stairs. Popping, grinding, or giving way may occur from long-standing misalignments.

Conservative care, like the type provided in this office, is generally successful at relieving your symptoms. It is important for you to minimize activities that provoke your pain, especially running, jumping, and activities that stress you into a “knock-knee” position. Do not allow your knees to cross in front of your toes when squatting. Some athletes may need to modify their activity to include swimming or bicycling instead of running. Performing your home exercises is one of the most important things that you can do to help recover. The use of home ice or ice massage applied around your kneecap for 10-15 minutes, several times per day, may be helpful.

I’ve got a sharp burning pain in my foot, what could it be? 

~ Dr. Robert Speirs DC ~ Leave a comment

Morton’s neuroma is a benign (non-cancerous) enlargement of one of the nerves in your foot. The problem most commonly occurs between your third and fourth toes, but can occur elsewhere. Morton’s neuroma is a nuisance for 10% of the adult population, with females being affected 5 times more often.

The irritation is thought to be brought on by activities that require repeated or forceful back-bending of your toes, like dancing, walking, squatting, and running- particularly running on your forefoot, or on hard surfaces. Wearing high heels or shoes that are too tight can provoke your symptoms.

You may experience brief, intermittent episodes of sharp burning pain that are followed by a persistent dull ache begins near the ball of your foot and radiates into the toes. You may feel as though you are “walking on a marble.” Occasionally, numbness, tingling, or cramping may accompany your pain. You may find relief by removing your shoe and/ or gently massaging your foot. Be sure to tell us if your symptoms affect your entire foot, if you notice any weakness, or have pain that starts in your back and travels into your thigh and leg.

You should avoid wearing high-heeled narrow or unpadded shoes. If you are a “forefoot” runner, you may consider transitioning to a mid-foot strike. Your treatment will likely consist of wearing a specially designed felt pad to help take stress off of the irritated nerve. Most patients report relief by modifying their shoes and undergoing conservative therapies, like the ones provided in our office.

Trigger points in the temporalis muscle

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The temporalis muscle is located in the temple area of the skull. It originates on the temporal lines on the parietal bone of the skull, and inserts on the coronoid process of the mandible. It’s main action is to close the jaw. The posterior and middle fibres bilaterally retrude the mandible. Acting individually, this muscle will deviate the mandible to the same side. Trigger points in this muscle refer into the teeth causing hypersensitivity, and into and above the eye and temple, causing headaches.

Osteoarthritis of the Hand

~ Dr. Robert Speirs DC ~ Leave a comment

The bones in your hand have a slick, protective covering called “cartilage” on the joint surfaces that touch each other. This cartilage serves as a friction reducer and shock absorber, thereby, helping to extend the life of your joints. “Arthritis” means that your cartilage has begun to thin or crack and may eventually wear away –impairing your strength and dexterity. Painful hand arthritis affects

up to 1 in 4 people. This degeneration has a tendency to affect specific joints, especially those of your index and middle fingers and the base of your thumb.

Your chance of developing arthritis increases with age. Hand arthritis is 2 1/2 times more common in women. Arthritis occurs more often in joints that have been previously injured and in patients who perform repetitive movement of the hands- particularly labor and manufacturing jobs. Other risk factors include obesity and the presence of arthritis in your parents. Contrary to popular opinion, knuckle cracking does not increase your risk of arthritis, regardless of duration or frequency.

Symptoms usually begin slowly and progress into longstanding hand pain that comes and goes. Your symptoms are likely aggravated by activity and relieved by rest. Hard, bony enlargements often develop along the joint lines, especially in women. You may notice morning stiffness that subsides fairly quickly. Be sure to tell your doctor if you notice lasting morning stiffness or swelling, as this could be a sign of a different type of arthritis.

The American College of Rheumatology recommends the use of non-drug treatments (like the type provided in this office) for hand osteoarthritis. Patients with thumb osteoarthritis may benefit from a nighttime splint. Topical creams, especially those including “capsaicin” may help relieve symptoms. You may find relief by warming your hands with a hot pack or “paraffin bath” when they feel stiff. Some patients report benefit by taking Glucosamine Sulfate. The mainstay of treatment includes exercises to help improve your mobility and strength.

Runner’s Knee Sucks.

~ Dr. Robert Speirs DC ~ Leave a comment

Patellofemoral pain syndrome (PFPS) describes a painful irritation of the cartilage behind your kneecap. Although anyone may be affected, it is often the result of overuse of the knee in sports that require jumping or running so it is sometimes referred to as “Runner’s knee”. PFPS is the most common cause of knee pain in the general population, affecting an estimated 25% of adults.

One of the most common causes of PFPS is an imbalance between the muscles that help to guide your kneecap in its V-shaped groove at the end of your thigh bone. Repeatedly flexing and extending a misaligned kneecap leads to pain, swelling and eventually arthritis. Misalignment of the kneecap (patella) is often secondary to problems in the hip and foot, especially weakness of your gluteal muscles or flat feet.

PFPS produces a dull pain behind the kneecap that is aggravated by prolonged walking, running, squatting, jumping, stair climbing or arising from a seated position. The pain is often worse when walking downhill or down stairs. Longstanding misalignment can cause damage to the cartilage, which results in popping, grinding or giving way.

Conservative care, like the type provided in this office, is generally successful at relieving your symptoms. Initially, it is important for you to minimize activities that provoke your pain, especially running, jumping and activities that stress you into a “knock-kneed” position. Don’t allow your knees to cross in front of your toes when squatting. Some athletes may need to modify their activity to include swimming or bicycling instead of running.

Performing your home exercises consistently is one of the most important things that you can do to help realign the patella, relieve pain and prevent recurrence. The use of home ice or ice massage applied around your kneecap for 10-15 minutes, several times per day may be helpful.

What is knee tendonitis?

~ Dr. Robert Speirs DC ~ Leave a comment

Tendons are strong bands of fibrous tissue that connect your muscles to your bones. Your “patellar tendon” connects your kneecap (patella) to your shin bone (tibia). “Patellar tendonopathy” results from repetitive straining and micro-tearing of this connection, resulting in pain and inflammation. The condition is referred to as “jumper’s knee,” since damage is thought to often result from repetitive jumping.

The condition should probably be called “landing knee,” since forces on the patellar tendon are twice as great during landing as compared to those created during take off.

Patellar tendinopathy is common, affecting almost 20% of all athletes with a rate as high as 50% in sports that require repetitive forceful jumping, like basketball and volleyball. The condition may affect one or both knees and may be slightly more common in males.

Weakness in the quadriceps muscle of your thigh can allow excessive bending of your knee when you land following a jump. This places your patellar tendon at a greater risk for injury. Having strong quadriceps muscles protects your knee from excessive flexion and injury.

Symptoms of patellar tendinopathy include pain or swelling just below your kneecap. This may begin without an identifiable injury and may come and go for months or years. Symptoms are usually aggravated by activity, but most athletes have been able to continue playing through the pain. Pain often increases during activities that require strong quadriceps contraction, like jumping, squatting, arising from a seated position, stair climbing, or running. Walking down stairs or running down hill seems to be more bothersome than going up.

Some athletes may have unconsciously learned to protect their knee by developing unnatural jumping mechanics. This could include landing with a more rigid knee, or allowing too much hip flexion. You may need to become more conscious of landing with the right amount of knee flexion with your foot in a neutral position and avoiding excessive hip flexion. Your doctor would be able to answer any questions you have about good jumping mechanics.

Patellar tendon straps, like a Cho-pat, can help reduce stress on your patellar tendon and relieve pain. Three fourths of the people who use patellar tendon straps for patellar tendinitis report improvement.

Patellar tendinopathy is treatable. Patients who follow a well-planned strengthening program show similar outcomes to those who have undergone surgery for the problem. Initially, you may need to decrease your training intensity to help protect your knee. You should stay away from activities that produce more than mild pain. You should avoid complete rest, as this could actually increase your risk of recurrence. Using ice packs or ice massage for 10-15 minutes at a time, especially following activity, may help to reduce inflammation.