Chronic Pain

Achilles Tendonitis: The Details

~ Dr. Robert Speirs DC ~ Leave a comment

Your Achilles tendon is the strong fibrous band of tissue that connects your calf muscles to your heel. The tendon is named after “Achilles” who was a powerful, yet vulnerable warrior in Greek mythology. Likewise, our Achilles tendon, being the largest and strongest tendon in the body, is susceptible to injury from the high demands placed on it. (Running can generate forces over 12 times your bo

dy weight on the Achilles tendon.)

The tendon may be strained or even ruptured from excessive stretch or forceful contraction of the calf muscles. More commonly, the tendon is repeatedly overloaded and suffers tiny “micro tears.” Damage usually occurs either directly behind the heel, or near the weakest area of the tendon- one to two inches above the heel.

Achilles tendon injuries affect between 250,000 and 1 million people per year. Most are middle-aged males, between the age of 30 and 50. Interestingly, Achilles tendon injuries occur more frequently on the left side. If you have suffered a prior Achilles tendon injury, you are at greater risk of injuring the opposite side. Two-thirds of all Achilles tendon injuries involve athletes. Runners are up to 10 times more likely to suffer Achilles tendon problems. You may at increased risk if the arch of your foot is too high or too flat.

Symptoms may begin abruptly following a strain but more commonly develop slowly from repeated irritation. Morning pain and stiffness are common. Your symptoms will likely increase with activity, especially walking or running. You may notice pain when you rise up on your toes. Walking down stairs stretches the tendon and usually increases symptoms. Some patients notice that the irritated area becomes firmly swollen. Ongoing irritation to the spot on your heel where the tendon inserts can cause a painfully elevated “pump bump.”

Research has shown that conservative care, like the type provided in this office, can produce “excellent results” in over 85% of patients. Initially, you may need to limit or stop activities that cause pain. Runners may need to switch to swimming or cycling for a short period of time. Be sure to introduce new activities slowly and avoid increasing your activity by more than 10% per week. Runners should begin on a smooth, shock-absorbent surface and start at a low intensity – first increasing distance, then pace. Avoid training on hard or unlevel surfaces like hills. Make sure you warm up properly and avoid over training. Avoid wearing high heels or shoes with an excessively rigid heel tab. One of the most important and effective treatments for Achilles tendinopathy is performing “heel drop exercises” as outlined below.

Eccentric Achilles Strengthening
Begin standing up on your toes with the affected foot on the edge of a step. Do not place weight on your good leg, but you may use it for stability. Slowly lower your affected heel, at a count of 4 seconds, until you reach a fully stretched position and can drop no further. Use your good leg to return to your toes. Repeat 3 sets of 15 repetitions with your knee straight and 3 more sets of 15 repetitions with your knee slightly bent, twice daily or as directed. Moderate pain during this exercise is acceptable but if pain is excessive, you should assist downward motion with the non-injured leg.
Here is a brief description of the treatments we may use to help manage your problem.

Joint Manipulation
Your chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any “restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints.
Therapy Modalities
We may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed.
Myofascial Release
Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft-tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility.
Therapeutic Exercise
Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.
Elastic Therapeutic Tape
Your chiropractor may apply a special elastic therapeutic tape in order to support injured areas or encourage better movement. This tape is thought to decrease pain and swelling, improve circulation and limit muscle soreness.
Foot Evaluation
Fallen arches and faulty foot mechanics are common problems that can perpetuate your condition. Our office will carefully evaluate your feet and consider the need for a change in shoe style, arch supports or even custom orthotics.
Ankle Brace
Our office may recommend using a support brace to protect your ankle from further injury. Your doctor will discuss the specific type of brace and provide instructions for use.
After this initial course of treatment we will reassess your progress. We will determine the need for any additional care after your reassessment.

Trigger points in the gluteus Maximus

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The gluteus Maximus is the buttock muscle. It originates on the gluteal surface of the ilium, lumbar fascia, sacrum and sacrotuberous ligament. It inserts on the gluteal tuberosity of the femur and the iliotibial tract. Extension and lateral rotation of the hip are it’s main actions. This muscle is heavily involved in activities like ice skating and is a common area to develops trigger points. When trigger points do develop they can refer pain in a crescent pattern from the gluteal fold to the sacrum. Trigger points can also refer pain deep into the buttock itself making it feel like other deeper muscles are involved. These symptoms can sometimes be mistaken for s.i. Joint problems.

Meditation goes mainstream!

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With growing evidence that meditation has significant health benefits, a 2016 study by a team of researchers from the United States, Spain, and France sought to explain how and why meditation actually works.

The study investigated the difference between “mindful meditation” in a group of experienced meditators vs. “quiet non-meditative activity” in a group of untrained control subjects. After eight hours of mindfulness practice, the meditation group showed a range of genetic and molecular differences, which in turn correlated with faster physical recovery from a stressful situation.

According to researchers, this is the first time a study has documented a rapid alteration in gene expression within meditating subjects. Interestingly, the researchers observed these changes in the SAME genes that anti-inflammatory and pain-killing drugs target! Thus, they speculate that mindful-based training may benefit patients with inflammatory conditions! This and prior studies have prompted the American Heart Association to endorse meditation as an effective cardiac preventative intervention.

Meditation has been found to be helpful for many conditions including stress management, lowering high blood pressure, heart disease, and depression. You can incorporate meditation into your life with three simple meditation exercises! The initial advice is “…go slow and be compassionate and gentle with yourself.” Your mind will try to wander (called our “default mode”) which consumes about half of our day, so try to focus (called “focus mode”)!

1)  WALKING MEDITATION: At a slow to medium pace, focus on your feet. Notice how your heel hits the ground and then feel the roll of your foot followed by the big toe pushing off prior to the swing phase. Feel for stones under the foot and other interesting sensations. If your mind starts to wander (default mode), gently bring your attention back to your foot (focus mode). You WILL get better with practice, and you’ll soon find it much easier to “focus” during stressful situations!

2)  NOVEL EXPERIENCES: It’s much easier to lose focus on the people you see everyday vs. those seen only one time a month. The next time you arrive home from work, pretend you haven’t seen your spouse/friend in 30 days. Give them your undivided attention. Then, try this on co-workers and other people you see every day. Believe me, they WILL notice a difference!

3)  GRATITUDE EXERCISES: When you’re not in their presence, focus on a person’s face and send them a “silent gratitude” for being in your life. Try this on family members, friends, co-workers, and others!

SI Joint Dysfunction. Nothing FUN about it.

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Your sacroiliac joint is the mechanical link on each side of your hip that connects your legs to the rest of your body. The joint has a limited but very important degree of mobility. Symptoms develop when one or both of the joints loses normal motion. When a joint becomes “restricted”, a self-perpetuating cycle of discomfort follows. Restriction causes the muscles to become overworked, leading to tightness, compression, inflammation, pain and more restriction.
Sacroiliac problems can happen as a result of repetitive strenuous activity or trauma- like a fall onto the buttocks. Other causes of sacroiliac joint problems include, poor posture, having one leg slightly longer than another, having an altered gait, having flat feet or scoliosis, or having pain somewhere else in your legs. Pregnancy is a common trigger for sacroiliac joint problems due to weight gain, gait changes and postural stress.

Sacroiliac joint problems often begin as a focal discomfort in your back just below the belt line, slightly to one side of center. Your pain can travel into your buttock or thigh. Symptoms are often worse by standing on the affected side. The pain may become more apparent when you change positions- like exiting a chair, car or bed, or during long car rides. The pain is often relieved by lying down.

To assist with your recovery, you should avoid any activity that provokes pain, like standing on the affected leg or prolonged sitting.

Trigger points in the supraspinatus

~ bryancobb ~ Leave a comment

The supraspinatus is a muscle of the rotator cuff. Is sits above the infraspinatus and originates on the supraspinous fossa of the scapula. It’s insertion point is the superior facet of the greater tubercle of the humerus. It’s main function is to abduct the arm at the glenohumeral joint working with the deltoid. All rotator cuff muscles act to secure and support the head of the humerus in the glenoid fossa during arm movements acting as a sling. This muscle often gets impinged during overhead movements such as painting a ceiling. When trigger points form in this muscle they primarily refer a deep achy pain into the mid deltoid area with spillover pain radiating down the arm into the elbow.

Can Chiro help me?

~ Dr. Robert Speirs DC ~ Leave a comment

Adjust

​Chiropractic is the most widely accepted and most frequently used type of “alternative” healthcare in the United States. This is largely due to the fact that it works, and because of that, there has been a steady increase in acceptance by the public, third-party payers, and the Federal government. Since the mid-1990s, a number of outside (non-chiropractic) observers have suggested that chiropractic has now entered mainstream healthcare.

One can position chiropractic as being BOTH alternative and mainstream. It is “alternative” since it approaches healthcare from an entirely different direction compared to the primary care medical profession. Chiropractic is non-surgical and promotes diet and nutritional approaches vs. drugs and surgery. Chiropractic is also arguably “mainstream” as it has evolved into a strongly utilized form of primary care through popular acceptance and utilization by the public.

So, what role does chiropractic play in today’s health delivery system? This question is still being debated, but there appears to be three camps: 1) Specialist—limited to musculoskeletal (MSK) complaints on an interdisciplinary primary healthcare team; 2) Primary healthcare “gatekeepers” that focus on ambulatory MSK complaints; 3) Generalist primary healthcare provider of “alternative or complementary” medicine that manage and/or co-manage both MSK AND non-MSK conditions.

Looking at this from the patient or “consumer” perspective, chiropractic already plays an important role in the healthcare delivery for many patients. In 1993, a report claimed 7% of American adults had received chiropractic care during the prior year. According to a 2015 Gallup poll (that included 5,442 adults, aged 18+, surveyed between 2/16/15 and 5/6/15) entitled, Majority in U.S. Say Chiropractic Works for Neck, Back Pain, “Chiropractic care has a positive reputation among many US adults for effective treatment of neck and back pain, with about six in 10 adults either strongly agreeing (23%) or agreeing somewhat (38%) that chiropractors are effective at treating these types of pain.”

The “highlights” from this Gallup poll include: 1) Two-thirds say chiropractic is effective for neck and back pain. 2) Many adults say chiropractors think of the patient’s best interest. 3) More than 33 million adults in the United States (US) saw a chiropractor in the twelve months before the survey was conducted. That means roughly 14% of U.S. adults saw a chiropractor in the 12 months prior to the survey (vs. 7% in 1993). An additional 12% who responded to the Gallup pollsters saw a chiropractor in the last five years but not in the last 12 months. Overall, 51% of those polled had previously seen a chiropractor.

Whether or not you have personally utilized chiropractic, the educational process, licensing requirements, public interest, third-party payer systems, and interprofessional cooperation ALL support firm ground for which you can comfortably and confidently seek chiropractic care for your complaints.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care, we would be honored to render our services.

Where should you turn when back pain strikes?

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Shrug

Where should you turn when back pain strikes?

https://tribunecontentagency.com/article/where-to-turn-for-low-back-pain-relief/

Chiropractic should be a first line defence when back pain strikes. We are special trained to recognize the cause of back pain and treat when appropriate. When the cause is outside the scope of our practice, we are able to educate you on where you should go next.

Trigger points in the infraspinatus

~ bryancobb ~ Leave a comment

The infraspinatus muscle is one of the muscles that makes up the rotator cuff. It originates on the infraspinous fossa of the scapula, and inserts on the middle facet of the greater tubercle of the humerus. It functions to externally rotate the humerus and to stabilize the head of the humerus in the glenoid cavity during upward movement of the arm. Trigger points in this muscle refer pain deep into the anterior shoulder joint and down the anterior arm. Trigger points near the lower medial border refer pain into the rhomboids. This muscle is often injured during throwing motions.

Is there an actual cure all?

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​Exercise Tip

No; but exercise seems to be as close as we will ever get! 

Some of you may have heard about how a modified form of boxing is helping patients with Parkinson’s disease (PD). If you haven’t, it’s been observed that people with Parkinson’s disease (PD) who engage in this boxing-like exercise routine can enhance their quality of life and even build impressive gains in posture, strength, flexibility, and speed. Proponents of the program report that regardless the degree of severity of PD, participants have a happier, healthier, and higher quality of life.

But must it be boxing? Maybe not. A report presented at the International Congress of Parkinson’s Disease and Movement Disorders in San Diego in June 2015 found that patients with Parkinson’s disease who began regular exercise early into the PD process had a much slower decline in their quality of life when compared with those who started exercising later. The researchers found just 2.5 hours per week of exercise is needed to improve quality of life scores. According to the report, it didn’t matter what exercise the participants did — simply getting up and moving for a total of 2.5 hours/week was reportedly enough (that’s only 20-25 minutes / day)!

Looking beyond Parkinson’s, other chronic conditions also benefit from adding exercise into a person’s lifestyle. Studies show that regular exercise as simple as walking helps reduce one’s risk for memory loss, and it slows down functional decline in the elderly. Incorporating aerobic exercise into one’s lifestyle can also improve reaction time in people at ALL AGES. Exercise has also been shown to improve both physical and emotional well-being in those afflicted with Alzheimer’s disease with as little as 60 minutes/week of moderate exercise! Patients with multiple sclerosis (MS) have also reported less stiffness and less muscle wasting when using exercise machines, aquatic exercise, and/or walking.

Research has shown just 30 minutes of brisk exercise three times a week can help reduce depressive symptoms in patients with mild-to-moderate depression. In a study involving teenagers, those who engaged in sports reported a greater level of well-being than their sedentary peers, and the more vigorous the exercise, the better their emotion health! In kids 8-12 years old, physical inactivity is strongly linked to depression.

Even anxiety, stress, and depression associated with menopause are less severe in those who exercise! So LET’S ALL GET OUT THERE AND EXERCISE!!!

What is Scoliosis?

~ Dr. Robert Speirs DC ~ Leave a comment

Your spine is made up of 24 bones that stack on top of each other- normally in a straight line. “Scoliosis” means that your spine is curving from side to side, rather than being straight. Scoliosis affects between 1-3% of the population. Scoliosis may begin at any time between birth and adulthood but is most common during times that your skeleton is growing rapidly. Most cases of scoliosis begin between the ages of 13 and 18. Researchers are not completely certain why some people develop scoliosis, but they have found that the problem tends to run in families.

The curve of your scoliosis may be measured with an x-ray. Although some curves get worse, most do not. In fact, only ¼ of all adolescent idiopathic scoliosis curves will progress. Small curves in mature patients have a low risk of progression (2%), while large curves in younger patients progress more frequently. (70%) Curve progression is more common in girls, especially those with larger curves (greater than 20 degrees). Your doctor may need to monitor your scoliosis for progression by performing x-rays every 6-18 months.

Scoliosis may cause your shoulders, hips, or waist to be unlevel. Most curves are classified as “right thoracic”, which means that the peak of your curve protrudes toward the right. This is often accompanied by a forward rotation of your right shoulder and “winging” of your right shoulder blade. Many patients have a secondary curve in their lower spine that helps to balance their body. The majority of patients with mild to moderate scoliosis have no symptoms, but approximately ¼ report back pain. Unfortunately, scoliosis increases your risk of developing back pain later in life.

The primary goal of treatment is to stop curve progression. While many cases can be slowed or even reversed through appropriate management, it is important to recognize that others may progress in spite of the best care. Conservative care, including spinal manipulation (like the type provided in our office) has been shown to help some patients with scoliosis. Exercise is another effective treatment for scoliosis. It is important that you clearly understand your home exercise program and that you perform it consistently.

Patients with larger curves (30-40 degrees), or those who are at high risk for progression may benefit from wearing a brace. Braces have been shown to decrease the need for surgery in about three out of four patients. Fortunately, less than 0.3% of all scoliosis cases will ever require surgery.

You should avoid carrying heavy back packs and consider switching to a wheeled version, if necessary. Sports and exercise will not worsen most cases of scoliosis, and you should continue to participate in the things you enjoy unless directed otherwise by your doctor. The diagnosis of scoliosis is always discouraging, but you must focus on what it is really most important. Be confident in who you are! Don’t let something like a curved spine (or any other medical condition) define you as a person.