fitness

Piriformis Syndrome; a real bummer.

~ Dr. Robert Speirs DC ~ Leave a comment

Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle.

When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.

Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year olds and affects women more often than men.

Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.

Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day.

Trigger points in the gluteus minimus

~ bryancobb ~ Leave a comment

The gluteus minimus is a small but important muscle that lies deep to the gluteus medius. It originates on the gluteal surface of the ilium, and attaches on the greater trochanter of the femur. It’s main actions are to abduct and medically rotate the hip. Trigger points in this muscle refer pain into the buttock and down the lateral and posterior leg, mimicking sciatica. This muscle should be the first to be examined if a straight leg test turns out negative.

Trigger points in the gluteus medius muscle

~ bryancobb ~ Leave a comment

The gluteus medius muscle plays an important role in hip and pelvic stability. It originates on the gluteal surface of the ilium, deep to the gluteus Maximus. It inserts on the greater trochanter of the femur. It’s main actions are to abduct the hip and to assist in internal rotation of the hip. It also maintains pelvic stability during walking and running. Trigger points in this muscle will refer pain into the sacrum, the iliac crest, and down the lateral hip and into the thigh. This muscle is often a cause of lower pack pain.

Posterior Tibial Tendon Dysfunction

~ Dr. Robert Speirs DC ~ Leave a comment
The posterior tibialis muscle begins deep in your calf. The muscle is connected to the arch of your foot by a tendon that runs along the inside of your ankle, just behind the large bump called the medial malleolus. When you walk, the posterior tibialis muscle lifts the arch of your foot.

Posterior tibial tendon dysfunction is one of the most common foot and ankle problems. The tendon may be damaged from an acute injury, like an accident or fall. More commonly, problems arise from overuse or repeated strain. Ongoing irritation slowly damages the tendon’s fibers and eventually leads to weakening and degeneration. This decreases the tendon’s ability to support your foot when you walk. As the tendon becomes less effective, the arch of your foot is allowed to collapse, which further increases the strain on the muscle and tendon.

The condition is often triggered from overuse and/or training on excessively hard surfaces. Other factors that can contribute to posterior tibial tendon dysfunction include: obesity, diabetes, hypertension, prior surgery or steroid injections.

Symptoms include pain or swelling along the course of the tendon, particularly behind your inner ankle bone. Symptoms often begin following an increase in training intensity or duration. Standing, walking, or running will likely increase your discomfort. Your pain may be aggravated by spending prolonged periods of time on your feet, especially, when standing tiptoe and walking stairs or uneven surfaces.

Early diagnosis and treatment is important to slow progression of the disorder. You may need to temporarily limit weight-bearing activity to allow your tendon to heal. Using a stationary cycle, elliptical machine, or swimming can be good alternatives to walking and running. Your doctor will likely prescribe arch supports or orthotics to help support your foot. You will be given exercises to strengthen the posterior tibialis muscle. These exercises should be performed while wearing shoes with good arch supports. In certain instances, a walking cast or boot may be needed to temporarily protect your foot.

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.
Sleep Posture
Your mattress and the position you sleep in may affect your condition.
✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.
RICE
The acronym RICE can help you remember what to do after a new injury:
✓ Rest – Limit stress to the injured area for at least the first 48 hours.
✓ Ice – Apply for 10-15 minutes. Break for 30 minutes. Reapply. (Alternatives to the ice pack include Ziploc bags filled with ice, or a bag of frozen vegetables.)
✓ Compression – Wrap the injured area with an elastic ACE bandage if possible.
✓ Elevation – Elevate the injured area to limit swelling.
Standing
To avoid extra stress on your spine while standing:
✓ Avoid high-heeled shoes or boots
✓ Use a footrest
✓ If excessive standing can’t be avoided, consider shock absorbent shoes or an anti-fatigue mat.
Footwear
Improperly supported feet can affect the alignment of all of the structures above. To improve your overall comfort:
✓ Choose shoes with good arch support.
✓ Avoid going barefoot or wearing shoes that lack support (i.e. flip-flops). The following brands of sandals provide better than average arch support: Naot, Fit Flops, Orthoheels, Abeo, Vionic and Yellow box.
✓ Avoid high-heeled shoes or boots (keep heels to a maximum of 1½ inches, especially if you are going to be doing a lot of walking).
✓ “Cross-trainer” athletic shoes tend to provide the best all around support and shock absorption for daily activities.
✓ Patients with fallen arches should consider adding arch supports or orthotics.
✓ Repair or replace shoes with worn soles or heels.
Running Shoes
Running shoes need to be replaced every 250 miles. There are three basic options:
✓ Motion Control Shoes – Designed for people with low or no arches, these shoes are for runners who strike the ground on the outer edge of their foot. Avoid overly stiff shoes as these decrease you perception of ground strike and lead to new injuries.
✓ Stability or Neutral Shoes – Designed for people with normal or average arches and running mechanics. The shoe contains some cushioning to absorb shock and prevent injuries and some rigidity to avoid pronation.
✓ Cushioned Shoes – Designed for people with high arched feet. Their footprint will typically leave a thin band along the foot’s edge. As they run weight is distributed from heel strike to the outer edge of the foot and small toes that bear the brunt of “lift off.” This shoe is more flexible and absorbs the shock created by the lack or rotation (under-pronation) created by their running style.

Knee Arthritis; Who, Where, Why and How?

~ Dr. Robert Speirs DC ~ Leave a comment

The bones in your knee 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, leading to a painful “bone on bone” situation.

Knee arthritis is very common, affecting more than 1/3 of adults over age 65. People who are overweight or have a history of knee injury or surgery are more likely to develop arthritis. Jobs and activities that require repetitive squatting, kneeling, pivoting or stair climbing may cause increased wear. Contrary to popular opinion, runners have no increased risk of developing knee arthritis. Women are two to three times more likely to develop knee arthritis as compared to men.

The pain of knee arthritis is often described as a “deep ache” that is aggravated by activity and relieved by rest. You probably notice morning stiffness that goes away after a short period of activity, but returns after sitting for long periods of time. Some patients have difficulty squatting, bending and walking stairs. You may notice that your knees pop and crack. Eventually, knee arthritis can cause you to walk slower, lose your balance and even fall more often. Many patients notice that their symptoms increase with weather changes.

Although there is no cure for the irreversible wearing associated with arthritis, there is help for your symptoms. Performing your home exercises is very important. The way that your knee is aligned (and wears) is largely based upon how your hip and foot function, so many of your home exercises will target those regions. Our office may prescribe arch supports or orthotics, since people with flat feet are almost twice as likely to suffer from knee arthritis.

Overweight patients should begin or increase low-impact aerobic exercises like walking, stationary cycling, elliptical exercising, water walking or swimming. Be sure to take frequent breaks from prolonged sitting and avoid overly painful activities.

The High Ankle Sprain (Don’t Let This Happen To You. These SUCK.)

~ Dr. Robert Speirs DC ~ Leave a comment

Your lower leg bones (tibia and fibula) are held together at the ankle by a group of soft tissues and ligaments called the “syndesmosis”. This connection prevents excessive spreading of these bones during normal activity, but injuries can cause these ligaments to be stretched or torn. This problem is called a “syndesmotic ankle sprain” or “high ankle sprain”. High ankle sprains often occur during contact sports (like football, hockey, and soccer) when your foot is planted while the rest of your body shifts forward and turns inward. High ankle sprains are much less common than other types of ankle sprains.

The pain of a high ankle sprain starts just above your ankle and runs up your shin. Interestingly, the “length” of pain correlates very closely to your severity of injury. Standing and walking is usually uncomfortable and sometimes unbearable. Bringing your toes toward your shin or rotating your foot outward will likely increase your pain. Significant bruising or swelling is possible. Be sure to tell your doctor if you notice numbness, tingling, or coldness in your foot.

Ankles that have suffered a complete separation usually require surgery, since they will have lost the ability to push off, propel, and cut. Most other stable sprains will respond to conservative care, like the type provided in this office. It is important to recognize that high ankle sprains heal more slowly than other types of ankle sprains. The average recovery time for a syndesmotic sprain is between two and seven weeks but some injuries may require up to four months away from your sport. You may need to wear a boot or avoid weight bearing for a period of time. Ice may help to limit swelling initially, and the home exercises described below are an important part of your recovery.

Trigger points in the gluteus Maximus

~ bryancobb ~ Leave a comment

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!

~ Dr. Robert Speirs DC ~ Leave a comment

​meditate-1851165_960_720

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.

~ Dr. Robert Speirs DC ~ Leave a comment

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.

The Medial Ankle Sprain. “The Other Sprain”.

~ Dr. Robert Speirs DC ~ Leave a comment

“Ligaments” are made up of many individual fibers running parallel to each other and bundled to form a strong fibrous band. These fibrous bands hold your bones together. Just like a rope, when a ligament is stretched too far, it begins to fray or tear. “Sprain” is the term used to describe this tearing of ligament fibers.

Sprains are graded by the severity of damage to the ligament fibers. A Grade 1 sprain means the ligament has been painfully stretched, but no fibers have been torn. A Grade 2 sprain means some, but not all, of the ligaments’ fibers have been torn. A Grade 3 sprain means all of the ligaments’ fibers have been torn, and the ligament no longer has the ability to protect the joint.

Ankle sprains are the most common soft-tissue injury and will affect up to 20% of active people at some point in their life. Most ankle sprains occur because you have “rolled your ankle”. Sprains like yours, involving the inside of your ankle (medial) are much less common than injuries to the outer side. Medial ankle sprains are often accompanied by other injuries like “high ankle sprains” or fractures.

Ankle sprains cause pain and swelling over the inside of your ankle. Walking may be difficult, and bruising is common. Be sure to tell your doctor if you experience numbness, tingling, or a dramatic cold sensation in your foot, as this may indicate more significant injury.

Ankle sprains can be successfully managed but will require some work on your part. You can help reduce swelling by elevating your ankle by lying or sitting with your foot elevated or by using an ACE wrap for compression. Applying ice or ice massage for 10 minutes each hour may help relieve swelling. Depending upon the severity of your sprain, you may need to wear an ankle brace to help protect you from further injury. If walking is painful, crutches may be necessary.

Initially, a period of rest may be necessary in order to help you heal. Mild Grade 1 sprains may allow return to sport in a couple of days, while more severe injuries may take six weeks or longer to recover.