Pain

FAI starts you on the road to failure.

~ Dr. Robert Speirs DC ~ Leave a comment

Your hip socket or “acetabulum” is covered by smooth, glassy cartilage extending all the way to its outer rim. The term “Femoroacetabular impingement” (FAI) means that this rim of cartilage is being pinched when you move your hip into certain positions. Repetitive pinching results in irritation, tearing, or even detachment of this cartilage from your hip socket.

FAI occurs because of a mismatch between the head of your femur and the socket of your hip. The mismatch may be from an abnormally shaped hip bone (cam deformity), or having too much cartilage on the rim of your hip socket (pincer deformity). Most frequently, FAI results from a combination of both (combined or mixed deformity).

FAI is most common in young active people. Although the deformity may be present on both sides, symptoms are usually one-sided. The condition is equally common among men and women. Symptoms of FAI include a constant dull pain with periods of sharp pain, made worse by activity. Walking, pivoting, prolonged sitting, stair climbing, and impact activities like running or jumping can aggravate your symptoms. Snapping, locking, and clicking are common.

Our office will help direct a rehab program to maximize your chance of recovery. You should attempt to stay active, but avoid activities that aggravate symptoms. You may consider temporarily switching to low-impact activities, like stationary biking or water-walking. You should avoid motions that combine flexion and internal rotation, like- getting out of a car with one leg at a time, swimming the breaststroke, or performing squats. Patients with FAI should avoid excessive stretching, as this could aggravate the condition, but will likely benefit from strengthening exercises in the type of treatment provided in this office.

Spring Cleaning Tips

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If you plan on doing a bit of spring cleaning soon, here is our friendly safety reminder: Don’t forget that some chores are a workout, so stretch accordingly before and after. Also, be mindful of your posture throughout your cleaning.

Keep a neutral spine, bend at your knees when lifting heavy items, and never twist your back at unhealthy angles.

I’ve got Shin Splints; what do I do?

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Shin splints, also called “Medial Tibial Stress Syndrome,” (MTSS) is caused when the muscles of your lower leg pull too hard on your bone, causing local pain and inflammation. Over half of all leg pain in athletes is caused from shin splints. Up to 1/3 of runners and soldiers experience shin splints at some point in their lifetime.

MTSS is an overuse injury frequently seen in sports involving running, jumping, or frequent stopping & starting, i.e. field hockey, soccer and cross-country. Shin splints do not occur overnight but over a period of time, often show up during the first two or three weeks of training for a new season. Shin splints can occur when there are changes to your exercise regimen, such as an increase in activity, change in shoes or a change in the surface you play on. Some doctors refer to these training areas as “the terrible toos,” – too much, too hard, too long, too fast.


Symptoms of shin splints include tenderness or pain over the inside lower portion of your shin. The discomfort begins at the start of exercise and eases as you continue. Some patients report “bumps” when touching the inner portion of their leg bone. Be sure to tell your doctor if you experience weakness, numbness or cold feet during exercise or find a very small area of sensitivity.

Unfortunately, MTSS usually develops during a time when you are training heavily for a sport or an upcoming event. Continuing this activity will often lead to ongoing problems and decreased performance. Shin splints are now believed to be a forerunner to stress fracture, so adequate rest is critical. You may need to consider non-weight bearing cross training, such as using a stationary cycle or pool running.

When directed, your return to activity should start slowly, beginning with a 1/4 mile run and progressing by 1/4 mile each time you have no pain for two consecutive workouts. You should initially avoid running on hard or uneven surfaces and begin at a lower intensity and distance, increasing by no more than 10-15% per week- first increase distance, then pace, and avoid hard or unlevel surfaces, including hills.

Sports creams and home ice massage may provide some relief. Use ice after any activity. Patients who have flat feet are predisposed to developing shin splints and may need arch supports or orthotics. Avoid using heel cushions in your shoes, as they may increase the recurrence of this problem.

Trigger points in the serratus anterior

~ bryancobb ~ Leave a comment

The serratus anterior muscle is located along the sides of the ribs. It originates on the outer surface of the upper 8-9ribs, and inserts on the medial border of the scapula. This muscle acts on the scapula in several different ways. First it rotates the scapula to turn the glenoid fossa upward. It also protracted and elevates the scapula. And lastly it helps to prevent wining. This muscle is often shortened from prolonged sitting and work on a computer. Active trigger points in this muscle refer pain locally around the trigger point with spillover down the inside of the arm. Pain can also radiate into the inferior angle of the scapula.

What is my Fibular Head and why does it hurt?

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The bone on the outermost portion of your lower leg is called the “fibula.” Your fibula is joined to the larger “tibia” at the ankle and the knee. These connections allow for better function and dispersal of weight (1/6th of your body weight is supported by the fibula).

Proper function of your knee requires natural gliding movements of the tibia/ fibula joint. The diagnosis of “Fibular head dysfunction” means that this joint has been “sprained” or has become “stuck” in an abnormal position. Fibular head problems affect all age groups but are particularly common in young females.


Problems involving the fibular head are often the result of an injury to your leg, hamstring, or ankle. Sports and activities that require violent twisting motions with the knee bent are particularly suspect. Athletes who participate in football, soccer, rugby, wrestling, gymnastics, judo, broad jumping, dancing, long jumping, and skiing may be more likely to suffer this type of injury. Patients who sprain their ankle or slip and fall with their knee flexed under their body may suffer fibular head problems. Sometimes, symptoms begin without an identifiable injury.

Patients with fibular head problems generally complain of pain on the outside of their knee. Symptoms become more intense with weight bearing or when applying pressure over the irritated area. Sometimes, the condition affects both knees at the same time. In more severe cases, you may experience numbness or tingling on the outside of your leg. Be sure to tell your doctor if you notice numbness, tingling, or weakness in your leg or ankle.

In most cases, fibular head dysfunction is treatable with conservative care, like the type provided in our office. Initially, you may need to limit excessive twisting movements and hyperflexion, (i.e. heel to butt.) Taping or bracing may help patients who have suffered a sprain or have an “unstable” joint.

There is nothing great about greater trochanteric pain syndrome. Nothing at all.

~ Dr. Robert Speirs DC ~ Leave a comment

Your hip typically has about six small fluid-filled sacs called “bursa” that act as cushions between tendons and bone. One of the most common causes of hip pain is a condition called, “hip bursitis” which means that one or more of your bursas have become painfully inflamed. The broader (more accurate) diagnosis of “Greater trochanteric pain syndrome” (GTPS) describes an uncomfortable collection of problems affecting the outermost portion of your hip. GTPS can include swelling of one or more of the fibrous tendons that attach your muscles onto your hip – a condition called, “tendinitis.” In addition to bursitis & tendonitis, GTPS may originate from tightness in the muscle that travels over your hip en route to your knee- resulting in compression and irritation to your hip.


Greater trochanteric pain syndrome is most common in middle age to elderly adults and is 2-4 times more common in females. Sometimes the problem affects both hips at the same time. Approximately 1/3 of patients with GTPS have lower back pain. Patients who have arthritis in their hips and knees are more likely to suffer from ongoing complaints.

Your symptoms probably include a persistent pain on the outside of your hip, buttock, and upper thigh. Your discomfort may be aggravated by sitting with your leg crossed, arising from a seated position, prolonged standing, climbing stairs, and high-impact activities, like running. Sometimes patients find it difficult to sleep, since lying on the painful hip usually increases symptoms.

For adults, x-rays may or may not be needed to confirm the diagnosis, but children and adolescents usually require films to rule out more serious childhood diseases. Be sure to tell your doctor if you notice that you have a fever, leg numbness, pain radiating significantly beyond your knee, or pain in the front of your groin crease (the area where you leg meets your pelvis.)

Conservative treatment, like the type provided in this office, is successful in about 90% of cases. If you have acute pain, you may need to temporarily limit or discontinue activities that increase your discomfort. Using ice or ice massage at home may help. Some patients find temporarily relief by applying sports creams. Very commonly, patients with pain on the outside of their hip suffer from weakness in one of their buttock muscles, called the “gluteus medius.” When this muscle lacks strength, it is unable to protect your hip during normal activities, like walking. Research has shown that strengthening your hip has a dramatic effect on your progress.

Athletes should avoid running on a banked surface, like the crown of a road or indoor track. Be sure to reverse directions each mile if you run on a circular track. Avoid running on wet or icy surfaces, as this can cause increased tension in your hip. Runners with a “lazy” narrow-based running gait will benefit by increasing their step width to minimize stress on their hip. Cyclists need to make sure that their seat is not positioned too high. Overweight patients should consider weight reduction programs.

Pes Anserine Bursitis; What Is It?

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The term “pes anserine” is Latin for goose’s foot, and describes the appearance of three tendons that converge and insert on the inner portion of your knee. The pes anserine bursa is a fluid-filled, friction-reducing cushion, sandwiched between these tendons and your leg bone.

Injuries or irritation can cause the lining of the bursa to produce too much fluid, resulting in painful swelling. Patients with knee osteoarthritis are likely to have chronic irritation of the pes anserine bursa. The condition is more common in overweight patients, diabetics, and females. Runners and athletes in sports that require rapid side-to-side movements (i.e. football, soccer, tennis, etc.) are more likely suffer from the condition. Swimmers who do the breast stroke commonly suffer from pes anserine bursitis.
Symptoms include pain on the inner side of your knee, just below the joint. Your pain is probably worse when you stand up or walk stairs. Discomfort increases during activities that require side-to-side movements (i.e. tennis, dancing). Be sure to tell your doctor if you notice clicking, popping, or locking of your knee, excessive thirst, excessive urination, fever, or pain & swelling in your calf.

In addition to the treatment provided by our office, you may find relief by applying home ice or ice massage for 8-10 minutes. Having flat feet places additional stress on the inside of your knee, so patients with fallen arches will benefit from arch supports or orthotics. Overweight patients will benefit from a diet and exercise program.

I have Plantar Fasciitis; now what?

~ Dr. Robert Speirs DC ~ Leave a comment

The “Plantar fascia” is a fibrous band running from the under surface of your heel to the ball of your foot. “Plantar fasciitis” is a painful inflammation of this tissue caused by chronic over stretching and mild tearing.

Plantar fasciitis is commonly associated with fallen arches of the foot. To understand how this happens, cup your hand to make a “C” shape. This represents a foot with a high arch. Imagine a band running from your fingertips to your wrist. This represents the plantar fascia. Now, straighten your fingers to simulate what happens when the arch “falls.” When this happens in your foot, the plantar fascia is stretched and can begin to tear away from your heel.


Plantar fasciitis affects 10% of the population and is more common in women. Approximately one fourth of patients have the problem in both feet at the same time. People who place excessive stress on their feet by being overweight, standing for long periods, or participating in endurance sports are more likely to develop the condition as well. Shoes without adequate arch supports, including sandals or going barefoot, increase your chances of developing plantar fasciitis. Wearing high-heeled shoes or boots may contribute to the problem.

The most common symptom of plantar fasciitis is pain in the heel or arch when standing up after a period of inactivity, particularly first thing in the morning. When you are sleeping, the arch is in a relaxed or shortened state, and the plantar fascia is able to heal. When you stand up first thing in the morning, you stretch the fascia, once again tearing it away from its attachment on the heel. The condition may progress to the point that you experience pain throughout the day, even while resting. The pain often eases after you walk for a period of time, only to redevelop. You may notice some tenderness when you touch your heel, and you probably have tight calf and hamstring muscles as well.

Plantar fasciitis can be a frustrating condition, often lasting 18 months or more if left untreated. Fortunately, you may recover more quickly with proper treatment. One of the most important things that you can do is to make sure that you are wearing shoes with good arch supports on a consistent basis. A period of rest may be necessary to help you recover. Runners may need to temporarily decrease mileage or switch to less stressful activities like swimming, cycling, or using an elliptical machine. A splint or “Strassburg sock” worn at night will help to keep your plantar fascia in a stretched position while it is healing.

Trigger points in the iliopsoas muscle

~ bryancobb ~ Leave a comment

This muscle originates on the bodies and disks of T12-L5 and the inner ilium. It inserts on the lesser trochanter of the femur. The psoas flexes the hip when the spine is fixed. When the leg is fixed it extends the lumbar spine increasing lumbar lordosis. This Muscle is often chronically shortened due to inactivity and sitting posture. When trigger points are present they will refer pain primarily to the lower lumbar area and the sacrum as well as into the anterior thigh. Trigger points in the iliopsoas muscle can mimic appendicitis.

What is a “Mild” traumatic Brain Injury?

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A concussion is a blow or jolt to the head that disrupts normal brain function. Concussions, also known as Mild Traumatic Brain Injuries, most often result from falls, sports injuries, and auto accidents.
Concussion symptoms may begin immediately after an injury, but sometimes take hours or days to appear. The most common symptoms of a concussion include; headaches, light-headedness, dizziness, visual disturbances, ringing in the ears, confusion, fatigue, difficulty sleeping, irritability, and difficulty remembering or learning new things. Patients sometimes struggle to understand conversations or make simple calculations like determining a restaurant tip. Patients often feel as if they are “in a fog”. Symptoms can range from subtle to debilitating.

Patients and their attendants should be particularly alert for signs or symptoms that could indicate a more threatening injury like; worsening headache, growing irritability, repeated vomiting, difficulty speaking or swallowing, shortness of breath, unequal pupils, fever, visual disturbances, seizures, clear discharge from the nose or ears, loss of consciousness, or increasing light-headedness, numbness, or confusion. These symptoms warrant immediate emergency medical attention.

Recovery times are quite variable and are dependent upon a number of factors. It is critical that you allow your brain to recover completely before returning to physical activity. A concussion can be likened to dropping a computer – you will need to allow time to reboot before trying to use it. Suffering a second concussion before the first has completely resolved can lead to significantly worse symptoms and long-term impairments.

Athletes who have suffered a concussion must not return to activity before being evaluated by a healthcare professional that is very familiar with concussion management.