Wellness

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.

Why Posture Is So Important For Fitness

~ Dr. Robert Speirs DC ~ Leave a comment

Why Posture Is So Important For Exercise & Fitness

Great article from http://www.brit.co on posture and fitness.

If you’ve ever rolled your eyes when your mom told you to “sit up straighter,” listen up! Turns out she was on to something. Good posture is important for more reasons than physical presentation. And for fitness fanatics, it’s actually critical. “Good posture impacts how you walk, jump, and lift,” says Aaptiv trainer Ackeem Emmons. “Proper alignment also eases strain or pain on your spinal cord.”

woman running outside

For runners and gym-goers, the impacts are even more specific. “When you’re running, having good posture allows you to breathe better,” Emmons says. “The more air in your diaphragm, the further you can go. The better your posture, the more fluid your form.” All of this translates to more efficient and successful running. In the gym, proper form and alignment help you isolate certain muscle groups and execute heavy compound movements, he adds.

Beyond the obvious physical gains, your posture can also impact you mentally as well. “Standing tall with proper posture gives the immediate impression of confidence and courage,” says Aaptiv trainer Ceasar F. Barajas. “You’re mentally setting the tone for success when you straighten up a bit.”

If you’re suddenly feeling hyper-aware of your spinal column, don’t worry. According to Aaptiv trainers Jaime McFaden and Benjamin Green, you can work every day to gradually correct limp posture. “Sit up straight and gently pull your shoulders back and down, stretching the neck. Press both feet firmly into the ground and lift your chest,” McFaden says.

“I’m on a bike anywhere from three to six days per week, hunched over with a rounded back,” explains Green. “Throughout the day, if I catch myself not standing up straight, I open up my shoulders.” If it helps, imagine a string attached to the top of your head, pulling you up, he adds.

For those looking for a more intense posture intervention, our Aaptiv trainers shared five exercises and poses that will help open up your chest, align your spine, and gradually correct poor posture. Keep reading for more moves and be sure to check out all of Aaptiv’s yoga and stretching classes in-app to support (pun intended) your good posture journey.

woman planking

1. Planks — Aaptiv Trainer Kelly Chase: Lie on your stomach with your legs straight behind you. Bring your arms forward and rest your weight on your forearms. Your elbows should be directly below your shoulders. Your arms can rest straight and flat with your palms facing the ground or you can bring your hands together to form a triangular shape. Engage your core and keep your body as straight as possible, careful not to create any dip or arch in your lower back. Hold for 30 seconds. As you become stronger, you can increase your hold time.

Woman Using Exercise Band

2. Band Scapular Retraction Rows — Aaptiv Trainer Candice Cunningham: You’ll need a resistance band for this exercise. Sit upright on the floor with both feet extended in front of you. Keeping your legs straight together, wrap the band around the bottoms of your feet, holding the ends in your hands. Focus on holding your back completely straight as you gradually pull the ends of the band into your chest in a row-style movement. Your elbows should bend out to the sides at chest height. Straighten your arms and repeat.

Complete 10 reps.

woman doing superman exercise

3. Supermans — Aaptiv Trainer Benjamin Green: Lie straight and face down on your mat. Extend your arms in front of you with your biceps next to your ears. Exhale and simultaneously, raise your legs, arms, and chest off the mat, creating a U-shape in your body. Squeeze your lower back and hold for two deep breaths. Inhale and lower your limbs back to the mat.

Complete 10 reps.

woman doing bird dog exercise

4. Bird Dogs — Aaptiv trainer Ackeem Emmons: Start on your hands and knees with your palms directly below your shoulders and your knees below your hips. Put your weight on your left knee and left hand as you slowly lift your right leg and straighten it behind you, keeping it in line with your flat back. Lift your right arm and extend it forward in line with your back. Reach with your fingers, careful to maintain a straight line through your body from fingertips to toes. Flex your right foot so your toes are pointed toward the ground and hold for five deep breaths. Repeat on the other side.

Complete 10 reps on each side.

woman doing yoga

5. Tadasana (Mountain Pose) — Aaptiv trainer Ceasar Barajas: You can perform this pose standing or sitting (at your desk perhaps?). Take a deep breath in and roll your shoulders up towards your ears. Exhale and roll them back down. Continue consciously breathing deeply and engage your core. Imagine someone poured cold water down your back to further engage your core and move deeper in the stretch.

Perform this move as often as you need.

Trigger points in the temporalis muscle

~ bryancobb ~ Leave a comment

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.

Trigger points in the lateral pterygoid

~ bryancobb ~ Leave a comment

The lateral pterygoid muscle plays an important role in prober jaw function. It originates on the greater wing of the sphenoid bone and the lateral pterygoid plate, and inserts on the condyloid process of the mandible. It’s action is to pull the head of the mandibular condyle out of the mandibular fossa while opening the jaw. When trigger points develop they refer pain into the temporal mandibular joint and maxillary sinus. This referral is commonly mistaken for TM arthritis. In addition to the referral pain, trigger points in this muscle can also effect proper movement of the jaw.

An Open Letter to our Medical friends.

~ Dr. Robert Speirs DC ~ Leave a comment

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In the past year, many trusted medical establishments including the FDA (1), CDC (2), Joint Commission (3,4), JAMA (5), and The American College of Physicians/ Annals of Internal Medicine (6) have encouraged medical providers to prescribe spinal manipulation as a first line treatment for acute, subacute, and chronic low back pain.

Most recently, The Lancet echoed that endorsement, and provided a unique perspective:

The reduced emphasis on pharmacological care recommends nonpharmacological care as the first treatment option and reserves pharmacological care for patients for whom nonpharmacological care has not worked. These guidelines endorse the use of exercise and a range of other non- pharmacological therapies, including massage, spinal manipulation, and acupuncture.

Gaps between evidence and practice exist, with limited use of recommended first- line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence. (7)

Unfortunately, personal experience skews our perception of each other’s merit, i.e., we primarily see each other’s failures since the successes don’t need to seek additional care. Regardless of our professional degree, we all have failed cases mixed into our many clinical successes. We must not lose sight of the evidence supporting each other’s overwhelming proven value for a given diagnosis. If we judge each other by our successes rather than our failures, we will work toward an integrated model where the patient wins. Together, we will help more patients than either working alone.

We are honored for the opportunity to co-manage your patients.

 

References
1. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.
3. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in
2018 Comprehensive Accreditation Manual for Hospitals.
4. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
5. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain; Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
6. Qaseem A, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
7. Foster, Nadine EBuchbinder, Rachelle et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, Published Online March 21, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30489-6

Spring Cleaning Tips

~ Dr. Robert Speirs DC ~ Leave a comment

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.

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.

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.

My abductors are weak, what does that mean?

~ 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.

Meet the Hip Cycle. You can thank me later.

1. Side lying with back and shoulders against a wall so you can’t roll back.

2. Bend your bottom leg and put the sole of your foot against the wall to be more stable.

3. Start position is with your foot directly in line with your hip. Do not let it get any lower than that. The highest point of your foot needs to be the bump on the outside of your ankle.

Do 5-10 reps of each of the following without rest between exercises twice a day. The goal is 20 reps each.

a. 6″ leg raises in abduction
b. Knee up to chest (90* knee and hip)
c. 12″ leg raises into abduction
d. Bicycling (knee up to chest, extend knee and sweep back to start with leg straight)
e. Clockwise circles
f. Counterclockwise circles
Good luck.