Trigger points in the triceps muscle.

The tricep muscle is named for its three heads long, medial, and lateral. The long head originates on the infraglenoid tubercle, the medial head on the posterior humerus, and the lateral head on the posterior humerus as well. They join together to insert on the Olecranon process of the ulna. The triceps function to extend the elbow. Strong extension under resistance can cause trigger points to form. Pain referred from triceps trigger points can be felt in the posterior shoulder and down the posterior forearm, as well as in in the olecranon process and the lateral epicondyle which can cause “tennis elbow” pain.


My knee hurts; I must have bad knees….


Due to bipedal locomotion (walking around on two legs), foot and ankle problems have the potential to affect EVERYTHING above the feet—even the knees!

When analyzing the way we walk (also known as our gait), we find when the heel strike takes place, the heel and foot motion causes “supination” or the rolling OUT of the ankle. As the unloaded leg begins to swing forwards, there is a quick transition to pronation where the heel and ankle roll inwards and the medial longitudinal arch (MLA) of the foot flattens and pronates NORMALLY!

During the transition from supination to pronation, the flattening of the MLA acts like a spring to propel us forwards followed by the “toe off”, the last phase, as we push off with our big toe and the cycle starts with the other leg. However, if you watch people walk from behind, you will see MANY ankles roll inwards too much. This is call “hyperpronation” and that is NOT NORMAL!

So at what point does this normal pronation become hyperpronation? The answer is NOT black and white, as there is no specific “cut-off” point but rather, a range of abnormal. Hence, we use the terms mild, moderate, and severe hyperpronation to describe the variance or the degrees of abnormality.  Hyperpronation can lead to the development of bunions and foot/ankle instability that can cause and/or contribute to knee, hip, pelvis, and spinal problems—even neck and head complaints can result (the “domino effect”)!

One study looked at the incidence of hyperpronation in 50 subjects who had an anterior cruciate ligament (ACL) rupture vs. 50 without a history of knee / ACL injury. They found the ACL-injured subjects had greater pronation than the noninjured subjects suggesting that the presence of hyperpronation increases the risk of ACL injury.

Doctors of chiropractic are trained to evaluate and treat knee conditions of all kinds. Often this may include prescribing exercises or utilizing foot orthotics in an effort to restore the biomechanics of the foot, which can have positive effects not only on the knees but also further up the body.

Work Station Ergonomics Advice

When dealing with Upper Crossed Syndrome the ergonomics of your workstation should be at the from of mind. Some workstation ergonomics advice is as follows:


Maintain proper body position and alignment while sitting at your desk – Hips, knees and elbows at 90 degrees, shoulders relaxed, feet flat on floor or footrest.
Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
Use a lumber roll for lower back support.
Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
Periodically, perform the “Brugger relief position” -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.
Addressing these areas will help reduce your symptoms, make your care more effective and the duration of pain decrease. If you need help with ergonomics or want more information, please contact us at

Some Sleep Habit Tips

SLeep Tip

Researchers recommend sleeping for 7-9 hours per night. Even small deficits can pose problems like decreased athleticism, diminished brain function, increased inflammation and a greater likelihood to get sick- sleeping only 6 hours per night makes you four times more likely to catch a cold when compared to sleeping 7 or more hours. Follow these additional tips for better sleep:
Limit screen time before retiring- the blue light emitted from computer monitors, phones and TV’s can limit melatonin production and adversely affect sleep. Try reading from a book or magazine instead.
Ideally, eat your last meal 3-4 hours before bedtime and especially limit heavy, spicy or high-fat foods. Ration how much you drink before bedtime to minimize bathroom breaks. Particularly limit caffeine in the afternoon and evening- caffeine has a half-life of 6-9 hours and can keep you awake long after the last sip.
Stick to a sleep schedule, trying to retire and arise at the same time each day, including weekends.
Sleep on a comfortable mattress and pillow. Choose 100% cotton sleep clothes and sheets over synthetic materials (i.e. polyester). Some research has suggested that your “deep” REM sleep improves when your mattress is oriented so that your body is aligned North and South as opposed to East and West.
Most people sleep best in a cool room; ideally between 60-67 degrees F.

Chronic Lumbar Disc Pain

Your low back consists of 5 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebrae. A disc is made up of two basic components. The inner disc, called the “nucleus”, is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus”, which is a tough ligament that wraps around the inner nucleus much like a ribbon wrapping around your finger.

Your low back relies on discs and other ligaments for support. “Discogenic Low Back Pain” develops when these tissues are placed under excessive stress, much like a rope that frays when it is stretched beyond its normal capacity. Most commonly, disc pain is not the result of any single event, but rather from repeated overloading. Your lumbar discs generally manage small isolated stressors quite well, but repetitive challenges lead to injury in much the same way that constantly bending a piece of copper wire will cause it to break. Examples of these stressors include: bad postures, sedentary lifestyles, poor fitting workstations, repetitive movements, improper lifting, or being overweight.

Approximately one third of adults will experience pain from a lumbar disc at some point in their lifetime. The condition is more common in men. Most lumbar disc problems occur at one of the two lowest discs- L5 or L4. Smokers and people who are generally inactive have a higher risk of lumbar disc problems. Certain occupations may place you at a greater risk, especially if you spend extended periods of time sitting or driving. People who are tall or overweight have increased risk of disc problems.

Symptoms from disc pain may begin abruptly but more commonly develop gradually. Symptoms may range from dull discomfort to surprisingly debilitating pain that becomes sharper when you move. Rest may relieve your symptoms but often leads to stiffness. The pain is generally centered in your lower back but can spread towards your hips or thighs. Be sure to tell your doctor if your pain extends beyond your knee, or if you have weakness in your lower extremities or a fever.

Repeated injuries cause your normal healthy elastic tissue to be replaced with less elastic “scar tissue.” Over time, discs may dehydrate and thin. This process can lead to ongoing pain and even arthritis. Patients who elect to forego treatment and “just deal with it” develop chronic low back pain more than 60% of the time. Seeking early and appropriate treatment like the type provided in our office is critical.

Depending on the severity of your injury, you may need to limit your activity for a while, especially bending, twisting, and lifting, or movements that cause pain. Bed rest is not in your best interest. You should remain active and return to normal activities as your symptoms allow. Light aerobic exercise (i.e. walking, swimming, etc) has been shown to help back pain sufferers. The short-term use of a lumbar support belt may be helpful. Sitting makes your back temporarily more vulnerable to sprains and strains from sudden or unexpected movements. Be sure to take “micro breaks” from workstations for 10 seconds every 20 minutes.

Pathophysiology of trigger points.

A large number of factors have been identified as causes of trigger point activation. These include acute or chronic overload of muscle tissue, disease, psychological distress, systemic inflammation, homeostatic imbalances, direct trauma, radiculopathy, infections, and lifestyle choices such as smoking. Trigger points form as a local contraction of muscle fibres in a muscle or bundle of muscle fibres. These can pull on ligaments and tendons associated with the muscle which can cause pain to be felt deep inside a joint. It is theorized that trigger points form from excessive release of acetylcholine causing sustained depolarization of muscle fibres. Trigger points present an abnormal biochemical composition with elevated levels of acetylcholine, noradrenaline and serotonin and a lower ph. The contracted fibres in a trigger point constricts blood supply to the area creating an energy crisis in the tissue that results in the production of sensitizing substances that interact with pain receptors producing pain. When trigger points are present in a muscle there is often pain and weakness in the associated structures. These pain patterns follow specific nerve pathways that have been well mapped to allow for accurate diagnosis or the causative pain factor.