Ankle Sprains

18 Feb 2015 Pain, Your Overall Health

How do ankle sprains usually happen?

It occurs with a twisting motion, most commonly with your toes pointed down and in. Some ways this can happen are as follows:
-Stepping on an uneven surface
-Landing on the outside of the heel
-Running with too much cross-over

What are signs of a sprain?

-Swelling, commonly on the outside of the ankle.
-Pain and difficulty putting weight on that foot.
If the pain is too great to bear weight at all, this is a sign of a fracture.

Which structures are most commonly affected?

In order of occurrence:
-Anterior talofibular ligament (aka ATFL)
-Calcaneofibular ligament
-Posterior talofibular ligament

How serious is it?

It depends on the grade of the sprain; which can be determined by the stability of the joint and how much pain is felt with walking. The grading system is as follows:
Grade 1: Slight tearing of the ligament with mild swelling and stiffness. There is mild pain with walking.
Grade 2: The tearing of the ligament is more severe but incomplete. There is less stability and moderate swelling and discoloration. Walking is painful.
Grade 3: A complete tear of the ligament with severe swelling and bruising. The ankle is unstable and cannot support walking. The pain is intense, especially when the ankle gives way under the persons full weight bearing on the ankle. This injury requires medical attention and surgery.

What are the possible complications?

Fracture of the talus
Fracture of the base of the fifth metatarsal
Dislocation of the peroneal tendons
Bifurcate ligament sprains
Achilles tendon injury
Ankle injuries are extremely common but fractures are found in only 15% of cases.

What is the quickest road to recovery?

Until the swelling has gone down:
Avoid full weight bearing. If it is a Grade 2 sprain, use crutches only for the first 1-3 days. Toe touching with crutch use will improve recovery time.
Ice three to five times a day for 20 minutes with an hour in between.
Rest, elevate, and compress the ankle.
See a chiropractor as soon as possible so that they may ensure that the bones in the foot are appropriately positioned to decrease undue stress on the ligaments and to speed the recovery.
Have the ankle braced with either a splint, a boot, or tape.

Once the swelling has decreased:
Wean off the crutches with gradual weight bearing.
Ice after activity

To avoid chronicity:
Before returning to activity, be sure that you are able to balance on one leg and hop on one leg without pain
Continue to ice after activity
Stretch prior to activities such as running and jogging

If chronicity does occur, do the above but also:
Tape for support before sport activities
Consider getting an orthotic fitting
Seek physical therapy

References:
Souza, Thomas. Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms. Jones & Bartlett Learning; 4th edition (October 3, 2008).

Chiropractic care can help with knee pain

1 Feb 2015 Pain, Your Overall Health

Knee pain is very common among our population. It can occur from injury or medical conditions such as gout, arthritis and infection.

What are the common Knee injuries causes?

  1. Ignoring minor knee pain – tight muscles and inactivated (non-working)muscles can leave a knee open for injury and more serious injury.
  2. Excess weight – there is a body perfect weight for each person. Gaining just 20-30 lbs can cause increased knee pain.
  3. Not resting after a knee strain or injury. If the knee doesn’t have time to heal, it makes the body more vulnerable to injury.
  4. Lack of flexibility in muscles can lead to a strain or injury.

What are the Medical Conditions that cause knee pain?

  1. Gout
  2. Arthritis Degenerative and inflammatory issues
  3. Infection
  4. Chronic Muscle injury

What are the components that make up the knee?

  1. 2 meniscus
  2. Anterior Cruciate Ligament and Posterior Cruciate Ligament
  3. Median Cruciate Ligament and Lateral Cruciate Ligament
  4. Femur, Fibular head and Tibial Head
  5. Quadriceps muscle, Hamstring, Groin Muscles, Anterior Shin muscles and Calf muscles
  6. Iliotibial Band (IT Band)
  7. Associated nerves and arteries

What are the symptoms of knee pain?

This may sound like a redundant question but when you think about the issues that make up pain, it is usually more than just pain itself. Look for the following symptoms to identify issues in your knee:

  1. Swelling
  2. Tight muscles
  3. Decreased range of motion
  4. Redness
  5. Palpable increase in temperature when feeling the knee
  6. Clicking or popping sounds that are accompanied with discomfort or pain
  7. Weakness or feeling like the knee will collapse

What are the red flags in knee pain or discomfort that alert you to go seek medical care?

  1. Swelling or increased temperature felt on the knee
  2. Weakness
  3. Inability to extend the knee
  4. Cannot bear weight on the Knee
  5. Deformity in the knee
  6. Muscle tension and Pain lasting greater than 10 days
  7. Knee pain following a fall or trauma

What are the Treatments for knee pain?

  1. Surgery if a meniscus, ligament or muscle is torn
  2. Physical Medicine: chiropractic treatment or physical therapy
  3. Massage for a muscle tension and help with injury recovery

In our office, we use manual adjustments and the Graston Technique to treat the ligaments and tendons, which is a good solution when surgery isn’t the best option.

The treatment duration takes several days to weeks with some rest and exercise strongly recommended.

Carpal Tunnel and our Modern world

21 Aug 2014 Pain, Your Overall Health , , , , , , , ,

What is Carpal Tunnel?

This is a condition that is defined by tingling and numbness in the hand and arm which usually occurs gradually over time.  It eventually leads to hand weakness and is due to an impingement of the median nerve which runs down the center of the forearm (when you are looking at your hand with the palm up).  There are several factors that can cause it, but most are due to the persons anatomy or a repetitive action by the arm and hand most typically due to overuse on the computer.  The bones of the palm form a tunnel that protects the nerve and the 9 tendons that helps the hand to function.

What are the Symptoms?

  • Aching:  One of the first symptoms to appear is not directly a symptom of Carpal tunnel but is a sort of “Canary in the Coal mine”, meaning it is the warning sign that tingling and numbness will follow.  It is an urgent message to see a practitioner to make sure that your hands and forearm anatomy are in proper alignment so more serious symptoms don’t develop.
  •  Tingling and Numbness:  Typically tingling is felt first, followed by numbness in the thumb, index and middle finger.  The ring finger will sometimes be effected, and the little finger is usually not effected because it is controlled by another nerve.  The sensation will be much like your hand has gone to sleep and you need to shake it to wake it up.  As symptoms progress, the numbness may go from occasional to constant.
  • Weakness:  Often dropping items or not being able to grasp very well progresses over time making symptoms much worse.  The most common weakness that occurs is the pinching movement of the thumb as this is controlled almost entirely by the median nerve.

What Causes Carpal Tunnel Syndrome?

It is a compression of the median nerve on the hand.  Here are the most common ways to get carpal tunnel in our modern world:

  • Repetitive jobs:  assembly line work, dental, computer work, and some construction jobs
  • Fractures
  • Pregnancy: increased swelling will sometimes cause carpal tunnel like symptoms till baby is born.
  • Women are more likely to get Carpal Tunnel due to having smaller carpal tunnels
  • Dislocation of the hand/wrist
  • Inflammatory conditions: Rheumatoid arthritis and many other disorders
  • Work with Vibrational tools

This is only a small list and many other things also can cause this condition.   Don’t assume you do not have carpal tunnel because your job factor isn’t listed here.

How is Carpal Tunnel Diagnosed?

It  is done by a thorough history or examination of your symptoms to see if you have some of the risk factors and how the gradual onset of symptoms or the trauma occurred.  The doctor will do a physical exam performing a series of orthopedic tests that put pressure on the Median Nerve in several different ways.  An Xray may be ordered or an Magnetic Resonance Imaging (MRI) will be done to rule out other issues such as arthritis, neuroma or other anatomical variations that may be causing the issue.  Lastly, a Nerve conduction study or a Surface Electromyography (EMG) study that will done to see if the median nerve is conducting a current all the way from the neck, elbow and into the palm.  This is to make sure that nerve damage isn’t occurring which would need to be addressed with a surgical option immediately.

How is Carpal Tunnel Treated?

If your history and exam only reveal a mild onset of symptoms, you can see a chiropractor that specializes in adjustments and soft tissue injuries.  We recommend that you see one that is specialized in the Graston Technique as it has been shown to be very effective for treating Carpal Tunnel and offers significant improvement in about 8 visits.  Graston releases the tight muscles and adhesions caused in the palmar forearm and will need to be iced after treatment as some minor swelling may occur.  Physical therapy may also be needed to strengthen areas of weakness that lead to the carpal tunnel issue originally as well as re-training those injured areas.  Splints may be recommended to keep the tunnel open and your wrist in as optimal a position as possible.  Corticosteroids are also tried if the previous more conservative treatments have failed.  We do recommend Corticosteroids over surgery.  Lastly if severe enough nerve compression is present, the patient will have to look at surgical options but we do recommend this as a last resort since the carpal tunnel is narrow and scar tissue can form post-surgically as well which causes further problems down the road.

We treat Carpal tunnel in our office and you can expect a combination of Graston therapy, Kinesio Tape and adjustments for the treatment regimen.  This is an area great concern. Silicon Valley has a lot of Carpal Tunnel issues because of how many of us use computers, cell phones and tablets on a daily basis.  Don’t wait for it to get so bad before getting it evaluated and treated.

The Chiropractic Approach to Low Back Pain

22 Oct 2012 Pain, Your Overall Health , , , , , , , , ,

What is Back Pain?

Back pain is usually a pain that occurs in the lumbar spine and pelvic region otherwise know as you buttock.  The pain can occur from a tightening of muscle or joints that get jammed due to a specific incident or small injuries that occur over time from say construction work, running or desk jobs.

What is the Most Common cause of Back Pain?

The most common cause of back pain is related to repetitive strain injuries that occur on the job or during daily activities.  Working on the computer, cooking, sewing or any activity that keeps you repeating the same movements from the same position can be the culprit of that nagging back ache. The strain happens when either the muscles are tight and you are unable to stretch them, or when a joint is misaligned and the muscles become painful as they try to re-align the joint.

What are the Less Common types of Back Pain?

Degenerative Disc Disease, Arthritus, Herniation and neurologic conditions are all injuries that occur to the spine and more commonly in the low back.  These conditions will likely cause you great distress and you will need to seek a health care provider’s services.  The following symptoms can help you determine if it is a must to see your doctor:

  • History of cancer
  • Unexplained weight loss >10 kg within 6 months
  • Age over 50 years or under 17 years old
  • Failure to improve with therapy
  • Pain persists for more than 4 to 6 weeks
  • Night pain or pain at rest
  • Persistent fever (temperature over 100.4 F)
  • §History of intravenous Drug Abuse
  • Organ Transplant
  • Recent bacterial infection
  • Major Muscle weakness
  • Trouble lifting your foot
  • Numbness and lower extremity weakness
  • Anal Sphincter dysfunction
  • Recent Trauma
  • History of osteoporosis

Basic ways back pain can occur:

  • Desk job
  • Osteoarthritis
  • Herniated disk
  • Gravity
  • Sports injury
  • Bacterial Infection
  • Fractures
  • Cancer
  • Repetitive strain
  • Jammed (misaligned) joints

Why See a Chiropractor instead of only Massage?

Chiropractic care helps realign joints which stops the pain related to the muscles trying to push the joint back into alignment.  A typical response to this type of pain might be to stretch or get a massage.  While this might temporarily ease the pain, if you don’t re-align the joints, the muscles will loyally return to their job of trying to push the joint back into place and you will be back in pain once again.  This isn’t to say that Massage can’t be a terrific partner in getting rid of long term pain and it can we feel that massage and chiropractic can make an excellent team.

Getting adjusted not only will help relieve your low back pain, but offers other health benefits as well.  According to research by Sean M. Hannon, BA, DC, chiropractic adjustment can result in the following physiologic changes:                 

  • Increased strength
  • Increased oxygen consumption capacity
  • Increased range of motion
  • Decreased pain
  • Increase cardiac regulation
  • Increased immunity

Considering these benefits, it is easy to see why athletes and other health conscious people seek out care regular chiropractic care. If you suffer from chronic or even occasional back pain, contact our office.  We can help!

Let us help you with your headache

22 Oct 2012 Pain, Your Overall Health , , , , , , , ,

What is a Headache?

Generally defined as a continuous pain in the head.  The medical term ranges from cervical or neck pain to general headache as a diagnosis.  Headaches can be hormonal and for example occur with a women’s cycle or they can be trauma related such as post concussive syndrome.  They can occur due to neck, back or jaw pain or be due to a hereditary condition.

What is the Most Common Type of Headaches?

Headaches fall into two general categories, tension or migraine. The most common are tension headaches that come from tightness in the shoulders and neck. These headaches can come from prolonged sitting at a desk or poor posture. The tension headache starts from the base of the skull with pain above the eyes or even pain in the eyes. Some patients will have nausea and sensitivity to light leading to a misdiagnosis of a migraine. This type of headache is easily relieved by getting adjusted and by exercising to improve posture and decrease muscle tension. Regular adjustments can reduce dramatically decrease the incidence of tension headaches.

What are some of the Less Common Headaches?

Cluster headaches and migraines are less common and have varying pathological causes. Migraines usually begin in childhood, adolescence or early adulthood. Although much about the cause of migraines isn’t understood, genetics and environmental factors seem to both play a role. A man that has never had a migraine in adolescence and then gets one as an adult is a red flag for more serious problems and should bring to his health provider’s attention. Women more commonly have migraines, usually first occurring between the ages of 12 to 40 and declining after that.

Tension Headaches or Migraine?

There are some common ways to tell if you have a tension headache or a migraine:

Tension

  • Constant, dull pain, usually mild to moderate
  • Not incapacitating
  • Pain is often accompanied by muscle tightness in the shoulders and neck often on both sides of the head
  • May last an hour, a week, or anywhere in between
  • The pain is often described as a band of pain around the head, pressure behind one or both eyes “vise like pressure”
  • Some relief from over the counter medications or caffeinated beverages.

Migraine

  • Visual signs prior to headache
  • Familial history of migraines
  • Throbbing, intense pain, generally moderate to severe and often disabling
  • Usually one-sided, though the pain can move from side to side, and sometimes affects both sides
  • Pain is often near the eye of the affected side
  • May last hours, days, or even weeks
  • Often accompanied by visual disturbances and/or extreme sensitivity to light, sound, and odors
  • No relief with over-the-counter remedies

When should a Headache Lead me to call my doctor?

Some headaches can be a warning of something more serious. If you have any of the following symptoms, consult a doctor immediately.

  • An intense, severe headache that comes on quickly, without warning, especially if you are normally headache-free.
  • Sudden, severe headache if you suffer from kidney problems, heart disease or high blood pressure.
  • A headache following a head injury, especially if the headache includes feelings of nausea, dizziness, or blurred vision.
  • A headache accompanied by seizures.
  • A headache accompanied by memory loss, confusion, loss of balance, slurred speech or vision, pain in the neck, or numbness in arms or legs.

What can we do for Headaches in our Clinic?

Since headaches can be due to a specific incident of trauma or due to repetitive strain such as sitting hunched at your computer, we can use our extensive knowledge of the musculoskeletal system to reduce mm tension and joint misalignment which are common in the two scenarios.  We also do work with hormonal fluctuations that occur in both men and women to help them regulate their cycles and decrease cyclical headaches.  In some cases we have even found that food sensitivities are the cause of a lot of headaches and we do test for this in our office if this seems to be related to your condition.  Even hereditary migraine sufferers will get relief through manual medicine, even if every headache isn’t magically gone.

What is Bursitis?

22 Oct 2012 Pain, Your Overall Health , , , , , , , ,

What is bursitis?

Bursitis is caused by inflammation of a bursa, a small fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.  There are approximately 160 bursae in the body.  The major bursae are located bordering the tendons near large joints such as the shoulders, elbows, hips, knees, and ankles. 

What causes bursitis?

Bursitis is most often caused by repetitive minor impact on the area, or a serious injury.  In addition, incorrect posture at work or home and poor stretching or conditioning before exercise can also lead to bursitis. The following risk factors have been associated with the development of bursitis:

  • Repetitive stress or overuse injury
  • Spine disease
  • Joint-related injury
  • Bone spurs or calcium deposits
  • Rheumatoid arthritis
  • Leg-length inequality

Who usually gets bursitis?

Bursitis is more common in adults, especially women over 40 years of age.

What parts of the body does bursitis affect?

Any part of the body that has a bursa can be irritated and inflamed.  However, the following joints have the highest risk factors for the development of bursitis:

  • Shoulder
  • Elbow
  • Hip
  • Knee
  • Achilles tendon

What are the symptoms of bursitis?

The symptoms of bursitis are directly related to the level of inflammation of the bursa.  The inflamed bursa can cause localized pain and tenderness.  If the bursa is so severely inflamed that swelling occurs, it can cause local redness and warmth.  The pain may increase gradually or sudden.  If calcium deposits are present, the pain can be severe. 

How can I prevent bursitis?

Avoiding behaviors and activities that make the inflammation of the bursa worse is the best way to prevent bursitis.  For example:

  • Avoid repetitive activities that put stress on the bursa.
  • Maintain strength and flexibility of the muscle surrounding the joint/bursa.
  • Maintain a healthy weight.

How is bursitis treated?

The doctor will feel the joint for swelling or tenderness.  An x-ray may be taken or fluid from the bursa may be removed with a small needle to check for infection.

Drug therapies include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)  reduce pain and swelling.  Over the counter NSAIDs include: ibuprofen (Motrin, Advil) and naproxen (Aleve). Be forewarned that using NSAIDs over a long period of time can increase the risk of stomach bleeding and heart attack.
  • Corticosteroid injections into the bursa can reduce inflammation.  Usually only one shot is needed.  Sometimes oral corticosteroids are used to treat chronic inflammation.

Natural therapies include:

  • A healthy diet including whole grains, fruits, vegetables, and fatty fish and avoiding sugary, fatty and processed foods.
  • Nutraceuticals such as glucosamine sulfate, omega-3 fatty acids, vitamin C with flavonoids and bromelain
  • Herbs such as Boswellia (Boswellia serrata), Turmeric (Curcuma Longa), White Willow (Salic Alba)

The use of nutraceuticals and herbs can decrease the level of inflammation.  However, they can trigger side effects and can interact with other herbs, nutraceuticals, or medications.  They should be taken with care, and under the supervision of a health care provider.

While massage may be tempting to relieve pain, it is not recommended until an infection has been ruled out. Then it may help to reduce the discomfort from a sore joint.

Chiropractic and Movement Therapy

  • Mobilizing the muscles around the joints will help reduce the pressure on the joint and bursa.
  • Graston Therapy may help break down adhesion, increasing flexibility and reducing muscle tension.
  • Other therapies, including chiropractic adjustments and muscle release techniques, may also be helpful to improve muscles and ligaments and reduce the tension caused by repetitive motions.
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