Common Conditions We Treat
Most know that it is advisable to rest, ice, compress, and elevate following an ankle sprain. This is most useful to reduce swelling and inflammation in the area. What is not as observable is the scarring that occurs within the ligaments that are sprained during injury. Most ankle sprains occur in which the ankle rolls in and causes damage to the ligaments on the outside of the ankle. Adhesions (scar tissue) are laid down over the damage to repair the ligament. However, scar tissue is a rather ‘cheap’ form of tissue and can easily re-tear, which predisposes the ankle to future sprains. While strengthening the foot and calf are important to rehabilitating an ankle sprain, scar tissue must be disrupted to allow for proper function of the ankle.
Both of these conditions are similar in their presentation, with the exception of location. Golfer’s elbow, or medial epicondylitis, occurs at the boney area on the inside of the elbow and tennis elbow, or lateral epicondylitis, occurs on the outside of the elbow. They are both due to repetitive overuse in which the tendons that insert on these boney areas develop micro-tears due to constant strain. The body naturally becomes inflamed and scar tissue is laid down in place of the tears to ‘patch up’ the area. Scar tissue, being a tough, dense, inelastic form of tissue binds and restricts these tendons, causing further stress on the tissues. Very often general stretching and ice is not enough to permanently resolve the issue. Active Release Technique and Graston Technique must be used to breakdown the specific areas of scarring. These conditions are not exclusive to golfer’s and racquet sports players. Manual laborers (plumbers, painters, gardeners, and carpenters), even typists or pianists are subject to this condition.
Carpal Tunnel Syndrome
Nerves that exit the spine interface with many muscles and ligaments as they course through the arm, wrist, and hand. There are various locations where these nerves may become caught or entrapped. The carpal tunnel, which is made up by the bones and soft tissues of the wrist, allows for the passage of nerves that supply the hand. Repetitive wrist movements, such as those used in typing or carpentry, cause friction and pressure within the carpal tunnel. This repetitive overuse promotes scar tissue development in the tissues that house the nerves in the wrist, resulting in numbness, tingling, and pain into the hand. Active Release Technique (A.R.T.) is diagnostic as well as therapeutic in that it allows the practitioner to evaluate the connections between muscles, ligaments, tendons, and nerves. The practitioner will evaluate the quality of movement and degree of scarring within these tissues that may disrupt nerve function.
Sacroiliac Joint Pain
The tail bone (sacrum) and hip bone (ilium) join to form the sacroiliac (SI) joint in the pelvis. This joint is surrounded by dense ligaments and powerful buttock muscles that support this important joint. Lifting objects and prolonged sitting and standing is commonly painful when this joint is irritated. Symptoms consist of a sharp/achy pain directly over the SI joint in the upper buttock and may radiate into the thigh and groin. Excessive stress due to bending, lifting, prolonged sitting in combination with a weak core and gluteal muscles can stress this joint and its surrounding network of ligaments. Clinically, we have found that manipulation and treatment to eliminate scar tissue has provided with significant relief and return to normal function.
Naturally, we are designed to walk barefoot, which allows the toes to grip the ground as we walk or run through gait. As the toes flex to grip the ground, the muscles that support the arch of the foot engage and strengthen. However, because we spend most of our time walking on hard, flat surfaces we wear footwear that pads and supports our feet but does not allow these muscles to engage. So what takes most of the load, if the musculature is weak? You guessed it, the plantar fascia. This thick, fibrous band becomes overload and small tears occur in the fascia. Scar tissue forms to repair the damage, further constricting the plantar fascia until tension and pain develops, typically at the inside arch toward the foot toward the heel. This condition typically responds well to advanced myofascial therapy (A.R.T.) of the plantar fascia and calf, foot manipulation to restore mobility to the many joints of the foot, followed by strengthening exercises.
Sciatica occurs due to irritation of the sciatic nerve and/or low back nerve roots. Pain is often sharp, shooting, and may feel like an electric shock running the back, buttock, thigh, and leg. Weakness, numbness, and tingling may also occur in the lower extremities. Pain may come on gradually with prolonged, improper sitting or suddenly with bending, lifting, and twisting motions. The sciatic nerve may be irritated at the spine or entrapped within deep muscles of the buttock and leg. Those who present with this condition without prior significant trauma commonly have a history of chronic joint stiffness in the pelvis and mid back, in addition to weak core and buttock muscles. All of these factors produce stress on the lower spine and discs, which may lead to disc problems, muscle tension and consequent sciatic symptoms. Joint manipulation of stiff joints and core strengthening to support the low back are essential for alleviating and preventing this condition.
Shin splints is a term used for overuse syndromes involving the lower leg muscles that move the ankle and foot. During the first injury, most often due to running in poor shoes, the muscle fibers tear from the bone. During the body’s attempt to heal this tear the site can become fibrotic. This fibrotic (scar) tissue becomes less resilient than normal muscle attachments. During further use (running) these muscles can fail to lengthen properly, which increases the tension on the already scarred attachments. Proper soft tissue treatment will breakdown the fibrotic tissue (scar) tissue making the muscle behave more like a rubber band than a tight rope as it lengthens during activity such as running.
Knee Sprain & Tendonitis
The knee joint is a very stable joint unlike the shoulder, which is an aerobatic joint, controlled to a great degree by muscle. When the knee is injured it many times occurs with loading (compression) and twisting (torque). The knee also can be injured by forces applied to an extended knee. It is common for the ligaments and meniscus (cartilage) to take this abuse. Micro tearing and inflammation can occur, which then leads to scar tissue formation. Overuse of the muscles controlling the knee as it flexes and extends during running can overload the tendons, which can cause inflammation and scarring. Advanced soft tissue therapy (A.R.T./Graston) is designed to disrupt this scar tissue formation thus allowing these tissues to support and move the knee joint as it is designed.
The muscles of the calf fuse to form the Achilles tendon which attaches to the heel. Because the tendon is very dense, strong, and has constant tension on it, the blood circulation in the tendon is limited. This makes repair from a minor tearing injury difficult. And these minor defects (tears) can lead to major tears over time due to heavy use such as running sports. Advanced soft tissue therapy (A.R.T.) attempts to gently move the tissue to encourage fluid exchange and release the fibrotic (scar) tissue, which the body has laid down to heal the original tears.
IT Band Syndrome
The Iliotibial (IT) band is a thick, fibrous band of tissue that extends from the hip to the outside of the knee and performs as a stabilizer of these two joints. If the buttock muscles are under-trained, the IT band and its adjoining muscle will become overactive during repetitive motions like running and cycling. The IT band interfaces with the quadriceps and hamstrings and should glide smoothly over these muscles during walking and running gait. If pressure and friction occurs between these tissue, scarring will develop over the region. Active Release Technique attempts to break down these adhesions (scar tissue) to allow for a smooth gliding action of the IT band on the adjacent musculature. It is also very important to functionally assess the foot in addition to the hip and knee as excessive pronation of the foot can be a major contributing factor to this condition.
Hip Flexor Syndrome
The major hip flexor muscles, iliopsoas and rectus femoris, can become chronically tight due to too much sitting as well as repetitive motions like running and cycling. If any muscle remains in a contracted state and is continually overused, small local contractures (trigger points) may form in the muscle body. These contractures can result in scar tissue after time. As the hip flexor becomes tighter, more tension can develop at the tendon, which may result in pain and sometimes snapping in the groin and front of the thigh. The hip flexors attach directly to the low back. If there has been injury to the low back or if the core is weak, the hip flexors will tighten their grip on the spine, limiting lumbar spine mobility. When these muscles are tight, they will pull the spine and torso forward, forcing strain onto the low back. Active Release Technique reduces contracture of the muscle while chiropractic manipulative therapy restores mobility to the spine. Once movement is restored it is important to strengthen the core and buttock muscles to avoid future episodes.
Calf strains commonly occur due to tightness in the calf musculature, which may be precipitated by hip and ankle inflexibility. During walking or running gait the hip and ankle require a certain amount of flexibility for a proper stride. If the hips and/or ankles are tight due to too much sitting, repetitive athletic endeavors, or wearing high heels, the calf will be forced to work harder during gait. As calf muscles become tighter, they become shorter and subject to increased tension. Any muscle under these conditions may develop strains, micro tearing, and subsequent scar tissue, which further shortens the muscle. This cycle repeats itself until other tissues become involved, such as the Achilles tendon. Active Release Technique is required to break this cycle by breaking down scar tissue that has developed due to repetitive strain.
Painful and limited shoulder mobility is a common complaint in our office. It is often seen after recreational sports and exercise. We also see this with patients that over-exert themselves, commonly referred to as the “weekend warrior syndrome”. The shoulder is an aerobatic joint, meaning it is a joint suspended by muscle. This gives the shoulder great mobility and function, but can also make it susceptible to injury. Shoulder impingement syndromes can often be helped with advanced muscular therapy (A.R.T.) to the ligaments and muscles of the shoulder.
Tendonitis is painful with muscular effort in a pinpoint location of the shoulder. We evaluate the patient to uncover the particular tendons that have become scarred and inflamed, and apply advanced soft tissue treatment (A.R.T. and/or transfriction massage) to resolve the condition.
Frozen Shoulder Syndrome can last for many months and can occur from micro tearing in the Rotator Cuff muscles. These tears become inflamed and scar over, which can reduce range of motion of the shoulder. Locating the specific areas of scarring and lengthening the injured muscles can play an important role in resolving this difficult condition.
Numbness/Tingling In The Arms
Cervical radiculopathy includes any process that causes irritation, compression or dysfunction of one or more of the cervical (neck) nerve roots. Irritation of the nerves that emit from the neck can occur from loss of joint mobility of one or more segments of the spine. Irritation and/or entrapment can be caused even further from the actual cervical joints and the muscles that move the neck. The spinal nerves must pass through these tight, contracted muscles to deliver nervous impulses supplying the arms and hands. Disc protrusions and herniations of the neck, although much less common than joint dysfunction (loss of mobility) and soft tissue spasm/adhesions, do occur, but present differently. Special imaging, i.e., an MRI, may be required for patients where disc pathology is suspect. Chiropractic care to stiff, immobile joints, along with advanced muscular therapy (A.R.T.) can resolve these complaints.
Neck pain with restrictive movement is a common condition that can appear suddenly and resolve in a few days. Reoccurring or prolonged neck pain will often have its origin in the soft tissue and/or skeletal joints. Soft tissue adhesions (scar tissue) can develop from acute injury such as motor vehicle collision or recreational sports. Scar tissue can also develop from prolonged postures, such as working on a computer. The soft tissue can become overloaded while in the forward head posture, causing irritation and scarring. The prolonged postural stress or sudden ballistic loading of the neck can create spinal joints to become blocked, losing their ability to participate in the full range of motion. These small areas of reduced mobility can create palpable muscle spasm and tenderness, in time creating headaches. A well known orthopedic researcher, Bogduk, demonstrated that by injecting anesthetic nerve blocks into spinal neck joints, chronic headaches were successfully eliminated in 7 out of 10 patients. A thorough examination of the soft tissues and joints of the cervical spine should be performed on all patients who suffer with neck pain and headaches.
Low Back Pain
Low back pain is one of the most common disorders for which patients seek health care. Acute low back pain by nature is usually very sudden in onset and commonly results from activities of daily living as well as recreation and sport activities. Research has revealed that 90 to 95% of acute low back pain is due to musculoskeletal or mechanical dysfunction. 5 to 10% can be secondary to a pathological cause including disc protrusions and herniations. Low back pain, due to mechanical reasons, generally present differently than the less common form of pathological back pain. A detailed history and examination will most often uncover which category of low back pain the patient experiences. If a patient falls into the category of mechanical low back pain, or mild to moderate disc pathology, chiropractic care along with advanced muscular therapy (A.R.T.) and therapeutic exercise can help to resolve this condition.