Month: May 2017

Upper Cross Syndrome, Back pain, and Trap Dominance

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Upper Cross Syndrome & Trap Dominance

Upper Cross Syndrome (UCS) is a group of symptoms that leads to muscle imbalances and pain the upper shoulders and neck. It is typically seen in people with poor, slumped posture and those who spend their days at desks or looking down at their phones. It also becoming an increasingly common presentation in the Crossfit athlete.

UCS occurs as a result of forward head carriage, an increased thoracic kyphosis (hunchback), and consistently elevated shoulders that round forward. A head that is forward and flexed puts strain on sub-occipital muscles and upper traps, tightening and shortening them. This lengthens, and subsequently weakens the deep neck flexors. When the shoulders are rounded and slumped, the pecs become tight and the rhomboids and lower traps weaken. In the athlete, weakness in the rhomboids and rotator cuff muscles means the upper traps must compensate and fire every time the shoulder moves. Trap dominance may be especially noticeable when performing high rep cleans or snatches, as the aggressive shrug is facilitated by the trapezius.

UCS may manifest as pain in the shoulders, headaches, instability in overhead positions, numbness or tingling in the hands and/or weakened grip. Over time, it will cause postural changes that can put the body, especially the shoulders, at risk for injury. Muscles that are not working synergistically cause the joints they act on to become unstable as the imbalance in musculature pulls the joint out of optimal position. A joint that is not being stabilized correctly or moving in the proper plane will cause repetitive strain on the tissues and lead to complications in the form of impingement, rotator cuff strains, ligament sprains or dislocation of the shoulder.

To treat UCS, the tight, shortened muscles must be addressed first. Stretching, mobilizing and having manual therapy applied through the pecs, upper traps and sub-occipital muscles is a necessary first step. Close attention to posture is also imperative. Many people hold tension through the shoulders and are unconsciously holding them in an elevated position. Throughout the day, make note of shoulder position, then relax and lower them if necessary. Also be sure to pull the shoulder blades back. If you need a cue, think about squeezing them together or pinching your shirt between them. You should always think about this when setting up for a lift. Be sure to also keep the head level on the shoulders, not flexed forward. Think about making a double chin. This is the motion needed to pull the head upright. The final step is to strengthen the weak muscles. The following exercises are ideal for this:

  • Scap Pull-Ups
  • Y, T, I Raises
  • Band Pull-Aparts
  • Band Rows

IT Band Syndrome

Though it is typically an issue that plagues the endurance athlete, Iliotibial (IT) band syndrome is becoming more common in those that Crossfit. The IT band runs down the lateral side of the leg, from the hip to just below the knee. Due to its insertion near the knee, many people mistake IT band issues for lateral knee pain. The IT band functions to stabilize the knee. It is a very strong band of fascia, but faulty body mechanics combined with high repetition or high mileage can be extremely taxing on the tissue. This can lead to inflammation and swelling on the lateral aspect of the knee, and pain that can be felt up the length of the tissue, spreading has high as the hip. It may even cause a snapping noise when the knee is bent beyond 45 degrees.

Mechanically, the culprit is instability at the pelvis, knee, and/or foot. If just one of these structures is out of alignment, the knee and lower leg will rotate inwards and put increased strain on the IT band, increasing its contact with the bony structures of the knee joint. A flat or pronated foot can cause the knees to cave in. An unbalanced pelvis creates a leg length discrepancy, increasing the stress on one leg as the majority of load is shifted to that side. This can be due to a structural misalignment, or a weak gluteus medius, a dynamic stabilizer of the lower extremity. There isn’t one cause of IT band issues, so there isn’t just one solution. The underlying cause needs to be found, and addressed appropriately. Running shoes may need to be replaced or be supplemented with arch supports if you are an over pronator. The foot should also be adjusted to ensure the various bones that comprise it are aligned and functioning synergistically. The hips should also be assessed by your chiropractor to ensure proper alignment. The glute med can be muscle tested to determine whether or not it is inhibited. If this is the case, proper strengthening of the muscle should be implemented.

Regardless of the cause, if you are experiencing IT band pain or discomfort, you should address the issue immediately. Resting from activity, applying ice and consulting with your chiropractor are all imperative to resolving the issue.

Wrist Pain: Is it my Forearm?

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Walking into a crossfit gym for the first time can trigger a wide range of emotions. Excitement, anxiety and, potentially, mild regret as you stand there watching the current class splash in pools of their own sweat and release guttural noises while throwing heavy things in the air. You’re in too deep to leave, and so you make it through your first workout, exhausted yet invigorated. This is the typical story of the crossfit rookie. Regardless of fitness level, the beginner is new to many of the programmed movements and, in turn, will be adding many stresses to their body that have never been experienced before. Not only are the movements new, but so are the body aches and pains that accompany them. Wrist pain, shoulder impingement, IT band tightness, low back & upper trap pain are a few of the most common issues seen in the beginner WOD-er. In the following paragraphs, we will aim to explain more about the trials and tribulations of each of these issues and how you, a rookie or a seasoned vet, can work to prevent and treat them.

Wrist Pain

As a crossfit athlete, you are almost guaranteed an experience with some type of wrist pain. This could range from a mild ache post-workout to an uglier, chronic pain. Unfortunately, it’s the nature of the beast as the majority of functional movements performed in the crossfit setting require repetitive or prolonged wrist extension. Pushups, ring dips, front squats, cleans, thrusters, overhead squats, handstands. The list could go on. Performing these movements under load and in a fatigued state can push the joint into hyperextension and increase the potential for ligament sprains, muscle strains and cartilage tears. These are more of the severe injuries you could encounter, and they are actually located at the wrist joint. However, the type of pain that most people experience in their wrists is actually referred pain from the forearm. If you thought the list of exercises that put the wrist into loaded extension was long, start thinking of all the times you are required to grip something during a typical 60 minute crossfit class. Yeah. Almost the entire time. Holding on to a bar, a weight, a rope, a rowing handle. Cue Popeye forearms. Even if you don’t leave the box unable to grip your blender bottle and car keys, the repetitive use of these muscles class after class, without any stretching or treatment, is enough to elicit wrist pain. For the most part, people neglect caring for their forearms not because they’re lazy, but because they don’t even realize their forearm muscles are sore until a practitioner digs into them with a thumb or soft tissue tool. It’s pretty common to think that if a joint hurts, then the problem must be there! Often, it’s not, and this is especially true with wrist pain. At least once a week, be sure to show your forearms some love in at least one of the ways listed below.

Here are some ways to keep the forearms & wrists happy:

  • Wear wrist wraps! These are a low cost way to provide support to the joint & prevent wrist hyperextension
  • Strengthen the wrists by improving grip strength. Farmer carries, pinch grip weight carries, loaded barbell holds, and timed hangs from pull-up bar are all great ways to do this.
  • Stretch & roll-out the forearm compartments with a barbell after workouts
  • Have a practitioner perform active release or instrument assisted soft tissue work on the forearms

If you can relate to any of the following statements, your wrist pain may be due to a more serious issue. You should seek out a medical provider for an exam and diagnosis.

  • Stabbing, sharp, shooting pain at the wrist or hand
  • Hearing a snap or pop, followed by pain
  • Pain that doesn’t go away regardless of treatment or position
  • Bruising at the wrist or hand
  • Weak grip holding lighter objects like a coffee cup, or inability to grip a heavier object

 

Shoulder Impingement

Crossfit is notorious for high-rep overhead movements such as push press, overhead squats and handstand pushups. This can be great for the guns, but not so great for a shoulder that isn’t being mobilized properly after class or outside of the gym. Repetitive overhead movements without preventative shoulder care can put you at risk for shoulder impingement syndrome, an issue that causes inflammation and micro-tearing of the rotator cuff muscles. The tendons in the shoulder can then be pinched under the acromion process of the scapula, causing pain and limiting range of motion. The first step in preventing this problem is to ensure you are properly warmed up and increasing the load on the shoulder at an appropriate pace. Addition of weight to movements should be done gradually, and when choosing a weight for the WOD, a load that is suitable to your skill level should be used. If you’re not sure what you should use, ask your coach. At the same time, listen to your body, and if you begin to lose proper form or if movement becomes unstable, take a quick rest before continuing. The second way to prevent shoulder pain is to take care of them after class! Stretch & use a lacrosse ball on the muscles of the upper back, pecs and arms. Tightness in any of these regions can pull the shoulder out of ideal alignment. You should also work to strengthen the muscles of the rotator cuff to create resilience. Finally, see your chiropractor at least once a month to ensure your body is moving properly and have any soft tissue issues addressed.

  • Maintaining a proper, upright posture with shoulders back when sitting or working
  • Using proper technique when lifting or performing exercises
  • Strengthening the rotator cuff and upper back muscles
  • Stretching the anterior shoulder and chest, neck and back muscles
  • Regular chiropractic visits

Knee Pain | The Great Myth of Patellofemoral Pain Syndrome

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Anterior knee pain, often diagnosed as Patellofemoral Pain Syndrome (PFPS), is a common complaint in the chiropractic office. This complaint is typically from runners and other endurance athletes who are overtraining, but can also be due to increased load on joints and repetitive impact from running or jumping. The pain will be centralized to the front of the knee, feel achy, and get worse when moving up or down stairs. It may also ache while sitting for prolonged periods.

The knee is a hinge join connecting the femur to the tibia, and allowing for flexion and extension. The patella, or knee cap, is a bone that receives the quadriceps tendon and links it across the knee joint to the tibia via the patellar tendon. It also acts to protect the articular surface of the knee. As the knee moves through its range of motion, the patella moves in combination, tracking up and down, tilting and rotating to help facilitate proper body mechanics. Traditionally, anterior knee pain has been attributed to improper tracking of the patella. It is theorized that the muscles acting on the patella are weak or tight, pulling it off course. The issue with this theory, however, is that a clear definition of a proper tracking motion has not been established. In fact, many studies have found that every individual’s patellar tracking pattern may be distinct, and a normal movement path many not actually exist. A research study conducted in 2006 at Queen’s University in Canada discovered that there is no evidence to link aberrant patellar motion to knee pain. This means there is a good chance that if you assessed the patellar movement of healthy knees, you would see patterns similar to those in pathologic knees.

So, if the knee cap is not the culprit, then what is? Why has this pain occurred and where is it coming from? The answer is to look beyond the site of pain and assess the body as a whole. Currently, the gold standard treatment for this issue is to strengthen the vastus medialis, one of the muscles comprising the quadriceps. This is an effective treatment if weakness of this muscle is the legitimate cause of the pain. If it is not the cause, though, then improving the strength of it will do little to improve the situation. The practitioner should perform a comprehensive assessment of the lower limb; the foot, ankle, knee, and hip joints should all be assessed for subluxation and aberrant motion, and the muscles checked for hypertonicity and weakness. They should also be working to find which motions or regions of muscle reproduce, exacerbate, or relieve the knee pain. From here, a proper solution can be provided and an effective treatment plan can be developed. This may include initial reduced activity or a period of time away from sport, adjustments, stretching, instrument assisted soft tissue work (FAKTR, Graston), active release therapy, massage & resistance exercises.

core health knee pain

The following are potential causes of PFPS:

  • Weakness of the quadriceps muscles
  • Tightness of the iliotibial (IT) band
  • Inhibited or hypertonic gluteal muscles
  • Hypertonicity of the quadriceps, hamstrings and/or calves

By Taylor Meyers

Shoulder Impingement Syndrome: Causes, symptoms, and treatment

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Shoulder Impingement Syndrome, a common cause for shoulder pain.

Shoulder Impingement Syndrome, also known as Swimmer’s or Thrower’s shoulder, is a common over-use condition that occurs when the shoulder bursa or rotator cuff tendons become compressed within the shoulder joint. The shoulder joint is comprised of the scapula, humerus and clavicle. The tip of the scapula, called the acromion process, joins the clavicle to create the acromioclavicular joint. The narrow passage below this joint, the subacromial space, is where compression occurs.

Those who perform repetitive overhead movement (athletes, laborers) are at the highest risk of developing shoulder impingement. However, as technology and careers have evolved, it is becoming more common in those with poor posture and rounded shoulders. Overuse and poor positioning of the shoulder can cause tendon microtrauma and inflammation of the rotator cuff muscles. This may cause thickening of the tendon, decreasing the diameter of the already narrow subacromial space. At this point, movement of the shoulder may cause the tendon to be pinched underneath the acromion, causing pain and limit range of motion.

There are a wide range of treatment options for shoulder impingement syndrome, including adjustments, manual therapy and exercise. When you visit your practitioner, their goal should be to discover the underlying cause of impingement. Is it due to a recent trauma to the shoulder, too many pull-ups and presses, or repetitive use of a tool overhead? Once the cause is determined, therapy can be applied accordingly. The first step should be to manage the pain and reduce the strain on the area. Limiting the use of the shoulder, in combination with cryotherapy, will help relieve pain and inflammation. You may be asked to modify or take time away from your job or sport in order to achieve this.

The next step is to reduce muscle tension, correct structural misalignments, and improve range of motion. Chiropractic adjustments of the neck, thoracic spine and shoulder will be effective in achieving improved function and may be done in conjunction with another soft tissue therapies such as instrument assisted soft tissue mobilization (IASTM),  blood flow restriction therapy, or massage.

The final step in treating this issue is strengthening of the rotator cuff muscles and shoulder retractors and stretching the anterior shoulder and chest. By working to stretch and strengthen these muscles of the shoulder and back, proper posture and alignment can be restored and future damage may be prevented. Most of these strengthening exercises are performed with small dumbbells or resistance bands, making them very approachable and easy to do on your own. Your practitioner should provide you with a basic regimen to be done at home or at clinic visits.

In order to prevent this issue from occurring, you may implement the following strategies:

  • Maintaining a proper, upright posture with shoulders back when sitting or working
  • Using proper technique when lifting or performing exercises
  • Strengthening the rotator cuff and upper back muscles
  • Stretching the anterior shoulder and chest, neck and back muscles
  • Regular chiropractic visits

-Taylor Meyers, Intern Core Health Chiropractic