Tag: IT band syndrome

The Adjustment

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What do chiropractors do, and how can we help you?

Chiropractors are experts of the spine. We go to school for a minimum of 3 years prior to being accepted into chiropractic college. From there, we go through a rigorous doctorate degree that encompasses many of the same core classes as a medical doctor as well as other specialized classes that have to do with the musculoskeletal system and how to adjust and align the spine.

Throughout that doctorate degree, we learn the specifics of how the brain talks with, and controls your body. Such as how your body has an inhibitory reflex when you touch a burning candle. Your body is equipped with an automatic draw reflex that makes you pull your hand away from the flame without consciously withdrawing your hand. We also learn how the individual vertebra move on one and other and how altered movement of those vertebra can cause pain, dysfunction, altered biomechanics and can also lead to an increased rate of joint degeneration.

When we talk about joint dysfunction (subluxation), we look at a joint that is fixated and that does not move independently from its adjacent segment. These fixations can be caused from stress, inflammation, trauma, repetitive movements and poor posture. When we have these subluxations, they can cause increased pain in the area of restriction, refer pain to another area of the body, it can cause increased muscle tension on surrounding muscles. The increase in muscle tension can be a protective mechanism in which the muscle tightness up because the joint feels vulnerable or it can be caused from a malposition of the spinal segment itself.  Altered spine motion can also alter your biomechanics (the way your body moves).

When your body is aligned and each segment is moving within its normal range. Our bodies have balance in the sense that there is no undo stress on any particular muscle or joint. When we develop these misalignments and fixations our bodies start to compensate for the subluxation. In the area of restriction there is likely be a segment of hypermobility above or below to compensate for the restricted segment or you may start to shift your weight to one side of your body more than the other to create a sense of balance.

You see the body is very smart and will do whatever it can to continue to function as normal as possible, but this often comes at the expense of another joint or part of your body. That is where we come in, as chiropractors we correct those areas of restriction and help to get the patient moving and pain free as best we can.

Each joint in out body has receptors that have various functions that provide feedback to the brain. These mechanoreceptors provide feedback on how much stretch is in each muscle surrounding the joint, the position of the joint in space which allows us to maintain balance and be able to move in space with coordination and balance. These receptors also send pain signals when they are irritated such as when there is lack of motion in a segment or the segment is subluxated. When we assess the joint and finds the restriction we are then able to apply a high velocity low amplitude (HVLA) adjustment to the segment in the direction of malposition or fixation to realign and create motion through the joint. The adjustment also sends feedback to the brain through the mechanoreceptors that tell the surrounding muscles to relax and also inhibits the pain receptors. The final outcome of a HVLA adjustment facilitates proper motion of individual segments, relaxation of surrounding musculature, improves biomechanics and ultimately leads to a decrease in pain.

So, if you have a back, there is a good chance that chiropractic care is going to help you.

-Daniel Hounjet, Core Health Intern

 

 

Listen Up!

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Auditory Acuity of self.

I’ve been around the health and fitness industry a long time, which means I’m getting old, but it has allowed me to personally commit all the mistakes I see patients come into the clinic with.   For the purposes of this article, let’s call the health, fitness, and food industries the wellness industry. The only constant about the wellness industry is that it’s always changing.  Information evolves, trends come and go, and maybe something we thought was “healthy” turns out to be false.  Your circumstances play a significant role in how you apply the information and methods available, which like the topic itself, is in a constant state of flux.

So how do we navigate this chaos?  Start by understanding that it’s a journey.   Be ready to try various methods of self-care, nutrition, and exercise knowing that you’re going to fail and frustrate yourself with things that have worked so well for others.  You’re not everyone and you have to find what works with for you AND your circumstances with wherever you are in your life at that time.   Don’t give up, keep trying new things, keep learning, keep discovering, and push on.

Now I could write a novel covering each of these industry topics, but I want to focus on exercise for this post and more specifically listening to your body.  I have been SO bad at this the past few years and it has been costly.   Low back pain, rib pain, knee pain, shoulder pain, neck pain, waking up every day with some sort of ache or pain and continuing to mindlessly train and push my body past its limits.   This affects how comfortable I am when I work, when I do recreational activity, and when I’m spending time with my kids.

Why? Unless you’re a professional athlete, isn’t the purpose of exercise and training to better your life outside the gym?  Aren’t we supposed to train to build ourselves up not break ourselves down?   Sure, there are going to be workouts and training sessions that push you to your limits and you’re going to be sore and beat up but that should be the exception, not the rule.   I wouldn’t want to see that go away and I don’t think it has to for you to still maintain an effective fitness routine, improve and push yourself to be a better version of your current self.    Intensity and pushing the limits is a critical part of any successful training program.  However, in my opinion, depending on your circumstances (sleep, stress, nutrition, self-care, age, recovery, etc) we must pick and choose our battles.

All too often I have a patient present after starting a new training program that they’ve been going 100mph at since day 1 and their body finally hits the brakes and things start to deteriorate.   Learning to decipher when your body is telling you to slow down because of mental fatigue vs physical fatigue can be tricky.   But if you’ve gone into training 4 days in a row, maxed out your heart rate every session, lifted as heavy as possible, ran as far and as hard as possible, done zero mobility, had no body work done, ate horribly, slept poorly, then chances are that is your nervous system telling you to take it easy.  The reason this warning is so critical is as the window of fatigue widens, so does the vulnerability for injury.   When it’s broken down it sounds like common sense, but when we are in the heat of the moment surrounded by peers and coaches we tend to push it all aside and go through the motions.

One approach that I’ve really been gravitating towards lately is identifying an intended stimulus prior to working out.  Before beginning I take stock on how I’m feeling and try to match my training stimulus to that.  How recovered do I feel?  Do I have any pain or stiffness? How did I eat this week/weekend? How much did or didn’t I sleep?   If the grading on all those questions are positive, then I may attack that workout with full intensity and really push it.    If I feel like I’m falling short on a few or all those topics, then I’ll scrap what was planned and reprogram for what I can handle.   If the scaling or changes you need to make is going to significantly change the workout in a class setting, then you may need to attend an open gym or workout from home that day.  Don’t put yourself in a situation where you’re going to succumb to peer pressure and put yourself at risk for injury or burnout.  But if you can make a few small modifications and still be in your class or group setting then go for it, you’re not going to be letting anyone down!

Start practicing this week.   Take stock of your overall wellness that day or week and come up with an intended stimulus for your training.  Quality movement is going to be the foundation for longevity and nothing derails a training program faster than injury.   I’m still learning from my mistakes and I’m looking forward to continuing my journey, now with more acuity to what my 33-year-old body is telling me.

 

Yours in Health,

Dr. Crane

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.

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