Neuroplasticity is great when you are looking to regain movement from a prior stroke paralysis. However, when it involves chronic pain often neuroplasticity will make the pain regions grow even if the injured tissue is healed. This is where visualization of these pain regions in the brain need to be shrunken in your mind and done relentlessly especially when you feel pain. This has been proven through body image studies that when a person looks at their swollen painful hands through a magnifying device they often feel more pain, and consequently when the hand was minimized there was less pain. These are not quick fixes with immediate results. Make the mind body connection and heal that chronic pain. More info to come.
This is a review of a few uncommon, but easily missed, injuries that need special attention when x-rays look normal.
Wrist bone dislocation (Scapholunate dissociation)
Mechanism: Fall back on hand
Pain: Back of hand pain and swelling, tenderness on the bump before the wrist (lister’s tubercle) in a straight line from between index and middle finger toward the wrist.
Treatment: Thumb splint, early referral to a specialist if moderate to severe (grade 2-3), Expect: 4-6 months recovery
Improper Treatment: Scapholunate Advance Collapse (SLAC) - this is the most common degenerative arthritis of the wrist from poor wrist bone alignment
Wrist fracture (Triquetral Flake Fracture):
Mechanism: Fall on outstretched hand (or FOOSH) with wrist flexed towards forearm - ligament,
Pain: tender on the back of the hand in the wrist divot which is inline with ring finger.
Treatment: Volar splint, then short arm cast, immobilization for 3-4 weeks
Improper Treatment: Significant ligament (lunotriquetral ligament tear) injury and could also tear the TFCC (triangular fibrocartilage complex) tear leading to chronic wrist pain and possible loss of grip strength
Hand/Wrist fracture (Hook of the hamate fracture):
Mechanism: FOOSH or repetitive, direct blow or repetitive strain.
Pain: pain in the palm of the hand 2 cm above wrist in line with the middle of the ring and pinky fingers. Pain with gripping
Treatment: Hand surgeon immediately, short arm cast until pain free and range of motion is full. 4-6 weeksImproper
Improper Treatment: Nerve damage causing carpal tunnel complications and numbness. Possible fracture of the hook of the bone protecting nerve that can does not heal is relatively high.
Elbow fracture or dislocation (Cornoid process fracture, or radial head fracture)
Mechanism: FOOSH or direct impact to elbow
Pain: At back of elbow. Feels weak and unstable
Improper Treatment:: Possibility of 2 fractures, ligament damage (ulnar collateral ligament), nerve and blood vessel injury, loss of full elbow straightening, chronic arthritis possible
Treatment: If displaced 2 mm, and large bone fragment seen on X-ray need immediate orthopedic surgeon to look at it.
Mid-foot injury (Lisfranc Injury-sprain or fracture: 1st big toe and 2nd toe)
Mechanism: Plant foot on toes with a twist and downward force.
Pain: Swelling bruising and pain on the inside of the top mid-foot. Painful to so player does not want to go onto toes at all.
Improper Treatment: Significant muscle and ligament injury, arch collapse, chronic pain and disability, arthritis. Sometimes player may never regain to pre-injury function.
Treatment: Dislocated immediate orthopedic referral for stabilization/fixation. If not displaced and stable injuries, then cast. Long recovery, 4-12 months.
High Ankle Sprain (Syndesmosis injury): Front and back outside and transverse ligament damage of the ankle.
Mechanism: Outward rotation with flexing of the ankle and foot pointing outwards.
Pain: Outside ankle, in front of the ankle
Improper Treatment: Unstable fracture in young teenager (Tillaux or Maisonneuve fracture) ligament tears off bone, needs screw to stabilize in moderate to severe injury (grade 2-3) ligament tears.
Treatment: Stable injury (grade 1) - Post Slab cast, no weight bearing.
Unstable (grade 2-3) see orthopedic surgeon for stabilization/fixation.
Remember these things
* Information courtesy of lecture by Dr. Jody Murray, sports medicine fellow *
The function of a running shoe is to protect the foot from the stress of running, while permitting you to achieve your maximum potential. Selecting the right shoe for your foot can be confusing without the proper knowledge.
People with low arches, called pronators, will need a shoe that provides stability. A shoe with good cushioning is important for people with high arches, called supinators.
There are three main features that you need to consider when selecting a running shoe: shape, construction, and midsole.
ShapeTo determine the shape of the shoe, look at the sole. Draw a straight line from the middle of the heel to the top of the shoe. In a curve-shaped shoe, most comfortable for supinators, the line will pass through the outer half of the toes. A straight-shaped shoe will have a line that passes through the middle of the toes. These shoes are built to give pronators added stability.
ConstructionTake out the insole and look at what type of stitching is used on the bottom. In board construction shoes, built specifically for pronators, the bottom of the shoe will not have any visible stitching. Combination shoes, appropriate for mild pronators or supinators, will have stitching that begins halfway. On slip-constructed shoes, you will see stitching running the entire length of the shoe providing the flexibility supinators need.
MidsoleMost of the cushioning and stability of a running shoe is determined by the midsole. A dual-density midsole provides shock absorption as well as some stability, perfect for pronators. Single density midsoles offer good cushioning but are not great at providing stability, making them better for supinators.
Keep in mind that a chiropractor can help you prevent running-related problems by assessing your gait, as well as the mobility of the joints in your feet, legs, pelvis and spine.
Thank you to the OCA for this information
I had a patient ask me yesterday “I think I am getting carpal tunnel in my feet when I walk a couple of blocks or standing for a longtime. Do you know what this could be?”
I explained to him that he might have neurogenic (narrowing of the spinal canal in the lower spine) or vascular claudication. This is where the spinal cord or circulation gets pinched and cuts off the nerve supply to the feet giving a numbness or tingling feeling like carpal tunnel during walking or standing (other symptoms can include heaviness and weakness in the buttocks or lower leg). I continued that bending forward or sitting down for a couple of minutes will relieve the pain by opening up the spinal canal and stop the pinching on the spinal cord.
Some recent research has recently come out about exercise and treatment protocols that are listed below for neurogenic claudication.
1. Stretching the glutes (Piriformis, Gluteus Medius), quadraceps, groin muscles (adductors), and hip flexor muscles. (see below)
2. Nerve flossing (spinal cord and sciatic nerve) in a slumped position with leg straight and then reverse.
3. Lastly, treatment should focus on manual therapy aiming towards increasing flexibility of the low back in flexion.
Make sure to switch up exercises to give a variation and strengthen muscles back and lower body.
Some examples of stretches include 1. Laying on back knee to chest and knee to opposite chest stretches 2. Laying on your side heel to butt quadricep stretch 3. Kneeling hip flexor lunge stretch.
Exercise for controlling the low back may include: 1. Laying on your back pelvic tilts. 2. half sit ups 3. Laying on side straight leg raises, and clams (knee bent to 45 degrees). 4. Laying on stomach with leg extensions.
A graduated cycling program: using a stationary bike with a forward lean to improve lower extremity conditioning and overall fitness.
Remember take Pro-Action and be pro-active
Adductor Gluteal Medius Piriformis
Stretch Stretch Stretch
Quadracep Stretch Psoas Stretch
Study: Clinical Outcomes for Neurogenic Claudication Using a Multimodal Program for Lumbar Spinal Stenosis: A Retrospective Study
Author: Ammendolia C & Chow N
University of Toronto; Mount Sinai Hospital, Toronto; Canadian Memorial Chiropractic College, Toronto, Canada.
Publication: Journal of Manipulative & Physiological Therapeutics 2015; 38(3): 188-194.
Degeneration is a progressive condition (osteoarthritis, cartilage damage, disc injuries) and here is an overview of what can happen over time. Conservative care does not fix this condition and usually for knee replacements and other surgeries you often have to go through an immense amount of pain and suffering for a surgeon to consider you for surgery. Conservative treatment however will slow down the progression of these conditions helping decrease pain, increase range of motion, and increase strength and stability for a better active quality of life. You have 2 problems- degenerated condition, which is an irreducible block and adhesion/scar tissue which is very much so reducible. As we treat the scar tissue we get the above mentioned things better and slow down the progression of the condition. Good motion = more manageable load on the joint= less pain and decrease degeneration. Symptoms and ranges may plateau but that does not mean there is a magic pill or treatment that will help. Meds will increase pain threshold. Acupuncture will often do the same. Strength training will put more load on damaged joint and should be for maintenance of health done under supervision.
Often with an increase in pain especially without treatment you start taking more and more medications to deal with symptoms which has less and less effectiveness and may affect stomach health, mood, energy levels, etc. Eg a rotator cuff partial tear and then ends up later as a full tear.
Hot & Cold- Not just a Katy Perry Song
Happy holidays everyone! The weather has certainly been unseasonably warm during this holiday season, with record highs being broken and not a snowflake in sight. Now is as good of a time as any to discuss the debate of ice versus moist heat. We will discuss what ice and heat will do for you, as well as appropriate situations to use one versus the other. Both of these options are inexpensive, can be done without practitioner supervision & offer minimal risks.
Cryotherapy (AKA Ice)
Thermotherapy (AKA Heat)
As with all the information floating around the Internet, always proceed with caution when soliciting for medical advice. Ask questions and know your own body.
Small (& shameless) plug for the office: We are now offering hot/cold packs at the office for only $10. These handy packs can be either frozen in the freezer or heated up in the microwave. Our office wishes you all the happiest of holidays- with whatever you may be celebrating.
Yours in great health,
Shayne, Lindsay & Sherry
Now that we are in full swing with the fall season, it’s a great opportunity to tackle some strength training and improve in the stability department.
When talking about the gluteal muscles (“the glutes”), this group of muscles are comprised of 3 major ones: the gluteus maximus, the gluteus medius and the gluteus minimus. Hip extension is primarily performed by glut max, whereas hip abduction (the focus of today’s blog post) is performed primarily by glut med and glut min. Also included on the list is the Latin-named outcast: tensor fascia lata (TFL). The TFL is primarily responsible for hip flexion and abduction, as well as internal rotation.
So who cares if you have a lazy butt?! For one, we need our gluts to do squats, deadlifts and lunges (just to name a few). Out of the gym, our gluts are needed for walking/running, cycling, skating, tennis, rock climbing, cross-country skiing, etc. The list goes on and on and on. However, it’s not a question of if and when we are going to use our glut muscles. It comes down to the ability to get stronger in the right places. It is a very common occurrence that one’s gluteus medius is not doing its job. And this can become an aggravating problem for any athlete.
Glut med weakness can mimic and be associated with various aches and pain. These include hip impingement (femoroacetabular joint), IT Band syndrome, patellofemoral (knee) pain and even chronic ankle sprains. Out of all the hip abductors, glut med has the largest volume & physiological cross-sectional area. In plain English, this muscle should be pulling the most weight out of the group. However, when glut medius decides to not do its job the following can occur:
The solution is about getting your body to work efficiently so that ALL your movements are driven by the correct muscles. The key is to choose exercises that preferentially support gluteus medius activation. With glut med weakness, it is hypothesized that the TFL takes over a being the primary hip abductor. One popular hip abductor–strengthening exercise is side stepping with an elastic resistance band secured around the lower extremities. Following an article found in Journal of Orthopaedic & Sports Physical Therapy, it is stated that during resisted side-stepping two different things occur:
How to do a Resisted Side-Step in a Mini Squat
1.) Keeping the band flat, not bunched, place it just above each ankle and wrapped around both legs.
2.) With your feet shoulder width apart, the band should be taught, but not stretched.
3.)Bend your knees slightly and move into a half-squat position in order to activate the glute medius.
4.) Keep your feet in line with your shoulders, and face forward with your body weight evenly distributed over both feet.
5.) Maintaining the half-squat position, shift your weight over one leg and take a step laterally (sideways) with the other leg. (You will be moving this leg in and out, sideways, for 8-10 reps.)
6.) Keep your hips level during the movement. Try not to bounce up and down or sway side to side.
7.) Slowly shift your weight to the moved leg and bring the other leg inward to a new ready position maintaining tension of the resistance band.
8.) Continue for 8-10 side steps and return the other direction to the start position.
This exercise addresses gluteal endurance and helps to target the appropriate muscles for hip abduction.
Lastly…. Joint movement and scar tissue formation within the soft tissue have to be considered and addressed. Working with your chiropractor will help clear this issues out and will allow you, the patient, to effectively get the most out of your workouts! Come visit us at Pro-Action Sports Injury Clinic, located at 308 Palladium Drive, Suite 108 in Kanata.
Yours in Great Health,