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Elbow Pain Part 1: Tennis Elbow

So did you know you could get Tennis Elbow even if you have never played tennis?

True story.

My mom got it from mowing the lawn (She tended to do that especially after my Dad cut off the tip of middle finger once upon a time after a bar mitzvah luncheon.  FYI, don’t stick your hand into a lawn mower if it gets clogged. Better idea, don’t mow the lawn after a couple of beers or three… it was the late 70s, ’nuff said.)

So, if you have never played tennis why the hell do you have tennis elbow?

Possible causes of tennis elbow

  • repetitive strain injuries
  • vibration
  • overuse

These can happen from all sorts of things including: overuse at work, prolonged computer or mouse work, heavy work such as construction and repetitive strain, mowing lawns, all sorts of other stuff and of course…. tennis.

 

Symptoms of tennis elbow

Symptoms of tennis elbow can include the following or may be just one of the following:

 

  • pain at the outside (lateral side) of the elbow just above or at the joint line
  • sharp pain when picking things up (even an empty cup)
  • heat or swelling at the joint (possible but not always)
  • forearm pain or tightness
  • pain can be in ‘strange’ places such as wrist or thumb ( ‘whaddaya mean its my elbow not my thumb?’)

Treatment of tennis elbow

So what can you do for this painful condition?  The best thing of course is to get it treated… Here is what I do for a patient I diagnose with tennis elbow:

  1. adjust the spine
  2. Post Isometric relaxation (PIR) technique for the elbow extensors
  3. deep muscle tissue release of the forearm
  4. kinesiotape application
  5. muscle care application
  6. Wrist adjustments
  7. exercise prescription
  8. Icing instructions for the patient

 

So there is a gold standard exercise for this problem is super easy but really important to do daily.  Please see the YouTube Video below for full instructions on it!

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Lower back pain and the dreaded herniated disc

So you slipped/popped/herniated a disc.  Nope nothing sipped or popped really. But this sucker hurts.  Like a lot.

Let’s back up a minute. What the hell is a herniated disc and why does it cause so much back pain?

Ok here is a bit of a small anatomy lesson.  The spine is made up of bony vertebrae and in between them sits a disc that is made of connective tissue with a gel filled middle.  Picture a jelly donut with the donut part actually made up of concentric rings layered like an onion.  Are you with me so far?  Ok, so then really close to these discs are nerves on either side of the spine at each disc level (kind of).  Now that you have that picture in your head I can explain what happens to the discs sometimes when we injure them.

Sometimes with repetitive movement, lots of flexion, sitting, moving, lifting, standing (and just life in general – because these things are cumulative) the jelly in the disc starts to make its way through the concentric rings causing the outer layers of the jelly donut to bulge outwards.  If this bulging is anywhere near the nerve the nerve gets ANGRY. Nerves do not like pressure. Nerves. Do. Not. Like. Pressure.  In fact it only takes 8 mm of pressure to cause the nerve to have altered function and possibly cause pain, numbness or a whole host of other symptoms.  8 mm of pressure is the amount of pressure you feel on the back of your hand if you place a dime on it. So not much pressure on the nerve and you get back pain. This is just mechanical pressure but the nerve can also be irritated by chemical mediators released in the area such as inflammation… ok lets not get too complicated.

Where were we?  Ok, we have a bulging jelly donut and this is causing pain in the nerve.  This could translate into back pain, back pain with leg pain or even numbness and tingling in the leg.  This can get even worse if the jelly makes its way all the way out of the  donut rings and we call this a herniated disc.

Right so what do we do?

Firstly most herniated discs do not like flexion of the lower back or increased intra abdominal pressure.  That means sitting, bending and often coughing and sneezing too.  These things will cause increased symptoms and should be avoided if possible.  Because of the common course of herniation bending forward at the waist actually forces the jelly in the donut backwards causing the bulge or herniation to get worse.

For this reason those with a herniated disc may respond really well to the McKenzie protocol which I prescribe to patients in my clinic.  I am going to upload a video with a simple exercise below but you have to promise me that if you suspect you have a herniated disc to please go check with your health care professional to make sure that this is the thing for you to do. If you do try it on your own and symptoms worsen – STOP.

Ok now that that is out of the way  – the easiest (but not always the correct) McKenzie exercise to show you are simple back bends or extensions.  All I want you to do is stand up and put your hands on your lower back. Then bend backwards keeping your neck in neutral and arching only your back then stand up again.  I want you to do that 5-6 times in a row – all of this should take less than 15-20 seconds.  That is it. If you are doing this right and you do have a herniated disc the pain or numbness in the leg should feel better a little bit better.  If it feels worse please discontinue the exercise!!!

****Important note – if you have bowel or bladder changes such as a loss of control you need to seek emergency care – as in go to the Emergency Room.  Do not pass go, do not collect $200. Ok?

Good.

Right, so if this exercise does make the leg pain or numbness less but increases the lower back pain that is actually ok and expected… If it does some of all of these things you can do this up to once an hour.

You still need treatment and fast so please contact me or another health care provider so that we can help you  – hope this helps!!!

Exercise video listed below (underlined: “McKenzie Exercise” please click it and it will take you to the video)

McKenzie Exercise video click here

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Foot pain, Fallen Arches and Tight Muscles

So I put it out there on facebook and I did get a request for this article…  Its a pretty broad topic but suffice it to say that I do treat these things. Often.

Feet are amazing things really.  We walk on them all day and pretty much forget about them until they hurt.  There are a huge number of diagnoses related to feet some of the most common being plantar fasciitis, fallen metatarsal head (fallen arches), stress fractures, tarsal tunnel syndrome, turf toe, sesmoiditis and the list goes on and on and on…

From a simple sprain to chronic pain, there are a host of different solutions for different problems.

One of the things you hear associated with foot pain is often the prescription of custom made orthotics.  These little insoles can be amazing as therapy for the right foot condition. The drawback is that they are also expensive.  Although lots of people have plans to cover some or all of the cost, some people aren’t as lucky.  While they are a useful tool for things like fallen arches (fallen metatarsal heads) they aren’t the only solution.

When a patient comes to me with foot pain, fallen arches and tight calves I always prescribe strengthening exercises for the small muscles of the feet.  – these are easy to do exercises that will help support the natural arch and help a person retrain themselves to avoid the problem in future.  These include fun things like picking up marbles with your toes, and scrunching towels with the toes as well as learning to position the foot in the proper “short foot” position. (this one is much harder than the other two and really needs to be shown in person in a hands on fashion).

Also effective are muscle techniques such as ART for the muscles of the foot and scar tissue treatment if that is deemed to be a problem in the specific patient and adjustments of the small bones of the feet. If these bones are ‘stuck’ and not moving through their normal range of motion it causes inflammatory changes surrounding the joints and irritation and inflammation in those regions – this decreases the range of motion even further and increase the pain – all super easy to solve with a small corrective adjustment in the area.

The last thing I did want to mention was that if you have a fallen arch it tends to put a bunch of strain on the calf or back of the lower leg – the mechanics of the arch falling actually pulls on the gastrocs/soleus complex- those two giant muscles at the back of your leg attached to the Achilles tendon. This makes the muscle appear tight or reflexively be tight – stretching it will really do very little as the problem is in the foot to begin with  – correcting the arch with exercise, hands on treatment and an arch support (custom or otherwise) is the first course of action – this will likely improve the tightness in the back of the lower leg – if not then we can show some stretches to remedy this at that point but in general it corrects itself if we have done the rest of the therapy.

So, if you are suffering with foot pain please don’t wait any longer! Call us to find out how we can help you.

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TMJ Pain – My jaw hurts just writing this post

 

I am highly suggestible.  Anytime anyone comes in with jaw pain the right side of mine hurts. TMJ stands for Temporomandibular Joint aka Jaw. The TMJ is a very complicated joint and without going into specifics it is very mobile which can make it susceptible to injury.

If you suffer with this you have probably already been to the dentist.  Maybe more than a couple different dentists.  You likely have a night guard and maybe a couple of other appliances.  They help a lot, some or not at all. So now what?  My friend, who is a dentist helped me with this post … He didn’t like my line about a couple of dentists above (but it does depend on who you see and I going to bet it wasn’t him…) He adds: “It’s all about position. Your teeth and muscles need to balance out so together with a dentist who knows how to balance the hardware and chiro helping out with the support, treatment is very successful”.   He is smart so I am going to agree.

Did you have any idea that a chiropractor can treat TMJ pain? So what does that mean or look like?

Here is what I typically do with patients – I will assess the jaw opening – how far does it open, is there a click somewhere on opening or closing, is the jaw opening with a shift to one side or the other – or does it open in an ‘S’ pattern?  I do a full history and examination and then…. treatment.  Usually this involves treatment of the muscles including ones right on the outside of the jaw (the Masseter muscle), the temple (Temporalis) and even ones that are intra-oral (the Pterygoids) – This hurts like hell but it works.  Usually in just a few treatments.  I also assess the neck and upper back, work on restoring the normal curves of the spine and give exercises for the jaw and neck to improve posture.  Depending upon the severity of the case we may do other things such as kinesotaping or other techniques.

Important point here – it works, it doesn’t usually take too long and it works.

Conservative care with a dentist and chiropractor can be super effective – I have a bunch of dentists referring to me now and hopefully more soon (I wrote this post upon prompting from a dentist friend in facebook-land who I actually haven’t seen in person in about 18-ish years …. now maybe eh D?)

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Have a more comfortable and healthy Pregnancy with Chiropractic

I am a chiropractor and a mom.  I have been through a pregnancy and a really rough delivery.  I know the pain that can happen during pregnancy – I had some pretty severe back pain during my pregnancy and at times had difficulty getting out of bed.  With some self care, a specific stabilizing belt that I wore for a couple of months, and some care from chiropractic friends, I managed to make it through it all while continuing to practice right up until I had the baby.

It can be rough. But it doesn’t have to be – there is help out there.  I love helping pre- and post-natal women and have been doing it since I started practicing almost 17 years ago.  I have to say I developed a much MUCH better appreciation for what pregnant women go through regarding pain after my own.  I really feel we are best at providing treatment when we can really empathize with the problem.

Over the years I have seen it all from sciatica to round ligament pain to swollen and sore legs and feet, carpal tunnel syndrome (from swelling due to pregnancy), headaches and neck pain and way more.  More than once I have been called in for an emergency house call for someone who couldn’t get out of bed because of back pain during pregnancy and after the birth of the baby.  I am always honoured to be able to help.

While writing this blog I found some information directly from the Canadian Chiropractic Association – so I though why try to re-write something so well written? The following was taken directly from the Canadian Chiropractic Association Website –

“At least 50% of pregnant women will experience back pain, with many suffering from severe discomfort that impacts their activities of daily living. Pregnancy-related back pain can be multi-factorial and rarely only has one cause. Back pain, wrist pain and leg cramps are the most common complaints reported.

The average healthy weight gain is approximately 30 lbs, most of which is around the abdomen adding a significant frontal load. The added weight puts stress on the back, hips, knees and feet/ankles. Additional weight can lead to altered posture and biomechanics as we change the way we sleep, stand, and move during pregnancy. As the baby grows and the uterus expands, the abdominal muscles also stretch and lose their ability to support as they did. The change in posture, shifting forward, may cause pain and discomfort specifically in the lower back.

During the third trimester, levels of the hormone “relaxin” increase and contribute to the loosening of joints in order for the pelvis to accommodate for enlarged uterus, the baby and later birth. However, the loosening of joints can decrease joint stability and further alter posture. Other structures including musculature may be taxed, resulting in a predisposition to pain and injury. This may result in back pain.

Women report pain and discomfort including:

  • Neck pain
  • Low back pain
  • Mid-back pain
  • Pelvic pain and pressure
  • Aching legs and buttocks
  • Peripheral swelling
  • Sciatica or shooting pain down the leg/foot
  • Fatigue and low energy
  • Night-time muscle spasms
  • Carpal tunnel syndrome
  • De Quervain tenosynovitis
  • Sleep disturbances

Studies have shown that manual therapy, including chiropractic, can help decrease pain in pregnancy and labour. Chiropractors can provide safe, effective and drug-free conservative care to relieve pain and improve function during pregnancy and after birth.

 

Reduce back and pelvic pain: Conservative care including spinal manipulation and mobilization of joints and soft tissue therapy can help reduce pain and improve function.

Relieve fatigued, aching muscles: Chiropractic treatment plans can include soft tissue therapy and various modalities including TENS, IFC, and acupuncture among others. Chiropractors can also recommend exercises to help rehabilitate postural changes.

Help prepare for childbirth: A chiropractor can recommend safe, effective exercises and stretches to help prepare your body for the baby’s delivery.

Ensure a faster recovery: As part of a comprehensive plan of management, chiropractic treatment can help manage quicker recovery and address post-natal biomechanical complaints and rehabilitation.”

 

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Sciatica – it can be a pain in the butt (also in the thigh, leg, groin…)

Sciatica can be an amazingly painful condition.  The symptoms can include back pain with pain into the butt, thigh, calf, sometimes the foot and even the groin.  There can even be pain into the genital area.   Amazingly sometimes there is no back pain at all but just a combination of pain in the other regions mentioned (leg, butt, thigh, groin etc…).

I have had patients come in to see me embarrassed about their symptoms (especially with the groin or genital pain) and confused because their family doctor really had no suggestions or solutions.

Here is the cool thing:  We can help you fix it.

If its chronic and has been around a long time, or if it is relatively new and only been there a week or two there are a ton of things we can do.

Often sciatica results from inflammation in and around the sciatic nerve.  This big nerve travels down your leg and provides motor power and sensation to the whole leg.  This is why the pain can be is such varied locations.  Prolonged standing often really aggravates this pain.  Sometimes it is difficult to find a position that is at all comfortable.  Sleep can even be interrupted.

When I treat this condition I always do deep tissue treatment to the sacroiliac joints and piriformis muscle.  This joint and muscle are the closest things to the sciatic nerve and the piriformis muscle actually lays right on top of the sciatic nerve and can compress it if it is too tight.  So muscle treatment, treatment of the joints to relieve the inflammation in the area and restore motion to the joint are key in solving this problem.  Prescription of exercise is also key to stretch tight muscles and strengthen the core to ensure this condition doesn’t come back.

I too have suffered with sciatica and know what a pain in the butt it can be.  It doesn’t need to be suffered with – there is something that we can do about it.

 

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Scoliosis – what you can do about it

Scoliosis is a condition that causes abnormal curves in the spine.  Scoliosis is more prevalent in females but all children while they are growing should be checked for scoliosis.  This can be done at a routine visit to the chiropractor and is something that I do with all of patients regularly re-checking the children and adolescents.

So what if you have scoliosis?  Generally it gets evaluated and measured and monitored.  It used to be that the most severe cases would require surgery or bracing. Recently, the literature has shown that the surgery for scoliosis (the insertion of rods in the spine) is not as effective as it was once thought to be and may not help at all.

Unfortunately, there really isn’t much that will actually correct a scoliosis.  But it can be managed with conservative care.

Because there are unusual curves in the spine this can put pressure and irritation into different muscle groups and joints of the spine.  One side will be really tight, and the other really lax or loose.  Pain can result from tight muscles and joints causing inflammation which often manifests as upper back or neck pain, headaches or lower back pain.  With regular physical care and maintenance I have seen patients with scoliosis go from having pain on a daily basis to no pain at all. There is always hope.  Even if you have had scoliosis and pain for years, there is something that can be done.  With gentle physical treatment including adjustments, soft tissue release and exercises the pain can be lessened and even removed.

For young children and teenagers with scoliosis it is important to keep the spine moving and the muscles prone to tightness loose so that the pain doesn’t manifest at all.

Don’t ignore your scoliosis! I can help you and teach you things you can do to keep yourself well, moving and out of pain for as long as possible.

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Shoulder Pain – What the Rotator Cuff?

I recently had someone ask me if I treat shoulders.  The treatment that chiropractors are best known for is back pain and neck pain.  This is great but for me really falls short of describing what I do every day.  One of the things I love most about my job is the variety of problems I see daily and my ability to problem solve for them and help patients get the care and treatment they need to heal.

I had a patient recently who came to me after having care for a shoulder injury for three months somewhere else.  He told me that he was no better at all and still had trouble sleeping despite the care he received.  We did an examination and I diagnosed him with a rotator cuff problem – specifically a possible small tear in the supraspinatus muscle (one of four muscles the rotator cuff).  He had been given exercise, ultrasound and some massage already but hadn’t seen improvement.

What I do differently is examine the whole spine as well as the shoulder and add treatment that also involves much more hands on therapy and support for the spine – the shoulder doesn’t float around in space it is attached to the skeleton by muscles – muscles that get tight, angry and irritate all of the joints surrounding them.  Irritated joints tend to cause inflammation.  More inflammation causes more tightness in the muscles – a vicious cycle that we need to break.

Pain from rotator cuff problems can refer down the arm, into the hand, into the upper back and neck and can even cause headaches.  This can cause decreased range of motion of the shoulder and weakness in the arm.  I love treating shoulders because the results can be super dramatic.

Within 2 weeks of seeing the patient I was talking about he told me he felt 80% better and his range of motion was amazing and almost 100% better.  He told me he could sleep again at night and started bringing me lunch because he loved to cook and was able to do that again.

Please don’t live with shoulder pain – it usually gets worse and sometimes turns into a frozen shoulder which is often much harder to treat and takes much longer to heal.  I would love to help you.

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Falling on your tailbone – A pain in the ass (literally)

Have you ever fallen smack on your butt and felt like you broke your tailbone?  They may or may not even X-ray it at the hospital because if it is broken frankly there is nothing you can do about it.  Most of the time really it isn’t broken but you walk around, or rather sit around, very carefully for about 2-4 weeks because it hurts so much.  If you really smacked it good it hurts longer.  If you are really unlucky it can hurt for years or indefinitely and you just live with it.

What would you say if I told you there IS actually something you can do about it?  Would it be worth a couple treatments with me to make it go away, usually permanently?

Ok, so we will get to that….So what made me think of this? It’s October, there is no ice on the ground (though its coming – even though its been warm….it’s coming). My almost-grandmother*** fell a couple weeks ago and fell right on her tailbone.  She is 90 and ended up at the hospital for other reasons but they didn’t bother X-raying her (see above) and the pain she had (in her butt) was one of her biggest problems upon her return home (she is doing well btw -thanks!)

***Sidebar – what in the what is an ‘almost-grandmother’?  Ok so we aren’t related by blood.  She has no children or grandchildren and all of my biological grandparents and my mom are gone.  Rita has been part of my life since I was 12 as she worked for my Dad as his bookkeeper.  She and her husband Jake spent every holiday I can remember at our house and after my Mom died I continued that tradition.  She is one of my closest family members, I love her.  I’ve adopted her and she has adopted me. So there you have it ‘almost-grandmother’ Oma Rita.

Ok back to the pain in the ass that is tailbone pain.  I went to her house a few days in a row to help her out and now there is no pain anymore.  With a fall onto the tailbone, often the pain comes from irritation and inflammation to the ligaments that attach the tailbone (or coccyx) to the bottom of the spine (the sacrum).  Fixing this problem is as easy as doing some soft tissue treatment (gently) to the area to settle the inflammation.  Yes this means I may have to touch your butt –  I promise to ask first and not catch you by surprise.

All joking aside, its simple, it works, it takes very little time and its worth it.

Next time you fall on your ass – think of me.