On a daily basis in our office we see pain, numbness, tingling, weakness, burning, overuse injuries, trauma – you name it, but did you know that most cases are not pathological and do not usually require invasive intervention? Though cases that present with numbness or tingling are more likely to be the result of a disease process like disc or joint degeneration, for most of these, an exam and closely monitored treatment by a chiropractor can resolve many of these issues before they go any further. What you need to know is that there are ways to quickly narrow down each case to determine the likelihood of pathological processes.

As a chiropractor, we often don’t order or perform the same types of tests as MD’s because we are        A) Looking for neuromusculoskeletal causes in addition to pathology B) Mainly trying to decide if the patient is a good candidate for conservative care or whether they need a referral to another specialist.

Here are a few of the tools that we use to determine a diagnosis:

1) Active and passive range of motion: The first thing to establish is whether or not range of motion is intact. If pain is present either on active (patient moves the joint through a range of motion) or passive (doctor moves patients joint through a range of motion) it can be an indicator of strain/sprain or capsular injury. These types of problems usually respond very well to short term conservative care with manipulation and soft tissue modalities.

2) Orthopedic testing: Individual orthopedic tests are used to help localize pain to a specific structure in order help gather information about the problem and help rule in or out particular structures. These tests are not all-inclusive, but they can get the doctor headed in the right direction.

3) Muscle/reflex and sensation: These tests provide basic neurological information. For instance, a nerve root compression injury will most likely result in a loss of varying degree to all three whereas irritation to nerve tissue usually causes tingling and sharp shooting pain.

4) X-Rays: X-rays are used frequently by many chiropractors to view boney alignment as well as degenerative changes. However, in most cases, conservative treatment can begin on a trial basis without the need for films.

These are the basic tests, though most practitioners have their own protocols that lead them to a diagnosis and treatment plan. The most important thing to determine is if the patient is a good candidate for conservative care. If the patient can be helped conservatively, the provider will put together a plan of action to address the patient’s concerns in the shortest time frame available. If the patient isn’t a good candidate, then the provider will most likely have a referral and further testing in mind to help.

There you have it! If you have questions about chiropractic practice, please feel free to write or call the office.

Wilmington NC, with its many athletes, weekend warriors and especially runners is a mecca of sports injuries for chiropractors who are adept at their treatment. This week I will focus on one of the more common injuries that runners face: Achilles Bursitis and Tendonitis and how it is effectively treated without drugs/steroids or surgical procedures.

First lets quickly look at how injury to the Achilles area occurs. Typically, injury occurs from overuse due to heavy training, more importantly, because of abnormal mechanics either related to the foot itself, the the runner’s gait, muscle tightness etc.. Either long or short term abuse can cause the tendon or bursa to become irritated and inflamed. This results is pain just over the heel that can last for months if improperly treated.

To address the issue, I first perform an exam of the foot and lower extremities to figure out why the tendon or bursa became inflammed in the first place. The most obvious signs of a problem are usually easy to spot and include: mechanical deformities like flat feet, knees that are too close together, redness and/or swelling, abnormal weight distribution and standing posture. Palpation of the inflamed area and surrounding tissues is also helpful in uncovering the underlying cause.

Once we know why the problem occurred, treatment can begin. My first recommendation to the patient is to cease the aggravating activity for at least two weeks while we aggressively treat so that healing can occur with limited interruption. In the office, I prefer a combination of lower extremity adjustments to realign the bones of the foot, which has an effect on the way that muscles fire and respond to movement in weight bearing. Next, I treat over the irritated tendon using Active Release Technique and cross fiber friction massage to break up scar tissue adhesion and allow oxygenated blood to enter the area. For some patients, a custom orthotic is used to provide proper support and hold bones in place to control pronation (foot flattening) through all the phases of gait.

Home instruction usually requires the patient to use ice within the first few treatments followed by heat and stretching about a week into treatment to help make the tissues more pliable.

After a few visits the patient will usually report much less pain over the treatment site  and can usually resume light training within a few weeks while we monitor and make further corrections. I also like to recommend sessions with a running coach to help the patient develop their technique and prevent future injury. Within no time, most patients report full recovery and usually perform much better than before the injury occurred because the underlying mechanics have been corrected.

There you have it! If you have questions about this or other articles or you would like to make an appointment please feel free to contact the office.

In medicine as well as in chiropractic and other forms of physical medicine, changes must be made on a continual basis to insure that patients are receiving the best care available. These changes may include new technologies, new techniques or even changes in perception.

Chiropractors study bio-mechanics, a field that is rapidly changing in light of many new studies. For example, the current model of the spine talked about in “Chiropractic education” often compares the structure of the body to that of a column or building. If this were the correct model of the spine, then the calculated forces needed for a grandfather to lift his three year old grandchild would crush his spine, catching a fish at the end of a fly rod will tear the angler limb from limb, and the little sesamoid bones in our feet will crush with each step.

The current model of mechanics assumes that the spine operates much like a column and thus adjusting the bones without addressing other aspects of the anatomy are all that is needed to resolve the issue. However, columns are vertical structures and operate in only one gravitational field. Human beings can function and move independent of gravity. Thus, these assumptions are wrong.

Columns, pillars, and skyscrapers, are rigid, immobile, unidirectional and base-heavy to withstand crushing forces. They do well when under gravity, but required massive amounts of reinforcement when dealing with bending and swaying. If biologic systems worked this way, the human spine would bend under the weight of your head and throwing a ball would cause your limbs to be torn off. Animals larger than a lion would continually break their bones and dinosaurs larger than an elephant would have crushed under their own weight. (1)

So what is my point? Simple, when treating patients, alignment is important, but viewing the entire body using the correct assumptions about mechanics means treating the body like a dynamic structure capable of taking forces from many angles; thus the need for soft tissue treatment, orthotics, traction and so on can all be used at the same time to improve total body function in a much shorter time frame than joint manipulation alone. This will subsequently, decrease pain in the effected structure and improve performance.

Questions about this or other articles? Send us an email.

Reference:

Levin, Stephen. “The Tensegrity-Truss as a Model for Spine Mechanics: Biotensegrity.” Journal of Mechanics in Medicine and Biology, vol. 2, #3&4, 375-388. http://biotensegrity.com/tensegrity_truss.php

Our latest Wilmington Health Nuts adventure was a beach walk, which we like to do from time to time. We prefer to walk on the beach versus the street for many reasons. Aside from being a beautiful place to walk, the sand offers various benefits depending on your location. You can walk in the soft stuff, along the water’s edge where the sand is a bit harder or in the water. Each area has its own challenges.

Walking in sand requires more effort than on flat surfaces, which is great for burning calories and strengthening your body. Statistics wise, walking in sand requires 2.1 to 2.7 times more energy than walking on hard surfaces. Jogging in sand uses1.6 times more energy than jogging on hard surfaces

As a physician who regular treats foot, ankle and lower back problems associated with athletics and injuries, we are in a unique position to take advantage of an excellent rehab opportunity. The sand itself provides varying surfaces for our feet and stabilizing muscles to adapt to over time unlike walking on concrete where we have only one type of surface. Often the best thing for a patient to do when treating the foot is to get out and walk on the sand to strengthen the muscles of the feet and lower legs. Time on the sand can vary, but start by walking between the piers at Wrightsville beach. The distance between the two is approximately 2 miles. Follow up with some stretching techniques that can be found on the King Chiropractic website.

If you have any questions about this or other articles, feel free to write or call our office.

You don’t have to look far to find interesting literature pointing to the efficacy of soft tissue modalities to treat common musculoskeletal issues. For example, ischemic compression (trigger point therapy) is probably the simplest and most readily used soft tissue therapy in a chiropractor’s office. For those of you not in the know about musculoskeletal issues and alternative care, there has always been debate over the most effective way to treat difficult areas of the body. As a chiropractor, I was taught that if adjusting the spine didn’t resolve the patient’s chief complaint, then either we weren’t exercising our abilities correctly or that patient was thoroughly broken. Either way, we were minimally encouraged to utilize soft tissue or other modalities, mainly because of conflicts in philosophy. At any rate, studies and reports are popping up all over the place attesting to the apparent results attainable through the use of soft tissue and other physio-therapies in conjunction with manipulative therapy.

A simple article to illustrate my point was taken from the June 2010 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) and focused on the use of ischemic compression (trigger point therapy), a very simple form of soft tissue therapy, to alleviate the symptoms of chronic shoulder pain. Shoulder pain itself is a very common musculoskeletal complaint with nearly half the population having at least one episode of shoulder pain per year. (1) The researcher found in his own study that the use of trigger point therapy at various structures around the shoulder produced significant improvements to function and decreases in chronic pain in a very short time. Though there were many confessed limitations to the study, such as patient population, follow-up time, number of clinicians etc., this article brings up many new questions that warrant further study in a more controlled environment.

Interestingly, there is growing interest among chiropractors toward the use of soft tissue modalities to treat patients. One statistic mentioned in the article declares that trigger points are treated by 91% of chiropractors. When I graduated from chiropractic school and started to see issues outside of neck and back pain, I began to notice that if I couldn’t manipulate the joints above or below the problem area and see results in a few visits, I knew of nothing else that  I could use to effectively treat the problem and provide lasting results. This is the main reason that I sought out training in Active Release Technique, a highly specific soft tissue technique.  I have observed similar results to the article with athletes in my own practice and firmly believe that to effectively treat musculoskeletal issue, not just the shoulder; the involved soft tissue  must also be treated. This could be big news to athletes preparing for marathons or triathlons who are concerned about joint pains related to running, swimming and bicycling, but don’t wish to rely on corticosteroids or other drug/surgery related treatments.

Check out our website or give us a call today to schedule an appointment.

Works Cited

Hains G,Descarreaux M,Hains F. Chronic Shoulder Pain of Myofascial Origin: A Randomized Clinical Trial Using Ischemic Compression Therapy. J Manipulative Physiol Ther 2010;33:362-369.

As a Chiropractor and Active Release Provider in Wilmington, NC I have spent a lot of time at races in and around the area, worked with trainers and runners and been amazed at the work and effort that goes into getting ready for their event. The biggest observation that I have made is that Triathlons are about consistency and being prepared. I am not talking about the competition aspect alone, simply completing these events is a wonder all its own. The training is no easy task either. You have to believe in yourself and your abilities and be ready for all the aches, pains and possible injuries if you want a little taste of the glory.

Triathlon means three sports events all in one. So, unlike other types of events you will have to be three times as prepared but you will also get three times the satisfaction when you cross the finish line. Once you have decided and really committed yourself to the training you’ll need to follow some basic guidelines to help you be your best.

Training/coaching: You can probably look back and see this one tip in many of my previous articles, but coaching for first timers and even veteran Triathletes is highly advised. Because of the stress involved learning proper form can help you to avoid habits that can lead to not only pain or mechanical issues but can cause you to be less energy efficient, which will reduce your overall performance.

Mental preparedness: Working on mental skills is maybe the most neglected aspect of triathlon training. Most athletes work out to make their muscles stronger, but ignoring mental strength. Focusing on mental skills improves an athlete’s ability to focus on the task at hand and get the most out of the body despite the pain. Many athletes do all they can to take their minds off the pain as they redline. Top athletes, however, stay intensely tuned in to the pain and effort in order to constantly monitor the body’s condition and make pace changes.

Warm-ups: Whatever your sport it is important to put in the proper time warming up, cooling down and stretching. If you own a high performance car, you wouldn’t get in, crank it up and immediately put the gas pedal to the floor would you? Your body is the most complicated machine on the planet, take care of it and it will take care of you. There are many routines to available online and in video format from each of the different events so I won’t compile a list here. I will give an example though as seen in this video.

Consistency: Triathlon training requires long hours of training done in segments over a long period of time in order to achieve the results you are looking for without causing severe damage to your body. Don’t try to do too much at once or you will find yourself benched for weeks or even months causing you to lose valuable training time. Remember to fit in adequate amounts of rest; I usually recommend at least 2 days a week. While you are resting you can concentrate on getting the proper nutrients and hydration.

Interest building: Long hours of training in the same event can tend become tedious if your routine never changes. Varying your workouts, where you go to train, who you train with, different intervals of time and even the music you listen to can help you to build interest and keep you focused. Always keep your goal in your head. Group workouts and practice sessions are great interest builders since most people like a little competition.

Injury Prevention: Most athletes I know are used to pain and mostly just fight through it, however, pain that is out of the ordinary can cause you to train poorly, ruins your form due to compensation, takes away from the fun of competing and can ultimately cause you to quit training altogether. A simple bio-mechanics exam from your local Active Release Provider can help you before disaster strikes. Getting these problems taken care of early will help you to train more efficiently, and increase your performance. If unresolved issues go too long into your training there is a point of no return where it would be unwise to make last minute changes.

Now that you have the basics you should also look into some magazines such as Runners World or USA Triathlon Life to get more specific information and tips on training and workouts which can definitely help you with your consistency and interest building. Happy, training!

Check out our website or give us a call today to schedule an appointment.

Simple show of hands, how many of you are runners? Well if you are just learning to run or you used to jog alongside the dinosaurs you have probably heard at one time or another that running will speed up or cause the development of osteoarthritis. Well, I have some great news for you. There is actually no body of evidence to suggest that long distance running causes arthritis. On the contrary, running may actually be of benefit in promoting healthy joint function.

Now that I have your attention, I have to add that just because there isn’t any conclusive evidence doesn’t mean that you should throw all precaution out of the window. Most professionals, including myself, agree that long distance running on “normal” joints with no other contra-indications or history of pre-existing disease has not been proven to increase incidence of osteoarthritis. However, there is evidence to suggest that joints that have had previous injuries and/or abnormalities in bio-mechanics are at increased risks of developing joint issues. In addition, body size, weight, training regime and age can also play into the risk factors for the development of Osteoarthritis.

According to “The Journal of the American Osteopathic Association”, a 1-mile run may require anywhere from 1000 to 1500 strides, depending on the body mechanics of the runner. In long-term, repetitive strain, the body responds by increasing water and proteoglycan content in the joint fluid while surrounding ligaments and supporting muscles get larger and stronger. In properly trained athletes, localized pain is usually a sign of upcoming injury to a specific joint. Also, advice to any runner should take into account the individuals size. The greater your BMI (body mass index) the higher your chances of increased radiographic evidence of osteoarthritis. (Tyler Childs Cymet & Vladimir Sinkov)

So, what can you do and how can you protect yourself so that you have the best chances of avoiding injuries that can lead to eventual osteoarthritis and disability? Well, the best advice that I have to give anyone that comes to my office is to get a certified running coach. They can help to train you in proper running mechanics. Have you ever played in any competitive sport without a coach? It is just as important for a runner. In amateurs, injuries typically occur due to errors in mechanics possibly due to old injuries, bad habits that have not been corrected early or overly aggressive training. A coach can help you to avoid this by keeping you on track with a schedule.

Stretching is also very important. Many times I will work on a runner whose left hamstring is shorter and tighter than the right. As a result, their stride is shorter on one side than the other causing eccentric rotation of the pelvis and a string of compensations all the way up the kinetic chain.

To conclude, although there is currently a lack of evidence to support running itself causes osteoarthritis, most data seems to suggest that moderate running does not increase your risk for developing osteoarthritis and for people with normal joints, may have a protective effect. It is important to consult a physician before starting a new exercise regimen as well as a coach so that bad habits and injury can be avoided. If you are already aware of current or past injuries it is important to seek the help from a physician trained in sports injuries and soft tissue treatment. ART (Active Release Technique) is the method that I recommend and use for my athletes to help them recover quickly and increase their performance. You can learn more about active release here.

Happy running!

For more information about King Chiropractic or to schedule an appointment please visit our website.

Works Cited

Tyler Childs Cymet, D., & Vladimir Sinkov, M. (June 2006). Does Long-Distance Running Cause Osteoarthritis? . JAOA, 342-345.

All sports have common injuries associated with them, some more than others. Baseball and Softball are no exception. Injuries in these sports typically involve high amounts of torque (force around and axis; twisting force). For both Softball and baseball the shoulder can be injured due to over-training and throwing. Injuries to the legs, lower back, pelvis and knees are also common since both games involve sudden starts, stops and shifts. The most common type of knee injury is the ACL and medial collateral ligament but the PCL and Lateral Collateral is also frequently injured.

Since there is so much information out there about different injuries related to this sport,  I am going to focus on the shoulder and explain how these injuries happen and give some tips and exercises to provide support and prevent injury.

How do I know I have a shoulder problem?

One of the most obvious clues to shoulder injuries is a decrease in performance or speed. The player may also feel as if their shoulder feels loose in the socket or they may have pain before or after each throw.

What causes the shoulder to hurt?

The pain after throwing is typical of inflammation of the rotator tendons, simply because they are overworked. This is definitely true of pitchers, however other positions can have similar issues based upon how much they play and practice. There is much debate across many professions as to what structures actually cause pain though the answers are not known. There are many interesting theories however. One possibility is that the rotator cuff tendons are overstressed due to rapid conditioning. Another reason for shoulder problems can be due to instability of the area. This occurs because the ligaments that support the shoulder can become stretched out over time and cause the shoulder to feel like it is coming out of the socket, though it is not.

How is diagnosis made?

The first step in any injury is history and exam to help guide the doctor to a diagnosis, however tests for the shoulder can be very unreliable due to their subjective nature. Simply put, injuries such as labrum tear don’t have a distinct set of pain symptoms and can seem very similar to tendonitis making them hard to spot via physical examination. MRI can be useful, however, they too cannot always show the reason for pain though they can detect damage to tendons and ligament, which may or may simply be a result and not the problem. Basically, the best way to discover the source is to rule out problems over time.

What can I do to treat shoulder injuries?

One of the most common ways to treat the shoulder is to simply let it rest. If this doesn’t help physical therapy can help in providing some stabilization to the area. In my office, I employ A.R.T. (Active release technique), which is quickly becoming the gold standard for the treatment of soft tissue injuries due to its highly specific nature and the speed at which most patients recover. Corticosteroid shots can also be implemented to help reduce pain and swelling however, it is not recommended by most professionals more than a few times since it can also weaken the tendons. Finally, if all else has failed, surgery may be the only option. Since I am not a surgeon, I will refer you to the the good people at Johns Hopkins where they have a good article detailing more about surgical procedures.

There are some great exercises as well that can help maintain and strengthen the shoulder, which can help to prevent injuries before they become an issue. Download them here. Finally, perfect practice makes perfect. For all you young aspiring athletes out there, learning how to play a sport correctly can be your biggest ally in preventing problems that can ruin a potential career. Remember that the next time you catch yourself wishing the coach would quit telling you how to throw the ball for the hundredth time.

For more information about King Chiropractic or to schedule an appointment please visit our website.

Lateral Epicondylitis, known to many as is prevalent in many sports and jobs and is characterized by sharp, throbbing pain on the outside of the elbow and aggravated by repetitive movement of the fingers or elbows. It can also be associated with loss of grip strength.

Tennis Elbow is caused by repetitive stress from activities such as typing or gripping. Over time and with repeated overuse, scar tissue begins to build over the origin of the wrist extensors. This overuse begins the “cumulative injury cycle”, which leads to a loop of repeated stress and more pain and inflammation. Some other problems associated with this sport include: Rotator cup tendonitis, tennis elbow, frozen shoulder, bursitis of the elbow, wrist tendonitis, Achilles tendonitis/ITB syndrome and osteoarthritis.

As I mentioned previously, Tennis Elbow isn’t exclusive to tennis player, golfers are prone to this problem as well. Treatment usually involves some type of manual therapy to break the cycle of damage and inflammation followed by proper swing instruction.

Common treatments for Tennis Elbow:

• (NSAIDs) Non-steroidal Anti-Inflammatory Drugs – Over the counter medications can help for a short time to help with pain relief. This can be great for weekend warriors where you know you aren’t going to be playing for a while. This should keep you out of pain long enough for the tissues to heal. However, if you are using these more often than recommended for pain, they can actually make healing take longer, not to mention the damage they can cause to your liver and kidneys.

• Corticosteroid Injections – More effective than over a four week period than NSAIDS, however the majority of the effect is seen over the first 2 weeks. Use is generally limited to 3 injections do to the damage that can occur to the joint capsule with repeated use not to mention the risk of infection.

• Elbow Braces – Though it seems most people instinctively run for the elbow brace whenever they injure a joint, many studies suggest that they don’t actually fix anything. It seems that patients in the study can’t tell the difference between the actual brace and a placebo. Therefore, you are probably better off saving your money.

• Surgery – As in every situation regarding your body, this should always be the absolute last resort, since once it is done, it can’t be undone and can even disqualify you for other types of treatment if it is unsuccessful. However, if you run out of options (usually only considered by surgeons after 6-12 months of non-surgical treatment) surgeons can cut the tendons on the side of the elbow, remove the scar tissue and re-attach the tendon to the fascia.

• Active Release Technique – This is an extremely effective way to treat tennis elbow because it breaks the “Cumulative Injury Cycle” and fixes the tennis elbow without any of the above treatments. According to a study from the Journal of Occupational Rehabilitation, patients with Tennis Elbow responded favorably to ART with a 71% improvement rate within 1-3 months of treatment.

Basically, ART can provide a favorable response in any condition that is the result of chronic repetitive injury. Most patients experience a significant response to treatment within only 3-4 treatments. Play on!

If you have any questions about this or other articles or to make an appointment click here to visit our website.

References

1.Assendelft W, Green S, Buchbinder R, Struijs P, Smidt N. Tennis elbow. Clin Evid 2004;(11):1633-44.

2.Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med 2005;39:411-22.

3.Struijs PA, Smidt N, Arola H, Dijk CN, Buchbinder R, Assendelft WJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev 2002;(1):CD001821.

4. Schiottz-Christensen, Berit, Mooney, Azad, Selstad, Gulick, Bracker. “The Role of Active Release Manual Therapy for Upper Extremity Overuse Syndromes—A Preliminary Report.” Journal of Occupational Rehabilitation Volume 9. Number 3September 1999 201 – 211.

As a chiropractor and ART (Active Release Technique) provider in a Golf town like Wilmington, I often see golfers with injuries as a result of repetitive stress. Most of the patients that I see with injuries related to this particular sport has to do with the shoulder or lower back. This is pretty easy to understand given that most golfers swing in singular direction, such as a right handed golfer that swings from right to left, for example.

Let’s say you are a decent golfer with a handicap of 18 on a par 72 course. That means that you will swing at least 90 times during the course of a game and this does not include warm ups, do overs, practice swings etc… Therefore, if you are like me, you swing the club in one direction 200 times or more (add in at least 10 swings straight into the dirt, as in my case). So, it makes sense that this repetition can have negative effects on your performance and cause some problems.

However, there are some great tips that you can do now to improve your swing and reduce the wear and tear on your body, which will allow you to play for many years.

1) Take a few lessons. If you are new to the sport or you just kinda started playing, there can be some real advantages to learning from a professional teacher. If you learn how to do something correctly, you can avoid many problems. This may sound like a no-brainer, but I would be willing to venture a guess that many of you reading this article are guilty of this one.

2) Most golfers warm up before they play, but how often do they stretch during play? Stretching every few holes can help to keep the muscles warm and loose as well as help the golfer “un-wind” and help to balance the stress caused from repetitive motion.

3) Get a proper base. Due to the mechanics involved in swinging a club, having a solid foundation and core can really help you go a long way in preventing injury and increasing your abilities. If you are going to go to the gym, get a trainer who has experience training in sport specific exercise. They will know exactly which muscles and ways to train you so that you can be your best.

4) Eat the right foods and get proper supplementation. You can only get out of your body what you put into it. Although golf isn’t a high intensity sport like track, football or bodybuilding, unless you hit your fifth ball in a row into the lake,  it is important to give your body the supplies it needs to repair all the little tears and damaged areas that occur in every sport, as in life. A proper diet is essential in limiting inflammation to your joints and other tissues.

5) Get your biomechanics checked with your neighborhood chiropractor to scan for any mechanical issues before they become a real problem that can hinder you from playing down the road. This may include a few adjustments, soft tissue modalities, orthotics, oil change etc… Just like with your car, it’s is easier to fix problems early or before they become a problem.

So there you have it. A few simple tips that can keep you injury free, help you recover faster and make you perform better. Have a great day on the course!

For information about Dr. Rhett King or King Chiropractic in Wilmington NC please visit our website.