Well, I haven't written in quite awhile, but I have quite a bit of experience treating injuries related to motor vehicle accidents and want to emphasize the importance of safety restraints for both children and adults. This article (http://www.cnn.com/2011/HEALTH/03/21/car.seat.guidelines.parenting/index.html?eref=mrss_igoogle_cnn) came out today saying that children should remain in a rear facing seat until they are at least 2 years old or until they exceed the height or weight limit for the car seat, which can be found on the back of the seat.
As a parent, I recognize the convenience of being able to see your child when he/she is facing forward, but the recommendation to keep them facing to the back really makes sense. Toddler's relative large head size related to the relatively little strength of their neck muscles puts them at a greater risk for injury when they face forward. This means that even very minor accidents can cause injuries. Unfortunately, kids this age aren't really capable of communicating their injuries to parents or doctors so they often get left untreated. Typically signs of injury other than pain and lack of range of motion are a sudden change in behavior, like being more irritable, sleeping more or less than usual or clinging to mom or dad more than usual. If you see any of these symptoms in your child after an accident please get them checked out by a qualified practitioner. Fortunately, children respond really well to conservative care.
Please take the advice of the experts in this article and keep your child in a rear facing seat as long as possible.
Showing posts with label low back pain and treatment. Show all posts
Showing posts with label low back pain and treatment. Show all posts
Monday, March 21, 2011
Wednesday, June 23, 2010
The Upper Back
THE THORACIC SPINE:
Overlooked and Undertreated
By
Dr. Nicholas Studholme, DC, CCSP, CCEP, FAFS
To say one area of the spine is more important than another would be unfair to the rest of the spine; however, it is clear that when we closely inspect the thoracic spine, it is profoundly different than the cervical or lumbar spine. It typically has twelve segments, many more than the other spinal regions, and it has a ribcage attached to it, providing significant stability and support. It also is located between the cervical and lumbar regions so any bottom‐up or top‐down movements will be forced to go through the thoracic spine.
One of the most important principles of Applied Functional Science (AFS) is gravity, and in our daily lives, the thoracic spine is constantly fighting this tremendous force. Generally, all daily movements require that we have our hands pronated, thereby constantly shortening our pecs and lats, and also create a stretch and inhibition of our scapular stabilizers (traps, rhomboids, serrratus anterior, etc.). As a result, we tend to hunch forward and yet because we have to see the horizon, we look up, thus creating anterior head carriage. This can result in significant sub‐occipital and cerico‐thoracic pain as these areas are now taking on excessive load to compensate for the rounded thoracic spine.
If we understand the mechanics of the thoracic spine, then we can use the principles of AFS to assist our patients in creating meaningful, sustainable changes. First, we must understand coupled motion, which requires nothing more than the knowledge that any movement of the spine in one plane is normally accompanied by a compatible spinal movement in another plane. A common example used is that spinal lateral flexion is always accompanied by spinal rotation. In other words, two types of motions are "coupled" together. Type 2 Motion is defined by the joints rotating and laterally flexing the same direction; Type 1 Motion is defined by the joints rotating and laterally flexing in opposite directions). The thoracic spine tends to exhibit Type 2 Motion from T1‐T5 and Type 1 from T6‐T‐12. It is theorized that when a spinal section (or an individual vertebral segment) moves in two directions that are not the expected coupled movements, then this is considered to be uncoupled mechanics. Uncoupled mechanics in spinal sections or in a vertebral segment can lead to abnormal ranges of motion, recurrent joint dysfunction, joint degeneration, inflammation, and pain.
However, when we look at many athletic endeavors, we realize that both coupled and uncoupled motions occur all the time. Therefore, we need to assess, mobilize, and train our patients and clients to be successful in all motions to avoid injury and enhance performance. When treating the thoracic spine, I always use the AFS principle of starting with success and building on success. For a majority of thoracic spine conditions, success is typically that our patients have great movement into flexion and dysfunctional extension. If we understand that all movements are three‐dimensional and understand the concept of relative joint motion, then we can create a strategy that drives motion that encourages flexion with side bending and rotation, and as we return from flexion to our starting position, we remarkably are creating thoracic joint extension. Again, keeping the patient in a successful movement pattern allows for chasing the endgame of better extension.
A great case example is the nursing mother patient who presents significant neck and upper thoracic and rib pain, who has to constantly hold her newborn, and who additionally has an increase in breast tissue due to nursing. This patient is permanently in an anterior head carriage neck position, has rounded shoulders, and has a more anterior center of mass. What this patient does not know is that her pain is rarely due to the neck and more often due to the thoracic spine. A typical progression in my office is to manually work tissue, then mobilize through adjustment(s) and Functional Manual Reaction (FMR), and to stabilize with matrices (three‐dimensional, logical movement patterns). For this example, I would use manual adjustments, combined with FMR in Type 1 Motion and Type 2 Motion of the thoracic spine with the pelvis in and out of synch with relationship to the shoulders (in the TrueStretch™). This would then be followed by the patient performing anterior lunges (beginning with both arms extended in front of his/her body at shoulder height) and reaching both hands in front of the lunging knee (or even in front of the lunging foot at ground height). This drives flexion of the thoracic spine as the patient lunges and creates extension of the thoracic spine as the patient returns from the lunge. If this is successful, we then go to three‐dimensional waist to shoulder dumbbell press, and then to a three‐dimensional shoulder to overhead press. Finally, if we are having success, we will ultimately finish with a Thoracic Spine Matrix.
Please review FMR of the Thoracic Spine (Functional Video Digest Series v3.10) and Thoracic Spine (Functional Video Digest Series v1.8) for more specifics pertaining to Dr. Studholme’s explanation of treatment.
Overlooked and Undertreated
By
Dr. Nicholas Studholme, DC, CCSP, CCEP, FAFS
To say one area of the spine is more important than another would be unfair to the rest of the spine; however, it is clear that when we closely inspect the thoracic spine, it is profoundly different than the cervical or lumbar spine. It typically has twelve segments, many more than the other spinal regions, and it has a ribcage attached to it, providing significant stability and support. It also is located between the cervical and lumbar regions so any bottom‐up or top‐down movements will be forced to go through the thoracic spine.
One of the most important principles of Applied Functional Science (AFS) is gravity, and in our daily lives, the thoracic spine is constantly fighting this tremendous force. Generally, all daily movements require that we have our hands pronated, thereby constantly shortening our pecs and lats, and also create a stretch and inhibition of our scapular stabilizers (traps, rhomboids, serrratus anterior, etc.). As a result, we tend to hunch forward and yet because we have to see the horizon, we look up, thus creating anterior head carriage. This can result in significant sub‐occipital and cerico‐thoracic pain as these areas are now taking on excessive load to compensate for the rounded thoracic spine.
If we understand the mechanics of the thoracic spine, then we can use the principles of AFS to assist our patients in creating meaningful, sustainable changes. First, we must understand coupled motion, which requires nothing more than the knowledge that any movement of the spine in one plane is normally accompanied by a compatible spinal movement in another plane. A common example used is that spinal lateral flexion is always accompanied by spinal rotation. In other words, two types of motions are "coupled" together. Type 2 Motion is defined by the joints rotating and laterally flexing the same direction; Type 1 Motion is defined by the joints rotating and laterally flexing in opposite directions). The thoracic spine tends to exhibit Type 2 Motion from T1‐T5 and Type 1 from T6‐T‐12. It is theorized that when a spinal section (or an individual vertebral segment) moves in two directions that are not the expected coupled movements, then this is considered to be uncoupled mechanics. Uncoupled mechanics in spinal sections or in a vertebral segment can lead to abnormal ranges of motion, recurrent joint dysfunction, joint degeneration, inflammation, and pain.
However, when we look at many athletic endeavors, we realize that both coupled and uncoupled motions occur all the time. Therefore, we need to assess, mobilize, and train our patients and clients to be successful in all motions to avoid injury and enhance performance. When treating the thoracic spine, I always use the AFS principle of starting with success and building on success. For a majority of thoracic spine conditions, success is typically that our patients have great movement into flexion and dysfunctional extension. If we understand that all movements are three‐dimensional and understand the concept of relative joint motion, then we can create a strategy that drives motion that encourages flexion with side bending and rotation, and as we return from flexion to our starting position, we remarkably are creating thoracic joint extension. Again, keeping the patient in a successful movement pattern allows for chasing the endgame of better extension.
A great case example is the nursing mother patient who presents significant neck and upper thoracic and rib pain, who has to constantly hold her newborn, and who additionally has an increase in breast tissue due to nursing. This patient is permanently in an anterior head carriage neck position, has rounded shoulders, and has a more anterior center of mass. What this patient does not know is that her pain is rarely due to the neck and more often due to the thoracic spine. A typical progression in my office is to manually work tissue, then mobilize through adjustment(s) and Functional Manual Reaction (FMR), and to stabilize with matrices (three‐dimensional, logical movement patterns). For this example, I would use manual adjustments, combined with FMR in Type 1 Motion and Type 2 Motion of the thoracic spine with the pelvis in and out of synch with relationship to the shoulders (in the TrueStretch™). This would then be followed by the patient performing anterior lunges (beginning with both arms extended in front of his/her body at shoulder height) and reaching both hands in front of the lunging knee (or even in front of the lunging foot at ground height). This drives flexion of the thoracic spine as the patient lunges and creates extension of the thoracic spine as the patient returns from the lunge. If this is successful, we then go to three‐dimensional waist to shoulder dumbbell press, and then to a three‐dimensional shoulder to overhead press. Finally, if we are having success, we will ultimately finish with a Thoracic Spine Matrix.
Please review FMR of the Thoracic Spine (Functional Video Digest Series v3.10) and Thoracic Spine (Functional Video Digest Series v1.8) for more specifics pertaining to Dr. Studholme’s explanation of treatment.
Wednesday, May 12, 2010
Functional Flexibility
FUNCTIONAL FLEXIBILITY: Complex Made Simple
by
Lenny Parracino PT, FAFS
Whether training for golf, football, baseball, or any sport, most athletes realize the benefits from a strength training program, yet rarely recognize the importance of a flexibility program. Flexibility is the foundation of what we do! In fact, without flexibility the body will not exhibit optimal levels of power, strength, cardiovascular fitness, or muscle endurance. Flexibility is the cornerstone of rehab, performance, and preventing injuries. However, flexibility programs seem to be less popular, most likely for a variety of reasons – one being research shows mixed reviews which often leads to confusion.1 When reviewing the principles (or lack thereof) behind most research it is easy to understand why the mixed reviews exist. As professionals, it is important that our decisions on what technique to choose be determined by a principle-based approach that is specific to each person’s intended need, not an arbitrarily designed guideline. To assist in determining what technique to choose, we will first explore three primary principles that should be considered, followed by a strategy to assess and address your patient’s / client’s functional flexibility.
Three Primary Principles of Functional Flexibility:
1. Individual and Task Dependent
2. Three-Dimensional
3. Mobility / Stability System
Functional flexibility is flexibility that allows us to function better. It allows one to perform tasks optimally and efficiently.2 The exact function is individual and taskdependent. 3 Therefore, general stretching techniques designed for muscle origininsertion will not provide us with an optimal functional outcome. Instead, the practitioner must appreciate the function of the muscles during the task. In other words, what a muscle does is task driven not textbook driven. This doesn’t make the textbook authors wrong, their right relative to the position, motion in which they concluded function at that time. When the body changes angles, positions, etc., its function changes; this is why for flexibility to be functional the techniques must look like the intended function. Therefore, we need to understand how the muscles, fascia, tendons, ligaments, nerves, joint capsules, and joints are moving three-dimensionally during the exact task; not only how much motion but also how well. This is the principle of mobility-stability, the right amount of motion with the right amount of stability in all three planes specific to the individual (not textbook) and intended task (all tasks require different levels of motion-stability).
To help simplify this complexity, we would like to share a practical strategy applying our three principles. This strategy can be used practically during your next assessment / evaluation…
First and foremost, understand each unique individual and task. Once you understand the individual’s current condition, limitations, concerns, and what they want to do, assess the intended task with as much authentic function as possible. The key is in understanding what they want / need to do and what they currently can do successfully. From here build a strategy to lead them in the right direction as quickly and safely as possible. For example, start with level one and only move to level two and three as needed per individual, per task.
Level One: Task specific. Assess the ability to perform the exact task. For example, walking, lunging, squatting, pivoting, stepping, reaching, running, balancing, picking up a specific object, sitting while reaching with right hand, etc. If this produces pain, discomfort, and/or lack of confidence, create authentic support to assist in the task. For example, one may reach forward at knee height from a split standing stance and feel low back stress. What if you changed the height of the reach to waist height? Same discomfort or less? If less, is it the back or the hips inability to allow the back to be successful from the range first assessed? Become a detective by changing body angles, positions, heights, drivers, ranges, etc. before leaving the intended task. Figure out a way to gain success in what they want/need to do. If this fails, progress to level two (although level two will look like level one).
Level Two: Task with outside support. Subtly add outside support or points of stability to the intended function. Using our example, simply add outside support such as in a True Stretch or a doorway. The outside support will allow you to position your patient / client in a specific range or zone to then apply authentic drivers. As their driving motion, use your palpation skills to assess the entire chain reaction searching for the “weak-link.” This is the application of the motion-stability principle. Then the body perceives stability it will exhibit mobility, providing it’s there. If one suspects the mobility is not there and desires to assess structural tissue texture, tension level three can provide information regarding the suspected structure (not exact function).
Level Three: Structure specific. Provides an environment for a structural assessment such as a plinth or table. This deviation from the exact functional task must be understood as a deviation and the results then correlated and integrated back into function, if function is the desired outcome.
Traditionally many techniques have been taught to start from the symptom or structural tightness to level three eventually getting to level one. In this paradigm shift, we allow the exact function to dictate how far away from function and into isolated structure we go. This strategy saves time but most importantly gives hope to your patient / client – function feeds function. Although function is complex due to its always changing nature, we can simplify function by simply following function. Use what your patient / client is saying, what they have experienced, and how they are moving as your guide to improving their wellbeing. When we apply the principles of Applied Functional Science (convergence of physical, biological, and behavioral science), flexibility takes on a new meaning. Functional flexibility recognizes the individual as a whole. Once you understand the dynamics of the whole, you derive, at least in principle, the properties and patterns of interactions of the parts.
1 Journal of Bodywork and Movement Therapies (2003) 7(1),1
2 Gray G: Functional Video Digest. Functional Flexibility Enhancing Life. V2.11
3 Gray G: Fast Function. Flexibility, Mobility. 2006
by
Lenny Parracino PT, FAFS
Whether training for golf, football, baseball, or any sport, most athletes realize the benefits from a strength training program, yet rarely recognize the importance of a flexibility program. Flexibility is the foundation of what we do! In fact, without flexibility the body will not exhibit optimal levels of power, strength, cardiovascular fitness, or muscle endurance. Flexibility is the cornerstone of rehab, performance, and preventing injuries. However, flexibility programs seem to be less popular, most likely for a variety of reasons – one being research shows mixed reviews which often leads to confusion.1 When reviewing the principles (or lack thereof) behind most research it is easy to understand why the mixed reviews exist. As professionals, it is important that our decisions on what technique to choose be determined by a principle-based approach that is specific to each person’s intended need, not an arbitrarily designed guideline. To assist in determining what technique to choose, we will first explore three primary principles that should be considered, followed by a strategy to assess and address your patient’s / client’s functional flexibility.
Three Primary Principles of Functional Flexibility:
1. Individual and Task Dependent
2. Three-Dimensional
3. Mobility / Stability System
Functional flexibility is flexibility that allows us to function better. It allows one to perform tasks optimally and efficiently.2 The exact function is individual and taskdependent. 3 Therefore, general stretching techniques designed for muscle origininsertion will not provide us with an optimal functional outcome. Instead, the practitioner must appreciate the function of the muscles during the task. In other words, what a muscle does is task driven not textbook driven. This doesn’t make the textbook authors wrong, their right relative to the position, motion in which they concluded function at that time. When the body changes angles, positions, etc., its function changes; this is why for flexibility to be functional the techniques must look like the intended function. Therefore, we need to understand how the muscles, fascia, tendons, ligaments, nerves, joint capsules, and joints are moving three-dimensionally during the exact task; not only how much motion but also how well. This is the principle of mobility-stability, the right amount of motion with the right amount of stability in all three planes specific to the individual (not textbook) and intended task (all tasks require different levels of motion-stability).
To help simplify this complexity, we would like to share a practical strategy applying our three principles. This strategy can be used practically during your next assessment / evaluation…
First and foremost, understand each unique individual and task. Once you understand the individual’s current condition, limitations, concerns, and what they want to do, assess the intended task with as much authentic function as possible. The key is in understanding what they want / need to do and what they currently can do successfully. From here build a strategy to lead them in the right direction as quickly and safely as possible. For example, start with level one and only move to level two and three as needed per individual, per task.
Level One: Task specific. Assess the ability to perform the exact task. For example, walking, lunging, squatting, pivoting, stepping, reaching, running, balancing, picking up a specific object, sitting while reaching with right hand, etc. If this produces pain, discomfort, and/or lack of confidence, create authentic support to assist in the task. For example, one may reach forward at knee height from a split standing stance and feel low back stress. What if you changed the height of the reach to waist height? Same discomfort or less? If less, is it the back or the hips inability to allow the back to be successful from the range first assessed? Become a detective by changing body angles, positions, heights, drivers, ranges, etc. before leaving the intended task. Figure out a way to gain success in what they want/need to do. If this fails, progress to level two (although level two will look like level one).
Level Two: Task with outside support. Subtly add outside support or points of stability to the intended function. Using our example, simply add outside support such as in a True Stretch or a doorway. The outside support will allow you to position your patient / client in a specific range or zone to then apply authentic drivers. As their driving motion, use your palpation skills to assess the entire chain reaction searching for the “weak-link.” This is the application of the motion-stability principle. Then the body perceives stability it will exhibit mobility, providing it’s there. If one suspects the mobility is not there and desires to assess structural tissue texture, tension level three can provide information regarding the suspected structure (not exact function).
Level Three: Structure specific. Provides an environment for a structural assessment such as a plinth or table. This deviation from the exact functional task must be understood as a deviation and the results then correlated and integrated back into function, if function is the desired outcome.
Traditionally many techniques have been taught to start from the symptom or structural tightness to level three eventually getting to level one. In this paradigm shift, we allow the exact function to dictate how far away from function and into isolated structure we go. This strategy saves time but most importantly gives hope to your patient / client – function feeds function. Although function is complex due to its always changing nature, we can simplify function by simply following function. Use what your patient / client is saying, what they have experienced, and how they are moving as your guide to improving their wellbeing. When we apply the principles of Applied Functional Science (convergence of physical, biological, and behavioral science), flexibility takes on a new meaning. Functional flexibility recognizes the individual as a whole. Once you understand the dynamics of the whole, you derive, at least in principle, the properties and patterns of interactions of the parts.
1 Journal of Bodywork and Movement Therapies (2003) 7(1),1
2 Gray G: Functional Video Digest. Functional Flexibility Enhancing Life. V2.11
3 Gray G: Fast Function. Flexibility, Mobility. 2006
Tuesday, September 29, 2009
Chronic Pain and the often overlooked glut muscles
Chronic Pain and the Often Overlooked Glut Muscles
Most people look at the abdominal wall when they have chronic low back or pelvic problems. They do endless amounts of crunches and Pilates type movements to strengthen their core. While this does build strength, it doesn’t address an often overlooked group of muscles which includes the external rotators of the hip and the gluteus muscles. For ease, I’ll call them the butt muscles.
When the butt muscles are weak (inhibited) they can cause multiple problems for the musculoskeletal system. Let’s look at the gluteus maximus as an example. This muscle attaches to the outside of your upper leg to a thick band called the iliotibial band. Its other attachment is at the top of your pelvis and to the small pie shaped bone at the base of your spine that forms the foundation of your spine, called the sacrum. It crosses the sacroiliac joint and the hip joint. It’s nearly always involved in sacroiliac pain, lumbar spine pain and hip pain.
You can notice the gluteus maximus muscle working when you walk with a long stride. If you place your hands over the lower portion of your buttocks and walk with a short stride, you will feel very little muscle contraction. Now lengthen your stride and you will feel the muscle contract when you toe off and when your heel strikes the ground. This is actually a good way to keep the muscle strong. Walking in heels prevents long strides and contributes to inhibited butt muscles.
Getting out of a chair or car and climbing stairs are other common uses of the butt muscles. When they are weak, you have to lean forward to shift your weight more over your knees in order to get up.
Why is the strength in these muscles important?
When these muscles are weak there will be a slow lengthening of the sacroiliac ligaments which causes pain and pelvic imbalances that become chronic. If this occurs, there will usually be muscle tightness running up your back even up to the neck muscles.
What are the symptoms of weakness of the butt muscles?
1. Chronic pelvic problems
2. Chronic knee pain
3. Stiffness to the lower back
4. Restriction in neck rotation
5. Difficulty sitting for long periods of time
6. Difficulty getting out of a car or up from a low chair
What can you do about this?
First you have to have your pelvis, hip, foot and thoracic spine tested for any structural imbalance. Then the muscle needs to be tested for its proper function and corrected if it cannot contract properly. Once the muscle is able to function properly, simply walking with long strides may be enough to keep the muscle contracting properly. If this is not enough, then specific exercises can be prescribed to help allow for proper biomechanics of the butt muscles. Unfortunately, all of the machines at the gym don’t take into account the way the butt muscles actually function when walking and they often work the hamstring and low back muscles more than the buttock muscles which leads to further imbalance.
If you have chronic problems or know someone with this type of problem, please talk to me about it. Often treating this group of muscles helps with many problems at once, from the foot to the neck.
As always, your referral is my greatest compliment.
Kevin Colling, D.C. 503-808-9145
¬¬
Most people look at the abdominal wall when they have chronic low back or pelvic problems. They do endless amounts of crunches and Pilates type movements to strengthen their core. While this does build strength, it doesn’t address an often overlooked group of muscles which includes the external rotators of the hip and the gluteus muscles. For ease, I’ll call them the butt muscles.
When the butt muscles are weak (inhibited) they can cause multiple problems for the musculoskeletal system. Let’s look at the gluteus maximus as an example. This muscle attaches to the outside of your upper leg to a thick band called the iliotibial band. Its other attachment is at the top of your pelvis and to the small pie shaped bone at the base of your spine that forms the foundation of your spine, called the sacrum. It crosses the sacroiliac joint and the hip joint. It’s nearly always involved in sacroiliac pain, lumbar spine pain and hip pain.
You can notice the gluteus maximus muscle working when you walk with a long stride. If you place your hands over the lower portion of your buttocks and walk with a short stride, you will feel very little muscle contraction. Now lengthen your stride and you will feel the muscle contract when you toe off and when your heel strikes the ground. This is actually a good way to keep the muscle strong. Walking in heels prevents long strides and contributes to inhibited butt muscles.
Getting out of a chair or car and climbing stairs are other common uses of the butt muscles. When they are weak, you have to lean forward to shift your weight more over your knees in order to get up.
Why is the strength in these muscles important?
When these muscles are weak there will be a slow lengthening of the sacroiliac ligaments which causes pain and pelvic imbalances that become chronic. If this occurs, there will usually be muscle tightness running up your back even up to the neck muscles.
What are the symptoms of weakness of the butt muscles?
1. Chronic pelvic problems
2. Chronic knee pain
3. Stiffness to the lower back
4. Restriction in neck rotation
5. Difficulty sitting for long periods of time
6. Difficulty getting out of a car or up from a low chair
What can you do about this?
First you have to have your pelvis, hip, foot and thoracic spine tested for any structural imbalance. Then the muscle needs to be tested for its proper function and corrected if it cannot contract properly. Once the muscle is able to function properly, simply walking with long strides may be enough to keep the muscle contracting properly. If this is not enough, then specific exercises can be prescribed to help allow for proper biomechanics of the butt muscles. Unfortunately, all of the machines at the gym don’t take into account the way the butt muscles actually function when walking and they often work the hamstring and low back muscles more than the buttock muscles which leads to further imbalance.
If you have chronic problems or know someone with this type of problem, please talk to me about it. Often treating this group of muscles helps with many problems at once, from the foot to the neck.
As always, your referral is my greatest compliment.
Kevin Colling, D.C. 503-808-9145
¬¬
Friday, August 21, 2009
Hips- The Powerhouse to the Entire Body
HIPS
The Powerhouse to the Entire Body
The hips provide power to the entire body. When they are working correctly they are your best friend, but when they are inhibited they quickly become your worst enemy. The hips affect joints as far away as the elbow and the ankle. An improperly functioning hip can easily contribute to low back pain (disc bulges/herniations), knee injuries (ACL, tendonitis), shoulder injuries (impingement, rotator cuff) and elbow injuries (tennis and golfer’s elbow).
The hip joint is a tremendously mobile yet stable joint. It connects the femur (thigh bone) to the pelvis via a deep cup called the acetabulum. It has 17 of the thickest, strongest muscles attached to it and these muscles are held together by fascia which functionally links the hips to pretty much the entire rest of the body. The secret behind the power of the hip is its ability to load and unload in all three planes of motion. This allows the hip to control motion of the kinetic chain. Let’s use the knee as an example of how the hip has an effect down the kinetic chain. Most traditional rehabilitation stresses the quadriceps and the hamstrings, but these muscles really only control knee motion when the knee is flexed close to 90degrees. This excludes them from being the primary stabilizer during everyday activities like walking. The hip muscles, on the other hand, are well designed to control the three dimensional motion of the knee because they are oriented to slow down the motion of internal rotation, adduction and flexion of the knee. This takes tension off the ligaments of the knee (especially the ACL).
Now let’s look at an example of how the hip has effects up the kinetic chain. The hip helps protect the rotator cuff of the shoulder and the ligaments of the elbow. In this case it’s the muscles in the front of the hip that do the work. Namely, the iliopsoas, abdominals and adductors… When I see tennis players with elbow pain in my office, I always examine their hips. This is because they play a significant roll in stabilizing the body for movement. To see how the hips influence the shoulder stand up and take a long step forward with your left leg and then raise your right arm out to the side to shoulder height. Did you feel tension at your hip? This means that the muscles of the front of the hip are loaded and ready to contract. Now sit down and lift your right arm up. Did you feel the same tension? Probably not, because the flexed position of the hip inhibits its ability to contract and properly stabilize the body.
As you can see proper hip function is essential to injury prevention and optimal performance. It is important to keep the hips strong in order to stabilize the rest of the body. But be careful! Not all training exercises are the same. Most of the traditional exercises used to build abdominal and gluteal strength actually inhibit the ability of the hip muscles to contract at the right time. And activities like prolonged sitting actually promote faulty capsular patterns of the hip. Your training program should be unique to your needs and functional goals and should promote both mobility and stability. Whether you are an active or inactive person your hips are a key piece of a pain-free life.
Dr. Colling has extensive training an experience dealing with hip biomechanics. If you would like an evaluation, have an injury or would like advice on how to properly train your hips for optimal performance, please call 503-808-9145.
The Powerhouse to the Entire Body
The hips provide power to the entire body. When they are working correctly they are your best friend, but when they are inhibited they quickly become your worst enemy. The hips affect joints as far away as the elbow and the ankle. An improperly functioning hip can easily contribute to low back pain (disc bulges/herniations), knee injuries (ACL, tendonitis), shoulder injuries (impingement, rotator cuff) and elbow injuries (tennis and golfer’s elbow).
The hip joint is a tremendously mobile yet stable joint. It connects the femur (thigh bone) to the pelvis via a deep cup called the acetabulum. It has 17 of the thickest, strongest muscles attached to it and these muscles are held together by fascia which functionally links the hips to pretty much the entire rest of the body. The secret behind the power of the hip is its ability to load and unload in all three planes of motion. This allows the hip to control motion of the kinetic chain. Let’s use the knee as an example of how the hip has an effect down the kinetic chain. Most traditional rehabilitation stresses the quadriceps and the hamstrings, but these muscles really only control knee motion when the knee is flexed close to 90degrees. This excludes them from being the primary stabilizer during everyday activities like walking. The hip muscles, on the other hand, are well designed to control the three dimensional motion of the knee because they are oriented to slow down the motion of internal rotation, adduction and flexion of the knee. This takes tension off the ligaments of the knee (especially the ACL).
Now let’s look at an example of how the hip has effects up the kinetic chain. The hip helps protect the rotator cuff of the shoulder and the ligaments of the elbow. In this case it’s the muscles in the front of the hip that do the work. Namely, the iliopsoas, abdominals and adductors… When I see tennis players with elbow pain in my office, I always examine their hips. This is because they play a significant roll in stabilizing the body for movement. To see how the hips influence the shoulder stand up and take a long step forward with your left leg and then raise your right arm out to the side to shoulder height. Did you feel tension at your hip? This means that the muscles of the front of the hip are loaded and ready to contract. Now sit down and lift your right arm up. Did you feel the same tension? Probably not, because the flexed position of the hip inhibits its ability to contract and properly stabilize the body.
As you can see proper hip function is essential to injury prevention and optimal performance. It is important to keep the hips strong in order to stabilize the rest of the body. But be careful! Not all training exercises are the same. Most of the traditional exercises used to build abdominal and gluteal strength actually inhibit the ability of the hip muscles to contract at the right time. And activities like prolonged sitting actually promote faulty capsular patterns of the hip. Your training program should be unique to your needs and functional goals and should promote both mobility and stability. Whether you are an active or inactive person your hips are a key piece of a pain-free life.
Dr. Colling has extensive training an experience dealing with hip biomechanics. If you would like an evaluation, have an injury or would like advice on how to properly train your hips for optimal performance, please call 503-808-9145.
Wednesday, August 19, 2009
Chiropractic costeffective and safe
Print This Page
Media Contacts:
Caitlin Lukacs: (703) 812-0218 | clukacs@acatoday.org
FOR IMMEDIATE RELEASE: August 12, 2009
New Pilot on Quality Shows Cost-Effectiveness of Chiropractic Care for Musculoskeletal Disorders
A new pilot program shows that conservative heath care, including chiropractic, may reduce overall health care costs in patients with musculoskeletal disorders, such as back and neck pain. The pilot, conducted by Wellmark Blue Cross and Blue Shield to measure quality of patient care for its members in Iowa and South Dakota, also shows promising outcomes for the patients choosing chiropractic and other conservative care.
“The cost-effectiveness and safety of chiropractic has been documented in several studies. ACA is pleased that insurance companies are starting to recognize the value that doctors of chiropractic and other conservative providers can offer to their members,” said ACA President Glenn Manceaux, DC. “Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he added.
Wellmark conducted the Physical Medicine Pilot on Quality in 2008 for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists and occupational therapists provided care to 5,500 members with musculoskeletal disorders. According to Wellmark, data from participating clinicians show that 89 percent of the patients treated in the pilot reported a greater than 30-percent improvement in 30 days.
The pilot compared data for Wellmark members who received care from doctors of chiropractic or physical therapists with a member population with similar demographics who did not receive such services. The comparison showed that those who received chiropractic care or physical therapy were less likely to have surgery and experienced lower total health care costs, according to Wellmark.
Chiropractic is widely recognized as one of the safest non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints. A significant amount of evidence shows that chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes:
* A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.
* A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients’ first year of symptoms.
* A study published in a 2003 edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than do a variety of medications.
The American Chiropractic Association is the nation’s leading chiropractic organization representing more than 15,000 doctors of chiropractic and their patients. To find a chiropractor near you, visit www.acatoday.org.
Chiropractic Symposium and Expo '09
1701 Clarendon Blvd. Arlington, VA 22209 | 703 276 8800 | Copyright © 2009 ACA
Media Contacts:
Caitlin Lukacs: (703) 812-0218 | clukacs@acatoday.org
FOR IMMEDIATE RELEASE: August 12, 2009
New Pilot on Quality Shows Cost-Effectiveness of Chiropractic Care for Musculoskeletal Disorders
A new pilot program shows that conservative heath care, including chiropractic, may reduce overall health care costs in patients with musculoskeletal disorders, such as back and neck pain. The pilot, conducted by Wellmark Blue Cross and Blue Shield to measure quality of patient care for its members in Iowa and South Dakota, also shows promising outcomes for the patients choosing chiropractic and other conservative care.
“The cost-effectiveness and safety of chiropractic has been documented in several studies. ACA is pleased that insurance companies are starting to recognize the value that doctors of chiropractic and other conservative providers can offer to their members,” said ACA President Glenn Manceaux, DC. “Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he added.
Wellmark conducted the Physical Medicine Pilot on Quality in 2008 for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists and occupational therapists provided care to 5,500 members with musculoskeletal disorders. According to Wellmark, data from participating clinicians show that 89 percent of the patients treated in the pilot reported a greater than 30-percent improvement in 30 days.
The pilot compared data for Wellmark members who received care from doctors of chiropractic or physical therapists with a member population with similar demographics who did not receive such services. The comparison showed that those who received chiropractic care or physical therapy were less likely to have surgery and experienced lower total health care costs, according to Wellmark.
Chiropractic is widely recognized as one of the safest non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints. A significant amount of evidence shows that chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes:
* A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.
* A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients’ first year of symptoms.
* A study published in a 2003 edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than do a variety of medications.
The American Chiropractic Association is the nation’s leading chiropractic organization representing more than 15,000 doctors of chiropractic and their patients. To find a chiropractor near you, visit www.acatoday.org.
Chiropractic Symposium and Expo '09
1701 Clarendon Blvd. Arlington, VA 22209 | 703 276 8800 | Copyright © 2009 ACA
Sunday, June 28, 2009
Low Back Pain - Treatment considerations
The Low Back
The low back (lumbar spine) is perhaps the most dysfunctional and weakest musculoskeletal link in the body. It is one of the leading reasons for visits to the emergency room. And anyone who has had a bout of back pain will tell you it affects everything they do throughout the day. It is active in nearly every functional activity of the body and its proper function is integral to most of our movements in every day life.
Interestingly, the low back is rarely the first to move. If you take a swing in golf, first your arms move, then your upper back, and then your low back moves then hips. If you step forward and bend down to pick something up, first your foot moves then your leg and hip then your sacroiliac joint and then your low back moves. This is a very important point, because the low back relies on proper communication from the rest of the body in order to function properly. Thus, any therapy for low back pain should integrate the rest of the body and promote proper communication between the low back and the upper and lower body.
What does communication to the low back mean? It means the ability to transfer triplane (sagittal, frontal and transverse) motion into triplane stability. The low back is designed to move really well in the front to back motions (sagittal plane); it has some movement in the side to side (frontal plane motion) and very little motion in rotation (transverse plane). The limitation in rotation allows the lumbar spine to be stable enough to transfer rotational motion between the upper and lower body. As a practitioner I consider how the body functions in its transformational zones between two stages of motion. The load and the unload. Loading is the preparation for a movement. The unload is performance of a specific movement. Let’s look at an example.
I recently treated a person who was training for her first marathon that was to take place in 3 weeks. She had been having right low back pain for the last 2 months of her training and had just recently started to get right knee pain and swelling. She was unable to run or even go from sitting to standing without pain.
I started her evaluation by observing her walk. I immediately noticed that she walked on the outside of her right foot, her right foot turned out more than the left and her heel came off the ground early. My next step was to get more specific and see how her right foot moved in all three planes of motion and when she was doing a balance reach exercise she lacked balance in the frontal and transverse planes. In response to this unbalance she said, “I do remember spraining my ankle about a year ago”. Next I assessed her hip function on the TrueStretch which allowed for a stable environment to look at triplane motion. It quickly became evident that she lacked sagittal, and more importantly, transverse plane motion of her right hip. “Yeah, but what does this have to do with my back”, she asked me. Next I set out to re-gain motion in her right ankle and hip by facilitating these motions in a pain-free range of motion and then I followed up with triplane functional lunges to activate some sleeping muscles. Within one and a half weeks, this patient was back to pain-free running.
Although the patient’s original complaint was right low back pain and knee pain, I believe the true cause of pain and dysfunction was rooted in the foot/ankle and hip. Since the low back only has a nominal amount of rotation to begin with, there is not much it can do to compensate for lack of motion in other parts of the body. Therefore those restricted parts of the body must be evaluated and treated in order to have a truly successful and lasting resolution of back pain.
The low back (lumbar spine) is perhaps the most dysfunctional and weakest musculoskeletal link in the body. It is one of the leading reasons for visits to the emergency room. And anyone who has had a bout of back pain will tell you it affects everything they do throughout the day. It is active in nearly every functional activity of the body and its proper function is integral to most of our movements in every day life.
Interestingly, the low back is rarely the first to move. If you take a swing in golf, first your arms move, then your upper back, and then your low back moves then hips. If you step forward and bend down to pick something up, first your foot moves then your leg and hip then your sacroiliac joint and then your low back moves. This is a very important point, because the low back relies on proper communication from the rest of the body in order to function properly. Thus, any therapy for low back pain should integrate the rest of the body and promote proper communication between the low back and the upper and lower body.
What does communication to the low back mean? It means the ability to transfer triplane (sagittal, frontal and transverse) motion into triplane stability. The low back is designed to move really well in the front to back motions (sagittal plane); it has some movement in the side to side (frontal plane motion) and very little motion in rotation (transverse plane). The limitation in rotation allows the lumbar spine to be stable enough to transfer rotational motion between the upper and lower body. As a practitioner I consider how the body functions in its transformational zones between two stages of motion. The load and the unload. Loading is the preparation for a movement. The unload is performance of a specific movement. Let’s look at an example.
I recently treated a person who was training for her first marathon that was to take place in 3 weeks. She had been having right low back pain for the last 2 months of her training and had just recently started to get right knee pain and swelling. She was unable to run or even go from sitting to standing without pain.
I started her evaluation by observing her walk. I immediately noticed that she walked on the outside of her right foot, her right foot turned out more than the left and her heel came off the ground early. My next step was to get more specific and see how her right foot moved in all three planes of motion and when she was doing a balance reach exercise she lacked balance in the frontal and transverse planes. In response to this unbalance she said, “I do remember spraining my ankle about a year ago”. Next I assessed her hip function on the TrueStretch which allowed for a stable environment to look at triplane motion. It quickly became evident that she lacked sagittal, and more importantly, transverse plane motion of her right hip. “Yeah, but what does this have to do with my back”, she asked me. Next I set out to re-gain motion in her right ankle and hip by facilitating these motions in a pain-free range of motion and then I followed up with triplane functional lunges to activate some sleeping muscles. Within one and a half weeks, this patient was back to pain-free running.
Although the patient’s original complaint was right low back pain and knee pain, I believe the true cause of pain and dysfunction was rooted in the foot/ankle and hip. Since the low back only has a nominal amount of rotation to begin with, there is not much it can do to compensate for lack of motion in other parts of the body. Therefore those restricted parts of the body must be evaluated and treated in order to have a truly successful and lasting resolution of back pain.
Subscribe to:
Posts (Atom)
