Category: Pain

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Chiropractor Joint Health Pain Spine Sport

Pain reduction

As a Chiropractor and manual therapist, I always recommend people to move well and move often to reduce or prevent joint pain.

If your spine, shoulder or ankle have joint pain or not moving well, it might not just affect your ability to move but can even have effects on your breathing, stress and even your immune system. Of course, follow a healthy diet (fruits, vegetables, not too much red meat, whole foods, no preservatives etc.), sleeping well, and exercise are all good ways to keep your joints healthy and free of pain.

I had a friend recently ask what are the top things people aren’t doing that they should start doing for their joint pain and health.

Here are my top 3:

 

  1. Self Screening- Prevention is key to joint pain and knowing when to see a professional and when something can be treated on your own is important to be able to differentiate. I always teach my patients how to screen for joint problems and whether or not they should seek advice from a health professional. If they are in doubt, I always recommend consulting with one as soon as possible. What do I teach patients with Joint pain for screening? CARs or Controlled Articular rotations. They allow for screening for all joints in all ranges of motion. Knowing what type of pain or restriction is considered abnormal is a great way of preventing further problems. For an example of CARs click here

 

  1. Joint Mobility training- FR and FRC practitioners define Mobility= flexibility + strength. One can never be too mobile. Improving and maintain mobility is important for life. Whether you want to plays sports or just want to play with your kids, adequate mobility is required. FRC and FR protocols allow you to strengthen your joint articulations (hips, neck, lower back, wrist, pinky finger). There is no age limitations to joint mobility training as it is dependent on your own body. Those with joint pain also can benefit from these exercises as they can be geared specifically to their complaint without aggravating the pain. For more information on FR and FRC click here or visit functionalanatomyseminars.com

 

  1. Capacity Training- Injury= load > capacity. Injury occurs when a load on your body is greater than the capacity that your body can take. Joint pain can occur when your capacity to do an activity is low. Do you train yourself in your weakest areas? Do you prepare your body for all ranges of motion? Increasing your capacity in weak areas will reduce the likelihood of injury and therefor pain. If you have been injured before, improving the injured areas capacity will prevent re-injury. What type of capacity training can I start with? You can start with simple Joint mobility training, see above. No equipment is required and it is done with body weight. You can also begin to do general strength and aerobic training. Sometimes just being strong in both your heart and skeletal muscle can prevent a lot if injuries and chronic disease.

 

Stay Healthy and Happy New year!

 

BB

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Chiropractor Health Hong Kong Joint Health Pain Sport

Tennis Elbow: Tendonitis or Tendonosis

Wimbledon Tennis Championships is underway and it reminded me to touch on the dreaded “tennis elbow” diagnosis. I hear this all the time from people who complain of lateral elbow pain (pain on the outer elbow) but don’t even play tennis. I always ask “did you hurt your arm playing tennis?” If not, then you don’t have “tennis elbow”. Patients then claim to have some kind of tendonitis or lateral epicondylitis . Unfortunately, you most likely have a tendonosis or epicondylosis. I spoke with some Crossfit and basketball athletes last week who have battled “tennis elbow” before without ever playing tennis. “Tennis Elbow” affects not only sports people but office workers and labourers as well.”

 

“”Tennis Elbow” affects not only sports people but office workers and laborers as well.”

My doctor or therapist said I have “tennis elbow”, I guess I have some kind of tendonitis or tendonosis. What is the difference?

Tendinitis is the active inflammation of the tendon. The mechanism usually occurs due to micro-tears that occur with repeated heavy or sudden overload. Tendonitis occurs overs a few days to weeks and time to recovery can be anywhere from 4 to 6 weeks. The key for this diagnosis is that there has to be an inflammatory, chemical, component.  Unfortunately, research has shown us that more often than not, there is NO active inflammatory component in long standing cases of “tennis elbow”.

Tendonosis is more degenerative in nature. The injury occurs due to the tendon chronic overuse. Without adequate rest, even light, repetitive strains can result in a tendonisis.  Tendonosis occurs typically over 7 to 10 weeks and time to recovery can take even longer, between 3 to 6 months. This tendonisis has a degenerative component over an inflammatory one.

 

Why is the diagnosis important?

Depending on what process is going on will depend on what treatment will best affect your body.

Depending on what process is going on will depend on what treatment will best affect your body. Inflammatory tendonitis requires an initial anti-inflammatory treatment protocol. By trying to give strengthening or stretching during this phase could hinder your recovery. Less conservative approaches, such as anti-inflammatory medications, and corticosteroid injections, may not be particularly effective if you do not have an active inflammatory component in your injury. In some cases, corticosteroid injections risks have been shown to increase the degeneration of tendons, risk of recurrence and therefore, make the tendon at risk for rupture.

Degenerative tendonosis requires an approach that addresses rebuilding the tendon as quickly and safely as possible. Specific exercises like those prescribed by FR and FRC practitioners can target the muscles and tendons without causing further degeneration. Diagnosis is also important to know when to rest and when do proceed with more advanced exercises like eccentric training. Modalities such as shockwave therapy, to help with proper neovascularization (big word meaning blood vessel supply) may be used. Blood vessel formation in tendonosis problems tends to be poorly done by the self-healing body which can lead to pain and slow healing. Other modalities such as dry needling and supportive taping can help improve pain control and support other tissues.

Coaching proper technique for the specific tasks is required for both diagnoses. Supportive bracing may also be recommended to reduce load on the elbow tissues.

 

How do I know which one I have?

See a health professional, like a Chiropractor, that can provide a detailed physical exam. The physical exam should consist of a general history of your complaint and specific palpation, muscle and orthopaedic testing. Your health practitioner should be able to discern the trouble muscles. Is it ECRL, ECRB, common extensor,blah blah …. All important structures involved in any “tennis elbow” complaint need to be thoroughly examined by hand.

In addition to the elbow, I would look at the wrist, shoulder and neck. There may biomechanical problems that need to be addressed to take pressure off of the affected tendon.

 

Are you in Hong Kong and suffer from elbow pain or “tennis elbow”?

Contact me for a healthy conversation. Perhaps I can help.

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Chiropractor Hong Kong Injury prevention Media Pain Spine Sport Videos

Combat Neck Pain

Why did I decide to write about neck pain?

I was both a volunteer and injury consultant this past weekend for the mini Copa de Hong Kong Jiu Jitsu Tournament. I had a couple athletes ask, “what is the most common condition I see from combat athletes?”.  In the past, I saw many lower back pain patients but most frequently it has been all neck injuries. I believe this is because athletes now train their core, abdominal and back strength much more frequently. As well, strength and conditioning for the lower back is a staple in many general body programs.  Neck strength, conditioning and mobility is generally forgotten and currently this leads me to see more neck pain patients.

“Neck strength, conditioning and mobility is generally forgotten and currently this leads me to see more neck pain patients.”

Neck pain from both combat (jiu-jitsu, boxing, wrestling, muay thai, mma, football, basketball) and non-combat sports (basketball, football, tennis, golf, badminton) are quite common. Neck pain from combat sports can be particularly difficult to treat.  This is due to the fact that sports typically involve techniques that strain the neck during training. Common injuries tend to occur in hyperflexion, rotation, traction and compression. The most common form of neck pain I see is from flexion based injuries from getting your neck snapped down, being pulled in a thai plum, being stacked while playing guard or being choked and head locked.

Neck pain is usually felt in the highest portion of the spine, the cervical spine area. The cervical spine area, has 7 vetebrae. When the area becomes moved beyond the normal functional range of motion both passive (bone, disc, ligament, capsule) and active tissues (muscle, joint, tendon) can become injured. The neck and upper back area has both superficial to deep areas of soft tissue that covers vertebrae (see below). Neck injuries may also cause pain into the mid back or shoulders and many times is mistaken for problems in those areas.

 

I have neck pain from a jiu-jitsu, wrestling, boxing and/or muay thai, what can I do?

Having your neck pain evaluated by a Chiropractor will help determine the extent of the injury and what your prognosis (the forcast of your condition) will be. If you have already recovered from a previous neck pain or injury, prevention of the next one should be what you are thinking about. Having your neck and body assesed is the best way to know how your body is moving and how painful or dysfunctional issues have affected the function of your joints.

In my clinic, if a person reports pain then I perform an SFMA, neurological, orthopaedic and palpatory assessments. Your Chiropractor should locate the dysfunctional issues and tissues (tissue Extensibility, Joint mobility, chemical pain, motor control issues, or vestibular issues). A skilled practitioner should be able to palpate using a layering technique like Functional Palpation before performing any Functional Release or Active Release techniques. Many Chiropractors possess the skill to palpate specific structures and are experts to do so. The type of treatment administered will be based on what will provide the quickest neck pain relief and return to function.

I have recovered from a neck pain and injury, what is a safe and effective exercise I can peform to help strengthen my neck?

Many athletes will typically stretch to get rid of pain and improve passive range of motion. Is that enough to prevent injury? Just stretching in order to allow your body to get into a range of motion is not enough. Aquiring strength and control in ALL RANGES (short and long ranges of motion) will help prevent injuries. This means having active ability in these ranges of motion.

Below is a video from my colleague and mentor, Dr. Andreo Spina. Featured on Jits TV, our functional range conditioning exercise will help prevent neck pain injury. This exercise is also beneficial for those who just want general conditioning for there neck.

There are other great conditioning and neck strengthening execises that a qualified personal trainer or strength and conditioning coach can give you to help prevent neck pain. Just be sure you have all the prerequesites for doing the exercises by seeing you Chiropractor. They can determine if your neck is prepared for more difficult movements.

 

Do you practice brazillian jiu jitsu (BJJ), muay thai, boxing, wrestling, or judo and get neck pain? See a Chiropractor for an evaluation and improve your joint health and mobility.

 

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Chiropractor Health Hong Kong Joint Health Pain Sport

Pull Up Pain

Pull up pain tends to exist at the elbows, shoulders and wrists.  The pull up exercise is a great way to develop back, shoulder and arm strength. Pull ups can be done at home or in the park on a bar or with suspension equipment (Gymnastic rings, “TRX” equipment).  Those who utilize a horizontal bar tend to complain more of pain as it can be slightly more strenuous due to your joints in a fixed position rather than suspension equipment, a free motion exercise.

 

Pull up pain tends to occur due to 2 main reasons:

 

  • Incorrect form causing compensation at the various joints.
  • Dysfunctional articulation AKA Problematic Joint

 

2 common mistakes that cause pull up pain (Refer to Picture Below)

  • Not setting the shoulders
  • Not keeping your elbows back.

 

 

Keeping the scapulae (shoulder blade) back and down (Depressed and retracted) is the first step before initiating your first pull up to prevent pull up pain.

Keeping the scapulae (shoulder blade) back and down (Depressed and retracted) is the first step before initiating your first pull up. By “setting” your shoulder-scapulae-thoracic complex, will allow you keep your back muscles tight. It will also allow to reduce the strain on your biceps muscle and use the back muscles such as the latissimus dorsi and trapezius. Without proper setting, compensation can cause shoulder impingement syndromes, overuse in the biceps tendon or elbow sprain/strains.

 

Keep your elbows forward rather than keeping them back to prevent pull up pain.

The second common mistake is to keep your elbows forward rather than keeping them back. The elbows need to be driven back otherwise the area of stress over the elbows will be large.  This can lead to medial elbow pain or “Golfer’s elbow”.

After these cues, what happens if you or your client cannot keep their shoulders down and back or keep the elbows back?

The person may not have the ability to perform this movement because they have poor mobility (flexibility, control and strength) in certain articulations (joints-elbow, shoulder, thoracic spine). Many trainers or healthcare practitioners will try to downgrade the pull up exercise to try to make it “easier” to perform. Unfortunately, if your joints are not moving like joints, no matter how basic or “easy” you make the exercise (using bands for help, standing on chair/ball etc. ) you will not be able to perform the exercise. Although regression/downgrading (making it “easier”) of the pull up is important but the person needs to have prerequisite mobility.

Do you or your client have the prerequisite joint mobility to start? Can you  or your client move your joints independently and with control?

Restriction of mobility can be because of a tissue (muscle and/or joint) problem or an issue with control (stability, nervous system control).

 

The source of why the poor movement is happening should be diagnosed and treated by a trained health professional, such as Chiropractor. Health professionals trained in Functional Range Release and Conditioning will be better equipped to assess your overall joint health.

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Media Office Pain Photos Posture Spine

Office Posture

Office Posture Workshop
Office posture workshops.

Office Posture Workshops

Office Posture in Hong Kong

#Flashback Friday. The last two Fridays we met to speak with a corporation in regards to their occupational health and ergonomics. We also had 1 on 1 sessions with each participant and looked at and adjusted their workstation to decrease overuse injuries and improve their posture and performance.  You can learn how to sit better by clicking here.