Archive for the ‘Rehab’ Category
How many repetitions does your back have left?
Tuesday, April 19th, 2011
I was recently listening to a webinar by Stuart McGill PhD, a researcher in Canada who has made it his life’s mission to solve the puzzle of low back pain. He was speaking about recent research that has shown that flexion-type exercises such as sit-ups, crunches or ab machines increase lumbar disc degeneration by overloading the delicate structures of the low back.
For the past year, we have eliminated the use of all flexion exercises in our rehab department and also have been encouraging patients not to do sit-ups and ab machines at the gym — especially if they already have low back pain. Sometimes it’s hard to convince patients that there is inherent risk with these exercises. After all, we all have been doing sit-ups since we were in PE class.
Dr. McGill used an example that I think will help patients better understand why flexion exercises increase risk for low back pain. If you wanted to make a break in a wire hanger, what would you do if you didn’t have wire cutters? You would repetitively bend the hanger at the spot that you wanted it to break. After a few dozen bends, you would have two pieces of wire hanger. Mission accomplished.
The lumbar spine (low back) has the same properties as that wire hanger. Every low back has a limited number of “bends” until something breaks. The number of “bends” each back has in its capacity is predetermined by genetics and other injuries that we may have experienced over the years. Since we all need to flex forward to accomplish certain movements and tasks, the best strategy to avoiding low back pain is to limit flexing to when we need to do it — not burning up thousands of repetitions through sit-ups.
So instead of using up your reserve through sit-ups (which are very ineffective ab exercises, by the way), investigate the use of bridging, planks, bird-dogs and other dynamic floor exercises which have been shown to prevent low back pain by stabilizing the spine — avoiding flexion. And as always, if you have questions on how to add this into your home exercise program, please let us know and we’ll be sure to set aside time to assist you!
Easy test for hip strength can predict knee pain risk
Tuesday, April 5th, 2011Knee and thigh pain are some of the most common complaints that we see in our pediatric and adult athletic patients, whether they run track, play softball or compete in triathalons. Many times, patients will come in with a stack of CD’s containing MRIs, x-rays and other testing done on their leg to no avail — they’re still in pain. Since nailing down the exact cause of knee and thigh pain can be tricky (especially if there is nothing showing up on imaging), chiropractic sports physicians and other rehab specialists started testing various hypothesis on how muscle imbalances in the hips and legs might contribute to knee pain.
Proper positioning during the SLST
One of these hypothesis is that weakness in the muscles that abduct the hip (keep the thigh from tilting towards the midline) creates additional pressure on the thigh and knee, creating additional wear and tear along the backside of the patella. To test the strength of these hip muscles, we have the patient stand on one leg and perform a small squat or dip, keeping the torso perpendicular with the ground. If the hip, knee and ankle all stay in one line during the test, the patient’s hip strength is good. If the knee moves towards the midline during the test, the patient’s hip strength is poor. This test is called the Single Leg Squat Test (SLST).
Athough this hypothesis has been working well for doctors in a clinical setting, researchers at the
Failing position during the SLST
Melbourne School of Engineering in Australia wanted to test the reliablity of the SLST for measuring hip strength as well as predicting risk for knee pain. In the February issue of the American Journal of Sports Medicine, their study was published and it confirmed that the SLST was a reliable tool and also can identify those at risk for knee pain. What’s even better about the SLST is that it doesn’t cost anything to perform and can be done by the sports doctor in 60 seconds — much easier than spending thousands of dollars on MRIs and CT scans.
It’s important to see a doctor who is familiar with sports injuries and also is up to date on the latest diagnostic and treatment methods to get you back to your sport as quickly as possible. Although family practice and immediate care physicians are great at detecting fractures and life threatening conditions, they may not be up to date on functional strength tests such as the SLST and possibly miss the true cause of your knee pain.
If you have knee pain or think that you might not pass the SLST, feel free to email me at drerin@ducatchiropractic.com and I would be glad to answer your questions. Remember the longer you compete on an injured or weak area, the longer it will take to get back to 100%!
The problem with stress balls…
Tuesday, March 29th, 2011
How many of you squeeze stress balls to strengthen your hands? Stop! It’s a big mistake. Using stress balls on a frequent basis has been linked to tingling in the hands, weakness in your grip and a variety of tendonitis complaints including tennis and golfer’s elbow.
From a doctor’s view, stress balls should have a warning label on them (as should cell phones, computers and video games) telling the unsuspecting public that they are hazardous to their health. Since the FDA is unlikely to mandate these labels in the near future, let me explain the dangers and let you decide for yourself!
When you squeeze a stress ball, you strengthen the flexor muscles of the forearm that run along the inside part of your elbow to your palm. These flexor muscles already tend to be over-strong and tight in the majority of the population because we use our hands all day to write, type, text or handle materials at work. The stronger the flexor muscles become, the weaker the extensor muscles on the opposite side of your forearm become.
If your flexor muscles are over-strong, they can compress the median nerve that runs inside of your carpal tunnel, causing tingling in your hands. In addition when you have the imbalance of tight/weak muscles in the forearm, it leads you open to tendonitis such as tennis and golfer’s elbow — which are not fun!
So instead of strengthening the over-strong flexor muscles, start strengthening the extensor muscles of your forearm by putting a tight elastic band around all of your finger tips and stretching open all of your fingers at once. We even have special elastic bands available at our office, free of charge, and can show you how to do this exercise safely and effectively.
The next time you see a co-worker using a stress ball, tell them the risks and get them a band to use instead!
Using your brain helps you stay pain-free
Tuesday, March 22nd, 2011
What’s the difference between doing exercises in our office and strengthening your core/back at home? The rehab exercises don’t seem that hard. At other therapy places, they get you started and just walk away. Can’t you just watch the videos at home and do it by yourself?
If you want results from rehab exercises, the answer is that you need someone to assist you, hands-on, to get your brain to re-wire and strengthen muscles weakened by injury. New research out of Australia studied low back pain patients who had weakened back and abdominal muscles contributing to their pain. They connected the patients to EMG machines to measure muscle contractions in the weakened areas as well as monitored brain activity to see if the patient was actively focusing on their exercises when performing them.
The patients who had hands-on direction from trained assistants who helped them cognitively think about the motions and muscle activation behind the exercise showed greater strength gains in the weakened muscles than the patient who were given simple instructions and allowed to do the exercises on their own.
So the take home message is two-fold from this research study: (1) In order to help our patients get better and become stronger, we have to engage your body and your brain to get you to focus on your movements in the rehab department and just not go through the motions; and (2) Patients shouldn’t be frustrated when they are not getting results from just strengthening at home after an injury — they simply need direct instruction to help them re-wire their brains.
Going back to babyhood?
Wednesday, February 16th, 2011
Have you ever noticed that we all enter the world in a fetal position, straighten out and then slowly return to that same fetal position as we age? We also start out walking with wobbly, unstable movements as toddlers. Most of us gain our stability as children. But somewhere in adulthood, we start getting a little more shaky and eventually have difficulty keeping our balance as we walk — just as we did when we were 1 year old.
In the rehabiltation world, a lot of time and research is spent on studying how we all learn to move as children. This research is important for treating children with movement disorders, but is also very valuable for use in adult rehabilitation as well. When we become injured, a little part of our brain forgets how to move that body part properly. If the injury is small, we might not even consciously notice this change.
Slowly these small injuries add up and we develop incorrect movement patterns (like using our hamstrings to do what our butt muscles should do and having raised shoulders all of the time). The longer these incorrect patterns are there, the more discomfort we feel and the less coordinated our movements are. Eventually, these incorrect patterns can cause you to lose your independence while walking and doing household chores.
To retrain the brain after an injury, we use many movements/exercises that mimick what we did as infants/toddlers such as crawling and reaching based exercises. Although our patients think we are crazy, the research shows that these movements are the best way to regain stability and strength. Even seniors with balance difficulties can see impressive gains with some of these simple exercises.