Chiropractic

People who suffer from lower back pain are often encouraged to participate in their own recovery, but they are seldom given the knowledge and tools needed to accomplish this. This discussion will help you acquire a basic understanding of the reasons for lower back pain, and take charge of your own health by taking the appropriate steps to rehabilitate your back.

Of course, getting better is only the beginning, since further episodes of back pain are quite common as time passes. Fortunately, you can improve your chances of avoiding recurrences by rehabilitating your back, whether you are experiencing your first bout with low back pain or have had extensive treatments or even surgery.

Causes of back pain

There are several structures in the back that can cause and/or contribute to low back pain.
Although the intervertebral disc is a remarkably versatile and strong structure, essentially acting as a shock absorber as we go about our activities, sometimes the disc fails when there is a sudden, unexpected force (such as a fall, lifting or other trauma). And when the disc does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common.

Making matters worse, the pain often prevents us from getting enough exercise, which adversely affects disc nutrition. Nutrition for the disc is achieved when physical activities cause the disc to swell up with water and then squeeze it out - much like a sponge. When pain affects our physical activity, the injured disc is deprived of its nutrition and begins to degenerate.

Activity is also needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material.

The muscles, ligaments and tendons in the back are also very important in maintaining proper spinal balance and strength. With decreased activity, the connective fibres of ligaments and tendons can begin to adhere to each other and lose resilience and may tear when sudden overload occurs. Unlike discs or connective tissue, however, when muscles are injured, they can quickly repair themselves.

However, muscles contribute to chronic back pain. When nerves are cut or pinched, the muscles they control cannot work, as sometimes happens when a herniated disc presses on a nerve. Also, since muscles are in constant communication with the central nervous system, anger or anxiety can tense the muscles and cause muscle spasms. Ongoing tension inhibits normal muscle function and leads to muscle wasting and further stability problems, which in turn can lead to chronic lower back pain.

Acute vs. chronic back pain

It's important to note that acute pain is different from chronic pain. We have all experienced acute pain from a sudden soft tissue injury, such as a sprained ankle, or even just a simple paper cut. The pain is immediate, but gradually resolves as the injured part heals.

Unlike acute pain, chronic pain comprises a constant low level of stimulation to the nervous system that eventually becomes a pattern. It may even persist as a “neural memory” after the initial source of irritation has resolved. The adaptation of our nervous system to this chronic stimulation creates an environment in which events that previously caused no pain become a source of pain. Pain may even progress to uninjured areas.

Emotional distress and certain medications can exacerbate this phenomenon. An effective solution is to distract the nervous system by means of active exercise in a controlled, non-destructive manner. Chiropractic adjustments aid in the body’s ability to regulate the neural feedback much like a dimmer switch can control light. This also helps to create the physiological conditions that allow the injured structures to heal.

Rehabilitation exercises

One of the keys to recovering from an episode of back pain or surgery, and to help avoid future recurrences of back pain, is to undergo proper rehabilitation in terms of stretching, strengthening and aerobic conditioning of the back and body. This requires a basic understanding of the types of muscles that need to be conditioned.

There are three types of muscles that support the spine:

• Extensors (back and gluteal muscles): used to straighten the back (stand), lift and extend, and move the thighs out away from the body.
• Flexors (abdominal and iliopsoas muscles): used to bend and support the spine from the front, they also control the arch of the lumbar (lower) spine and flex and move the thigh in toward the body.
• Obliques or Rotators (side muscles): used to stabilize the spine when upright, they rotate the spine and help maintain proper posture and spinal curvature.

While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.

For all forms of exercise, it is advisable to see a trained and licensed chiropractic physician, physical therapist, or occupational therapist. Depending on your specific diagnosis and level of pain, the rehabilitation program will be very different, and these specialists are trained to develop an appropriate rehabilitation program and provide instruction on correct form and technique.
Stretching

Any form of inactivity, especially where an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can be tolerated (in a controlled manner). Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain.

Stretching exercises should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, the hamstring muscles play a role in lower back pain, as it is clear that hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back.

Specialized equipment is available that helps repetitions to be done in the same manner so that progress can be identified and the level of exercise regulated.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don't make the mistake of thinking that something as simple as stretching won't be effective.

Strengthening

It is thought that re-injury is less likely to occur if back strengthening is accomplished than if mere pain relief is achieved with just stretching. An episode of back pain that lasts for more than two weeks should be treated with proper strengthening exercises to prevent a recurring cycle of pain and weakness.

There are two primary forms of exercise for strengthening and/or pain relief that tend to be used for specific conditions. When appropriate, the two forms of physical therapy may also be combined.

McKenzie exercises, in general focuses on extending the spine to reduce pain generated from the disc space. Theoretically, extension may also help reduce a herniated disc and reduce pressure on a nerve root. For patients who are suffering from leg pain due to a herniated disc (e.g. sciatica), extending the spine may help reduce the leg pain by "centralizing" the pain (moving the pain from the leg to the lower back). For most people, back pain is usually more tolerable than leg pain. Sometimes, based on the structured evaluation, flexion exercises are appropriate.

Lumbar stabilization exercises focus on finding the patient's "neutral" spine, or the position that allows the patient to feel most comfortable. The back muscles are then exercised to teach the spine how to stay in this position. Performed on an ongoing basis, these exercises can help keep the back strong and well positioned. Special attention is paid to the extensor muscles of the lower back with resistance exercises.

Additionally, a strengthening program that involves progressive loading and unloading of the lumbar spine by means of flexion/extension exercises can reduce pain and increase the perception of improved back strength. This training, called facilitation, is best accomplished when the muscles to be facilitated are isolated in some way so that other muscles cannot take over the job. Often specific equipment is required to achieve that goal.

Low-impact aerobic conditioning

Finally, conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to gradually lose their ability to perform everyday activities.

Examples of low impact aerobic exercises that many people with back pain can tolerate include:
Stationary biking. Riding a stationary bicycle provides aerobic conditioning with minimal impact on the spine. This is also a good exercise option for people who are more comfortable positioned leaning forward.

• Walking. Many people think that walking as part of their daily routine (e.g. at work or while shopping) is enough. However, this stop-and-start type of walking is not adequate for aerobic conditioning. Instead, continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.
• Water therapy (also called pool therapy or hydrotherapy). For people with a great deal of pain, water therapy provides a gentle form of conditioning as the water alleviates gravity and provides buoyancy as well as mild resistance.

Depending on your injury and exercise preferences, you may prefer a different form of exercise. It may be helpful to discuss your options with your chiropractor or physical therapist to identify an appropriate form of aerobic exercise for you and incorporate it into your exercise routine.

Guidelines for successful recovery

In addition to stretching, strengthening and aerobic exercises, there are several basic guidelines that can help you in your healing and rehabilitation process. These guidelines include:

Manage anxiety

Controlling anxiety and fear of re-injury is very important to regain normal muscle function. The basis for these psychological reactions to low back pain lies in the central nervous system, which responds to pain by instructing the muscles near the affected part to protect against further injury. Only appropriate physical training that specifically tells the muscles to improve their function can overcome this neurological barrier to normal muscle function.

Eat properly

The healing process can be aided with appropriate nutrition, which includes adequate calorie intake in a balanced manner. If all calories consumed are in the form of sugars (such as breads, pasta, and sweets), any calories not immediately needed for energy are converted into fat. You don't need extra weight while you are in the healing process. Your diet should include adequate protein as a source of the building blocks of soft tissue healing. Additionally, fresh fruit and vegetables supply the vitamins and trace elements necessary for effective healing. A vitamin supplement may also be helpful.

Get adequate sleep

One of the best ways to encourage sleep is to induce physical weariness through active exercise. Chronic inactivity does not create a need for the deep sleep that is so helpful for physical and emotional healing. Clearly, stimulants such as caffeine or nicotine should be avoided at bedtime. Smoking should also be avoided because it diminishes the available blood supply and makes the nervous system more sensitive.

Control medication use

While medications are often important for pain relief, one should also be careful about the use of medications. Dr. Serné recommends natural forms of anti-inflammatories, muscle relaxants, and other tissue healing alternatives. The use of heat or cold, or liniment or massage, as a mechanism for pain control is a very safe and positive alternative for pain management.

Exercise properly

Exercise in a controlled, gradual, and progressive manner is the only way we can tell our body to heal. Injections and medications can provide pain relief but cannot stimulate the healing process. If a pain problem has persisted for many weeks, the body is demonstrating that there are barriers to the healing process that need to be eliminated. The natural stimulus for the healing process is active exercise. Active exercise means we use our nervous system to tell the muscles what to do, and includes dedication to an appropriate, comprehensive exercise and rehabilitation program.

Finally, an important guideline is to seek the assistance of an appropriately trained and licensed health professional for your rehabilitation. Likewise, it’s always important to see the Chiropractor if your lower back pain lasts for more than a few days or if you have any symptoms that cause you concern, as the continued pain and/or symptoms may signify a serious medical condition.
Ultimately, participating in developing and maintaining an active rehabilitation program for back pain should help you heal faster and have fewer recurrences of pain. Should you wish to book an appointment with Dr. Serné, please contact the office @ 604.687.7678 (604.68.SPORT)

Fibromyalgia and Chronic Fatigue Syndrome (CFS) are thought by many to be separate manifestations of the same disorder, the main difference being the major symptom associated with each of the disorders.

Fibromyalgia is a chronic disorder in which the sufferer complains of severe pain throughout their body. This pain can affect the muscles, joints and soft tissues i.e. tendons and ligaments, to the extent that any movement is a struggle. This particular disorder affects the female gender in 90% of cases and is commonly diagnosed between the ages of 25 and 40 although the symptoms can begin to show at any age. Other symptoms that are used to diagnose fibromyalgia include:

• Tenderness in 11 of the 18 pre-determined sensitive spots of the body
• Chronic fatigue
• Sleep disorders
• Headaches
• Stiffnes of the joints

Many individuals diagnosed with the condition suffer with all or the vast majority of these symptoms however because fibromyalgia is a relatively new disorder many physicians mistake it for other, more common disorders. One such disorder is CFS.

CFS is another life long illness that is characterized by the above symptoms however in this case the major diagnostic symptom is fatigue, as apposed to widespread pain. The fatigue associated with the condition is often debilitating and is described by many as like ‘having concrete arms and legs’. Muscle and joint pain is also common in CFS and so it is understandable that many experts get the two disorders confused.

The cause of fibromyalgia and CFS is still unknown although many research papers commonly refer to four possible aetiologies:

• Toxicity – due to long term exposure to chemicals, pesticides, insecticides, etc.
• Traumatic experiences and life long stress, possibly from a pre-existing medical condition or illness.
• Genetic susceptibility.
• Immunological breakdown – due to prior bacterial or viral infection.

Whatever the underlying causes of the two disorders they are both as yet incurable and so treatment and management of the symptoms is seen as the key to relief. Surprisingly exercise has been found to be very beneficial with regards to reducing the pain and fatigue associated with fibromyalgia and CFS and so a regular exercise regimen needs to be tailored to each individual sufferers needs.

Precautions, limitations and dangers

As with any exercise plan, an exercise plan for people diagnosed with fibromyalgia or CFS needs tocater for the individual’s level of fitness, mobility and experience. Extra precautions need to be taken to allow for the persons disability and so only certain types of exercise should be included. Please consult with Dr. Serné prior to commencing any exercise routine to ensure she has the ability to develop a program that is right for you!

Because many of the joints, muscles, ligaments and tendons will be affected by fibromyalgia and CFS only low impact or non-impact exercise routines should be practiced. This acts to reduce any additional stress that would normally be placed on already tender and painful spots.

Each
case of fibromyalgia is different i.e. one person may only have pain in their leg muscles and joints whereas a second person may have all over pain, and this will inevitably affect the type and intensity of the exercises performed. All people with fibromyalgia or CFS should know their limitations and should thus try to stick to exercises that they know won’t exacerbate their main symptoms.

Over exercising will often cause pain and soreness in even the healthiest of people and so in those already suffering with chronic pain, the intensity can effectively double making any subsequent movements absolute torture. It is important for sufferers of fibromyalgia and CFS to increase their levels of exercise very slowly and only push themselves as far as is comfortable. By overexerting themselves and causing their pain to become more intense, many sufferers of fibromyalgia will enter a period in which they refrain from all activity and effectively become inactive. This then causes de-conditioning and as a consequence, more pain.

Individuals diagnosed with either fibromyalgia or CFS need to break the above cycle by becoming active and keeping their bodies conditioned and strong.

The best types of exercise for fibromyalgia and CFS

Non-impact and low impact aerobic exercise has been found to be very beneficial for sufferers of fibromyalgia and CFS. The cardiovascular training involved with aerobic exercise has been shown to significantly reduce
the degree of pain and stiffness experienced by sufferers.

Light aerobics

For those who can manage it, low impact aerobics sessions, which can include activities such as brisk walking, cycling, using a Stairmaster etc. can be very good for reducing all levels of pain. Aerobic exercise should be performed for around 30 minutes per day, 3-4 time per week for it to have a significant effect however it is very important not to rush into things and stress the muscles and joints unnecessarily.

It is advised that people with fibromyalgia or CFS start with a simple 5 minute walk and build up gradually until they reach the 30 minute target. Pre-exercise stretching is also highly recommended as this helps to make the exercise session more comfortable and reduces the risk of injury. Regular stretching will also help with posture and flexibility while reducing the amount of muscle and joint stiffness experienced during and after the workout.

Aqua aerobics

Water makes the body weightless and so any form of swimming or aerobic activity in water greatly benefits people with painful muscles and joints. This non-impact form of exercise takes all of the strain off the joints meaning that for a time they don’t have to bear the weight of the body. This is perfect for fibromyalgia sufferers with very tender body areas who get excruciating waves of pain with every jolt. It is important however
that the swimming water is warm because cold water can cause the muscles and joints to seize up and become infinitely more painful.

Stretching

Apart from the pre-exercise stretching that will be discussed in more detail as part of the following section; there are a number of exercise forms that involve specific types of stretching.

Stretching, as it relates to physical health and fitness, is the process of placing particular parts of the body into a position that will lengthen the muscles and associated soft tissues. Stretching is a simple and effective activity that helps to enhance athletic performance, decrease the likelihood of injury and minimize muscle and joint soreness.

Stretching can be practiced in the privacy of the home or at the gym where a qualified instructor can demonstrate the correct way to stretch so that the maximum benefit is achieved.

As with most activities there are rules and guidelines to ensure that they are safe. Stretching is no exception. Stretching can be extremely dangerous and harmful if done incorrectly. It is vitally important that the following guidelines be adhered to, both for safety and for maximizing the potential benefits of stretching.

Stretching Guidelines

It is incredibly important to stretch correctly as an incorrect stretch can do more harm than good, especially with regards to a fibromyalgia sufferer. There are five main things to remember when stretching which will help to keep the body in great shape and injury free.

1. Warm up the muscles prior to stretching

Cold muscles can injure very easily and so it is vitally important to warm up the body before strenuous stretching and before an exercise session. Bringing the body’s core temperature up by performing a warm-up will ultimately increase the temperature of the muscles, so making them more supple and loose i.e. in the condition needed to stretch safely.

A warm up will also act to increase the heart rate and therefore the blood flow and nutrients reaching the muscles. As the breathing rate also increases, the amount of essential oxygen reaching the muscles rises dramatically, again creating the perfect internal environment for safe stretching.

A safe warm up for a fibromyalgia or a CFS sufferer might consist of a brisk walk or a short swim. The warm up should not last more than 10 minutes and it shouldn’t be overly strenuous, especially if the individual’s level of fitness is relatively low or severe pain is experienced.

2.Stretch slowly with gentle movements

Slow gentle stretching helps to relax the muscles of the body, which is often highly beneficial to the fibromyalgia sufferer. Jerky movements or over-stretching can lead to increased pain, muscle strain and even muscle tears and so all stretches should be done as if in slow motion and as smoothly as possible.

3. Stretch only as far as is comfortable

Over stretching is one of the major causes of muscle strains and tears and so it is important that individual muscles are only stretched as far as is comfortable. The idea of stretching is to relax the muscles and make the body generally more flexible which, in the case of fibromyalgia and CFS, can reduce the amount of pain felt in specific areas of the body. Over stretching a muscle can cause the tendons and ligaments attached to the muscle to spontaneously contract and this can cause major problems if the stretch is then forced beyond the comfort level. Stretching should never be painful and if it is then it is a sure bet that the muscle concerned is being greatly over stretched.

4. Control of breathing while stretching

It is important to concentrate on breathing while stretching as many individuals have a tendency to hold their breath and often they don’t even realize they are doing it. Unfortunately holding the breath can cause the
muscles to tense up and trying to stretch tensed muscles will, more often than not, lead to injury, especially in fibromyalgia sufferers who already have tense and painful muscles. Holding the breath also limits the amount of oxygen and nutrients reaching the muscles and if this anaerobic state continues for any significant length of time, the muscles will build up lactic acid and become highly painful, which is the opposite of what stretching is supposed to achieve.

5. Stretching correctly

Each stretch should ideally be held for around 30 seconds for the maximum beneficial effect. Anything less than this will not provide a sufficient length of time for the muscle to relax and lengthen. In addition each muscle group needs to be stretched two or three times in rotation and this is considered the bare minimum. Fibromyalgia sufferers may initially have trouble stretching to this extent and so should only stretch until they begin to feel uncomfortable. Any form of stretching is better than no stretching at all and so even a few minutes is worth doing.

People diagnosed with fibromyalgia or CFS will benefit from stretching on a daily basis but it is vitally important that they don’t overexert themselves on a particular day as the following day may be more painful than the person can bare, in which case the beneficial cycle will be broken i.e. the pain causes inactivity which continues for a number of days or even weeks and this eventually causes even more
pain.

Chiropractic Treatments

Chiropractic
treatments are often very effective in aiding with the discomfort that is often associated with fibromyalgia and CFS. However, the technique used is very different than the traditional high velocity manual adjustments. Mobilizations, Thompson technique and Activator technique have been widely used in patients suffering from fibromyalgia and CFS.

Should you wish to book an appointment wit Dr. Serné, please contact Vitality Clinic at 604.687.7678 or reception@vitalityclinic.ca

Chiropractic & Increased Immunity

Chiropractic is about encouraging patients to maintain a state of well being, an increased quality of life, and the prevention of disease and symptoms. Recent research (see the article that follows) and case history analysis suggests that vertebral manipulation may have wide-ranging effects. Chiropractic treatments have been found to improve physical symptoms (i.e. numbness, tingling, and pain) and promote stimulation of immune system components. In addition, chiropractic encourages generalized health maintenance through nutritional guidance, stress reduction, and exercise. As a holistic health-care practitioner, one can ascertain that a primary focus of chiropractic is the maintenance of good health through educating the patient towards an immunopositive lifestyle and the removal of nervous system interference. This is the tip of what regular chiropractic treatments can offer.

Even though you may not feel sick, your body may be acquiring misalignments of the spine (subluxations) that are interfering with your nervous system and thus your immune system. Regular chiropractic check-ups can help you to maintain a healthy immune system and stave off illnesses or allergies. A chiropractic adjustment will restore the balance of your nervous system and restore the flow of energy and information throughout the body. Think of your immune system much like a garden. If your nerves represent the hose that supplies water to the garden (your immune system) one can appreciate that if you have a kink in the hose, the water will not be able to easily reach the garden and allow it to thrive. Regular chiropractic adjustments will maintain the steady flow of water to the garden, ensuring that just the right amount of water gets to the garden at the right time.

The immune system is actually composed of a number of different systems including a variety circulating cells such as neutrophils, lymphocytes, macrophages, eosinophils and basophils, hormonal factors, a number of various immunoglobulin (antibody) factors, etc, etc. The immune system is involved in protecting us from viruses, bacteria, parasites and toxins. Allergies are often the result of immune system imbalances. The immune system also protects us from cancer. When the immune system goes haywire it can lead to problems in literally any part of the body. The immune system can even attack our own tissues causing diseases like hypothyroidism, multiple sclerosis and rheumatoid arthritis.

One of the most important studies showing the positive effect chiropractic care can have on the immune system and general health was performed by Ronald Pero, Ph.D., Chief of cancer prevention research at New York's Preventive Medicine Institute and professor of medicine at New York University. Dr. Pero measured the immune systems of people under chiropractic care as compared to those in the general population and those with cancer and other serious diseases. In his initial three-year study of 107 individuals who had been under chiropractic care for five years or more, the chiropractic patients were found to have a 200% greater immune competence than people who had not received chiropractic care, and 400% greater immune competence than people with cancer and other serious diseases. The immune system superiority of those under chiropractic care did not diminish with age. Dr. Pero said, “I have never seen a group other than this chiropractic group to experience a 200% increase over the normal patients. This is why it is so dramatically important. We have never seen such a positive improvement in a group.

Specifically, the study demonstrated that the “phagocytic respiratory burst of polymorphonuclear neutrophils (PMN) and monocytes were enhanced in people that had been adjusted by chiropractors.” In other words, the cells that act like Pac-Man™ eating and destroying viruses, bacteria, parasites and cancer cells are anywhere from 2 to 4 times more active in people who get regular chiropractic care. Pero concluded that “chiropractic may optimize whatever genetic abilities you have” so that you can fully resist serious disease. “I’m very excited to see that without chemical inter­vention...this particular group of patients under chiropractic care did show a very improved response,” he told CBSRF. “These changes occur from chiropractic treatment.” Source of Pero study: www.planetc1.com/search/boosting-your-immunity-through-chiropractic.html?

So are you and your children benefiting from regular chiropractic wellness care - even when feeling symptom free?

 
Glossary of terms:

Hard tissue manipulation– manipulation of bone and/or cartilage, including joints

High velocity thrust– manual manipulation that involves movement of the selected joint to its end range of voluntary motion, followed by a quick manual thrust

Interferential therapy– a form of electronic stimulation

Ischemic compression (Travell-Simons trigger point therapy)– a technique in which progressively strong pressure is applied to a pressure point, trigger point, or tight muscle

Joint mobilization– slower or gentler manual techniques in which the joint remains within its passive range of movement.

Low amplitude thrust– amplitude refers to the depth of, or distance traveled by, the practitioner's thrust. Most adjustment/manipulation is of low amplitude, minimizing total force applied to the patient.

Manipulation–manual techniques that move a joint beyond the end point of its passive range of motion.

Soft tissue manipulation– manual manipulation of muscle, tendon, and ligament.

Spinal manipulation– manipulation of the vertebrae

Subluxation– where alignment, movement integrity, and/or physiologic function are altered although contact between the joint surfaces remains intact.

Thrust– the therapeutic maneuver delivered by the practitioner during high-velocity adjustment and manipulation.

Many individuals develop imbalance and pain as a result of a leg-length discrepancy. If one leg is longer, it is similar to driving around with one car tire bigger than the others. The center of gravity changes as weight is transferred to one side of the body. One shoe heel will usually wear away more than the other. One foot, ankle, knee and hip will be under more stress, and there will eventually be compensatory changes that take place above the pelvis as the balance of the spine is altered. Scoliosis develops with eventual premature joint degeneration on one side of the spine.

The short-leg syndrome has been an enemy to both runners and doctors for many years. Questions such as the following are asked daily: (1) Can it be an aggravation to, or cause of, low back pain in lower extremity problems? (2) Should a lift or orthotic be put in the shoe of the long leg or the short leg? (3) Will I always have to run on beveled road shoulder to have even lengths?

The first thing that should be considered is that there are two types of short-leg syndrome:

1. Anatomical Short Leg. The measurement from the bony protuberance (the greater trochanter) of the hip joint to the lateral ankle measures shorter on one side than the other. This is seen in approximately three percent of all short-leg syndromes.
2. Functional Short Leg. The measurement from the same two points is equal on both sides, but there is still an apparent short leg. With this type an apparent short leg. With this type, there is usually a rotation or displacement of the pelvis on one or both sides. This causes abnormal stress on all muscles, nerves and joints that are involved. The longer a person has this type of short-leg syndrome, the greater the chance for a secondary compensatory problem somewhere else in the body, usually in the upper back, shoulders or neck. Common symptoms here are muscular pains in the involved areas, headaches, numbness and/or tingling in the arms or hands.

There is an easy way to determine which short-leg syndrome you may have. It is known as the Deerfield Test. With the person lying face down, check the length by correcting any pronation or supination of the feet so that the heels are parallel and perpendicular to the plane of the legs. This is easier to visualize with shoes on than with bare feet because the shoe has a flat heel as opposed to the foot's rounded heel.

After noticing which leg is short, flex both knees to 90°. If it is anatomical shortness, the difference in leg length will be identical in positions 1 and 2. If it is a functional shortness, the short leg will either become longer as the other leg or longer when in the flex position. If it is functional shortness, the short leg will be either become as long as the other leg or longer when in the flex position. This is called cross-over. Whichever syndrome one is suffering from, the weight distribution through each leg will be uneven. As a result of the increase in poundage and stress on the body and legs during running, the symptoms will be more pronounced in a runner than a non-runner.

What symptoms should make a person think of short-leg syndrome? First, any symptom that is exaggerated by running, such as low back pain, hip, knee, ankle or foot pain. A tendency to pull repeatedly the same muscle even though you have given it sufficient time to heal is a symptom commonly seen. Also, shin splints and sciatic neuralgia (inflammation of the sciatic nerve that produces pain in the buttocks and down the back of the leg) are very common symptoms.

How does a functional leg-length difference develop? Over a number of years, one side of the spine may develop stronger than the other. Sleeping on one side; carrying items on one side; running clockwise on a track; using the phone on one side; facing traffic when you run; lifting suitcases; carrying kids; acquiring injuries when as a child, or even forceps delivery at birth, for example, can result in a functional imbalance.

A person with a large difference in leg length often first notices something peculiar in photographs of himself or herself. One shoulder is a bit higher, and the head is always tilted a tiny bit to the side of the high shoulder. Sometimes the person that hems pants is the first one to notice the leg-length discrepancy. Many runners with leg-length discrepancy tell us that when they run, they feel one foot impact the pavement more than the other. Some runners state that they feel a bit “lopsided” when running, and as noted earlier, one heel usually wears away faster than the other. Further, sometimes runners notice the difference when they receive photographs in the mail from the "finish-line" photographers. At the end of a race, fatigue has set in and the true raw structural imbalance can be viewed in its entirety.

After it has been determined which syndrome is evident, a correction can be considered. With an anatomical shortness, correction is made simply by placing a heel lift in the shoe of the short leg. The lift can either be inserted in the shoe itself or constructed onto the inside shoe (or of your orthotic). This can be done by any qualified chiropractor, orthopedist, or podiatrist.

When it comes to a functional shortness, which is more complex, the first thing to consider is the underlying cause of the short leg. A functional leg-length discrepancy is present in three out of five people. The difference may be minimal or very great. If the difference is minimal, there are usually no symptoms from it. Over time, however, a minimal difference always becomes greater. In the runner, there is usually a more rapid change in leg length, as running involves tremendous vertical impact. Gravity eventually wins if nothing is done to combat the imbalance.

Some common causes are: (1) Arches are not the same in both feet. (correction can be aided with the arch supports or orthotics). (2) An abnormal range of motion, in the joints. Each joint, including ankle, knee, hip, and low back, should be put through a full range of motion to ensure normal equal motion. (3) A weakness of one or more lower extremity muscles, which allows the pelvis to rotate either anteriorly (forward) or posteriorly (backward) in relationship to the other side. (4) Bad habits, such as poor posture, slouching in chairs, crossing legs while sitting, standing with all your weight on one leg, always running on the same side of a beveled roads or insufficient stretching. (5) Poor quality running shoes.

Correction of functional shortness involves a number of factors. First, correction of any structural faults has to be made to allow for normal weight distribution and normal functioning of the joints and muscle involved. This is done by correcting any muscular imbalances (right vs. left and front vs. back) that become apparent after a through kinesiological examination by a qualified chiropractor. After correction of the muscular imbalances, manipulation of the involved joints is performed to correct any structural imbalances. This allows all joints to functional under a proportionate weight distribution. Second, a visual observation of the patient running is a must to determine if there are any abnormalities in the gait or stride, such as one arm held close to the body in its correct motion. All muscles being balanced and working equally on both sides of the body allows for maximum efficiency of oxygen usage. Third, correction of the short-leg syndrome must be made in order to prevent any undue stress.

The body is the most amazing piece of machinery imaginable. With a little care and understanding of its normal function, and with proper balance and alignment, it will give you many more quality miles on the road, with much less chance of injury.

In my clinic, during the patient's first visit, we examine and determine the amount of leg-length difference, then treat it and develop specific exercises to correct the condition. In four weeks, we re-examine to determine what changes have occurred. If the patient is under 25 years of age, the change is very rapid, and usually improves by 50 percent at the end of the first month. If the patient is between 25-40 years of age, there is usually a moderate rate of change. If the patient is over 40 years of age, the change is the slowest and a 20 percent improvement per month in leg-length discrepancy is common.

The best time to check for a leg-length difference is when a child is in elementary school. Examination by a sports injury chiropractor is recommended. We have had many children referred to us by parents after they have performed a basic scoliosis check on a child and found that a problem existed.

When you are having discomfort in the neck, upper back, head, and/or shoulders, ordinary activities which you have taken for granted become a source of irritation. Therefore, it is important for you to be aware of the basic principles of good care.

General Advice:

1. Balance activities with rest. Change positions and take short rest periods often. Slowly increase activities over a period of time.
2. Use ice or contrast treatments to help alleviate muscle tension and increase circulation. Moist heat applied to the muscle is the next best alternative for non-acute problems.

Sleeping:

1. Avoid sleeping on stomach
2. When sleeping on back:
1. Use a Therapeutic© pillow or towel roll under neck
2. Elevate legs by placing one pillow under the knees.
3. Try to quiet the mind; when our minds are active, so are our muscles. Focus on deep breathing.

Most non-traumatic conditions that produce neck pain can be managed by chiropractors, with physical therapy to augment rehabilitation.  One key role the chiropractor can often play is to reassure the patient that the injury is not serious.  After that, the goal of immediate treatment is to minimize pain and inflammation with recommendations of natural anti-inflammatory supplements, application of TENS, icing, and in some cases immediate manipulation.  The chiropractor will perform an examination to determine if manipulation is clinically warranted at the onset of treatment.  Rehabilitation to recover lost function should address the entire kinetic chain and include an aerobic component.  Return to play must be gradual.  Some injured or aging patients may have to cut back on activity or cross-train to maintain an active lifestyle.

The primary care practitioner must have a rational approach to non-traumatic neck and associated upper-limb pain during all phases of rehabilitation management: acute, recovery, and maintenance.  Early pain control combined with appropriate rehabilitation techniques and followed by a gradual return to activity is the key in safely putting patients where they want to be: back in action. 

Immediate Treatment

General guidelines.  A specific diagnosis of non-traumatic neck pain is sometimes difficult to make, especially if the pain is localized.  Therefore, the chiropractor’s key role can be in assuring the athlete that the problem is not serious.  If the patient has normal strength and reflexes and a history consistent with mechanical pain, he or she can be told with confidence that no significant herniated disk or nerve injury exists, and that resolution or control of symptoms is expected without surgery or other invasive techniques.  Even in the setting of a herniated intervertebral disk with radiculopathy, aggressive conservative care frequently prevents the need for surgical intervention (5).

The shoulder is one of the most commonly injured joints in the body.

Four bones involved:

• humerus,
• scapula,
• clavicle,
• and first rib.

“SITS” muscles (rotator cuff): supraspinatus, infraspinatus, teres minor, and subscapularis The subacromial space contains the tendons of the rotator cuff and biceps and the subacromial bursa.

The coracoacromial arch creates a functional space that is occupied by the tendons of the rotator cuff, biceps, and subdeltoid bursa. Impingement is increased by internal rotation of the humerus, which jams the greater tuberosity under the coracoacromial arch.

Range of Motion

Capsular Pattern- lateral rotation, ABD, medial rotation

• Flexion: 160°- 180° Extension: 50-60°
• Medial rotation: 60-100°
• Lateral Rotation: 80-90°
• Adduction (ADD): 50-75°
• Abduction (ABD): 160- 180° Muscles
• Abduction: supraspinatus (0-35°) and deltoids.

Adduction: pectoralis major, latisimus dorsi, and both teres minor and major. Lateral (external) rotation: infraspinatus and teres minor.

Medial (internal) rotation: subscapularis, pectoralis major, lats, and teres major Resisted forward flexion: ant.

Deltoid, pectoralis major, and coracobrachialis

Resisted extension: posterior deltoid, lats, and pectoralis major.

Stabilizer: serratus anterior; most important stabilizer of the of the shoulder complex Ligaments The glenoid labrum is a fibrocartilagenous ring that attaches to the outer margin of the glenoid fossa; it helps to deepen the socket.

Spina bifida occulta is common. A recent study of the available literature suggests that the most accurate estimate is that 5-10% of people whose spines have been examined have spina bifida occulta. Even though these people have a very slightly increased chance of a slipped disc, very few people with spina bifida occulta will ever have any problems because of it. If a person has no symptoms from spina bifida occulta as a child, then it is unlikely that they will have any as an adult. Most people will not even be aware that they have spina bifida occulta unless it shows up on an X-ray, for which they have for some unrelated reason. For the majority of people with spina bifida occulta, it is a minor fault involving one vertebra in the lower back. The unfortunate use of this term for such a minor fault can lead to distress for the person concerned.

However, it should be considered as insignificant, both for that person and his or her children. It must be emphasized that, for the vast majority of those affected, having spina bifida occulta is of no consequence whatsoever. Often people only become aware that they have spina bifida occulta after having a back x-ray for an unrelated problem. However, for a few (about 1 in 1,000) there can be associated problems. For people with spina bifida occulta, there may be associated difficulties which may include: leg length inequality, gait abnormalities, foot deformity, back pain, weakness and reduced sensation of the legs, change in hand function, bladder infections and incontinence and bowel problems. These problems arise because the spinal cord becomes tethered to the backbone.

Often a child who is previously symptomless may experience difficulties during the rapid growth of adolescence. This is due to the nerves of the spinal cord being overstretched and therefore, the symptoms may become progressively worse.

Approximately eighty percent of people will have low back pain at some point in their lives. The good news is that very few people who feel pain in their low back have a serious medical problem that requires surgery. Ironically, the severity of the pain is often unrelated to the extent of physical damage. Muscle spasm from a simple back strain can cause excruciating back pain that can make it difficult to walk or even stand, whereas a large herniated disc or completely degenerated disc can be completely painless. Most low back pain symptoms will get better with time (anywhere from 2 - 12 weeks) and non-surgical care. There is usually no single identifiable cause for an episode of back pain. Most back pain comes from the soft tissues of the spine (ligaments, muscles and joints.) One of the most common factors in back pain is that your spine is out of align causing excess fatigue to your joints, muscles and connective tissue. This can be triggered by prolonged sitting or standing in a poor position, or prolonged bending. The problem can also be made worse by heavy or repetitive lifting. Many conditions can cause back and neck pain, ranging from injury to infection to simply twisting the wrong way. An injury sustained in an automobile, skiing, diving or other type of accident may cause damage to bone, muscles, tendons, ligaments, joint capsules, and nerves.

Acute pain in the lower back that does not extend to the leg is most commonly caused by a sprain or muscle tear, usually occurring within 24 hours of heavy lifting or overuse of the back muscles. The pain is usually localized, and there may be muscle spasms or soreness when the doctor touches the area. The patient usually feels better when resting. A strain is the result of a heavy load or sudden force applied to the muscles before they are ready for activity. The muscle essentially rips, along with the blood vessels within the muscle tissue. This may cause bleeding into the injured area. It can take up to two to three hours before sufficient bleeding or irritation sets in to produce significant pain. This can help explain why many people often can tolerate finishing the task at hand, only to suffer from intense pain later. Sprains refer to an overstretching of one or more of the ligaments of the back. The ligaments can be stretched beyond their natural integrity and in some cases can completely tear. It is common to have both ligament sprains and muscle strains occurring together. This is especially the case in severe falls and motor vehicle accidents.

Overview

Your feet are a complex system of 52 bones, 66 joints, 214 ligaments and 38 tendons and muscles, containing 25% of all the bones in your body. In your lifetime your feet will take over 100 million steps, with every step an impact on your body. Abnormal stresses and structural problems in your feet can cause pain throughout your entire body. Whatever the source of your pain – consider the possibility that custom prescribed foot orthotics can help. This is a service Dr. Crysta Serné offers in house.

Orthotics are orthopedic devices designed to treat or adjust various biomechanical foot disorders. They may be simple, commercially made devices, such as cushioned heel cups or insoles for shoes. These are sold over-the-counter in drug stores or other retail establishments. The best orthotics, however, are custom-tailored devices specifically crafted to meet the needs of a particular individual. This is done by making an impression of the foot called a cast. The impressions in the cast duplicate any misalignments in the foot. Specialists in an orthotic laboratory can then correct the misalignments with compensation and stabilization techniques. The finished orthotic is then placed in the patient's shoe and helps keep the foot in proper alignment. Depending upon the patient's needs, the orthotic may have padding to cushion the foot against the weight of the body.

Types of Orthotics

In general, orthotics are grouped into four broad categories.

• Functional orthotics incorporate special wedges to adjust the heel or forefoot, correcting defects in the arch that cause poor shock absorption, such as excessive pronationsupination (an arch that is too high). (flattening of the arch) or


• Weight-dispersive or accommodative orthotics typically feature padding designed to relieve pain caused by excessive pressure on the metatarsal heads. Other accommodative orthotics are designed to treat pain and pressure on the sesamoid bones, collapsed tarsal bones, sores and chronically inflamed toes.


• Supportive orthotics are arch supports usually prescribed to treat problems of the plantar arch.


• Early childhood orthotics are special devices designed to correct biomechanical walking problems identified in young children. They include splints, gait plates and night bars - devices used to hold a child's feet and legs at a proper angle while sleeping, thus promoting corrective adjustment for excessive toe-in or toe-out walking.

Will Orthotics help me?

Because perfect feet are very rare, almost anyone can benefit from orthotics. They can prevent and alleviate many of the common foot complications that cause discomfort in otherwise healthy people. An analogy can be made between orthotics and eyeglasses. Both adjust bodily imperfections that inhibit people from functioning at their maximum physical potential. In both cases, a specially trained Practitioner will do a complete examination and prescribe the proper amount of correction.

Almost anyone can achieve some benefit from an orthotic. There are several common symptoms that may indicate misalignment of the feet. You may be a candidate for orthotics if:

• one side of the sole of your shoe wears out faster than the other;


• you frequently sprain your ankle;


• you have chronic heel, knee or lower back pain;


• your shins hurt;


• your toes are not straight;


• your feet point inward or excessively outward when you walk; or


• your feet hurt in general.

Your feet should not hurt. Pain is the body's way of warning you something is wrong. If you ignore your pain, the condition causing it could become worse. Relief is closer than you think. If you answered yes to any of the above conditions you should be aware that faulty mechanics in the bones of the feet or pelvis may be the cause. Treat the cause & the pain goes away. Treat the symptom and it will just keep coming back.

Indications for Orthotics:

• Improper Biomechanics


• Shock Absorption


• Sports Performance


• Uneven Leg Length


• Matatarsalgia


• Morton's Neuroma


• Arthritis


• Diabetes


• Heel Spurs


• Bunions

How Does an Orthotic Work?

To explain how orthotics function, it is important to understand the mechanics of walking. Each step, the vertical axis of the heel ideally should land almost perpendicular to the ground, with a slight inclination of only a few degrees toward the outside of the heel. From there, the weight is distributed progressively toward the lateral (outside) side of the foot. As the little (or fifth) toe starts to touch the ground, the arch of the foot should flatten slightly, shifting the body's weight toward the medial (inside) side of the foot. The heel then should start to lift off the ground, shifting the weight to the medial forefoot, principally the ball of the foot and the first.

This coordinated motion occurs in much less time that it takes to describe. It is, nevertheless, a complex process in which many things can go wrong. If a structural problem is present, the foot can collapse under the body's weight. Runners in particular exert much greater forces on their feet than those generated by simple walking. This can lead to more severe injuries, such as sprained ankles, shin splints and even fractures.

Over time, stresses on the feet can deform them. One of the foot's main functions is to absorb shock as the body's weight shifts with each step. It does this through a complex process in which the arch of the foot flattens slightly. This absorbs and distributes the weight throughout the entire foot. There are two major problems that can occur in this mechanism.

The first occurs when the arch does not flatten at all. This typically occurs in a person with a high arch, called a cavus foot. Because the arch does not flatten, it absorbs shock poorly. Instead of spreading it throughout the entire foot, the weight of the body falls only on the heel and the bases of the toes. This increases stress on the foot, especially the heel. Furthermore, because the weight is not absorbed well in the foot, it radiates up the leg to other joints. Over time, this can cause pain in the knees, hips and lower back.

To correct this condition, an orthotic is used to bring the ground into even contact with the rest of the foot. This allows the entire foot to support the weight of the body. Extra cushioning can be built into the orthotic so that some of the force does not even reach the foot.

A different problem results if the arch flattens too much. This is known as a planus or flat foot. In such cases, the weight distribution on the foot is too far on the medial side. A flat foot is unstable and cannot maintain a proper arch. Over time, the weight of the body on an unstable foot will cause the bones of the foot to become misaligned. This can lead to the development bunions, hammer toes and other foot deformities, as well as knee and lower back pain.

To address this problem, an orthotic with an increased arch will be prescribed to distribute the weight laterally. Depending on shape of the foot, the heel of the orthotic can be slanted to shift the weight more toward the center of the heel.

How Is an Orthotic Made?

While orthotics can be made by several different processes, Dr Serne prefers to make a biofoam cast of the patient's foot. This is called a negative impression. The cast is sent to a laboratory with a prescription for recommended modifications. At the lab, a positive cast is made by pouring plaster into the negative cast. When this dries, it forms a perfect reproduction of the bottom of the foot. Using the chiropractor's recommendations for corrections, the lab technicians custom-mold an orthotic that incorporates the necessary adjustments. This will provide the patient with the support, stability, cushioning and alignment necessary to keep his or her ankles and lower body comfortable, healthy and pain-free.

Posture is essential to the position of the body in space. Optimal posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity, whether at work or at rest. Correct posture involves the positioning of the joints to provide minimum stress on the joints of the body. Conversely, faulty posture increases stress on the joints. This increased stress can be compensated for by strong muscles, but if they are weak or the joints lack mobility or are too mobile, joint wear and modification can occur. As well, damage and changes to the surrounding tissues can occur. Posture can also involve the chain link concept of body mechanics in which problems anywhere along the body chain can lead to problems above or below that point. For example, knee pain can arise from pelvic joint disorders. Without good posture, your overall health and total efficiency may be compromised. Because the long term effects of poor posture can affect bodily systems (such as digestion, elimination, breathing, muscles, joints, and ligaments), a person who has poor posture may often be tired or unable to work efficiently or move properly. Even for younger people, how you carry yourself when working, relaxing or playing can have big effects. Did you know that just fifteen minutes reading or typing when using inappropriate biomechanics will exhaust the muscles in your neck, shoulders, and upper back?

Causes of Poor Posture

The causes of poor posture can be divided into two categories: positional and structural. Structural causes are basically permanent anatomical deformities not amenable to correction by conservative treatments. Positional causes of poor posture include:

• Poor postural habit for whatever reasons the individual does not maintain a correct posture
• Psychological factors, especially self esteem
• Normal developmental and degenerative processes
• Pain leading to muscle guarding and avoidance postures
• Muscle imbalance, spasm, and contracture
• Respiratory conditions
• General weakness
• Excess weight
• Loss of proprioception - the inability to perceive the position of your body in space

Physiology of Posture

Posture control involves static and phasic reflexes. Static reflexes involve sustained contraction of the musculature while dynamic, short term phasic reflexes involve transient movements. Both types of reflex are integrated at various levels in the central nervous system (CNS) from the spinal cord to the cerebral cortex and are largely affected through extrapyramidal motor pathways. Postural reflex patterns from reflexes, such as the stretch and withdrawal reflexes, result in a coordination of many joint movements and combinations of muscle actions. These include contraction of prime movers, synergists, and stabilizers, along with the necessary relaxation of antagonists. These muscles are regulated for contraction intensity, speed, duration, and sequential changes in activity. The integrative pattern of posture is predominantly automatic and unconscious, resulting from the incessant shifting of weight (postural sway.) Postural corrections are continually mediated by the myotatic stretch reflex. Posture is further mediated by the visual, labyrinthine, neck righting reflexes, and by the interplay of joint reflexes. While the control of posture is primarily controlled by various reflex mechanisms, there is also extensive input from the higher centers of the central nervous. Therefore, posture to some extent can be relearned (corrected) just as it was learned in the first place. What does perfect posture look like?

Normal Posture

Perfect standing posture is when the following are properly aligned:

• The points between your eyes, chin, collarbone, and midpoint between your ankles
• From the side, you can easily see the three natural curves in your back
• From the front, your shoulders, hips, and knees are of equal height
• Your head is held straight, not tilted or turned to one side
• From the back, the spinous processes of your spine should be in straight line down the center of your back

Obviously, no one spends all day in this position. But, if you naturally assume a relaxed standing posture, you will carry yourself in a more balanced position and with less stress in your other activities.

Poor Posture

When you have poor posture, the body’s vertical position is out of alignment and the back’s natural curves become distorted. Head forward or slouched posture:

• Rounded shoulders
• Head forward, rounded upper back
• Arched low back
• Protruding buttocks
• Chest flattens
• Abdominal organs sag, crowding and making more work for your heart and lungs
• Seen often in women who have osteoporosis in later years

Military Posture:

• Head pulled back
• Shoulder blades tightly pulled back
• Arched lower back
• Knees locked (hyperextended)
• Minimizes the spinal column’s ability to be a shock absorber for the body

Slumped sitting posture:

• Upper back humped or too rounded
• Head forward
• Rounded lower back

Tests for Postural Faults

The Wall Test- Stand with the back of your hand touching the wall and your heels six inches from the baseboard. With your buttocks touching the wall, check the distance with your hand between your lower back and the wall, and your neck and the wall. If you can get within an inch or two at the low back and two inches at the neck, you are close to having excellent posture. If not, your posture may need professional attention to restore the normal curves of your spine. The Mirror Test- (Anterior View) Stand facing as full length mirror and check to see if:

1. your shoulders are level
2. your head is straight; no chin deviation; ears are level
3. the spaces between your arms and sides are equally spaced
4. your iliac crests and hips are level
5. kneecaps face straight ahead
6. a 5° foot flare is shown
7. arches are not flat
8. there is no Achilles deviation, and
9. no evidence of scrunching of the toes

Check for the following:

1. head is erect, not slumping forward or backwards; no anterior head carriage
2. chin is parallel to the floor; no hyperlordosis
3. shoulders are in line with the ears, not drooping forward or pulled back,
4. stomach is flat; neutral spine
5. knees are straight, and
6. pelvis is neutral (slight anterior tilt)

Correcting Postural Faults

A patient’s postural faults must be accurately diagnosed before they can be effectively corrected. Examination and diagnosis should include the following:

• observation of the patient as they sit and move about
• measurement or estimation of the deviation from the ideally erect postures using plumb lines, inclinometry, and posture guides
• three dimensional analysis
• spinal segmental alignment
• flexibility tests
• muscle length and strength tests

The importance of muscle testing to postural analysis can not be over-emphasized. Also, much of the specific therapy in posture correction relies on muscle tightness and weakness found during the examination.

Conventional Corrective Therapies

Five main modalities are employed in the conventional treatment of faulty body mechanics and hence postural faults: chiropractic treatments; heat; massage; and stretching and strengthening exercises. Shortened agonist muscles must be stretched before the antagonist muscle can be optimally exercised to increase their strength, or vice versa. Depending on the condition, manipulation may also be required to release and accompanying fixation.

Orthotics

Often postural faults are the result of a leg length discrepancy; either functional or structural (anatomical.) Correction of functional shortness involves a number of factors. First, correction of any structural faults has to be made to allow for the normal weight distribution and normal functioning of the joints and muscles involved. This is done by correcting any muscular imbalances (right vs. left and front vs. back) that become apparent. Adjustments allow all joints to function under a proportionate weight distribution which is essential as they are the holding elements for muscles. Lastly, orthotics are prescribed to maintain any structural discrepancy remaining.

Based on the article written by Dr. Vic Weatherall

To view other great articles written by Dr. Weatherall, please visit his website @ http://www.advancechiro.on.ca.

Neck Pain

Neck pain or related upper-limb pain can be very disabling for active patients young and old. The broad differential includes such conditions as strain, sprain, disk injury, radiculopathy, carpal tunnel syndrome, ulnar neuropathy, and degenerative shoulder disease. Approxiamtely 70% of diagnosis' can be made solely based on history and physical exam findings. It is essential to determine whether the pain is localized or radiating. Localized neck pain generally points to muscle strains, ligament sprains, and degenerative facet or disk processes. Pain that radiates into the upper limbs frequently stems from nerve involvement. Unless significant trauma has occurred, diagnostic images are not warranted unless they are likely to change treatment.

The typical active person takes neck movements for granted until pain limits activity. Fitness clubs and physical therapy facilities are filled with people striving to develop an increased strength and/or flexibility in their upper and lower limbs, as well as in the abdomen. Often the neck is frequently neglected when it comes to preventing and rehabilitating injuries.

The cervical spine is one of the key links in the kinetic chain of physical motion. It controls head movement and, therefore, a person's ability to direct his or her organs of sensation. When bone, muscles, or nerves of the neck region are damaged, activities ranging from sedentary to record-setting are disrupted. The chiropractor, therefore, must have a rational approach to diagnosing patients' common neck and associated upper-limb syndromes so that appropriate treatment can be initiated.

Muscle strains usually resolve within a few days to a couple of weeks, ligament sprains may take up to a couple of months, and disk injuries or herniations with radiculopathy can take up to 6 months for full recovery. Chronic pain beyond 6 months is likely associated with a degenerative process; the intervertebral disk, bone, or ligament, or from subtle mechanical instability caused by faulty posture or biomechanics.