Active Care Rehab, Manual Therapy

Dry Needling

Dry needling is a therapy that uses an acupuncture/filament needle to pierce the body and cause a positive effect on the underlying muscles, tendon, nerves and ligaments. The needle can enter the muscle and yes penetrate to the bone. How deep the needle is inserted depends on what structures we are looking to treat.

Many patients that experience dry needling feel immediate pain relief and others feel an increase in range of motion or that their joints and muscles just work better. The common questions we get are; it going to hurt and why do those needles help me so much? Dry needling can be somewhat painful but the needles are more surprising than anything. Many patients do not realize the needling has been put in or taken out and after the first therapy session most patients do not complain that is hurts.

The needles do many things in the body. Most important they effect the site that we needling, the surrounding nerves to the spinal cord, and the brain. At the site of needling vasodilation occurs which means the blood vessels open and allow increased blood flow to the area. Increased blood flow helps facilitate healing and repair. At the spinal cord chemicals are released that help block pain and pain signals in the surrounding tissues. Lastly, the brain releases endorphins and endorphins are everyone’s best friend. They decrease pain, cause relaxation and produce a full body calming effect.

So, if you suffer from trigger points or knots in muscles or chronic tightness and pain dry needling can help release the knots and calm down your muscles. When muscles are free to contract and relax than your joints will have more movement and less stiffness. Adding dry needling to chiropractic therapy can  help speed recover and PUT YOUR LIFE BACK IN MOTION!

Active Care Rehab

Do you have Bunions?

Bunions have become a normal appearance in many chiropractic and manual therapy offices. This has occurred due to shoe and footwear choices and improper ankle mobility. Surgery is the only option to decrease the size of the bunion, but to stop growth and decrease pain soft tissue work and rehabilitation is your best bet. Strengthening the peroneal muscles can help stabilize the big toe joint and ankle mobility exercises can help decrease the rate growth. Here is an easy way to start stabilizing the toe.

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Setup:

  1. Stand facing a wall using your hands to balance yourself.
  2. Spread your feet apart wider than shoulder width.
  3. Flatten your inner foot and raise your heels off the ground.
  4. Only raise the heels, do not come up on the toes.
  5. Repeat 3 sets of 25.

Notes:

  • This is not a calf exercise, do not perform calf raises.
Active Care Rehab

Knee Pain

Do you have knee pain and do not like to squat? Your problem may not be the knee themselves but who you squat and how you move through the hips. Proper hip posterior/backwards translation can take pressure off the knees and allow you to squat and train your hip and gluts without pain. Try these ball squats and see if your pain while squatting goes away.

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Setup:

  1. Begin by standing feet shoulder width apart just far enough from the wall that the ball is sandwiched between your low back and the wall.
  2. Start your squat by sitting BACK and down.
  3. Go down until your knees reach a 90°, angle being sure that your knees do not extend past your toes.
  4. DO NOT LET YOUR BUTT AND LOW BACK COME OFF THE BALL!!
  5. Return to the standing.
  6. Perform 3 sets of 10 repetitions 2-3 times every day.

 

Progression:

  1. Begin with a band around your knees, standing feet shoulder width apart just far enough from the wall that the ball is sandwiched between your low back and the wall.
  2. Repeat setup above.

 

Notes:

  • You should be able to do 3 sets of 10 of the regular ball squats with little to no fatigue before beginning the advanced ball squats.
  • Make sure you are squatting back and down.
Active Care Rehab

Hallux Limitis

Hallux Limitis literally means limited big to motion. Hallux Limitis is a degenerative or arthritic condition in which the big toe becomes progressively stiffer ad more painful. While motion still exist in the  big toe with Halux Limitis, Hallux Rigidus is an extreme version of  Limitis where little to no motion is present.

Many people have Hallux Limitis and do not realize it. Pain generally does not occur until toe range of motion is less an 35-40 degrees. Hallux Limitis occurs more commonly in runners, especially those whose big toe is longer than their second toe. With this condition a bone spur begins to grow directly on top of the big toe “knuckle.”

Hallux Limitis can cause many biomechanical problems and needs to treated correctly. Techniques like Active Release and Graston can restore motion by 30 degrees and home exercises can help prevent the recurrence of ROM loss. General ankle mobility should be addressed and over-the-counter orthotics can help lessen pain. Click here for ankle mobility exercises.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

IT Band Syndrome

IT-BandIliotibial (IT) Band syndrome or Runner’s Knee frequently occurs in runners, especially those upping their mileage. ITB is described as a burning pain in the outside of the knee and the pain is increased with activity. If left untreated and activity continues pain can begin to move upward from the knee, into the IT Band.

The IT Band is a fibrous, extremely strong structure that begins in the hip as the gluteus medius, maximus and tensor fasciae latae. It travels down the outside of the leg and attaches just below the knee. The pain associated with ITB is due to tension in the band due to the muscle pull in the hip.

Studies have shown that individuals with ITB Syndrome have greater inward rotation at the knee and an increase in hip drop on the side of pain. Lack of hip muscle flexibility can increase the risk for ITB Syndrome by increasing the strain placed on the band. The foot, although commonly ignored, plays a significant role in IT Band pain. Having a high arched or rigid foot has shown to cause ITB Syndrome. This means that the foot and the hip need to be treated for resolution and preventative treatment for IT Band Syndrome.

Click here to see exercises for IT Band Pain.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

Patella Tendinopathy

indexPatella tendinitis or jumper’s knee is more accurately called patella tendinopathy. Tendinitis mean inflammation of the tendon but patella tendinopathy is a degenerative condition of the patella tendon. This condition is described as local tenderness of the patella tendon at the attachment on the patella.

Patella tendon injuries occur more commonly in distance runners, sprinters, and athletes that freqently jump. The increase is knee flexion or bending predispose these individuals to the injury because knee flexion increases the force and stress on the tendon. Excessive quad tightness or dominance may increase the risk for injury as well.

Treatment for patella tendinopathy consist of Active Release and Graston on the quad muscles as well as the tendon to decrease tightness and built up adhesions. These myofascial release techniques also start the rebuilding of the tendon by starting a controlled inflammatory response. Rehab exercises to strengthen and lengthen the  quad muscles help decrease longevity and recurrence of the injury.Interestingly, research has shown that resistance quad strengthening such as knee extension exercises has a negative effect on recovery.

 

Yours in health

 

Dr. Justin Hildebrand

Active Care Rehab

Knee Cap Pain

imagesPatellofermoral Pain Syndrome, also called retropatella pain,  is successfully treated in more than 2/3 of cases with conservative treatments including rehabilitation. The goal of these programs should be to reduce pain and restore function of the foot, knee, and hip. A classic sign of PFPS is pain in the knees while sitting for long periods of time and reduction of pain when standing.

The exact cause of patellafemormal pain syndrome is debated by many different specialists. Many believe that weakness in the VMO or medial/inside quad muscle causes abnormal movement of the knee cap and leads to pain and dysfunction. Exercises to strengthen the VMO are commonly preformed but these exercises only make the underlying dysfunction worse.

Current research shows that the true cause of PFPS is not the abnormal movement of the knee cap but the abnormal movement of the femur under the knee cap. This abnormal movement is caused by weakness in the hip muscles, which allow increased inward movement of the leg. Not only the hip but the foot can increase one’s risk of developing PFPS. Loss of motion of the ankle joint or major excessive pronation or supination of the foot can increase the stress on the knee and lead to pain under the knee cap.
Braces and straps can help decrease symptoms.

For PFPS exercises click here.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

Squat Mechanics

Squat Mechanics

I wanted to share these videos on proper squat mechanics and how you should squat. Key points are proper ankle motion and hip motion. If you can not properly move through the ankle and hips your squat will suffer, actual your knees will suffer. See my article on posterior hip motion and exercises here. Also, need ankle more ankle motion these exercises can help.

Active Care Rehab

5 Injury Prevention Exercises

5 Injury Prevention Exercises

I wanted to share these 5 injury prevention exercises by real simply. These exercises cover shoulder blade stability, low back strength, core stability and correct movement of the hips and shoulders. For other articles on injury prevention see: Ankle, Low Back, and Desk Worker.

Active Care Rehab

To Barefoot Run or Not

barefoot 1Barefoot running has become popular and does have advantages. But does this mean that you should ditch your shoes and hit the pavement with no protection. To answer these we must look at the pros and cons of barefoot running.

Barefoot running, unlike exercising in shoes, allows your foot muscles to do their jobs. Your intrinsic or deep foot muscles are supposed to help stabilize the foot while allowing them to form to the terrain around you. These muscles are traditionally weak or overused due to today’s footwear. High heels or raised heels can shorten the foot causing the foot muscles to tighten along with the joints. Wearing the wrong shoe, motion control or minimalist when not needed, can weaken the foot muscles.

Barefoot running encourages forefoot striking instead of heel striking. Forefoot striking is a more natural running form and is more efficient, so less energy is used. Any runner, beginning or advanced, understands that running efficiently is very important. Although, forefoot striking is natural, those accustomed to heel striking or rearfoot running experience an increase in Achilles tendon injuries when running barefoot.

Barefoot running leaves your feet open to the terrain. This exposes the runner to higher risk of puncture wounds, infection and other potential injuries. Having a clean field, trail, track or sidewalk is not an easy thing to find. Most running tails contain rocks and other dangerous obstacles that can cause serious injury to an unprotected foot.

Barefoot running depletes the fat pads located in the heels. Studies have shown that running barefoot or in minimalist shoes causes the depletion of the protective fat pads located in the heels. This syndrome is also common in the over weight individual. Decreasing the fat pad can cause irritation to the heel bone and nerves causing pain and symptoms mimicking plantar fasciitis. Heel cups like, Tuli’s Classic Gel Heel Cups, Regular (Under 175lbs), can help if this issue develops.

Barefoot running can be beneficial if done correctly and your foot is prepared. I advise my athletes to start by walking around the house barefoot or in a minimalist shoe and than start walking in a safe area outside. While in the beginning phases of walking barefoot, rehabbing the foot muscle should be a priority. Click here for exercises. Strengthening insoles can  be helpful as well. After walking and rehab, one can transition to light running and work up to 3 miles in barefoot or minimalist.

Yours in health,

Dr. Justin Hildebrand