Active Care Rehab

Cervical Disc and Neck Pain

This week we are going to discuss the cervical (neck) disc herniations. The cervical spine or neck consists of seven vertebrae and five disc which allow the spine to be flexible.

http://livefit.net.au/tag/c7/
http://livefit.net.au/tag/c7/

When the discs (much like the Lumbar Spine) become irritated they can begin to migrate posterior or backwards and cause pain. When the disc migrates it can become a bulge or herniation.

A herniated disc usually is caused by wear and tear of the disc. Today, we speed this process up due to postures such as rolled shoulders and forward head posture. These positions place a large load on the lower neck and place the disc under increased pressure.  Herniated discs are much more common in people who smoke, Cervical or Lumbar.

Herniated discs in the neck can cause pain, numbness, or weakness in the neck, shoulders, chest, arms, and hands. Early signs are pain in the neck, shoulder and shoulder blade. It is often described as sharp, deep pain that massage can not get to. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don’t need surgery to correct the problem. According to Mayo Clinic, 90% of disc injuries resolve with conservative treatment.

Conservative Treatment for cervical disc injury or irritation consists of a combination of corrective exercise, posture restoration, and myofascial release. Releasing the tissues in the neck with Active Release or Graston can take strain off of the disc and allow the rehab exercises to be more effective. Since a disc injury involves inflammation, anti-inflammatory nutrition may help reduce the pain while undergoing treatment. Cervical Neck Traction and Treat Your Own Neck 5th Ed (803-5) can be helpful as well.

Classic Seated Posture
Classic Seated Posture

Forward head posture (FHP) has almost become the norm in society today. This occurs when sitting with poor posture for long periods of time. FHP leads to a reduction in the normal curve of the neck and muscle imbalance. When these changes occur the posture is visible when standing or walking as well.

When the normal curve of the neck straightens, the upper back compensates by rounding and becoming stiff. This places increased stress and load on the lower cervical spine. The disc and ligaments can become overworked and leads to pain. Increased stress on these ligaments and disc can start to weaken their collagen fibers and allow the posterior or backwards migration of the disc material.

When the head protrudes forward the muscles in the back of the neck become tight and when this condition is chronic scar tissue can develop. The muscles in the front become stretched and start to weaken. This is why most individuals with FHP can not touch their chin to their chest. So if you are dealing with disc-like symptoms or FHP the exercises here may be beneficial to you.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab, Manual Therapy

Shoulder Impingement and Rolled Shoulders

shoulder_impingement_intro01The shoulder joint consist of the shoulder blade, the humerus, and many muscles and ligaments. The key muscles are the rotator cuff (supraspinatous, infraspinatus, subscapularis, and teres minor), scapula stabilizers (serratus anterior and low-mid traps), and the pec muscles. When these muscles become imbalanced limitations and injury can persist.

Shoulder pain occurs in nearly ¼ of the general population and shoulder impingement is the most prevalent diagnosis in these cases. Shoulder impingement is also called supraspinatus syndrome, swimmer’s shoulder, and thrower’s shoulder and occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the joint. The rotator cuff muscles become compressed during movement and the body has to adjust to perform movements.

Symptoms of shoulder impingement are pain with raising arm from the side, weakness in lifting the arm, and loss of range of motion in the shoulder joint. This occurs due to incorrect repetitive motion and faulty posture. These faulty movements and postures tend to cause overuse of the pec muscles, levator scapulae, upper trap, and some of the supraspinatus.  At the same time, weakness of the mid and lower trap occurs. These imbalance leads to increased faulty movement patterns of the shoulder and injury occurs.

 (Photo: erikdalton.com)
(Photo: erikdalton.com)

In today’s society, rolled shoulders or forward shoulders are occurring more and more. This occurs due to computer/desk jobs and the fact that we sit for most of our day.

Commonly when the shoulder rolls forward the pec, upper trap and levator scap muscles become overactive. As a result the shoulder blade elevates and the arm rotates inward. This position places the shoulder stabilizers in a long, weak position. When imbalances occur in these muscles stability is lost and the chance of injury greatly increases.

As the imbalances and faulty posture continues, increased stress is placed on the shoulder, especially the supraspinatus. Due to the rolling and shoulder blade position the space the supraspinatus tendon runs through is lost and the tendon becomes impinged. Over time this compression leads to irritation and inflammation and pain follows.

Treatment for shoulder impingement consist of stretching, Active Release and/or Graston, and functional rehabilitation of the shoulder blade stabilizers, thoracic spine, and rotator cuff muscles. So if you are dealing with shoulder pain see this weeks exercises by clicking here.

Yours in Health,

Dr. Justin Hildebrand

Nutrition

Tired of Taking NSAIDS?

http://cutittachiro.com/NSAID.html
http://cutittachiro.com/NSAID.html

The amount of over-the-counter non-steroidal anti-inflammatory drugs and prescribed anti-inflammatory medications taken in the United States is continually increasing every day. So much so that kidney problems have climbed higher due to these drugs. According to uptodate.com “an increased risk of acute kidney injury within 30 days of NSAID initiation was noted” the study also found a correlation between hospitalizations with a diagnosis of acute kidney injury with the initiation of NSAIDS.  What else can you do?

Most people do not realize that many diseases and ailments are caused or promoted by inflammation. Anti-inflammatory nutrition is very effective in decreasing chronic pain. It can be used to help control headaches, neck and back pain, general muscle and joint soreness and conditions such as osteoarthritis, rheumatoid arthritis, acne, syndrome X, diabetes, heart disease, and peripheral vascular disease. For a larger list of inflammatory conditions see www.deflame.com

So what is anti-inflammatory nutrition? Anti-inflammatory nutrition is incorporating foods into ones diet that have anti-inflammatory properties. By adding these foods and limiting inflammatory foods one can decrease the inflammatory process in their body and therefore decreased the aches and pains associated. Yes, the inflammatory process is important in healing but if one is dealing with the conditions or issues above than they are experiencing chronic inflammation.

To incorporate an anti-inflammatory diet one must first know what foods are inflammatory. All grains and grain products, trans fats, soda’s, sugar, and almost all packaged foods. These foods make up the majority of the classic American diet. To decrease inflammation one does not have to cut out all grains but one must ingest more anti-inflammatory food than inflammatory foods. Anti-inflammatory foods are fruits and vegetables, many types of fish, grass fed meats, omega 3s, raw nuts, dark chocolate, and spices such as turmeric, garlic, and ginger. For a larger list of inflammatory and anti-inflammatory foods see www.deflame.com.

One must ask themselves how much inflammation do I want, when planning meals. Instead of spaghetti with meat sauce, you can cook gluten free noodles or spaghetti squash and add sautéed onions, garlic, and sweet peppers to a lean meat sauce. Instead of buying HIGH inflammatory dressings at your local store try making your own with extra virgin olive oil, balsamic vinegar (or lemon juice), mustard if you like, and spices (Greek, Italian, ginger, dill, oregano) to taste. Choose snacks such as fruit smoothies, raw nuts or dark chocolate and skip the soda and have water or green tea. When have a drink choose red wine or gluten free or stout beer.

Breakfast: Try omega-3 eggs with sautéed potatoes and veggies, granola with fruit and yogurt or almond milk.

Lunch/Dinner: Chicken salads with homemade dressing, lean steak with sautéed potatoes, or pizza with gluten free crust, fresh tomatoes and your favorite vegetable toppings.

This type of lifestyle change seems tough at first but there are many anti-inflammatory foods available and many good cook books to help you along your way. For guidlines to start your anti-inflammatory lifestyle click here.

Yours in health,

Dr. Justin Hildebrand

Manual Therapy

What High Heels Do To Your Posture

High heels may be pretty or spectacular to some but let’s look at what they do to your posture. First and the most obvious is that they point the toes causing constant contraction of the calves. This places the plantar fascia in a shortened state and causes the feet to become stiff and tight. Contraction of the calves places strain on the knees and weakens the shin muscles, predisposing one to shin splints.

http://erikdalton.com/media/newsletters-online/high-heels-and-back-pain/
http://erikdalton.com/media/newsletters-online/high-heels-and-back-pain/

Due to the changes in the foot position and tightening of the calves, the hip flexers and quads have to contract to keep the body’s center of gravity neutral. This pulls the lower back into extension or into anterior pelvic tilt, giving the illusion of full rear end.  The new position of the lower back disrupts breathing, tightens the back muscles and weakens the glute muscles, predisposing one to lower back and hip pain.

With the buttocks pushed back and the pelvis tilted forward, the mid back has to round out for balance. The shoulders begin to round with the mid back and the head shifts forward realigning itself over the body. The neck muscles tighten predisposing one to shoulder and neck pain along with headaches.

All of these changes occur due to wearing high heels. The center of gravity is changed completely stressing not just the spine but many of the joints throughout the body. All of this occurs just because you wanted to wear those pretty little heels.

Counteracting the effects of wearing high heels is not as simple as taking them off. The effects they have on the body cause long term changes in posture and center of gravity. We suggest 5 activities to start the counteracting measures necessary for high heel wear.

1. Self Myofascial Release-Foam rolling or using a ball to release your own plantar fascia, calves, hip flexors, and thoracic spine can help lengthen the muscles and mobilize the joints that are most effected.

2. Activate Weakened Muscles-Glute, core and breathing exercises are essential in reversing the compensating factors that occur with high heel wear.

3. Increase Ankle/Foot Mobility-Your feet need to move to function correctly. Increasing mobility will increase the proper function of your feet.

4. Retrain Center of Gravity-Exercises like squats and hip hinging will help push your center of gravity backwards were it belongs.

5. Stop Wearing High Heels-The most important and most logical way to counteract the negative effects of wearing high heels.

See exercises by clicking here to get started.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab, Manual Therapy

The Importance of Hip Mobility: The Posterior Hip

In this weeks post we are going to discuss the importance of the posterior hip and what the lack of movement in the hips does to the body.

http://en.wikipedia.org/wiki/File:Posterior_Hip_Muscles_1.PNG
http://en.wikipedia.org/wiki/File:Posterior_Hip_Muscles_1.PNG

Being able to move through the hips is very important in any athletic movement but also in day to day activities. Every time one goes to sit down, squat, or bend over proper posterior hip movement is crucial and necessary for injury prevention.  Without proper posterior hip movement the lower back and knees are put under tremendous stress and have to work much harder than they should.

The posterior hip is made up of primarily six muscles, a fibrous joint capsule and the hip joint. These muscles help rotate the leg and control pelvic stability. When they have to over-work to control the pelvis they become tight and restrict hip motion. Once motion has become restricted, the hip capsule then begins to shrink further limiting motion. Treatment of the posterior hip is a combination of mobilization, soft tissue techniques such as Active Release Techniques and/or Graston, and home rehab exercises.

Individuals that lack posterior hip mobility and have tight hip external rotators commonly have a posture that is termed “Butt Gripper”.  This is due to the appearance that one is squeezing the buttocks muscles together and the flattening of the low back.

The “Butt Gripper” appears to not have a well-defined back side and is aware that they are not very flexible, especially in the hamstrings and hips. Their lower back will be very flat if not rounded and may have trouble finding pants that fit or stay up on their waist. This individual may be guilty of showing off his “plumber’s crack” when bending over or stumping down.

“Butt Grippers” appear to have very strong back, hip and core muscles, but they actually have very weak core and glut stabilizing muscles. This posture and weakness places them at higher risk for lumbar disc injuries and low back pain. If you or someone you know is a “Butt Gripper” check out the posterior hip exercises by clicking here.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab, Manual Therapy

Are you considering expanding your family?

According to the Baby Center, the most births in the United States are in the months of July, August, and September. This means that planning and discussion is well underway. Mother’s consider finances, work schedules, family life, and much more in decision and plans but they forget about one important thing, Their Bodies. We must consider the whole picture.

Is your body ready for pregnancy? Anywhere from 50%-80% of woman report having low back or pelvic pain during their pregnancy and 68% continue to have pain post pregnancy. Many of these women could have decreased this pain if they would have prepared their bodies pre or during pregnancy.

http://www.medicinenet.com/stages_of_pregnancy_pictures_slideshow/article.htm
http://www.medicinenet.com/stages_of_pregnancy_pictures_slideshow/article.htm

What changes occur in pregnancy that increases your chance of experiencing pain? A women’s body goes through many changes in pregnancy but only a specific few are related to pain. One’s abdominal muscles are stretched to their limit, muscle and ligament strength decreases, joint hypermobility occurs (postural changes), and the pelvic floor becomes strained. If these conditions are thought of pre or in early pregnancy, the pain related to pregnancy could be decreased and post-partum pain may be controlled.

How can I prepare my body? It is important to get your body in shape, this is not a strenuous exercise program but a functional rehab program that is simple and is not time consuming. These types of exercises will help decrease the muscle imbalance and weaknesses that occur during pregnancy. Check out the pregnancy exercises.

Manual therapies such as Active Release and Graston can help remove any adhesions or scar tissue that builds up and aid in pain reduction. If you are interested in learning more about reducing pain during pregnancy contact me and/or find a chiropractor/manual therapist that specializes in pregnancy or rehabilitation. See the pictures below for examples of ART on the pelvic ligaments.

 

ART starting Position

ART Finishing Position

 

Remember it is important to plan ahead but women do not forget about your bodies.

Yours in health,

Dr. Justin Hildebrand