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Ankle Sprains

One of the most common injuries in all of athletics, ankle sprains claim fame in soccer, football, dance, tennis and just about any other sporting event you can think of! If you have been a victim of this not so fun injury, you know just how annoying it can be getting back to your sport pain-free. Before I discuss some of the best, most common treatments for this injury, let’s first look at some of the anatomy and mechanisms behind what occurs in an ankle sprain.

ankle sprainsThere are several classifications of ankle sprains. Inversion, eversion and high ankle sprains are the three common mechanisms for injury and combinations of high ankle sprains with inversion/eversion mechanisms occur as well. As seen in the photos, different ligaments are effected as the direction during injury of the foot and ankle changes. Instead of going into the boring specifics of what structures are effected, I am going to discuss treatment immediately following injury and the weeks following.

When an MLB or NBA player rolls their ankle and has a sprain, most of the time there is an immediate 6 week period on the DL. Depending on the time of the season and the age of player, this time period lengthen or shorten accordingly. The reason I bring this up is because this is always the time line that should be used with young kids who get an injury during their sport. When the body does not go through a full rehab schedule, the likelihood of re-injury goes through the roof! This is because in the last few weeks of return to play, the focus is on proprioceptive work. Proprioception is a fancy term that describes the bodies ability to recognize where each joint, muscle and body part is in space. It allows us to have balance, change direction quickly without injury and properly activate our muscles during various activities. This is the most important step for injury prevention even before an ankle sprain has occurred!

Immediately following an ankle sprain, the athlete should first be examined to determine any instability in the area. By performing several orthopedic exams and stressing the ligaments in different directions, the practitioner would be able to tell if surgery is needed due to an extreme injury. While this is not common, it can occur. The more common, mild sprain is treated the same no matter the direction. Rest. Ice. Compression. Elevation. RICE is an acronym recognized by most sports physicians as one of the best rules of thumb to go by in the first few days following injury. Now, while I think this concept is extremely important, I use the first 2 steps a little differently.

Rest. Pretty easy concept, but one of the most difficult especially for those who love their sport and wish to return as soon as possible. The biggest difference I use with my patients here is the fact that I want them using the ankle, just backing off of their sport. The sooner they are able to return to full weight baring walking, the better. I do not want them baby-ing the injury during walking gait because that will move up the chain and effect other tissues in the hips and lower back. The other thing I have my patients do is keep it moving while they are not doing much. Doing pain-free ankle circles while watching TV or writing the alphabet in the air with their big toe under the desk during class. As we keep motion in the ankle, the inflammation is able to be controlled and blood flow is constantly being pumped to the area without being stagnant for too long.

Ice. The rule with ice and heat is pretty black and white. 48 hours following injury should be ice then after that heat. I do agree with this, but there are other ways to use this that are better for injury. Meaning there should be a little gray area in between the transition when both are used. With ankle sprains, my favorite way to ice the bumpy, odd shaped joint is with an ice bath. Grab a 5 gallon bucket and fill it with some ice and water then put your entire foot in. After a couple minutes has past and the ankle is numb, I will add in writing the alphabet with the ankle or small circles. This keeps the joint moving and is an awesome way to help reduce some of the inflammation. I normally will only tell patients to do this for about 15 minutes a few times per day, but it is the easiest way to effectively get to the entire area. The other good way to ice a difficult area is to put ice in a gallon bag and add some water to the ice. The bag will form better to the ankle and you will notice it is much more effective.

Compression. Elevation. Both of these are used to limit the amount of inflammation to the area. It is why athletes leave their shoe on following an injury and why you see them almost immediately have their foot propped on something. Inflammation is good to a certain extent, but when too much builds in one area, range of motion is limited and pain also begins to occur. I will use compression in something as easy as an ace bandaged for the few days following injury. This will limit the range of motion enough to not aggravate tissues and offer a little more support to the joint. Once the inflammation has been controlled, the compression will be taken off in order to restrengthen the injured muscles. Elevation is also good for an ankle sprain because it assists the flow of blood back to the heart and lymphatic drainage. If at work or school, simply put a chair or stool in front of you to rest your foot on. While at home, simply use a pillow to elevate your foot just above the hip, especially important in bed.

Once pain and swelling is reduced, the next step is getting back all of the range of motion. When an injury occurs in a ligament, new fibers are replaced in a random pattern. This leads to scar tissue and fascial restrictions which may limit range of motion. In the office, I use a few tools plus my hands in order to pin and stretch muscles to reduce some of these restrictions and promote the fibers to run in a smooth, parallel fashion. Many of the exercises used to promote range of motion are also helping to activate some of the fine muscles that were injured during the sprain.

To further promote proper healing, strengthening exercises become extremely important. Many times I will start patients on an easy regimen that can be performed anywhere. Including writing the alphabet with the foot, patient will also be sent home with essentric calf raises, soleus calf raises, foot activation exercises and foot gripping exercises depending on the case.

Simply strengthening muscles however is not prevention enough. As discussed before, one of the most important aspects of treatment following an ankle sprain is the proprioception aspect. With the many joints found in the foot and ankle, balance and feedback allowing the brain to know where each of these joints is in space is extremely important for preventing further injury. Once the first and second stages of recovery are met, many athletes will return to play too early. Many of the exercises used for proprioception retraining are simple and can be implemented for the first few weeks after sport is reintroduced. My favorite is just a simple one legged balance test in a quarter squat or athletic position. Holding this position for 30 seconds to a minute then closing the eyes and repeat a 30 second hold is enough to start with. Then we add in an uneven surface like a towel or wobble board and repeat the same exercise. As we stress balance with both eyes open and eyes closed, the brain is required to retrain the balance receptors in the joint without relying on sight for feedback.

The other awesome exercise for prevention in general that I give to many patients is the star pattern. Standing on 1 foot with equal pressure between the front and back of the foot, reach the other foot as far forward, to the side, in a diagonal to the back then across the front and back of the standing leg creating a star like pattern. This exercise was shown in a video on my Facebook page. This exercise again can be performed eyes open or eyes closed and an uneven surface can also be added to make this more difficult.

These two simple exercises can be the difference between having repeated ankle sprains for life and properly rehabing an original injury to ensure your risk is tremendously reduced. That is a bet I will take any day! Who wants to keep having pain and tweaking your ankle every time you try to return to your sport? I know I definitely do not!

Question? Comments? Want to schedule a consultation? Call the office at 704-845-0777 and ask for Dr. Kylie. I am happy to help and offer free consultations to answer any questions you may have about yourself or your child. These exercises are awesome for prevention for high school and college athletes and I have seen awesome results with them.

Until next week,

-Dr. Kylie

Sciatica? Maybe Not

Dear Dr. Google: I am experiencing a tingling sensation down the back of my leg. What’s wrong with me?

Funny you should ask such a question! Those symptoms sound like Sciatica, a blanket like diagnosis used for any sort of radiating symptoms into the back of the leg by many practitioners in many different professions. Even if the symptoms can be traced in with your finger and start and end no where near the sciatic nerve, it is definitely sciatica. Symptoms traveling all the way down the side of your leg and into the top of the foot? Sciatica. Feeling tingles that start in your buttocks and wrap around to the top of your thigh? Sciatica.

The problem with the term and diagnosis of sciatica is the insane volume in which it is utilized.

Sciatic Nerve

Sciatic Contributions

The sciatic nerve is the largest bundle of nerves in the body. With contributions from the lower lumbar nerve roots and all of the sacral nerve roots, the diameter is often described as the size of your thumb- where as most other nerves are about the size of the wire on your mouse. As everything comes together, the large nerve with pass under the piriformis muscle which is located beneath the large gluteus maximus muscle.

True Sciatica is irritation of the sciatic nerve causes radicular symptoms in the back of the thigh or buttocks. Many times this is caused by tightness in the piriformis or spasm of that muscles. As seen in the photo to the right, however, there are other muscles and tissues that can be involved in irritation to this muscles. Sit on your bum all weekend at a dance recital or on metal bleachers at any of the various sporting activities your child is involved in? As there is increased pressure between the sit bone and this nerve, irritation is very common which will result in inflammation. With decreased space and inflammation around the nerves sheath, radicular symptoms are likely to occur. There is also a large bursa located in the area of this sit bone and if it is irritated, symptoms may mimic those of sciatica. Also, sciatica like symptoms almost never cross the knee and should respond rather quickly once inflammation is decreased.

But….

LumbarSpineAnatomyDiscThe more common diagnosis involved in radicular pain that travels down the leg is actually irritation to a specific nerve root. This can be caused from inflammation around the facet joint or the disc located between each of your vertebra. You can see in the photo, all of these structures are very closely related! If you are experiencing symptoms that you are able to trace with your finger from point A to point B, this is a more likely culprit.

Another thing to consider is when did your symptoms begin? Do you remember one specific movement that you did where immediately after you felt numbness and tingling start in your leg that go progressively worse? Did you sit a lot or have a direct injury to the buttock recently? All of this things will come into play when diagnosing your current symptoms. A good history of everything that you can remember will be of great help with a good practitioner. If you remember reaching down to pick up your purse or even a bag of groceries and feeling a pop in your back and not being able to stand up exactly straight after that, this is most likely the issue!

Nerve root irritation is something that I am very familiar with and have had great success with. Most of the time we are able to give you a take-home exercise that is very simple the first time you come into the office. I like to have patients be part of their care and also be held accountable as they are getting better! Once we get your initial symptoms under control, areas of spinal fixation are decreased and we begin to equal out some muscular imbalances. Specific strengthening exercises will be what prevents this from happening again. Starting at a lower level and working up to more difficult exercises, you will start to have better overall control of your core and will see that you have better stability in your lower back. Stability is our end goal once we have decreased your pain.

Did Dr. Google diagnose you with sciatica? Come in for a free consultation with me, Dr. Kylie and see if there is more to the story. I utilize a very in-depth, functional examination to get to the root of your problem. Treatments with get you, the patient involved as we start to retrain function and get you exceeding your health goals!

Until next week,

-Dr. Kylie

Healthy Mind-Healthy Life

positive thinking funny

The power of positive thinking has long been researched. One thing to keep in mind is that power from a healthcare stand point.

A major factor in patients feeling better and actually getting better has to do with the thoughts going on between the ears. When individuals come in who have been told they have degenerative disc disease or a disc bulge in their neck, many times they will own the diagnosis. “Well I don’t know how well I am going to respond because I have this.

If you are going to a good, research based chiropractor, they will know where to go next. Many times in the office, I will receive some push back from patient’s who have first seen their primary care provider several times and had several studies done when I start to explain my approach to care. They may say, “Well I tried all of this stuff and nothing worked” or “They have done every test in the book and told me there is nothing wrong with me.”  The trouble with this is that people feel as though their symptoms are being dismissed. Like everything is in their heads. We are not supposed to just deal with pain and learn to live with certain symptoms because “that’s just the way it is.”

It is human nature to crave validation of our feelings and to be touched. Research has shown that many who visit a chiropractors office after seeing their primary care provider are shocked by the extent of the examination. Some will say, “Wow, no one has ever actually touched me where I hurt. I just tell them what is going on and they give me a pill or set of exercises to do at home.”  Masking symptoms and not getting to the root cause of their pain or discomfort.

Another problem is the lack of patient education. A doctors office is a vary intimidating place for many. This creates an environment where questions are not answered because they were never asked. When reviewing exam findings, patients may leave even more confused than they were when walking into the office; resorting to Dr. Google or Web MD for all the answers. As information is becoming more readily available, it is becoming more difficult to weed out the good sources from the bad sources. Bad press from good press. Just as in politics, every opinion or article you read should be taken with a grain of salt and an open mind.

Here at the office, patients must first believe that my process is different and that I can and will help them. Until they buy in, results won’t be seen. Adjustments can only help to a certain extent. Many patient specific take home exercises are given with the expectation they will be done. Putting patients in charge of their care is a powerful thing.

If I ask how their exercises have been going, I can usually tell right away if they have been doing them or not. Patient also get super proud when they come back into the office having done their exercises and are happy to report they really feel like they are helping. Once they have bought the process and understand I am doing everything I can to make them better, the positive energy begins to flow and healing begins to show.

We have also tried to create a very warm and welcoming environment in the office. If you are excited to visit your chiropractor because you know you will be leaving feeling better than when you walked in, that positive thinking helps speed the healing process as well.

Stress, both physical and emotion, plays a large role as well. As a society, we work long hours and have to juggle many things throughout the day. From kids to bills and student loans to lunch meetings, we have a lot on our plates. Americans reportedly work longer work weeks, take less vacation time and feel overall more stressed than some other large countries. They aren’t missing work or taking vacations because they want to look good for their boss or don’t want to miss out on an opportunity for promotion.

This creates a negative energy which can present itself in many different ways. Chronic pain and tight muscles is one of the biggest side effects seen in patients. Getting a proper assessment and finding a way to bring some positive thoughts into your life, you will begin to help others decrease negative thoughts which will only further improve your life.

positivity

 

Think happy, be happy.

Be happy, act happy.

Act happy, spread happy.

-Dr. Kylie

The Truth About Gluten

gluten epidemicProblems with gluten are becoming an epidemic. With the most recent research showing that consumption of gluten and its closely related compounds can cause innumerable disease processes, there is a lot that is still not understood by both the general public and those in the medical field. Many people have heard of a gluten sensitivity or know someone who suffers from Celiac disease, but this issue reaches much further.

Gluten gets its origin from the Latin word for “glue.” Made up of 2 proteins, gluten makes up at least 80% of the protein found in grains. Giving bread dough its elasticity and baked goods a chewiness, the Latin-based term gives a good definition. It is found in numerous grains which includes wheat, rye and barley as well as oats due to the modern processing methods. Small amounts of a similar structure, gliadin, are found in corn products and cornstarch. Many processed foods use gluten as an additive and is becoming a more popular stabilizing agent in numerous personal-care products. Yes- even your shampoo isn’t safe.

We, as humans, have spent the last 2.6 million years eating a specific way and the inclusion of gluten is a very new practice. This protein is very difficult to digest, even when prepared properly, and can complicate your health in a wide spectrum.

Let’s start with fully diagnosed Celiac Disease, which has been shown at a 400% increase in the last 50 years. Your small intestine is lined with villi, which resemble the shag carpeting throughout your house. These finger-like projections increase the total surface area of your small intestine and aid in the proper absorption of nutrients. The diagnosis of Celiac disease is awarded when all of these villi have been completely destroyed. The interesting thing here is that if the villi are only partially warn down, the full diagnosis is not given. Unless you swap your carpet for hardwood floors, you are blind to what is happening in your tummy. Un-diagnosed Celiac is just as potent as the complete atrophy itself. CD is simply a form of gluten sensitivity, both of which result in chronic malabsorption of  nutrients which leads to other disease states and increases the degenerative process.

celiac

So what destroys the villi? If you are genetically predisposed to a gluten sensitivity, when you consume the compound you body crosses over into a heightened state of immunologic response due to the ingested protein. Similar to what occurs when you get a virus, your body is fighting off the foreign body that it does not know how to break down. Both CD and the much more common gluten sensitivity are autoimmune conditions which lead to wide-spread inflammation and effects the entire body, not just the gut.

Gluten sensitive individuals are at a greater risk for heart conditions as well as several cancers. Their bodies essentially cease blood flow to the brains frontal cortex which is used for focus, planning, organization, manage emotions and short-term memories- basically everything that makes you human. Have a child that struggles focusing in school? Due to our changing GI tracts, children are at a much greater risk for developing a sensitivity. There are numerous markers on routine blood tests that might point you to this diagnosis. Sub-clinical anemia, elevated or raised protein levels, raised or elevated levels of HDL, low BUN levels and even chronically elevated liver enzyme levels may point to chronic, full-body inflammation.

Another very important factor in all of this is the presence of morphine-like compounds found in grains called exorphins. These compounds are EXTREMELY addictive in nature. Leaving you craving more of some of the worst foods out there, this is one sign there is a potential gluten sensitivity present. Do you crave pizza in large amounts and want nothing but pastas or breads? You may want to read this twice.

What about my dairy sensitivity?

Funny you should ask! Gluten sensitive individuals are at an increased risk for developing a cross-reaction with several other compounds. This includes casein (milk protein), oats, rye, barley, spelt, kamut, yeast, coffee and milk chocolate. In some cases, once gluten is removed from the diet, a dairy sensitivity is decreased.

I also get a lot of questions about Italian roots. People will say “My ancestors grew up on breads and pastas. How am I supposed to stop eating my cultures foods!?” In this case, you have to look at the difference in the quality of what people were consuming in the past. Many times, these grains were fermented in house and with modern processing methods, gluten is so modified that we are literally not able to recognize the compounds. So if you want to germinate and ferment your own grains and press your pasta yourself, go ahead!

Some underlying symptoms of a possible gluten sensitivity are: headaches, general fatigue, indigestion, feeling overly full after a meal, bloating, pain or symptoms in several parts of the body, mood swings, crankiness or a skin rash/bumps on the arms (very common symptom of an underlying issue in children!).

There are a few things to try if you feel you have a sensitivity. The easiest is to use an elimination diet. Consume no gluten for 2 weeks then reintroduce it. If symptoms get better at the end of the two weeks then return as gluten is re-added, it is most likely you have a sensitivity. The best way to test for this is through Cyrex laboratories. They are the leading in research and have several tests for both gluten and its many cross-reactive compounds. You do require diagnosis from a healthcare provider to be tested through their methods. The good news? I am a Cyrex approved provider and can assist you in getting tested! All that is needed is a 5 mL blood sample which is sent to their lab. Results are then given within 7-10 days and I am able to sit down to discuss what was found.

If you are questioning if you have a sensitivity to gluten or one of its many cross reactors, feel free to schedule a FREE CONSULTATION with myself, Dr. Kylie. We can discuss your symptoms and look into getting a test done if we feel necessary. Most insurance is beginning to cover at least a portion of the cost of the Cyrex Lab test which I am also able to check for you.

If you want to live the healthiest life possible for as long as possible, please consider this article. Much of the information shared has been studied and cited in several articles. My sources for this are The Encyclopedia of Natural Medicine and Primal Body, Primal Mind. Both are very well researched and have a large index for all the research cited throughout the books. Again, any questions, please call and request a consultation.

Stay healthy, stay happy,

-Dr. Kylie

Common CrossFit Injuries

As we finished up last week, I said repetitive injuries are relatively common in the CrossFit athlete. Secondary shoulder impingement following scapular instability is probably the most common thing we see in our office in this population. What does that even mean!? 

Basically, your arm and shoulder blade are held onto your body with small ligaments and muscles. If not trained properly, some of these muscles are not used enough and become weak. This is most commonly seen in the lower part of the trapezius and in the serratus anterior muscles. So your on the bar and kipping away at some pull-ups or toes to bar followed by a snatch or ground to overhead, all movements that require a lot of stability of the shoulder, you will start to get far too much motion to your shoulder. Because you are not recruiting the proper muscles, your body begins to compensate and over-use the upper traps and pecs. Over-time we see a severe roll forward and upward of the shoulders. In someone who sits at a desk all day with this forward posture in their shoulders, this starts to reek havoc.

Myofascial restrictions begin to form in the overactive muscles and the shoulder joint will not be allowed to move properly. The shoulder joint wants to be centralized at all times. When this does not occur, the small muscles that make up the rotator cuff start to rub against the various ligaments and bones that surround the joint.

impingement-syndrome

In the rounded forward posture, the supraspinatus muscle is locked long, meaning it is at its full length and being pulled on all the time. This tiny muscle is responsible for initiating the movement of your arm to the overhead position. When it is locked long, this initiation is not done as efficiently. The muscle is fatigued from being stretched all the time and gets pinched in the fully locked overhead position. In the photo above, the acromion process will be the piece of anatomy putting pressure on this muscle in the overhead position.

Through myofascial release techniques, mobilizations to the shoulder and take home stretches and exercises, this can be treated. Although treatment is not overly fun or easy to handle in the room, fascial restrictions are a very common cause of this and the results are normally seen shortly after beginning treatment. The best way to prevent this injury? Make sure you are doing proper strict pull-ups prior to adding a kip. You should be able to fully engage the shoulder complex in all overhead movements. If you feel overly wobbly as you catch weight in a snatch or during an overhead squat position, scale back to the bar and work from there. Work up to 1 minute holds overhead with your shoulder blades squeezed down and in. Try adding in a bottoms up kettle bell press to your accessory work after workouts.

The next very common complaint we get coming into the office is some sort of mechanical low back pain. This shows up in a number of ways from different movements, but many times after a functional analysis we get to the root cause of the symptoms. Following this years Open, specifically workout 17.4, many people were complaining of low back pain. If you recall, the 13 minute AMRAP started with 55 relatively heavy deadlifts.

deadlift-lower-back

A deadlift is a very feared exercise in the general population, and for good reason! If you do not have good form in this movement, you might have back pain, neck pain, knee pain or hip pain for weeks following. This exercise, however, is one of the best exercises we as a society could be doing to prevent injury in our everyday lives. Since starting at the local gym here in town, this movement is my only complaint.

Within CrossFit, a deadlift is performed for almost every single movement both in the strength portion and in the WOD portion. I have posted a video explaining proper deadlift form to minimize low back injury and it starts with a fill of the belly with air along with a proper hip hinge. Each time you pick up a kettle bell for swings or a wall ball or a bar bell or plate from the ground for any movement, you are performing a deadlift. Ingrain this movement into your brain in order to prevent injury to the back. As soon as you get lazy in the middle of a 20 minute AMRAP and bend over to lift something from the ground or want to hit that 5 pound PR at whatever cost, remember it takes at least 4-6 weeks for a strained muscle to heal.

Finally, I would say knee pain is third on my list of common injuries. This comes in various forms and is can be caused by several mechanisms. If you are having knee pain, I would say the best thing to do immediately is have someone look at it. When there is a minor strain to any of the tissues around the knee, compensation begins to occur. If you continue to go as hard as you can through your daily workout, there is a chance these changes in biomechanics from a minor injury will cause a much greater issue. Don’t be scared to take a day off, or an entire weekend even! The knees get a lot of stress put on them in the CrossFit arena, both with weighted loads and with a run, row or bike. Keep in mind that form is important all the way through a long WOD. Once you begin to break form and your knees start creep forward or in towards each other, all of the load will start to build up on the tendons of the knee joint.

As a chiropractor, I am able to assess your biomechanics and perform an examination with orthopedic tests to see if there is anything serious going on and refer you to the proper person. However, if you just having nagging knee pain that you feel when you do almost any movement, chances are you are putting too much stress on your knees. There may be an issue in your ankle, hip or pelvis that is preventing you to have proper shared motion in the leg. Almost always, decreased motion in any of these areas shows up as pain in the knee. Once we get things moving properly, the knee pain should decrease. I also have several exercises that I give patients to allow them to activate their entire posterior chain and foot which helps decrease stress to the knee and leg.

Although I am biased, I do believe that every athlete at every level should be getting a full body adjustment at least once every 4-6 weeks. By improving biomechanics, stretching areas that are tight and strengthening areas that are weak, injury prevention results will go through the roof. Along with prevention, overall increase in weight should start to occur as well as an overall feeling of stability with that increased weight. I am an advocate for all things CrossFit, as I find it a fun way to workout and it gives a strong sense of community. If you enjoy this type of workout and are looking for ways to improve your overall health, feel free to give my office a call.

I offer free consultations and am happy to answer any questions you have. As a functionally based chiropractor; I do a very thorough exam that includes gait and deep squat analysis to get a better picture of each of my patients complete biomechanics. Our phone number is 704-845-0777 and you can ask for Dr. Kylie. We do our best to get you in for same day appointments and have early morning, evening and Saturday morning appointments for your convenience!

“Do something today that your future self with thank you for.”

-Dr. Kylie

CrossFit and Chiropractic

OHS

For almost 3 years now, I have been doing CrossFit workouts. Prior to this, I have a background in Olympic Lifting that started with my high schools Advanced Weight Training class that replaced a conventional gym course. We were extremely fortunate to have a coach that was focused on fundamentals and form before an increase in weight for all movements. Throughout my college career, I continued to lift weights my freshman year with our softball team and new strength coach who was extremely impressed with my form. As I moved from school to school, I continued to lift weights a few times per week until I got to Palmer. A good friend of mine was one of the coaches for our schools “Functional Fitness” program which is where my CrossFit journey began.

In my first week, I knew that I had found I workout that I both enjoyed and could see myself doing for a long time. With constant variation in workouts and the concept of competing against yourself each time you went to the gym, I was able to re-connect with the competitive edge I had become so accustom to in my years of sport. A background in Olympic Lifting served me well as I was familiar with almost every movement in CrossFit, minus a kipping pull-up and handstand push-ups.

After 6 months of training, many of the coaches were graduating and leaving the school. I was given the opportunity to over-see 4 classes per week and my roll changed from athlete to coach in the blink of an eye.

As I was in the heart of my studies, learning about the human bio-mechanics and functional evaluations of strength in sport, I started to combine the concepts of CrossFit and rehabilitation in some of the students coming for classes. I developed very specific warm-up routines based on what big movements we would be doing for the day. Always keeping things interesting, I would change up accessory work to strengthen specific areas that were commonly weak to better help prevent injury.

When I left school and moved to Cincinnati, Ohio for an internship at one of the largest, functionally based office in the US, I evaluated myself even further for deficiencies. Instead of joining a CrossFit gym, I chose to go to a smaller gym and work on my weaknesses with DNS based exercises incorporated with Olympic Lifting. As I worked through and began to strengthen common patterns, I noticed almost immediate improvement in form and increases in weight I was able to lift while maintaining better form. Because DNS is based in proper activation of muscles that better stabilize, I was protecting my joints and muscles while increasing my endurance in my stable strength.

Since rejoining an established CrossFit gym, my lung capacity has decreased slightly due to the nature of my training over the last several months. Although workouts have been tough, I am noticing the movements are easier and I feel much stronger as well as more stable throughout WOD’s. In my time away from a conventional CrossFit gym, I focused on better overall shoulder stability in the overhead position and proper activation of the lower half during all Olympic-style Lifts.

I have been asked by several people why other chiropractors are so against CrossFit. To that I say, they are concerned that without a proper coach with a focus on form and not weight or repetitions, the general public is very prone to injury in this setting. While I agree with this fact, I also believe that CrossFit combines strength training with cardiovascular training. Both of these promote a longer life span and both are important as we age.

It has been shown that weighted training is preventative for osteoporosis if completed on a regular basis in the first several decades of life. As we stress the muscles and joints, the bones are forced to lay down stronger bone. When we do this early enough, the bones are built much stronger and we see that they stay stronger for a longer period of time. While this does not condone very heavy weight training through adolescence, it does help show that light weight training without extreme muscle atrophy provides benefit later in life.

Another argument is the muscle imbalance that occurs in the CrossFit athlete. Many times the upper portion of the trapezius muscle, the quads and lumbar paraspinal muscles are seen to be much larger in those who compete or use CrossFit for their regular exercise routine. While much of this is due to the highly repetitive movements done within a workout, proper form can prevent much of this from happening- which gets us back to having a good coach for this workout.

All of this being said, repetitive injuries are seen very commonly in the CrossFit world. Stay tuned next week as we start to explain some of these common injuries and ways to both prevent them as well as common treatments in our office.

I hope you enjoyed learning about my background in the sport and will consider calling to make an appointment to be evaluated. As a chiropractor and CrossFit athlete, I believe they are extremely compatible. If you are working out at a CrossFit gym, I urge you to be evaluated by a functionally based doctor such as myself to help take your skills to the next level.

-Dr. Kylie

Posture

In today’s world, much of our days are spent sitting at a computer for many hours at a time. Here are a few key points about why this may be detrimental in the long run.

Now since we started talking about posture, I bet you perked up in your seat doing your best to improve how you have been sitting this morning. Although this is great, if your computer screen is not at least sitting at eye level, there is probably some degree of forward head posture in your neck. While in a relaxed sitting posture, your ear should sit over your AC joint which is the large bump on the top of the shoulder. For each inch forward that your head moves from here, there is 10 extra pounds added to your head. This leads to extra strain of the muscles in the back of the neck trying to pull it back. Because these muscles are on, the muscles in the front which are required to bring the head backward shut off and become progressively more weak over time.

Soreness at the bottom of your neck and headaches that feel like they are coming from the base of your skull and wrapping around to your forehead or behind your eyes are the most common complaint we see from this posture. If chronic in nature, it does take several treatments to work out the tightness in the joints. Take home stretches and self-mobilizations are almost always given to start. Once flexibility and shared joint motion are improved, strengthening exercises are given to better stabilize the entire neck, making it easier to maintain good neck position.

Bruggar’s exercise is the most common exercise given. It starts with a chin retraction; focusing on bringing the entire head backward and upward, as if to give yourself a double chin. This brings the head over the shoulders. Once here, slightly pull the shoulder blades down and together; feeling a squeeze in the middle of the back. Hold here for 3-4 seconds and perform 8-10 times about once per hour.

This exercise is not a simple one as you first introduce it. Many people feel as though they are hitting a brick wall as they retract the chin backwards. The thing to realize though is each time you perform the exercise, you are stretching the muscles and mobilizing the joints. This will lead to loosening the area over time, making it much easier to do.

None of this will help, however, if your computer screen is not at an optimum height. When patients come in with question about their work station, the first thing I do is have them ask a co-worker to take real photos of what their posture is during the day. This is without you knowing they are taken! I can notice very quickly if your screen is too low and causing strain on your neck.

The next big topic of discussion is the lower back. Although it is said that sitting is the new smoking, standing all day is not great for the back either! Most people will jump right to switching over to a standing desk, but the problem isn’t sitting. It is staying in one spot for too long.

Your joints were built to move and move often. This is especially true of the joints of the lower back, pelvis and legs. If I had it my way and could go into every single office space, I would give every desk jockey a vari-desk; something they can both sit and stand at. They would change from sitting to standing each hour when a buzzer went off and would be required to walk the length of the office at least once an hour. For their chair, they would have both a regular chair with some sort of low back support for good spine position and a stability ball to sit on. Each varied posture will work different muscles and the joints would not stay in one place for too long.

That’s right! You can still sit at your desk, but not for 8 hours straight.

A lumbar support is a very inexpensive device which allows the lumbar spine or the low back to have a proper curve while in a seated position. Most of the time, we see a very flat almost rounded back with a tucked under rear end in office setting photos. Don’t get me wrong, people will also overly arch the back when trying to sit in a good posture which is just as bad for the joints of the lower back. Neutral is what you are looking for to decrease stress.

Along with the lower back, is the feet. If your feet are not touching the ground in your chair, you have zero points of stability for the rest of the body. There are cases where vertically inclined patients have to bring a box to rest the feet on, which works just as well. You really want the thigh to be flat with the ground and the knees to be bent to 90 degrees. Also, no crossing of the legs ladies. One point of support is just as bad as no support at all.

Common exercises for the lower back are Cobra pose and standing lumbar extensions. Both create motion in the lower back and get those big joints moving. Once better shared motion is created and we see relaxation of the muscles, core strengthening exercises are given for optimal stability.

The last point we will touch on today is arm position. If you are working from a laptop, this is especially important. With the hands on the keyboard, you want your elbows relaxed close to your sides and forearms to be flat with the ground or just below 90 degrees. In order to make this happen with a laptop, a wireless keyboard is a must. With both neck and shoulder positioning in mind, this puts the least amount of stress on the muscles and allows for all of the joints to be in a neutral position.

Would you like your work station evaluated? Call (704) 845-0777 to set up a consultation with Dr. Kylie and get the process started! I can also write a professional letter to your company requesting a better work station if necessary or even give a presentation to your entire company about the importance of ergonomics. Become more efficient and decrease pain with simple exercises and movement of equipment!

-Dr. Kylie

The Big Move

Outdoor Signage

As much as we loved our office in beautiful, historic downtown Matthews, we grew! Over the weekend, with the help of many amazing workers, we moved just down the street to a brand new, state of the art, larger facility in the Matthews Medical Center.

Located at 434 Trade Street, our new location is around the corner from our old office! To get to the parking lot from Trade Street, turn onto Andrew Carolina Drive between the Urgent Care and Eastover Foot and Ankle. Take an immediate left at the T-intersection and our office is located in the middle suite of the second building. This plaza has very welcoming neighbors, including dentists, personal trainers and podiatrists. Our friends from Matthews Internal Medicine will be moving in right next door by the end of the month and another dentist office will be moving in by the end of the year to complete our 434 Trade Street office space.

Our new location includes 4 treatment rooms for adjusting, a designated acupuncture-massage room, a digital X-ray room and a large therapy bay. Dr. Bryan and Dr. Kylie will have the luxury of treating out of their own 2 treatment rooms on each side of the office, with the X-ray room located in the middle of the office.

The doctors are not the only ones getting more space. Mrs. Fiordaliza will be upgrading to a larger space at the front desk that includes a separate, more private area to discuss billing and payments.  With the ability to see all aspects of the office, she is able to keep an eye on the office flow and keep the doctors both in line and on time. Busy as ever, she will be able to easily navigate patients from one area to the next.

In addition to our growth into the new office, we are growing as a team as well! Mrs. Jocelyn Renteria has joined the Chiropractic Health of Matthews team. A warm smile and optimal work ethic along with an extra set of hands will keep our busy office churning on all cylinders. As Dr. Kylie’s schedule is picking up, adding another member to the team is just what we needed.

Door Signage

We will miss our home in historic downtown, but hope you will be by soon with your families to check out our new facility! In our first week seeing patients here, we can tell this office is going to allow us to help even more people in the Matthews and South Charlotte communities. Stay tuned in the office and on Facebook for our announcement of an official Ribbon Cutting Ceremony and patient appreciation day in the very near future!

Reaching and exceeding your healthcare goals is our main focus here at Chiropractic Health of Matthews. Weekend, evening and same day appointments are available. Call today for a consultation and see if chiropractic is right for you! 704-845-0777. Se habla español.

-Dr. Kylie

 

Core Strength: Beyond the Six Pack

“Show me a six-pack and I will show you dysfunction.” -Dr. Brett Winchester, DC, DNS Instructor, MPI Board

As the summer is fast approaching and every one is hitting the gym doing 45 minutes worth of crunches, this quote will hit home and confuse many people. We as a society have been taught to believe that a thin stomach and walking around with a 6-pack is ideal. Unfortunately, I am here to tell you that it is not.

Although pleasing to the eye, a tight stomach and abs actually show a lot of dysfunction. In order to accomplish getting a perfect six-pack, the oblique muscles actually start to waste away creating a hollowing effect on each side. While walking around and maybe even right now as you read this, most people suck in their tummies trying to create the appearance of a flatter stomach. As you suck the stomach in, you recruit the muscles in your lower back which increases overall tone leading to dysfunction in the joints. In order to breath, the muscles of your neck will start to be used which causes large trigger points between the shoulder blades and at the base of the head. Desk Jockies almost always complain of neck and lower back pain because they are using big muscle to stabilize their core and to breath. These larger muscles fatigue much quicker and have to work harder to perform these tasks.

The core is made up of several muscles, not just the six-pack like most people are lead to believe. The rectus abdominis is the most superficial muscle and will create the 6 pack that most people are looking for. Next are your external and internal oblique muscles that run like an X on top of one another. The deepest layer of your core is created by the transversus abdominis muscle which is actually the biggest lower back stabilizer in the body. It’s fibers runs side to side and acts like an internal back brace- if you know how to use it! Just under your rib cage is the diaphragm, a very important muscle used to help facilitate a stable and fully functioning core.

core muscles 1

All of these muscles are designed to work together to stabilize the spine and body during movement. It has been shown in studies that improper activation of the core can predict injury to the lower back in overhead and kicking sports. When these muscles are not used correctly and movement of the arms or legs begins, extra stress the back endures which can result in a strain of the muscles or injury to the joints.

So when doing crunches, you are training only the rectus abdominis. This creates a shortening effect of the muscle and fascia. When tone is held in this muscle all the time, other muscles will begin to turn off and we begin to see a hollowing effect or “gutters” begin to form in the abdomen. While the transversus abdominis is the biggest lower back stabilizer, it is also the most commonly weak or inhibited in terms of the core.

The diaphragm plays a large role in the proper activation of the entire core. This dome shaped muscle will flatten towards the abdominal contents as it contracts, increasing the pressure inside the belly wall. As the pressure increases, it forces the transversus abdominis and oblique muscles to eccentrically contract or lengthen and tighten as they contract. This eccentric contraction is what creates stability in the lumbar spine which prevents injury with various movements of the arms and legs.

Proper motion the the thoraco-lumbar junction and in the pelvis also helps create an ideal environment for these muscles to properly activate. Most of the muscles of the core have attachments in both areas so with increased tone or fixation, there is increased pull and stress on the core which does not allow for the most effective activation.

What is the best way to train these muscles?

Through several take home exercises! Dynamic Neuromuscular Stabilization or DNS is a rehab treatment that was founded at the Prague Institute of Rehabilitation. Some of the leading experts in conservative care of low back pain and stabilization came from this school and created extensive research in which exercise progression are the best for facilitating an ideal environment for activation of the entire core. Much of my training and exercises have just been stolen from them!

During school and my internship, I was able to study along side some of the instructors for this technique and actually teach patients under their supervision using these concepts. I believe that proper exercises that promote core strength should be at the key of all treatments, including things like shoulder pain and ankle pain. When the proper base is taught, trained and understood, the progressions through other training go much smoother. This includes squat form, over head throwing mechanics and even kicking. With a strong, properly activated core, the muscles of the rest of the body begin to also activate more efficiently, decreasing the risk for injury.

My favorite place to actually see this proper activation at work is in the UFC arena.

chuck core

If you took a photograph of a fighter mid punch, as seen above in Chuck Liddell, you will notice their rib cage is stack on top of their pelvis similar to a barrel through their mid-section. There is also no tone held in the six-pack and there are no gutters seen on either side. This is because in order to create the most efficient and powerful blow, there must be very efficient core activation to create a stable base! Although most of these fighters will suck in for photos, you will notice a relatively relaxed core as they are bouncing around inside the ring.

Keep this in mind as you train your core next time! Think in terms of functionality instead of just looks.

-Dr. Kylie

The Power of the Hip Hinge

Sitting down, picking something up off the ground and approaching the tee for your golf swing; what do all three have in common? They should all start with a hip hinge!

A common mistake in a lot people’s everyday lives is the lack of a proper hip hinge. Each time you sit down and stand up out of a chair, you are actually performing a squat. Many times when asked to perform a squat in the office, a functional test that gives a lot of information about bio-mechanics, patients will either start the movement in their knees or will overly round their back. Mastering this concept of hinging over the hips will take pressure off your knees and your low back.

So what is a hip hinge?

The hip joint, where the femur or leg meets the pelvis, is classified as a ball and socket joint. Just as it sounds, the ball of the femur attaches into the socket of the pelvis which allows for movement in a 360 degree fashion. Large muscles off the buttocks and thigh work together to control this joint. Although the joint of the shoulder also falls under the same classification, it is much more freely movable because the muscles that control it are much smaller.

A hinge at the hip is a complex movement and many muscles are required to work together to accomplish it. Starting with stability in the lower back, the core must eccentrically contract to prevent strain on the muscles of the lower back. Once this occurs, the muscles of the posterior chain in back of the legs allow for a backwards movement of the hips without overly bending the knees. Because bending is happening over the hip joint, stress is removed from the back and the knees.

From here, we can perform other movements like a golf swing or sitting down into a chair. If you enjoy lifting weights, this same concept should start all of your movements. Once a hip hinge is established, the very strong muscles of the glutes are able to properly engage as well as the muscles all the way down into the feet. This will allow for an increase in weight as well as a decrease in injury risk! Something that everyone is looking for.

When people come into the office who have hurt their backs, a lot of the time they will protect their back by not putting any motion into it at all but will use nothing but their knees to sit and stand from a chair. Although you have protected your back, the better option is to implement a hip hinge along with an abdominal brace with the breath. If a proper brace is used in the core, you are able to decrease the motion and increase the stability. The brace will also create a stable foundation for you to move from, making the hip hinge not only possible but also much easier.

Here is 3 side by side photos showing the 3 most common patterns when squatting.

Hip Hinge

The first photo shows a knee bender. When motion starts in the knees for a squat, they slowly begin to glide forward. This forward glide puts an increased stretch on the front side of the knees. When under load, possibly with a box or when lifting weights, this stress on the knees can cause injury.

In the second photo, much of the same is true. When all of the motion comes from the back, the muscles have to work much harder. As we bend forward, there is a lot of stress put on the joints in the back and also each of the discs that separate the bones in the back. If load is introduced, even something as light as a purse, strain of the joints or even worse, irritation of the disc is much more likely.

The third and final photo shows an ideal hip hinge. With backward movement of the hips and a generally up-right torso, strain is minimized in the lower back and in the fronts of the knees.  There is slight bend in the knee, but it remains over the foot and does not move in front of the toes. The rib cage is stacked on top of the pelvis and the neck is neutral.

Hanging out in this position will help activate many of the muscles required to properly get into this position. I will also send patients home with a small side to side lateral step once they have mastered the hinge. By promoting the use of the glutes, it becomes easier to use them in everyday life. A proper hip hinge is great for someone who lifts weights, but also for elderly individuals at risk for falling. If we can get them back to squatting more efficiently, they will become much more stable overall. With exercises promoting strength and balance, proprioception is increased exponentially. Although not nearly as much resistance is needed, these concepts are what allows the sense of individuality to last much longer in the aging population.

Now watch me hip and watch me hinge hinge!

-Dr. Kylie