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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

Can you adjust babies and kids?

A very common question we get in the office is can my kids get adjusted? And the answer is yes. The misconception is that they will be adjusted just like an adult. Because they are much smaller and muscles haven’t developed like an adults, adjustments to children require much less force.

DSC_0040

The next question we get is when do you know a child needs to be adjusted? Just like an adult, the joints of the spine are palpated looking for areas where motion is lacking. You as a parent may notice your child getting sick or being overly fussy. This is a good indication that they need to get in to be seen. When the spine is sharing movement properly, the nerve signals can move at optimum speeds and the immune response is much quicker. This is important to not only prevent sickness, but also prevent injury. Just like in an adult, when the spine isn’t moving properly areas will begin to move more, putting that area at risk for injury which is especially important in the developing athlete for preventing repetitive motion injuries like throwing or kicking a ball.

When should I first get my child checked? As a chiropractor, I believe it is important to have your newborn checked as soon as you can. The birth process is the first large stress put on the body, and that is in a non-complicated vaginal birth. If you have ever seen a C-section birth, you will see that once the mom is opened up, baby is then pulled from mom using large clamps on either side of the head. This pull places a lot of stress on the neck and can cause the first misalignment. The same is true for a vacuum excursion and sometimes even just a regular birth when the doctor has to give a little pull on babies head during delivery.

There are a few other indications that your newborn may need to be checked. Improper latching during breastfeeding, overly fussy, troubles sleeping, difficulty passing stools, increased spit up and even if you notice your baby does not like to turn to one side or the other. Although there may be other factors involved with each of these cases, a chiropractor can get some of your questions answered and get you to the right place.

Dr. Kylie with a 12 month old newborn.

Dr. Kylie with a 12 month old newborn.

An adjustment to a newborn also looks much different than even an adjustment to a child. Because they are so delicate, the amount of pressure needed to correct an alignment is as much pressure as you can handle when pressing on your eyelid. In the neck, there is almost always no thrust and although the baby may be fussy with their head being held, once the adjustment is performed you can actually see their breathing and temperament change. During adjustments to the pelvis, pumping mechanisms are used to decrease the amount of force needed. In the cases of difficulty passing stools, some moms report the “blow out” as early as on the drive home.  Newborns who don’t like to turn there head to one side, which can include even nursing on one side, have better range of motion once the upper neck is free from fixation.

Newborns and kids are some of my favorite patients to work with. Kids will be very blunt most of the time and tell you how they feel after getting adjusted. It is also extremely rewarding to hear back from parents who report an improvement in behavior at school or improvements in breast feeding once treatment has started.

Because the nervous systems of little ones is so delicate and areas of decreased motion are much less fixed than in adults with more chronic conditions, and results are also seen much quicker. By getting your newborns and kids adjusted, you are helping them improve their bio-mechanics all the way through development. From lifting the head for tummy time all the way through riding a bike or mastering throwing a football, shared motion in the spine will help develop the proper muscles to keep these kids performing at their highest potential.

Interested in getting your children checked? Call and request an appointment with me, Dr. Kylie today at 704-845-0777. I would love to answer any questions you have and help to decrease your concerns about getting your little ones adjusted. Have an athlete in the family? I also teach preventative exercises, which are best implemented from a young age to help decrease season and career ending injuries!

Happy Tuesday!

-Dr. Kylie

Runners Knee: What you Need to Know

Knee pain is a relatively common complaint we see in the office, especially within the running community. Some may come in with clicking, some have used Google to self-diagnose themselves with IT Band syndrome because it is so common in the running population, some won’t even notice the knee pain until they’re 15 miles into a marathon. But all with knee pain, runners or not, should take a step back and consider a few things.

The knee is a slave to the hip and foot/ankle. What does this mean? It’s located right in the middle and similar to the spine, when the things on either end aren’t working properly, the knee picks up the slack. The knee is also the attachment point for most of the muscles in the thigh as well as the origin for most of the muscles of the calf. All of the muscles intertwine to create the stable foundation which is the knee.

It is takes a very comprehensive and functional evaluation to find the true cause of symptoms. And most of the time we see a combination of muscle imbalances, both in the leg and the lower back as well as joint fixation- sometimes in the foot or ankle and sometimes in the hip or pelvis.

Consider this common example: there is a fixation in the tibiotalar joint. Meaning: there is lack of motion where the tibia or shin comes down and attaches to the talus or ankle bone. Most of the time the talus will shift forward, ever so slightly and stick there. When this occurs, the ankle is unable to fully flex and the shock absorption mechanism of the ankle is diminished. Down the chain of events, this will cause an increase forward glide of the knee which causes even more stress to the front of the knee; compensation for the lack of motion in the ankle. Over time, trigger points will form in the calf and the outside of the lower leg. Once this occurs, it is more likely for a simple fixation in the ankle to travel further up the chain and cause symptoms into the lateral part of the thigh or even into the hip. Even if there is never any pain in the knee! A mid-foot striker may never notice they have a difference in this area of the foot side to side, until they are put through a deep squat screen and notice they struggle to maintain one heel on the ground.

tibiotalar

IT Band syndrome, or an overly tight lateral thigh can be caused by a number of things. The large ligament located in the side of the leg gets blamed a lot and is the catch-all diagnosis for runners.

What you may not know is that there is actually a muscle embedded in the top of that ligament that lays over top of the glutes. The most lateral portion of your quad has insertions into this band as well as the lateral portion of the hamstring, from the front and back of your thigh respectively. As the IT band attaches into the knee, it crosses over the joint and inserts where the hamstring and the quads do as well as where the lateral calf muscles originate from. The purpose of this very intertwined group of ligaments, crossing over each side of the joint is to create stability.

itband

When there is tightness in any of the aforementioned muscles, there is increased stress on the IT Band. If the hip joint is overly tight in the posterior aspect (common among all athletes) the same is true. The pelvis, which is where this large ligament originates, plays a role as well. When there is lack of motion here, it will pull on the IT band from the top, creating symptoms all the way down the course of the ligament.

Recent research also shows that using a foam roller or lacrosse ball to loosen this muscle is fine and dandy before a run, but a dynamic stretch or even getting on an exercise bike actually accomplishes this much more efficiently. Why? Because you are warming up all of the muscles surrounding the ligament, which is much more effective than simply focusing on the IT Band itself. Get to squatting, lunging and inch worming!

Proper glute activation in runners plays a big role as well. The largest muscles in your body for a reason, these muscles of the buttocks will create stability into the knee as well as the ankle when activated properly. When there is a break the in chain down the leg, the proprioceptive feedback is lost which is needed for proper balance and coordination. This is seen most easily on a one-legged balance or squat test. After having the ankle and hip adjusted, the results are 2-fold. Balance is restored and much of that is due to the increased signal to the brain allowing the glutes and other muscles to work together more properly. There is also proper shared motion through the leg and ankle, allowing for a smoother and easier movement which is lacking when there is fixation.

As muscle imbalances begin to decrease, simple exercises are able to be given to further help increase all of this stability and get rid of some of the unnecessary tone. If you are a runner, you will notice yourself feeling much more stable through each stride as all the muscles work together properly and joints move as they are supposed to.

If you want to take things to the next level or have questions about any of these concepts, feel free to stop in for a free consultation with me, Dr. Kylie. I would love to be able to help you meet and exceed your goals and keep you running better, longer!

Until next time,

-Dr. Kylie

 

I have TMJ, now what?

I love when patients come in and tell me they have TMJ. My reply is usually, “Really? Because I have 2!” A common misconception is that TMJ is a diagnosis when actually is describes a piece of anatomy. The Temporal-Mandibular Joint, or TMJ is the joining of the jaw to the skull. TMJ Dysfunction is a more accurate term for the diagnosis which may include pain or clicking in the jaw.

TMJ

As seen in the photo above, the condyle of the mandible or jaw is separated by a thin disk from the articular fossa of the temporal bone or skull. The 2 thin muscles show are the medial and later pterygoid muscles, which help create movement of this hinge and gliding joint. The temporalis muscle, named as it is located on the temple and can be felt when clenching the jaw here. Another large muscle is the masseter, which can be felt on the side of the jaw. All of these muscles work together for chewing and speech.

So, why is my jaw clicking or in pain?

To better understand this, we have to look at what each of these muscles does more closely. When used bilaterally and together, the temporalis, masseter and lateral pterygoid all close the jaw. The temporalis and masseter allow for lateral movement to the same side when only the right or left is used. The medial pterygoid is the main muscle used in opening the jaw and also retracts or brings the entire jaw backward when used bilaterally. Opposite of retraction, we have protraction or jutting forward of the jaw, which is controlled by the lateral pterygoid. Both the medial and lateral pterygoid muscles will allow for side to side movement when only the right or left is used, but will actually push the jaw to the opposite side unlike the temporalis and masseter.

One other key point to mention here is the fact that the lateral pterygoid muscle has an attachment into the disk located between the two bones. This will play a factor later on.

As the jaw begins to open, the condyle of the mandible is pulled forward and down which puts pressure on the articular disk. For maximum, pain-free opening to occur, this disk will slide forward slightly to maintain it’s position between the jaw and the skull. The lateral pterygoid controls this action. Near the middle of the opening phase, the jaw will begin to retract or move backward in an arching fashion which allows the jaw to be completely open. Closing the jaw happens in the opposite order, with slight protraction forward through the first half then straight upward movement until closed. Ideally, this will look symmetrical side to side and will happen at similar rates.

A lot of the time when there is pain or clicking, we almost always see a quick move to one side or the other during the opening, closing or even through both phases. What that movement creates is increased stress on one side of the jaw which will cause pain. Side to side movement is almost always caused by spasm of these fine, very tiny muscles of the jaw. When one side goes into spasm, there is not equal recruitment on the right and left through the opening and closing phases. Some patients can feel these muscles in spasm and actually feel very sore and tight on one side versus the other.

Clicking actually has a much different meaning than what most people think. As the jaw opens and there is slight contraction of the lateral pterygoid, the articular disc will move forward. When that thin muscle goes into spasm during opening, it will yank the disc forward and cause an audible “click” within the joint. During the closing phase, there is enough force created by the rest of the muscles to force that disc back into the joint which may create yet another “click.”

So what can I do?

I have taken courses outside of school for rehab and treatment of this very delicate joint. Although painful and slightly uncomfortable during treatment, the results are amazing. Some patients notice a difference immediately in the office. Some will go home and do their exercises and come back proud of how much further they are able to open their mouths; further than they can ever remember! All that I do during treatment is help strip some of the extra tension out of the muscles by using a proprioceptive stretch called PIR. Post-Isometric Relaxation uses the contraction of the muscle to then relax the muscle. In some cases, a light mobilization of the joint is also needed which helps increase the space of the joint and relax the muscles further. The key here being LIGHT. After education on the mechanics of the TMJ along with its muscles, patients are sent home with a handout explaining things to avoid as well as exercises to do in between treatments.

Now this is not an end-all procedure. If you have been dealing with these symptoms for years, there is a chance that a night-guard to prevent clenching may be necessary from your dentist. This is an important factor in many cases, as clenching through the night will cause the muscles that were just relaxed to go right back into spasm. There can also be anatomical variations that can cause these symptoms. Although both are true, conservative care should always be tried before more invasive treatments.

Another thing to consider is extra tension held in the neck or cervical spine. Most of the muscles used for chewing and talking get there nerve supply from the upper neck. They also have attachments here. If the spine is not moving properly, adjustments will help decrease overall tone of the muscles as well as help improve the shared motion throughout the neck.

Consider conservative treatment for the pain or clicking you get in your jaw. It might surprise you how simple and effective it can be! Questions? Call 704-845-0777 for your FREE CONSULTATION with Dr. Kylie today!

Until next time,

-Dr. Kylie

 

Bulges and Degeneration: Why you may not have to worry

'Your infrastructure needs work.'

As advanced imaging is getting more affordable and available, it is important to point out a few things about your most recent MRI. In the last several years, more doctors have utilized both X-rays and MRI’s to better help explain away why a patient is having specific symptoms; both in the neck and lower back. Studies have shown, however, that a certain degree of degeneration is normal. When using this technology on an asymptomatic subject, or someone who has no complaints of neck or lower back pain, images show that even 30% patients in their 20’s will show at least 1 disc bulge. When we get past the age of 50, we see a rise in this number to at least 60% and the degree of degeneration starts to rise. Finally, 77% of patients over the age of 70 will show at least 1 disc bulge and signs of degeneration in people with no symptoms what-so-ever.

So what does this mean for you? What came first? The chicken or the egg?

A disc bulge or herniation is actually a sign of degeneration, along with loss of overall disc height and increased bone growth. But with research showing this occurs even in healthy individuals with no back pain at all, some of this is normal. 37% of 20 year-olds will show signs of degeneration with that number rising to 96% of those over the age of 80. This is important to keep in mind because although advanced imaging is great for catching some of the extreme cases and causes of pain, it is unable to be determined that a patients lower back pain can be correlated with the amount of degeneration seen on films.

There are 2 categories that we use for patients with a disc bulge: A- the bulge is not related to your back pain (the more common finding), or B- the bulge is contributing to your back pain. There are treatments for both and we see them in our office all the time. If you fall into the first category, you will be evaluated and treated just as any other patient would be with lower back pain. Adjustments, muscle work and take home exercise usually to strengthen the core and better stabilize the low back are used. If you fall into the second category, there are a few more things to consider. 63% of all disc bulges actually resorb or get smaller and heal with time. That means that even if you do absolutely nothing, that bulge seen on MRI will shrink if only you give it time.

Don’t think that we can’t help facilitate and speed this process along, however. Most of the time what we see with a disc bulge that is contributing to lower back pain symptoms is actually areas above and below that injury to be fixated or need to be adjusted. When the body is not sharing motion properly through all of the joints, other areas pick up the slack and begin to move too much. That puts the lower back at high risk for injury. After irritation and irritation, inflammation begins to build up,  creating the perfect environment for disc and nerve injury to occur. Other contributing factors may be diet, activity or overall movement level and even something as simple as water intake. A series of take home exercises have been found to decrease symptoms tremendously, along with adjustments to the areas of the spine that need adjusted. Once the initial injury has been addressed and patients are no longer in acute pain, conservative treatment that includes strengthening the area around the healing tissue is a must in order to prevent re-injury.

In a very recent interview of the NBA Golden State Warriors head coach Steve Kerr, someone with on going low back pain who had surgery in 2015, he explained to the world what I am telling patients every single day. “I can tell you if you’re listening out there, stay away from back surgery,” Kerr said. “Rehab, rehab, rehab. Don’t let anyone get in there.” In the last several weeks, he has had debilitating pain that has kept him from coaching. After his surgery, he went through a similar episode that rehab helped him with. In his interview, he reiterated that he wishes he would have never had the surgery and that he wishes he would have found REHAB prior to surgery!

Bottom line here is that not everything seen on X-ray or MRI is a contributing factor to pain. Even if you see degeneration or disc bulges on imaging performed, conservative treatment is still a great first step. Sometimes when things are explained after having these exams done, patients leave with even more questions along with a feeling of impending doom. Not to worry! Give us a call and we can sit down with you to help you better understand what it all means. Do you have a disc bulge and are now wondering if chiropractic can help? We would love to get you scheduled for a complete exam to get a better idea of your biomechanics overall.

Until next time,

-Dr. Kylie

Curious where all this research came from? Check out this article with very easy to read charts explaining results:

W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes and J.G. Jarvik. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Patients.