The muscle responsible for flexing your hip toward your trunk, is called the Psoas. This muscle begins on your lower spine and passes through your pelvis to attach onto the top of your femur (thigh bone). Along this course, the muscle travels across the front of your hip socket and over several bony prominences. If the muscle is too tight, its tendon may rub over these “bumps”. This occasionally produces an audible snapping sound, hence the moniker, “snapping hip”, aka “psoas tendinopathy”. The tendon can be irritated by an acute injury, but more commonly from overuse- particularly repeatedly flexing your hip toward your trunk. The condition is also known as “dancer’s hip” or “jumper’s hip”, as movements associated with these activities are known culprits. Likewise, the condition is frequently seen in athletes who participate in rowing, track and field, hurdling, running (especially uphill), soccer, and gymnastics. Your symptoms may include a “snapping” sound or sensation when you flex and extend your hipalthough many cases are silent. Repeated rubbing causes inflammation and subsequent deep groin pain that can radiate to the front of your hip or thigh. Long-standing problems can trigger weakness or even limping. The diagnosis of snapping hip is frequently overlooked. In fact, some studies show that identification is often delayed more than two years, while other potential causes are pursued. Fortunately, your problem has been recognized, and our office has several treatments to help you recover. Psoas problems often start when one group of muscles is too tight, while another is too loose. Your home exercises will help to correct this problem. Depending upon the severity of your condition, you may need to avoid certain activities for a while. You should especially avoid repetitive hip flexion. Prolonged seated positions can encourage shortening of your hip flexors so be sure to take frequent breaks. Patients with fallen arches may benefit from arch supports. If you or someone you know suffers from this condition, call our office today. Our doctors are experts at relieving many types of pain including hip injuries.
Reprinted with permission from ChiroUp
Medline contains more than 24 million articles, with almost one million new citations added each year. Evidence-based chiropractors know that they must employ and continually refine “best practices” to obtain great outcomes. The following up-to-date chiropractic research review offers 11 new studies that impact our patients and practices.
1.A new paper provides additional confirmation that patellofemoral pain syndrome (PFPS) and dynamic knee valgus do not arise from within the knee, rather from hip abductor/ external rotator weakness and/or foot hyperpronation: “The most effective intervention programs included exercises targeting the hip external rotator and abductor muscles and knee extensor muscles.” and “PFPS patients with foot abnormalities, such as those with increased rearfoot eversion or pes pronatus, may benefit the most from foot orthotics.”Petersen W, Rembitzki I, Liebau C. Patellofemoral pain in athletes. Open Access Journal of Sports Medicine. 2017;8:143-154.
2.A systematic review and meta-analysis of more than 1700 cases determined that patients with a decreased lumbar lordosis have significantly higher levels of lumbar disc herniation and LBP. Chun, Se-Woong et al. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. The Spine Journal , Volume 17 , Issue 8 , 1180 – 1191
3.A study of more than 300 adult patients found that both hypo- and hyper-lordosis correlate with DJD in the lumbar spine. Murray KJ, Le Grande MR, Ortega de Mues A, Azari MF. Characterisation of the correlation between standing lordosis and degenerative joint disease in the lower lumbar spine in women and men: a radiographic study. BMC Musculoskeletal Disorders. 2017;18:330.
4.Weakness of the deep neck flexors is a known contributor to chronic neck pain, particularly cervicogenic headaches and cervicogenic vertigo. A systematic review confirmed that low-load craniocervical flexion exercise is highly effective for improving deep cervical flexor muscle impairments in these patients. Amiri AS, et al. The Effect of Different Exercise Programs on Size and Function of Deep Cervical Flexor Muscles in Patients With Chronic Nonspecific Neck Pain: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Aug;96(8):582-588.
5.In a small study of patients with cervicogenic headache, chiropractic spinal manipulation resulted in decreased headache frequency and intensity with only mild and transient adverse events. Chaibi A, Knackstedt H, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for cervicogenic headache: a single-blinded, placebo, randomized controlled trial. BMC Research Notes. 2017;10:310. doi:10.1186/s13104-017-2651-4.
6.In patients exhibiting a loss of the cervical lordosis, a 12-week home exercise program consisting of isometric cervical extension improves cervical lordosis and reduces pain levels. Alpayci M et. al. Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2017 Sep;96(9):621-626.
7.Regarding cervical spine pain, the definition “acute” should be reserved for the period of 0-4 weeks. Nyirö L, Peterson CK, Humphreys BK. Exploring the definition of «acute» neck pain: a prospective cohort observational study comparing the outcomes of chiropractic patients with 0–2 weeks, 2–4 weeks and 4–12 weeks of symptoms. Chiropractic & Manual Therapies. 2017;25:24. doi:10.1186/s12998-017-0154-y.
8.In patients with neck pain, intermittent cervical traction provides significant immediate relief but little functional improvement or long-term benefit. Yang JD et al. Intermittent Cervical Traction for Treating Neck Pain: A Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976). 2017 Jul 1;42(13):959-965.
9.A randomized clinical trial of patients with shoulder impingement syndrome determined that thoracic manipulation decreased pain and improved scapular upward rotation i.e. lessened the impingement effect of scapular dyskinesis. Haik, Melina N. et al. Short-Term Effects of Thoracic Spine Manipulation on Shoulder Impingement Syndrome. Archives of Physical Medicine and Rehabilitation , Volume 98 , Issue 8 , 1594 – 1605
10.Belief about the relative risk of acute lumbar disc herniation (LDH) resulting from chiropractic spinal manipulation varies by profession. Chiropractors generally fell into a group with the most optimistic views, believing that chiropractic SMT reduces the incidence of acute LDH by about 60%. Family physicians expressed a neutral belief, while orthopedic surgeons comprised the majority of a group with the most pessimistic views believing that chiropractic SMT increases the incidence of acute LDH by about 30%. Hincapié, C.A., Cassidy, J.D., Côté, P. et al. Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study Eur Spine J (2017).
11.An electromyographic study confirms that athletes with rotator cuff tendinopathy demonstrate an aberrant patter of scapular movement, i.e. delayed activation of the serratus anterior and lower trapezius. This muscular dysfunction impairs upward rotation of the scapula resulting in further rotator cuff impingement. Leong HT. et al. Rotator cuff tendinopathy alters the muscle activity onset and kinematics of scapula. J Electromyogr Kinesiol 2017 Aug;35:40-46.
Reprinted with permission from Chiro Up
Simple Steps for Healthier Living
Many people feel that a healthy lifestyle entails inconvenience. But eating well, exercising, and taking care of your body doesn’t necessarily need to be time-consuming or expensive. Here are some simple ways to create healthier habits.
- Add more activity to your day by taking the stairs instead of the elevator. Park farther away for extra steps. Walk or ride a bike to complete errands.
- Find an activity that you’ll look forward to doing. Try rollerblading, cycling, or go hiking and explore some new trails in your area.
- Save money on a gym membership and perform body-weight exercises at home like push-ups, lunges, or wall squats.
- Prep healthy meals on the weekend to stay on track during the work week. Consider wraps, fruits, nuts, or salads with wet and dry ingredients packed separately.
- Eat mindfully by sitting down at the table- away from distractions like the computer or television.
- Practice smart portions. The protein on your plate shouldn’t be larger than the size of your palm. A serving of fat should only be the size of your thumb. Vegetables should be about the size of your hand- the fiber and volume will help keep you full.
- Carry a refillable water bottle everywhere you go and strive to drink at least 48-64 ounces per day.
- Bring your own lunch to work. It will save money and if you prep your lunches for the week on the weekend, it shouldn’t be a time-consuming chore.
- Take time out for yourself every night to de-stress. Common healthy stress-relievers include taking a warm bath, going for a walk, drinking a cup of decaf tea, painting, or meditating.
- Get more sleep at night by turning off all electronics at least an hour before bedtime.
Don’t feel that you need to make a complete transformation immediately. Changing your routine slowly and gradually tends to produce the best and most lasting results. Pick one tip and run with it today!
-Reprinted with permission from ChiroUP
For the second time in as many months, a prominent medical journal has endorsed spinal manipulation for the management of low back pain. (1) On April 11th 2017, JAMA published a systematic review of 26 randomized clinical trials to evaluate the safety and effectiveness of spinal manipulation for low back pain. The authors concluded:
“Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.”
This study comes on the heels of a February 2017 Clinical Practice Guideline from the American College of Physicians recommending spinal manipulation for acute, sub-acute, and chronic LBP. (2)
Low back pain (LBP) can arise from disks, nerves, joints, and the surrounding soft tissues. To simplify the task of determining “What is causing my LBP?” the Quebec Task Force recommends that LBP be divided into three main categories: 1) Mechanical LBP; 2) Nerve root related back pain; and 3) Pathology or fracture. We will address the first two, as they are most commonly managed by chiropractors. Making the proper diagnosis points your doctor in the right direction regarding treatment. It avoids time wasted by treating an unrelated condition, which runs the risk of increased chances of a poor and/or prolonged recovery. Low back pain is no exception! The “correct” diagnosis allows treatment to be focused and specific so that it will yield the best results. Mechanical low back pain is the most commonly seen type of back pain, and it encompasses pain that arises from sprains, strains, facet and sacroiliac (SI) syndromes, and more. The main difference between this and nerve root-related LBP is the ABSENCE of a pinched nerve. Hence, pain typically does NOT radiate, and if it does, it rarely goes beyond the knee and normally does not cause weakness in the leg. The mechanism of injury for both types of LBP can occur when a person does too much, maintains an awkward position for too long, or over bends, lifts, and/or twists. However, LBP can also occur “insidiously” or for seemingly no reason at all. However, in most cases, if one thinks hard enough, they can identify an event or a series of “micro-traumas” extending back in time that may be the “cause” of their current low back pain issues. Nerve root-related LBP is less common but it is often more severe—as the pain associated with a pinched nerve is often very sharp, can radiate down a leg often to the foot, and cause numbness, tingling, and muscle weakness. The location of the weakness depends on which nerve is pinched. Think of the nerve as a wire to a light and the switch of the nerve is located in the back where it exits the spine. When the switch is turned on (the nerve is pinched), and the “light” turns on—possibly in the outer foot, middle foot, inner foot, or front, back or side of the thigh. In fact, there are seven nerves that innervate or “run” into our leg, so usually, a very specific location “lights up” in the limb. Determining the cause of your low back pain helps your doctor of chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Let’s first look at the anatomy of the neck in order to better understand the structures of the cervical spine that can generate pain. Starting at the back of the spine, the facet joints allow us to move our neck and head in all directions, and each facet joint is surrounded by a joint capsule that is rich with nerve endings and when swollen, can generate pain both locally and radiating. One study of volunteers with existing neck pain looked at the various pathways that pain travels when investigators injected each individual facet joint capsule with normal saline solution. Interestingly, the subjects felt pain in parts of the body other than just the neck. For example, injecting the C6 facet joint capsule consistently reproduced radiating pain down the arm into the thumb side of the forearm and hand, similar to when a disk herniates and a nerve root is pinched. The primary difference was that a deep aching pain occurred in this area, as opposed to a more geographically well-defined pathway when a disk ruptures and pinches a specific nerve root.
The intervertebral disks are small shock absorbers that lie between each vertebral body. These disks are sort of like a jelly doughnut, which can sometimes leak out and pinch a nerve root producing pain (as well as numbness, tingling, and even weakness) that radiates along the course of the nerve. Poor posture is perhaps one of the most common causes of neck pain. The muscles in the chest tend to be stronger than those in the upper back and pull the shoulders forward resulting in forward head carriage with protracted shoulders. For each inch of forward head shift, an additional ten pounds is added to the weight of the head, which already weights around ten to twelve pounds. Hence, a five-inch forward head carriage places an additional 50 pound load on the upper back and neck just to hold the head upright!
Doctors of chiropractic are trained to identify these faulty postures and track down the pain generator(s) when a patients presents with neck pain. Through patient education, spinal manipulation, mobilization, exercise training, modalities, and more, chiropractors can greatly help those struggling with neck pain!
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For patients with chronic low back pain (cLBP), treatment guidelines recommend a non-surgical approach as the FIRST-LINE treatment. Ideally, the goal would be to avoid an initial surgery unless it’s absolutely indicated. That means, unless there is loss of bowel or bladder control or retention (which represents a medical emergency) or if there is progressive neurological motor and sensory loss, one can safely avoid surgery and conservatively manage the condition. Interestingly enough, a systematic review of the results from three randomized controlled studies carried out in Norway and the United Kingdom found the outcomes or results between the surgical fusion vs. non-surgical treatment of patients with cLBP showed NO DIFFERENCE at an 11-year follow-up! Studies have shown chiropractic to be highly beneficial for acute and chronic low back pain cases. In one study, researchers reviewed data on 72,326 cLBP patients in the Medicare system who received one of four possible treatment combinations between 2006 and 2012: 1) chiropractic only; 2) chiropractic followed by conventional medical care (CMC); 3) CMC followed by chiropractic; 4) CMC alone. The research team found that chiropractic care alone (group 1) resulted in the lowest costs, and these patients had lower rates of back surgery and shorter episodes of care. The group receiving CMC alone (group 4) had the highest costs, with the second and third groups being similar—both costing less and being more effective than CMC alone.
The conclusion of the study reads, “These findings support initial CMT [chiropractic manipulative therapy] use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.”
Content Courtesy of Chiro-Trust.org. All Rights Reserved.