Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle. When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.
Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year-olds and affects women more often than men.
Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.
Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day.
If you experience any of these symptoms, give our office a call 772-286-5277.
Phosphatidylserine(PS) is directly or indirectly implicated in practically every cell membrane from the brain and nervous system to hormone function and the adrenal glands. Although an exhaustive list of possible applications for the phospholipid is not included, the following are the primary scientifically backed reasons why anyone – from professional athletes to weekend warriors, even healthy athletes should consider adding PS from iStressedOut to their health, wellness and recovery regimen.
PS is an essential sports recovery supplement for the serious professional athlete and the weekend warrior.
Taking 2 iStressedOut tabs after every workout is the essential recovery advantage!
We Offer Affordable, Short Term Care For Your Relief Of Most Stress Related Health Issues.
Nowadays, almost every household owns a television, computer, and a smartphone – sometimes several of each. Although these devices make our lives easier, society has seen a significant increase in the amount of physical stress caused by excessive technology usage. Here are a few tech-related injuries that are on the rise and what you can do to prevent them.
1. Text Neck
Staring down at your cell phone places additional stress on your neck, shoulders, and upper back - causing pain with repetitive use. In fact, for every inch that your head tilts forward, your spine undergoes an additional 10 pounds of strain.
Prevent it: Be mindful of your posture while using your tech devices. Position your computer, tablet, or smartphone so that you’re not tilting your head downward. Ideally, when holding your head upright, the center of your screen should be at eye level.
2. Trigger Thumb
Sometimes called “texting thumb”, this condition is another repetitive stress injury caused by all that swiping, scrolling, and tapping on our cellphone screens.
Prevent it: If minimizing your overall screen time isn’t feasible, be sure to rest your hands and fingers. Switch sides often and stretch your muscles periodically. Enable and use voice recognition whenever possible.
3. Carpal Tunnel Syndrome
People with jobs that require a lot of keystrokes are at risk for Carpal Tunnel Syndrome, which is a painful condition of the wrist.
Prevent it: Try to minimize repetitive strain and learn to keep your wrists in a neutral position while working. Use keyboard and mouse wrist rests as not to allow your wrists to press against hard desk edges. Stretch your muscles periodically with an exercise like this.
4. Tech Arm
Holding your smartphone or tablet out in front of you for prolonged periods can cause elbow and shoulder pain.
Prevent it: Switch arms often to give your elbows a break from being in an awkward position. For time-consuming tasks, switch to an ergonomically-correct workstation.
There are many ways you can still use your devices and prevent these digital disabilities, but ultimately, reducing your screen time is the best course of action. Take frequent tech breaks and move your body to combat a sedentary lifestyle. If you do experience pain in the neck, thumb, wrist, or elsewhere, give our office a call at 772-286-5277.
Review the latest news:
*Avoiding surgery for rotator cuff tears
*Transverse friction massage is superior for lateral epicondylopathy
*Muscle energy tops mobilization for restoring shoulder ROM
*Chiropractic care excels for lumbar stenosis
*Ultrasound and TENS may not work for….
5 Treatments That Work
1. Journal of Shoulder & Elbow Surgery: “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. The operative and nonoperative outcomes at 5-year follow-up were not significantly different. 75% of patients remained successfully treated with nonoperative treatment at 5 years.” Boorman RS, More KD, Hollinshead RM, et al. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2018;27(3):444-448.
2. A study comparing the effectiveness of three common strategies for lateral epicondylitis (splinting/ stretching, cortisone injection, and transverse friction massage) concluded: “At 6-month follow-up, only patients in the deep friction massage group demonstrated a significant improvement in all outcome measures, including VAS pain score, DASH score, and grip strength.” Yi R, Bratchenko WW, Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand (N Y). 2018 Jan;13(1):56-59. doi: 10.1177/1558944717692088. Epub 2017 Feb 1.
3. JMPT: “Patients with mild to moderate carpal tunnel syndrome benefit from manual therapy including neurodynamic techniques.” Wolny T et al. The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2018 Dec 26. pii: S0161-4754(18)30334-8. doi: 10.
4. “Posterior shoulder tightness, defined as limited glenohumeral horizontal adduction and internal rotation motion, is a common occurrence in overhead athletes. (This study found) the application of muscle energy techniques to the horizontal abductors provides acute improvements to glenohumeral horizontal adduction, while joint mobilizations provide no improvements.” Reed, ML et al. Acute effects of muscle energy technique and joint mobilization on shoulder tightness in youth throwing athletes: a randomized controlled trial. Int J Sports Phys Ther. 2018 Dec; 13(6): 1024–1031.
5. A JAMA randomized clinical trial of 259 lumbar spine stenosis patients compared the effectiveness of three non-surgical options:
The results: “manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care or group exercise.” Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open.2019;2(1):e186828. doi:10.1001/jamanetworkopen.2018.6828
5 Less Promising Interventions
6. A Cochrane Database systematic review concluded: “Acupuncture and laser acupuncture may have little or no effect in the short term on symptoms of carpal tunnel syndrome in comparison with placebo or sham acupuncture.” Choi GH. Et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev. 2018 Dec 2;12:CD011215. doi: 10.1002/14651858.CD011215.pub2. [Epub ahead of print]
7. A study of 54 patients concluded “the addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis.” Yigal Katzap, Michael Haidukov, Olivier M. Berland, Ron Ben Itzhak, and Leonid Kalichman. Additive Effect of Therapeutic Ultrasound in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy 2018
8. A clinical trial of 97 patients: “This study does not support the use of TENS in the treatment of patients with chronic LBP.” Garaud T. et al. Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation. Medicine (Baltimore). 2018 Dec;97(52):e13782. doi: 10.109
9. An RCT of 61 TMD patients concluded: “The efficacy of manipulation seems to be limited, in contrast to our expectations. The advantage of manipulation was observed only during the first treatment session.” Nagata K et al. Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy. J Prosthodont Res. 2018 Dec 15. pii: S1883
10. “Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective.” Jenkins HJ, Moloney NA, French SD, et al. Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. BMC Health Serv Res. 2018;18(1):734. Published 2018 Sep 24. doi:10.1186/s12913-0
5 Thought-Provoking Studies
11. The fascial system includes solid and liquid fascia, closely inter-linked, without interruption. Each cell communicates with neighboring cells by sending and receiving signals. Therapeutic touch at the skin triggers cell deformation which sends electromagnetic and mechanometabolic messages throughout the entire body–like electricity in water. This concept is known as quantum entanglement. Bordoni B, Simonelli M. The Awareness of the Fascial System. Cureus. 2018;10(10):e3397. Published 2018 Oct 1. doi:10.7759/cureus.3397
*Our friend and mentor Dr. Tom Hyde commented on this research and reminded us of the incredible “Strolling under the skin” video from Dr. Jean-Claude Guimberteau that provides a fascinating look into the fascial system. You can check out the full 28 minute version or this brief clip.
12. A new study mapped carpal tunnel pain vs. paresthesia: “Painful symptoms were clearly centered over the carpal tunnel and were reported much less frequently in the digits. Non-painful sensory disturbances (e.g. numbness, paresthesias) were found to have a much more peripheral and lateral distribution.” Nelson JT et al. Patient Reported Symptom-Mapping in Carpal Tunnel Syndrome. Muscle Nerve. 2018 Dec 14. doi: 10.1002/mus.26398. [Epub ahead of print]
13. Following ankle sprain, the supporting muscle (peroneus longus) undergoes fatty degeneration with resultant loss of strength. This process “increases with increasing frequency of ankle sprain” – with obvious implications for chronic ankle instability. Sakai S et al. Quantity and quality of the peroneus longus assessed using ultrasonography in leg with chronic ankle instability. J Phys Ther Sci. 2018 Dec;30(12):1396-1400. doi: 10.1589/jpts.30.1396. Epub 2018 Nov 21.
14. Q: How thick is an average healthy disc?
A: Generally less than 9mm
An imaging analysis of 240 healthy spines measured the height of the intervertebral disc and compared those measurements against age and gender: “Variation in disc height is determined much more by sex rather than age. The maximum height of the interbody space in the adult lumbar spine was at the L4/5 level (8.9±1.7 mm males, 8.6±1.8 mm females).” Bach K et al. Morphometric Analysis of Lumbar Intervertebral Disc Height: An Imaging Study. World Neurosurg. 2018 Dec 19. pii: S1878-8750(18)32836-5. doi: 10.1016/j.wneu.2018.12.014. [Epub ahead of print]
15. A new JAMA article discussed the link between dementia and chronic pain: “compared with pain-free controls, those with chronic pain showed a more rapid decline in memory and increased probability of dementia.” (Whitlock et al) “These findings are especially relevant for patients with low back pain given that current pharmacotherapy has the potential to cause central nervous system depression and further compromise cognition.“ (Bailey et al) Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med. 2017;177(8):1146-1153. Bailey DM et al. Low Back pain. Lancet. Volume 392, Issue 10164, P2548, December 15, 2018
Can you reduce the cortisol response to stress right now? Yes. This is the precise impact that the short range strategies will provide for you. These reliable, safe and healthy strategies will impact your symptoms by stopping the downward spiral of your health and your stress system. The first action step is supplementing your body with iStressedOut™, a phosphatidylserine product formulated to modulate your cortisol response to stress. iStressedOut is now available from Coastal Medical and Wellness Center.
There are over 3,000 published research studies that have confirmed that phosphatidylserine can rejuvenate your brain cell membranes, strengthen your memory, increase vigilance and attention, boost learning, increase mental acuity, intensify your concentration, relieve depression and improve your mood, inhibit exercise and stress induced increases in cortisol, AND decrease stress whether you are young or old. Let’s take a closer look at this valuable treatment strategy that is available to everyone.
Phosphatidylserine (abbreviated PS) is 1 of 5 phospholipids essential to the functioning of every cell in your body. All the phospholipids contribute to the structure and composition of every cell membrane in your every cell of your body 63. PS is unique in that it regulates the functional state of key proteins of cell membranes, 64, 65, 66, 67 , 68 , 69 , 70 , 71 and helps membrane-to-membrane union, which is a central process in nerve transmitter release 72 and activates cell surface receptors.73,74,75 PS supports nerve signal transferring, the process of how the cell responds to chemical signaling substances.
Several studies in the US and Europe have shown that PS extracted from cow brain improves the intellectual and memory function of the elderly 76,77,16,17 including Alzheimer’s disease patients 78, 79, and people with age associated memory impairment 80. However, the use of PS made from cow brain sources is now discouraged because of the risk of Mad Cow Disease. 81 These problems have been overcome by isolating, extracting and purifying PS derived from soy which has led to the development of enzymatically made PS from soy lecithin that makes it risk free from getting Mad Cow Disease. 82
Many people are allergic to soy. For many of these people, no matter how perfect the PS is extracted in the manufacturing process, the end result remains that some of these people may react to PS. Some people cannot even take soy lecithin without reacting. Even if there is no obvious reaction, the body may have a hidden response below the surface of the iceberg! These people should avoid PS nutritional supplements derived from soy.
The most important contributions of PS to the structure and function of individual nerve cells are expressed in the performance of the brain as a whole. More than 35 human studies in 3 decades indicate PS supports improved brain function that can be measured in many ways including: brain wave integration, the Brain-Adrenal Connection (hypothalmic-pituitary-adrenal axis), and bio-rhythms of hormone release. Some 16 clinical trials indicate that PS benefits measurable intellectual and brain functions which tend to decline with age such as: memory, learning, vocabulary skills and concentration, as well as mood, alertness and sociability.
PS is a phospholipid, abundant and present in every cell membrane and essential for All cells of the body. PS should be considered a semi-essential nutrient. It can be made in your body from many smaller pieces of nutrients, its multi-step creation requires massive amounts of energy that must be stolen from other parts of your metabolism. It is very inefficient and is energetically costly. It is like using corn to make fuel for your car. You have hybrid fuel that costs more than regular gas and you now have no corn to eat!
With its proven benefits against age-related mental decline, phosphatidyl serine represents a truly safe and effective means for improving the quality of life.83
Phosphatidyl Serine is absorbed in the blood about one half-hour to one hour after being taken, and it reaches the brain within minutes after that. Phosphatidylserine is especially helpful for people over 50 and for people who may have prematurely damaged brain cell membranes due to disease, alcohol, drug use, pollution or other causes, and it protects against stress hormone release in adults of any age.84
The hip is a very unique joint. The depth of the socket, the strength of the muscles and ligaments surrounding it, and the way it functions in weight bearing activities is unlike any other joint in the body. The focus this month is on the relationship between the hip and the rest of the body.
The hip joint is a synovial joint, meaning it moves freely. It is a ball-and-socket joint that is made up of the femoral head (the “ball”) and the acetabulum (the “socket”). The ball is largely contained within the cup or socket, though there are genetic and cultural differences with regards to the depth and shape of the hip joint in any one individual.
The relationship between the hip and the surrounding joints is intimate in that each joint affects the next. For instance, ankle pronation—or the inward rolling of the foot and ankle—results in a knocked knee, which can then shift the hip outwards. The pelvis then drops down on that side, the tailbone or sacrum becomes unleveled or sloped, and the lower spine curves to compensate with the ultimate goal of keeping your eyes level. Hence, when your hip hurts, your doctor of chiropractic will examine and treat the ENTIRE lower kinetic chain—the foot, ankle, knee, hip, pelvis, and spine—as ALL are so closely related to each other. When it comes to managing you and your hip pain, be prepared for management of any of the following:
Once ankle pronation is properly corrected with a rear foot post and the hind foot is repositioned back to neutral (if LLD persists) a heel lift can be placed under the foot orthotic to corrective this imbalance. ONLY then will the pelvis become level and stable so it can properly serve as a strong foundation for the spine the rest of the body to rest on!
We haven’t touched the subject of muscle imbalance, strengthening of commonly weak hip extensor muscles, or stretching of overly tight hip flexors and adductor muscles—topics for another day! The good news—doctors of chiropractic can help you with this common problem!
Last month, we discussed common causes of back pain including mattresses, shoes, diet, exercise, and posture. Here are some additional considerations…
6. OFFICE CHAIR: Because of vast differences between people’s height, weight, body type, and preference, it’s difficult—if not impossible—to find a one-size-fits-all solution when it comes to office chairs! In the ideal world, the option to sit, stand, walk, and stretch as needed would be perfect but this simply is not reality! Low back pain (LBP) from sitting is common due to the excess pressure it places on the joints and disks (the “shock-absorbers” of the spine). Here are some remedies: 1) Find a chair that FITS YOU. 2) Get up and move at least once every hour (set the timer on your smartphone as a reminder). 3) Place the computer monitor directly in front of you and keyboard/mouse so the elbows bend only 90°. 4) Keep your feet on the floor at your desk (use an upside down box if you have short legs). 5) Perform “in the chair” stretches when your timer goes off!
7. BODY TYPE: We’ve discussed obesity as an obvious cause of back pain, but other factors are important as well. A very common cause of back pain for women is breast size. Here, the topic of a supportive bra is important, as carrying more weight in front of you adds additional stress on the back and shoulders.
8. SHOULDER BAGS: Back pain can be caused and/or perpetuated by a heavy purse, bag, briefcase, and even a thick wallet in the back pocket! To keep your eyes level, your body has to compensate and assume a less-than-ideal posture that may place unnecessary stress on your back! So before leaving the house today, CLEAN OUT that bag and/or put your wallet in a front pocket and lessen the load on your spine!
9. SMOKING: Smoking can reduce the amount of oxygen that reaches your cells, which can cause them to function at a less than optimal state. You’ve perhaps heard that a conscientious back surgeon will NEVER operate on a smokers’ back due to both the prolonged healing time and subsequent bad outcomes. So in addition to giving your heart, lungs, and those around you a break, if you want your lower back to heal, STOP SMOKING! Studies also show smokers are TWICE as likely to develop LBP compared with non-smokers, so quit. Better yet, DON’T START in the first place!
10. STRESS & DEPRESSION: Remember, “health” is a balance between structure, chemistry, and mental factors. Stress increases muscle tightness and alters posture in a way that can lead to or exacerbate existing LBP. Exercise, meditate, eat smart, and resolve your differences with family members and friends to minimize this problem! When needed, your doctor of chiropractic can refer you for counseling!
11. ERGONOMICS: How we “fit” into our job, lifting properly, workstation set up, work pace, and work stressors ALL play into LBP management. Have an assessment to see what can be fixed!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
Most allergies involve the release of histamine and other substances that produce inflammation, this acts like a blow torch on your body. Your body's first defense mechanism is to make cortisol to put out the fire (inflammation). Your body must have enough cortisol circulating or at least available in order to control the level of inflammatory reactions in the body. It is easy to understand that your first line of defense the healthy adrenal function plays an important role in controlling the allergic-histamine release and inflammatory reactions that produce allergy symptoms.
When your adrenals are fatigued, and they do not or cannot make enough cortisol to stop the allergic reactions you may notice that you have more allergies or your allergies get worse.
The more histamine your body makes, the harder the adrenals have to work to produce enough cortisol, the more fatigued the adrenals become. It is very common that people with food and environmental allergies also have adrenal fatigue. This causes a repeating downward spiral of lower cortisol allowing histamine to inflame the tissues more, leading to more adrenal fatigue and causing bigger allergic reactions.
Actively supporting your adrenal glands and eliminating or reducing your exposure to foods and other substances that cause allergic or sensitivity reactions can help break this cycle as well as strengthen adrenal function. We Offer Affordable, Short Term Care For Your Relief Of Stress Related Health Issues.
Cervical spondylosis (CS) is another term for osteoarthritis (OA) of the neck. It is a common, age-related condition that you will probably develop if you live long enough. Or, if you suffered a neck injury as a youth, it can develop within five to ten years of the injury, depending on the severity.
It is basically caused by the “wear and tear” associated with normal daily living to which some refer to as “the natural history of degeneration.” According to the Mayo Clinic, CS or OA affects more than 85% of people over 60 years old, and that is probably a conservative estimate!
Common symptoms associated with CS/OA vary widely from no symptoms whatsoever to debilitating pain and stiffness. For example, when CS crowds the holes through which the nerves and/or spinal cord travel, it creates a condition called spinal stenosis that can result in numbness, tingling, and/or weakness. In severe cases, this can even affect bowel or bladder control (which is an EMERGENCY)!
CS occurs when the normal slippery, shiny cartilage surfaces of the joint(s) gradually thin and eventually wear away from excessive friction caused by years of repetitive use related to a job, sport, or just time. Bone spurs often form, which results from the body trying to stabilize an unstable joint. In some cases, the spurs can actually fuse a joint, which often helps reduce pain. (Bone spurs can also form if the intervertebral disks or shock-absorbing pads between the vertebrae are injured or become dehydrated due to arthritic conditions.)
Risk factors associated with CS include: aging, injury, years of heavy lift/carry job demands, and jobs and/or hobbies that require the neck to be outside of a neutral position (like years of pinching a phone between the ear and shoulder). Genetics and bad habits (like smoking) also play a role in CS. Obesity and inactivity also worsens the severity of CS symptoms.
The good news is that even though most of us will have CS, it is usually NOT a disabling condition. However, CS may interfere with our normal activities. Depending on its location, pain may feel worse in certain positions, like when sneezing or coughing or with movements like rotation or looking upwards.
Stiffness is a common symptom, which can vary with weather changes. Too little as well as too much activity can be a problem, but the BEST way to self-manage CS is to keep active! Range of motion exercises, strength training, and walking all help reduce the symptoms of CS.
Doctors of chiropractic are trained to identify CS/OA. Gentle manipulation, mobilization, nutritional counseling, exercise training, modalities (and more) can REALLY HELP!
Cliff Atwell, B.S., D.C.