Glossary

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This is when wear-and-tear arthritis degenerates the meeting point between the shoulder (scapula) and the collar bone (clavicle).

This is an AC joint sprain, taken to and beyond the joint’s limits.  Also called “separated shoulder.”

This is when the collar bone (clavicle) and the shoulder bone (scapula) are traumatized.  This condition can be very painful, long-lasting, and can disrupt the movement of the entire shoulder complex.

The Achilles tendon connects the powerful calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus).  Tendonitis (inflammation of the tendon and/or the sheath around it) can vary from an annoyance, to severe.  In some cases the tendon may degenerate to the point of rupture, which is always addressed via surgical repair.

Treating Achilles tendonitis may include treatment to the tendon itself.  Certain specialized forms of soft tissue manipulation are especially helpful.  In athletes, correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as running on banked roads, or always running the same direction around a track) may be a part of management.  Addressing the entire biomechanical chain is also recommended in most cases.  This means that the foot and its bones, the ankle, the knee, the hip, the sacroiliac joints, the spine, and the area’s muscles and nerves must all be considered as contributors to the problem, and the solution.  Custom orthotics may be of value.  Dry needling and/or acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

The art, science, and philosophy of treating disease and injury by stimulating specific energy modulating points on and beneath the skin. Methods of stimulation include, but are not limited to: needle insertion, electrical stimulation, light, heat and pressure (acupressure).  Acupuncture addresses a wide variety of health conditions which includes all systems and tissues of the body and focuses special attention to the relationship between the spine, nervous system and the meridian system.  Acupuncture is inclusive of all diagnostic and therapeutic principles and procedures that are consistent with Western, scientifically-validated methods.

According to the 2002 National Health Interview Survey, an estimated 8.2 million Americans have been to an acupuncturist, and an estimated 2.1 million U.S. adults used acupuncture in the previous year. Since the use of acupuncture has spread widely in the U.S. in the past 20 years, researchers are studying the benefits of acupuncture for many conditions, including low-back pain, headaches, and osteoarthritis of the knee.

Acupuncture may be useful as an independent treatment for some conditions, but it can also be used as a complement to other healthcare therapies.  [source: American Chiropractic Association]

The most common ankle sprain is a sudden over-stress to the anterior talo-fibular ligament on the lateral (outside) of the foot.  It is possible to hear a “pop” sound during an ankle sprain, even when no fracture occurs.  Bruising and pain may occur on the outside of the ankle, on top of or beneath the foot, or on the lateral (outside) aspect of the leg where the peroneal muscles reside.  In very severe cases, the peroneus brevis tendon can pull a piece of bone off the foot (avulsion fracture of the base of the 5th metatarsal).

As with all conditions, treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  First-line of treatment for an ankle sprain is PRICE:  Protect it (remove stress, tape, use a brace if practical and necessary), Rest it, Ice/cool it (see separate guidelines on ice/cooling as anti-inflammatory therapy), Compress it (wrapping & taping are popular methods), and Elevate it (to drain excess fluid).

After acute management, treatment should begin promptly.  Nutritional therapy may be an important anti-inflammatory and healing consideration.  Certain specialized forms of soft tissue manipulation to the peroneus longus, peroneus brevis, and anterior talofibular ligament are especially helpful.  Addressing the entire biomechanical chain is also recommended in most cases.  Adjusting the foot (especially the cuboid bone) is often indicated;  but addressing the ENTIRE biomechanical chain means considering the foot and its bones, the ankle, the knee, the hip, the sacroiliac joints, the spine, and the associated muscles and nerves.  Custom orthotics may be of value;  though this is not necessarily a component of “ankle sprain” management, they may be a factor in returning the individual or athlete to full and high levels of function.  Dry needling and/or acupuncture may play a role.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases – though stretching a stretched ligament is specifically contraindicated.

The muscles in front of the shin serve to raise the toes (dorsiflexion) and turn the foot inwards.  They also control the motion of the foot and ankle, allowing control and impact adaptation during running or walking gait.  When overwhelmed (uphill running is one culprit), the muscles can become inflamed.  In more severe cases, normal walking or running becomes impossible.

Treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  In this area, muscular pain must be differentiated from stress fracture.  Also, muscle-based anterior shin pain must be differentiated from anterior compartment syndrome, a situation where the “compartment” containing these muscles, and related nerves and blood vessels, is too small to accommodate exercise-induced increases in pressure.

The feet (especially those that spend too much time in pronation, so-called “over-pronation”), the knees, the hips, the sacroiliac joints, and the lumbar spine may contribute to these strains—and thus, may be a part of addressing the problem.

Treatment will likely include soft tissue manipulation.  This may or may not be sufficient to avoid surgical correction in cases of anterior compartment syndrome.  Dry needling is one very effective tool that can be used to directly affect myofascial trigger points and optimize healing rates.  In athletes, correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as running on hills without adequate build-up) may be a part of management.  Acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

Arth means “joint.” Itis means “inflammation.” “Arthritis” means inflammation of joints, i.e. inflammation where two bony surfaces meet. There are two main categories of arthritis: Systemic, which includes rheumatoid arthritis, gout, Lyme disease, and others; and “wear-and-tear” or osteoarthritis (AKA degenerative joint disease or DJD).  Systemic arthritis may be autoimmune, as in Rheumatoid;  in these cases, the body attacks its own joint linings as if they were invaders or foreign.  Osteoarthritis is the result of microtrauma (daily wear, such as standing for hours on end, that adds up over the years) or macrotrauma (such as falls, car accidents, and sports injuries).

Proper treatment for arthritis depends on the severity of the condition, as well as the type of arthritis.  Failing joints may be good candidates for replacement;  though recent product recalls offer a sobering caution (yes, companies have actually recalled their defective or sub-optimal joint hardware after it was implanted in patients).  Pain-killing medications and injections are merely stop-gap measures that delay the inevitable;  and some of these drugs may in fact accelerate joint destruction.  Modern science is working on regenerating joint cartilage, and injections of joint fluid substitutes may prolong joint function and decrease pain;  but conservative management is preferred when feasible.  Hydrate your joints with fluid, preferably by drinking water.  Keep joints strong, and avoid over or under –use.  Proper biomechanical function—the key area that doctors of chiropractic work with—is highly likely to preserve joint function.  Additionally, conservative care may include:  anti-inflammatory therapy for inflamed tissues; soft tissue manipulation (chiropractic soft tissue manipulation techniques and/or massage therapy); needling techniques (acupuncture—which is especially effective for osteoarthrosis of the knee); chiropractic spinal manipulation/adjusting to restore normal function to each affected joint, and to optimize nerve function to the affected joint(s); and therapeutic rehabilitative exercises to ingrain normal function and prolong its functional life.

Also known as: Herniated Disc

The cartilage pads between your back bones (vertebrae) are called discs, or intervertebral discs.  The center (nucleus pulposus) is under pressure;  and this pressure changes dramatically with stress and load.  If the outer ring (annulus fibrosus) is overwhelmed, the pressurized center can bulge through it.  If this bulge presses on a nerve, it may cause symptoms at the site of the spinal bulge, and/or where the nerve travels.  This may cause numbness, tingling, pain, or weakness down the arm or leg.  Disc herniation is especially common in the low back (lumbar spine), though it can occur anywhere in the spine.  The second most common site, after the low back, is the neck (cervical spine).  Discs are themselves very pain sensitive, and a bulging disc can cause considerable pain at the site of the herniation.


Proper diagnosis may include diagnostic imaging such as MRI, a clinical diagnosis based on a doctor’s examination, or both.  It is important to note that some degree of disc abnormality – including disc bulging – is present in up to 1/3 of the asymptomatic population, so MRI alone may not tell the full story of why you hurt, or do not.

Surgery (including various forms of discectomy and decompressive laminectomy) is not the first line of defense for bulging or herniated discs, as outcomes are poor.  The only clear exceptions are the cauda equine syndrome, where a disc herniation is damaging bowel and/or bladder function;  and progressive neurological deficit, where the condition is worsening over time and permanent loss of function is a risk.  Anti-inflammatory medications and injections do not improve function, though they may in some cases reduce inflammation and pain.  Though this sounds like a good thing, it is not--  you may be overriding protective signals, thus allowing your body to hurt itself considerably.

Since discs are often 65-92% water, hydrate well -- preferably by drinking water.  Core strength, balance, and control are also key (your doctor of chiropractic can tell you more, and guide you appropriately).  Stop smoking—smoking dries out the disc.  In addition, spinal manipulation (sometimes called spinal adjustments) are often very effective at restoring local joint (facet) motion and decreasing local nerve irritation;  and dysfunction of the facet joints may in fact be a correctible cause of failed discs.  Specialized chiropractic techniques like Cox Flexion-Distraction (see) are particularly gentle, safe, and effective ways of “pumping” nutrition to discs and allowing inflammatory waste products to drain from around the nerve roots.  Additionally, conservative care may include:  anti-inflammatory therapy for inflamed tissues; soft tissue manipulation (chiropractic soft tissue manipulation techniques and/or massage therapy directed at protective muscle spasms [note:  treating this symptom needs to be done wisely, as the protective mechanisms—though painful—also serve the function of limiting further injury); needling techniques (acupuncture and/or dry needling); chiropractic spinal manipulation/adjusting as noted to restore normal function to each affected joint, and to optimize nerve function to the affected joint(s); and therapeutic rehabilitative exercises to ingrain normal function and prolong its functional life.

Bursitis is a painful condition that affects the small fluid-filled sacs or pads — called bursae — that act as cushions vs. friction. Bursitis occurs when bursae become inflamed.

The most common locations for bursitis are in the shoulder, elbow, knee (patellar; iliotibial band friction), and hip. Bursitis often occurs near joints that perform frequent repetitive motion or have considerable friction (such as at the knee, with kneeling; or at the side of the knee with running or cycling).

Simply resting the area may provide some relief; though, like pain-relieving medications and injections, failure to address underlying biomechanical faults sets you up for re-injury. Proper management may initially include PRICE (Protect, rest, ice/cool, compress, elevate the affected part if feasible) and natural reduction of inflammation (dietary modifications, cryotherapy [see]). Other conservative interventions may include soft tissue manipulation (chiropractic soft tissue manipulation techniques and/or massage therapy); needling techniques (acupuncture; dry needling for acute or persistent trigger points); supportive devices such as custom orthotics (knee and hip bursitis can result from foot dysfunction); chiropractic manipulation/adjusting to restore normal function to the kinetic chain (example: hip “bursitis” may be the result of sacroiliac joint dysfunction, and may possibly not be a true bursitis at all); and therapeutic rehabilitative exercises to ingrain normal function and decrease likelihood of recurrence.

The calf muscles consist of superficial and deep muscles that help us push off when walking, running, jumping, or standing on tippy-toes.  The deeper muscles attach beneath the foot and help stabilize, absorb impact shock, and control subtle but important motions of the foot and ankle.  The more superficial muscles are very powerful, and they attach to the heel bone (calcaneus) via the Achilles tendon.  These superficial calf muscles are the gastrocnemius (which plays a role in knee flexion, as well as in ankle push-off), and the soleus.  When overwhelmed due to acute (sprinting) or chronic (misuse/overuse) stress, the muscles can rip or tear (grade 2 or 3 strain), or can microtear (grade 1 strain).  This can be very painful.

Treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  Calf strain must be differentiated from more sinister entities, as clots from the legs can travel to the lung with disastrous consequences.  The feet (especially those that spend too much time in pronation, so-called “over-pronation”), the knees, the hips, the sacroiliac joints, and the lumbar spine may contribute to calf strains—and thus, may be a part of addressing the problem.

Treatment will likely include soft tissue manipulation.  Dry needling is one very effective tool that can be used to directly affect myofascial trigger points and optimize healing rates.  In athletes, correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as running on banked roads, or always running the same direction around a track) may be a part of management.  Acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

True carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist. A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems, patterns of hand use (including your workstation setup)-- even pregnancy.

Bound by bones and ligaments, the carpal tunnel is a narrow passageway — about as big around as your thumb — located on the palm side of your wrist. This tunnel protects a main nerve (median nerve) to your hand and nine tendons that bend your fingers. Compression of the nerve produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome. True carpal tunnel syndrome never affects the pinkie.

Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the pain and numbness and restore normal use of their wrists and hands. SEE ALSO THORACIC OUTLET SYNDROME.

Treating the condition—as with all conditions, illnesses, and diseases—requires proper diagnosis. T.O.S. must be differentiated from Carpal Tunnel Syndrome (see). By determining which tissues are irritating the nerves or nerve trunk, the doctor of chiropractic can address them appropriately (adjusting, soft tissue manipulation, acupuncture, dry needling). Braces may or may not help the condition.

 
Also see: Thoracic-Outlet Syndrome (T.O.S.)

A health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.  Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.

Doctors of Chiropractic – often referred to as chiropractors or chiropractic physicians – practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.  [source: American Chiropractic Association]

One of your main enemies may be your chair. Sitting -- especially in front of your computer or driving long distances -- is a tremendous stress to your spinal discs. Discs require motion for proper nutrition, so consider taking frequent breaks. Be sure your feet are comfortably placed, and adjust your seat if possible so that your neck isn’t tipped too far forward or back for long periods of time. Also, be sure your computer monitor is located directly in front of you. Here’s a simple way to locate a good position for your monitor: Sit comfortably in your chair, and close your eyes. Adjust your body until you feel comfortable. Open your eyes, and you should be looking at your monitor. If you have to look up, down, or to the side, then your monitor isn’t where it should be. Relocate it.  And remember:  Doctors of chiropractic are fully and expertly trained in the human body and ergonomics (the relationship of the human body to our work and play environment).  Take advantage of their expertise and live, better.

Degenerative Disc Disease is a long term meaning "spinal arthritis" due to drying out of the spinal discs.  Between your back bones lies a cushion called an intervertebral disc or "disc" for short.  This cartilage is mostly water-- up to 92% water in a very young, healthy person.  As we age, these discs dry out ("desiccate"), which means less shock absorption between your spinal bones, and less space for the delicate nerve roots that exit the spine via portholes called "foramina" ("intervertebral foramina" or IVF''s).  This can result in stiffness (especially with inactivity, or excessive sitting, or exercise), or nerve symptoms (sciatica, numbness, pain, or weakness wherever the nerve travels).  That pain in your foot, or the weakness in your grip may be related to your spine, and DDD.  Surgical options include replacing the disc with an artificial device;  or cutting away bone (foraminotomy, laminectomy) in order to free up space for the affected nerve(s).  Conservative, non-invasive methods include the use of therapeutic exercises and teaching adaptive postural strategies, nutritional support (especially emphasizing proper hydration), acupuncture to modify pain perception and improve the ability to engage in normal motion patterns, and spinal manipulation.  Spinal manipulation may include classic, hands-on adjusting of vertebrae, thus normalizing stresses applied to the disc;  or techniques like Cox Flexion-Distraction to gently "pump" nutrition to the discs and free up the IVF.


Also see: Osteoarthritis

Though the hip rarely dislocates, the shoulder (glenohumeral joint) fairly commonly does so.  This occurs exclusively through trauma.  Repeat dislocations can cause instability and glenoid labrum tears (see).  The more times you’ve dislocated a shoulder, the more likely it is to re-occur.

Dry Needling is “a physiologic therapeutic technique and procedure. Its purpose is to neutralize soft tissue, [release myofascial trigger points], and to restore and improve muscle and fascial function. This treatment mechanically disrupts physiologically locked tissue. It consists of insertion of a monofilament, sterile, thin-gauge needle, a needle that also happens to be used by acupuncturists.” He adds, “The soft-tissue entities in the periphery are influenced by and influence the central and peripheral nervous systems."

Comparison to acupuncture:  “The dry needling procedure works with myofascial trigger points and tender points. It is based on Western concepts of anatomy, physiology, neurology, and biomechanics. The only common element is the choice of tool.”

Source:  American Chiropractic Association (JACA).  Quotes by Dr. David Fishkin.

Frozen Shoulder (glenohumeral adhesive capsulitis)

Frozen shoulder is a disorder in which the shoulder capsule, the connective tissue surrounding the main (glenohumeral) joint of the shoulder, becomes inflamed, contracted (shortened), and stiff. This limits normal motion and causes chronic pain and loss of function.

Adhesive capsulitis is a painful and disabling condition that often causes great frustration for patients and caregivers due to slow recovery. Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, and when the weather is colder; and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.

Patients often ignore the condition until pain sets in, or when basic life functions become difficult or impossible (putting on or taking off a bra; leisure activities; basic bathing and toileting functions). The condition is usually preceded by some form of injury/trauma or disuse. A stroke is one known way this condition may develop.

Proper treatment often includes natural reduction of inflammation (dietary modifications, cryotherapy [see]); manipulation of the cervical spine (the nerves of which control the shoulder joint and related muscles); manipulation of the thoracic spine, which medical literature suggests (when in combination with treating the shoulder directly) is more effective than physical therapy to the shoulder alone; manipulation of the shoulder complex (glenohumeral joint, scapulothoracic joint, etc.); acupuncture; dry needling; specific therapeutic exercises; and soft tissue manipulation-- especially to the tissues that form the rotator cuff.


Also see: Frozen Shoulder

This occurs when the fibrocartilage “cup” holding the arm bone (humerus) into the scapula tears.  Most commonly, this is associated with trauma such as a dislocation.  Includes SLAP Lesions & Bankart Lesion.

Golfer's elbow is pain and inflammation on the inner (medial) aspect of the elbow, where the tendons of the forearm muscles attach to the bony bump on the inside of your elbow (medial epicondyle). The pain may spread into your forearm, and even your wrist.

Interestingly, tennis elbow (SEE) may be more common in golfers than golfer's elbow.

Any activity or sport that requires repeated use of wrists or strong grips may cause golfer's elbow.

Simply resting the area may provide some relief; though, like pain-relieving medications and injections, failure to address lifestyle and/or ergonomic faults (poor workstation setup, poor or suboptimal golf form, bad habits) sets you up for re-injury. Proper management may initially include PRICE (Protect, rest, ice/cool, compress, elevate the affected part as feasible) and natural reduction of inflammation (dietary modifications, cryotherapy [see]). Other conservative interventions may include soft tissue manipulation (chiropractic soft tissue manipulation techniques and/or massage therapy); needling techniques (acupuncture; dry needling for acute or persistent trigger points); chiropractic manipulation/adjusting to restore normal function to the kinetic chain (adjusting the elbow or cervical spine, for example); and therapeutic rehabilitative exercises to ingrain normal function and decrease likelihood of recurrence.

The hamstrings are the muscles at the back of the thigh.  They are the biceps femoris (yes, there’s a “biceps” in the thigh), the semitendinosus, and the semimembranosus.  When overwhelmed due to acute (sprinting) or chronic (misuse/overuse) stress, the muscles can rip or tear (grade 2 or 3 strain), or can microtear (grade 1 strain).  This can be very painful.

Treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  Hamstring strain is more complicated than it might at first seem, and can be caused by faulty movement patterns and neurological mis-firings.  The feet, the knees, the hips, the sacroiliac joints, and the lumbar spine may contribute to hamstring strains—and thus, be a part of addressing the problem.

Treatment will likely include soft tissue manipulation.  Dry needling is one very effective tool that can be used to directly affect myofascial trigger points and optimize healing rates.  In athletes, correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as running on banked roads, or always running the same direction around a track) may be a part of management.  Acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

Cervical spine (neck) based headache - Some headaches originate in the neck;  in fact, up to half of all headaches may relate to the cervical spine and suboccipital (base of the skull) region, rather than originating in the head itself.  By manipulating the tissues and bones of the neck, doctors of chiropractic can decrease irritation to tissues that can cause these headaches… especially irritated nerves.  Needling techniques (acupuncture, dry needling) address local nerve function, blood flow, and muscle tension/tone -- all factors in cervicogenic headaches.

These headaches are characterized by recurrent, severe, unilateral [one-sided] orbitotemporal [around the eye and temples] pain associated with ipsilateral photophobia [one-sided aversion to bright light], lacrimation [crying/weepy eye], and nasal congestion.  One theory is that they are caused by a hypersensitivity to histamine;  but long-term drug (pharmacological) therapy may be a losing battle.  These headaches may respond well to acupuncture, which lacks the side effects of many common medications.

These very painful, sometimes overwhelming headaches are characterized by pain in the head, vertigo (dizziness), nausea and vomiting, phonophobia [aversion to noise], and scintillating appearances of light.  Sub-classifications include classic migraine, common migraine, cluster headache, hemiplegic migraine, ophthalmoplegic migraine, and ophthalmic migraine.  Chiropractic, acupuncture, or a combination of the two may have a role in management-- both before the headache, and during it.  The latter is called "abortive" intervention;  the former, "preventative."

Headache associated with nervous tension, anxiety, etc., often related to chronic contraction of the scalp muscles.  Sometimes called muscle contraction headache.  Chiropractic, acupuncture, or a combination of the two may have a role in management.  Studies show very favorable results, with fewer side effects and longer-lasting benefits, compared to common pharmaceutical (drug) therapies.

Also known as: High Blood Pressure

The so-called “standard” approach to hypertension is to use drugs.  Why does blood pressure increase?  That question is rarely addressed.  If chronic stress is a factor, taking steps to mitigate those stressors is wise (see “Stress”).  Atherosclerosis (hardening of the arteries) and systemic inflammation may also contribute; as do dysfunctions or maladaptations of the nervous system.  A study has shown that certain specific chiropractic adjustments (spinal manipulation) may be able to at least temporarily lower blood pressure.  Acupuncture has also been demonstrated to do the same.  Neither has any of the negative side-effects associated with pharmaceuticals (drugs/pills).

Theories of how acupuncture lowers blood pressure vary, but include balancing out the body’s energies (“Chi,” in Chinese), and stimulating the Vagus nerve and parasympathetic (calming) nervous system.  These protocols may be used as part of a more comprehensive plan including exercise, anti-inflammatory diet recommendations, and co-management with other professionals.  Though we do not make any recommendations regarding your pills, we will be honored to help you lower your need for them.  Your M.D. or D.O., in consultation with you (you get a vote!), will make the final call regarding your drug dosages, if any.

Also known as: IT Band Friction Syndrome

The IT band is not a group of up-and-coming musicians;  rather, it is a thickening of fascia much like a strong rubber band that attaches the powerful gluteus maximus and a smaller muscle in front of and atop the hip called the TFL (tensor fascia lata) to the outside of the knee.  With all the powerful muscles acting upon it, it’s not surprising that it can rub on the outside of the knee and cause irritation or pain.

This condition is common in endurance athletes or others who perform repetitive activities:  Cyclists, runners, hikers, and others may experience this painful condition.

Treatment of this joint may involve anti-inflammatory therapy.  One of the best short-term methods that lacks the negative side-effects of medications and injections is cooling the area with ice or other means (see separate information on safe cooling guidelines).  Other treatments—depending on the condition—may include dry needling;  acupuncture; and manual manipulation of dysfunctional joints that may have caused the condition in the first place (feet, hips, and sacroiliac joints are common culprits).  Custom orthotic inserts (customized shoe inserts designed to support optimal function of your unique feet) may also help, sometimes dramatically.  Updating equipment (different or new shoes;  proper fitting to a bicycle) are also important considerations.  Add to this a comprehensive rehabilitation program to restore regional and core strength, coordination, balance, and function, and you have a recipe for success.

Shoulder impingement syndrome occurs when the supraspinatus tendon (one of the four rotator cuff muscles) becomes irritated and inflamed as it passes under a bony arch of the shoulder called the acromion process. This can result in pain, weakness and loss of movement at the shoulder.

Historically, and sometimes currently, medical management may include anti-inflammatory medications, steroid (cortisone) injections into the tendon, physical therapy, and surgery (literally shaving off the end of the acromion). Conservative management includes natural inflammation reduction (dietary modifications, cryotherapy [see]), manipulation of the cervical spine (the nerves of which control the shoulder joint and related muscles); manipulation of the thoracic spine, which medical literature suggests (when in combination with treating the shoulder directly) is more effective than physical therapy to the shoulder alone; manipulation of the shoulder complex (glenohumeral joint, scapulothoracic joint, etc.); acupuncture; dry needling; specific therapeutic exercises; and soft tissue manipulation-- especially to the tissues that form the rotator cuff.

The spine is a latticework of joints, which are the places where two bones meet and move.  Between each vertebra (backbone) are tiny "facet" joints that guide the motion of the vertebrae.  When these joints become stuck or fixated, classic joint dysfunction exists.  This may or may not be symptomatic;  but this condition, combined with time or physical stress, will result in spinal arthritis, so-called spinal "muscle strain" (SEE), or both.  Doctors of chiropractic are uniquely trained to assess the function of spinal joints, and to normalize their function through spinal manipulation (aka spinal "adjustments").

The muscles on the outside of the leg serve to point the foot down-and-out, and to control aspects of foot motion during normal gait.  They take a beating, especially should you sprain your ankle (an event in which these muscles are suddenly overstretched and overwhelmed) or pound them mercilessly with excess stress related to standing, walking, running, or other weight-related impact.

Treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  Lateral shin pain must be differentiated from fibular stress fracture.  The feet, the knees, the hips, the sacroiliac joints, and the lumbar spine may contribute to these strains—and thus, may be a part of addressing the problem.

Treatment will likely include soft tissue manipulation.  Dry needling is one very effective tool that can be used to directly affect myofascial trigger points and optimize healing rates.  In athletes, correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as running on hills without adequate build-up) may be a part of management.  Acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

According to Stedman's Medical Dictionary, Massage Therapy is "A method of manipulation of the body or part of the body by rubbing, pinching, kneading, or tapping."  (Source:  Stedman's Medical Dictionary. Copyright © 2006 Lippincott Williams & Wilkins)  These hands-on procedures are done to produce a variety of physiological responses and benefits.  According to the American Chiropractic Association:

"Massage has been shown to reduce aggression and hostility in violent adolescents, to improve mood and behavior in students with ADHD, and to lead to better sleep and behavior in children with autism.  Massage has other therapeutic properties, as well. Regular massage may reduce blood pressure in people with hypertension and may lead to less pain, depression, and anxiety and better sleep in patients with chronic low-back pain. Compared to relaxation, massage therapy also causes greater reduction in depression and anger, and more significant effects on the immune system in breast cancer patients.  (Source: American Chiropractic Association)

"It is the position of the American Massage Therapy Association (AMTA) that those who participate in exercise programs, as well as athletes in training, can benefit from massage therapy." (Source:  American Massage Therapy Association, Position Statement, "Massage Therapy for Those Who Exercise," Approved October 2011)

The feet each contain five “rays” culminating in a toe.  The main body of each “ray” is a bone called a metatarsal. The “heads” of these bones contact the ground, especially when pushing off (as in running or jumping), and even more so in standing on “tippy toes.”  When these metatarsal heads become irritated or inflamed, metatarsalgia (literally “pain in the metatarsals”) exists.  It’s not uncommon for age, gravity, and abuse to result in a tender metatarsal head or “dropped” metatarsal that withstands excess pressure and pain with every step.  A single bad step or “stone bruise” may also precipitate the condition.

This condition is sometimes short-lived; but in many cases it is persistent, even with proper care.  Treating metatarsalgia may include correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as excessive running on hard surfaces, or barefoot running/walking when the body is not fully prepared for the stress).  Custom orthotics, supportive pads/cushions, and taping may be of value.  Addressing the entire biomechanical chain is also recommended in most cases.  This means that the foot and its bones, the ankle, the knee, the hip, the sacroiliac joints, the spine, and the area’s muscles and nerves must all be considered as contributors to the problem, and the solution.  Dry needling and/or acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

The muscles of the hip and thigh are powerful stabilizers and propulsion engines.  Major and sudden overload can cause sharp, debilitating pain;  but daily wear-and-tear due to being overweight, misuse or overuse, or structural or neuromuscular imbalances can also cause these muscles to strain and exhibit pain.

Treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  Muscle strain in these areas must be differentiated from referred pain (for example, the spine and sacroiliact joint can refer pain to the hip, and the knee can also refer pain to the hip) or joint issues (hip joint arthritis may at times feel like muscle pain).  Dysfunctions in the feet, the knees, the hips, the sacroiliac joints, and the lumbar spine may interrelated and contribute to a particular, focal strain—and thus, a comprehensive approach is often a part of addressing the problem in both the short and long term.

Treatment will likely include soft tissue manipulation.  Dry needling is one very effective tool that can be used to directly affect myofascial trigger points and optimize healing rates.  In athletes, correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as running on hills without adequate build-up) may be a part of management.  Acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

This occurs when muscles, the contractile elements that actively move and control bony motion, are overwhelmed by the forces upon them.  This can occur due to sudden overload, or repetitive trauma (pitching is a classic example in the upper extremity).

Also known as Degenerative Joint Disease, this “wear and tear” arthritis is characterized by erosion of articular cartilage, either primary or secondary to trauma or other conditions, which becomes soft, frayed, and thinned with eburnation of subchondral bone (“bone-on-bone”) and outgrowths of marginal osteophytes (“bone spurs”); pain and loss of function result.  Early or mid-stage signs can include noisy joints (some patients describe “grinding” or “it sounds like there’s sand in my neck”) and loss of ability to turn the head, as in backing out of a parking space or doing a shoulder check while driving.

Since osteoarthritis always involves dysfunctional or malfunctioning joints, doctors of chiropractic focus on optimizing their function—including the function of other joints that may affect the primary joint.  The feet, for example, can affect knee function, hip function, and spinal function.  Joints in the neck can refer headaches.  Doctors of chiropractic will seek the cause, rather than just treating the painful  areas.

Acupuncture may also have a role in restoring optimal nerve and blood flow, and reducing stiffness.  With osteoarthrosis of the knee, for example, this is an especially effective approach.

An osteoporotic bone has lower strength and density than a normal bone.  "Dexa scans" (DXA, or dual-energy x-ray absorptiometry) measures bone mineral density.  The result is a "T-score." A T-score ranging from -1 to -2.5 is "osteopenia."  Anything beyond -2.5 is "osteoporosis."  The more severe the condition, the more likely you will fracture the weakened bone.

The number one thing you can do to promote bone health is to get appropriate exercise (typically weight-bearing) that stresses your bones.  Bones respond to healthy stress by getting stronger.  Add in appropriate levels of calcium, avoiding smoking, and getting enough Vitamin D to help with calcium absorption, and you've got a solid foundation for bone health.  Note that there is only one vitamin your body can actually manufacture:  Vitamin D.  Your skin produces it when exposed to sunlight.  Just be sure not to overdo it and burn!

Chiropractic methods must be tailored to the patient. A patient with osteopenia or osteoporosis CAN be adjusted;  though caution, and specialized techniques designed for these patients’ needs, are essential.  Acupuncture, of course, poses zero risk for people with osteoporosis.

Pharmaceutical management of low bone density is a mixed blessing.  Some drugs have been found to actually LOWER bone density, either focally (such as in the jaw), or systemically.  Interestingly, bone density may not be the sole factor in determining fracture risk.  Here are some studies on exercise and bone:


  • Exercise lowers fracture risk.  Women who walked 8 hours at a moderate pace (approximately 24 mets /week) had 55% less hip fracture risk than sedentary women.  Those who walked just 4 hours a week had 41% lower risk.  On average, the risk for fracture dropped 6% per 3 mets of exercise per week. (Feskanich D, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. Journal of the American Medical Association. Nov 13 2002; 288(18): 2300-6.)

  • In animal studies on rats, bone density changed only 5.4% but resulted in a 64% increase in the ultimate force (the maximum amount of force the bone could support before breaking).  New bone formation was localized at area where mechanical load and stress was greatest.  “In rats, even small changes in bone mass, which are marginally detectable by DXA (dexascan), can significantly improve bone strength by favorably altering bone geometry.” (Turner C, Robling A, Designing Exercise Regimens to Increase Bone Strength. Exercise and Sport Sciences Reviews.  Jan 2003; 31(1):45.)

  • “In elderly adults with low bone mass, exercise constitutes only a moderately effective bone-building therapy….  However, exercise can effectively reduce fracture risk even without dramatic effects on bone mass.”   (Turner C, Robling A, Designing Exercise Regimens to Increase Bone Strength. Exercise and Sport Sciences Reviews.  Jan 2003; 31(1):45.)

  • In a 2-year study of women aged 58-75, 27 exercisers (23 controls) practiced 10 back lifts 5 days a week, progressing to a maximal weight of 50 lbs in a specially constructed backpack.  After 2 years, there was no change in BMD for controls or the exercise group despite large changes in back erector muscle strength in the exercise group.  Exercise was discontinued.  In a follow-up 10 years later, the exercise group had a significantly higher BMD in the spine, and the relative fracture risk was 2.7 times greater in the control group than the exercise group. (Sinaki M, Itoi E, Wahner H, Wollan P, Gelzcer R, Mullan B, Collins D, Hodgson S. Stronger Back Muscles Reduce the Incidence of Vertebral Fractures: A Prospective 10 Year Follow-up of Postmenopausal Women. Bone. June 2002; 30(6), 836-841)

  • Physical activity, including running, is beneficial, rather than detrimental, to joint health. (Urquhart et al, "What Is the Effect of Physical Activity on the Knee Joint? A Systematic Review."  Medicine & Science in Sports & Excercise, 2011, pgs. 433-442)

This is a stress fracture of the back part of a vertebra, most common at the base of the spine.  It is especially common in intense sport such as those demanding excessive hyperextension (gymnastics, diving, football lineman).  Since it is a stress (overuse/misuse) fracture, it may also show up in endurance athletes.

In young people, bracing may allow the fracture to heal.  If the fracture is not active, i.e. it’s permanent, management rather than cure is the goal.  These patients often respond well to manipulation of adjacent spinal joints.  Acupuncture, dry needling, soft tissue manipulation, and massage therapy may also play roles in management.  Finally, though muscles are not designed to do the work of bones and ligaments, in the case of a pars fracture muscles may have to be trained to become exquisitely strong and balanced in order to maximize stability and minimize pain.

Also known as: Patello-Femoral Pain Syndrome, Chondromalacia Patellae

The patella or “kneecap” is designed to move (“track”) smoothly within a groove in your thigh bone (femur).  It may track poorly due to abuse, trauma, muscular imbalances, surface or shoe issues, foot problems (the knee bone IS connected to the…), imbalances in the low back/hips/sacroiliac joints, and anatomical deficiencies.  One of the most commonly “challenged” groups is females.  Why?  Because the angle at which their quadriceps muscles (the muscles in front of the thighs) pulls on the patella tends to be stressful due to the typically wider hips of a female vs. a male.

If the patella rubs sufficiently on the bone beneath it, this may cause pain known as Patello-Femoral Pain Syndrome (PFPS).  In advanced cases, the cushioning cartilage may actually wear away (chondromalacia patellae).

Managing Patellar Tracking Dysfunction and related disorders may include specific exercises, such as “terminal extension” exercises targeting activation of a muscle called vastus medialis obliquus; but treatment is inappropriate until a thorough history, examination, diagnosis, prognosis, and plan are developed.  A doctor of chiropractic can perform all of this;  and take and read x-rays (if necessary) as well.  Once the picture is clear, exercises may be combined with interventions targeted at correctible dysfunctions.

Treatment of this joint may involve anti-inflammatory therapy; but focusing on causative factors is critical.  Other treatments—depending on the unique case—may include dry needling; acupuncture; soft tissue manipulation;  and manual manipulation of dysfunctional joints in the feet, hips, sacroiliac joints, and/or spine.  Custom orthotic inserts (customized shoe inserts designed to support optimal function of your unique feet) may also help, sometimes dramatically.  Updating equipment (different or new shoes; proper fitting to a bicycle) are also important considerations.  Add to this a comprehensive rehabilitation program to restore regional and core strength, coordination, balance, and function, and return to high levels of activity is likely.

A pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissues — such as bones, cartilage, muscles or tendons. This pressure disrupts the nerve's function, causing pain, tingling, numbness or weakness.  Technically, a pinched nerve only causes symptoms when a biochemical process called inflammation exists, in addition to the pressure, pinch, or trauma.

A pinched nerve can occur at several sites in your body. A herniated disk in your lower spine, for example, may put pressure on a nerve root, causing pain that radiates down the back of your leg (sciatica). Likewise, a pinched nerve in your neck, forearm, or wrist can lead to pain and numbness in your hand, thumb, and lateral fingers (one sign of carpal tunnel syndrome).

There’s only one thing worse than the thrill of victory, and that’s the agony of “da feet” (in addition to caring for our patients, we also provide questionable humor—at no extra charge, of course!).  The plantar fascia is a band of tissue underneath the foot. It’s analogous to a rubber band, and helps provide some of the “spring” in a healthy step.  When it is overwhelmed—such as the classic couch potato who tries to become a champion marathoner in 6 weeks—it can become painfully inflamed.  In severe cases, the plantar fascia’s constant tugging on the heel may cause a heel spur that is actually visible on x-ray.  Plantar fasciitis cases typically take months, or even a year or more, to fully resolve.

As with all conditions, treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  First-line of treatment often includes PRICE:  Protect it (remove stress, tape), Rest it, Ice/cool it (see separate guidelines on ice/cooling as anti-inflammatory therapy), Compress it (wrapping & taping are popular methods), and periodically Elevate it (sometimes done in conjunction with icing).  Icing using a frozen golf ball or water bottle is a common, easy, and inexpensive home management method.

Nutritional therapy may be an important anti-inflammatory and healing consideration.  Certain specialized forms of soft tissue manipulation to the plantar fascia and related musculature can be very effective and important.  Addressing the entire biomechanical chain is also recommended in most cases.  Adjusting the foot (including the talus bone and/or calcaneus) is often indicated;  but addressing the ENTIRE biomechanical chain means considering the foot and its bones, the ankle, the knee, the hip, the sacroiliac joints, the spine, and the associated muscles and nerves.  Custom orthotics are very commonly valuable.  Dry needling and/or acupuncture may play a role (warning:  acupuncture is often painless, but needling on the bottom of the foot may not be).  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

As a pregnancy proceeds, mom's body undergoes numerous changes.  The most obvious changes involve body shape and posture, but a hormone called relaxin subtly makes ligaments a little looser.  A good analogy is that the "rubber bands" (ligaments) that hold bones together become more easily stretched.  Though this extra "play" between the bones will be useful upon delivery, it can also predispose mom to injury (knees, fallen arches, back pain).  Since the feet are part of the shock-absorbing system that protects the knees, hips, and spine, and since chiropractic doctors are uniquely trained to help the human frame function at its best, it’s not surprising that some chiropractors will prescribe orthotics to support the feet to help limit pain during pregnancy and avoid permanent post-pregnancy fallen arches.

Special tip:  Acupuncture, and acupressure, have some remarkably effective ways of dealing with nausea.

Here's a self-care tip:  Many pregnant women may benefit from certain forms of exercise.  Though all people should consult a health care provider before embarking on an exercise program, and though pregnant women need to be especially cautious, water-based exercise may be a good aerobic outlet for the expectant mom.  A 2006 study of 290 healthy, pregnant women indicated that a water-based exercise program was more effective than a land-based program for decreasing back and pelvic pain.  Pregnant women can and should take steps to care for their changing bodies, and this and other studies suggest that the rewards of so doing may be significant.

As the trimesters roll by, mom will tend to develop what's known as a lordosis, an accentuated "dip" in her low back.  Though the public and some doctors associate this posture with back pain, researchers suggest that lordosis alone may not cause low back pain.ii  Another study suggests that imbalances in the joints at the base of the spine (sacroiliac joints) are highly correlated with pregnancy backache. iii   Doctors of chiropractic commonly work with fixated or "stuck" joints in the spine, and since symmetry of sacroiliac joint motion is so important in pregnancy back pain, these unique doctors' skills become especially relevant for moms-to-be.

Numerous studies show chiropractic care's value in decreasing pregnancy back pain. iv  When it comes time to deliver, a history of chiropractic care may be related to a smoother, less painful process-- and that's a very valuable consideration.  A published study showed decreased incidence of painful back labor in women who had received regular chiropractic care. v  Though athletes, workers, and others appreciate the long-term benefits of regular trips to the chiropractor, there is no group more appreciative of those benefits than pregnant women.

Doctors of chiropractic are trained to care for people of all ages.  If you haven't already done so, consider taking advantage of the full range of their skill and training -- and your entire family will reap the rewards for generations to come.

i  Granath, Aina et al.  "Water Aerobics Reduces Sick Leave due to Low Back Pain During Pregnancy."  Journal of Obstetric, Gynecologic, & Neonatal Nursing 2006;  Volume 35 Issue 4, Pages 465 - 471.

ii  Hansson T, Bigos S, Beecher P, Wortley M. The lumbar lordosis in acute and chronic low-back pain. Spine. 1985; 10:154-155.

iii  Damen. Léonie et al.  "Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints."  Acta Obstet Gynecol Scand, 2005.  Volume 80 Issue 11, Pages 1019 - 1024.

iv  A. Lisi.  "Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: A Retrospective Case Series."  Journal of Midwifery & Women's Health, Volume 51, Issue 1, Pages e7-e10.iv    xxx

v    Diakow PR, Gadsby TA, Gadsby JB, Gleddie JG, Leprich DJ, Scales AM.   J Manipulative Physiol Ther. 1991 (Feb); 14 (2): 116-118.

Many of our patients come to us believing they've "pulled a muscle" in their back. It sure feels that way! The muscles in the spine don't function in a vacuum, however.  Joint dysfunction (SEE) typically goes hand-in-hand with spinal muscle pain.  Hilton's Law states that a muscle that crosses a joint will be enervated (fed) by the nerve that goes to the joint itself.  In the spine, adjusting or manipulating stuck or "fixated" joints is one very safe and effective way to normalize joint function, as well as to begin the process of normalizing nerve signals to the related musculature.

 

The 12 pairs of ribs each attach in back to a thoracic vertebra, and most of them attach in front to the breastbone (sternum).  When the places where ribs connect are irritated or do not move properly, pain may result.  You may even wonder if you’re having a heart attack, the pain may be so severe!  Though many things can cause pain upon a deep breath, this is one symptom that can be associated with rib dysfunction.

Addressing rib dysfunction may mean scaling back activity;  but even more important is addressing the problem.  If a fixated or “stuck” joint is the issue, a doctor of chiropractic may adjust the rib, the associated vertebra, or both.  Soft tissue manipulation may also have a role in dealing with the traumatized, related musculature.

This occurs when, for a variety of reasons, the tendons (which connect muscles to bones) become irritated.  If they are chronically irritated and/or overwhelmed, they can actually tear.

This is one of the most common presenting conditions a chiropractor sees.  At the base of your spine is a triangle-shaped bone called the sacrum, wedged between the 2 halves of the pelvis (“ilium” bones or “ilia”).  Where the sacrum and the ilium meet is a sacroiliac joint.  You have one of these on each side of your very low back.

It was once thought that this joint did not move, that it was fixed in place.  Not so!  The joint has a small yet very important range of motion.  Too much or too little motion can result in severe back pain that may be mistaken for disc pain.  The joint can refer pain to the thigh, the groin, even all the way to the knee;  and dysfunction of this joint can result in knee problems and other regional issues—especially for athletes.

Treatment of this joint may involve anti-inflammatory therapy.  One of the best short-term methods that lacks the negative side-effects of medications is cooling the area with ice or other means (see separate information on safe cooling guidelines).  Other treatments—depending on the condition—may include joint injections by a physiatrist or other specialist;  dry needling;  acupuncture; and manual manipulation as performed by a chiropractor.  Manual manipulation (aka chiropractic adjustments) of this joint can be remarkably effective in normalizing function.  In addition to freeing up a fixated joint, the adjustment also has effects on nerves that control local and regional muscle function and pain.  Add to this a comprehensive rehabilitation program to restore low back, hip, and core strength, coordination, balance, and function, and you have a recipe for a solid recovery.

Sciatica isn't a specific medical term. Pain in the butt or down to your toes, has several causes. Disc problems, unbalanced or fixated joints in the low back, and piriformis syndrome are common causes.

The sciatic nerve is a huge nerve trunk travelling down the back of the thigh.  It feeds sensation and motor function (muscles) all the way down to the calf and foot.  If the nerve is irritated, or if the nerves in the low back that join to form this nerve are irritated, pain may result.  A “hamstring strain,” “pain in the butt,” or “pain down the back of my leg, shooting out my toe like a laser beam” are all descriptions we’ve heard that have turned out to be related to this condition.

The piriformis is a pear-shaped muscle in the gluteal region (your backside, buried beneath the gluteus maximus).  When the piriformis (Latin for "pear-shaped," as the muscle is roughly shaped like a pear) is chronically irritated, it can mechanically irrirtate the nearby nerve trunk, or chemically irritate via a substance called "substance P" (P for "pain").

Pain in the gluteal region can also come from the joints of the low back, or the large joints where the base of the spine and pelvis meet (the sacroiliac joints).  The nerves that feed a joint also tend to feed its related muscles and connective tissues (Hilton's Law), and thus irritation of one area can "refer" pain to associated areas.  This is different from nerve root pain, which is more common in such situations as a bulging or "herniated" disc.  The shock-absorbing discs between the spinal bones can bulge and fail, thus irritating the low back nerves that send signals down the back of the thigh and calf.

The key to treating any condition-- whether in a car, or the human body-- is identifying the source of the problem and correcting it.  In the case of "sciatica," the doctor's job is to differentiate between the sources of pain listed above, and to apply the appropriate treatment.  A pulled hamstring is very different from a piriformis syndrome or disc bulge causing hamstring pain.  Doctors of chiropractic are highly trained in anatomy, including the neurology of disc, low back, and muscle/joint problems.

While physical therapy modalities (ice, ultrasound, intereferential electrotherapy) may have a role in treating sciatica and back pain, they are typically only a component of the treatment rather than the entire plan.  Acupuncture has shown promise in a variety of pain syndromes, including sciatica i .  Ergonomic changes are also recommended in some sciatica cases.  For example, chronically sitting on a wallet in the back pocket may irritate the sciatic nerve, the piriformis muscle, or unbalance the pelvis (the "hips," loosely speaking) and related structures.  Simple self-care measures such as moving your wallet to the front pocket are first-line treatments for some patients.

Though some doctors will treat a piriformis or related syndrome with anti-inflammatory agents, and though other doctors will actually inject botulism extracts directly into the piriformis muscle ii, chiropractic management for "sciatica" is ideal.  After narrowing down a differential diagnosis, and after ruling out self-sabotaging behaviors that are ergonomically incorrect, the doctor of chiropractic will focus his or her treatment on the affected tissues.  If the disc is involved, specialized chiropractic techniques exist that directly address the pathologies.  Some chiropractors will also focus on the nutritional components of inflammation;  and since the intervertebral disc is up to 90% water, hydration may also be a topic your chiropractor may choose to address with you.  Finally -- and in many cases, most importantly -- doctors of chiropractic will address the joints, muscles, and nervous system patterns that tend to prolong pain-generating patterns.  Manual manipulation of spinal joints, soft tissues, and related areas can have a very powerful effect on an otherwise chronic, debilitating condition.  Balancing out the function of the hips, spine, and related structures can have a profound effect on your pain levels, your level of function, and your return to a more normal life.

http://www.acupuncturetoday.com/mpacms/at/article.php?id=29001

ii http://www.ncbi.nlm.nih.gov/pubmed/17461700?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Scoliosis is a rotation combined with twisting of the spine.  Chiropractic management and therapeutic exercises can be very important in its management.  For more information on this topic, see the following article:  Scoliosis

This term is a common or “lay” term for pain in the shins.  It is not a proper diagnosis. Most shin pain is not caused by fractures or microfractures—though in some cases (such as with endurance athletes) stress fractures can and do occur.  More commonly, “shin splints” are caused by overload of the tibialis posterior

Treatment requires a comprehensive history and examination, followed by development of a differential diagnosis and treatment plan.  If stress fracture or a stress reaction are in the differential, then backing off impact-related activities is critical, and cross-training must be introduced (pool running, swimming, etc.) to maintain fitness and allow healing.

If the tibialis posterior tendon is involved (and it often is), treatment will likely include soft tissue manipulation.  Dry needling is one very effective tool that can be used to directly affect myofascial trigger points in the tibilais posterior.  In athletes, correcting equipment problems (worn-out or improper footwear, for example) or surface issues (such as running on banked roads, or always running the same direction around a track) may be a part of management.  Addressing the entire biomechanical chain is also recommended in most cases.  This means that the foot and its bones, the ankle, the knee, the hip, the sacroiliac joints, the spine, and the area’s muscles and nerves must all be considered as contributors to the problem, and the solution.  Custom orthotics are often of value not to eliminate pronation, but to control it.  Specialized taping methods may be of value.  Acupuncture may play a role.  As in all cases of inflammation, cryotherapy (cold therapy) and anti-inflammatory dietary measures may be of value during the acute or chronic phases of the condition.  Normalizing function of affected body parts may require manual manipulation of relevant joints (which affects the nerves that feed these joints, and related muscles and tendons).  A comprehensive program of stretching, strengthening, and balancing exercises is also advisable in most cases.

This term means a “slipping” vertebra, most commonly due to degeneration or failure of the intervertebral disc.  Since spinal discs hold the vertebrae together, degenerating (aging) discs may begin to fail to hold the bones in their original positions.

Proper management begins with not panicking.  A little (under 25%) slippage of a vertebra is not an emergency, and many people with this condition are not even aware they have it.  That having been said, stabilizing a spondylolisthesis typically does not mean surgical intervention.  Manipulation of the affected and surrounding joints can relieve pain;  and a comprehensive program for degenerative disc disease (see “Degenerative Disc Disease”) may also be appropriate.  Acupuncture, dry needling, soft tissue manipulation, and massage therapy may also play roles in management.  Finally, though muscles are not designed to do the work of ligaments, in the case of a spondylolisthesis muscles may have to be trained to become exquisitely strong and balanced in order to maximize stability and minimize pain.

This term means “morbid (degenerative) condition of the spine.”  It encompasses degenerative disc disease (see “degenerative disc disease”).  It is a common condition with aging, and is made worse through trauma (violent trauma, or daily wear-and-tear such as with excessive sitting or prolonged postures).  Smoking is a known risk factor, as chemicals in cigarettes interfere with the delivery of nutrition to the spinal discs, as well as with blood flow to the spine.  Chiropractic management works to slow the rate of progression of the condition, rather than to reverse it;  though patients commonly report an improved sense of “springiness,” less pain, and more energy.  Acupuncture, soft tissue manipulation, massage therapy, and a system of prescribed therapeutic exercises are also valuable components to managing this condition.

Stenosis means “narrowing.”  This can happen at a specific nerve root level in the spine due to bony overgrowth (“bone spurs”);  bulging or herniated discs (see “Herniated Disc”);  or drying out of the disc that separates the bones (see “Degenerative Disc Disease”).  It can also occur within the spinal column itself, so-called “central canal stenosis.”  This will commonly affect multiple areas, such as pain, numbness, or weakness down both legs.

Treating a narrowed area means opening it.  Surgically, this is done through a variety of methods.  Conservative management may involve spinal manipulation—especially the technique known as Cox Flexion-Distraction, a very gentle method that flexes specific spinal segments through the use of a special chiropractic table, guides by 2 well-trained hands, to open up the restricted spaces and pump nutrition to the disc.  Results are often quite positive;  and the common benefits far exceed any risks.

The body is well adapted to all sorts of stresses:  thermal (hot/cold), pathogenic (viruses and germs), emotional, environmental, etc.  When stress is chronic (think family, work, or relationship dynamics), or when our coping ability is overcome (unexpected loss of job, or death of a loved one, for example), there are serious consequences.  Studies of medical students show decreased immune function during exam time, for example.  Cardiovascular maladaptations (heart disease) can result from prolonged, poorly-compensated stress.  A trained counselor, psychiatrist, or trusted other (friend, religious leader) may help.  Acupuncture also may play a role.  Theories of how acupuncture lowers stress markers varies, but include balancing out the body’s energies (“Chi,” in Chinese), and stimulating the Vagus nerve and parasympathetic (calming) nervous system.  These protocols may be used as part of a more comprehensive plan including exercise, anti-inflammatory diet recommendations, and co-management with other professionals.

Also known as: Lateral Epicondylitis

Tennis elbow is pain and inflammation on the outer (lateral) aspect of the elbow, where the tendons of the forearm muscles attach to the bony bump on the outside of your elbow (lateral epicondyle). The pain may spread into your forearm, and even your wrist.

Interestingly, many people with tennis elbow don't even play tennis! Golfers, racketball players, manual laborers, young moms and dads carrying infants, and others can acquire this condition. Any activity or sport that requires repeated use of wrists or strong grips may cause tennis elbow. In tennis players, excessive or improper backhand returns, and overly tightly strung rackets, are common causes.

Simply resting the area may provide some relief; though, like pain-relieving medications and injections, failure to address lifestyle and/or ergonomic faults (poor or suboptimal golf form, bad habits) sets you up for re-injury. Proper management may initially include PRICE (Protect, rest, ice/cool, compress, elevate the affected part as feasible) and natural reduction of inflammation (dietary modifications, cryotherapy [see]). Other conservative interventions may include soft tissue manipulation (chiropractic soft tissue manipulation techniques and/or massage therapy); needling techniques (acupuncture; dry needling for acute or persistent trigger points); chiropractic manipulation/adjusting to restore normal function to the kinetic chain (adjusting the elbow or cervical spine, for example); and therapeutic rehabilitative exercises to ingrain normal function and decrease likelihood of recurrence.

Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This can cause pain in your shoulders and neck and numbness in your fingers or entire hand.

Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having a “cervical rib”), and pregnancy. Even a long-ago injury can lead to thoracic outlet syndrome in the present.

Treating the condition—as with all conditions, illnesses, and diseases—requires proper diagnosis.  T.O.S. must be differentiated from Carpal Tunnel Syndrome (see).  By determining which tissues are irritating the nerves or nerve trunk, the doctor of chiropractic can address them appropriately (adjusting, soft tissue manipulation, acupuncture, dry needling).

TMJ

We all have a temporomandibular joint, which is where the jaw bone (mandible) connects to the temporal bone of the skull just in front of the ear.  Temporomandibular joint disorder (TMJD or TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint. It may be the result of muscle imbalances, chronic bruxism (grinding the teeth, whether awake or while asleep), joint dysfunction, or trauma (such as sports collisions or motor vehicular trauma). The disorder and resultant dysfunction can result in significant pain and impairment.  Some patients will use a night splint, prepared by their dentist or dental specialist, to help.  In our office, we've found that the condition responds well to manual procedures, including chiropractic manipulation of the cervical spine (neck), chiropractic manipulation of the TMJ itself in order to normalize its function, and soft tissue manipulation to dysfunctional muscles and their trigger points.  Needling techniques (acupuncture, dry needling) are also effective in some cases.

A state of optimal physical, mental, social, and spiritual well-being.  Also called being in a state of “balance” or “homeostasis.”  This condition is characterized by healthy energy, positive outlook, physical capability, strong immune system, and a zest for life.  It is the most commonly overlooked condition in Western medicine… yet it can, indeed must, be our focus if we are to become “well” individually, and a society.

Whiplash is a sudden, moderate-to-severe strain/sprain injury affecting the bones, discs, muscles, nerves, or tendons of the neck. About 1,000,000 whiplash injuries occur in the United States every year. Most are the result of motor vehicle accidents or collisions involving contact sports. When unexpected force jerks the head back, then forward in a short period of time (such as a motor vehical accident, or even a football hit or other trauma) the soft tissues-- and sometimes even the bones-- of the neck are overwhelmed. We might expect that in whiplash the neck curve would go backward (exaggerated C-curve), then forward (reverse C-curve); but the injury happens in such a short period of time that the neck actually briefly assumes an “S” curve. Subsequent abnormal function of joints, muscles, ligaments, tendons, and nerves can and do often result in local and referred pain syndromes, sometimes including headaches. Left untreated-- or treated with drugs or soft collars only-- the condition will persist for months, years, or even a lifetime as your “normal pain.”

Proper treatment for whiplash may include: anti-inflammatory therapy for inflamed tissues (cryotherapy, or cold therapy, is usually safe and effective and-- when used properly-- lacks negative side effects); soft tissue manipulation (chiropractic soft tissue manipulation techniques and/or massage therapy); needling techniques (acupuncture; dry needling for acute or persistent trigger points); chiropractic spinal manipulation/adjusting to restore normal function to each affected joint; and therapeutic rehabilitative exercises to ingrain that normal function and (in the best case scenario) return the patient to pre-injury status.

NOTE: A 1993 study in the medical journal Injury showed 93% improvement in chronic whiplash cases treated with chiropractic methods. That's a stunningly positive outcome for chronic cases. Imagine the results for injured people seeking proper care early in the course of the injury, even if symptoms initially seem minor?