This week’s blog is going to stray a bit from the usual format. I’m going to postpone the already prepared blog about hip bursitis and discuss the mild lower back pain that I woke up with this morning. Time for me to be the patient!

As is often the case with acute lower back pain, I have no idea why this is occurring. I woke up with a mild ache on the right side which is causing me to move much slower than I usually would. Like everyone else in this situation I’m tracing back over my activities for the past few days. I started yesterday with a short workout before treating patients…nothing out of the ordinary. So what should I do? Perhaps I should try and figure out the diagnosis!  Should I look it up on Google?  Ha!  In case you can’t pick up on my tone, I would strongly recommend against searching the internet for a diagnosis of your condition. Usually, Dr. Google is wrong.  I’m fortunate that I can ask my wife for her opinion (she’s also a Chiropractor). If I didn’t have this luxury I should seek the help of a qualified health professional with the education (and legal right) to diagnose my condition.

In the meantime, before I get an opportunity to see a health professional, what should I do? The following are some common recommendations that our clinic gives our patients. Keep in mind that this is not “official advice”. Think of it more as some general information for interest sake. These recommendations are based on scientific evidence and some educated common sense. If you’re a patient of ours you likely recognize some of it! 

Lower Back Pain and Ice

Many people like the feeling of heat. Although this might provide some temporary relief, it isn’t likely to help. If anything, it has a greater chance of prolonging your recovery.  We usually recommend the application of ice in short duration. Ten minutes on, ten minutes off, ten minutes on. The purpose of ice is to assist in reducing inflammation.

Keep Moving

In the past we would recommend that patients with acute lower back pain lie in bed for a few days and allow healing to occur. The scientific evidence doesn’t support this. We usually recommend to our patients that they try to keep moving as best they can without exacerbating their condition. A good brisk walk is generally the idea.

Avoid Heavy Lifting

Perhaps this is some of that “educated common sense”.  Very obvious, no explanation required.

Sitting and Lower Back Pain

Prolonged static postures aren’t helpful for acute lower back pain. Whether lying, standing or sitting, staying still for long periods is not helpful. A common mistake for those experiencing acute lower back pain is sitting with poor posture.  Sometimes life can’t be put on hold and even though your back is hurting you still have to go to work and sit at a desk for the day. In this case, do your best at getting up every twenty or thirty minutes and walk around a little.

Online Advice

On a regular basis, patients search the web and read horrible advice. I realize that this information you’re reading right now is on the web, but it’s always best to meet your “expert” in person and make sure they’re basing their opinion on a solid foundation of science and not just opinion.

Stretching and Lower Back Pain

Until your condition is properly diagnosed, don’t try and help.  Don’t stretch your lower back.  Brisk walking, general movements within a pain-free range and no stretching (even if it feels really good).

Hope that helps! Now that I’ve been sitting at the computer for almost a half hour, I have to get up and go for a walk. Then I’m going to put ice on my lower back. After that, I’ll probably ask Dr. Leslie to fix me!

Put your hand on your clavicle (or collar bone as many people call it) and follow it outwards as far as you can toward your shoulder; that big bump at the end on the top of your shoulder is called your acromioclavicular joint or “AC joint”. Traumatic injuries to this joint are common accounting for 9% of injuries to the shoulder. Sprain of the AC joint is often referred to as a separated shoulder.

Physiotherapy in Burlington for a Separated Shoulder

Separated Shoulder vs. Dislocated Shoulder

A dislocated shoulder is when the large bone in your arm actually comes out of the shoulder “socket”. An AC joint sprain or shoulder “separation” is when the lateral portion of your collar bone pulls away from the shoulder joint after trauma. Quite often these injuries involve a “step defect”, where the ligament damage has left the shoulder with a visible deformity since they can no longer hold the collar bone in place.

Who gets Separated Shoulders?

AC joint sprains are more common in younger adults, probably because they are more likely to be out taking chances and playing more aggressive sports.  Statistically, these injuries are far more common in men than women. Usually the trauma would involve impact on the shoulder (like falling) with the arm either across the body or outstretched.

Types of Shoulder Separations

There are generally six types of AC joint sprains. The first being a mild sprain with no visible dislocation of the collar bone, all the way to the sixth type, which involves a rather significant dislocation of the joint. Types one and two can usually be managed conservatively with physiotherapy or chiropractic. Type three is border-line, but anything above (type four to six) warrant a consultation with an orthopedic surgeon.

Symptoms of Shoulder Separation

Usually there is pain locally in the joint (on the top pointy part of your shoulder) but you can also get some pain in the neck and throughout the shoulder joint. Newer injuries are usually painful with pressure and aggravated with bringing your arm up to shoulder level and across your body.

Treatment for AC Joint Sprains (Shoulder Separation)

As mentioned above, the milder types of AC joint injuries are the ones that we normally treat. Chiropractic and / or physiotherapy at our clinic can involve the use of various treatment modalities depending on the presentation of the patient. Some of these modalities include laser, interferential current (IFC), graston, active release technique, acupuncture and rehabilitative exercise. Consulting with a chiropractor in this case is helpful so that diagnostic x-rays can be ordered and the degree of separation can be determined. 

Unsure what to do?  We can help you! Call or email us at info@burlingtonsportstherapy.com

References
Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. American Journal of Sports Medicine 2007; 35(2): 316-329.

Many people don’t realize that our shoulder muscles (in particular the rotator cuff muscles) can wear down with time. The concept of rotator cuff degeneration is now a well established explanation for shoulder pain for many patients over the age of 40.

Rotator Cuff Injury is Progressive

There are different theories as to how the aging rotator cuff gets injured. Sure, there can be a spectacular event which initiates all the pain, but there doesn’t have to be. For many people, an “event” of injury is what they relate the symptoms to, but there was years of tendon degeneration already occurring which perhaps made the injury inevitable.  Tendon degeneration can be considered progressive.  Over time it gets worse and worse, where at the far end of progression is a complete tear of a rotator cuff tendon.

Causes of Rotator Cuff Degeneration

The factors that cause rotator cuff degeneration can be divided into two main categories; intrinsic factors and extrinsic factors.  An example of an extrinsic factor would be a surrounding structure compressing a rotator cuff tendon, whereas an intrinsic factor would be that the tendon is degenerating because of the inherent characteristics of that tendon itself.  This may be a little too technical for our average reader, so we’ll just review some of the basic reasons our shoulder muscles (namely the rotator cuff muscles) degenerate. This may assist you in learning how to keep your shoulders healthy!

Tendon Compression

Rotator cuff tendons are susceptible to degeneration when they are repeatedly subjected to compression.  This can occur for various reasons.   Some of us have a unique shape to the bones in our shoulder which can lead to tendon compression.  For others, degenerative arthritis (and the bone spurs related to arthritis) are the real problem.  These bone spurs have the ability to compress muscles and tendons leading to advanced tendon degeneration.  Muscle tightness can also cause problems.  For various reasons, some of us get tight in certain areas of the shoulder.  This can lead to the development of altered movement patterns in the joint and can eventually cause tendons to get compressed. In each of these scenarios, the tendon gets compressed and is subjected to wearing down or degeneration.

Age Related Shoulder Pain

For many of us, the activities we choose place an enormous demand on our shoulder muscles. This demand can often outweigh the ability of the tendon to repair itself. What results is a net breakdown of the tendon…this is rotator cuff degeneration in a nutshell. Unfortunately age plays a large role. The literature suggests that those people over the age of forty have a reduced ability to keep up with this degeneration / rebuilding process and perhaps explains the prevalence of shoulder pain in those over forty.

Treatment for Rotator Cuff Degeneration

With respect to treating rotator cuff degeneration, it’s important to combine all the information and formulate a plan that reflects your specific situation. For example, if you’re over the age of 40, have bony changes in the shoulder joint on your x-rays, you show altered movement patterns on examination and you like doing dumbbell shoulder press exercises, it may be necessary to get some professional help. Consulting with one of our physiotherapists or chiropractors may be helpful in limiting the rate of degeneration. This can be accomplished through the prescription of the appropriate rehabilitative exercises, guidance with exercise selection or therapeutic treatment using modalities like laser therapy or active release technique.

For more information about our services and the ways we treat rotator cuff degeneration, shoulder pain or shoulder impingement, please call us or email at info@burlingtonsportstherapy.com.

References
Nho S, Yadav H et al. Rotator cuff degeneration etiology and pathogenesis. American Journal of Sports Medicine. 2008; 36(5): 987-993.
Seitz AL, McClure PW, Finucane S et al. Mechanism of rotator cuff tendinopathy: intrinsic, extrinsic or both? Clinical Biomechanics 2011; 26: 1-12.

Spasm and Knots

One common explanation for this condition is that prolonged sitting and poor posture lengthens muscles beyond their tolerance.  The muscles can’t keep up with the constant demand being placed on them and they decide to shout back.  As a result, the muscles shorten and become tender.  This is what most people describe as ”tight” with spasm, “knots” and scar tissue in the muscles of the neck and around the shoulder blade.  The pain usually worsens after postural activities like sitting at a desk for prolonged periods. 

Treatment for Poor Posture

So what is the cure for poor posture?  For most people, a combination of strengthening weak muscles, stretching tight muscles and remembering to change postures regularly and sit up straight is the key to avoiding excessive pain.  We usually recommend that you alter your workstation so that your head is not turned all day and your arms are comfortably positioned when working.  Treatment is often required to eliminate the areas of chronic muscle irritation and tightness.  At Burlington Sports Therapy, we use techniques like active release and graston technique for this.  These approaches have a great track record for effectively treating these areas of chronic muscle dysfunction and can eliminate those areas of painful muscle spasm. 

For more information about how we treat this condition, please call or email us. info@burlingtonsportstherapy.com

Whiplash is a common injury affecting people involved in a car accident. In fact, whiplash is the most common traffic injury affecting approximately 83% of those people involved in a motor vehicle accident. For some, the condition resolves quickly. For others (10% according to the literature), whiplash can turn into chronic neck pain. According to some literature, some risk factors for developing chronic neck pain after whiplash have been identified. They are as follows…

High initial pain level

Unfortunately it seems that the higher your initial pain after a whiplash accident, the greater the chance that your symptoms will be chronic.

High Initial Headache Intensity

Similar to the first risk factor, if you have really strong headaches after the accident, there is a greater likelihood that your symptoms will become chronic.

Pins and Needles In The Arms

If you’ve been in an automobile accident, experienced whiplash and now have symptoms in one or both of your arms, there may be a greater chance of having chronic symptoms. These arm symptoms are often referred to as radiculopathy and can be described as numbness, tingling, pins and needles, burning, a feeling like your arm is asleep or you hit your “funnybone”. 

Gender

According to the literature, females are more likely than males to experience chronic whiplash symptoms.

Neck Stiffness

Most people experience stiffness in their neck after a whiplash injury. If you have a significant loss of motion though, it might make you more prone to chronic whiplash symptoms.

Treatment For Whiplash At Our Clinic

It’s important to keep in mind that only a small percentage of people develop chronic whiplash symptoms. Despite these identified risk factors, only 10% of people complain of their whiplash symptoms in the long term. For most, whiplash is a temporary inconvenience that can be treated effectively and efficiently with chiropractic, physiotherapy and massage. Our clinic usually treats whiplash with methods like active release technique, acupuncture, interferential current (IFC), chiropractic adjustments, joint mobilizations, stretching and strengthening and laser therapy. If you’ve been in an automobile accident and are looking for treatment in the Burlington area, feel free to contact us! Info@burlingtonsportstherapy.com

References
Cote P et al. Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result? Arthritis and Rheumatism 2007; 57(5):681-688.
Kongsted A et al. Neck collar, act as usual, or active mobilization for whiplash injury? A randomized parallel group trial. Spine 2007; 32(6): 618-625.
Nolet PS, Cote P, Cassidy JD, Carroll LJ. The association between a lifetime history of neck injury in a motor vehicle collision and future neck pain: a population based cohort study. European Spine Journal 2010.