Quite often patients present to our clinic with what they describe as a “pinched nerve”.  Their symptoms can include pain, numbness, weakness, and sensations of tingling, pins and needles, feeling like an arm or leg is asleep or a dull achy throb.  These entrapments can occur almost anywhere there is a nerve.  Common areas include the neck, arms, lower back and legs.  Diagnosis can sometimes be tricky, since the symptoms don’t always occur where the nerve is being compressed.  To understand how nerve entrapments work, it is important to have a basic understanding of the anatomy…

Burlington Ontario Chiropractic and A Pinched Nerve

Anatomy of a Pinched Nerve

In simple terms, the brain descends into the spinal cord which has nerves that branch off at every spinal level.  These nerves course between and through various structures as they head toward their destination. Entrapment can occur at the spine or closer to the destination, compressed by various tissues such as muscles, fascia or ligaments.  One of the most common examples of a nerve entrapment is what is often referred to as “sciatica” or sciatic nerve pain. 

Sciatica – What is it?

Sciatica is a frequently used term describing irritation or “pinching” of a nerve that is present in the back of the thigh and leg.  Quite often, after the nerves have exited the spinal canal they can be compressed by the spinal disc.  A proper diagnosis is crucial in this situation since a small percentage of the population can get compression of the sciatic nerve by a muscle in the gluteal region known as the piriformis, instead of the lumbar disc. 

Piriformis Syndrome – What is it?

Piriformis syndrome can mimic lumbar disc herniation and sciatica.  Both of these conditions involve nerve compression and although their symptoms are similar, a treatment won’t be successful if it isn’t directed at the correct location.  For example, treatment of piriformis syndrome might involve techniques that stretch the muscle, whereas the treatment for lumbar spine nerve compression might avoid those same stretches. 

Carpal Tunnel Syndrome – What is it? 

Another common nerve entrapment involves the median nerve.  The median nerve is a nerve in the arm that travels from the area of the shoulder down to the hand.  The most talked about site of entrapment for the median nerve is at the carpal tunnel, producing numbness, tingling, pain and weakness into the hands and fingers.  These symptoms can also be reproduced with compression of the nerve roots at the neck.  Again, two conditions with similar symptoms yet the nerve compression occurs at different locations.

Treatment for a Pinched Nerve

There are various treatment approaches for nerve compression. Our clinic employs chiropractors and physiotherapists who both use a combination of manual treatments and home exercise. One treatment approach that we frequently use with nerve entrapment injuries is Active Release Technique. Active Release Technique is a popular method of breaking down dysfunctional scar tissue and thereby releasing pressure on nerves. In fact, our Active Release Practitioners have taken specific courses in nerve entrapment treatment. Unsure what is right for you? Give us a call at 905.220.7858 or email us at info@burlingtonsportstherapy.com. We can help!

References
McCrory P, Bell S, Bradshaw C. Nerve entrapments of the lower leg, ankle and foot in sport. Sports Med 2002; 32(6): 371-391.
McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med 1999; 27(4): 261-274.
Schoen, DC. Upper extremity nerve entrapments. Orthopedic Nursing 2002; 21(2): 15-32.
Leahy M. Active Release Techniques Peripheral Long Tract Nerve Release – Course Manual. 2005.

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The supraspinatus, infraspinatus, teres minor and subscapularis muscles are often referred to as the rotator cuff muscles. Injury to the rotator cuff musculature is one of the more common conditions affecting the shoulder, ranging from mild strains to complete tendon rupture.

Symptoms of Supraspinatus Tear

Rotator cuff injury (including rotator cuff tear) can cause significant pain, weakness and reduced range of motion. Quite often, it causes difficulty with common daily tasks like putting your arm in a coat sleeve, putting your seat-belt on or reaching in the back seat of your car. Of course, there are many different conditions affecting the shoulder that can make these daily activities difficult and painful, so it is important to have this condition properly diagnosed.

Diagnosing Shoulder Pain

Soft tissue imaging (like diagnostic ultrasound or magnetic resonance imaging) is the optimal way to diagnose rotator cuff tears. Unfortunately, there is often a waiting list for these diagnostic tests so the preliminary diagnosis is made clinically in your health practitioner’s office. This is not always a simple step, since the commonly used clinical tests are not always easy to interpret. According to the scientific literature, there does not seem to be a reliable correlation between symptoms and tearing of the rotator cuff muscles. In other words, studies have found that many patients with minimal pain and normal function of the shoulder often have imaging results indicating partial thickness tear of the supraspinatus or full thickness tear of the supraspinatus.

Rotator Cuff Treatment

Consulting with a knowledgeable and skillful diagnostician can eliminate wasted time by deciphering which tissue is likely damaged and focusing treatment on the appropriate structures as quickly as possible.  That’s the first step as it helps to determine what avenue of treatment is best.  For some, surgery is necessary.  For most, conservative treatment like physiotherapy or chiropractic is the best choice.  What is right for you?  There are many factors to consider and we can assist you with that process.  For example, a recent injury might benefit from laser therapy or gentle exercises with our physiotherapist.  For others with more chronic rotator cuff injury (like supraspinatus tendinosis or tendinopathy) active release or graston technique with one of our chiropractors would be the best treatment.  Unsure?  Give us a call or send us an email…we can help you!  905.220.7858  email - info@burlingtonsportstherapy.com

References

Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. British Journal of Sports Medicine 2007; 41: 200-210.

Uhthoff HK, Sarkar K. An algorithm for shoulder pain caused by soft-tissue disorders. Clin Orthop Relat Res 1990; 254: 121-127.

Frost P, Andersen JH et al. Is supraspinatus pathology as defined by magnetic resonance imaging associated with clinical sign of shoulder impingement? Journal Shoulder Elbow Surgery 1999; 8(6): 565-568.

Schibany N, Zehetgruber H, Kainberger F et al. Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study. Eur J. Radiol; 2004; 51(3): 263-268.

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Osteoarthritis in the knee is the most common condition affecting synovial joints.  When this type of arthritis is present, it usually involves degeneration and destruction of the various joint structures, especially the cartilage. 

Knee Arthritis Symptoms

Symptoms of osteoarthritis in the knee often include pain with weight bearing, swelling, locking and crepitus (clicking and popping in the joint).  It is different for everyone.  For some people, prolonged weight bearing increases the pain in a joint.  For others, their primary complaint is stiffness and soreness after being still (like waking in the morning or getting up from prolonged sitting). 

Treatment for Knee Arthritis 

There are many different treatment options available for osteoarthritis in the knee, depending on the stage of arthritic change.  Of course, nothing can reverse the degeneration that has occurred, but slowing the degenerative process and keeping the joint healthy is the best way to delay a joint replacement and allow a person with arthritis in the knee to be able to participate in the activities they like to do. 

Living with Osteoarthritis

According to a 2008 systematic review published in the journal Physical Therapy, there is high quality evidence supporting exercise and weight reduction for managing osteoarthritis in the knee.  At our clinic, we combine this approach with the use of low-level laser therapy.  Numerous studies have advocated the use of low-level laser therapy as a means of reducing pain in arthritic knees. 

Physiotherapy for Knee Arthritis

Unfortunately, there is low quality evidence to support the usefulness of therapeutic ultrasound, bracing or thermotherapy (three approaches that are frequently used in physiotherapy).  As mentioned above, our clinic tends to utilize laser therapy, safe strengthening and activity selection that keeps the joint asymptomatic.  This service can be provided by either our physiotherapists or our chiropractors. 

Are There Other Ways to Treat Arthritis?

Yes.  The goal of managing osteoarthritis in the knee is to slow the degenerative process and keep the joint healthy.  There are many different ways to do this, each with varying levels of evidence to support them and therein with variable success rates.  Everyone is different and what works for one person might not work as well for another.  Glucosamine, acupuncture, synovial injections, orthotics and surgery are also common treatment approaches for knee arthritis.  Consulting with a knowledgeable health care practitioner is a great first step in choosing the appropriate treatment strategy for you! 

For more information – 905.220.7858   email – info@burlingtonsportstherapy.com

References

Bjordal JM, Couppe C, Chow RT et al. A systematic review of low-level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiotherapy 2003; (4).

Brosseau L, Gam A, Harman K et al. Low level laser therapy (classes I, II and III) for treating osteoarthritis (Cochrane Review). The Cochrane Collaboration 2004; 3.

Jamtvedt G, Dahm KT, Christie A et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Physical Therapy 2008; 88(1): 123-136.

Lopez AD, Murray CCJL. The global burden of disease, 1990-2020. Nat Med. 1998; 4: 1241-1243.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. Appropriate practitioners include (but are not limited to) chiropractors and physiotherapists. This information is not intended to diagnose or treat your condition. Our Burlington Chiropractic Clinics, Burlington Physiotherapy Clinics, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our Burlington Chiropractic Clinics or Burlington Physiotherapy Clinics.

Iliotibial band friction syndrome (IT Band Syndrome) is one of the most common injuries affecting long distance runners.  When iliotibial band syndrome occurs (also known as iliotibial band friction syndrome or “IT band syndrome”) a part of the band can get irritated as it rubs against the femur (thigh bone) just above the knee.  This can occur when certain biomechanical factors and tissue changes are subjected to repeated use, like that during endurance exercise.

IT Band Syndrome – Causes

There are many different opinions and ideas as to how and why iliotibial band syndrome occurs.  In general, the majority of the literature suggests that the iliotibial band tissue is “frictioning” on the femur because the iliotibial band is taut against it.  Given this, it is advisable to try and reduce the tension in the iliotibial band. Stretching is one option.  Foam rolling is also gaining popularity as a method to try and reduce tension in various soft-tissues, although to my knowledge this approach is lacking scientific evidence (perhaps because it is relatively new).  Unfortunately, stretching and foam-rolling as stand-alone remedies are unlikely to resolve iliotibial band syndrome. 

Treatment for IT Band Syndrome

To effectively treat iliotibial band syndrome our clinic combines some “homework” (as mentioned above) with targeted soft-tissue treatment such as active release technique and graston technique.  These techniques have the ability to separate the iliotibial band from the underlying and surrounding tissues that may be adhered.  Perhaps this is why stretching has limited effectiveness since it cannot adequately separate tissues or specifically target areas of adhesion.  At Burlington Sports Therapy, active release technique and graston technique are performed by our chiropractors.  We also have physiotherapists on staff who are able to treat iliotibial band syndrome.

Physiotherapy for ITBand Syndrome

According to the literature, weakness in certain hip flexor and gluteal muscles can be contributing factors in the development of iliotibial band friction syndrome.  When this weakness is identified, the appropriate strengthening exercises are an important aspect of recovery.  Consulting with a knowledgeable physiotherapist can assist you in this regard, providing you with the appropriate tools to prevent iliotibial band syndrome from recurring.  Our physiotherapists also treat iliotibial band syndrome using laser therapy, soft tissue therapy and strengthening.

Unsure what to do?  Give us a call, we can assist you.  905.220.7858.  info@burlingtonsportstherapy.com

References

Fredericson M, Wolf C. Iliotibial band syndrome in runners. Sports Medicine 2005; 35(5): 451-459.

Fredericson M, Cookingham CL, Chaudhari AM et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine 2000; 10(3): 169-175.

Niemuth PE, Johnson RJ, Myers MJ, Thieman TJ. Hip muscle weakness and overuse injuries in recreational runners. Clinical Journal of Sports Medicine 2005; 15(1): 14-21.

Taunton JE, Ryan MB, Clement DB et al. A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine 2002; 36(2): 95-101.

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One of our first blogs on this site was entitled “where do you get your health information”?  The purpose of this entry was to address the difficulty in searching the internet for health information.  Often times, you don’t know who is writing the article and you don’t know what they are basing their opinion on.  We provide references at the end of our entries to help reassure our readers that we’re bringing them quality information derived from good quality scientific journals…not just our opinion, but advice and treatment methods that have some objective evidence behind them.  It often surprises me how many patients forget to challenge the recommendations they read on the internet.  The following will illustrate the point…

Stretches for Sciatica – Ill Advised?

Quite often, patients present to our clinic with evidence of lumbar disc herniation.  This herniation causes symptoms in the lower limb (numbness, tingling, weakness) which are often described as “sciatica”.  Prior to writing this blog, I did a google search for “stretches for sciatica”.  The following is a snap-shot of what the first website gave me…

Lower Back Pain Stretches…Helpful?

You’ve probably already seen the stretches pictured above.  More than likely, you’ve tried them before.  These stretches are frequently used for low back pain management yet to my knowledge there is no scientific evidence to validate their use.  When a patient presents to our clinic with low back pain and we have appropriately diagnosed them with lumbar disc herniation (“sciatica”) we usually start their care with eliminating these stretches.  We do this because there is no evidence supporting their use, and the balance of the evidence suggests that these stretches would more than likely aggravate or worsen lumbar disc herniation (sciatica).

Best Stretches for Sciatica

So what are the best stretches for sciatica?  What are the best stretches for low back pain?  As some exercises can be helpful for low back pain, some can be harmful.  To ensure that your condition is treated effectively it needs to be diagnosed properly.  Once diagnosed, the appropriate management strategy can be implemented.  Although you’re reading this online, Google isn’t a doctor!

Chiropractors for Lower Back Pain?

Chiropractors are qualified to diagnose your lower back pain and the numbness and tingling in your leg.  Your chiropractor should be able to give you good advice on the appropriate rehabilitation exercises for your specific case of low back pain or “sciatica”.  If you choose to search on the internet for your advice, beware…a website can’t diagnose your condition and if the author hasn’t provided references, you can’t necessarily be certain that the information you are reading is correct!

Treatment for Sciatica

If you’re experiencing back pain, sciatica, or numbness and tingling in your leg, feel free to call our clinic today and have your condition examined by one of our practitioners.  There are various treatment options.  Physiotherapy, Chiropractic, laser therapy, active release technique…we have lots of options.  What’s right for you depends on many factors such as how long you’ve had your condition, what you’ve already tried and of course, your comfort level.  If you’ve been to a chiropractor before and it worked, you might be best to try it again!  Regardless, give us a call or email us; we can help!  905.220.7858   info@burlingtonsportstherapy.com

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References

Hahne Aj, Ford JJ.  Functional restoration for a chronic lumbar disk extrusion with associated radiculopathy.  Physical Therapy  2006; 86(12): 1668-1680.

McGill S. Low Back Disorders. 2002 Human Kinetics.

McGill S. Ultimate Back Fitness and Performance 2nd Ed. 2006 Stuart McGill. 

Rhee JM, Schaufele M, Abdu WA.  Radiculopathy and the herniated lumbar disc.  The Journal of Bone and Joint Surgery 2006;  88-A: 2070-2080.

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