Many patients present to our clinic with hip pain. In the past, muscle strain or osteoarthritis may have been on the top of the diagnostic likelihood, but this is changing as our knowledge of the hip is improving. One condition that we have a relatively new understanding about is femoroacetabular impingement.

Hip Impingement

More and more literature is being published on femoroacetabular impingement syndrome. Since we are still learning about it, we really don’t know how common it is. We do know that it is painful and is a cause of early degenerative arthritis in young adults. The pathomechanics of the condition is relatively simple since the name almost says it all; the femur abuts against the cartilage in the hip “socket” (acetabulum) and causes an impingement of the tissue. This usually occurs when the hip is placed at the end of its movement range. For those people at risk, the repeated movement in this manner damages the cartilage, causing advanced degeneration of the cartilage and potential tearing of the labrum. (The labrum is a round, bowl like structure of cartilage that the femoral head sits in).

Symptoms of Hip Impingement

Symptoms of femoroacetabular impingement include hip pain (in the groin area or on the lateral aspect of the hip) and stiffness, usually after prolonged sitting or prolonged activity. Progressive degeneration of the cartilage occurs with repeated aggravating activity; this increases the pain. When there is tearing of the labrum, patients may report catching or locking sensations.

Treatment for Hip Pain

The treatment for femoroacetabular impingement is variable. As with most musculoskeletal conditions, conservative treatment is a good starting point. If there is a certain activity that aggravates your hip it would be advisable to stop doing it for a while. Your family doctor may be able to offer you temporary medication to help control your pain and inflammation. Corticosteroid can also be considered as an option for temporary relief. From the perspective of physiotherapy or chiropractic, treatment geared at the tight muscles of the hip may be helpful. Therapeutic modalities like interferential current and low intensity laser may also be helpful for reducing pain and inflammation, and the regeneration of healthier cells in the area of the joint (as in the case of low intensity laser).

Surgery for Hip Impingement

Keep in mind that conservative treatment does not alter the structural changes occurring in the hip joint itself. To address these changes, referral to an orthopedic surgeon who is knowledgeable about this relatively new condition is paramount. Early, effective treatment can help reduce the progression of femoroacetabular impingement and preserve the joint structures for the future.

Diagnosing Hip Impingement

According to the literature, there are some subtle radiographic signs that can help determine whether femoroacetabular impingement is present. Our Chiropractors are able to assist you with this. We can refer you for the appropriate imaging and perform the appropriate clinical tests to see if this may be the cause of your persistent hip pain.

For further information about treatment for this condition at our Burlington clinic, feel free to email us at info@burlingtonsportstherapy.com

References
Emary P. Femoroacetabular impingement syndrome: a narrative review for the chiropractor. Journal of the Canadian Chiropractic Association 2010; 54(3): 164-175.
Martin RL et al. Acetabular labral tears of the hip: examination and diagnostic challenges. Journal of Orthopaedic & Sports Physical Therapy 2006; 36(7): 503-515.
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What is the difference between tennis elbow and golfers elbow? This is a common question we encounter in our clinic and the answer is quite simple. It actually has nothing to do with either of those sports really; it is more based on anatomical location.

Location of Pain in Golfers and Tennis Elbow

Golfers can have tennis elbow and tennis players can have golfers elbow. The primary difference is that one affects the outside of your elbow and the other affects the inside of your elbow. Active Release Technique is a very effective way of treating both of these injuries. The following blog will help teach you a little more about tennis and golfers elbow and the different ways to treat these injuries.

Golfers Elbow

The term “golfers elbow” is actually a slang term given to a common overuse injury. The bone that “sticks out” on the inside of your elbow (the side closest to your body) is called the medial epicondyle. This boney area serves as a tendon attachment for our wrist and finger flexor muscles. When we use our hands too much with activities like gripping, pinching and flexing our wrist and fingers (as in golf) the wrist and finger flexor muscles located in our forearms can become overused. Also called a repetitive strain injury, the tissue responds to this unreasonable demand by degenerating and changing its texture.

Symptoms of Golfers Elbow

The pain can be located in the forearm, but it quite often localizes to the boney insertion on the inside of your elbow. This is what many people call golfers elbow. The more current, technical term for golfers elbow is a tendinosis or tendinopathy of the wrist and finger flexors in the forearm.

Tennis Elbow

The term “tennis elbow” is also a slang term. It is very similar to golfers elbow, only this condition affects the bone and tendons on the other side of your elbow and forearm. The bone that you can feel on the lateral or “thumb side” of your elbow when your palm is facing upward is called the lateral epicondyle. This boney area serves as a tendon attachment for our wrist and finger extensor muscles. When we use our hands too much with activities like gripping, pinching and extending our wrist and fingers (as in tennis) the wrist and finger extensor muscles located on the back of our forearms can become overused.

Symptoms of Tennis Elbow

The same as golfers elbow, tennis elbow is called a repetitive strain injury. The extensor tissues respond to the unreasonable demand placed on them by degenerating and changing their texture. The pain can be located in the back of the forearm, but quite often localizes to the boney insertion on the outside or lateral side of your elbow. This is what many people call tennis elbow. The more current, technical term for tennis elbow is a tendinosis or tendinopathy of the wrist and finger extensors in the forearm.

Treatment for Elbow Pain

So how do you fix golfers elbow or tennis elbow? At our clinic we use Active Release and Graston Technique as a method of returning the tissue to a more normal texture. Laser therapy is also used to assist in replenishing the area with healthier cells. This is a very different from how we may have treated this injury in the past. In the past, these conditions were believed to be inflammatory injuries. We called them medial epicondylitis (for golfers elbow) and lateral epicondylitis (for tennis elbow) since we thought that the boney insertion point was inflamed. This has since been discovered to be inaccurate and is why the terminology and recommended treatment approach for these injuries have changed over the years.

For more information please email us – info@burlingtonsportstherapy.com

References
Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. The Journal of Bone and Joint Surgery 2007; 89: 1955-1963.
Cook JL, Khan KM, Maffulli N, Purdam C. Overuse tendinosis not tendonitis: part 2: applying the new approach to patellar tendinopathy. The Physician and SportsMedicine 2000; 28(6).
De Smedt T, de Jong A, Van Leemput WV et al. Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. British Journal of Sports Medicine 2007; 41: 816-819.
Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Time to abandon the “tendonitis” myth. British Medical Journal 2002; 324: 626-627.
Khan KM, Cook JL, Taunton, J, Bonar F. Overuse tendinosis, not tendonitis: part 1: a new paradigm for a difficult clinical problem. The Physician and Sports Medicine 2000; 28 (5).
Kraushaar, B., Nirschl RP. Current concepts review – tendinosis of the elbow (tennis elbow) clinical features and findings of histological, immunohistochemical, and electron microscopy studies. The Journal of Bone and Joint Surgery 1999; 81: 259-278.
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Laser therapy has become a popular method for treating various injuries. Many professional athletes and professional sports organizations are utilizing this technology because of its effectiveness in resolving many different injuries and conditions. Is it right for you?

What is Laser Therapy?

The basic concept is the use of light energy (photons) to stimulate healing in a particular area of the body.

Different Types of Laser Therapy

These days we hear many different words used to describe a similar approach to treatment. Cold laser, low energy laser, LLLT or low level laser therapy, LILT or low intensity laser therapy or light therapy…these all aim to utilize certain wavelengths of light energy to facilitate healing.

How Long Has Laser Therapy Been Around?

The concept of using light to aid in healing is not a novel one. In fact, the idea was even utilized by the ancient Romans and Greeks! Obviously, with modern science treatment methods with light have evolved to be more sophisticated, precise and effective. LASER (Light Amplification by Stimulated Emission of Radiation) was developed in 1960 and has proved to be an efficient way to deliver intense light at wavelengths that stimulate a specific biological and physiological response.

How Does Laser Therapy Work?

A good analogy is to think about how our body uses sunlight to start a series of reactions in our cells to make vitamin D. Just as there are certain receptors on our cell surfaces to receive photon energy from the sun, there are receptors on the cell surface that can receive photons at certain wavelengths to stimulate energy (ATP synthesis). As a result, healing!

Conditions Treated with Laser Therapy

At our Laser Physiotherapy clinic in Burlington, we use both the Bioflex and Theralase Laser Systems. As the treatment is aimed at actually stimulating cell regeneration, one can imagine the number of conditions that could potentially benefit from laser therapy. Arthritic conditions (Osteoarthritis and Rheumatoid arthritis), overuse conditions (golfers and tennis elbow, achilles tendonosis, rotator cuff tendinosis), injuries (sprained ankle, rotator cuff tear, groin tear) and painful conditions (plantar fasciitis, bursitis, disc herniation) are just a few of the conditions that have shown to respond well with laser treatment.

Insurance Coverage for Laser Therapy

As always, the most important step in your quest to be healthy and pain free is to first obtain a proper diagnosis from a qualified practitioner. Call our Burlington Laser Clinic now for an appointment. Our skilled practitioners can discuss your treatment options and assist you in finding the right path to recovery. Your treatment at our clinic can be billed as either chiropractic or physiotherapy for insurance purposes (since the treatment can be performed by either practitioner).

For more information or an appointment – info@burlingtonsportstherapy.com

References
Bjordal JM, Lopes-Martins RAB, Iverson VV. A randomized, placebo controlled trial of low level laser therapyfor activated achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. British Journal of Sports Medicine 2006; 40:76-80.
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. Australian Journal of Physiotherapy 2003; 49: 107-115.
Gur A, Cosut A et al. Efficacy of different therapy regimes of low-power laser in painful osteoarthritis of the knee: a double blind and randomized controlled trial. Lasers in Surgery and Medicine 2003; 33: 330-338.
Weber JB, Pinheiro AL, De Oliveira MG et al. Laser therapy improves healing of bone defects submitted to autologus bone graft. Photomedicine and Laser Surgery 2006; 24(1): 38-44.
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Heel pain is a common complaint at our clinic here in Burlington Ontario. Maybe it’s because so many people are active here…not sure. Regardless, most patients come to our clinic thinking they have plantar fasciitis. Plantar fasciitis is not the only condition that causes pain in the foot and heel. Stress fractures, fat pad syndrome and arthritis are a few other causes of foot and heel pain. A pinched nerve can also cause pain in our heels.

Nerve Pain in the Foot

Our spinal cord is basically a collection of nerves. At various levels of the spine the nerves branch off and travel to their destination. In the case of the heel, the nerves come from the lower levels of the spine and travel as part of the “sciatic nerve”. The sciatic nerve gets smaller and smaller down the leg since much of the nervous tissue has branched off to their destinations. A pinched nerve can occur when a physical structure (like bone, tendon or muscle) bears down on it, similar to stepping on a garden hose.

Symptoms of Nerve Pain

Symptoms of a pinched nerve in the foot are variable but commonly consist of burning, sharp, stinging pain. Pins and needles, numbness, tingling…these all commonly occur with a pinched nerve. Entrapment of the calcaneal and plantar nerves can send pain to the area of the heel, mimicking conditions like plantar fasciitis. Baxter’s nerve entrapment and tarsal tunnel syndrome are examples of nerve entrapments around the heel and foot. These examples of pinched nerves can have similarities with plantar fasciitis, such as pain during or after weight bearing that improves with rest. Severe pain after rising from bed can also occur in each of these conditions.

Heel Pain Treatment

The treatment for a pinched nerve in the foot and heel is variable, depending on the skill set of the treating practitioner. Supportive footwear or orthotic devices can prove helpful as can soft tissue therapy targeted at the entrapment site. Being certified in Active Release Technique Nerve Entrapment Protocols, we usually start with this approach at our clinic since it tends to achieve good results. As always, the starting point for recovery is to have your condition diagnosed properly; remember, plantar fasciitis is not the only condition to cause pain in the bottom of the foot!

For further information – e; info@burlingtonsportstherapy.com t; 905.220.7858.

References
Alshami AM, Souvlis T, Coppieters MW. A review of plantar heel pain of neural origin: differential diagnosis and management. Manual Therapy 2008; 13:103-111.
Hudes K. Conservative management of a case of tarsal tunnel syndrome. Journal of the Canadian Chiropractic Association 2010; 54(2), 100-106.
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The rotator cuff is a general term used to describe four muscles in the shoulder that lie deep to the deltoid muscles. These muscles include the infraspinatus, supraspinatus, teres minor and subscapularis. Of these muscles, the supraspinatus is the most commonly injured.

Supraspinatus Tendon

The supraspinatus muscle is located on the top and back of your shoulder / shoulder blade. It does various functions, most notably bringing your arm up from your side. Shoulder pain is often due to supraspinatus Injury. It can occur in the tendon area of the supraspinatus tendon and can range from tendinosis to a tear.

Strengthening for the Supraspinatus

Traditionally it has been thought that “empty can” movement is what best challenges the supraspinatus muscle. To perform this exercise you would move your arm to approximately 45 degrees between your front and side and bring your arm upwards (with your thumb down).

What is the best way to Strengthen the Supraspinatus?

A 2007 study published in the Journal of Athletic Training investigated the activity of the supraspinatus during various exercises. The exercises investigated were the standing full can (thumb up), standing empty can (thumb down) and prone full can (lying on the stomach with the thumb up). The results found that each exercise activated the supraspinatus to the same extent; however the standing full can isolated the supraspinatus the best.

Conflicting Results?

To cloud the picture, a different study published in 2009 found that the supraspinatus was activated equally with various exercises but the deltoid activity was decreased with the prone full can exercise. Unfortunately, this is an example of two studies with different results and therefore different specific recommendations for isolating the supraspinatus. Regardless, it seems that either the standing full can exercise or the prone full can exercise may be your best options, depending on the patient’s symptoms. It seems that the balance of the literature is no longer advocating empty can testing or strengthening for specifically isolating the supraspinatus muscle. Keeping the thumb upwards (full can) seems to be a better option for rehabilitating or investigating the integrity of the supraspinatus.

Treatment for Shoulder Pain

Our clinic uses a variety of treatment methods for injury to the rotator cuff muscles (like the supraspinatus). Active Release, Laser Therapy, Graston, IFC (interferential current) and acupuncture are frequently used for this condition.

For more information or for an appointment with our chiropractor or physiotherapist, please call or email us. info@burlingtonsportstherapy.com

References
Boettcher CE, Ginn KA, Cathers I. Which is the optimal exercise to strengthen the supraspinatus? Medicine & Science in Sports & Exercise 2009; 41(11): 1979-1983.
Brookham R et al. Construct validity of muscle force tests of the rotator cuff muscles: an electromyographic investigation. Physical Therapy 2010; 90(4): 572-580.
Hughes PC, Taylor NF, Green RA. Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Australian Journal of Physiotherapy 2008; 54: 159-170.
Kibler WB et al. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. American Journal of Sports Medicine 2008; 36(9): 1789-1798.
Reinold MM, Macrina LC, Fleisig GS, Ellerbusch MT. Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. Journal of Athletic Training 2007; 4: 464-469.
Reinold MM, Escamilla R, Wilk KE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. Journal of Orthopaedic and Sports Physical Therapy 2009; 39(2): 105-117.
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