“Sciatica” is a slang term often used to describe pain in the sciatic nerve distribution.  More often than not, this involves symptoms down the back of the thigh below the knee and into the foot.  This is caused by an irritation of the sciatic nerve.  As we’ve mentioned in previous blogs, sciatica is not actually a diagnosis but rather a slang term used to describe nerve irritation in the back of the thigh and leg.

Physical Therapy Burlington Ontario for Sciatica

Numbness, Tingling in the Leg

One of the more common causes of numbness, tingling, pain or aching in the lower limb (following a sciatic pattern) is lumbar disc herniation.  Many people refer to this condition as a “slipped disk”, a “pinched nerve” or a disc bulge.  Lumbar disc herniation is an area of considerable interest for researchers as the treatment options range from exercises, clinical treatment (like that from a physiotherapist or chiropractor) to surgery.

Treatment for Sciatica

There is ample evidence supporting each avenue of treatment for sciatica.  For example, a large 2006 study published in the Journal of the American Medical Association found no difference between patients who underwent micro-discectomy (surgery) to a group that were treated with physical therapy modalities and steroidal injections.  Another study, published in the Journal of Manipulative and Physiological Therapeutics found that lumbar spine traction, ultrasound and low intensity laser therapy were all effective in the reduction of sciatic nerve pain and the reduction of the size of the lumbar disc protrusion.

Sciatica Exercises…Do They Work?

A third example of research for sciatica treatment is a 2006 study published in the journal Physical Therapy.  The authors of this paper found that exercise-based management of a patient with lumbar disc herniation not only decreased symptoms after nine weeks, but demonstrated resolution of disc extrusion and relief of the nerve root compression on a follow-up MRI. So what is the best way to treat a lumbar disc herniation?

Treatment For Lumbar Disc and Sciatica

There are many variables that play a role in the decision making process for lumbar disc herniation management.  Our clinic usually recommends starting with the most conservative approach that is appropriate for an individual’s symptoms. Occasionally, in severe cases, surgical intervention may be warranted.  In the province of Ontario, your medical doctor or your doctor of chiropractic have the ability to diagnose this condition for you.  Obviously, a proper diagnosis is the first step for a successful treatment outcome!  Need help?  Give us a call! 905.220.7858  info@burlingtonsportstherapy.com

Want to meet our Chiropractor?  Click here.  Our Physiotherapist?  Click here.

References

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

Unlu Z et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics 2008; 31: 191-198.

Weinstein JN et al. Surgical vs. non-operative treatment for lumbar disk herniation: the spine patient outcomes research trial (sport): a randomized trial. JAMA 2006; 296: 2441-2450.

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Shoulder pain is very common among active individuals.  Although there are many different causes of shoulder pain, many studies have been published in recent years which link scapular (shoulder blade) position and the activity patterns of the muscles around the scapula to many types of shoulder injury. Among the evidence is the consistent finding of delayed lower trapezius activity in dysfunctional shoulders. 

Lower Trapezius Exercises

A 2009 study published in the Journal of Orthopaedic and Sports Physical Therapy used EMG analysis to examine muscular timing in the trapezius muscles during various exercises. The results of the study indicate that the prone extension exercise and the prone horizontal abduction (with external rotation) both promote early firing of the middle and lower trapezius muscles (when compared to the other muscles that move the shoulder).  This is a good thing for those of you who might be confused…in other words, many shoulders have weakness in this area and we now have scientific evidence as to the best way to strengthen these muscles.

Shoulder Exercises – Lower Trapezius

In the prone extension exercise, you simply lie on your stomach (on a bench) with your shoulders flexed to ninety degrees. You then extend your shoulders to achieve the end-position pictured below. (Don’t use a stick as pictured below…it is recommended to use dumbbells).

In the second exercise, you start in the same starting position as the first exercise but you bring your arms out to the side (as pictured below).  Finish the exercise with your thumbs pointing up to the ceiling. 

Treatment for Shoulder Pain

As always, we do our best to bring you the most current and accurate information both in our clinic and on our website.  References are provided below.  If you’re experiencing shoulder pain we suggest that you have your condition examined by one of our doctors; jumping into a strengthening program without being diagnosed is not recommended.  Most cases of shoulder pain not only benefit from strengthening the right areas, but they also require focused treatment at the dysfunctional structures.  Laser therapy is one of our popular treatment methods for shoulder pain and can be applied by either our physiotherapists or our chiropractors.  For more information, call 905.220.7858 or email us at info@burlingtonsportstherapy.com. 

References

Cools AM, Dewitte V, Lanszweert F et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? The American Journal of Sports Medicine 2007; 35(10): 1744-1751.

De Mey K, Cagnie B, Van De Velde A et al. Trapezius muscle timing during selected shoulder rehabilitation exercises. Journal of Orthopaedic and Sports Physical Therapy 2009; 39(10): 743-752.

Hirashima M, Kadota H, Saraurai S et al. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. Journal of Sports Science 2002; 20: 310-310.

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Quite often we hear of patients who repeatedly sprain their ankles. Weeks, months or even years may pass between episodes, but there is a definite pattern of inversion ankle sprain (or “rolling your ankle”) on a specific side. Often times this can be attributed to what we call a functional ankle instability.

Rolled Ankle – What is it?

Quite often, patients tell us they keep “rolling their ankles”.  In this case, they more than likely have functional ankle instability.  With functional ankle instability, our body controls the muscles around the affected joint in an altered fashion due to repeated episodes of injury. So what can we do to fix this?

Physiotherapy for Ankle Sprains

The specific approach a physiotherapist or chiropractor might use to treat an ankle sprain can vary.  Often times, it depends on the stage of the injury.  To combat chronic, repeated ankle sprains it is essential to retrain and strengthen certain muscles and movement patterns in the ankle.  This is not appropriate immediately after an acute ankle sprain however.  In the case of a swollen, recent ankle sprain the treatment approach is different. 

Treatment for Acute Ankle Sprains

The physiotherapists in our Burlington sports injury clinic often use a combination of laser therapy and acupuncture in the initial stages of ankle sprain recovery.  Laser therapy has a reputation for reducing swelling and eliminating pain quickly.   For further information about laser therapy, please visit our laser page.

Active Release for Ankle Sprains

In our Burlington clinic, Active Release Technique is performed by our chiropractors.  Active release has a great reputation for assisting with tissue mechanics in chronic ankle sprains.  Again, if you just sprained your ankle it is not likely to be appropriate.  In the later stages of healing it may be more helpful.

Graston Technique for Ankle Sprains

The Graston Technique is another technique that can be helpful for ankle sprains.  Similar to active release, Graston is more appropriate in the later stages of healing.  It assists in the breakdown of dysfunctional scar tissue that occurs as a result of the initial injury.  Again, in the early stages of recovery from an ankle sprain a treatment like laser therapy is more beneficial.

Exercises for Ankle Sprains

According to some recent research, the peroneus longus muscle has been found to be dysfunctional in many patients who have experienced repeated ankle sprains. Although the specific cause is unknown, this altered muscular activity can be expected to reduce protection against ankle sprain.  Consulting with one of our practitioners is recommended to assist you in finding the appropriate management strategy for your ankle sprain.  For more information about our Chiropractors, please visit our Chiropractic Page.  For information about our Physiotherapist, please visit our Physiotherapy page.  Burlington Sports Therapy – 905.220.7858  info@burlingtonsportstherapy.com

References
Santilli V, Frascarelli MA, Paoloni M. Peroneus longus muscle activation pattern during gait cycle in athletes affected by functional ankle instability. The Journal of American Sports Medicine 2005; 33(8): 1183-1187.

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Since the World Cup is on everyone’s mind these days, we thought it would be only fitting to make you aware of a crucial paper published in the American Journal of Sports Medicine which analyzed score-celebration injuries among soccer players.

The authors of the study observed professional and amateur soccer players over the course of two seasons, looking at the incidence and nature of injuries sustained by players during their goal celebrations. Over the study period, 152 players were evaluated for injuries sustained in matches. Of these, 6% (9 players) sustained injuries during their goal celebrations. The pertinent findings were as follows…

7 of the 9 players were male and their average age was between 17 and 29.
The injuries happened on real grass in 8 of the 9 cases.
Most injuries occurred in the second half.
Sliding injuries (on the stomach, back or knees) accounted for 5 cases.
Piling up or over-excited teammates were the other major cause.
Injuries included fractures to the ankle, clavicle and rib. Other injuries included knee ligament sprain, lower back strain, and lower limb muscular strains.
Perhaps the most interesting statistic is that the average recovery time for these injuries was 6.2 weeks! Perhaps enough reason to take it easy when celebrating a goal!

References

Zeren B, Oztekin HH. Score-celebration injuries among soccer players. The American Journal of Sports Medicine 2005; 33(8): 1237-1240.

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Have you been injured in a car accident?  Quite often patients come to our clinic with a sore, stiff neck after being involved in a car accident.  We can help.  This blog will outline for you some of the more commonly asked questions by our patients about whiplash and whiplash treatment.

What is Whiplash?

Whiplash injury is a condition that involves damage to both the muscles and joints in the neck after it has been “whipped” backwards.  Most commonly associated with rear-end motor vehicle collisions, whiplash is a common yet sometimes complicated condition to resolve.  Due to this, a great deal of literature has been published on whiplash injury and different pieces of the puzzle are slowly being put together.

Whiplash – What is Injured?

One of the common areas of the neck injured in a motor vehicle accident is the cervical facet joint.  The cervical facet joint is located at the back of the neck.  It is compressed together when the head is extended (like the motion of looking up).  To challenge the right facet joints, we turn the head to the right and extend the neck backward.  Likewise, to challenge the left facet joints, we would turn the head to the left and extend the neck backward.  A recent study published in the journal Spine investigated the affect of having your head turned when rear-ended and whether or not that made injury to the facet joints (whiplash) worse.  Perhaps predictable, this study indeed found that a head-turned posture increases the facet joint injury associated with whiplash.  Unfortunately, it is common for drivers to turn their head to the right and look out the rear-view mirror a split second before an impending collision.  Of course, we hope that none of us are ever in this situation, but in the unfortunate event of a rear-end collision remember to keep your head straight!

What is WAD I, WAD II or WAD III?

Whiplash injury is now often referred to as Whiplash Associated Disorder, or “WAD”.  WAD injuries are graded between one and four. WAD I is a whiplash injury from a motor vehicle accident in which the patient has a sore neck.  WAD II is a whiplash injury from a car accident in which the patient has a sore neck and a decreased range of movement (stiff neck).

What if I have a “pinched nerve in neck”?

WAD III is more serious than WAD I or WAD II. WAD III is a whiplash injury that is characterized by a sore neck, a decreased range of movement (stiff neck) and numbness and tingling in the arms.  Often described as a pinched nerve in neck, the involvement of neurological structures makes this injury a little more severe and consequently, a little more difficult to resolve.  If you have been in an accident and are experiencing these symptoms (like a “pinched nerve in neck”) please contact our clinic or your medical doctor; x-rays are more than likely necessary.

Whiplash Treatment

Treatment for whiplash injury can vary, depending on the individual characteristics of each person’s condition.  In the past, treatment for whiplash included the use of a soft cervical neck collar.  Unfortunately, this seemed to prolong recovery.  We’ve now learned that early return to normal activity is helpful for recovery from Whiplash and whiplash associative disorder, depending on the case.  The first priority is to have your injury diagnosed by a qualified practitioner.  Our clinic has these practitioners.

Whiplash Diagnosis

It’s important that your neck injury is diagnosed properly before choosing a management strategy; there are some neck injuries that should not be moved.  Sometimes X-rays are required.  Once deemed safe and a diagnosis of WAD I or WAD 2 is made, it is usually recommended that the neck is moved within a relatively pain free range of motion.  Again, diagnosis is paramount with WAD injury before any movement or treatment is attempted.  Our clinic often uses the expression “hurt vs. harm” for our whiplash patients.  This means that although it may be a little painful to move your neck, it likely won’t harm you.  Diagnosis for your injury and referral for appropriate x-rays can be performed by our Chiropractor.

Physiotherapy or Chiropractic for Whiplash?

Our Burlington Physiotherapy and Chiropractic Clinic sees many patients with whiplash injury.  We adapt the treatment toward the needs and comfort level of each patient; for some patients, active release technique and Graston are a great way to treat these injuries.  This is performed by our Chiropractor.  For others, laser therapy and exercise is the best starting point…this is performed by both our Chiropractors and our Physiotherapist.  Whatever the case, we offer our whiplash patients many treatment options depending on their specific needs.  If you’ve been in a car accident and need treatment for your injuries, please call our clinic today!  905.220.7858 info@burlingtonsportstherapy.com

References
Lord SM, Barnsley L, Wallis BJ et al. Chronic cervical zygapophysial joint pain after whiplash. A placebo controlled prevalence study. Spine 1996; 21: 1737-44.
Siegmund GP, Davis MB, Quinn KP et al. Head turned postures increase the risk of cervical facet capsule injury during whiplash. Spine 2008; 33(15): 1643-1649.
Sturzenegger M, Radanov BP, Distefano G. The effect of accident mechanisms and initial findings on the long term course of whiplash injury. Neurology. 1995; 242:443-9.

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