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!

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.

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

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.

About Frozen Shoulder

Frozen shoulder affects approximately 2-5% of the population. Also called adhesive capsulitis, frozen shoulder can be linked to certain health conditions (such as diabetes or rheumatoid arthritis) but not always. For many patients, frozen shoulder occurs for no apparent reason.

Why is my shoulder stiff?

The precise mechanism of frozen shoulder is still relatively unknown. That being said, it is generally understood that some form of “event” causes the cells in your shoulder to change their activity. Inflammation likely causes the different tissues in the shoulder to contract or “bear down” on the joint. As a result it is very difficult to move since there is a type of “debris” in the way.

Symptoms of Frozen Shoulder

A person with frozen shoulder will likely experience pain when they move their shoulder to the end of available range. Often, the shoulder won’t hurt with movement in a short range and will not really hurt at rest. Contrary to popular belief, the muscles are not damaged or weakened in any significant way. Although it seems like the muscles must be damaged or torn, they usually aren’t. The joint just won’t move!

Tests for Frozen Shoulder

Unlike many conditions, there really aren’t any imaging findings for a practitioner to look for. When a person presents to our clinic with pain, loss of movement and no obvious findings on x-ray, diagnostic ultrasound or MRI, frozen shoulder is a diagnostic possibility.

Phases of Frozen Shoulder

It’s important for people with frozen shoulder to realize the expected healing rate (according to the published literature).  Although some lucky individuals recover from their frozen shoulder relatively quickly, many patients experience symptoms for over a year. According to the literature, the first phase of frozen shoulder lasts approximately 3-9 months. This is the “freezing” period which involves progressive pain and loss of motion.

Second Phase of Frozen Shoulder

The second phase of frozen shoulder occurs between 9-15 months since onset. At this point the shoulder is stiff…frozen shoulder has arrived!

Recovery from Frozen Shoulder

The last phase of frozen shoulder is often referred to the “thawing” phase. It can often occur between 15-24 months and involves a relatively gradual improvement in mobility.

Treatment for Frozen Shoulder

The treatment for frozen shoulder really depends on the phase of development and the amount of pain the patient is experiencing. Conservative treatment (like chiropractic or physiotherapy) is usually recommended and involves such things as stretching, assisted stretching, active release technique and other forms of manual therapy, laser therapy, interferential current, graston and acupuncture. Sometimes a combination of these approaches does the job. For those with very painful frozen shoulder, corticosteroid injections can be helpful. Surgery is also an option for those who fail to respond to conservative treatment (like physiotherapy or chiropractic). Unsure if you even have a true frozen shoulder? Want to know your options for treatment?

Call or email us – info@burlingtonsportstherapy.com. We can help you!

References
Favejee M, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions – systematic review. British Journal of Sports Medicine 2011; 45: 49-56.
Johnson AJ et al. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy 2007; 37(3): 88-99.
Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(2): 135-148.

Bursa and Bursitis

Bursa are anatomical structures that are present throughout our body. A simple way to explain them is that they are “spacers” to separate different tissues in our body to prevent friction…think of a balloon filled with pudding.  Under normal circumstances we don’t even know we have them. They are present in our shoulders, knees, hips (and other major joints) and they usually don’t cause any symptoms or signs of dysfunction. When provoked, these structures can become inflamed. When this happens they swell with fluid and create the painful condition called “bursitis”.

Shoulder Bursitis

Most forms of bursitis are not visible but some can be. In these cases, you might actually see an area of collected fluid which correlates with the painful area. Keep in mind that bursitis doesn’t have to be painful though! In the most common case of shoulder bursitis, the bursa underneath the acromion (the pointy bone on top of your shoulder) gets inflamed. This is called subacromial bursitis. Since there isn’t a lot of extra space in that area to begin with, things get compressed. This is usually painful.

Symptoms of Shoulder Bursitis

A broad area of pain in the shoulder is common for shoulder bursitis. It usually doesn’t involve a specific point area of tenderness, but rather a “spread out” ache. Shoulder bursitis is usually aggravated with overhead activity, compression (like lying on that shoulder) and excessive use. Diagnostic ultrasound and MRI can be helpful in determining whether there is swelling in the bursa.

Treatment of Shoulder Bursitis

There are various treatments for shoulder bursitis. Anti-inflammatory or cortisone injections can be provided by a medical professional. Consistent with the literature, our clinic offers conservative treatment options through our chiropractors and physiotherapists. This avenue of treatment involves various treatment modalities like laser therapy, interferential current, manual treatment (like active release on surrounding tissues), acupuncture and rehabilitative exercise.  The treatment that is right for you can depend on many different factors, such as the duration of symptoms and treatment approaches that have already been tried.  Unsure what to do?  Feel free to give us a call or email us at info@burlingtonsportstherapy.com.  

Chiropractic Burlington Ontario and Degenerative Disc Disease

Our spine is made up of boney blocks called vertebrae. Separating each vertebrae are cartilage discs. These discs can wear down with time and use, which lead to the diagnosis of degenerative disc disease. Degenerative disc disease can be considered a relatively normal process that occurs in the spine. Unfortunately, it can also be associated with considerable pain and disability for some individuals.

Facts About Degenerative Disc Disease

In a nutshell, degenerative disc disease is a process that occurs over a considerable length of time.  Various factors (age, genetics, occupation, previous trauma) wear the disc down and cracks can form.  The jelly like material on the inside dries up and the overall height of the disc decreases.  The surrounding joint structures (such as ligament, bone and cartilage) can also be involved. Significant reduction in disc height can also affect the nerves that exit at each level of the spine.

Who Gets Degenerative Disc Disease?

For many people, signs of degenerative disc disease begin when they are in their twenties.  Although the prevalence of degenerative disc disease increases with age, genetics seem to be the best predictor of those who will be prone to the condition.  The activities that you do on a regular basis also seem to play a role. I often use the analogy of the tires on your car; you can’t expect to drive your car day after day and not see any wear in the tires. Your spine (and the discs in your spine) is somewhat similar.

Disc Bulge or Disc Herniation?

An easy way to understand the intervertebral disc is to picture a jelly donut. There is an outer crust to the disc and an inner jelly material. Simply stated, a disc herniation is when the crust is torn right through to the jelly in the middle and the jelly pushes out of the crack. A disc bulge is when the jelly in the donut squishes really close to the edge of the donut (because there are tears in the crust) but the jelly doesn’t pierce through the entire dough to be visible from the exterior.

Treatment for Degenerative Disc Disease

Surgical treatment for degenerative disc disease is usually viewed as a last resort if conservative treatment didn’t do the job. Conservative treatment usually consists of treatment like chiropractic, physiotherapy, laser therapy, acupuncture and massage therapy.  At Burlington Sports Therapy we have a variety of treatment techniques and services that can assist patients with degenerative disc disease. What is right for each individual patient depends on a variety of factors, including duration of symptoms, severity of symptoms and previous failed treatments.

For more information about how we can assist you, please email us at info@burlingtonsportstherapy.com

References
Adams MA and Roughley PJ. What is intervertebral disc degeneration and what causes it? Spine 2006; 31(18): 2151-2161.
Beattie P. Current understanding of lumbar intervertebral disc degeneration: a review with emphasis upon etiology, pathophysiology and lumbar magnetic resonance imaging. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(6): 329-340.
De Schepper EIT, Damen J, van Meurs JBJ et al. The association between lumbar disc degeneration and low back pain. Spine 2010; 35(5): 531-536.
Viderman J, Gibbons LE, Kaprio J, Battie MC. Challenging the cumulative injury model: positive effects of greater body mass on disc degeneration. The Spine Journal 2010; 10: 26-31.

What is a rotator cuff tear?

A rotator cuff tear is a very common injury affecting one (or more) of four different muscles in the shoulder. A tear can be partial or complete and can sometimes involve retraction of the tissue. Rotator cuff tears can be painful but they don’t have to be. They can often be associated with a traumatic event…but they don’t have to be! Rotator cuff tears can occur after years and years of use and are much more common in those people over 60.

Symptoms of Rotator Cuff Tear

Rotator cuff tears typically cause local pain in the shoulder. The pain can also travel down the shoulder toward the elbow. Surprisingly though, you may have one right now and not even know! A 1995 study published in the Journal of Bone & Joint Surgery performed MRI’s on people without shoulder pain. They found that rotator cuff tears in 4% of patients under 40 and in 54% of those greater than 60. A similar study found tears in 40% of those older than 50.

How do you know if you’ve torn your rotator cuff?

A skilled practitioner with the appropriate knowledge to diagnose your condition is obviously essential. One benefit of seeing a chiropractor is that we can order the appropriate x-rays right away. Although a rotator cuff tear is a muscular injury, there are clues that can be found on plain x-rays. Combining this information with certain clinical tests performed during your examination can allow for an early diagnosis so treatment is not delayed.

What is the best imaging for rotator cuff tears?

MRI (magnetic resonance imaging) is known to be one of the most accurate tools for diagnosing rotator cuff injuries. In Ontario, the wait can be long so many patients are referred for a diagnostic ultrasound. Although this modality isn’t as accurate, the wait times are usually shorter and can usually provide an early diagnosis.

Surgery for Rotator Cuff Tears

Surgery is appropriate for some individuals, but there are many different factors to consider. Many rotator cuff tears “re-tear” after surgery. Despite this, surgery can still improve function and decrease pain. Delaying surgery can be a bad idea though; your tear can get larger (especially if you’re over 60 years old), it can retract, can become infused with fat tissue and it can also atrophy (shrink). Each of these events will make recovery more difficult. Surgery is usually a more obvious decision for younger patients with a new, severe tear. Older patients have to carefully discuss with their surgeon and weigh out the benefits and risks.

Should I try more conservative treatment first?

According to the evidence, it is usually a good idea to try conservative treatment (like chiropractic or physiotherapy) for approximately six to twelve weeks prior to choosing surgery. This approach is most suitable for those people who still have some strength in their shoulder. Thinking of waiting to see if it improves? It is generally understood that larger tears will not heal with time. In fact, it would be more likely to get worse and retract. Significant retraction can make surgery more difficult.

Physiotherapy for Shoulder Pain

Our Burlington Chiropractic and Physiotherapy clinic offers many different ways to treat rotator cuff tears. Exercise, interferential current, laser therapy, acupuncture, graston or hands on treatment (like Active Release) are some of our “tools”. The best treatment for rotator cuff tears depends on many factors. Age, the duration of your symptoms, your x-ray findings and clinical findings (like strength) all play a role in the decision making process. Give our clinic a call and start with a diagnosis…we’ll help you figure it out!
Email – info@burlingtonsportstherapy.com

References
Hansen M, Otis J, Johnson J et al. Biomechanics of massive rotator cuff tears: implications for treatment. The Journal of Bone and Joint Surgery 2008; 90(2): 316-325.
Keener JD, Wei AS, Kim HM et al. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. The Journal of Bone and Joint Surgery 2009; 91: 1405-1413.
Maman E, Harris C, White et al. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. The Journal of Bone and Joint Surgery 2009; 91: 1898-1906.
Sher JS, Uribe JW, Posada A et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. Journal of Bone & Joint Surgery 1995; 77:10-15.
Wolf B, Dunn W, Wright R. Indications for repair of full-thickness rotator cuff tears. Americal Journal of Sports Medicine 2007; 35: 1007-1016.
Zingg PO, Jost B, Sukthankar A et al. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. The Journal of Bone and Joint Surgery 2007; 89: 1928-1934.