What is the difference between a sprain and a strain?

The term ”sprain” usually refers to ligament damage.  This is different from a “strain”, which primarily involves muscle damage.  Ankle sprains are arguably the most common type of sprain and are usually a result of trauma.

Symptoms of Ligament injury

When you “roll your ankle” you sprain the ligaments in and around the joint.  As with most sprain injuries, this affects the overall stability of the joint.  For most sprains (but not all) the joint will swell and feel difficult to move.  Usually, ligament injuries cause a joint to “give way” or feel unstable and can often be prone to repeated trauma in the future.

Healing Process for Ligament Injuries

When we tear a ligament (as with a sprain) the body tries to repair the area. It quickly and hastily lays down an inferior type of tissue to repair the ligament. You can also say that it lays these pieces down in a haphazard manner. A good analogy is to think of a big pile of uncooked spaghetti, where all the different pieces are thrown in different directions. One way to align all the pieces of spaghetti would be to roll your hand over them…eventually all the pieces of spaghetti would line up. In a sense, some treatments we provide are similar! 

Treatment for Ligaments

A 2009 study performed on rat MCL’s (a ligament in the knee) found that instrument assisted soft tissue treatment (like the Graston technique) may accelerate early tissue healing. This effect was primarily found in the early stage of healing.

What does this mean?

It’s important to remember that a study like this was performed on rats! Nevertheless, it is another example of substantiating evidence for treatments like the Graston technique. At Burlington Sports Therapy we use various methods for treating ligament injuries. Laser therapy, IFC (interferential current), acupuncture, manual therapy like active release and of course Graston can all be helpful methods for accelerating healing.  For more information about Graston Technique, click here. 

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

References
Hammer W. The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies 2008; 12: 246-256.
Lohgmani MT, Warden SJ. Instrument assisted cross fiber massage accelerates knee ligament healing. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(7): 506-514.

Neck Headaches

Approximately 2.5% of the adult population gets cervicogenic or “neck headaches”. These comprise 15-20% of chronic and recurrent headaches.

Symptoms of Neck Headaches

Headaches that originate from the neck are actually somewhat simple. Typically, a person suffering from these headaches will complain of neck pain associated with their headache. The neck pain usually occurs before and sometimes also during their headache. There is usually an absence of symptoms that are well known in migraine headaches. That is, a person experiencing a true neck pain headache would not complain of associated nausea, vomiting or visual changes.

Treatment of Neck Headaches

Obviously, the treatment of headaches associated with neck pain is geared toward the dysfunctional area; the neck. According to the scientific literature, the majority should be expected in the upper region of the neck. Specifically, the C1-2 levels, which are essentially right under your skull. At Burlington Sports Therapy, our chiropractors and physiotherapists use a variety of treatment methods. Some of the options include laser therapy, manual therapy like active release, spinal mobilizations or chiropractic adjustments, acupuncture and rehabilitative exercise. If you’re prone to this type of headache you’ve probably already realized what the scientific evidence also says; stretching (by itself with no other intervention) does not work.

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

References
Hall J et al. Intertester reliability and diagnostic vailidity of the cervical flexion rotation test. Journal of Manipulative & Physiological Therapeutics 2008; 31: 293-300.
Ylinen J et al. Effect of neck exercises on cerviogenic headache: a randomized controlled trial. Journal of Rehabilitation Medicine 2010; 42: 1-6.

Does your neck get sore when you sit at a computer for too long?

What causes a trigger point?

Trigger points are the result of overuse. They can occur in muscles that are subjected to obvious use, like the legs of a marathon runner. Perhaps less obvious but quite common, are the trigger points that form in postural muscles. These areas of dysfunction occur because of the constant low level demand placed on them, such as the muscles in the shoulder and neck after slouching at a computer desk.

What happens to the muscle?

A trigger point makes a muscle short and weak.  Sometimes they can affect a person’s movement.

Types of Trigger Points

There are two major types of trigger points; latent and active. Latent trigger points are not usually painful unless someone pushes on the area or unless you move in a way that stimulates the muscle. An active trigger point is painful even without touching it or moving it.

How do you diagnose a trigger point?

There really aren’t any diagnostic tests for a trigger point (that are usually necessary at least). Trigger points are usually palpable by the practitioner. As previously mentioned, a trigger point (by definition) refers pain in a characteristic pattern and increases pain locally with pressure.

Treatment for Trigger Points

There are various treatment approaches for muscular trigger points. Massage therapy, acupuncture, active release technique and graston technique are all common methods for treatment. In most cases, rehabilitative exercises are important to not only reverse the muscular aggravation, but to change the function of an area so that the muscle does not become overused in the future. In the same line of thinking, activity modification may be helpful in avoiding overuse of an area.

Think you may have a muscular trigger point? Give us a call, we can help! info@burlingtonsportstherapy.com

References

Hyde TF, Gengenbach MS.  Conservative Management of Sports Injuries 2nd Ed.  Jones & Bartlett Learning 2007.

Stretching for neck pain...does it work?

Strengthening for Neck Pain

Many people accept the idea that strengthening the abdominal muscles is a good way to prevent (or help resolve) lower back pain. For some reason the neck doesn’t get the same appreciation. Numerous studies have now shown that many patients with chronic neck pain show a deficiency in function of the deep cervical flexors. In other words, the muscles in the front of your neck (deeper than the superficial layers that you can see) are not at their optimum for assisting the various joints and structures of the neck.  For those people who display weakness in this area, strengthening should be helpful. 

Treatment for Neck Pain

So how do you strengthen this area of the neck?  Unfortunately, this is a tricky one to explain through a blog.  Strengthening of the deep neck flexors is very helpful for many people with neck pain because there are certain muscles “doing too much work” and we want to correct this imbalance.  Incorrect form when strengthening this area could actually perpetuate the muscle imbalance and be of no help to the person with neck pain.  As much as the internet can be a handy place to learn “do it yourself” strategies for different things, strengthening of the deep neck flexors is not really one of them.  Despite this, we’ve listed the instructions for strengthening of the deep neck flexors below.  It is strongly recommended that you consult with a suitable healthcare practitioner to ensure proper technique with this exercise.

Deep Neck Flexor Strengthening

Lie  flat on the floor and place your tongue on the roof of the mouth.  Tuck your chin toward your chest (just slightly) while leaving your head on the floor.  While mainitaining this “chin tuck”,  lift the head off the floor approximately one inch.  This position should be held for as long as possible, however the skull must stay in a ”tucked” position.  If the chin begins to move outward, discontinue the exercise and rest.  

For more information about Chiropractic, Physiotherapy and rehabilitative exercises for the neck at Burlington Sports Therapy, please contact us. info@burlingtonsportstherapy.com

References
Jull GA, O’Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. Journal of Manipulative and Physiological Therapeutics 2008; 525-533.

Obesity and back pain...is there a link?

Disc Degeneration

Our spine is made up of boney vertebrae with cartilage discs between each level. These discs have a tendency to degenerate or wear down with time. For some people this happens quicker than others. Many of us thought that being heavier accelerated this process of lumbar disc degeneration. Yet an interesting study published in the Spine Journal challenged this idea in a very interesting way. The authors of the study investigated 44 pairs of male twins. In this study model, they were able to compare identical twins and the amount of degeneration in their spines. Obviously, they were interested in the differences of disc degeneration between the heavier twin and the lighter twin.

Being Heavier May Benefit Your Bone Density

The average weight difference of the twins was 13 kilograms. The results indicated that the heavier twin tended to have a 6.2% higher bone density in the lumbar spine vertebrae. This makes sense when you think of people with Osteoporosis. Usually, the recommendation for people with Osteoporosis is to continue with weight bearing and resistance exercise. This stimulates better bone formation. In this study, the heavier twins stimulated more density in the cells of the bones.

Body Weight and Disc Degeneration

With respect to the spinal disc heights and their relation to body weight, the twins were similar. In other words, the heavier twins didn’t show a reduced or more “worn down” intervertebral disc!

Progressive Load and the Spine

Our bodies are constantly remodeling based on stimulus. A weightlifters body takes a certain shape after loading the muscles in certain ways. Similarly, a marathon runner adapts a certain body shape given the different stresses and loads placed on their system. In the case of this study, we can perhaps view a gradual increase in weight over time to be helpful for various structures of the spine, challenging the general belief that heavier people are more prone to lower back pain. This study has taught us that heavier people may not be more prone to disc degeneration.

Treatment for Disc Degeneration

The results of this study should be taken with a grain of salt. Obviously, obesity is not a good thing for your spine or your general health.  However, many patients believe that their back pain is entirely related to those “few extra pounds”. Although I always encourage my patients to maintain a healthy body weight, there may be better areas for those experiencing back pain (and disc degeneration) to focus their efforts on. Perhaps it would be more important to look at all aspects of lower back pain prevention. Exercise, strengthening, posture and activity selection are all important aspects of preventing lower back pain. Consulting with our chiropractors or physiotherapists can be a great start to preventing lower back pain; these practitioners can assist you in developing a strategy that fits your individual situation.

For further information – 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.

Hip Bursitis

What is Trochanteric Bursitis?

Although there are different bursa in the hip, the one that receives the most attention (since it gets injured the most) is the trochanteric bursa. It is located on the side of your hip. When it gets irritated it can inflame, causing the condition of bursitis. In this case it would be called hip bursitis, or more specifically, trochanteric bursitis.

Who gets Hip Bursitis?

Hip bursitis usually occurs in the 4th to 6th decades of life. It typically gets entrapped or irritated by the gluteal muscles or the iliotibial band. Hip bursitis is more common in women and at our clinic, it is mostly seen in distance athletes like marathon runners or triathletes. This is not an absolute though; hip bursitis can affect people from all walks of life and all fitness levels.

Symptoms of Hip Bursitis

Usually, pain is present in the area of the lateral hip. It can often be described as a warm, swollen, achy pain that is aggravated with pressure or excessive activity. Sleeping on the affected hip often exacerbates or worsens trochanteric bursitis.

Treatment for Hip Bursitis

For those patients who have persistent bursitis in the hip that won’t respond to conservative treatment like chiropractic or physiotherapy, corticosteroid injections have some scientific validity.  Prior to this, it is always recommended to try something less invasive.  At Burlington Sports Therapy, hip bursitis can be treated in a variety of ways. Active release to the surrounding musculature, acupuncture, laser therapy, interferential current (IFC) and rehabilitative exercise are just some of the options.  Unsure what to do?  Unsure if you have hip bursitis?  We can help!  info@burlingtonsportstherapy.com

References
Rowand M, Chambliss ML. How should you treat trochanteric bursitis? The Journal of Family Practice 2009; 58(9): 494,500.

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.