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What is Chiropractic Care?

What is Chiropractic Care?

Chiropractors are trained to evaluate, diagnose and treat neuromuscular and musckuloskeletal conditions. It is a common misconception that chiropractors only treat spinal conditions with spinal manipulative therapy, or adjusting techniques. In fact, chiropractors treat a wide array of muskuloskeletal conditions which include neck pain, back pain, and headaches but also tendon disorders, muscle strains, and ligament sprains which commonly affect our upper/lower extremities. In our Mission Valley, San Diego office, we commonly treat soft tissue injuries with a combination of joint manipulation, Active Release Technique, Graston Technique, and rehabilitative exercise.

What to Expect for your First Visit?

History

There are a few forms to be filled out that answer questions regarding your current injury (or reason seeking care) and past health issues. One of our chiropractors will then go over this information with you and ask a series of questions regarding your current and past injuries; this helps give us information that leads to a working diagnosis.

Exam

Pain Fighting Exercises

After the history is complete, a physical exam is performed. This normally includes: active/passive range of motion, orthopedic testing, neurological testing, and functional tests such as squats/lunges. All these tests give us further information to accurately diagnose the condition that you are presenting with. This in turn will develop an appropriate treatment plan moving forward. In some cases, the history and exam may reveal a condition that is in need of further testing (X-ray, MRI) before treatment can begin. In rare cases, a referral to a specialized health care provider is warranted.

Many of our patients at our Mission Valley office seek out our care for sport performance and are not currently injured. In these cases, we focus on evaluating musculoskeletal imbalances that may be limiting sport performance.

Treatment

As mentioned above we utilize the latest therapies and treatment protocols for each injury we see in our office. Treatment may include some or all of the following:

                                          Active Release Technique Mission Valley

  1. Joint manipulation/mobilization- If it is determined that there is loss in range of motion at a joint, joint manipulation or mobilization can be performed to restore proper range of motion and joint function   
  2. Active Release Technique– Active Release Technique or (A.R.T) is considered the “Gold Standard” for treating soft tissue injury. The practitioner identifies the injured structure, applies pressure, and has the patient perform active movements. This helps break down scar tissue and restore proper function to the soft tissue. Treatments usually last 5-15 minutes and can be painful in areas where the injury is.
  3. Graston Technique– Graston is another technique we use in our Mission Valley office that helps break down scar tissue in the superficial layers of muscle and fascia in our body. Graston is also excellent for treating chronic injuries due to its ability to increase blood flow to the injured area. After treatment, you may notice red marks and feel warm in the area due to this increase in blood flow.
  4. Rehabilitative Exercise– An individual exercise plan is prescribed for each patient. Exercises may include flexibility, mobility, strength, stability, etc.depending on your injury and or goals with care. Our goal is to always keep the exercises progressive to avoid plateaus in care.

 graston technique in san diego Active Release Technique Mission Valley

 

Our goal is return patients to their sport, activity, job as quickly as possible, pain free. We often see significant results between 4-8 visits, depending on the severity of the condition. Once a patient has reached maximal improvement for the condition we recommend periodic check ups to re-evaluate the area. This allows us the opportunity to offer further advice, change exercises, etc. to avoid future re-injury. 

Please do not hesitate to contact our Mission Valley office at 619-818-4306 if you have any questions. You may call our office or visit our website to schedule today! We accept most major insurances, offer affordable cash rates, and offer a military discount for treatments.

Ergonomic Chair Setup

Comfortable desk work begins with proper chair setup. Follow these helpful tips to ensure a proper ergonomic chair setup.

Chair Setup

  • Push your hips as far back as they can go in the chair.
  • Adjust the seat height so your feet are flat on the floor and your knees are equal to, or slightly lower than, your hips.
  • Sometimes the desk height forces you to have the chair higher than you what will allow you to touch the ground.  If your feet don’t reach the ground put a small box under your desk to rest your feet on.
  • The back of the chair should be at a 100°-110° reclined angle which should create an angle between your body and your thighs of 90° -100°.

    Step 1 Chair.

    From UCLA Ergonomics

  • Make sure your upper and lower back are supported. Use extra cushions at the small of your back if your chair does not have adequate support.
  • Adjust the armrests so that your shoulders are down and relaxed.
  • If your armrests prevent your shoulders from being in a relaxed position, remove them.
  • Keep your body straight with the head and neck upright and looking forward, not to the side. Do not hunch over or slouch.

OTHER TIPS

  • Don’t cross your legs while sitting. This can cut off circulation and/or lead to hip problems.
  • Make sure your chair seat has a soft, downward curved edge so that it does not dig into the back of your thighs. This can also cut off circulation.
  • When purchasing a chair the best feature is its ability to adjust each component separately.
  • If sitting is too painful, consider a standing workstation.

 

Next post “Ergonomic Keyboard and Mouse Setup”

Best Chiropractor in Mission Valley

 

Congratulations to Dr. Rose, DC on being voted 2012 Best Chiropractor in Mission Valley by Mission Valley News.

Click Here for the entire release.

Mission Valley News offers community news and information on Mission Valley, Old Town, Linda Vista and surrounding areas.

Sciatic Nerve Glide

Piriformis Syndrome Part III- Treatment

Piriformis Syndrome Treatment

The two main goals of treatment are 1) to relief irritation to the sciatic nerve and 2) address any functional problems that may be contributing.
If the sciatic nerve is inflamed the first step is to decrease aggravation from compression. Things to avoid are leg crossing, sitting on your wallet, and sitting on hard surfaces.  Things you should begin doing are applying ice to the piriformis, stretching of the piriformi, and taking oral anti-inflammatories (as directed).  Stretching every 2-3 hours (while awake) is a key to the success of non-operative treatment. Prolonged stretching of the piriformis muscle is accomplished in while lying on your back with the hip flexed and passively adducted/internally rotated (see picture).  Another exercise that can be helpful to decrease irritation between the piriformis and sciatic nerve is a nerve gliding exercise.  This exercise tensions the sciatic nerve and allows it to move relative to the piriformis. It is sometimes called nerve flossing to better describe how the nerve moves through other structures.  Two types of nerve gliding exercises are pictured below. (Pictures from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53203)
 Sciatic Nerve GlideSciatic Nerve Tensioner
Manual therapy can be extremely helpful in releasing tension on the sciatic nerve and addressing functional deficits.  Soft tissue therapies, including myofascial release and Graston®, aimed at releasing tension and muscular adhesions within the piriformis can be beneficial.  Chiropractic spinal adjustments can help address functional contributions from the spine such as sacroiliac joint hypomobility and low back dysfunction.  Hyperpronation of the foot can be addressed through orthotics in the short term and foot strengthening in the long term.  Pronation is a normal foot motion however overpronation may lead to increased external rotation of the hip with walking putting tension on the piriformis and sciatic nerve.
Treatment may take several months of consistent work and it is important not to get discouraged. As long as there is no progression of neurological symptoms conservative treatment is the best option. Your symptoms should be monitored by a healthcare practitioner to ensure there is no progression.
-Dr. Kevin Rose, DC
Q Angle

Piriformis Syndrome Part II- Evaluation

Clinical Diagnosis

Piriformis syndrome occurs most frequently between ages 40-60 and is more common in women than men.  Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome; , possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the pelvis of women. Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%.

Q-Angle

The most common  symptom of patients with piriformis syndrome is increasing pain after sitting for longer than 15 to 20 minutes. Many patients complain of pain over the piriformis muscle (ie, in the buttocks), especially over the muscle’s attachments at the sacrum and medial greater trochanter. Symptoms, which may be of sudden or gradual onset, are usually associated with spasm of the piriformis muscle or compression of the sciatic nerve; these symptoms include radiating/shooting pain or tingling or numbness in the back of the thigh, leg, or foot.  These symptoms must be evaluated by a healthcare provider to differentiate the possible causes.  Patients may also complain of difficulty walking and of pain with internal rotation of the involved leg, such as occurs during cross-legged sitting or walking. X-rays or an MRI offer little help in directly diagnosing piriformis syndrome but may be used to rule out other causes of sciatica such as a herniated disc in the lumbar spine.

Functional Evaluation

There are many functional abnormalities that may have either caused or resulted from this condition.  Once the diagnosis has been made, these underlying, perpetuating biomechanical factors must be addressed.

Functional biomechanical deficits associated with piriformis syndrome may include the following:

  • Tight hip external rotators including pirifromis
  • Tight adductors (groin)
  • Hip abductor weakness
  • Lower lumbar spine dysfunction
  • Sacroiliac joint hypomobility
  • Hyperpronation of the foot and prolonged toe-off

Functional adaptations to these deficits include the following:

  • Ambulation with the thigh in external rotation
  • Functional limb length shortening
  • Shortened stride length

Next post will discuss treatment options for piriformis syndrome

Piriformis Syndrome

Piriformis Syndrome: Overview and Causes

Piriformis SyndromePiriformis syndrome is a unique cause if sciatic nerve irritation (neuritis) or sciatica. The condition, which can mimic lumbar disc herniation, usually is caused by irritation of the sciatic nerve due to spasm and/or contracture of the piriformis muscle. Piriformis syndrome is also referred to as “pseudosciatica”, “wallet sciatica”, and “hip socket neuropathy”.
It frequently goes unrecognized or is misdiagnosed in clinical settings. Piriformis syndrome can “masquerade” as other common somatic dysfunctions, such as intervertebral discitis, lumbar radiculopathy, primary sacral dysfunction, sacroiliitis, sciatica, and trochanteric bursitis.

 

(Image from http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=4214fc65d020761633286131e407d037)

Anatomical Considerations

The proper understanding of piriformis syndrome requires knowledge of the anatomy and anatomical variations in the relationships between the sciatic nerve and the piriformis muscle.

The piriformis muscle is flat, pyramid-shaped, and oblique. This muscle originates on the front of the sacrum and inserts at the greater trochanter of the femur. With the hip extended, the piriformis muscle is an external rotator of the hip; however, with the hip flexed, the muscle becomes a hip abductor.

In most of the population, the sciatic nerve exits the pelvis deep along the lower surface of the piriformis muscle. However, many developmental variations of the relationship between the sciatic nerve in the pelvis and piriformis muscle have been observed. In as much as 22% of the population, the sciatic nerve pierces the piriformis muscle, splits the piriformis muscle, or both, predisposing these individuals to irritation of the sciatic nerve.

Sciatic N and Piriformis Orientation

 

 

 

From http://www.anatomyatlases.org/AnatomicVariants/NervousSystem/Images/70.shtml

Causes of Piriformis Syndrome

Piriformis syndrome can be caused by a variety of issues. The underlying mechanism is from irritation to the sciatic nerve. Below are some causes of irritation to the sciatic nerve as it passes the piriformis muscle:

1. Muscular problems

  • Spasms and adhesions in the piriformis muscle cause compression and irritation of the sciatic nerve. Muscular damage or tightness can develop from a single injury or repetitive use injury. Vigorous physical activity can lead to such an injury- (commonly seen in athletes such as runners, cyclists, and dancers).

2. Postural

  • Hyperlordosis (increased curvature of the low back) and increased foot pronation are both risk factors for piriformis syndrome

3. Traumatic

  • Direct compression of the piriformis and/or sciatic nerve from an external soure such as a wallet.

4. Partial or total nerve anatomical abnormalities

  • An anomaly in the nerve itself as it passes through the piriformis muscle can lead to dysfunction

5. Other causes can include the following:

  • Pseudoaneurysms of the inferior gluteal artery adjacent to the piriformis syndrome
  • Bilateral piriformis syndrome due to prolonged sitting during an extended neurosurgical procedure
  • Cerebral Palsy
  • Total hip arthroplasty
  • Myositis ossificans

Stay tuned…… the next post will talk about how this problem is diagnosed and treated.

Lateral Demipointe Compressed - Xray of Ankle

POSTERIOR IMPINGEMENT IN DANCERS

 

Posterior ankle impingement is a common cause of pain in ballet dancers.   Other names for this condition are “os trigonum syndrome” and “nutcracker syndrome”.  It is called “nutcracker syndrome” not because of its common occurrence in ballet at Christmas-time but because of the way the tissue of the ankle is squeezed at the ankle.  The following is a brief overview of this condition and how it relates to dancers.

Posterior impingement of the ankle is often attributable to the presence of an accessory bone growth called an os trigonum or a Stieda process that is located just behind the talus (see x-ray for anatomy).   The stress from repetitive plantarflexion by dancers, especially at a young age, is the suspected cause of the development of the os trigonum.  Pain in posterior impingement occurs when the soft tissue of the ankle is pinched between the posterior lip of the tibia and the calcaneus.  This occurs when the foot is in extreme plantarflexion such as during releve in the demipointe or en pointe positions.Lateral Demipointe Compressed - XRay of Ankle

Proper diagnosis of posterior impingement is imperative for recovery from this injury.  Posterior impingement attributable to an os trigonum is usually misdiagnosed as Achilles’ tendonitis/tendonopathy, peroneal tendonitis or flexor hallucis longus strain. The two main symptoms of posterior impingement are a decrease in plantarflexion compared with the unaffected ankle and pain in the posterior region of the ankle.  Often dancers are aware of a lack of ability to fully pointe in one foot compared to the other, this may be an early sign of impingement.   Another common description dancer’s use is it feels like pinching in the heel during releve.  Diagnosis is often aided by x-Rays of the ankle.  It is best to request an x-ray to be taken during releve to evaluate the biomechanics of the injury.  If there has been persistent pain for a period of 1– 4 months, local swelling, and radiographic assessment indicating a posterior ankle impingement, then an MRI should be performed.

Once posterior impingement is diagnosed focused treatment should begin.  Non-surgical care is usually successful and should be the first line treatment.  Treatment should be focused on taking pressure off of the tissue being pinched.  Exercises should focus on engaging the deep muscles of the leg especially the deep flexors.  One exercise that is helpful and can be done at home is a self traction maneuver with plantarflexion (see picture).  The patient holds his or her ankle, as shown, with downward pressure and performs the motion with a bent knee.  Bending the knee helps disengage the gastrocnemius muscle and soleus forcing the deep flexors to engage. Post Impingement Exercise Compressed Another great exercise is ankle range of motion with traction applied by a therapist using very strong elastic bands.  Dancers may experience relief with traction and feel they are able to fully plantarflex; this can also be a good way to support the diagnosis as Achilles’ tendonitis is often unchanged with traction.  Manipulation of the ankle especially the talus can provide relief as well. Conservative therapy is successful in the majority of cases. Recovery may take several months.

A surgical approach should only be adopted in the following cases:

  • recurrent or unremitting symptoms in professional ballet dancers;
  • persistent decreased plantarflexion compared with the unaffected ankle;
  • failure of physical and medical therapies after 1– 4 months (depending on the level of the athlete/dancer);
  • posterior impingement clinically suspected and indicated by both x-ray and MRI.

 

Ankle pain and heel pain is a common symptom in dancers and posterior impingement is only one of the causes. If you think you may be suffering from posterior impingement seek advice from a qualified healthcare professional with expertise in dance injury.

 

-Dr. Rose, DC, CCSP®

Dr. Rose is a Certified Chiropractic Sports Practitioner® with experience in dance medicine.  He is currently Director of Physical Rehabilitation at Ballet San Jose and a member of the International Association of Dance Medicine and Science.

 

 

 

REFERENCES

Albisetti W, Ometti M, Pascale V, De Bartolomeo O: Clinical evaluation and treatment of posterior impingement in dancers. Am J Phys Med Rehabil 2009;88:349–354.

Niek van Dijk C: Anterior and posterior ankle impingement. Foot Ankle Clin 2006;11:663– 83

F Cilli, M Akcaoglu: The incidence of accessory bones of the foot and their clinical significance. Acta Orthop Traumatol Turc 2005;39:243– 6

Stretching Aerobics

POSTURAL STABILITY IN DANCERS AFTER INJURY

Dancer in ActionBallet dancers are widely known for their superior body control in various challenging body positions.  In fact it has been found in recent studies that ballet dancers have better postural control when compared to other elite athletes. However, what has not been examined is the effect of injury on postural balance in dancers.  A recent study in The American Journal of Sports Medicine by Lin, et al, addresses this vary issue.

Postural balance requires a combination of several different sensory inputs: visual, vestibular (inner ear), and somatosensory (from the skin, joints, muscles, etc). Somatosensory input gives the brain information about where the body is in space; this is called proprioception.  These sensors can be damaged with ligamentous and muscular injuries such as ankle sprains and in turn lead to a deficit in proprioception.  Proprioceptive deficits can put a dancer at more risk for re-injury or new injury.

The recent study by Lin was the first study that evaluated stability in dancers in ballet specific postures following an injury. Three different groups were studied: healthy dancers, injured dancers (with sprained ankles), and health non-dancers.  Postural stability was evaluated on a balance sensor that monitors subtle deviations in stability.  This was done with the eyes open and then again with the eyes closed to further stress the proprioceptive component of balance.  As expected the injured dancers had decreased control not only in ballet specific positions but also in a simple single leg standing position when compared to healthy dancers. Surprisingly the injured dancers had worse stability control than the non-dancers.  Many dancers, and other athletes, that I have treated often assume that a skill such as balancing will come back without training, however this is not the case, and as the study indicated it regresses to the point that is worse than untrained people.Ankle

The postural deficits were most notable in side to side control with single leg standing and front to back control with first and fifth position.  Compensation was noted at the knee and hip joints in an attempt to make up for the injured ankle.  The en pointe position crated the most stability issues; injured dancers were inferior in all directions of stability.  With lateral ankle sprains the most commonly damaged ligament is the anterior talofibular ligament. This ligament is stressed maximally when the ankle is plantar flexed, such as during en pointe positions.  It is not surprising that when this ligament is damaged the proprioception during pointe is significantly disturbed.

This study brings to light the importance of a thorough rehabilitation program that includes proprioceptive training in ballet specific positions.  Typically a sprained ankle takes 6-8 weeks to recover.  During this time it is critical to begin proprioceptive training to ensure that the balance deficits do not lead to further injury.  Additionally if a dancer has a past injury of ankle sprain without proper rehabilitation it is likely that postural stability still remains and there is an increased risk to further injury.  If this is the case, dancers should begin a 3-4 week proprioceptive training plan that includes ballet specific posture.

Dance injuries and rehabilitation are unique and should be managed by a healthcare practitioner that is experienced with the subtleties of dance medicine.  Proprioception training for ballet typically includes balance exercises on an unstable surface such as a Bosu ball or stability disc.  These exercises should be done in normal stance position as well as ballet specific positions.  Whole body vibration may additionally add value as a proprioceptive trainer especially early during rehab when range of motion is limited.  KinesioTape or RockTape are also good taping methods that help protect the joint and provide increased proprioception when applied properly. Keep in mind that a training plan should be designed specifically for each injury and you should not attempt to manage the injury without the supervision of an experienced healthcare practitioner.

Kids Backpack

BACKPACK SAFETY

Child Backpack Fit Guide

Backpacks are a practical way for students to carry schoolbooks and supplies. They are designed to distribute the weight of its contents among some of the body’s strongest muscles; however, in recent years, the weight of student backpacks has increased dramatically and has become a public health concern. Studies show that heavy backpacks can lead to both back pain and poor posture, notes the American Chiropractic Association (ACA). In fact, in 2001 backpacks were the cause of 7,000 emergency room visits and countless complaints of muscle spasms, neck and shoulder pain.

Here are some tips on purchasing a backpack, packing a backpack, and wearing a backpack to reduce the risk of injury.

 

 

Purchasing a backpack, what does a good backpack need

  1. Wide( > 2), Padded Straps 
    The bag should have wide padded shoulder straps. Wide straps and padding distribute the load over more area of
    the shoulder and alleviate pressure points.
  2. Padded Back
    The back of the backpack should padded as well to encourage the pack to sit flat against the back.
  3. Lightweight
    Reducing the overall weight carried begins with a light backpack. The stress on the back is caused by the weight of the bag, don’t forget that the weight of the bag contributes to the overall weight. Anything you can do to reduce that weight will reduce the stress.
  4.  Waist Strap
    A waist strap dramatically helps direct the load away from the shoulders and onto the much stronger waist and hip muscle group.
  5. Proper Size
    Use the chart below for general recommendations by age or for more accuracy you can take measurements of your child’s back.  The width should be from the outside ridge of the one shoulder blade to the other. The height should be from the shoulders to the waist line (belly button) plus two inches. See the diagram below to help with measuring.

 Child Backpack Fit Guide

Child Backpack Size Chart

 

 

 

 

 

 

 

 

 

 

Loading a Backpack

  1. Load heavy items close to the back (the back of the pack)
    Heavy flat items should be placed against the back. This increases the body’s ability to support the weight with stronger muscle groups such as the hips and core.
  2. Don’t overload (see weight chart below)
    As a general rule the weight of the backpack should not be more than 15-20% of the students body weight. It should not exceed 25 pounds in any case.  Below is a table with the recommended weight to be carried based on the student’s weight.

Backpack Weight Chart

 

 

 

 

 

 

 

How to wear a backpack properly

  1. Wear BOTH straps                                                                                                                                                                    
    This helps distribute the load more evenly and helps hold the load more securely to the back. Wearing one strap can lead to shoulder and back pain.
  2. Adjust shoulder straps so the backpack fits snugly against the back                                                                                   
    The back pack should rest no lower than 4 inches below the waist line. Remember that the waistline is in line with the belly button not the top of pelvis.
  3. Fasten waist belt and adjust strap length to secure and distribute the weight evenly                                                       
    The benefits of the waist strap can only be seen if the strap is worn. Don’t forget to have your student fasten it when wearing.
  4. The lower bulk of the backpack should rest in the curve of the lower back and not more than four inches below the waist
    This also contributes to allowing the stronger muscles of the hips and shoulders to support the load.

 

Other considerations

  • Monitor what your child is carrying to school each day to help him or her avoid carrying unnecessary items which add weight to the backpack.
  • Periodically check to see if your child is wearing his or her backpack correctly.
  • Assist your child with cleaning out and organizing the backpack weekly.
  •  If the backpack weighs more than 15% of your child’s body weight have child carry a heavy book or two under his or her arm.
  • Ask your child if he/she has any discomfort during or after wearing the backpack.
  • Help your child file work at home so he/she only needs to bring required work to school each day.
  • Talk to your child and teachers about ways to reduce backpack weight.
  • Some books can be found online at low cost. Consider purchasing a second copy to keep at home so your child doesn’t have to carry it back and forth.
  • Share any concerns about backpack weight with your child’s teacher or administrator.

 

Taking the time to make careful consideration regarding your child’s backpack use is important to prevent injury.  If your child does develop back pain have him or her seen by a qualified health professional for proper diagnosis and treatment.

-Dr. Rose, DC

Dr. Rose is a San Diego Chiropractor located in Mission Valley.  More information regarding the services he provides can be found at www.RoseChiropracticSD.com.

 

References

American Chiropractic Association. Backpack Misuse Leads to Chronic Back Pain, Doctors of Chiropractic Say. Accessed at acatoday.org

Admas, Chris. A Fitting Guide for a Child’s Backpack. 2006.

Howard County Public School System. Backpack Safety Guidelines

Glabrum - Picture of Shoulder

Labral tears of the shoulder: surgery or not?

 

At the recent American Orthopaedic Society for Sports Medicine, a comparison of non-surgical treatment and surgical treatment for SLAP labral tears of the shoulder in baseball players was presented. The labrum is a cartilage structure that makes the Glabrum - Labral Shoulder Tearsocket of the shoulder deeper and helps hold the upper arm. SLAP tears are a specific type of labral injury that is mainly caused by repetitive throwing.   Although surgical repair of SLAP tears is common, little is known about the effectiveness of nonsurgical pain relief and the effects of surgery on performance.

Return to play

Return to same level of play

Surgery

48%

7%

Non-Surgery

40%

22%

 

 

 

The return to play rate in SLAP injuries is low, typically reported at less than 50%. In this study the return to play rate for those that underwent surgery was 48% while those that underwent rehabilitation was only slightly lower at 40%. The most interesting finding in this study however was that the group that had surgery rarely, only 7% of the time, returned to the level of play that they had previously attained. The non-surgery group in comparison returned to the same level of play 22% of the time.

John E. Kuhn, MD, associate professor of orthopedic surgery and rehabilitation and chief of shoulder surgery at Vanderbilt University Medical Center in Nashville, Tennessee described the findings as “very significant” and summed up the findings:

“A lot of these throwing athletes can be treated non-operatively,” Dr. Kuhn said. “They had very good success with rehabilitation.  That suggests that patients can throw with SLAP tears, and that not every SLAP tear needs to be repaired,” he said. “Many can be rehabilitated; the sources of pain or disability may not even be the SLAP lesion itself,” he added. The research suggests that surgery in this patient population really should be a career-salvaging option, he explained. “It really shouldn’t be something you throw at somebody quickly or early. Rehab them, do everything you can to prevent surgery,” he concluded.

Another take home message from these findings that should be discussed further is the importance of avoiding shoulder injuries from throwing.  As stated the percentage of those injured with SLAP tears that return to play is less than 50%.  The best advice then logically is to avoid getting a SLAP tear altogether.  Unfortunately, there is no sure fire way to avoid getting a tear if you are a pitcher. However what can be done is limiting the risk factors for injury.  Risk factors for throwing injuries include a decrease in shoulder internal rotation, poor scapular control, and high pitching load.  These risk factors should be screened for and proper preventative exercises should be built into any strength and conditioning program for baseball players, especially pitchers. Non surgical treatment in these cases included rehabilitation that focused on stretching the posterior capsule of the shoulder to increase internal rotation and training the scapular muscles to hold the scapula in a stable position during the wind-up and cocking phase of the throwing motion. These exercises should also be at the core of any preventative arm care program for baseball players. Manual therapy, including myofascial release and Graston treatment can also be beneficial to aid in increasing range of motion.  These preventative strategies should be overseen by a healthcare provider knowledgeable in baseball injuries.

If you would like more information about how to recover from or prevent shoulder injuries contact our office today.

Another article outlining preventative exercises is coming soon…

-Dr. Kevin Rose, DC

 

 References

Yin, S.”SLAP Tears Often Treated Successfully without Surgery”. Medscape Medical News, July 7 2012.

Wilk et al. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation.  Clin Orthop Relat Res. 2012 Jun;470(6):1586-94.

Wilk et al. Shoulder injuries in te overhead athlete.  J Orthop Sports Phys Ther. 2009 Feb;39(2):38-54.