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Facet joint syndrome and pain

Facet Joint Syndrome and Pain

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Facet Joint Syndrome Overview

Facet joint syndrome can be a significant source of back and neck pain. It is caused by irritation of the joints between the vertebrae on the back side of the spine. The facet joint can become inflamed from a variety of causes such as a bad night’s sleep, prolonged poor posture, awkward lifting and others.  When the joint gets irritated it triggers pain signals in nearby nerve endings.

Anatomy of the Facet Joints

The spine is made of a column of moveable bones called vertebrae that connect to one another. Each vertebra functions as a three-joint complex with a large disc in the front and two facet joints in the back. This tripod design is strong, keeping the bones linked together while allowing our spine to bend and twist. Facets are synovial joints that are lined with cartilage, lubricated in synovial fluid and covered by a joint capsule. Healthy facet joints glide and slide as the back moves, but prevent over-twisting.

Facet Joint syndrome can be a source of pain anywhere in the spine. Facet joint syndrome is due to poor posture, awkward sleeping positions, and trauma.

Figure 1. Side view of the spine shows a normal disc and facet joint (top). Irritation to the disc and facet joint syndrome can cause arthritic pain, swelling and stiffness (bottom).

In Facet joint syndrome, the facets get inflamed which causes pain and loss of motion in the joint. In turn, the muscles in the area can stiffen and spasm leading to further pain and decreased motion.

The irritated facet joint (facet syndrome) sends pain signals to the brain via small nerves in the capsule called medial branch sensory nerves

Figure 2. The irritated joint sends pain signals to the brain via small nerves in the capsule called medial branch sensory nerves

What are the Symptoms of Facet Syndrome?

There are several symptoms that indicate a person’s pain is coming from the facet joints. The pain is often a diffuse, dull ache in the neck or in the shoulder blade area. Often people describe the pain as a sharp, pinching, catching or a “crick” in their neck.

Movements such as looking up or turning your head side to side especially towards the affected joint will often cause pain. Facet joint symptoms may also mimic the pain of a disc herniation. If the inflammation irritates the spinal nerves, pain may be felt down the extremity. The pain may be chronic, or come in periodic flare-ups.

How is a Diagnosis of Made?

Different movements through the injured area and pointing to the painful area help with the working diagnosis. The doctor may manipulate your joints or feel for tenderness over the spine. In some cases, imaging studies, such as X-ray, CT, or MRI, may be ordered to help in the diagnosis. Imaging can help rule out other pathology of the spine, shoulders, hip, etc. which may be causing the symptoms.

What Treatments are Available?

Chiropractic adjustments are effective in relieving the pain from facet joint syndrome. In fact, the sound of that is made when your spine is adjusted is actually gas escaping from the facet joints which leads to decreased pressure and improved movement. Traction of the head and neck is also effective for the same reason as adjustments in that it helps to open the facet joints and decrease the pressure that is creating pain.

Active Release techniques (ART) are deep tissue muscular treatments that help relieve tightness and spasm surrounding the irritated facet joint. By decreasing muscle tension around the facet joints, adjustments are much more easily performed.

Home Exercise Therapy

After treatment, targeted stretches and exercises are important to perform daily while recovering.  Towel neck mobilization exercises are one of the best types of exercises for facet syndrome. This exercise (as shown below) uses a towel to create a fulcrum for the spine to bend over. This allows the facet joint to remain open as you move; we often see people that can barely look up without pain quickly gain pain free motion by performing this exercise.

Stretching encouraging flexion of the neck as shown in the video below is helpful. Rotational mobilization may be helpful as well. In acute injury, this is often too aggressive but as the neck heals, the neck rotational exercise can be very beneficial.

Cervical Spine Devices

At home traction devices are a great at home treatment option. Inflatable neck traction devices are easy to use and you can take them anywhere with you. The Neck Hammock is an easy to use system that only requires a door handle to use. The absolute best neck traction device is the Saunders Pneumatic Traction device. It is bulky but is ale to deliver substantial traction to the neck joints.

Lumbar Spine Devices

For lumbar spine traction, there are two devices that we find most useful. The first and most commonly known is an inversion table. The Teeter Inversion Table is one of the best and most reliable inversion tables. As with all inversion tables, they take up quite a bit of space and are not easily moveable. The second device is the Back Bubble. This is a convenient alternative to an inversion table. You need a place to hang it from, a doorway pull-up bar is the easiest. Not only does this device work well, you can put it away when you are done using it! You do not need permanent space in your home like the inversion table.

Day to Day Self Care

Self care is an important component of care for facet pain in the neck. Using correct posture and keeping your spine in alignment are important things you can do to prevent painful episodes. You may need to make adjustments to your daily standing, sitting, and sleeping habits.  Light cardiovascular exercise like walking or riding a bike is very helpful for a painful facet joint, and it can help you heal faster.  Facet joint pain usually resolves after 4-6 treatments over the course of 1-3 weeks. 

Recovery and Prevention

Regular stretching, strengthening, postural awareness, and cardiovascular exercise reduces stress to the facet joints.  Facet pain can be recurrent and in some cases lead to chronic neck pain if not treated effectively and cared for by making long term preventative changes.

Dr. Kevin and Travis Rose DC are chiropractors trained in treating overuse and sport related injury. Peak Form Health Center is located in Mission Valley, San Diego near the neighborhoods of La Jolla, Mission Hills, Kensington, and Carmel Valley. Schedule an appointment with use by using “Schedule Now” tab at the top of this page, or call 619-818-4306.

Treat Tennis Elbow at Home

Top Tips to Treat Tennis Elbow at Home

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When you treat tennis elbow at home it will often help significantly reduce the amount of time this painful condition persists. At home, using a combination of pain relieving gels, taping/strapping, myofascial release, and specific exercises, tennis elbow will improve.

Lateral epicondylitis, or more commonly “Tennis Elbow”, is a painful tendinopathy that affects the outer elbow. It is considered an over-use injury to the extensor muscles of the forearm. The extensor muscles of the forearm connect into a common tendon which inserts into the bony part of the outer elbow. With excessive use the muscles tighten and pull at the outer elbow. Pain can be sharp, achy, and fairly constant.

*The following tips are general recommendations. We highly recommend seeking the advice of a qualified healthcare provider to provide a diagnosis and proper treatment plan.

Common Causes of Tennis Elbow are as follows:

  • Playing tennis
  • Excessive computer use (typing)
  • Rock Climbing
  • Repetitive wrenching (mechanics, plumbers)
  • Jiu Jitsu
  • Excessive weight training

Tips to Treat Tennis Elbow at Home

  1. Armaid Foam Massage Tool – The Armaid is a self myofascial release tool designed to break down tight muscles of the forearm. It comes with a number of different attachments to isolate myofascial adhesions (scar tissue) and break them down. With consistent use, the muscles will begin to regain their normal flexibility which will relieve pressure from the painful elbow insertion. This device, in our opinion, is one of the best devices you can use for treating tennis elbow at home. It is especially useful if you participate in a job/sport that causes a lot of strain into the forearm muscles.
    This device is excellent not only for treating tennis elbow at home but for treating “Golfer’s Elbow” which affects the opposite side of the elbow. Watch Dr. Rose demonstrate how to use the Armaid in our video below.
  2. TheraBand FlexBar, Tennis Elbow Therapy – The FlexBar is a flexible bar with grip ridges that allows the bar to twist. The exercise performed is an eccentric load to the extensor muscle group of the forearm. Eccentric loading has been shown in research to strengthen damaged tendons and stretch the muscle fibers. The FlexBar accomplishes this by having the patient grab the bar with the wrist down, and twist the bar up so the wrist is now up. Slowly release to perform the eccentric contraction. Watch Dr. Rose demonstrate this treatment for tennis elbow at home. It can be a little confusing when you start!
  3. RockTape– RockTape is a brand of kinesiology tape. It is designed to support muscle strains, joint sprains, and proper movement mechancis. To treat Tennis Elbow at home, it helps by supporting the extensor muscle group, and the cross strap before the elbow, helps absorb forces from traveling to the painful point on the elbow.
    Treat Tennis Elbow at home
    We prefer rock tape for one simple reason, it just seems to stick better than other brands. It can also be used in conjunction with RockTape’s Rock Sauce Hot and RockSauce Ice, depend if you prefer hot or cold sensations. You put RockSauce on first to which helps remove oils from the skin and you get the benefit of pain relieving effects of hot or cold sensations. You can then apply the Rocktape to the same area.
  4. Biofreeze Pain Relief Gel– Another option to RockSauce. We recommend Biofreeze Pain Relief Gel as it is one of the stronger topical pain relieving gels you can get. It is a product we use daily in our office and can be great for treating tennis elbow at home. Just apply a dime sized portion all around the elbow to help with pain.
  5. Simien Tennis Elbow Brace– A Tennis Elbow Brace can work well for in a couple different scenarios. First, when Tennis Elbow is affecting day to day activities such as opening doors, cooking, shaking hands. Second, when you still need to train or compete at a high level for a competition. The brace works by compressing the tendon right before the insertion point which is the most painful. When forces travel up the forearm, they get dispersed at the site of the brace, minimizing the amount of force that travels all the way to the painful point. Ideally, we want to treat and work tennis elbow to get rid of the symptoms, but this works well to treat tennis elbow at home when dealing with pain.
  6. Muscle Floss AKA Voodoo Floss– Muscle Flossing is a relatively new treatment method for various conditions. It can be a great too to treat Tennis Elbow at home. Muscle flossing works through ischemic compression with rapid blood release into the injured area.
    To explain further, you tightly wrap the elastic band around the elbow. You want to the band to be pretty tight to where it is mildly challenging to bend the elbow. For 30-60 seconds, bend then elbow back and forth, and move the wrist up and down. The band restricts blood flow to the area and movement pumps blood out of the area. You then rapidly release the band which releases rapid blood flow to the area.
    The idea is, this rapid injection of blood to the injured area will help increase the healing process to the tissue. In the pictures below, you can see the elbow is red due to blood flow after 30 seconds of elbow motion.
    treat tennis elbow at home
    treat tennis elbow at home

Those were the top tips we give to patients to help treat tennis elbow at home. We recommend these tips with in person treatment to help fix tennis elbow effectively and quickly. Countless cases of tennis elbow have been treated in our Mission Valley, San Diego office. We primarily use Active Release Techinque, Graston Technique, exercises and a combination of the above tips to treat tennis elbow at our office. Our office is near the neighborhoods of Pacific Beach, UTC, La Jolla, Clairemont Mesa, Santee, La Mesa, Kensington, North Park and South Park.

Runner's Knee Treatment San Diego

Runner’s Knee Treatment |San Diego

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Runner’s Knee Treatment | San Diego

Patellofemoral pain syndrome, aka runner’s knee, is characterized by achy, dull pain generally around the front of the knee. Runner’s knee is a common type of running injury that we see in our San Diego running injury clinic. With a combination of manual therapy, exercise, and run program modification, the runner returns to running pain free. Let’s take a look at common symptoms/causes of runner’s knee and the treatments that will get you back to running pain free.

Symptoms

Most runners will feel dull, achy pain diffusely around the front of the knee. The pain may favor the outer front or the inner front of the knee. It is usually worse with longer or down hill runs. Sitting for long periods usually increases tightness and soreness around the knee. Stretching often makes the knee feel better.

Runner's Knee Treatment San Diego

Common Causes of Runner’s Knee

Here are the most common causes for developing runner’s knee.

  1. Running Form– Many runners, beginner through experienced, have running form flaws that create excessive tension at the knees. Common culprits are running with a low cadence, over striding, running with a crossover gait, and poor posture. Read our blogs for more information: Increase Your Cadence!, Do You Run With a Cross-Over Gait?, Improve Running Posture.
  2. Performing “Too much, Too Soon”– This is what most commonly affects newer runners. They begin training for their first 5k, 10k, or half marathon and start running too many miles with too little recover. The tissues do not have enough time to heal between running sessions, and eventually injury results.
  3. Training Error– If a runner drastically changes their training, runner’s knee can develop. Adding significant amounts of hill training, particularly running down hill, is the most common training error that can cause or exacerbate runner’s knee.
  4. Muscular Imbalance– Runners who are excessively tight in the quadriceps muscles are prone to developing discomfort in their knees. Keeping up with a stretching regimen will help ease the symptoms.
  5. Older Age– Older runners tend to have some decrease in joint space due to wearing down of the tissues over the years. When the joint between the knee cap and knee wears down, there is more compression at the cartilage which can cause swelling and irritation of the local tissues. Every hear cracking, popping , or tearing when walking up and down stairs or with squats? Those are signs of cartilage wear called crepitus.

Runner’s Knee Treatment San Diego

Treatment for Runner’s knee involves 4 main approaches. The first is to address the injured tissue using Active Release Technique and Graston Technique. Active Release Technique for runner’s knee is effective at breaking down tight scar tissue around the knee. The second, using a running gait analysis to identify and correct common running form errors. Check out our full gait analysis for our patient with runner’s knee here: Runner’s Knee Case Study. The third is to modify the run training plan. Proper periodization is critical when coming back from injury. The goal is to modify certain factors (ex: terrain) that are known to irritate the knee. The fourth is to add strength training to the supporting muscle groups. This will provide more support, resist strain, and ultimately decrease chance of developing a running injury.

If you are experiencing pain in the front of the knee, you may be dealing with runner’s knee. It is important that you get the knee evaluated to get a proper diagnosis. This will help develop a correct treatment plan. Each person may benefit from slightly different approaches. The exercises and training modifications given to each patient are unique to the individual.

Our office is located in Mission Valley, San Diego near Normal Heights, La Mesa, Hill Crest, Point loma, Bay Park, Clairemont, Pacific Beach, and Bird Rock. Schedule online with one of our sports chiropractors today. We will help you get back to running pain free!

Chiropractic Treatment for headaches

Chiropractic Care for Headaches

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Chiropractic Care for Headaches | San Diego Chiropractic

Summary

  • Chiropractors are trained to diagnose the type of headache you are experiencing
  • They are trained in manual therapies designed to treat muscles and joints that are causing or worsening the headaches
  • They will work with you to identify reasons to why the muscles and joints are causing headache symptoms
  • If there is a need for a referral, chiropractors can make sure you are sent to the right physician
  • Our chiropractic office for treating headaches is located near La Mesa, Mission Gorge, Kensington, Serra Mesa, Bay Park, and Clairemont Mesa
  • The types of headaches we treat are migraines, tension headaches, cervicogenic headaches, posture related headaches, trigger point referral headaches

Does Chiropractic Care Help Headaches?

Does chiropractic care help headaches? Chiropractic care can help reduce and even fully eliminate headache symptoms. Many headaches are due to muscle imbalances, and/or joint injury to the upper back, neck, and head region.

What Are Common Causes of Headaches?

Headaches are often experienced after trauma to the head and neck. They can also begin the develop over time as a result of poor posture or repetitive strain (same movements during sport, sitting at a desk 40 hours a week). As repetitive stress continues, the muscles and joints become irritated and start referring pain to the head region.

Pain referral patterns of muscles?

Chiropractic Care treats headaches

Upper Trapezius Trigger Point Referral

Acutely or chronically strained muscles can develop trigger points. Trigger points are hyper irritable fibers within a muscle unit that can cause local and referred pain. An active trigger point, actively causes pain. Example: pain in the muscles at the base of the skull with headache symptoms at eyeball area.

In this example, the muscle itself is sore and painful and is referring pain to the eyeball/forehead area. Another example is the upper trapezius muscle which connects the top of the shoulder to the neck. When that muscle develops a trigger point (often due to postural strain), headache symptoms can begin from the neck area up the side of the head, around the ear and to the temples. It looks like a question mark and headache symptoms can be felt anywhere along that path.

Ever tried rubbing your temples to get your headache to go away? Didn’t work? Try addressing the upper trapezius muscle which refers pain to the temples!

Pain Referral Patterns of the Joints

An inflamed and painful joint in the neck may also refer pain to various points of the neck, upper back, and head. Joints are normally injured through whiplash type injuries or quick movements without proper stabilization. Degenerative joints can also be a source of headache symptoms. As the joints wear down from past trauma and age, the degenerative joints compress the local tissues which then can refer pain.

There are plenty of referral patterns that result in headache symptoms. A chiropractor will evaluate the muscles and joints of the neck, shoulder, and upper back to identify the likely culprits. A proper referral will be made if the presenting symptoms are found to be outside of the musculoskeletal system.

Chiropractic Care for Common Headache Symptoms

In our San Diego based chiropractic office, we use a handful of therapies to treat common headache symptoms. Chiropractic adjustments or joint mobilization to the neck and upper back help restore motion to stiff, achy joints and relax local muscle tissues. Active Release Technique, and Graston Technique break down trigger points and tight muscles to eliminate muscular causes of headaches. Home exercises are then given to help combat headache symptoms and decrease the likelihood of the headaches returning.

Here is an example of how we treat a patient with neck and headache symptoms.

Why do the joints and muscles keep causing pain after treatment?

Many chiropractors, physical therapists, and other physical rehabilitation specialists claim they treat the “root cause” of your conditions. Many will treat the muscles and joints that cause the headaches as the “root cause”. Yes, that is treating what is causing the symptoms, but what is causing those muscles and joints to become irritated? Proper chiropractic care for headaches will also look at the entire picture. Here are a few likely causes for recurring headaches:

  • Poor Posture
  • Poor movement mechanics
  • Diet
  • Hydration
  • Stress
  • Sleep

Working working those categories, starting the most likely first, will identify the true cause of the headaches and eliminate them from returning!

Get Your Headaches Treated Today!

Our San Diego chiropractic team is trained to evaluate and treat your headaches. We are confident our chiropractic care for headaches will help reduce and even eliminate the frequency, intensity, and duration of the headaches you are experiencing. We are conveniently located in Mission Valley, San Diego near Ocean Beach, Pacific Beach, Normal Heights, and Hillcrest! Call or schedule online today!

San Diego Chiropractic Hip Flexor Stretch

How to Perform an Effective Hip Flexor Stretch

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A Safe and Effective Hip Flexor Stretch

The main muscles that make up the “hip flexors” are the rectus femoris, iliacus, and psoas major. This muscle group can become overactive and tight resulting in a variety of musculoskeletal issues. Many people perform a hip flexor stretch as a routine, or to help with a specific condition: knee pain, hip pain, back pain. Unfortunately, we see many patients who are performing a hip flexor stretch incorrectly and are exacerbating their condition. Take back pain as an example. Tight hip flexors can cause abnormal posture through the low back resulting in joint compression and irritation. Many patients will then stretch the hip flexors aggressively to help alleviate the symptoms. However, in an effort to loosen up the hip flexors, patients are compromising their low back by compressing a twisting the joints. To stretch the hip flexors properly, there are a few cues that you want to pay close attention to. Take a look at the following video; we go through the proper set up and execution of a safe hip flexor stretch.

Now, if you search “Best hip flexor stretch” you will get thousands of results and some are going to look really cool, and effective. At our chiropractic office in Mission Valley, San Diego we strive for keeping the exercises simple, accessible, and effective. Many of the “cool” or “aggressive” hip flexor stretches often put patients into compromised positions for their condition. Try this version of the hip flexor stretch. If you are suffering from low back, knee, or hip pain, please schedule with us to get a full evaluation. We specialize in treating sports injuries and tight hip flexors are a common presentation we see in our athletes as well as our workforce patients. Our office, Peak Form Health Center, is conveniently located off Texas Street, in Mission Valley, San Diego.

Hip pain running doctor San Diego

Sciatica- Conservative Management San Diego

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Sciatica is a term that encompasses any condition that that can effect the sciatic nerve. Low back and hip injuries are the most common types of injuries that produce sciatica or sciatic symptoms. Less commonly, peripheral entrapment of the nerve around the hamstrings, and lower leg muscles cause sciatica symptoms in the back of the leg. Our San Diego chiropractor at Peak Form Health Center has treated countless conditions that cause sciatica symptoms.

Piriformis Syndrome Sciatica

What causes Sciatic Symptoms?

The sciatic nerve is made up of many different nerve roots from the low back and sacrum (tail bone). The nerve roots are extensions from the spinal cord that exit the spine to form peripheral nerves (ex: sciatic nerve is a peripheral nerve). If you have a back injury like a disc bulge, the disc bulge can press on the exiting nerve root which causes nerve irritation. Nerve irritation symptoms can cause numbness, tingling, hot/cold sensations, shooting pain, loss of sensation, and/or loss of function to the muscles that nerve innervates. Those same symptoms are what are described as “sciatica” but typically patients refer to sharp shooting pain as sciatica. Other conditions that can cause sciatica are:

  • Low back injury- See our post on types of low back pain here: Different Types of Low Back Pain
  • Disc bulge
  • Disc herniation
  • Piriformis syndrome– see our thorough blog post on piriformis syndrome here: Piriformis Syndrome: Overview and Causes Piriformis Syndrome Part II- Evaluation Piriformis Syndrome Part III- Treatment
  • Degenerative Disc Disease
  • Degenerative Joint Disease
  • Foraminal stenosis of the lumbar spine (Bone Spurring)
  • Central canal stenosis
  • Sciatic nerve entrapment
  • Spondylolisthesis 

In rare but serious cases, sciatic symptoms may be due to: tumors, infection, tethered spinal cord, and other neurological conditions.

Conservative Management for Sciatica

First and foremost, a proper diagnosis is required to treat your symptoms effectively. Depending on what the cause is and how long it has been going on, usually a combination of manual therapy, specific exercise protocols, and home education can help resolve sciatica. Let’s take piriformis syndrome as an example. In piriformis syndrome, the piriformis muscles compresses the sciatic nerve. To treat this, targeted Active Release Techique and other myofascial release techniques often results in drastic improvement of symptoms. If however, the sciatica is due to a low back condition, manual therapy to the piriformis muscle will likely not result in significant relief of symptoms.

To reiterate the first point, it is important to see a sports chiropractor or sports medicine professional who will accurately diagnose what is causing the sciatica. Many times we see patients who have been dealing with sciatic symptoms for months and have been doing self treatments that are actually perpetuating their symptoms. Be very wary of a “do this one thing for your sciatica.” type blog post as it may be causing more harm than good.

Our San Diego based chiropractic group treats many different causes of sciatic symptoms. If there is ever concern of a more serious condition causing sciatica, or further investigation is required, we will make an appropriate referral to get the best care for you. Schedule today to get a thorough evaluation. Our office is conveniently located in Mission Valley, San Diego.

Big toe pain treatment San Diego

Big Toe Pain and Conservative Treatment

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Many sports and activities of daily living require movement through the foot and big toe. When you are experiencing big toe pain, sports and certain activities can become quite difficult to perform. If your big toe pain is extreme, simple tasks such as standing, or walking can become very difficult. You may have heard of professional athletes missing months from their sport due to “turf toe” or other big toe conditions. The first thought (and I used to be guilty of this!) is, “It’s only your toe! Get out there and play!”. Well, if you are a 300 pound lineman in football and yue pressing through your big toe to try and stop an equally sized person, then there is tremendous load though a very small joint! When thinking of it from that perspective, it’s amazing that more athletes do not succumb to big toe pain and dysfunction.

Causes of Big Toe Pain

Acute Causes

Most commonly, a big toe joint can become sprained when it is bent backward or forward forcefully. This over stretches the joint and tendons in of the big toe. The following two acute conditions are commonly seen in our sports injury clinic:
Turf toe-Using a football lineman as an example again, when he is pressing forward and is met with equal or greater force by the opposing lineman, the big toe can get over stretched. Pain is generally felt on the bottom of the big toe and is difficult to walk due to the inability to push off.
Sand toe- A soccer player is playing barefoot on the beach and goes to kick the ball. She misreads the position of the ball on the sand and kicks the sand more than the ball. This forces the big toe joint downward, overstretching the top of the
joint and attached tendons.

Chronic Causes

We more commonly treat big toe pain due to chronic reasons. These conditions generally develop over time and are seen in middle aged and older patients (although these can affect younger populations in some cases). The following are common big toe conditions we treat:

  • Hallux valgus
  • Bunion deformity
  • Sesamoiditis
  • Functional hallux limitus
  • Hallux rigidus

Structural issues

In many cases, especially associated with chronic conditions, foot structure may cause pain and dysfunction at the big toe. Most commonly, we see the following:

  • Forefoot valgus
  • Forefoot varus
  • Plantarflexed first ray
  • Subtle cavus foot
  • Pes planus
  • Pes cavus

Inflammatory conditions

Some patients deal with recurring inflammation of the big toe joint. There are a few inflammatory arthritides that can affect the big toe. The most common cause of big toe joint pain and inflammation is Gout. A referral to a rheumatologist is warranted if an inflammatory arthritis is suspected.

Evaluation

Our Sports Doctor of Chiropractic will evaluate the big toe, foot, ankle, lower leg, and possibly continue up the body into the lower back. Some conditions can be affected by muscle/joint dysfunction above where the pain is actually occuring.

Treatment

When it comes to big toe pain, Active Release Technique and Graston technique can help restore normal tissue function around the big toe. Chiropractic adjustments to the ankle, and midfoot can help with proper foot function to de-load the painful big toe joint. Exercises are also prescribed to strengthen/stretch the small muscles of the foot to improve big toe mobility. If there are structural issues present and a patient has recurring symptoms or does not improve with care, orthotics may be prescribed to accommodate the structural issue.

Preventing Shoulder injuries

Shoulder Impingement and Shoulder Pain

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Shoulder impingement is a common condition that we treat at our sports injury clinic in Mission Valley, San Diego. Not only do we see shoulder impingement in the athletes we treat but we see it in many different professions that require repetitive use of the shoulder. Our conservative, non invasive shoulder treatments help provide pain relief quickly and prevent shoulder impingement from reoccurring in the future.

What is shoulder impingement

Shoulder impingement syndrome is a condition where the space between the head of the humerus (upper arm bone) and the acromion process (portion of the shoulder blade) narrows due to structural or functional causes. Structural narrowing of the space is due to arthritis, or bone spurring where the bone spur presses into the tissues in that space. Functional narrowing is due to poor shoulder stabilization from the rotator cuff, scapular dyskinesis (shoulder blade not moving well), and/or muscular imbalances between the front and back of the shoulder.When the space is narrowed, several structures are at risk to become irritated: rotator cuff, bursa, and biceps tendon.

Shoulder pain anatomy San Diego Sports Doctor

What are the symptoms of shoulder impingement? 

Classic signs and symptoms are pain in the shoulder while lifting the arm overhead, turning a steering wheel, pressing/reaching in front of body. Sport specific signs and symptoms include, pain with overhead activities (throwing baseball, volleyball spiking), swimming,Crossfit (thrusters, snatches), weightlifting, bodybuilding.

As impingement syndrome progresses and shoulder structures become more irritated, pain at night, pain and stiffness in the morning is a common complaint.

Evaluation

Our sports doctors will take a thorough history of the shoulder pain and perform an exam to the shoulder, upper back, and neck as there are many structures that overlap between those areas. The exam will help identify shoulder impingement and which structures are causing pain. The most common conditions that are diagnosed with impingement syndrome are:

  • Rotator cuff strain
  • Rotator cuff tear
  • Biceps tendonitis
  • Biceps tendinosis
  • Subacromial bursitis
  • Labral tear (SLAP tear, degenerative tear)

In certain cases, advanced imaging may be necessary to determine the extent of the impingement syndrome and subsequent injury to the und. An MRI can identify rotator cuff tears and Labral tears.

Noninvasive Shoulder Treatment in San Diego

At our Mission Valley office, we utilize the latest techniques to treat shoulder impingement including: Active Release Technique (ART), Graston Technique, joint mobilization/manipulation, and targeted rehabilitative exercise.

Initial stages of care usually involve working on the flexibility and mobility of the tissues around the shoulder. This helps by improving functional limitations at the shoulder joint. After mobility has improved, targeted strength and control exercises for the shoulder are prescribed. This helps avoid re-injury to the shoulder in the future and can help improve performance.

In some cases, if the impingement is due to bone spurring or labral tear, an orthopedic referral may be warranted.

Shoulder pain treatment sports doctor

Schedule today to get a proper assessment and treatment for your shoulder pain. Our sports chiropractors are trained to treat your shoulder pain and other sports injuries effectively, and efficiently.

Knee pain san diego treatment

Patellar Tendonitis and Knee Pain

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The patellar tendon runs from the bottom point of the patella (knee cap) and runs down to the top of the tibia (shin bone). It acts as a pulley to lift the leg upward into extension when the quadricep muscles contract. Leg extension is important in many sports and day to day activities; squatting, walking up and down stairs, getting in and out of cars, etc.
When the quadriceps become overused, excessive amount of load occurs at the patellar tendon and patellar tendonitis begins to develop.

What are the Symptoms of Patellar Tendonitis?

Patellar tendonitis is characterized by pain and possibly inflammation along the patellar tendon. Early stages of patellar tendinitis tends to cause pain after exercise/aggravating activity, and then goes away hours after the activity; it may also be felt at the start exercise but feels better as exercise continues. As the condition progresses, pain may be felt before, during, and then is worse after exercise. If it gets ignored and an athlete tries to push through the pain, the tendon will actually start to deteriorate resulting in patellar tendinosis.

Patellar Tendonitis Treatment San Diego

Who are at risk?

Athletes who perform repetitive jumping and leg bending are at risk to develop patellar tendonitis. Basketball players, CrossFit athletes, volleyball players, runners, cyclists, backpackers/hikers, triathletes, are all at a higher risk due to the potential overuse of the quadricep muscles. Specifically for running and hiking, performing lots of down hill routes will increase the likelihood of developing patellar tendonitis.

Evaluation

In most cases, patellar tendinitis can be diagnosed with a thorough history of the injury and brief physical exam. In some cases, imaging such as a X-ray or MRI may be necessary to rule out other conditions such as meniscus injury, patella alta, chondromalacia, arthritis, etc. Check out our blog here for other causes of anterior knee pain.

Treatment for Patellar Tendonitis in San Diego

For acute pain relief, Active Release Technique, Graston Technique, stretching, foam rolling, and training modification are essential. As the patient improves, eccentric exercises are prescribed to repair the patellar tendon. This helps strengthen tendon fibers to resist future load from activity. Eccentric loading for patellar tendinosis is even more important as this restarts the inflammatory process at the tendon so the tendon can heal.

Stop dealing with patellar tendinitis on your own. Schedule today to get evaluated by our sports chiropractors located in Mission Valley, San Diego. We have helped countless athletes overcome knee pain with our targeted approach.

Hip pain running doctor San Diego

Types of Hip Pain and Running

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The hips play an important role during running. Running is essentially a single legged sport once you break down the movement.  The hip not only helps propel the body forward but also is a stabilizer of the lower back and the leg during the gait cycle. Due to the demands placed on the hip, it is susceptible to overuse, and acute running injuries. A running doctor can help by diagnosing the problem correctly and developing a treatment plan to get you back to running pain free.

Common types of hip injuries found in runners

There are many types of running injuries that can occur at the hip. Pain may be felt in the front, outside,inside, or back of the hip. Certain cases runner’s will describe the pain as deep in the hip joint. We will categorize the most common types of injuries we see based on location of the injury:

Front hip pain in runners

  • Hip flexor strain
  • Rectus Femoris/quadricep strain
  • Iliopsoas bursitis
  • Iliopsoas tendinitis/tendinosis
  • Rectus femoris tendinitis/tendinosis
  • Hip impingement
  • Hip labral tear
  • Stress reaction/stress fracture
  • Hernia

Outside hip pain in runners

  • Gluteus Medius tendinopathy
  • Iliotibial band syndrome
  • TFL strain
  • Trochanteric bursitis

Inside hip pain in runners

  • Adductor strain
  • Adductor tendinopathy
  • Iliopsoas tendinopathy
  • Hip impingement
  • Hernia

Back hip pain in runners

  • Hip osteoarthritis
  • Hip labral tear
  • Gluteal muscle strain
  • High Hamstring injury
  • Piriformis syndrome
  • Low back pain referral
  • Sciatica

To complicate the injury spectrum, there are cases where runners feel pain in the hip but is a referral from joint/nerve impingement from the lower back. Also if the hip is weak and injured, other injuries to the lower back, knee, shin, and foot may become prominent. Receiving a diagnosis from a running doctor trained in diagnosing and treating runners is very important.

Hip pain treatment

Our sports chiropractors at our Mission Valley office are trained to treat a wide variety of running injuries. We specialize in Active Release Technique, Graston technique, running form analysis, and rehabilitative/performance exercise. Schedule today to get evaluated by a running doctor who knows how to get your training back on track!