Cross-Over Gait Correction

March 24, 2018/in Sports Injury/by admin

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How to Fix a Cross-Over Gait

The best way to work on cross–over gait is to perform running drills! Many runners are simply unaware that they run with a cross-over gait. Specific running drills to address a this type of gait will significantly improve running efficiency and decrease risk for injury. At our Mission Valley sports injury clinic, we stress the importance of running drills to all of our running patients.

There are three main drills that significantly reduce cross-over gait: increasing cadence, running wider, and activating the hip stabilizers while moving through gait.

Cadence– I talk extensively about cadence in our blog post here. In a nutshell, by increasing running cadence, there is less time for your feet to travel across midline. Slow cadence allows more time for your feet to creep over midline.
Run wide using a track line– Run around a track with lane lines (or white bicycle lane line). Run so the line is in the middle of your body. The goal is to land with the inner right foot touching the right outer border of the line and vice versa for the left foot. It may feel like you are running VERY wide but with practice it will feel more normal. Practice this drill on the straight away on the track about 4-6 times. Over time you will start to run wider naturally.
Walking hip hikers– The goal is to activate the gluteal muscles, and hold while taking a step. This builds the mind body connection to the hip/core muscles while moving during gait. Watch the video below for a detailed look at the walking hip hiker.

What About Increasing Core Strength?

Core and gluteal strengthening drills alone will not magically get rid of a cross-over gait; again working on correcting the gait will do that. That being said, working on the core and gluteal muscles in conjunction with gait retraining, will support proper running gait. The stronger the supporting muscles are, the more capable they are to resist fatigue during workouts and races. Some runners have no issues with their gait for runs between 3 and 10 miles. Once long runs increase to the 12, 14, 16 mile range, gait issues begin to occur. In this scenario, strengthening workouts to the core and gluteal muscles are paramount to avoid running form breakdown during longer runs. Here are a few of our favorite core and gluteal strengthening exercises:

Gluteal bridge

Lay flat on your back, knees bent, and feet flat on the floor just wider than hip width apart. Brace your abdomen to engage the core. Press through your heels to lift the pelvis upward until it is in line with the knees and shoulders. Avoid arching through the back. Add a band around the knees for more gluteal activation. Sets: 3 Reps: 10-20

Monster walking

Place a medium resistance mini-loop band around the ankles. Spread feet shoulder width apart and sit into a shallow squat, keeping your core engaged. Step forward and slightly outward with one foot and then repeat with the other. Take 5-10 steps forward and 5-10 steps backward. Continue until you feel a good exercises burn in the muscles of the outer hip. Sets: 3 Reps: Go until it burns

Crab walking

Place a medium resistance mini-loop band around the ankles. Spread feet shoulder width apart and sit into a shallow squat, keeping your core engaged. Take a step to the side, then take the same distance step with the other foot in the same direction; important to not over step inward with the follow up step as this looses tension in the band. Take 5-10 steps one direction and 5-10 steps back in the other direction. Continue until you feel a good exercises burn in the muscles of the outer hip. Sets: 3 Reps: Go until it burns

Dead bug

Lay on your back, with your knees and hips bent to 90 degrees and arms held straight in front of shoulder. Brace your core by squeezing back and abdominal muscles. Slowly lower one leg towards the ground, resisting the back from arching up off the ground. Alternate legs keeping a slow pace the entire time. If this version of the dead bug is too difficult, keep the knee bent when moving the leg and perform heel taps. Sets: 3 Reps: 10 per leg

Side plank

Begin by laying on your side with the elbow tucked underneath the shoulder and feel sacked. Keep the body as straight as possible and lift the pelvis off the ground. Focus on contracting the muscles on the side closest to the floor. Perform the side plank on both sides. Sets: 3 Reps: 1 Hold: 30-60 seconds

Self Myofascial Release to the Gluteal muscles

Take a look at the video below. By using a lacrosse/massage ball into the muscles, muscle tension will decrease which can help with soreness, pain, tightness in the area.

These strategies help with correcting a cross-over gait. If you are experiencing shin, knee, hip, back, or foot pain from running, I highly recommend getting the injury evaluated. A targeted approach to your specific injury can prevent time lost to injury. At our Mission Valley office, we perform Active Release Technique, Graston technique, and rehabilitative exercise to keep our endurance athletes competing pain free!

5 Ways to Strengthen Weak Ankles and Prevent Ankle Injuries

Prevent Ankle Injuries: 5 Ways to Prevent Ankle Injuries

December 10, 2015/in Sports Injury/by Dr. Kevin Rose

5 Ways to Prevent Ankle Injuries

Ankle injuries are one of the most common injuries among athletes. While it is impossible to completely prevent ankle injuries, taking precautionary measures before exercising can help limit the risks. Listed below are stretches to help strengthen and loosen up the muscles around the ankles. These exercises are great for both preventing injuries from happening and helping you recover from an existing injury:

Peroneal Stretches

One of the most important muscles to strengthen during any recovery or prevention of an ankle sprain is the peroneal muscle. These muscles extend from the top of the knee all the way down to where they attach at the bottom of the foot.

The exercise is easy: Gently roll onto the outside of your feet and walk around for 60 seconds. This helps strengthen your ankle muscles and gives them additional flexibility.
Ankle Circles

This simple exercise will help strengthen the muscles in and around the ankle, improving the joints stability. You can either sit on a chair or stand for this conditioning.

Extend your leg straight out, without bending the knee. Rotate your foot clockwise 10 to 20 times, rest leg for 5 seconds, and raise it again to rotate counterclockwise 10 to 20 times. Alternate legs and do 3 or 4 sets per side.
Dorsiflexion Stretches

The Dorsiflexion stretch is crucial amongst runners. This stretch is responsible for strengthening the muscles that run along the shin of the leg, called the Anterior Tibialis. This muscle is what controls the up and down movements of the toes. Therefore, strengthening this muscle will not only help prevent shin splints, but can also help protect the muscles and tendons in the ankle.

First, sit on the floor with your right leg straight out and the left leg crossed, with the sole of your left foot resting against the inside of your right leg. Place a towel or band around the ball of the right foot and gently pull your toes back toward you. Hold for 15 seconds, repeat the stretch 4 times, and then switch legs.
Write the Alphabet

This exercise is as easy as reciting the alphabet! All you are doing is tracing every letter of the alphabet with your big toe. This exercise is best if you are seated in a chair.

Hold your right leg straight out in front. Using your big toe as the “pen”, first write each letter of the alphabet in all capital letters. The same process again with lower case letters, then switch feet and repeat. Writing the alphabet is a challenging exercise that will help strengthen both of your ankles!
Achilles Stretches

Rupturing the Achilles tendon can set you back for quite a while. By doing regular Achilles stretches, you can help limit the risk of rupturing the tendon and help improve flexibility.

From a standing position, bend the knee of your left leg at a 45 degree angle. Step the right leg back and keep it straight. Ground the heel of your right foot and push the hips forward. Hold this position for 15 to 30 seconds and then switch legs, repeating 2 to 4 sets on each leg.

Athletes at Risk

At our Mission Valley Office, we see many athletes with injured ankles including: ballet dancers, MMA fighters, soccer players, baseball players, and foot ball players. It is important to perform the above mentioned exercises to help prevent ankle injuries. If you are currently experiencing an injury to the ankle, please schedule with our certified sports chiropractors today!

Ergonomic Chair Setup

January 29, 2013/in Ergonmoics/by Dr. Kevin Rose

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°.
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

December 3, 2012/in Uncategorized/by Dr. Kevin Rose

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.

Piriformis Syndrome Part III- Treatment

November 16, 2012/in Conditions/by Dr. Kevin Rose

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)

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

Piriformis Syndrome Part II- Evaluation

October 22, 2012/in Conditions/by Dr. Kevin Rose

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%.

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: Overview and Causes

October 19, 2012/in Conditions/by Dr. Kevin Rose

Piriformis 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.

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.

BACKPACK SAFETY

August 23, 2012/in Back Pain Prevention/by Dr. Kevin Rose

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

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.
Padded Back
The back of the backpack should padded as well to encourage the pack to sit flat against the back.
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.
Waist Strap
A waist strap dramatically helps direct the load away from the shoulders and onto the much stronger waist and hip muscle group.
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.

Loading a Backpack

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.
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.

How to wear a backpack properly

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.
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.
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.
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

Labral tears of the shoulder: surgery or not?

July 25, 2012/in Sports Injury/by Dr. Kevin Rose

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 socket 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.

Kinesiology Tape for Dancers

July 23, 2012/in Sports Injury/by Dr. Kevin Rose

Many dance medicine specialists and dancers have begun to use Kinesiotape as a staple to manage their injuries. Developed more than 25 years ago in Japan by chiropractor Dr. Kenzo Kase, the Kinesiotape method drew worldwide interest when the U.S. Olympic volleyball player Kerri Walsh wore the tape to support her shoulder during the 2008 Games in Beijing. Now many elite athletes, including dancers use Kinesiotape. Unlike traditional athletic tape, the latex-free Kinesio stretches easily, and permits greater range of motion, making it popular with dancers. It allows the dancer to perform while still protecting them from further injury. “The old way of taping was stiff and tried to support ligaments, but we have learned it gave less support than we suspected,” says Dr. Rebecca Clearman, M.D, “Kinesiotape, on the other hand, helps dancers self-correct. (For instance) if a dancer is hyper-extending, it can serve as a reminder at the end of the range to not go as far.”

Kinesiotape can be used to stimulate or relax a muscle, depending on the direction of the recoil of the stretched tap. Whether relaxing or activating, the tape gets placed along the line of the muscle. For activating, the direction of the tape goes from muscle origin to insertion. The tape’s degree of stretch determines the strength of the recoil action, so each application can be tailored to a dancer’s needs.

It’s like a brace, but better, because of it allows greater range of motion and also provides proprioceptive input (joint balance). Kinesiotape comes in a variety of brands and can be purchased by the consumer, however initially the tape should be applied by a dance medicine professional with knowledge of dance mechanics. After several sessions the injured dancer can learn to put the tape on properly by himself/herself.

Kinesiotape is not a magic bullet. Proper diagnosis of the injury by a qualified healthcare professional is always the first step and during recovery, proper rehabilitation and correction of biomechanical errors are keys.

-Dr. Rose is a San Diego Chiropractor and a Certified Chiropractic Sports Practitioner®. He is a member of the International Association of Dance Medicine and Sciences and has experience with ballet dancers from youth to professional.

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