Outer Hip Pain in Runners

April 18, 2018/in running form, running injury, Sports Injury, Uncategorized/by admin

Outer hip pain is a very common complaint we see with out runners at our Mission Valley office. The outer hip musculature is designed to provide hip, and lower back stabilization during running. When there is pain or tightness at the outer hip, the stability at the hip and lower back is compromised. This in turn can create abnormal stress into the hip, outer hip muscles, lower back, the knee, and even the lower leg/foot. The following conditions cause outer hip pain and dysfunction:

Causes of Outer Hip Pain

Glute Medius Muscle Strain
Tensor Fascia Latae Strain
Gluteus Medius Tendinopathy
Trochanteric Bursitis
Iliotibial Tract Syndrome (IT Band Syndrome)
Sciatic Nerve Entrapment

As mentioned above, the out hip plays a role in lower back and hip stability. If the outer hip is painful or dysfunctional the following conditions may also be present:

Low Back Pain
Facet Joint (Lower Back Joint) Irritation
Hip Impingement
Knee Tracking Issues
Outer Knee Pain (IT Band Syndrome)
Shin Splints
Plantar Fasciitis

Evaluation

It is important to be evaluated by a running doctor and sports chiropractor. We will help diagnose your outer hip pain and any potential compensatory injuries that may be occurring simultaneously. A combination of range of motion, orthopedic, functional movements, and strength/endurance tests will be used to pinpoint the exact cause of your pain.

Gait Analysis

We currently offer at home gait analysis for current patients. After being evaluated in our office, if it is deemed necessary, we have our patients video tape themselves running on a treadmill and send it back to us for evaluation. For outer hip pain, many runners with outer hip pain run with what is known as a cross over gait. Check out our previous blog posts here on what a cross-over gait consists of.

Potential sites for injury with cross over gait

Treatment for Outer Hip Pain

Active Release Technique is an excellent tool for helping runners with outer hip pain get out of pain quickly. A targeted home rehab approach is then prescribed b our running doctor as a way to prevent the injury from coming back again. Schedule with us today at our Mission Valley, San Diego running injury clinic today!

Overcoming Lower Back Pain with Chiropractic

Different Types of Low Back Pain

April 4, 2018/in Low Back Pain, Low back Sports Injury, Sports Injury/by admin

Common Causes of Low Back Pain

Low back pain is a very common issue experienced by the the general population at some point in life. Estimates vary but on average, about 38% of the general population experience low back pain in a year period.(2) Low back injury symptoms include: localized soreness, stiffness, and pain, radiating pain (pain into lower extremity), and possibly tingling and numbness into the lower extremity. The focus of this post will look at the common low back conditions we treat at our Mission Valley office.

First and foremost, we recommend seeking professional help from a certified sports chiropractor to correctly diagnose the low back injury. At our San Diego based sports injury clinic, we have seen many joint and disc injuries previously diagnosed as a “muscle strain” by a different provider. Simple diagnoses do patients no favors and will likely cause further harm!

Disc Injury

Let’s start by discussing what I would consider the most time intensive injury to resolve. Disc injuries have the following characteristics: occur in younger people (20-40 year old), common in athletes, associated with a memorable mechanism of injury (squatted and felt a “pop” in back), recurring back injury, worse with bending forward, muscle spasming, pain in the back with cough/sneeze/bowel movement, may have radiating pain (sciatica), and may have numbness/tingling in the lower extremities.

Joint pain

Lower back joint pain is characterized by the following: occurs in middle aged to older individuals (40-65+) with no mechanism of injury (gradually worsened) or younger people with a mechanism of injury (football player tackled in low back), worse when bending backward, sharp localized pain in low back, muscle spasming, possible pain into buttocks/thigh. The image below shows healthy low back joints. They can be injured with hyper extension or excessive bending through the spine

Piriformis Syndrome

Piriformis syndrome may be from acute spasming of the piriformis muscle (muscle runs from the tail bone to the outer hip) or from chronic tightening of the muscle. It is characterized by: pain in the buttocks, single sided sciatic symptoms, worse with sitting, no low back pain, worse with stretching hamstrings, and painful “knots” in the gluteal muscles/piriformis muscle. It is often misdiagnosed as a back related issue due to the symptoms of pain traveling down the leg. Check out our more thorough blog posts on piriformis syndrome found here: Piriformis Syndrome: Overview and Causes, Piriformis Syndrome Part II- Evaluation, and Piriformis Syndrome Part III- Treatment.

Low Back Muscle Strain

Please reread disc and joint causes of back pain. Both cause low back muscle spasming or muscles “locking up”. This is why doctors not certified to treat sport injuries diagnosis many low back injuries as a muscle strains. Technically they are not wrong because low back muscles are usually strained or spasmed when the deep structures (disc/joint) are injured. If you see a provider and they do not perform an evaluation including range of motion, orthopedic/neurological testing, and palpating (physically touching your back), get a second opinion. Once more serious conditions are ruled out, low back muscle strains are usually: local to the low back, muscle is sore/tight to touch, usually injured due to quick movements, and back muscles are often weak.

Special Types of Low Back Pain

Athletes with low back pain, especially in particular types of sports that involve repeated bending through the spine, may develop significant low back pain. Small fractures or stress reactions can occur to the pars interarticularis; a small portion of the vertebrea that when fracture can cause spondylolisthesis. Other injuries can involve the disc herniating into the end plate of the vertebral body of the low back. These types of injuries are confirmed with imaging (x-ray, MRI) but can be considered as a working diagnosis based on a thorough history and physical exam. If you have a sport related low back pain, please get evaluated by one of our Mission Valley sports chiropractors.

Treatment

In a recent review article discussing conservative management of low back pain, several methods are described as primary treatment choices for acute and chronic low back pain. For acute low back pain, chronic low back pain, and chronic low back pain with leg pain, a trial of spinal manipulative therapy with supplementary treatments such as exercise, massage, and patient education is recommended.(1) Specific types of exercises are prescribed based on the practitioner’s experience and patient’s tolerance. In other words, each person with low back pain may receive different exercises based on their presenting symptoms. Decreased pain and symptoms we found after short term (1-3 months) and long term (6-12 months) follow ups.
Initial treatment for low back pain is recommended between 4-8 visits over a 4 week period. (1)

At our office in Mission Valley, we customize treatment plans for each and every low back pain patient we see. For example, if a patient has a diagnosed disc injury in their back, extension based exercises for the low back may offer significant relief for one patient, yet cause terrible pain in the next patient with the exact diagnosis. Evaluation in person by a certified sports chiropractor will be able to determine the correct treatment approach. We utilize the latest techniques including spinal manipulative therapy, Active Release Technique, Graston Technique, and rehabilitative exercise.

References
Brussieres, A. E. et al. (2018). Spinal manipulative therapy and other conservative treatments for low back pain: a guideline from the canadian chiropractic guideline initiative. Journal of Manipulative and Physiological Therapeutics. 0 (0), 1-29.
Hoy, D. et al. (2010). The epidemiology of low back pain. Best Practice and Research Clinical Rheumatology. 24 (5), 769-781.

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.

Preventing Throwing Injuries in Youth Baseball

July 6, 2012/in Sports Injury/by Dr. Kevin Rose

More and more young baseball players, especially pitchers, are coming down with “Little League elbow,” or “Little League shoulder.” Don’t let the names fool you; these are real medical diagnoses with real consequences. Among pitchers under 12-years-old, as many as 45 percent complain of chronic elbow pain, according to several published studies. At the high school level, nearly six in every 10 pitchers suffer chronic elbow pain. Most will heal with a combination of rehabilitation and prolonged rest while some will require surgery.

How to prevent throwing injuries

Limit the number of pitches

A broad recommendation is that pitchers base their number of pitches each week by multiplying their age by 10, so an 8-year-old would limit his pitches to 80 per week. A 12-year-old would throw no more than 120.

The American Academy of Orthopaedic Surgeons (AAOS) recommends limiting the number of pitches per game to 60 to 100, with no more than 30 to 40 in a single practice session, adding that innings pitched should be limited to about four per week, with a minimum of three days rest between starts.

Warm Up

Research studies have shown that cold muscles are more prone to injury. The AAOS suggests an active full body warm up followed by slow, gentle stretching, holding each stretch for 30 seconds. A knowledgeable coach or trainer should be able to guide your athlete in this area.

Throw Correctly and Master the Basics

Poor throwing motions put undue stress on the elbow and shoulder. It is especially important that between the ages of 8 and 14 players receive skilled instruction in proper throwing mechanics. Pitching lessons should focus on gaining control, increasing velocity and developing a command of the strike zone.

Recognize the warning signs

One of the most important factors to preventing the development of serious injuries is early identification and treatment. Young players often ignore pain or are encouraged to play through it. This way of thinking can be extremely harmful and lead to more serious complications that may not heal without aggressive treatment and possible surgery. However, if caught early, most youth throwing injuries can be relieved with a combination of therapy, rest, and rehabilitative exercises.

Early signs of injury include decrease in ability to throw the ball as fast or as accurately, loss of enjoyment in playing baseball, elbow or shoulder pain with or after throwing. If any of these signs are present, the player should be evaluated by a healthcare professional. More significant signs include prolonged persistent pain after throwing, swelling at the elbow, and difficulty straightening the elbow.

Any persistent pain, loss of motion or joint should keep a player on the sidelines until the symptoms disappear or a doctor clears the players. Be sure to consult a health care professional familiar with the intricacies of baseball injuries if any of these signs are present.

-Dr. Kevin Rose, DC, CCSP®

Dr. Rose is a Certified Chiropractic Sports Practitioner® located in San Diego. As a former professional baseball player, having played three seasons in the minor leagues, Dr. Rose understands the unique characteristics of baseball injuries first hand.

Preventing Dance Injuries

June 15, 2012/in Sports Injury/by Dr. Kevin Rose

The physical demands placed on the bodies of dancers have been shown to make them just as susceptible to injury as football players. For this reason, more emphasis should be placed on creating awareness of risk and preventing injuries in dancers. Most dancers begin dancing at a young age, the repetitive practice of movements that require extreme flexibility, strength, and endurance make them prime candidates for overuse injuries. In fact, there is little doubt that the vast majority of injuries are the result of overuse rather than trauma. These injuries tend to occur at the foot, ankle, lower leg, low back, and hip. These injuries show up with greater frequency in dancers as they age, so it is extremely important to emphasize what the young dancer can do to prevent future injuries.

WHAT CAUSES DANCE INJURIES?

Dancers are exposed to a wide range of risk factors for injury. The most common issues that cause dance injuries include:

Type of dance and frequency of classes, rehearsals, and performances
Duration of training
Environmental conditions such as hard floors and cold studio
Equipment used, especially shoes
Individual dancer’s body alignment
Prior history of injury
Nutritional deficiencies

How to Prevent Dance Injuries

Getting and keeping dancers free of injury in a fun environment is key to helping them enjoy a lifetime of physical activity and dance. With a few simple steps, and some teamwork among parents, teachers and health professionals, dancers can keep on their toes and in the studio with a healthy body.

Key Points

Dancers should remember a few key things to prevent injury:

Wear properly fitting clothing and shoes
Drink plenty of fluids
Resist the temptation to dance through pain
Pay close attention to correct technique
Be mindful of the limits of your body and do not push too fast too soon
Perform proper warm-up and cool-down

Parental Oversight

Parents play a large role in injury prevention. First, they must be careful not to encourage their children to advance to higher levels of training at an unsafe rate. Specific to ballet, parents should ensure that the decision to begin pointe training is not made before the child’s feet and ankles develop enough strength. Age 12 is the generally accepted lower limit, but strength and maturity are more important than age.

Proper Instruction

The first line-of-defense to prevent injuries may be dance instructors. From the onset of instruction teachers should establish a class environment where students are not afraid to share that they are injured and need a break. Students should also be consistently instructed on the importance of warm-ups and cool-downs, proper equipment, and at what point, whether by age or maturity, it is appropriate to move on to the next level of dance.

Health Care and Screening

Health professionals play a significant role not only in treating and rehabilitating the injuries dancers incur, but also in preventing them. Dancers respond well to providers who respect both the aesthetics and intensity of dance. Experienced providers can initiate and facilitate screening sessions for dancers to help identify potential problems and prevent future injuries. They should be considered a natural part of a dancer’s career and sources of insight into staying healthy. A dancer should return after an injury only when clearance is granted by a health care professional.

REFERENCES

Clippinger, K. Dance Anatomy and Kinesiology. Champaign, IL: Human Kinetics, 2007.

Howse, J. Dance Technique and Injury Prevention. 3rd ed. London: A & C Black, 2000.

Solomon, R, J. Solomon, and SC Minton. Preventing Dance Injuries. 2nd ed. Champaign, IL: Human Kinetics, 2005.

www.stopsportinjuries.org

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