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San Leandro Chiropractor

Chiropractic Questions and Chiropractor Answers

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CHIROPRACTIC QUESTIONS ANSWERSChiropractic Questions and Chiropractor Answers

Question #25 

Lower back pains !!!? 

I work an eight hour shift almost every day and stand on my feet constantly. My work duties require me lifting heavy objects. I always try to lift with my legs and not my back. However, lately the lower right side of my back has been killing me. It is very painful to sit, so I stand more or lay down when I get the chance. What can I do to lessen the pain?

Answer: 

From my professional standpoint it appears that you might have an overuse or repetitive soft tissue injury. That might involve sprained tendons and strained musculature around the lumbar spine. Also herniated disc and subluxated lumbar vertebral level can also be contributing factors for the pain. I would suggest that you take some time off of work and see your local chiropractor who has physical therapy equipment and massage therapist in the office. The time off of work will allow your body to avoid farther soft tissue damage and proper rehabilitation will expedite the healing process. Hope it answered your question

 

Question #26 

What’s wrong with my ankle(s)? 

Last year during volleyball practice, I dove and twisted my ankle. Ever since it has been weird. I’ve had really flat feet since I was a little kid, and my ankles always hurt because of that. i don’t wear very supportive shoes, but even when I do it doesn’t help. I went to a podiatrist a few months ago, and he diagnosed me with an excessively flexible flat foot. Strange. I use an ace bandage on my ankle, but to no avail. Nothing has made it feel better. It hurts off and on, though, and when it hurts it hurts a lot. I think I sprained it that day, and since I have bad feet, it just never healed. Do you think that’d what happened? Also, do you recommend for me to get those sport supports you put on your ankles with your shoes while playing? Thanks in advance. Also, I’m kind of an injury magnet 😀 never broken anything, but I always seem to be hurting myself

Answer: 

You are correct about sprain injury to your ankle. When this happens the soft tissue needs a proper rehabilitation in order to prevent scar tissue formation. Most likely you did not have any rehabilitation at all thus is the reason for the pain. At this point it is in chronic stage and will require some time to fix it. Deep tissue massage and active/passive ROM will help. As to your second question about ankle support – you can use it if it does not interfere with your game and running pattern. The most important thing is keeping your gate normal.

 

Question #27

Tingling in my left leg, please help?

 

It started with lower back problem where i could sit down for a period of time, couldnt bend over or put on my socks. This happened overnight. This lasted for 5 months then I woke up with tingling and pain on my left butt cheek all the way down my leg. All of this has lasted for 8 months now and wont go away. Have been through 3 X-rays, and 3 Physical Therapist and nothing. They refuse to give me an MRI. They keep saying it’s a weak core but I know it’s not because I can do advanced core exercises with not problem. I believe my muscle is pinching my sciatic nerve. Can someone please shed some light on this for me?

Answer:

X-Rays will not show soft tissue problem. What you need is an MRI, but it looks like your ignorant doctors refuse to authorize it. Sounds like a Kaiser type of therapy. Physical therapy will not help either at this point and time as strengthening injured musculature and soft tissue is only going to make things worse. Get a second opinion about your problem. I am afraid if you are attached to a particular treatment facility your only option would be paying out of your own pocket and figure out what is going on. I think finding a local neurologist or a chiropractor would be my first step. It all depends on what kind of treatment you would prefer for this kind of problem. It could be Sciatica but it could also be Sacroilliac Joint misalignment.

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Soft Tissue Injury and Fibroblast Regeneration

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FIBROBLAST AND SOFT TISSUE REPAIR

Soft Tissue Injury and Fibroblast Regeneration

Mechanical friction during deep tissue massage, fascial manipulation or using techniques like Graston will activate the stimulation the fibroblast reproduction after soft tissue injury. These fibroblasts cells are the most common cells of connective tissue, and they synthesize the extracellular  matrix (ECM) and collagen, which is the main framework of our soft tissues. The properties of the connective tissues depends on the composition of ECM – tendons, ligaments and other connective tissues. Elastic and reticular fibers, glycoproteins, glycosaminoglycans, and collagen are all found in ECM and made by fibroblasts.  Collagen is the most important part of ECM and plays very important role in tensile loading. The stimulation of production of the above mentioned components can be achieved by frictioning tissues (in other words by providing cross-fiber massage).

Fibroblast production and degeneration is a normal process in every day mechanical loading such as walking, running, bicycling or any other form of movement. There are four basic types of loads: tension (tensile force-fibroblasts), compression (chondrocytes), fluid shear (vascular endothelial cells) and torsional shear. Collagen synthesis in patellar tendon ( which is used the most by bicyclist and runners) increases by nearly 100% as a result of just single bout of acute exercise, and the effect is till evident three days later. I guess I am doing a good job with my knees by keeping them busy with prolonged Mountain Bike Riding and avoiding soft tissue injury.

In the beginning of a training period the balance between synthesis and degradation is increased and there is a net loss of collagen. This enables a tendon to restructure and adapt to an increased loading pattern. It is not till training progress that there is a net gain in collagen synthesis. Deep friction massage can also help to repair a mild soft tissue injury to a knee tendon. Fibroblasts play an important role in wound healing. When connective tissue and blood vessels get injured, growth factors cause fibroblasts to enter the wound area, increase its numbers and begin synthesizing new collagen fibers, creating new granulation tissue and assisting in remodeling. The ECM of granulation tissue is created and modified by fibroblasts.

Recently I was exploring a new trail with another rider. During a steep rocky climb my rear wheel lost a traction and my right knee got over extended. I felt sharp pain but continued on riding. Next day I felt sharp pain around and under my right knee cap (patella tendon). Three to four sessions of deep tissue massage, cross friction massage and modalities such as electric stimulation and Erchonia Cold Laser L5000 model made my knee completely pain free. This is a real example of how Fabroblast is working.

There has also been research done that eccentric exercises may provide more benefit than concentric exercises regarding rehabilitation of muscles and tendons. Eccentric exercises provide greater stimulation of fibroblasts, increasing collagen synthesis and therefore stimulating the healing of soft tissue.

 

Heart Attack or Thoracic Outlet Syndrome ?

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TOSToday’s post is about real case that have treated on Friday. I saw this patient over a year ago for severe neck pain and headaches. Patient’s problem was resolved with very good results. This morning patient’s husband calls and asks me to see his wife today as an emergency visit because she has numbness in her left upper extremity, loss of temperature in that extremity, and shooting pain. Over the phone he explained to me what has happened couple of days ago.

He took his wife to a near by Hospital Emergency Room suspecting that she had a heart attack. She had severe shooting pain in her left upper chest and shooting pain down her arm. In a Hospital medical Doctors performed a complete check up, including laboratory test and fancy CT- Scan diagnostic. After numerous hours they found nothing wrong with his wife and discharge her home with some pain medications. She was not very happy with an outcome since the symptoms were still there even with pain medications.

This morning I performed my examination and was trying to figure out what was wrong with this lady. First off all she always carries her heavy bag on her left shoulder with her belongings and belongings for her two young kids. That was a first sign that the problem was mechanical in nature and something was compressing her arteries and nerves. Her intercostal muscles between first and second ribs were extremely painful. Her left clavicle (look at the picture on a left) was out of alignment and did not have any movements during passive and active range of motion. Both of her rhomboid major and rhomboid minor muscles were very sore as well.

My Solution to This Problem:

I have diagnosed this lady with TOS. The first procedure was the electrical stimulation and moist heat. I used electrical stimulation on PAIN and CONSTANT settings for 15 minutes. Two pads were placed on her first and seconds intercostal spaces and two pads were placed around rhomboid major and minor muscles. Moist heat pack was placed in the same area for 15 minutes as well. Next, my massage therapist worked on her tight muscles for about 20 minutes or so. My CMT has informed that her entire left side is completely out of balance. Muscles were tight and patient was guarding during the massage which made her job a bit more difficult. But she got it done. After the massage I have performed full spine Chiropractic Adjustment ( that included cervical, thoracic and lumbar spine) and I have adjusted her first rib and clavicle on the left side.

I have called later on today to follow with this patient. Patient has informed me that she did not feel any pain since I saw her this morning. She has also informed me that she felt wave of heat coming into the left side of her body and left upper extremity.

The moral of this case: – please carry your heavy bags on both shoulders if you have too. Make sure that your kids’ backpacks are not too heavy and they carry them on both shoulders as well. Let’s start 2011 with a healthy habit.

Happy New Year !!!

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Ultrasound Therapy and Chiropractic Rehabilitation

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When people hear the word “ultrasound” the first thing that comes to mind is the ultrasound from the OB-GYN where you can view a 2-dimensional or 3-dimensional image of what’s inside your tummy. But, this therapy is not this type of ultrasound as it is a therapeutic procedure that uses sound waves in treating injuries such as with soft tissues, muscles or joints.

The sound waves would vibrate at a frequency that is higher than the range that human ears could hear and it provides a mechanical vibration that provides a micro-massage.  I can either be a thermal or non thermal application at frequencies ranging from 0.72 MHz to 3 MHz.

Ultrasound therapy had been used as a treatment for years for musculoskeletal injuries as it helps in rapidly healing the injured tissue as well as decreasing the pain. However, it is underutilized despite its great potential and this is because of a few factors including the lack of education for therapists to use this treatment. The technique in using this treatment is very specific and some therapists are reluctant as they have been disappointed with previous outcomes which may have been a result of their insufficient training regarding ultrasound therapy.

Therapists must understand how this treatment works in order to get the desired outcome. The potential for success is increased as you combine the knowledge, correct technique and pathology of injury. Things that should be considered by the therapists to ensure a maximum effect for patients are the factors that would affect the absorption of the muscles, hemoglobin and fat, the physiology as well as the delivery process and contraindications for this treatment.

The basic benefits of the ultrasound therapy includes an increased in the elasticity of the collagen found in joint capsules, tendons and scar tissues; an increase in the motor as well as the sensory nerve conduction that helps in reducing the pain; the increase in blood flow; the reduction of muscle spasm from an altered contractile activity of the skeletal muscle; and the muscle spasm reduction through the reduction of the activity of the muscle spindle.

US therapy is just one of the treatments that must be considered in treating musculoskeletal injuries. Other treatments to be considered are electromagnetic radiation, hot packs, electrical stimulation, massage, cryotherapy, heat therapy, Erchonia Cold Laser PL 5000 and exercise. The choice really depends on the therapist and with the type of injury and the location of the injury as well as the condition of the patient.

There certain contraindications. If the patient has these medical conditions then this treatment must be avoided. Medical conditions include malignancy, pregnancy, myositis ossificans, circulatory insufficiency, acute infection, sepsis (severe) infection. Also, if the injury is situated over the heart, spine, eyes, testes, growing bones, carotid sinuses, epiphyseal plates, cervical stellate ganglion, pacemaker or vagus nerve then ultrasound therapy must also be avoided.

Precautions must also be observed for hypersensitivity to the treatment, area of the tendon repair, cemented prosthesis, or of reduced in circulation and with the diminished sense of pain and change in temperature or the lack of it. This type of therapy is available in our office for rehabilitation of our injured patients.

Question: Have you ever experienced ultrasound therapy while rehabilitating your injury?