Q. Why does my hip and knee hurt every time I ride my bike?
A. When cycling (as well as running) the most common culprit with regards to knee and hip pain is a piece of tissue called the Iliotibial Band or “IT Band”. The IT band contains the muscles that help you to flex and rotate your hip outwards as well as the ligaments and tendons that stabilize the hip and knee joints. When this band becomes tight it can rub and “snap” over the bony prominences of the hip and knee and cause pain and clicking noises. This time of year I see a lot of IT band problems as people come out of hibernation and begin to get active again. Thankfully ITB problems can usually be mitigated with some planning and therapy.
The first thing to keep in mind is to ramp up your training schedule slowly so as not to overuse muscles that have been dormant for most of the winter. For the first few weeks gradually increase your distance and intensity to longer rides/runs.
Make sure to stretch your glutes and ITB before and after you exercise. The best solo IT band stretch involves standing and crossing (for example) your right leg behind the left and leaning towards the left side. In this case you should feel the stretch in the right hip and knee. Hold 15 seconds, relax, and repeat 3 times. After you finish one side make sure you stretch the other. To stretch the glutes extend one leg while sitting and then cross your body with the other leg (your foot should end up at about mid thigh on the floor at the outside of your thigh). Take hold of the knee that you crossed in front and hug it towards you. Again hold 15 seconds, do it three times and then switch sides.
Many times the ITB will have some degree of what is called “fascial dysfunction.” Fascia is like a sweater for your muscles. When you have an injury or repetitive aggravation the sweater can get “snagged” and cause the muscles underneath to not work properly. The solution for this is to untangle the fascia which can sometimes be accomplished with a foam roller or a rolling pin-like “stick.” Sometimes if the fascia is particularly stubborn you will need to have a professional perform soft tissue mobilization with an instrument to straighten out the fascia and allow your leg to resume it's full range of motion without pain. Any fascial therapy whether performed at home or in an office is tender, but reducing long-term pain and preventing further injuries down the road are worth the temporary discomfort.
Additionally you should visit a bike shop and have them evaluate your bike to make sure that it is adjusted properly for your body type. Something as simple as your saddle being too high or too low can cause knee strain and lead to pain and injury. Please do not ignore nagging knee or hip issues. Knees and hips are far and away the most commonly replaced joints for a reason.
Q. I was recently diagnosed with carpal tunnel syndrome. Are there any stretches or exercises that I can do to help it?
A. Carpal tunnel syndrome occurs when the median nerve that travels down from the neck into the arm and through the wrist becomes pinched and inflamed. Some common symptoms include numbness, tingling, trouble with fine motor control, and a loss of grip and pinch strength. Fortunately many cases of CTS can be resolved without the need to go under the knife. Here are some ways that you can manage this condition.
- Rest and ice: Since CTS is primarily an inflammatory condition resolving the inflammation becomes extremely important. Giving the wrist a break from the activity that caused the problem (usually typing or something similar) will keep inflammation from recurring and ice will help to bring down the current swelling.
- Carpal Tunnel Splint: A splint which is usually worn at night keeps the wrist in a position that puts the least amount of stress on the median nerve. These can really make a big difference. You should be able to get one from your healthcare practitioner or a pharmacy.
- Exercises/Stretches: For each of these hold 5-10 seconds, and do 5-10 reps several times a day.
-Keep the big knuckles of the hand (the ones that attach your fingers to your palm) straight and bend your fingers and thumb, then extend your fingers as wide as you can.
-Make a tight fist then open your palm as wide as it can go.
-Bend hand downward as far as possible, then upward.
-Place forearm and whole hand on table-- elbow bent 90°, palm flat on tabletop. Rotate the wrist and forearm so the back of hand is now flat on tabletop.
-Bring your right ear as close as you can to your right shoulder and hold for 5 seconds. Reverse instructions for the other side.
-Shrug your shoulders up towards your ears, then squeeze the shoulder blades back and downwards, then roll them forward. Do the whole rotation slowly and reverse the direction.
-Stand in a doorway and rest your forearms on the door frame, keeping your shoulders at a 90-degree angle. Lean forward until a stretch is felt in the chest muscles. Hold 20 seconds.
4. Make sure your workstation is ergonomically correct. This is a big topic and probably warrants an entire column. If you are able have someone come and evaluate your workstation or ask your Dr. what you need to do. I'll cover this more soon.
5. Visit a chiropractor: Several studies have shown that chiropractic care for CTS can resolve the issues associated with the condition without the use of drugs or surgery. A chiropractor can treat the joints and muscles involved in the neck, shoulder, elbow, and wrist and also offer advice on how further exercises and stretches as well as workplace improvements. Whatever you decide to do make sure you visit your healthcare professional soon, as CTS is a serious condition that you do not want to leave untreated.
Q. My neck hurts and I get headaches when I sit in traffic or at the computer for too long. What is a good exercise or stretch to do to help?
A. Generally when your neck hurts after sitting for a long time it's due to poor posture. Your head starts to lean forward and the muscles in the back of your neck have to work a lot harder to hold your head up. Imagine that you are holding a bowling ball (which is about the same weight as your head) close to your body. It isn't hard to hold it there for a long time without getting tired. Now imagine holding that ball out in front of you at arms length. It gets pretty hard to do pretty quickly. The same principle applies to your head and neck. The closer your head is to your center of gravity, the less work your muscles have to do to hold it in place.
There's a bunch of names for this such as forward head posture, anterior head position, reverse cervical curve, etc. They all lead to the same outcome however which is a condition called upper cross syndrome. Certain muscles become weak, while others become very tight (not to be confused with strong). The weak muscles are the ones between your shoulder blades, and the neck muscles that bring your chin to your chest, while the tight ones are your chest and upper shoulder muscles. The picture in teh upper left is a good illustration.
So the trick is to strengthen the weak muscles and stretch the tight ones. A great exercise to strengthen the neck is called a chin tuck. Imagine you have a string that pulls your head up and back essentially “tucking” your chin. Hold that position for a few seconds and then release. Do this 20 times or so and you will have begun to strengthen those neck muscles. This is a great exercise to do in the car or after a long time at the computer. A great stretch for the chest is to put your arms up on the door frame of an open door and lean forward. You should feel your chest open up and get a really nice stretch.
Of course the whole key to this is to be mindful of your posture. If you let your head go right back to slumping forward after doing these stretches, it's not going to make much of a difference. A good benchmark is to try to keep your ears over your shoulders. There are many more stretches and exercises that I don't have room to go into in this article, but if you are interested in changing your posture and reducing your neck pain and headaches, I would recommend you call your chiropractor.
Q. What exactly is a “knot” in a muscle?
A. To understand what a knot is first you have to understand how a muscle normally works. Skeletal muscles (the muscles that move our bones) are made up of tiny fibers that wind together in bundles like an electrical cable. These tiny fibers have a complicated mechanism that allows them to “ratchet” against one another which makes the overall bundle shorter thus contracting the muscle. When a muscle is working perfectly all of these fibers work as one unit and pull together and release in order to tighten or relax a muscle. Unfortunately sometimes when a muscle gets injured or overused these fibers can get crisscrossed or damaged. When this happens you get a section of the muscle where the fibers get bunched up and stack on top of each other. That is what you feel when you rub a knot in a muscle.
Knots can cause problems in a muscle due to the fact that the normal mechanism for contracting a muscle hits a roadblock there and the overall muscle performance suffers. Due to the fact that fluids have a hard time entering and exiting from a knot you get a decreased blood supply to the area and you can also get a buildup of waste products like lactic acid which tends to be painful and irritating. Surprisingly enough when you have a knot in a muscle you can actually have pain in completely separate locations as well. An excellent example of this is knots in the muscles of the neck causing pain in the head. When knots refer pain to other locations they become known as trigger points. The reason that this happens is very complicated and still being researched but it is widely believed to be due to cross-wiring in the pain centers of the brain due to tissues developing at the same time when we are embryos/fetuses.
There are several ways to treat knots/trigger points. The simplest way is through pressure/massage. By pressing on the injured area you can break up the cross-linking fibers and squeeze out the waste built up. When the pressure is released blood rushes to the area re-oxegenating and healing the tissue. There are many different approaches and techniques that use pressure to release knots, and I find that a combination of approaches is generally the best way to go. One thing you can try at home however is to take a tennis ball and use it to press and roll on the area where you feel the knot. Obviously this works best on areas like your back or legs. Other than that a massage or a chiropractor is probably your best bet for getting rid of knots.
Ask Dr. Sullivan
Q. I spend a lot of my day sitting and using a computer. What can I do to make sure that I don't develop carpal tunnel syndrome?
A. One of the most important things that you can do is to make sure that your computer and desk are set up optimally. Not only will this reduce your chances of CTS but it will also help to reduce lower/upper back strain, neck strain, eye strain etc. Make sure your elbows are at a 90 degree angle with your forearms parallel to the floor. Your keyboard should fall under your fingers in this position. Make sure your monitor is high enough so that your gaze hits it without having to tilt your head up or down. Also make sure that it is directly in front of you and not off to the side. Your mouse should be at the same level as the keyboard and close enough that you don't have to reach for it. Your feet should be flat on the floor with a bend in the knees and hips of about 90 degrees. Try to keep your documents on a holder just to the side of the monitor so that you can see them without having to turn your head too much. The diagram above helps to reiterate the things I discussed above.
Posture is probably the most important part of the puzzle. Making sure to keep your head back and not creeping towards the monitor is crucial. Try to remember that the optimal position for your head is ears directly above the bump on top of your shoulders. Any farther forward than that and your center of gravity shifts and puts strain on the neck and shoulder muscles. Having a good lumbar support in your office chair can also be very helpful. If your chair does not have good lumbar support and a new chair is not in the budget consider rolling up a small towel and putting it behind your back. This will help to retain the natural curvature of your lumbar spine and prevent low back problems. Taking short stretch breaks every 30 minutes is extremely important as well. Some stretches that you can do are outlined below.
One more thing that I would like to mention is the squishy cushions that keyboards and mouse pads have that function as wrist rests. These are not beneficial and can actually accelerate CTS. They compress the wrist for long periods at a time and can cause swelling and narrowing of the carpal tunnel.
Adjustments and stretching of the neck, shoulder, elbow and wrist can be very beneficial in treating and preventing CTS as well. If you have or are concerned about CTS I would urge you to contact a chiropractor today.
So if you haven't seen The Dark Knight Rises yet you probably want to stop reading now and come back later when you have.
Seriously. This post will spoil the movie for you.
Still with me? Good. I just saw The Dark Knight Rises (finally) and I thought it might be of interest to some of you out there to get a chiropractor's opinion of Bruce Wayne's injury and subsequent treatment and recovery. As much as I love it that a chiropractic adjustment saves Gotham City (!!!), there are some pretty serious problems with Batman's recovery from a physiological standpoint. Let's talk about the injury first.
Bane lifts Batman over his head and slams him down over his knee. In the comics if I recall correctly (nerd alert!) Bane actually breaks Batman's spine like this. A posterior impact such as this is probably going to cause a spondylolysis type fracture which separates the arch structure of the vertebra from the vertebral body. They don't mention the specific injury in the movie, but we're going to assume for the sake of argument here that Bane does NOT break Batman's spine in the movie.
We can figure this out by the following logic. Once the fusion core is disconnected Fox says that they have 54 days (less than 8 weeks until it blows up). This means that if Bruce gets transported immediately to the Pit where we will assume he spends at least 2 weeks actively trying to escape and get back to Gotham after being able to walk again, he has at absolute max a little over 5 weeks to go from unable to move to climbing and jumping. With a fractured vertebra even the most physically fit person is going to take a lot longer to heal than 5 weeks. Not to say that you can't have your spine broken by a behemoth slamming you over his knee, just that it doesn't fit with Bruce's recovery. So the types of injuries we are left with are a severe sprain/strain of the lumbar spine and muscles, malposition/subluxation of vertebra(e), and/or a herniated disc.
So let's assume Bruce has all of these. It's certainly possible in this situation. The type of herniated disc that an injury like that would cause would probably be on the front of the disk towards the belly. In the lumbar spine the spinal canal has a lot more room to move than in the upper spine, so many times an anterior disc herniation will not have the same pain and loss of muscle function that the more common posterolateral herniation (which can press directly on the nerves that go down the legs) will cause. Terribly painful for sure, but not as detrimental to walking. The muscles and ligaments in that area would certainly be damaged by the blow and would take some rehab to recover, but let's assume that the guys in the pit have Bruce doing just the right stretches and exercises to heal ASAP.
Still with me so far? OK, now it gets weird. The guy in the cell with Batman tells Bruce that he has a vertebrae sticking out of his skin(!!!). Let's assume that English is not this guy's first language. Maybe he means that Batman's vertebra is poking his skin outwards noticeably. We have already determined that he doesn't have a fracture, and frankly if Bruce's lumbar spine has exploded through his back he's probably not going to last a week let alone 5. OK so one of Bruce's vertebrae has been knocked backwards and needs to be put back in place. This could certainly affect his ability to stand and walk properly. But wait a minute!
Didn't Bane slam his knee into Batman's back? How does that push his vertebra backwards to the point of pushing out of the skin? Shouldn't it have moved forwards towards his belly? And then the treatment for this is for the old man to punch Bruce in the back ? How is that going to help? That would just push the vertebra farther forwards and make the problem worse! The rope-around-the-torso (TM) traction machine might help a little I guess, but at this point things are looking grim for Gotham.
So like any true nerd I have decided that rather than the creators making a mistake (unthinkable!), there must be other factors that we have not considered yet. Here's what must have happened:
Bane drops Batman over his knee but due to the fact that his knee was at an angle and Bruce was slightly rotated he impacts one of his lumbar vertebrae on the posteroLATERAL aspect and ROTATES the vertebra counterclockwise. This causes a disc herniation to one or both sides (still pretty unlikely, but a severe rotation of a single vertebra could possibly cause this) causing disc material to press on the nerve root(s) causing excruciating pain and temporary paralysis to Batman's legs. Undoubtably there is ancillary damage to the muscles, tendons, and ligaments of the lumbar spine. Batman is immediately thrown in the Pit to languish. Shortly thereafter the old (I'm assuming chiropractor) hangs him by a rope from the ceiling and hits him juuuuuuuuuuust right in the mammilary/transverse process rotating the vertebra back into place and taking the pressure off of the disc in question. The traction from the rope allows the nuclear material of the disc to be pulled back into place and because Bruce is the pinnacle of health (let's conveniently forget that his Dr. in the beginning of the movie told him he was a physical wreck) his rehabilitation goes perfectly and within a few weeks he is back to running and jumping etc.
Now let me take off my nerd glasses for a minute. Unfortunately this scenario is all but impossible. Recovery from an injury like this could take months or even years and even then Bruce would probably never be good as new again, especially keeping in mind that he wasn't exactly young and in perfect health to begin with. Even in the comics he was out of commission for a long time and even had some mystical, comic book style help. Obviously this is all in fun and I realize that with any comic book movie you have to have a little suspension of disbelief. I loved the movie and can't wait to see it again, but I just wish Christopher Nolan had consulted with me first. The number is 207-837-6936 if you need me for your next movie Chris!
Sullivan Chiropractic is running a new contest beginning today and ending on June 1! The contest works like this. You earn tickets for doing certain things relating to the office. Some things are worth more tickets than others. The tickets all go into a fishbowl and at the end of the contest we will draw 2 names. These people will win a gift certificate good for an hour long massage at Studio 119 in Brunswick! If a winner is outside of the Midcoast area we will work something out that will be more convenient to you. If there is enough interest in the contest it will continue each month. The full list of activities is as follows:
10 tickets: Refer a patient to the office
10 tickets: Write a testimonial for the office
5 tickets: "like" us on Facebook (current FB followers get 5 tickets immediately)
5 tickets: Follow us on Twitter https://twitter.com/Sullivan_Chiro
1 ticket: Check-in at the office on Facebook
Various: Trivia questions etc. to be posted on FB, Twitter, or in the office.
Other possibilities TBD.
I hope this contest is fun for everybody! I'm looking forward to it!
Fall is here and you know what that means! Cold weather ahead and snow not too far away! Make sure your spine (or the spine of someone you love) is up to the task of raking and shoveling before it's too late. As an extra bonus Sullivan Chiropractic is running a contest until December 1st in which the person who refers the most new patients to the office will receive a check for $30 x the number of patients that they refer! Just in time for the holidays!
Second and third prize is a Sullivan Chiropractic T-shirt in the color of your choice!
Contest details: The person with the most referrals to the office from Oct 6-Dec1 will win the contest. The prize will be a check in the amount of $30 for every patient referred to the office in that timeframe. The upper limit of the check is $300. In the event of a tie the prize will be split evenly among the winners. A new patient is defined as a person having a new patient exam and beginning a course of treatment at Sullivan Chiropractic. A new patient can also be oneself. Prizes will be available to pickup at the office December 2nd. For further questions contact Dr. Sullivan at 207-837-6936.
Here is a conversation that I find myself having quite often. Someone will mention to me that they have a headache, and being the nosy guy that I am, I will ask them about it. 9 times out of 10 this person will tell me that it's a just a "normal" headache, to which I always reply "What's a normal headache?" Everyone gets a headache now and then, but there is always a reason for it. A headache is not a "normal" state for your body. In fact it is your body's way of telling you that something is wrong. You can get a headache for a number of different reasons, but they all fall into 3 different categories. Here are a few examples from each.
-The caffeine junkie whose husband accidentally gets her a decaf
-Food allergies or sensitivities
-Most people on March 18th
-Being a new parent (I can relate!)
-Having a fight with a loved one
-Allergies and stuffed up sinuses
-HItting your head on the car door
-Having tight muscles in your neck
Any one of these things can give you a headache, but none of them are normal. I've had patients who get 2-3 headaches a week, and they have for so long that that has become thier baseline. Their body is crying out for their attention, but they are so used to dealing with the pain that they ignore it. These are usually the people that have a serious problem with their necks, and I would say 80% of them have been in an auto accident (but I'll leave that for another post). All of the problems that I listed above can affect the nerves that come from the vertebrae in the neck. This irritation to these nerves causes the muscles that correspond to them to spasm and before you know it it's headache time. Many times the problem is transient and once your body is back to its normal state your headache will disappear. But sometimes the problem runs deeper and outside help is necessary.
Fortunately chiropractic care can help deal with this problem. By stretching the muscles of the neck and ensuring that the vertebrae are properly aligned, many times headaches can be dealt with without popping Aleve or other medications. At home stretches and exercises can also help to keep this problem from returning. If you or someone you know puts up with "normal" or any type of headaches, please call and make an appointment. Don't put up with headaches unnecessarily.
I'm very excited to announce that Sarah Matzke is going to be joining the office as of April 4th as our new receptionist! She's going to be a great addition to the practice. Make sure you stop by and say hi!