Shin Splints {Part II}

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In the previous post (Shin Splints {Part I}) we discussed the two main types of shin splints and what to do about them.

But how do you say “see ya” to shin splints for good?

Step 1: You have to REST. I rarely advocate time off completely (unless you’re obviously in danger of hurt yourself) but shin splints really is one of those injuries that research shows responds best to rest. If you decided to push through with this injury you set yourself up for stress reactions and possible fractures, which would side line you much longer than time off.

Step 2: During your rest of 3-4 weeks start working on calf stretching, isometric strengthening, hip & foot stregthening and cross training. This is the perfect time to bike, swim or get your yoga on.

Step 3: Start to slowly return to activity, after 4ish weeks. This is KEY to recovery. If you’re a runner we’re talking 1/2 mile jogs without pain before progressing, and then sticking to no more than a 10% weekly mileage increase. If you’re doing a lot of plyometrics you should be decreasing your volume by at least half and slowing your reps down by that much as well

Step 3a (runners): Increase distance BEFORE speed, speed is much more demanding on the body.

Step 4: Phase from rehab to prehab and add activation exercises before your workouts, get into a routine of muscle release and keep up with your calf and lower leg eccentrics.

Any tips or tricks that have worked well for you and kicking shin splints to the curb? Let us know!

Shin Splints {part I}

Shin splints have become a catch all term for lower leg pain.

So what are true shin splints? In short, there are two types: Type I is present in the deep compartment of the leg and affects teh tibialias posterior and flexor hallicus and digitorum muscles. The main actions of these muscles are to point the toes downward. Generally Type I shin splints are more acute in nature and cause pain the medial lower leg, this type is also known as Medial Tibial Stress Syndrome. Type II is present in the anterior compartment and affects the tibialis anterior and/or the extensor digitorum muscle. The main actions of these muscles are pointing the toes up. Generally Type II are more a stress/strain reaction stemming from a repetitive motion pattern. This type causes pain in the front/outside of the lower leg.

When something goes awry in the relationship between plantarflexion and dorsiflexion, irritation occurs. The affected muscles can begin to pull away from the bone at the tendoperiosteal junction. This leads to inflammation and irritation of the periosteum (the outer most layer of bone) in the lower leg.

If left unchecked the bone starts to form a stress reaction from the force of the muscle pulling, this stress reaction is typically a precursor to a stress fracture, which everyone wants to avoid.

Generally people experiencing shin splint pain have tight calf muscles. If the calves are tight the ankle can’t do its thing, if the ankle doesn’t work the foot doesn’t work and so it goes and then everything starts pull through the lower leg. So to combat this we work on stretching through the Gastroc and Soleus complexes. Here is an example of how to work through these guys on your own:

After you’ve stretched you want to strengthen. In the case of Type I or MTSS we want to go after the Posterior Tibialias and Flexor Hallicus & Digitorum. If the muscles and bone are irritated, starting with isometrics is a great way to do things. This isometric contraction develops tension without changing the muscles length or joint angle (very low force production). The two muscles are stretched in a vary similiar way, you only change toe curling placement :

And for Type II we go after that Tibialis Anterior. Once you’re comfortable with the isometric strengthening you can move onto resistance strengthening. Bands work great as a start point or you can wrap a light ankle weight around the foot.

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So how can you kick shin splints for good? We chat about that next! Stay tuned…

shoulder pain + impingement

Shoulders are incredibly complex in nature and rely on near perfect timing of the muscles in the area to keep them healthy. So it’s no wonder that with so many variables so many people experience shoulder pain at some point in their life.

Today we’re going to chat at a very over-viewed level about the most common shoulder injury we see here at TCSS; shoulder impingement syndrome.

Shoulder impingement is kind of a ‘catch all’ term that gets thrown around a lot but what’s happening in a true external shoulder impingement are tendons, ligaments or bursa (fluid filled sacks preventing friction) get pinched, or impingement, under the bony structures of the shoulder girdle.

shoulder pain impingement
Shoulder impingement mechanism

The shoulder is made up of three bones; the humerus (arm bone), the scapula (shoulder blade) and the clavicle (collar bone). The muscles of the shoulder joints are collectively called the rotator cuff. This is a combination of four muscles (supraspinatus, infraspinatus, teres minor + subscapularis) and is responsible for holding the humerus “down and in” within the shoulder joint.

In the scheme of things, the rotator cuff muscles are actually pretty small but they need to fire just riiiight for things to move correctly. So when these muscle decide to get lazy either from overuse or some sort of injury, the head of the humerus no longer has anything holding it down and larger muscles in the area will try to ‘help’ and take over. This allows the head of the humerus to jam up into the shoulder joint and pinch everything that happens to get in its way. Ouch.

Your body will try to avoid this pain pattern so you may start to subconsciously avoid the painful motion but what almost always happens is that pain will start to move its way along the kinetic chain; this is when that neck or midback pain start to show up along with your shoulder pain.

So what can you do? Being evaluated is step one. Since there are so many variables that play into shoulder pain it is important to get a proper diagnosis. Then, certain manual therapies and rehab programs can be put into place. At TCSS we utilize several manual therapy techniques for the soft tissue component of the injury and also look to adjust or mobilize any joints that are feeling restricted. A patient specific rehab program is then initiated to help the rotator cuff fire correctly and also balance musculature in the area.

As with any injury, it’s important to take care of them before they’ve progressed into a tendinopathy or potentially a torn muscle. If you’re experiencing shoulder pain or have any questions, get in touch with us today!

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

POP! goes the calf muscle…

calf pain 460So you messed your calf up, huh? You felt a little twinge during some activity that didn’t feel like much, but once you rested for a bit that little twinge started to feel like a cramping pain. Now you’re noticing it whenever you have to point your toes or walk up steps, forget about any plyometric exercises and running is less than fun.

Chances are you’ve sustained a grade 1 strain of your calf, more specifically the Gastrocnemius muscle (side note- best name ever, right?). Grade 1 strains are the lowest level of damage and often feel like a tight, tender muscle when contracted or stretched. Grade 2 is the next step up and will often produce more pain, more quickly when the muscle is contracted or stretched and may also be tender to the touch. Grade 3 is the highest level (often referred to a tear/rupture) and will produce sharp, stabbing pain at the time of incident that will affect or may actually inhibit walking. The key to these injuries is to recognize when a strain has occurred and take time off. Grade 1 may seem minimal but calf strains can progress into a higher level strain quickly if not treated properly.

I am typically of the mindset movement is the medicine, but in the case of calf strains – rest is best (to a certain extent).

A little anatomy before we get much further. The “calf” is comprised of 1-3 muscles (depending on how you break it down) located in the posterior compartment of the lower leg. The muscle that most people think of when talking of the calf are the lateral and medial heads of the Gastrocnemius. These muscles help flex the knee and plantarflex the foot (pointing the toes downward). Since the Gastroc is made up primarily of fast twitch fibers and is a 2-joint muscle, it’s typically utilized when the body requires quick movements and generally under a great deal of strain with certain power activities. Under the Gastroc lies the Soleus, which also helps plantarflex the foot. The Soleus is made up of more slow twitch muscle fibers and is primarily used in walking actions or those requiring less speed/power.

These guys get a lot of use and if something up or down stream isn’t pulling its weight the lower leg becomes ripe for injury. However, anytime you’re dealing with an intense pain in the lower leg you want to rule out things like blood clots or stress fractures (among other things) which sports chiropractors, physical therapists or medical doctors are trained to do so. But once those have been cleared, understanding what went wrong to cause the injury is important.

It’s no coincidence that patients with calf problems generally have an ankle that has been locked up for “as long as they can remember.”

Step 1- look at ankle mobility. If you don’t have any, you need to work on getting some.

Step 2, of course, look at the hips and glutes. If they’re totally slacking the body is going to try to pick up power from another source when needed, hello fast twitch muscles of the Gastroc.  Setting yourself up in proper gear is important too: does the drop in your shoe (angle of incline between forefoot and heel) meet your needs? Too much? Too little?

Step 3 (or is it 4?) Working on stretching and then strengthening the calf and core are going to be super important. Retraining muscles when they need to fire and how they should be firing is the key to this whole process- especially if you’re doing any explosive maneuvers (looking at you runners and crossfitters)

Here at TCSS we utilize manual therapies to help stretch and lengthen the muscles as well as break up any superficial adhesions that may be interfering with the calf doing its thing. We look to mobilize any “locked up” joints in the foot, ankle, knee, or hips and a rehab program is developed or discussed with each patient. Our goal is to get you back to doing what you love, faster.

Questions? Let us know!

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

hip pain + injuries

Maybe it’s just me but whenever I’m talking about hips I can’t stop Shakira’s “Hips Don’t Lie” from playing on repeat in my head. Hopefully it’s currently in your head now as you read all about hips– if you have no idea what I’m talking about go on and google it.

hipI see a ton of hip complaints in practice. Hip injuries show up in all sorts of people of all shapes and size but many patients are, or were, runners and cyclists.

The hip joint is comprised of the femur (thigh bone) which articulates with the acetabulum (hip socket) to form a ball-in-socket joint.  For a relatively straightforward bony joint you wouldn’t think there’d be a ton that could go wrong. But since the hips are the drivers in forward motion there are a ton of muscular attachments that need to be strong, stable but also be mobile. Tricky.

So what could your hip pain be stemming from? Let’s discuss.

 

Labral Injuries labral-tear

The most common injury I see in my practice are previously undiagnosed labral tears. The labrum is a cartilaginous ring that sits between the head of the femur and the acetabulum within the hip joint to help hold it in place and absorb shock. Many people have bony anomalies of either the femur or an over growth of the acetabulum causing an impingement of the joint. When this happens the labrum is caught and repeatedly ‘jammed,’ eventually causing fraying and tearing. Since the labrum is pure cartilage and doesn’t have pain receptors you’re typically not catching any real issues until the damage has been done. Individuals with labral injuries will typically report a vague groin pain or hamstring pain that moves around. Generally, our focused history and physical exam gives us a very solid working diagnosis, but the only way to definitively confirm labral involvement is with an MRI where contrast is injected into the hip. At that point surgery or aggressive rehab are the best options. Many, but not all, cases are surgical to get a person back to the activity level they desire without pain.

Piriformis Syndrome

The piriformis muscle runs from the sacrum (tail bone) to the outside of the hip, helping with internal rotation. It’s actually a pretty small muscle in the scheme of things but the mack daddy of all nerves, the sciatic, typically runs really close if not through the muscle. So if the piriformis is not happy, typically the sciatic nerve is not happy and that’s when the issues arise. Stretching and rehab specific exercises generally calm the muscle down, but with all things- it may take some time. Checking out bio-mechanics and why the issue arose in the first place is key to help minimize episodes of re-occurrence.

Hamstring Injuries

The ‘hamstring’ is comprised of 3 muscles that run from the ischium (“sit bone”) to the tibia. They are the main knee flexors of the body and the nemesis of all middle aged softball playing men (amongst others).  When one, or all, of the hamstrings are injured there is typically pain in the back of the leg and people are generally correct in assuming it’s a straightforward hamstring injury. Hip involvement comes into play when the hamstrings are damaged at the origin site. Often times a tendinitis or more advanced tendinopathy will refer into the hip and might be a bit misleading in where the pain is originating from.

Iliopsoas Injuries

The iliopsoas runs from the lower lumbar vertebrae to the front of the hip. This is often referred to the ‘hip flexor’ and does just that, flexes the hip by bringing the knee up and off the ground. When this guy gets inflamed there is typically pain experienced in the front of the hip worse with, you guessed it, flexion. The tendon also may snap or click over the bony prominences of the hip joint. This injury is commonly an overuse injury from increasing activity too quickly. Stretching, releasing and modifying activity until the issue is under control is key to a quick(er) recovery.

Bursitis

The bursa are like these small water balloons that sit under tendons to them help glide smoothly and aid in hip range of motion. They, like everything else, can become overused and irritated. Bursas are everywhere but the most commonly aggravated one sits on the outside of the hip.

HOWEVER, in my opinion, a diagnosis of “bursitis” is a cop out diagnosis. Sure, it’s accurate but WHY did the bursitis develop? What muscle isn’t firing? What muscle is tight? Are your bio-mechanics totally skewed? Is there some other injury you’re compensating for? If anyone gives you a “bursitis” diagnosis and simply says “anti-inflammatories and rest” and provides you NO other insight -do yourself a huge favor and find someone that’s willing to dig deeper.  *steps off soap box*

Stress Fractures

And finally, let’s chat stress fractures. These are typically thought of happening in the lower leg but they can and do happen in the hip. Stress fractures develop when everything else fails. Muscles and tendons are generally the shock absorbers of the body, when they are fatigued or not firing correctly force is transferred to the bones. Stress fractures are somewhat tricky in that they take time to develop and generally refer elsewhere (groin, low back). They’re also tricky in that they don’t typically show up on X-rays, and if they do it’s not until well after the process has begun. So people get an X-ray while they’re having pain, nothing shows up and they’re cleared for activity while the fracture is allowed to worsen. Therefore, an MRI is the best imaging to have done if a stress fracture is suspected.

Picture A) "normal" xray. Picture B/C) same patient- MRI of hip showing stress fracture
Picture A) “normal” xray. Picture B/C) same patient- MRI of hip showing stress fracture

 

Hopefully this quick overview of some common injuries contributing to hip pain has helped you out. Keep in mind there is still an extensive list of things that could be contributing to your hip pain. Getting checked out by a movement specialist and someone that really understands hip injuries is your best course of action.

Questions? Comments? Concerns? Let me know! And if you’re dealing with hip pain, get in to get it checked out today!

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

tendinitis + tendinosis; what’s the difference?

hip-bursitis-s2a-what-is-bursitisIf you’ve participated in any form of athletics or have a job that involves repetitive motion, you’ve probably heard the term tendinitis (or tendonitis depending on your spelling preference: both are correct terms). Tendinitis, in it’s true form, means inflammation of a tendon. A tendon is fibrous connective tissue that attaches muscle to bone. They are often under a great deal of stress and more so when a muscle is not firing properly. Tendons typically have a very poor blood supply and thus take much longer to heal than something exposed to a generous blood supply. This creates an environment ripe for injury. Common sites of tendinitis are the shoulder, Achilles, and elbow. Typically if a true tendinitis is caught/addressed at the start of the process- rest from activity (1-3 weeks), sticking to an anti-inflammatory diet (omega 3s, limiting sugar, refined foods, etc) and stretching are enough to take care of the problem.

Issues set in when a tendinitis is not addressed quickly enough and progresses into a tendinosis. Many people think they are dealing with a tendinitis issue but have actually slid into tendinosis territory. So what difference does a suffix make? Well, a big one. When you’re dealing with an -osis you are now dealing with degenerative changes on a cellular level NOT an active inflammatory process. No inflammation, no healing. When the inflammatory cascade is happening- the body is trying to fix itself, it’s laying down collagen and scar tissue. Inflammation, under control, is not a bad thing. Inflammation NOT in control is problematic. There’s a very fine line to walk. So when you’ve ventured from tendinitis to tendinosis- inflammation has stopped and micro tearing has taken over.  This is when you open yourself up to larger tears or ruptures, and I think we can all agree we’d like to avoid those.

Addressing the Achilles tendon with Graston Technique
Addressing the Achilles tendon with Graston Technique

So how do you know if you’re dealing with an -osis vs an -itis? Advanced imaging (MRI) will visualize these microscopic changes but a general rule of thumb is that an -osis tends not to respond to rest. So once you’ve taken time off and get back at it, your issues start up again. If you’ve been dealing an issue for more than 3 weeks, it’s time to enlist some outside help.

Sports chiropractors and physical therapist are trained to deal with soft tissue injuries including tendinitis and tendinosis. Twin Cities Spine + Sports handles these issues through addressing the tissues with manual therapy, modifying activities while things calm down and putting together a specific rehab plan for each case. Tendinosis injuries are often frustrating for patients (rightfully so) and certainly take some time (it didn’t start overnight, it’s not going away overnight!) but with proper care many can be treated conservatively before more invasive measures need to be taken.

Dealing with what you think may be a tendinitis issue? Contact us today!

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/

running injuries + quick fixes

It’s that time of year again….

The days are getting longer and warmer. Sunshine has finally reappeared. Everyone is dying from allergies. And runners are rejoicing that their eyelashes are no longer freezing when they head out doors to get their fix.

If you’re planning on racing in one of the inaugural runs of summer you are probably well into training mode and your miles are creeping up. It’s inevitable to develop some minor aches and pains as you pound pavement. But when those aches start to turn into something more, you begin to enter the territory of risking a full blown injury. So let’s cover a couple of the most common running injuries and what you can do to if you’re dealing with one.

running injury PFPlantar Fasciitis– We’ve chatted about this bad boy before, check out a full explanation here. Many people are familiar with PF and the classic pain it produces in the bottom of the heel, typically worse in the morning or taking a step after the foot has been relaxed for a while. The key with treatment is to recognize the issue early and take steps to correct faulty bio-mechanics ASAP. These mechanics could be a run gait with a heel strike followed by a sloppy neutral follow through creating a ‘foot slap’ motion with each step OR it could be landing with a very dorsiflexed (pointed) toe that causes too much stress on the plantar fascia (tricky, right?).

The Fix: Ensure proper running mechanics: keep your feet under you and think of “pulling” yourself forward instead of actively pushing yourself off the ground to propel forward. Get those calves worked out. Make sure you’re in the right shoe. And (maybe a controversial opinion) stay away from hard molded orthotics- these are often incorrect for the situation and may make matters worse.

running injury AchillesAchilles Tendinitis– the Achilles is that big ole tendon that is your calf connecting to your heel. When this guy is irritated it typically produces pain in the low calf region or right behind the heel where the tendon attaches. You might also feel the tendon ‘flipping’ or clicking back and forth over your heel bone. Pain in the Achilles typically occurs from landing on your toes and not allowing that heel to gently touch the ground, in effect never actually lengthening the tendon fully.

The Fix: Ensure proper running mechanics (oh, is there a theme here?) keeping your feet relaxed while running and letting the heel touch ground is important. Myofascial work on the calf and Achilles and finally strengthening through the calf and foot. Eccentric calf raises and plyometric exercises are a couple of my favs.

running injury ITBIliotibial Band Pain– we’ve covered this one too, check out everything you’re dying to know about ITB pain here. The ITB is a long fibrous band that runs from your hip bone to your knee. It has a tendency to get tight producing a deep, dull ache along the outside of the leg and into the knee. Pain typically comes and goes during your run and you may feel it more running down hills. This is always an issue of a compensation pattern arising somewhere else in the body. Typically a glute has gotten lazy and now the ITB is trying to help stabilize or the quads are so tight they’re not doing their shock absorbing job anymore thus putting more stress on the ITB.

The Fix: (yes, running mechanics) and myofasical release techniques through the glutes, quads, calf complex and actual ITB. Developing a strengthening program for areas of weakness is also key. Typically honing in on the glutes, abductors and foot strength are helpful.

Have you dealt with any of these issues previously? What worked best for you?

If you currently find yourself trying to ‘just run through it’ my advice is this: if you’ve been thinking about a painful area for 3 or more days it’s time to enlist some outside help to take care of it. Chiropractic sports physicians and physical therapists are trained to deal with these soft tissue injuries and can get you back on the road quickly. As always, proper diagnosis is key to your treatment.

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

disc injuries + you.

MRI disc bulge At some point in your life you or someone you know has probably stated they’ve “slipped a disc,” pinched a nerve, or “thrown” their back out. This event is often associated with low back pain, and may be debilitating in some cases. So what‘s happening when all this slipping and pinching goes on? Short answer: some sort of disc injury has been sustained. Long(er) answer: continues below.

Well first, let’s talk about what a disc is and its function within ones’ body. An intervertebral disc is made up of two components, a gelatinous middle portion called the nucleus pulposus, and a fibrosis outer ring called the anulus fibrous.  Discs sit between each vertebral segment of your spine (minus the top cervical segments) and act as shock absorbers for the spine. They also help with spinal column motion and movement. Overtime, the forces and loads that the discs are asked to endure begin to break their structure down. This commonly presents as a compressed looking structure and is referred to degenerative disc disease (DDD), which is one type of disc injury. DDD symptoms are typically a feeling of stiffness in the area as range of motion is restricted from the disc being compressed and becoming less mobile.

A disc’s outer ring may also weaken overtime and that middle portion, acting as a shock absorber, may actually
push outward into this weaken spot. This creates a bulge which can impact the nerves around the area creating pain and/or symptoms down the legs (or arms, depending on the location). This event is a second type of disc injury called a disc bulge.

The third type of disc injury is a herniated disc. This can happen from either sudden trauma or a disc bulge progressing and breaking through the outer fibrocartilaginous ring. You can think of an intervertebral disc as a jelly donut. In this case the jelly (nucleus pulposus) is actually squirting out of the donut (anulus fibrous). This herniated portion of disc can affect movement of the spine, impinge the nerves in the area or actually impact the spinal cord itself.

It’s not uncommon for disc injuries to cause some level of pain. This could be from the disc itself, the spine, muscles trying to guard the area or the inflammatory response as the body tries to heal itself. Any one of these occurrences could also impact the nerves surrounding the area and create radicular symptoms (pain in areas other than the specific disc injury site). These disc injuries are permanent but their symptoms do not need to be. Many athletes and active individuals function at very high physical capacities with these types of issues. Conservative care has been found to be the most beneficial, and least expensive, first course of action in treating disc injuries. When these injuries occur the muscles around the area will spasm to protect itself often making the symptoms experienced more extreme. Manual therapies have been shown to be very helpful in relaxing these muscles and “calming” the area down. Once that has happened, a specific rehab protocol for your case can be employed to help strengthen the area, thus reducing symptoms and limiting future episodes.

Being properly diagnosed and undergoing a thorough exam is very important because, in some cases, weakness in the extremities or specific numbness patterns should not be ignored. Chiropractic sports physicians are trained to recognize and treat these injuries. At TCSS, we have extensive experience successfully treating the symptoms of disc injuries and will refer you to appropriate place if your case requires more aggressive measures.

Still have questions? Give us a call. Let us help you get better, faster.

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

Chiropractic + Pain Management

chiro first visitIf you’ve heard of chiropractic you probably associate it with the “cracking” or “popping” of painful joints in the neck, mid and low back… and that may be all you think chiropractors treat. But what you may not realize is that a chiropractor’s practice may include all joints, muscles and nerves. That means everything from your jaw to your toes, strains and sprains of any soft tissue and those pesky nerves that you may not notice until they start to do strange things… like tingle or burn. Chiros work in the realm of preventative and wellness care, as well as pain management. In fact, research has shown that the chiropractic manipulation combined with a physical rehab program (strengthening, stretching, releasing, retraining) is a more efficient approach to treating pain than medication for symptomatic relief, alone.

And since we’re talking about how to treat pain, lets chat about what typically causes said pain. Many people feel that a stiff joint is the culprit for their issue. However, unless a joint is specifically involved in a traumatic event or a specific repetitive maneuver it’s probably not the joint itself causing your pain, but moreso the myofascial tissues surrounding the joint. Your body is this crazy complex system of muscles and nerves sending input to your brain and your brain reacting accordingly. If you’re doing something day in and day out that is actually reinforcing a faulty biomechanical pattern (sitting all day, improper ergonomics at work, sleeping position) your brain will start to respond to that accordingly. However, “accordingly” may not be “appropriate” and now the muscles are starting to have some issues. They’re being “shut off” neurologically and thus begin to weaken and tighten. When they tighten, blood flow is reduced, scar tissue laid down and metabolic waste starts to build up. The muscles stiffen; they lock down the joints they are connected to and start to impinge the nerves that travel around and through them. This is when you, as a conscious being, start to notice physical changes- “it hurts to go from sitting to standing,” “I can’t turn my head to check my blind spot,” “I’ve got this weird tingling down my arm.”

As you can see this whole body/brain thing is complicated, and very obviously intertwined, so it only makes sense that the whole system needs to be looked at for optimal results. At Twin Cities Spine+Sports we take this into account and focus on manual therapies to relax trigger points and reduce hypertonicity (spasms) which helps promote blood flow and healing. We look to mobilize restricted joints, stretch shortened muscles and break down restrictions via ART or Graston technique. Once the myofascial issues have been addressed a rehab program is initiated to correct faulty biomechanical patterns, strengthen weak muscles and provide long lasting results for our patients.

Many patients ask “how long is this going to take?” – and I can never give a definite answer because everyBODY is different. A couple factors that play into the healing process are: the individual’s biological makeup, their response to treatment, what the faulty biomechanics are and how much work a person is willing to put in. The 2% of a person’s day spent in the clinic isn’t going to be enough, alone, to make the long lasting changes we’re both seeking. I aim to give my patients the tools to help themselves, the rest is up to them! But when you think about it, isn’t being pain free and functioning at max capacity worth the effort??

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

Upper Cross Syndrome. Road Warriors + Desk Jockeys Listen Up!

05-ALet’s face it; we find ourselves in a seated position more than we should. In fact, the healthcare industry has tagged sitting as the new smoking. That’s a powerful claim and one we’ve found is totally warranted. Whether you’re a desk jockey, a road warrior or a combination of both, it’s probably pretty likely you’re in that dreaded seated position way too much in your life.

There are several complications from the seated position (upper and lower). This post could get crazy long if we try to conquer both so lets start with upper body. Some of the most common issues that arise from the seated position are neck and upper back pain. These pain patterns are typically symptoms of a syndrome called Upper Cross Syndrome or nicknamed “Corporate Syndrome Posture”.

Typically a decent rule of thumb for proper head carriage is ears over shoulders, meaning that you head stacks up on top of your body, not stretching forward or downward. However, when we’re seated- staring at a computer screen, or down at some electronic- that head carriage starts to move anteriorly (as in the picture below). The musculature in the front of the neck becomes deconditioned because it’s not being used, and the muscles in the back of the have to start picking up the slack. Ooooonly… they were never meant to hold our heads back so they’re become tight and overused. We also have this rounding forward position that happens as we hunch over keyboards/phones, so with the posterior neck muscles the pecs become short and tight, while the Middle/Lower Traps and Serratus Anterior in the back become weak.

upper-crossed

Beyond contributing to a gnarly looking posture (think Grandma’s hunched back) these muscular dysfunctions can lead to pain throughout the neck and upper back, headaches, and/or numbness and tingling in the extremities. It’s important to recognize if something is tight and weak you need to address the soft tissue components. Active Release Technique helps break down adhesions that have built up over years of faulty repetitive motion patterns. With this, some sort of strengthening to retrain your muscles also needs to happen and measures to combat the faulty posture/motion need to be devised. You can also bet I’m going to recommend getting motion back into the joints that have become locked down, either from chiropractic manipulations or mobilizations.

A good start point is working through the structures previously mentioned. Some quick and easy stretches are as follows:

Upper Trap Stretch

image (5)

Tilting your ear to shoulder, lightly grasp your head to gently pull. Using your opposite hand, traction down on your seat to increase the stretch. This should be felt through the lateral neck to top of shoulder- 3x30s

Levator Scap

image (6)

Angling you nose in line with your knee, gently pull forward and down on back of head. Using your opposite hand traction down on your seat to increase the stretch. This should be felt through the posterior neck to the top of scapula (shoulder blade)- 3x30s

Rhomboids

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Reaching forward with your with both hands, round through your mid-back while trying to spread your shoulder blades apart- 3x 5-7s. To increase stretch tilt head forward and down.

Pectoralis Major

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Block your hand on another chair, or through an open door and gently push shoulder forward to stretch through front of chest. 3x30s

Chin Tuck (deep neck flexor strengthening)

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With your head against your head rest/wall/etc, tuck your chin back (creating a beautiful double chin). Keep your eyes level and forward, not letting your chin drop to you chest (or look down). This one can be quite deceiving with how difficult it can be, don’t over-do it.

Hopefully this provides some insight into a first line of defense to take for you road warriors or desk jockeys. If you have any questions please don’t hesitate to contact our office.

Dr. Katie Clare, DC, CCSP, ART

Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435
952.831.0242
dauntlessclinic.com

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