What can you do when stretching isn’t enough?

We’ve all heard many times, from many different sources, it’s important to stretch! We all have muscles that become stiff and tight and benefit from a regular stretching routine in order to keep ourselves loosened up and prevent pain. But what can we do when, after stretching faithfully, day after day, we still find ourselves with tightness in specific muscle groups? How do we deal with ever tight hamstrings or shoulders that just won’t relax? That’s when a technique known as Proprioceptive Neuromuscular Facilitation, or PNF for short.

PNF is a type of advanced flexibility training involving a combination of stretching and contraction of muscles. PNF is performed with assistance from a partner. It is best to use PNF after completing a work out or performing some type of physical activity in order to warm up the muscle tissues. Any type of stretching is more effective if performed on warm muscles.

PNF stretching is done by having a partner help to place tight muscles into a stretched position, then contracting the muscle for 5-6 seconds against resistance from the partner. The muscles are then relaxed while the partner applies a controlled stretch for about 30 seconds. The muscle is allowed to rest for 30 seconds and the entire process is repeated 2-4 times. By using PNF stretching after physical activity 3-4 times a week it is possible to increase the length of tight muscles.

References:

Brad Walker (2009); The Stretching Handbook     

When Carpal Tunnel Syndrome isn’t Carpal Tunnel

Carpal tunnel syndrome has become very commonly diagnosed in many office workers. It is common for anyone with pain or tingling in their hand to be told that they have carpal tunnel and that they need to brace their wrist, take pain killers, and, in bad cases, undergo surgery to decompress the carpal tunnel. Yet the surgery for carpal tunnel often fails to fix the problem and many people struggle with this condition for years. But what if their carpal tunnel isn’t really carpal tunnel?

Nerve impingement due to cervical facet dysfunction can cause symptoms very like those seen with carpal tunnel. This means that the pain and tingling in your hands may in actuality be coming from your neck and can often be helped by chiropractic care including adjustments and soft tissue therapy.

So how do you know when you have true carpal tunnel and when you need to consider other causes for the problem? In a true carpal tunnel syndrome the pain, tingling, or numbness in the hand occurs along the palm and affects your thumb, index, middle, and part or all of your ring finger. However, it does not affect the palm of the hand as sensation to your palm is provided by a branch of the median nerve which branches off of the median nerve before it enters your carpal tunnel. This means that if you are having symptoms into your palm the pressure on the nerve is coming from higher up in the arm, rather than from the carpal tunnel. If this is the case you need to explore other areas where the nerves to the hand may become entrapped. This can include the elbow, upper arm, or neck.

References:

Beers, Mark H., et al. (2006). The Merck Manual of Diagnosis and Therapy. Merck & Co.

            Ltd.; Whitehouse Station, NJ.

Netter, Frank H. (2003). Atlas of Human Anatomy; Third Edition. Icon Learning Systems.

            Teterboro, NJ.

Pain in the jaw

 

Temporomandibular joint dysfunction (TMJD) is a group of conditions affecting the jaw. These can include muscular tension, movement problems such as locking of the jaw, and damage to the articular disc in the TMJ. People with TMJD report a wide variety of symptoms including pain in the jaw, clicking or popping when opening or closing the mouth, reduced ability to open or close the mouth, headaches with tension in the jaw, burning or tingling in the face, or tenderness and swelling on the side of the face.

How can a chiropractor help?
Chiropractors can treat tense muscles in the jaw through a variety of soft tissue techniques and manipulate or mobilize the TMJ to break up any adhesions in the joint and restore proper movement. A chiropractor can also evaluate and treat any related problems which are often found in the neck and shoulders when a patient has TMJD. Finally, a chiropractor can provide a referral to a dentist if the problems may be related to oral health.

What can you do to help yourself?
First and foremost, avoid chewing gum or eating sticky, chewy, or exceptionally hard foods. Take smaller bites of food that will be easier to chew. Be aware of your reaction to stress and avoid clenching your jaw or grinding your teeth. Learn relaxation techniques to keep stress from affecting your jaw and avoid activities that aggravate the problem.

References:
Akhter, R., t al. (2004). Association of dietary habits with symptoms of temporomandibular disorders in Bangladeshi adolescents. Journal of Oral Rehabilitation. Vol. 31. Pg. 746-753
DeLany, J., et al. (1997). Temporomandibular dysfunction. Journal of Bodywork and Movement Therapies. Vol. 1(4). Pg. 198-214
DeVocht, James W., et al. (2003). Chiropractic Treatment of Temporomandibular Disorders Using the Activator Adjusting Instrument: A Prospective Case Series. Journal of Manipulative and Physiological Therapeutics. Vol. 26. Pg. 421-451

Pubic Symphasis pain during Pregnancy

Many women experience pain in the pubic symphysis at some point during their pregnancy. This can be felt as mild to severe pain in the area of the pubis which can extend down through the groin or down the inner thighs. The pain tends to be brought on by standing, especially on one leg, sitting for a long time, or moving from one position to another, for example rolling over in bed or going up and down stairs. Some women also experience a clicking in the joint. Women are more likely to experience pubic symphysis pain if they are higher in weight, have a previous history of joint hypermobility or have experienced pubic symphysis pain in previous pregnancies.

If you are experiencing pubic symphysis pain making changes to your daily activities can greatly help with pain. When rolling over in bed or getting out of the car it is important to keep your knees together. Both activities are often easier on a slightly slippery surface. Try putting silk sheets on your bed and sitting on a garbage or grocery bag in the car. This allows you to move more easily from one position to another. When getting into bed it is often easier to get into bed on all fours and then lay on your side rather than sitting on the bed and lifting your legs. When sleeping, placing a pillow between your knees and another under the baby bump can be helpful.
Since climbing stairs is often very difficult it can help to go up the stairs sideways stepping up one step at a time. Try to sit without crossing your legs with your weight evenly on both buttocks and stand with your weight evenly on both feet. If you can avoid a strenuous activity such as prolonged standing, lifting, twisting, etc. DO! If not, try to sit down for tasks that are generally done standing.
A variety of exercises can also be helpful in alleviating pubic symphysis pain. Your chiropractor can help you to learn exercises for pain relief.

Jeffcoat, Heather, DPT (2010). Help for Pubic Symphysis Pain During Pregnancy.
InternationalJournal of Childbirth Education. Vol. 25. No. 3.

Finding the Right Running Shoes

Now that the air has started to warm up and there's not so much snow and slush to contend with a lot of us are looking to move our workouts from the gym outdoors. Running is a great way to keep your heart and lungs in shape and requires very little equipment or cost. Running clothes can be as inexpensive or costly as you wish to make them. One thing you should invest in is a good pair of running shoes. When you run approximately three times your body weight goes through your foot with each step. With this added pressure improper foot mechanics can greatly predispose you to running injuries such as muscle strains and ligament sprains.

As a new runner or a long term runner who is prone to injuries it is very important to have your feet evaluated by a professional. A chiropractor, chiropodist, or podiatrist can all evaluate your feet and tell you if you are an over-pronator, over-supinator, or a neutral runner, and based on this, which type of running shoe is best for you. In some cases, patient’s foot mechanics may be problematic enough that they will require custom orthotics to fully correct their gait.

Once you know what type of gait you have and what type of shoe you need you need to make sure you have the proper fit for your shoes. You should always try on shoes at the end of the day, when your feet are at their largest. When trying on shoes check to make sure you have at least one thumb’s width of space between the end of your longest toe and the end of the shoes to allow your feet room to swell while running. Always try on shoes while wearing the socks you would normally wear to run and always try on both shoes. Most of us have one foot that is larger than the other. If you wear orthotics take them along and try on shoes with your orthotics in them.

To make sure your shoes are of high quality check for the stability in the shoes. Hold the back of the shoe in one hand and press back against the toe with the other. If you can fold the shoe in half it is not stable. Next, holding the back and the toe of the shoe twist it with one hand going in either direction. You should not be able to twist the shoe. Place the shoes on a shelf at eye level with the heels facing you. The sides of the shoe should sit directly above the sole. If the upper of the shoe tilts in or out they are not stable shoes. Finally, make sure that you are replacing your running shoes every 400-600 miles or every 6 months so that they do not wear out and lose their stability.

References
Asplund, Chad. A., & Brown, David L. (2005). The Running Shoe Prescription. The Physician & Sports Medicine. Vol. 33(1).
Martin, D.R. (1997). Athletic Shoes: Finding a Good Match. The Physician & Sports Medicine. Vol. 25(9).
Yamashita, Michael H. (2005). Evaluation and Selection of Shoe Wear and Orthoses for the Runner. Physical Medicine and Rehabilitation Clinics of North America. Vol. 16. Pg. 801-829

Ergonomics and Work Related Musculoskeletal Disorders

Chiropractors often treat desk workers for aches and pains related to improper ergonomics related to their desk set up and how they sit while they work. It is estimated that every year in the United States more than 65% of occupational illness and 13 billion dollars in losses due to decreased productivity can be attributed to these types of injuries. These types of injuries occur most commonly in people with jobs requiring repetitive actions, awkward postures, low levels of physical activity, poor placement of work equipment, high stress, and high work load.
For most people, following a few basic tips can help to make your work space as efficient as possible.

• Computer work should be limited to 20-25 hours per week maximum.
• Avoid repetitive movements as much as possible
• Position equipment for most common tasks in the most easily accessible areas or your work station. For example, if you use the phone a great deal it should be close by and easy to reach.
• Take frequent short breaks throughout the day
• Frequently change positions while working
• Your computer screen should be positioned high enough so that, when looking straight ahead, you are looking at the top 1/3 of the screen, and angled to reduce glare
• The keyboard should be placed so that it is at the level of your hands with your elbows bent to about 90 degrees and resting comfortably on the armrests of your chair. A keyboard tray can be helpful for this.
• You should be able to use both the keyboard and the mouse while keeping your wrists straight.
• Your chair should be able to swivel to allow you access to the entire desk and should have a lumbar support that fits into the curve of your low back comfortably.
• When seated your knees should be level with, or slightly lower than your hips and your feet should sit on the floor or on a footrest.

If your workstation is proving difficult to adjust or these tips are not enough to help you with work related stress on the neck, shoulders, and arms a chiropractor can assist you in a more thorough evaluation of your work space.

References
Boudreau, Luke A. & Wright, Geoff. (2003). Ergonomic considerations for a patient presenting with a work-related musculoskeletal disorder: a case report. Journal of the Canadian Chiropractic Association. Vol. 47(1). Pg. 33- 38
Sizer, Phillip S., et al. (2004). Ergonomic Pain – Part 1: Etiology, Epidemiology, and Prevention. Pain Practice. Vol. 4(1). Pg. 42-53
Sizer, Phillip S., et al. (2004). Ergonomic Pain – Part 2: Differential Diagnosis and Management Considerations. Pain Practice. Vol. 4(2). Pg. 136-162

Promoting Health Through Infant Massage

New moms often find themselves under stress and looking for ways to relax while still spending time with their baby. One great way to accomplish this is through infant massage. Spending time massaging your baby can provide mothers with time to relax with their baby and help calm your child and promote good health. Infant massage can be a great way to encourage bonding between the child and parent, and therefore can be a wonderful way for fathers to spend quality time with their child while giving mothers a much needed break.
Infant massage has been shown to stimulate the skin, muscles, and nerves of the body. This has been shown to help encourage proper weight gain and neurological development in infants in orphanages and also improve immune function in infants in hospital in a variety of studies. In children with special needs, infant massage can be used to help teach children how to deal with sensory stimulation more effectively.
Infant massage strokes can be used to stimulate specific areas of the baby’s body as needed. In children with congestion, massaging the chest and sinuses can help clear these areas, allowing the baby to breathe more easily and sleep more comfortably. Infants with gas or colic can often be very fussy, and parents can become desperate for anyway to calm their child. Massaging the baby’s abdomen can help the child to release painful gas, making them calmer and less fussy.
There are many different techniques that can be used to massage infants. There are a variety of classes available to allow parents to learn to massage their infants. If you are nervous about massaging your child a registered massage therapist or chiropractor experienced in infant massage can help to treat your child and help you to learn techniques to use at home between treatments.
References:
McClure, Vimala; (2000); Infant Massage: A Handbook for Loving Parents; Bantam Books; New York

Tension Headaches

Living in a city, I often see patients complaining of headaches. Many people experience pain around their head that feels like their head is in a vise, accompanied by muscle tightness or stiffness in the neck and shoulders. This type of headache is known as a tension headache and is often caused by stress, a lack of sleep, muscular tension, and/or tension in the jaw.

Tension headaches are more common in women than in men and generally affect people between 20 and 50 years of age. They are a very common condition. In fact, tension headaches and migraines account for 90% of headaches that present to medical doctors in North America. With most of us being affected by tension headaches at some point or another the question becomes, what do we do about them?
Tension headaches generally arise from tension in the muscles of the neck and shoulders or improper motion in the joints of the cervical spine. As a result, chiropractic care can help greatly with this problem. Chiropractic muscle work or registered massage therapy can help relax tight, tense muscles, while chiropractic adjustments can help restore proper motion to the joints in the neck. Beyond physical care a chiropractor can help you with strategies to manage stress and help with relaxation. They can also prescribe exercises and stretching which has been shown to help reduce the frequency of tension headaches.
Quick Tips:
When a tension headache strikes try gently stretching the neck and dropping your shoulders to relieve muscle tension. An ice pack wrapped in a towel and applied to the back of the neck can also help alleviate headache symptoms. The best way to avoid tension headaches is to find ways to reduce the stress in your life by staying active and doing activities that you enjoy.