Posts Tagged "hip"

It hurts to run.

Posted by Marc Croker | 0 comments

A 38 year old woman presented to this clinic in July 2010 complaining of lower back pain and right hip pain.  She reported that the pain had started three months prior without any specific injury.  The pain was initially mild but it was getting worse.  It was stopping her from running which is a passion for her – so much so that she had suffered from stress fractures of her right femur and fibula.  In 2006 she had had three pins inserted into her right leg to stabilise the stress fractures in her femur.

Her initial examination revealed a fairly classic presentation of pain with inflammation of the facet joints of L5S1 and obvious muscle spasm of her right gluteal muscles.  There was no restriction of movement of her right hip joint.  There was increased muscle tension in her calf muscles.

Her treatment consisted of chiropractic manipulation to her lower back, specifically at L5S1, to which she reported feeling better.  However after the 4th treatment there was no additional improvement and the pain was returning as soon as she started running.

Further examination revealed that there was no longer any sensitivity of L5S1 on physical examination but there was tenderness on examination of her sacrum (tailbone).  It was discovered that there was pain and restriction of movement when examining the movement of the right side of her sacrum.

Her fifth treatment consisted of manipulation of her sacrum to which she found immediate relief of her pain.  The crucial test of course was to see how she fared while running.

I was delighted to hear on her sixth visit that her pain had significantly subsided and she was able to run for much longer periods before the pain started to return (and this was only mild pain that she felt that she could push through).  After three more chiropractic treatments all of her pain was completely gone and she was able to enjoy her running again without fear of it starting all over again.

Related posts:

Grade IV Spondylolisthesis

Posted by Marc Croker | 0 comments

In March 2010 a 58 year old man presented to this clinic with pain in the left sacro-iliac joint (the left pelvis joint) and pain in the left calf muscle.  He reported suffering with lower back pain intermittently for the last 15 years.  The pain that he felt in the left sacro-iliac joint had been worse for the last two months, there was some pain in the left hip and some tingling in the left calf muscle as well.

When I examined him standing his pelvis was tilted so that the right side was lower than the left.  His lower back looked like it had reversed and was curved backwards rather than forwards.  This man was able to perform all movements without any significant pain but found changing positions difficult.  He reported finding it difficult to roll in bed, get out of bed and get up out of a chair.

The examination took on a really interesting turn when I examined his back while he was lying on his stomach.  For a person that was able to move in all directions without any pain his lower back was very sensitive to touch.  So much so that light pressure resulted in a very sharp sensation of pain and his back was reactively spasming.  Now when people have lower back pain they are often very sensitive to touch but his was very jumpy.  Due to the unusual degree of sensitivity and the reversal of his lumbar curve I sent him off for xrays.

The xrays revealed a Grade IV Spondylolisthesis.  What this means is that the very bottom vertebra just above the tailbone had slipped forward to the point where over 80% of the vertebra was in front of the tailbone below.  This is quite rare and in most people the vertebrae sit precisely on top of each other.  To say that his spine was precariously perched was an understatement.

In this image there are three vertebra that run diagonally down the screen from left to right.  One third up the right side of the image is the tailbone.  This is the bone that should be directly below the other vertebra and should be in the bottom right corner of the image not one third of the way up the picture.

Having made a definite diagnosis of this man’s condition it was time to progress to the treatment.  There is a specific chiropractic adjustment for this condition however the question was would he be able to receive the treatment without aggravating the condition.  There is a specific safety test to make sure that the adjustment is not going to worsen the condition and he passed it so we proceeded to gently adjust him.

After two treatments the patient reported feeling better and after four visits he felt significantly better.  This patient received a total of six treatments and is now symptom free.  His last treatment was two months ago and the symptoms have not returned.  Now to qualify the chiropractic adjustments did not “fix” his back as he will always have a grade IV spondylolisthesis  however the treatment was sufficient to clear out the inflammation that was present and remove his symptoms.  He should now get a chiropractic check up every three to six months to ensure that his symptoms do not return.

Related posts:

Preventative Care – Treat yourself

Posted by Marc Croker | 0 comments

The thing that is becoming most apparent to me when treating pain syndromes is that a lot of the conditions that people present with can easily be prevented. As treatment providers we are constantly correcting non traumatic acute injuries that are the result of long term muscle shortness and stiffness, and joint restriction. The most common cause of an injury is a strain/sprain injury. This is the result of too much muscle and joint tension. The treatment for these injuries involves massage, stretching and manipulation to minimise the tension and hence reduce the strain on an area.

So rather than waiting until an injury develops you can do a lot to prevent acute strain/sprain injuries. A general stretching program will go a long way to maintaining and improving flexibility and preventing injury. This can be made very specific to your body by having your chiropractor identify areas of muscle tension, muscle weakness, and joint restriction and giving exercises appropriate for your particular condition. Here at Parramatta Chiropractic we offer a ‘Length and Strength’ assessment to identify muscle weaknesses that should be strengthened and muscle shortness that needs stretching. Pop in today for a check up and a full musculoskeletal assessment.

In the meantime it is worth knowing the best stretches to prevent some common injuries.

1. Calf stretches.
   A lot of people suffer from plantar fasciitis, heel pain or knee pain.  Tightness of the calf muscles is a major contributor to these painful conditions.  Tightness builds up in the calf muscles as a result of standing and walking and causes tendonitis in the foot, heel, and knee.  The best stretch for the calf muscle is to stand with one heel on the ground in front of a step and the ball of the foot on the edge of the first step.  Then lean forward so as to bring the pelvis over the ankle.  This stretch can be done with the knee straight (tension develops higher up the calf muscle) and the knee bent (tension develops lower down the calf muscle).
2. Hamstring stretches.
   Tightness in the hamstrings will often develop with standing, walking and running, and will result in knee and lower back pain.  The easiest and safest way to stretch your hamstrings is to stand with one foot on a low bench.  Ensure that the raised leg is slightly bent and that the lower back is straight (this is achieved by lifting the head and bringing the chest forward).  Lean forward without bending the lower back and feel the tension develop in the back of the leg.  If any back pain is experienced cease the exercise and consult your chiropractor.
3. Adductor stretches.
   The adductor muscles are your groin muscles – those inner thigh muscles.  These muscles are hardly ever stretched.  Tightness in these muscles are responsible for a lot of knee injuries and groin strains.  The adductor muscles run down the inside of the thigh and cross the knee joint.  In so doing any tightness in the adductor muscles creates excessive force on the knee joint and is largely responsible for arthritis in the knee.  The best way to stretch the adductor muscles is to stand with the legs about 3-4 shoulder widths apart.  Then lean the torso to the left and to the right so tension develops inside the thigh on either side (on the left when leaning to the left and vice versa).
4. Quadriceps and hip flexor stretches.
   The quadriceps and hip flexors are the muscles of the front of the thigh.  These muscles often get short in people who sit a lot.  Tightness in the quadriceps is a common cause of lower back pain as the hip flexors cross the pelvis and joints of the lumbar spine.  The most common symptom of tight hip flexors is that the person will get pain in the front of the hip or groin area when standing from a sitting position, and they will find it hard to fully straighten up.  The best way to stretch the quadriceps is to stand with something to lean on for support.  Bend the knee and reach behind you taking your foot in one hand.  Pull the foot so that it approaches your bottom.  Ensure that your bent knee is close to the standing knee and that the torso is upright and not leaning forward. Tension should develop down the front of the thigh.  Stop the stretch if you experience pain in your knee or lower back. The hip flexors can be stretched by performing a deep lunge so that the shin of the front leg is vertical and the knee of the same leg is almost at 90 degrees.  Lean the torso backwards so that tension develops in the front of the hip and groin on the same side as the back leg.  Stop the stretch if you experience pain in your lower back.
5. Gluteal stretches.
   Tight hip muscles commonly cause hip pain and some thigh pain.  These muscles are used for standing, walking, running, lifting, and getting upright.  The best way to stretch these muscles is either to lie on your back and pull one knee to the opposite shoulder or to sit with one foot on the other knee and then bend your nose to the toes of the elevated foot.  In this sitting stretch do not push down on the elevated knee and bring the chest forward rather than rounding the lower back.  This stretch should be felt in and around the back of the hip.
6. Rotator cuff stretches.
   The rotator cuff muscles are the stabilisers of the shoulder joint and are used a lot of the time when active. They are responsible for a majority of shoulder injuries.  The easiest way to stretch the rotator cuff muscles is to use one hand to pull the opposite elbow across your face, stretching the back of the shoulder.  A more challenging stretch for these muscles is to place one hand in your back pocket of your trousers with the palm facing backwards. Using the other hand reach around and pull the elbow forward, stretching the back of the shoulder. These two stretches will prevent most non traumatic shoulder injuries.
7. Neck muscle stretches.
   Neck tension develops largely as a result of stress, working on computers, and any activity in which the arms are held in front of the body in an unsupported fashion.  This will lead to neck and shoulder pain, headaches, and even arm pain.  The neck muscles most in need of stretching are the scalene muscles and the levator scapular muscles. Generally speaking stretching your neck from side to side and turning it as far as you can to the left and the right is sufficient to alleviate some neck tension.  If this is insufficient in alleviating the tension or if you are suffering from neck pain or headaches it is best to see a chiropractor to get more specific help.

These stretches form the basis of a good general stretching program.  Once you are comfortable with these exercises consult your chiropractor or other qualified health professional for deeper, more specific stretches.

Related posts: