Case History

HISTORY
-22 year old male 6’3” 255lb muscular
-Right low back, hip and outer thigh pain progressing down leg
-Worsening over 2-3 weeks and noticed after aggressive run on the treadmill for 5 miles. Tightened up 2-3 days post. Had not been running consistently at that point
-Taking Ibuprofen as needed for pain
-Has not used ice consistently
-Past history of low back pain and left knee pain resulting in surgery

EXAM
-Nerve root traction tests were negative to decrease suspicion of nerve pinch due to lower back disc injury
-Right hip range of motion testing noted reduced and painful external rotation, abduction, flexion and extension
-Noted lower back spinal joint sensitivity to pressure and this may be secondary to muscle imbalance in leg, thigh and pelvis
-Trigger points noted in the right gluteal medius/maximus, piriformis, tensor fascia lata, hip flexor, outer quadriceps and hamstring, outer leg, peroneal muscles and iliotibial band (IT band) tenderness

DISCUSSION
History and exam pointed to muscle, tendon and bursa injury with a differential diagnosis of an atypical disc injury. This was likely brought on by running on treadmill too much too quick with a sprint form typical for his muscular physique. Form was also likely compensated due to previous left knee injury and surgery. Activity exaggerated mechanical compensation pattern and overload soft tissue. Now patient needs to reduce biomechanical stress in order to perform ADL’s without perpetuating problem.

- Patient responded to manipulative therapy to lower limb foot, hip, pelvis and spine, therapeutic exercise EMS, ice and biomechanical re-education. 6 visits over 3 weeks. Patient is continuing with functional recovery visits on a 1 time per 2 week frequency for 12 visits to achieve functional stability so that aggressive physical activity does not cause reoccurrence of active symptoms.

Healthy Tip: Be Open to Coaching

Be open to any and all coaching right now. Even if the topic you're recieving coaching on is something you already know and have been mentally beating yourself up over. By being "open" I mean let any input boost you up instead of getting you down. At first you may have to manufacture the ability to do this but it gets easier and it is worth it. Try to suck the positive energy out of any and all comments not the negative.

An excellent example of this is a commercial done by NFL quarterback Peyton Manning. It is worth searching on utube.

In the commercial, Peyton is waiting for the elevator in the hotel of a visiting city, the bellman of the hotel who is not a fan says "you are going down!". Peyton chooses a positive interpretation of the comment an poses it to himself as a polite question, "are you going down?" and responds "Ya, to the 4Th floor, for a massage, I can't wait!". He really sells it too. Perfect, I love this commercial because with that attitude you always win. I would recommend that we all set ourselves up to win this way, all the time!!

Typically at this time in January it is a crucial time in every ones health and fitness schedule. The New Year's resolutions have caused an initial flurry of activity and right now the results may not be matching your efforts. You may be more fatigued, hungry, sore and the stress may not be any easier to manage. It can be very frustrating right now!

The good news is that this is typical and you are not alone. This may be where some of the negative feedback you may be experiencing is coming from, others feeling the same way and giving off the wrong messages because of how they feel. Try to see through the fog.

You may be hurting physically because of new activity and you may be on the verge of mentally quitting of have already done so. That physical hurting though is your body telling you that it has not quit, it is actually just starting to get fired up. The natural rate of your body to see results and get into a physiological rhythm to maintain it, is 8 to 12 weeks of consistency.

Now is the time for a calm refocusing through coaching yourself and absorption not resistance to others comments/feedback, spin it all positive. What I have learned from playing sports is that if the coach is not talking or yelling at you, they don't care.

If you have quit already, I think a rest is a good thing, it allows the body to catch up to the rapid change, catch your breath and get back in the game, it is only a game and the path may be different than you anticipated. You are amazing, and you can do this, the path may look different than you had envisioned, but you are on it, now stay there!!!

I know you know this already at some level, and if you still cannot remember, come in and I will remind you and your body, that is my job.

Your Health Coach
Dr McMaster

Functional Recovery and Improvement: Foot and Ankle

I would like to introduce to you the ideal ranges of motion of all the major joints in the body over the next few weeks so that we have a goal to work toward with exercise and function. A long term goal would be to understand how the body is put together to function efficiently, and when it is not functioning efficiently, how it breaks down. Understanding function of our body is the key to preventing injury, improving performance and longevity.

Beginning with the foot and ankle I would like to apply a consistant mode of description of movement and that is to describe motion in the flexion / extension plain [sagittal] first, then the side bending plain of motion [frontal] and finally the rotational plain of motion [transverse].

The sagittal plain motion that occurs in the foot and ankle is called dorsi flexion and plantar flexion.

Dorsi flexion occurs when the top of the foot comes toward the front of the shin. Dorsi flexion typically occurs at heel strike during walking and is typically under exaggarated do to footwear, body position and weakness. This is a key area for improvement.




Plantar flexion is where the bottom surface of the foot is being pointed downward toward the ground or into the ground as it does during toe off while walking.
Plantar flexion is very important to us because it is where we get most of our propulsion from the foot during walking and running. This motion is often over done because of a forward body position causing us to also balance our body and decelerate our body with the muscles and tendons that create this motion. Due to this overload it is a common area for repetitive strain injuries.


The frontal plain motion is eversion and inversion, pronation and supination.

Eversion is when the outside edge of the foot is lifted upward toward the ankle.








Inversion is when the inside edge of the foot is lifted upward toward the ankle.










Motions that occur with eversion and inversion are pronation and supination.

Pronation is when the arch flattens as the foot rotates about a central long axis that goes through the center of the second toe through the foot and out through the center of the heel.



This motion helps the arch of the foot adapt to ground surfaces and to decelerate the body during walking and running. The shock absorption function is often over utilized causing a breakdown of the ability to create the arch at the right time for optimal propulsion at toe off during walking and running. This is related to the body being out of position rather than a weakness in the foot. You can simulate this motion by keeping your feet flat and leaning forward slightly while bending your knees slightly.


Supination is when the arch elevates as the foot rotates about a central long axis that goes through the center of the second toe through the foot and out through the center of the heel.



Supination is what helps the foot form a rigid stable arch for optimal efficiency during toe off to get the most propulsion power. This motion is created by a combination of muscle contraction, timing of the position of body parts during the walking/running or gait cycle and ground reaction forces. Often all of these elements can be improved upon. Some people have naturally high arches but they can still experience too much pronation which shoes and arch supports alone will not completely correct for the loss of function of the arch. That goes for all over pronators as well, shoes and orthotics/arch supports alone will not completely correct the loos of function of arch mechanics because they will only brace you not correct the body function above the foot and ankle that can creat the problem.

The transverse plain of motion includes foot external and internal rotation.

Foot external rotation is where the foot is flat and rotates outward.










Foot internal rotation is where the foot is flat and the foot rotates inward.









These are important motions to be aware of where they are coming from. Is it the foot/ankle, is it the knee/thigh or is it the thigh, hip, pelvis that is creating it or to some degree all of them. So it is important to test this at the ankle and compare right and left for symmetry.

The bottom line is that foot and ankle function is complex and understanding the function and being proactive with taking care of it is vital to your longevity and enjoyment of life. The function of the foot and ankle affects the whole body and the whole body affects the foot and ankle.

We offer functional improvement treatments and classes to help you optimize function of all the bodies joints and muscles. Check the blog frequently for class updates or schedule a functional recovery and improvement appointment today and let us know what area you would like to focus on to start with.

Dr. McMaster

Class Update

Classes this weekend will be 7:30 am at SHCC neck/shoulder and upper back. The 12:30 class at SHCC will be hip/pelvis/abdominals and low back. Class size is limited to 6 so please call and let us know if you will attend. Classes are $10.

Last week was the first hip/pelvis/abdominal and low back class and it went very well. Again all materials/ exercises presented in this class will help with the walking and running cycle.

Yoga classes with Werner Hildebrand will start back up Monday January 26th 6:30 to 7:45 pm. Cost: $50.00 for 5 week session. $12.00 a class for drop-ins.

Dr. McMaster will be doing stretching classes for Miami Township. There will be three classes held at the Civic Center on Meijer Drive, on Tuesday evenings 6:30 to 7:30 pm. January 27th, February 10th and February 24th. The first class is on stretching and flexibility for the whole body; the second class will be on core strengthening for walkers and runners; and the third class will be on walking and running technique and functional exercises that will improve your walking and running form. These will all help prepare you for spring physical activity.

Please call or email us with any questions
248-1040
DrBones@Signalhillchiropractic.com

DrMcMaster

Healthy Tips: Body Awareness

Even a small improvement in function in our body when we are hurting and don't feel well can be like a breathe of fresh air. The change may also be something that you don't appreciate right away but the improvement in function that it allowed for, the step in the right direction, can be the turning point that determines whether you stay the same, get worse or start getting better. This change like a new way to walk, a drink of water, eating something light, satisfying and healthy or a chiropractic adjustment can be a functional improvement that takes stress off the body and allows it to heal itself instead of maintaining it or putting more stress on it. This change may not be all the change that you need , but it is, for the moment, huge.

Awareness of how your body is functioning especially at this moment of change can help you capture the subtleties that teach you how to improve quicker. [Changing positions slow and controlled and/or frequently for movement and circulation instead of not moving to avoid pain; finding low stress neutral body positions for rest instead of sitting or lying long periods on the couch for rest; drinking water and eating lots of fruits and vegetables to minimize inflammation throughout the body instead of eating comfort foods]. Improving quicker is usually building on your successes instead of experiencing the frustration of the peaks and valleies of an unstable and incomplete recovery because of not knowing what you are doing right and what you are doing wrong.

Although, sometimes these ups and downs are necessary for the body or even the universe to communicate a deeper message, body awareness can help you get the message quicker.

It has taken me a lot of these ups and downs to learn this message.

Try for 30 seconds or some short period of time, to draw your attention out of your daily activities and onto your body position or the details of how it is moving. Try this 3 times an our for 4 hours, preferrably when you are busy because you will learn more, and see if you gain a greater appreciation of the body and the universe.

Dr McMaster

Hip, Low Back and Abdomin Exercise Class

Intoductory hip low back and abdomin exercise class which will help you strengthen improve flexiblity improve stability and understand how function of these areas is integrated.

This will be taught by Dr. McMaster and is classified as therapeutic exercise for all levels of fitness to avoid injury, stabilize and improve whole body function.
This will help you walking and running form!!!!

Location: Signal Hill Chiropractic Center

Time: This Saturday morning from 7:30am. to 8:30am.

Cost: $10.00

Please call or email if you are interested in attending. 248-1040 Drbones@signalhillchiropractic.com

Next week updates on future classes by Dr. McMaster and Yoga and Tai Chi classes.

Case History

-56 year old male
-Persistent left heel pain for 6 weeks aggravated by running and causing patient to stop running
-Running 4-5 times per week 30+ miles. Has been running for 30+ years
-Similar pain 5 years ago, resolved by orthodics and physical therapy
-Has had a neuroma surgery followed by staph infection on right foot.
-Has had previous chiropractic care for left hip pain
-Pain levels low without running
-Not taking medications

EXAM FINDINGS
-Tightness and tenderness throughout the upper back and lower back, left hip and thigh more so than the right. Bilateral leg muscles with more so on left calf and right tibialis and peroneal muscles (front and outside of right leg and back of left leg [out of balance])
-Joint dysfunction upper and lower back, pelvis, hips and feet.
-Posture compensated in a forward position with increased flexion and outward rotation of lower body more so on right and upper body is flexed with inward rotation of shoulder and arms.
-Gait favors propelling his body with right side and pivots with left non-dominant side.

DISCUSSION
-Patient has a repetitive strain injury to left Achilles complicated by asymmetries in whole body mechanics legs, thighs, pelvis, spine and shoulders. Asymmetries result form general stressors of side dominance, forward focus of ADLs, lower body favoring for walking and compensation for previous injuries.

TREATMENT PLAN
-Treat acute injury of left heel
-Treat surrounding areas to reduce stress on acute areas. Improve whole body mechanics to lessen repetitive strain on acute injury and allow gradual return to running while strengthening the function of the whole body as it re-integrates into fluid whole body efficient movement.
Goal complete injury recovery with less chances of recurrency and hopefully improved performance and greater longevity.

RESPONSE TO CARE
-First Month 10 visits adjusting feet, hips, upper back, lower back and pelvis. US/EMS for acute soft tissue injury to left heel 6 visits.
-Local exercise leg, foot, ankle, stretch and strength
-Progression to posture exercise emphasis spinal mobility strength and stability
-Gait exercises that focus on body symmetry and whole body functional integration.
-Post-first month treatment taper frequency of treatment to 1 time per 3 week and continued to taper while maintaining and improving function gradual increasing in running with initially frequent stops and stretching.
-Progression of exercise: to functional hip exercises to improve force transmission from lower to upper body and back again with the ultimate goal of improving performance and lessen foot/ankle demand.
-Backwards running to counteract forward running demands and build eccentric muscle contraction endurance strength.

Patient is back to 30 mile run week and continue functional recovery and improvement treatments currently at a one time per 2 to 3 week basis.

Functional Recovery and Improvement

I would like to cover 3 topics today: physical transitions in our body; the basics to understanding function in our body; and how SHCC can help improve the function of the body.

Transitions in your body
Whether going from good to bad body function, or bad to good, it is the experience of change or transition in function that can create symptoms. This happens because the body is growing toward the stress you put upon it at all times and some stressors (like a new pair of shoes, a new bed, or exercise) require a change faster than the body can grow and adapt to. Too much demand can slowly or sometimes quickly (depending on how much stress your body is already under) fatigue the body's tissues and lead to pain, stiffness and/or injury.

The Basics to Understanding Function in our Body
First understand clearly that we are 3-dimensional and we function in three dimensions. ( This may take practice and visualization).

3-dimensional means when referring to the body and it's parts:

1. Top and Bottom
2. Front and Back
3. Right and Left

Referring to the motion of body parts:

1. Facing forward: bending forward and backward (sagittal plane of motion)
2. Facing forward: bending side to side (frontal plane of motion)
3. Facing forward: rotating to the right or the left (transverse plane of motion)

Visualizing these motions of the body and thinking of the body and its parts in 3 dimensions will be the foundation to understanding and improving your body's function.

Functional Programs at Signal Hill Chiropractic Center

In addition to our acute pain relief treatments with Chiropractic, Massage and Reflexology we offer functional programs where the treatments focus on integrating the function of the whole body so that it can be most efficient. Outcomes of treatment become: ease of functional capabilites like squats, lunges, overhead reaches and balance challenges as well as walking analysis for symmetrical efficiency which can be captured on video upon request for your own visual inspection. Having a video of your performance can be a powerful awareness builder!
Please inquire about programs and costs for more information.

Excellent whole body stabilizer exercise classes we offer are Yoga and Tai Chi as well as walking and stretching classes with Dr. McMaster. Classes schedules will be updated tomorrow.

Two other function improvers that are offered are exercise programs on the powerplate and Earth shoes.

The powerplate (http://www.powerplate.com for research and a list of other users) uses whole body vibration to challenge the muscles, joints, bones and nervous system to strengthen, improve flexibility, relaxation and recovery, and improve circulation efficiently.







This is a tool I have used for over 2 years to personally train patients and feel strongly that it will aid patients in the strength and recovery phases of care.

The Earth shoes from a functional stand point I feel are the best shoes on the market at putting your body into the front to back neutral position. This neutral position, once you become used to it, transfers force through the body more efficiently and causes less reactivity of the muscles on the back half of your body which overwork typically in a heeled shoe to stop you from falling forward. Earth shoes require a physical transition from the forward position back to neutral. This can fall into the category of a bad to good transition which I referred to earlier which can create stiffness and soreness throughout the body. This is avoided by a good functional assessment with exercise and possibly treatment suggestions. Please call if you are considering a shoe change, the functional assessment is free. These are the only shoes I wear.

Up next in Functional recovery and improvement(FRI) are descriptions with pictures and hopefully brief videos of full 3-dimensional movement of all the major joints in the body to be followed by the integration of these movements into the ideal walking cycle. With running to come...

Dr. McMaster

Healthy Tips: Hydration

If you ever notice typically in late October or early November that when you wake up in the morning your nose and throat feel dry? This is because as the weather gets colder the air often gets dryer or the relative humidity drops and we loose more body water. This body water loss is significant because 70 percent of the water our body looses is by breathing and we typically don't think to rehydrate because of simply breathing.
An decrease in body water often affects the sinuses, mouth and throat first leaving us more susceptible to infection. This decrease in body water also can create a generalized pro-inflammatory state throughout your body causing more symptoms of aches, stiffness and even muscle spasms.
The solution is not as simple as it sounds, drink more water, and at least 10 to 12, 8oz. glasses of water a day. ( a google search can help you find the right amount for you based on body size and activity level ).
This is definitely a difficult habit to create especially when a cool glass of water does not sound appealling when you are already cold (try warm water without the tea or coffee), but the health benefit are huge and cost effective too. Maintaining optimal hydration can help cleanse the body of holiday over-indulging, it can make you feel fuller quicker and lessen consumption, it can improve organ function and maintain healthy muscles, skin, hair. Sounds like it should cost more.
Note that there is no replacement for pure water, tea, fruit juice, coffee, and soda do not count.
You should notice some benefits in the first few days but it does take approximately two weeks to rehydrate the depleted extracellular fluid to gain the full benefits.
The cost and health benefits are worth the extra trips to the bathroom.
Don't forget that once you get started maintain it, set yourself up for success and buy yourself a nice new shiny, non-plastic water bottle to increase your focus as you begin.

Dr. McMaster

What is new for 09

Beginning this week I would like to create three new weekly postings to keep you better informed on your health and how we at Signal Hill Chiropractic Center can help. These will fall under the headings of: Healthy Tips; Functional Recovery and Improvement and Case Studies.

Healthy tips will be helpful ideas that you can become aware of research and implement if it is something that you feel would benefit your life. These tips are ment to be informative, not a prescription, so please ask Dr. McMaster or consult other health care professionals to see if this meets your specific health care needs.
Functional recovery and improvement will be a collection of exercises, research studies and treatments that will be discussed to help give you a better understanding of how the body optimally functions from a muscle, joint and nerve interaction perspective. This will hopefully help you avoid injury and improve enjoyment of physical activity with greater longevity. Again before implementing consult Dr. McMaster or consult other health care professionals to see if this is right for your specific goals and health care needs.
Case studies will review the details of interesting cases that I deal with in the office to inform you of what injuries or dysfunctions treatment can help, how it can help and what to expect: exercises; ups and downs; duration of treatment etc..

I will also post upcoming classes and scheduling changes due to weather or other unforseen issues. Hopefully this can keep you well informed and at the same time not overload your email inbox.

I hope everyone had a wonderful holiday and are poised to make 2009 a healthy, fun and prosperous new year. Look for a tip on hydration tomorrow.

Dr. McMaster

What Signal Hill Chiropractic Center Has to Offer


Common Problems We Treat
-Low Back Pain
-Neck Pain
-Upper Back Pain
-Headache
-Heel Pain
Plantar Fascitis
-Hip Pain
IT Band Syndrome
TFL Syndrome
-Knee Pain
Patellofemoral Syndrome
Chondromalacia Patella
-Shoulder Pain
Impingement Syndrome
-Elbow Pain
Medial (Golfer’s Elbow)
Epicondylitis
Lateral Epicondylitis (Tennis Elbow)
-Wrist Pain
Carpal Tunnel Syndrome
-Jaw Pain
TMJ Syndrome

Top 5 Sports We Help With
-Running
-Walking
-Tennis
-Golf
-Cycling

-Also: Swimming, Baseball, Football, Bowling, Soccer Lacrosse

What Is Involved With Treatment

-Joint mobilization/manipulation therapy
-Soft tissue massage and release techniques
-Stretching
-Posture and therapeutic exercise instruction
-Electrical muscle stimulation and/or ultrasound



Results
-Decreased Pain
-Increased ease of movement
-Better rest
-Body awareness, strength, flexibility, symmetry
-More coordination, control of movement
-Decreased recurrency of pain

Top 5 Goals of Treatment
-Decrease pain
-Improve function (joints, body movement, and body symmetry)
-Improve posture (sitting, standing, lying, walking)
-Improve strength
-Improved flexibility

Top 5 Ways Our Treatments Help the Body
-Increase ease of joint motion
-Less muscle effort needed
-Less nerve irritation (muscles can relax easier, less pain)
-Improved circulation (improved healing response)
-Better utilization of your strength, flexibility and elastic recoil of tissues

Services Offered
-Chiropractic Treatment
-Massage Therapy
-Reflexology
-Body Boost/Walking Classes/coming soon exercise recovery classes with the powerplate
-Yoga
-Tai Chi
-Personal Training with the powerplate