Cervical Sprain/Strain.
A cervical sprain/strain involves the joint, tendon, ligament, and muscles of the cervical spine. This condition can come in an array of mechanisms, such as repetitive use, over exertion with certain exercises/movements, motor vehicle accidents (Whiplash), and even from an insidious onset such as “I woke up and my neck hurt”.
Cervical Disc Herniations/Bulges.
There are different classifications of disc pathology. The main two are herniations and bulges. Of the two, herniations are more sever and require a longer healing process. The disc itself is comprised of a nuclear material (the Nucleus pulposus) and the outer fibers (the annulus fibrosus). An easier way to explain the structure is with a popular American staple, the jelly doughnut. The inside/nucleus of the disc has a pliable/squishy substance similar to jelly. The outer portion of the disc, annulus, has a more rigid structure like the cake in the doughnut. In the human body this substance is more like grizzle from a steak. When a disc herniates, tears in the annular fibers are formed and the nucleus (jelly) passes through this structure and extends passed the outer most fibers. When this herniation is severe enough it can compress the spinal nerve and cause an array of problems that can extend into the lower extremity (radiculopathy /sciatica). A disc bulge is less severe; however, since the disc is a pain sensitive structure pain is felt. With a disc bulge tears in the outer fibers are present and the nucleus extends into the annular fibers. This causes an inflammatory response and the disc “bulges” taking on a physiological different shape.
Cervical Radiculopathy.
Radiculopathy is pain felt into an extremity associated with nerve irritation usually due to disc pathology. Nerves can also be affected by both muscle spasm and joint dysfunction or a combination of both. When a patient experiences radiculopathy they will usually feel numbness, tingling, and or burning into the upper extremity. If symptoms persist and it goes untreated the patient may then have developed weakness to the muscle and a slow or diminished reflex. Over time this can become a serious problem and should be evaluated immediately and taken seriously. Nervous tissue once compromised has a slow recovery rate when compared to other soft tissue in the cervical spine no chance of recovering to its initial state.
Cervical Joint Dysfunction.
Joint dysfunction is a loss in joint motion. The body is designed to have certain amounts of motion at each vertebral level. For example, the cervical spine has seven bones in its region. If a loss in joint motion is found between the C3 and C4 level the joints above and below will move more freely (hyper-mobile) to compensate for the loss of motion between the two levels. This loss is joint motion (hypomobility) if not treated may predispose the segment to advancement in arthritic changes.
Cervical Facet Syndrome.
Facet syndrome is a condition, which involves the posterior aspects of the vertebral bodies known as the facets. The facet joints glide upon one another when the joints are moved. Irritation to these joints may come in the form of joint dysfunction, muscle tension and osteoarthritis.
Cervical Spinal Stenosis.
Spinal stenosis involves encroachment upon the spinal cord. Disorders that have been known to cause this condition: Disc herniations/bulges, advanced osteoarthritis and spinal cord masses/tumors. Spinal stenosis when left untreated can cause severe disorders to the upper extremities (radiculopathy) and symptoms distal or below the encroachment.
Cervical Spine Arthritis.
Arthritis is a common variable as we age. With that said there are ways to prevent arthritic advancement and promote a healthy spine. The body needs motion to function properly. Undetected joint dysfunction (see joint dysfunction) causes instability in relationship to the joint above and below. Allowing a joint to move in its “designed” motion gives the body a chance to advance its “aging” process in a more uniform/symmetrical stage rather than severe advancement at one or two levels.
Scoliosis.
Scoliosis is an abnormal curvature of the spine. There are several types of scoliosis: idiopathic, congenital, neuromuscular, and degenerative. Scoliosis most commonly affects the thoracic and thoraco-lumbar spine. Residual curves may be present in the cervical spine; the body prefers to have the visual apparatus (the eyes) horizontal to the viewing field. An upper thoracic curve or a curve that is severe enough may affect the lower cervical spine, in that respect the upper cervical spine will compensate to keep the head level and the eyes at a horizontal viewing field.
Headaches/Migraines.
We have all had headaches in the past. Headaches that reoccur or become a daily nuisance should be evaluated thoroughly. Organic headaches (brain tumor, a brain aneurysm, hematoma, meningitis, brain abscess, brain infection, cerebral hemorrhage, or encephalitis) need to be ruled out to first and foremost, these conditions can be fatal when left untreated. Headaches can also stem from a neuromusculoskeletal disorder. Cervical segments in the upper spine can have an impact on the base of the skull leading to headaches. Increased muscle tonicity in the sub-occipital and posterior cervical musculature can impinge on the vertebral artery and the sub-occipital nerve, which supplies nutrients and innervates the base of the skull, top of the head and over the ear. Once organic headaches have been ruled out treatment with manual therapy has been show to be effective in treating tension/migraine headaches. Call or contact us today
Mid-back pain
Mid-back pain can stem from a wide variety of problems from: muscle spasms, thoracic joint dysfunction, scoliosis, to visceral referral pain (pain referred from organs in the thoracic cavity). A thorough evaluation and review of symptoms by a trained clinician will allow them to better understand where your pain is coming from. Pancreatic pain is usually felt over the epigastric (upper central region of the abdomen) area but can also refer pain into the mid-back at the area of T7. Diagnostic testing may be required to better evaluate the complaint and rule out these referral pain patterns from the organs in the thoracic cavity. Call or contact us today
Mid-Back Conditions treated at Elite Total Rehab include:
Spasm of Thoracic Spinal Muscles
Muscles in the thoracic spine become tight and people often refer to them as “knots”. These knots are actually called “trigger points”. Trigger points usually follow a pattern and can be very painful in their active state. Muscles that can be affected in this region include:
Lower trapezium Muscle.
Rhomboid Major/Minor Muscle.
Latissimus dorsi Muscle.
Thoracic Erector Spinae Muscle.
Thoracic Outlet Syndrome
This syndrome, usually refereed to as TOS, compresses the brachial plexus, which is a network of nerves and arteries, as it passes through the neck into the arm. Patients will usually complain of numbness and tingling into the upper extremity which can have a similar presentation of a cervical disc herniation (see cervical herniation). The key to differentiating the two conditions is with orthopedic testing and diagnostic testing.
Thoracic Joint dysfunction
Joint dysfunction is a loss in joint motion. The body is designed to have certain amounts of motion at each vertebral level. For example, the thoracic spine has twelve bones in its region. If a loss in joint motion is found between the T6 and T7 level the joints above and below will move more freely (hyper-mobile) to compensate for the loss of motion between the two levels. This loss is joint motion (hypomobility) if not treated may predispose the segment to advancement in arthritic changes.
Scoliosis
Scoliosis is an abnormal curvature of the spine. There are several types of scoliosis: idiopathic, congenital, neuromuscular, and degenerative. Scoliosis most commonly affects the thoracic and thoraco-lumbar spine. Radiographs of the mid-back will show a visible lateral curve resembling an “S”. Structural (abnormalities in the bone) scoliosis’ should be evaluated and monitored by an orthopedic physician, for possible bracing to slow down the progression of the curve. Non-structural scoliosis usually due to joint dysfunction and or muscle imbalance can be treated with manual therapy with positive results.
Call or contact us today
Lower Back Pain
Low back pain can be caused by many things. It is important to isolate the source of pain, the duration, and the intensity of your symptoms. Most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine. Over time muscle strain can lead to an overall imbalance in the spinal structure. This leads to a constant tension on the muscles, ligaments, bones, and discs, making the back more prone to injury or re-injury. Proper exercises, stretches, and chiropractic treatment can help to reduce low back pain and help prevent future episodes. Whether you step off a curb the wrong way, injure it lifting something heavy at work or even injure it in a motor vehicle accident treatment can help you. It is important to differentiate Neuromusculoskeletal (somatic and neuropathic) pain (pain from muscles, joints, ligaments, tendons, bones, nerves, and discs) from visceral pain (pain referred from organs). Physical examination and a thorough history of the problem will give the clinician a better understanding as to what is causing the symptoms. Diagnostic testing in the form of x-ray, MRI, urinalysis, and even blood draws may be required in cases that are more complex. If you experience low back pain it is important to have it evaluated and treated to help improve the quality of life and to help prevent future episodes through education and exercises that are available to you. Call or contact us today
Lower Back Conditions treated at Elite Total Rehab include:
Spasm of Lumbar Spinal Muscles.
Muscles in the lumbar spine become tight and people often refer to them as “knots”. These knots are actually called “trigger points”. Trigger points usually follow a pattern and can be very painful in their active state. Muscles that can be affected in this region include:
Quadratus Lumborum.
Lumbar Erector Muscle.
Lower Latissimus Muscle.
Gluteus Maximus/Medius/Minimus.
Piriformis.
Lumbar Sprain/Strain.
A lumbar sprain/strain involves the joint, tendon, ligament, and muscles of the lumbar spine. This condition can come in an array of mechanisms, such as repetitive use, over exertion with certain exercises/movements, motor vehicle accidents, and even from an insidious onset such as “I woke up and my low back hurt”.
Lumbar Disc Herniations/Bulges.
There are different classifications of disc pathology. The main two are herniations and bulges. Of the two, herniations are more sever and require a longer healing process. The disc itself is comprised of a nuclear material (the Nucleus pulposus) and the outer fibers (the annulus fibrosus). An easier way to explain the structure is with a popular American staple, the jelly doughnut. The inside/nucleus of the disc has a pliable/squishy substance similar to jelly. The outer portion of the disc, annulus, has a more rigid structure like the cake in the doughnut. In the human body this substance is more like grizzle from a steak. When a disc herniates, tears in the annular fibers are formed and the nucleus (jelly) passes through this structure and extends passed the outer most fibers. When this herniation is severe enough it can compress the spinal nerve and cause an array of problems that can extend into the lower extremity (radiculopathy /sciatica). A disc bulge is less severe, however, since the disc is a pain receptor structure pain is felt. With a disc bulge tears in the outer fibers are present and the nucleus extends into the annular fibers. This causes an inflammatory response and the disc “bulges” taking on a physiological different shape.
Lumbar Radiculopathy.
Radiculopathy is pain felt into an extremity associated with nerve irritation usually due to disc pathology. Nerves can also be affected by both muscle spasm and joint dysfunction or a combination of both. When a patient experiences radiculopathy they will usually feel numbness, tingling, and or burning into the lower extremity. If symptoms persist and it goes untreated the patient may then have developed weakness to the muscle and a slow or diminished reflex. Over time this can become a serious problem and should be evaluated immediately and taken seriously. Nervous tissue once compromised has little to no chance of recovering to its initial state.
Sciatica.
Sciatica is often used to diagnose a radiculopathy (see radiculopathy).
Lumbar Joint Dysfunction.
Joint dysfunction is a loss in joint motion. The body is designed to have certain amounts of motion at each vertebral level. For example, the lumbar spine has five bones in its region. If a loss in joint motion is found between the L3 and L4 level the joints above and below will move more freely (hyper-mobile) to compensate for the loss of motion between the two levels. This loss is joint motion (hypomobility) if not treated may predispose the segment to advancement in arthritic changes.
Lumbar Facet Syndrome.
Facet syndrome is a condition, which involves the posterior aspects of the vertebral bodies known as the facets. The facet joints glide upon one another when the joints are moved. Irritation to these joints may come in the form of joint dysfunction, muscle tension, increased weight due to obesity/pregnancy and osteoarthritis.
Lumbar Spinal Stenosis.
Spinal stenosis involves encroachment upon the spinal cord. Disorders that have been known to cause this condition: Disc herniations/bulges, advanced osteoarthritis and spinal cord masses/tumors. Spinal stenosis when left untreated can cause severe disorders to the lower extremities (Radiculopathy) and symptoms distal or below the encroachment.
Lumbar Spine Arthritis.
Arthritis is a common variable as we age. It is unavoidable and from the day we are born we slowly advance. With that said there are ways to sustain and avoid advancement. The body needs motion to function properly. Undetected joint dysfunction (see joint dysfunction) causes instability in relationship to the joint above and below. Allowing a joint to move in its “designed” motion gives the body a chance to advance its “aging” process in a more uniform/symmetrical stage rather than severe advancement at one or two levels.
Scoliosis.
Scoliosis is an abnormal curvature of the spine. There are several types of scoliosis: idiopathic, congenital, neuromuscular, and degenerative. Scoliosis most commonly affects the thoracic and thoraco-lumbar spine. Residual curves may be present in the lumbar spine. This curve may and can affect the lower lumbar spine at the area where it articulates with the sacrum thus affecting the sacroiliac joints.
Piriformis Syndrome.
Piriformis syndrome can be mistaken for lumbar radiculopathy if not evaluated properly. Both conditions create a localized low back/buttock pain with pain into the lower extremity. Orthopedic and diagnostic testing can differentiate these two conditions, which have different prognosis and treatment protocol. Piriformis syndrome is diagnosed with a contracture in the piriformis muscle (a muscle located in the buttocks) that irritates or entraps the sciatic nerve under the tight muscle.
TMJ
This disorder can be painful with isolated pain and even headaches caused by the joint disorder between the temporal bone of the face and the mandible, the jaw bone. This joint works as a sliding joint and with the disorder clicking, popping and locking of the jaw can occur. Symptoms associated with this syndrome are: jaw pain, ear pain, headaches, tinnitus (ringing of the ear) and dizziness. The cause of this disorder is usually a muscular imbalance associated with the muscles of mastication (muscle used to chew). The imbalance of muscles puts a constant stress over the area and when the jaw is opened, the tight muscles pull on the jaw, causing a deviation in the jaw upon opening. Stretching or breaking down the tight muscles and strengthening the weak or overpowered muscles will help balance this condition, keeping the jaw in the joint when opening and closing the mouth. This joint also contains a disc, which over time can breakdown causing pain and sensitivity over the joint. Call or contact us today
Carpal Tunnel Syndrome
This disorder is usually due to a repetitive stress, such as prolonged typing. The cause of carpel tunnel syndrome is compression of the median nerve, a nerve that passes through the wrist into the hand, more specifically the thumb, pointer finger, middle finger and the ring finger (on the middle finger side). Symptoms are usually increased when the wrist is extended (bent backwards) or flexed (bent downward). When the median nerve is compressed patients may feel numbness, tingling, and even weakness into the lateral hand (thumb, pointer, middle, and lateral aspect of the ring finger). This condition may mimic cervical radiculopathy (see cervical radiculopathy) in the fact that they may both create hand symptoms. Carpel tunnel syndrome is usually isolated to the hand, whereas radiculopathy patients may experience symptoms over the entire arm extending into the hand. A thorough evaluation and review of symptoms by a trained clinician should isolate the area of concern. Diagnostic testing such as a MRI or a nerve conduction test may be performed to better evaluate this condition. Carpal tunnel syndrome is often misdiagnosed and sometimes surgery is performed. Performing surgery can sometimes relieve this symptom if the actual condition is entrapment of the median nerve at the carpal tunnel. If the condition is associated with other disorders and misdiagnosed the surgery will not be effective and can cause scar tissue, leading to a failed surgery. Call or contact us today
Back Pain from Pregnancy
Low back pain can be very common in pregnant females. It is estimated that between 50 and 80 % of females will experience low back pain during their pregnancy. The incidence of pain is increased with pre-existing low back pain. The cause of the pain is straightforward; as women gain weight due to the fetus the mechanics of her body changes. The stress placed on the lumbar spine (low back) is increased as body weight increases. Weight gain increases the lumbar lordosis (the lumbar spinal curve) thus placing more stress over the posterior joints of the lumbar spine (facet joints/see facet syndrome). This causes muscle spasm to the erector muscles, and places an increased stress over the lumbo-sacral region (where the lumbar spine articulates with the sacrum). The pain may be reduced throughout the pregnancy with simple yet effective exercises that help improve the strength of the lower abdominal muscles with posterior pelvic tilts. Stretching therapy, myofascial release and joint mobilization to the lumbar spine has also been shown to help relieve symptoms. Call or contact us today
Rotator Cuff Syndrome/Tendonitis
No other joint is as complex or multi-functional as the shoulder joint, which is probably why it is open to so many injuries. Whether you are an avid tennis player, or an average Joe with a killer curve ball, when the shoulder or rotator cuff muscles are weak you open yourself to injuries that can have a long impact on your quality of life. The rotator cuff muscles are comprised of a group of muscle that make up the Glenohumeral joint and help keep the head of the humerus (top of your arm) in the glenoid fossa of the scapula (the shoulder blade). The rotator cuff muscles consist of: the supraspinatus, infraspinatus, teres minor, and subscapularis. The health of these muscles is imperative in a normal functioning shoulder. Once these muscles have been compromised by a fall, an awkward lifting motion, or repetitive motion-especially done overhead, symptoms can range from localized pain, pain with limited motion, clicking in the joint, and even joint instability (the feeling of the joint being loose). Evaluation and a review of the problem by a trained clinician will allow the patient to know where the pain and symptoms are coming from. Diagnostic testing such as x-ray and MRI may be considered to better evaluate the problem. Non-operative treatment has been proven to help this condition when modifications of the patient are addressed. The key to resolving this condition are rest, when the area is inflamed or in its acute stage, pain and swelling control, and therapeutic exercises to target and strength the key muscles that are affected. Pain in the shoulder may also be the product of bursitis, a condition in which the bursa (a fluid filled sac present to help lubricate the joint) is inflamed causing pain. Call or contact us today
Hip Pain
People often locate hip pain pointing over the sacroiliac joint (the joint between the sacrum/base of the spine and the iliac crest/a portion of the pelvis). The key to treating hip pain is accurate diagnosis localizing it. The hip joint is located over the lateral side of your leg where the femoral head, the top of your leg bone connects to the acetabulum, another bone of the pelvis. The joint is considered a ball-and-socket and is very stable. Localized hip pain, pain over the joint, may be due to tendonitis (inflammation of the tendons) or bursitis (inflammation of the bursa-a fluid filled sac to help lubricate the joint) from surrounding tissues. It is important to evaluate this properly to rule out a referral pain from other structures in the low back such as the sacroiliac joint which has a tendency to refer pain into the hip and lateral thigh. Arthritis in the aging population is a common site for the hip. An x-ray or MRI may be required to see the extent of arthritic changes and properly diagnose the complaint. Those who have had recent trauma to the area and have had prolonged pain may be evaluated immediately with a MRI to evaluate essential vascular structures, especially in the adolescent population. Call or contact us today
Knee Pain
Pain in the knee can come in an array of symptoms from: localized joint pain, pain with squatting, clicking and cracking (known as crepitus), locking, and even instability (the feeling of the joint being loose). A thorough history is important when evaluating the knee. Is there recent trauma? Was the knee bent or straight upon injury? Was there rotation with the injury? These clues can give the clinician information on what structures may be damaged and a plan of attack to address the issue. X-rays and a MRI may be required to further evaluate the symptoms, especially if conservative treatment fails in decreasing the symptoms. Common conditions of the knee include, tendonitis (inflammation of the tendons), bursitis (inflammation of the bursa-a fluid filled sac to help lubricate the joint), partial/full tears of tendons and or ligaments, meniscus pathology, chondromalacia, patellar tracking syndrome, IT band syndrome, and muscular imbalances. Prevention of knee pain can be taken by strengthening the surrounding musculature that helps to protect the joint such as the hamstrings, quadriceps, and gastrocnemius (calf muscles). Call or contact us today
Elbow Pain
The elbow is made up of the humerus (arm bone) and the bones that help make up the forearm, the radius and ulna. The elbow is most commonly affected by tendonitis (inflammation of the tendons). Common tendonitis of the elbow is termed Tennis elbow (pain over the lateral/outside aspect of the elbow) and Golfer’s elbow (pain over the medial/inside aspect of the elbow). Patients who have recently fallen should be evaluated for fractures, if the bony structures are normal and pain persists, bursitis (inflammation of the bursa-a fluid filled sac that helps to lubricate the joint) must be ruled out. Problems form structures more proximal may also cause elbow pain such as: pain from the shoulder or even the neck referring pain distally into the arm. Call or contact us today
Wrist and Finger Pain
Pain in the wrist and finger are not abnormal. People with repetitive jobs such as working at a computer or assembly line workers place their wrist and hands in constant tension to perform work activities. If recent trauma is reported such as a fall or strike different approaches are taken to the evaluation process. X-rays may usually be taken to proper evaluate the bony structures of the wrist and hand. Assuming there is no pathology with the bone (negative for fractures, tumors, metabolic disorder) the muscles in the wrist and hand may be overloaded and tight causing your symptoms. A thorough evaluation and review of symptoms by a trained clinician should isolate the area of concern and address the issues to help alleviate your complaint. Call or contact us today
Foot and Ankle Pain
The foot and ankle are prone to multiple problems including: sprains/strains, arthritic changes, joint dysfunction, radiculopathy from the lumbar spine (see radiculopathy), diabetic neuropathy, gout, vascular claudication, and bony abnormalities. A complete work up with x-rays, MRI, blood draws, and even biopsy of the joint may be required to thoroughly evaluate the symptoms. Call or contact us today
Poor Posture
Posture is the key to maintaining proper balance of the muscles and joints, especially for the spine. Three spinal curvatures help to maintain the spine: the cervical lordosis, the thoracic kyphosis, and the lumbar lordosis. Maintaining these curves with proper strengthening and stretching exercises helps place the weight of your body in the proper position. An imbalance in this chain of muscles creates a vicious cycle of muscle fatigue and pain over the neck, mid-back, and lumbar spine and predisposes the area to injury. Most of the postural exercises are relatively simple movements that work the intrinsic muscle of the spine (deeper muscle along the vertebrae). These simple but effective exercises maintain good posture and preventing injuries when done correctly on a regular basis. Exercises include axial retraction, axial retraction with rotation and bilateral lateral flexion for the cervical spine. The thoracic spine and lumbar spine are addressed with flexion and extension exercises in the “hands and knees position” (all fours) to strengthen and stretch involved muscles. The lumbar spine can be targeted in both the prone (face down) and supine (face up) positions. Advancement of postural exercises can be performed on a rocker/wobble board, foam roll and an exercise/Swiss ball to add an increased degree of difficulty. Recent research states that exercises for posture should be focused on higher repetitions rather than resistance. It is important to do more repetition per exercise than increasing the load or weight to the exercise. As with all exercises performed, movements should be made slow and deliberant; short ballistic (quick) movements should be avoided to prevent injury. Call or contact us today
Sports injuries
All athletes need to be evaluated thoroughly to rule out injuries that may be career ending if not addressed and treated properly. Injuries are a part of the game and sometimes can not be avoided. Injury prevention is as important as practicing and developing your skills. Proper warm ups are necessary to circulate blood flow to the tissue that is going to be trained. Whether you are an avid golfer or a trained cage fighter, warming up reduces the possibility of injuries. Sports specific training is also an important aspect for athletes who are on a competitive level and want to separate themselves from the rest of the playing field. All athletes are not created equal with respect to body type. Swimmers and wrestlers look differently and train differently using different muscle fibers for their respective sport. Different types of muscle fibers are found throughout the body, broken into slow-twitch (ST or type I), fast-twitch (FT or type II), or a mixture of fast twitch fibers (FT-A and FT-B) in which they share qualities of both slow and fast twitch fibers. Contraction time dictates these muscle fiber categories. Slow twitch fibers have a slower contraction time and higher endurance making them more usable for aerobic activities in which longer and less explosive movements are required such as a marathon runner. Fast twitch fibers are used for shorter, more explosive movements which you might find in a power lifter. Both athletes train differently to utilize the effectiveness of their muscle fiber and achieve greater results in their sport. The amount and type of muscle fiber is present at birth. Slow twitch muscle fibers and fast twitch muscle fibers may not be changed; we are born with what we have. The way you train your muscles fibers will ultimately change “which” ones will develop and dominate the make up of your muscles. Developing fast twitch muscle to use for explosive, short movements such as: power lifting, wrestling, judo, sprinting will benefit from high intensity, high resistance training. Slow twitch training can benefit marathon, runners, long distance swimming, athletes who prefer more endurance with their contractions, able to perform longer with less fatigue. These athletes should practice with the same amount of intensity but with less weight for a longer duration. Call or contact us today
