These are articles I have written to benefit my patients. Click any title on the left -- the article will appear on the right. Enjoy!
What is your body telling you about your health? Many things, if you understand the language. Postural cues are a common language we see daily in interacting with others and one we understand:
- Your co-worker walks in with slumped shoulders and slouched back and before saying a word you know they feel beaten down about a project.
- Your friend comes bouncing in with head up, shoulders back walking tall, and you know they are happy and full of energy.
- You see a customer at the counter with their shoulders hunched up, jaw tense, leaning slightly forward and you prepare for a difficult encounter.
- You watch someone walk out of the doctor’s office and you know if they are healthy and feeling good or if they are in pain and worried.
Are we as adept at understanding our own postural language and what it is showing us about our health? It is time for a home study course so you can better understand your postural cues. When you are dressing take a minute and look at yourself in a full length mirror; look from the front and then from the side. What do you notice?
First give a general impression: Do you look healthy and “young”, or do you appear tired and “old”? Do you appear tense or relaxed? What do you think makes you look that way? Shoulders rolled forward, head jutting out and slanted to the side, back rounded and your gut drooping makes you look like a grandparent. Head high and straight, shoulders comfortably back, spine nicely arched, belly in makes you look younger and vibrant.
Now change your posture and see how different you appear and think about what impression this posture gives to someone looking at you. Lifting your head up, pulling shoulders back and sucking belly in you look taller and happier. Let your shoulders droop forward and your belly stick out and suddenly you look frumpy, tired and older. Which do you prefer?
Bring yourself into the position you think looks best and notice what it FEELS like in your body. You will want to memorize this feeling, and remind yourself throughout your day to bring your body back to this posture. Work on it whenever you see your reflection and quickly you will see improvements. What will be most incredible is that others will notice a difference too, though they may not know why. They will think you lost weight, or are working out or simply think you look “great”.
But what else can we understand from our posture? Changing our posture may not be as simple as straightening our back and lifting our head. There may be issues that need attention or problems that require a professional to diagnose and treat in order for postural improvement. Here are some common postural distortions and what they may indicate:
- Head tilted to side or slightly rotated: Neck or shoulder muscles shortened and weak. Degeneration in the joints or discs of the neck.
- One shoulder lower than the other: Injury to the rotator cuff or the shoulder joint. Chronic poor posture related to our work or daily activities that created significant imbalances.
- Torso leaning to one side or partially rotated: Low back disc injury. Pelvis distorted out of position.
- Pelvis (“Hip”) lower/higher than the other: Pelvis twisted, hip joint problem, knee or foot problem.
- Forward lean to torso: Degeneration in lower spine, spinal stenosis, disc injury.
- Knee partially flexed/not as straight as opposite: Degeneration in knee, cartilage injury to knee.
These distortions accompanied by pain or weakness or the inability to move your body into a better posture without pain or stiffness indicates a need for evaluation to understand what is causing the poor posture to see if it can be corrected with professional help. If a painful distortion is ignored the underlying problem can worsen and may become permanent.
Sometimes we have imperfect posture and due to our unique situation (heredity, prior injury or illness) it can’t be fixed. It is very important to understand why we hold that posture and to know what we can do to stabilize our body and protect other joints from injury. Postural distortions – no matter the cause – create compensatory stresses and strains in other joints and tissues and if left unsupported can lead to increasing damage and other problems.
Healthy posture is not a short term project; instead it is a life-long activity. How can you keep a healthy posture? Do the self-analysis regularly, paying attention to how your posture changes with how you are feeling. Begin to observe people and their posture and start to notice how they look and what distortions they are demonstrating.
When you note a distortion in your posture that is accompanied by pain or other symptom that you can’t correct, get evaluated by a professional experienced in posture (Chiropractors and Physical Therapists are experts in this work) and commit to improving or at the least stabilizing your posture.
Go ahead, start RIGHT NOW! Step in front of the mirror and have a look. Don’t be scared, it won’t be terrible and the sooner you start, the better you will be able to improve your posture and look terrific.
Dr. Barry Wahner
Our Secrets to Staying in Shape - Or Getting There!
Our Secrets for Staying in Shape
(Or Getting There!)
“How do you guys stay in shape? What is your secret to stay thin? Is there something special you both do to keep the weight off? You guys are lucky that you don’t have to worry about your weight.”
Paul and I hear these questions every day. Our patients and other people we see always want to know our secret to staying in shape. The secret is it is not a secret. A simple formula exists to guide us on how to stay in shape: Eat plenty of vegetables and fruits. Drink plenty of water. Take in only as many calories as you need (or when you are trying to reduce your weight, eat less calories than you burn). Exercise consistently. Get enough sleep. In that simplicity is where we find the difficulty. Something is always pulling us off track. You must be committed to the formula to be successful.
When it comes to eating, there is a constant search for the magical diet that causes weight loss, tastes terrific, and satisfies hunger. Let’s emphatically state “There is NO super food or vitamin.” While television, magazines and countless internet sites relentlessly attempt to sell us the latest super foods and vitamins, they simply don’t exist. The formula for healthy eating: Eat plenty of fruits and vegetables, proteins and lean meats. Avoid processed foods. Don’t over eat.
The plan may be simple but it takes will power to maintain a healthy diet. There are many chances to be pulled off target during the day: Co-workers who bring in cake and baked goods, the candy bars by the cash register, the ice cream shop on the way home, the cookies we have at home. These temptations are always with us. It takes commitment to say no.
We all get cravings - even Paul and Barry!
If you think some people have it easy because they don’t have the same cravings or temptations and they just naturally eat healthy, you are incorrect. I work with athletes and others who maintain a healthy diet and weight and every single one of them tells me of certain bad foods they absolutely crave. They all struggle to limit eating those high calorie foods. I personally have battles every day. The other night I actually dreamt of doughnuts! Huge, delicious, frosted doughnuts. I woke up thinking about doughnuts and frankly could not get the thought out of my head for days. But I resisted the thoughts. I did not go out and buy doughnuts. I stayed committed to eating healthy.
Would you like water with that?
A major dietary challenge we all face is what we drink. Drinking beverages with calories is one of the quickest ways to gain weight. And of course most of what we drink these days is loaded with calories: Coffee with cream and sugar, iced teas, fruit drinks, sodas, sports drinks. In one 20 ounce soda there are 240 calories, no vitamins and no other beneficial nutrients. Fruit drinks are often no better as there is generally precious little actual juice in it. While a 100% natural juice is far healthier due to the vitamins and nutrients, there are still calories involved. Drink mostly water. Enjoy other beverages in very limited amounts.
The best exercise is….
Exercise is a key to good health and staying in shape. We must move and use our body to keep it going. What is the best exercise? Is it walking, cycling, aerobics classes, weight lifting, yoga? The best exercise is the one you enjoy doing. The secret to exercise is you must do it consistently. Get into an exercise routine that you do several times each week and stay with it. If you have not been exercising, start off small to get the routine going then build up. Commit to going to the gym to work out for 20 minutes 4 times this week. Once you get that habit, you will find that you can easily increase your workout time and soon enough you will see and feel a difference in your body.
When you exercise consistently you will find some common challenges that test your commitment. Some days you will feel tired and not want to work out. On those days start your workout anyway. Give yourself 10 minutes and generally you will feel energized and want to complete the workout. But if you are still tired, call it a day and go home. Often times the tiredness we feel is mental fatigue and a good workout is the cure to relieve that mental stress.
When you need to cut back, schedule your comeback
There will come times during the year when your schedule is overloaded and it is hard to make the time to exercise. At those points, take a break from exercise and focus on the work you need to get done. The challenge is not in taking a break from exercise for a week or two, but in forgetting to get back into your workout routine. Too often a short break from our routine turns into a long time away from exercise. When you decide to take a break, make a commitment on the date you will start again. Another option to stay on target during hectic times is to shorten and simplify your routine but keep doing something until you have time to get back into your full regimen.
Time issues and busy schedules are a constant challenge for me. Over the past 6 months I struggled to stay consistent in my training because my work and travel schedule was very busy. To stay on target I supplemented my normal cycling training with running. On days I was busy, instead of skipping a workout altogether, I would shorten it to 30 minutes. By doing these things I maintained my fitness and did not have to fight to get back into shape again.
And now for the fun part…
We think we’re being efficient and productive when we cut back on sleep. In our Type A culture, we get a merit badge for being too busy to take care of ourselves by sleeping. But wait! Research shows that lack of sleep contributes to higher stress levels, weight gain, lack of focus, loss of energy and a weaker immune system. We created poor sleep habits in our adult years. We go to bed too late, we leave the television on, we have our cell phones near us all night with their ring tones, alarms and message chimes frequently going off. Here is a simple idea: Practice the same rules we gave our children. Start to “settle down” before going to bed. Go to bed early. Read instead of having a television on. Keep the room quiet and peaceful. As for cell phones and other technology, simply turn them off or silence them. Enjoy the luxury of sleeping!
Simple, yes. Easy, not so much
Staying in shape and keeping your weight down is a commitment. The rules are simple; following them is the difficult part. Don’t feel alone in your challenge as even the best athletes and healthiest people you know all struggle to stay on target.
Do you look forward to going to bed? Are you comfortable while sleeping? Do you wake up feeling rested and pain free? If the answers are “no”, “No” and “NO”, you are definitely NOT alone!
Difficulty sleeping is surely frustrating but may lead to much more than that. Problems with comfort during and after sleeping mean you have too much stress and strain on your body while in bed. It means you can’t rest and recover properly and leads to a large list of potential health issues (stress, high blood pressure, obesity, diabetes, depression are but a few).
So if sleeping comfortably is a problem, can it be solved? Yes! But it may take some money or effort to fix. Even so, it is a good investment.
In theory, you should sleep for 25% to 30% of your daily life. That is a lot of time and if that time is spent in a poor posture, or with poor equipment or environment that is time spent stressing and straining your body.
Imagine this: Would you enjoy sitting on a lumpy chair with no back support in a hot room with truck traffic driving by while watching a movie? Of course not! It would be uncomfortable, annoying and frustrating. So why try to sleep for 8 hours with any one of those issues. Yet, many people try to do just that – sleep on a poor mattress, with their head propped up on a couple of pillows with the T.V. on and a fan blowing on them.
How do you do it right? By first knowing how it is done wrong. Study the Sleep Stress Worksheet and note each specific point that relates to your current sleep habits:
Sleep Stress Worksheet
- Not in bed – Do you sleep on one of the following?
- Air mattress
- Poor mattress – Is your mattress:
- Too soft
- Too hard
- Too small or too short
- Too Hot (a problem with memory foam mattress)
- Wrong pillow support – How do you describe your pillow?
- Too high
- Too low
- Too old
- Not supportiveNo pillow
- Poor sleep environment – is your bedroom:
- Too hot
- Air or fan blowing directly on you
- Too bright
- Too noisy
Posture – in which position do you sleep?
- Stomach sleeper
- Head twisted to side
- Arm under head
- One leg bent at hip and rotated out to side
- Side sleeper
- Hips twisted
- Shoulder pressure
- Head poorly supported
- Back sleeper
- Propped up on too many pillows
To enjoy better sleep, take your list of issues from the sleep stress worksheet and fix or improve those issues. While you may not be able to fix them all – at least not immediately – you can certainly correct many of them.
Do you find yourself falling asleep on the couch or a recliner? Commit to going to bed a little earlier, or at the first signs of fatigue. Have a consistent bed time and follow it. On those evenings you find yourself drifting off, go to bed early. Falling asleep crunched up in a recliner then waking after a couple of hours to finally go to bed disrupts your sleep and adds stress to your body.
Does your mattress feel squishy? Can you see a “valley” where you sleep on your mattress? Can you feel any springs? Is the mattress more than 10 or 15 years old? It is time to go shopping!
Do you wrestle with your pillow – shape it, scrunch it, punch it – and still your neck is uncomfortable? Does your neck feel unsupported? Is your head out of alignment from your spine? Is your pillow more than a few years old? Retire that pillow from neck duty (you will be able to use it in other ways you will learn later) and get a new pillow. Keep your pillow in good shape by replacing it when it does not feel good or it’s time has expired (see Pillow Talk sidebar).
For environment problems, make some changes to create a darker, quieter bedroom. Darker paint colors and room darkening blinds will help. If your room is too loud, new windows, heavier draperies and carpeting will do the trick. You could also buy “white noise” machines which create background sound that cancels out other noises. Or go low tech and get a set of ear plugs – they really work!
A surprising source of problems is a fan blowing directly on you. The constant stimulation of air moving across the skin chills the area, irritates the underlying muscles and the nerve system leading to spasms and inflammation which causes you to wake with pain and stiffness. You can have a fan or air conditioner in the room, but have the air moving indirectly around you. You will still be cooled down, but will not create irritation. Is there a ceiling fan above your bed? Reverse the fan direction so it pulls the air upward. This pulls cooler air up and circulates it making the room more comfortable.
Sleep postures – here is the one area you can fix that won’t cost you money. The bad news – sleep postures are dictated by habits and habits take commitment to change.
In what posture should you sleep?
On your back:
This is the best position in which to sleep. Your back, neck and shoulders are well supported in this posture with the least amount of stress placed on your joints.
Keep your head supported on a pillow but not too many. You want your neck and head in line with your shoulders and spine.
You can use a pillow (or pillows) under your knees or thighs to keep the hips and knees bent. This reduces pressure on the lower spine joints and muscles. People with low back pain often find this to be the most comfortable position to sleep. Using pillows this way also reduces pressure on the knees and hips so if you have problems in those joints give this a try.
On your side:
This is also a good position but will place more stress on your hips and shoulders. You may need some additional pillows to help you in this position.
Side posture generally requires a thicker pillow or more pillow volume under your head to hold your head straight. Too little pillow volume and your head drops down, too much and your head is pushed up; both of which are bad.
To help keep your spine aligned in side posture sleeping try one of the following:
- Put a pillow between your knees to keep your hips lined up
- Hug a pillow in your arms to keep your shoulders balanced
- Use a body pillow to lean against as you can both hug it and have it between your knees.
On your stomach:
This position is to be avoided. It contorts your spine and other joints and places significant stress on your body. When on your stomach your head is twisted to the side(damaging the neck), your low back and belly drops down (compresses the low back joints) and you generally rotate one hip out and bend the leg up to try to open up the low back joints but as a consequence twist the spine, and compact the hip.
Many people that use this position feel they can’t sleep in any other posture. The stomach sleeper likes to have pressure on their chest as it feels secure. Sleeping on the back or side leaves them feeling vulnerable. To help be more comfortable they can try to use a body pillow and hug it too them. This gives them the feeling of pressure they desire and if used while side sleeping will prevent them from rolling onto the stomach.
Even if you are an inveterate stomach sleeper, you CAN make the change to a better posture. Side posture is the easier transition. When going to bed decide to sleep in a different posture, and use pillows to help prevent rolling over. If you wake up on your stomach, just simply roll over. Don’t stress about it, just keep changing to your new position when you catch yourself on your stomach. The combination of committing to the new position, using pillows and having a good mattress and pillow can help you make the transition.
Sleep and proper rest is vital to good health. We often just accept poor sleep as unavoidable but often it can be improved. Work on your “bed time” for better sleep. Get good quality “equipment”, improve your “environment” and use relaxing postures. Your sleep quality will be enhanced, you will get better rest and you will have fewer aches and pains. The time and effort you put into your bed time will pay off with improved health and quality of life.
Dr. Barry Wahner
- Not in bed – Do you sleep on one of the following?
High Fructose Corn Syrup: The Debate Over the Dangers
High Fructose Corn Syrup: The Debate Over the Dangers
Obesity rates for adults and children remain a growing concern. Obesity rates for adults are reported to have doubled in the past 30 years with the rate among children tripling over the same amount of time. These are staggering statistics. Research shows the actual manufacturing and production of some food items could be a primary factor for the rising rates of obesity in our society.
A Little History
High-fructose corn syrup (HFCS) was developed in 1957 by researchers who developed an enzyme that re-arranges the molecular composition of glucose and converts it into fructose. When the natural glucose in corn syrup is converted to fructose, the syrup becomes sweeter. “High-fructose” simply means the percentage of fructose is higher. HFCS is a more cost-effective alternative sweetener. In 1977 new tariffs and sugar quotas made the cost of importing sugar more burdensome. Manufacturers of new dietary staples began using HFCS and production grew from 3 million tons in 1980 to 8 million tons in 1995.
Redefining the “Sweetness Scale”
Refined or table sugar, sucrose, was always considered highest on the “sweetness scale” and thus measured 100. Regular, unaltered corn syrup is glucose, which measures 70-80 on the sweetness scale. HFCS measures 120-140 on this same scale. HFCS is less expensive to make and so over the past three decades it began to replace sugar in the manufacturing of many foods and drinks.
The Primary Issue (this is the most important paragraph!)
HFCS should be a concern if for no other reason than because it is made by genetically altering the basic chemical makeup of another product – corn syrup. This means it is not a natural food item and our bodies don’t react to it like a natural food item. Most carbohydrates containing sucrose, glucose and or unaltered fructose cause our pancreas to create insulin. This in turn allows these sugars to be broken down into energy and then triggers our brain that we are full. HFCS on the other hand, does not cause the pancreas to produce insulin. Additionally, while natural carbohydrates are digested normally, HFCS goes straight to the liver, where it is then treated like a chemical and turned to fat!
What Does It All Mean?
While there may not be a proven connection (yet) between either HFCS or table sugar and the growing rate of obesity, the fact is that since 1977, more food items contain sugar. As the use of sweeteners has increased, so have the rates of obesity. Some of the food items that contain HFCS include most sugary cereals, toaster pastries, soft drinks, juice pouches and boxes, jams and jellies, salad dressings, canned fruit, cookies and crackers. Some unexpected products that may contain HFCS include canned ravioli and pasta meals, canned soups, peanut butter, bread, breakfast/snack bars, vegetable drinks and energy drinks.
We still believe moderation is the best policy where our diets are concerned. While HFCS is not the poison some would have you believe, we still believe it is best to return to the basics. Eat healthy, natural foods such as fresh vegetables and fruits, lean meats and grains. Read your food labels carefully!
**Thank you to Claudia Anrig, DC, and her article in Dynamic Chiropractic from which most of the information in this piece was directly borrowed**
Can Chiropractic Help Reduce Hip Pain?
Can Chiropractic Help Reduce Hip Pain?
Hip pain is common among seniors, especially those who are vulnerable to hip fractures. As a person ages, the bones become brittle, balance is a problem and vision is weakened; these are all factors that lead to falls and broken hips. When this occurs, surgery may often be needed to replace damaged joint parts.
Unfortunately, it takes time to recover from a hip surgery. As soon as the patient is out of surgery, physical therapy must be started immediately to restore functioning and mobility. The physical therapist will work with the patient on how to do safe exercises to improve strength as well as outline precautions and expectations after the operation.
For those who are susceptible to osteoporosis (weak bones), preventative measures can be taken to prevent falls such as improved nutrition (calcium intake), fall-proofing homes and chiropractic care.
Chiropractic treatment can assist in relieving pain, balance training and the reeducation of the neuromuscular system. This hip fracture guide outlines treatments and tips for preventing hip injuries among the elderly.
Ouch! That hurt... Now what?
Recovery from Injuries
Ouch! That hurt…now what?
Recovering from Muscle, Tendon or Ligament InjuryBy Dr. Barry Wahner
We All Get Injuries
Living an active life means you will experience injuries along the way. There are steps to take to prevent injury but even the most diligent person can’t remove all the risks. So at some point you will thus be recovering from an injury. The question at that time is: “How can I get better faster?”
The Most Common Type of Injury
Most commonly the injury will be a “soft tissue” injury which is damage to a muscle, tendon or ligament. These types of injuries fall into 4 Grades:◦Grade I: Tearing or damage of less than 50% of the tissue fibers.◦Grade II: Tearing or damage of more than 50% of the tissue fibers.◦Grade III: Complete tear of the tissue fibers separating the tissue into two sections.◦Grade IV: Complete tear of the tissue at the attachment to bone pulling off a chip of bone.Grades three and four require professional care and possibly surgery, thus the best treatment advice is to get an appointment with your Doctor ASAP. In the interim, you can follow advice for Phase One of Recovery designed to control inflammation.
THE GOAL: RECOVERING FROM INJURIES!Recovery from soft tissue injuries follows 3 phases. Understanding the phases will help you to make the choices and do things to help you heal faster and better.
Phase One - The Inflammatory PhaseObviously inflammation is the primary component of this phase. Phase one lasts 48 – 72 hours (as long as further stress or trauma is not placed on the injured tissue as this could lengthen the inflammatory phase). In this phase the damaged tissues leak blood and cellular products into the area. This causes swelling, irritation and pain.To improve recovery, inflammation must be controlled. The standard methods work well here - Remember PRICE:◦Protect the tissue from further stress◦Rest the injured area◦Ice the area◦Compression◦ElevationMost of this is simple to do but a bit of advice will help:ICE•Ice cubes work great. Just put them in a big plastic bag placed directly over the injured tissue.•Use a thin material between the ice bag and skin (paper towel or a t-shirt) to prevent the ice from sticking to the skin. Very often people place a thick towel under the ice, but this prevents the tissue from getting cold enough and thus limits the benefit.•Ice for up to 20 minutes for “thicker tissues” like the thigh or back and as little as 5 minutes for “thin tissues” like the elbow or hand. When the tissue returns to normal temperature, apply the ice again.COMPRESSION•Wrap the area firmly but not so tightly that blood flow is restricted beyond the injured tissue.•Monitor the area over time because if inflammation increases, the pressure could increase and restrict blood flow. Obviously if you see this occurring, loosen up the compression.
Phase Two - The Repair PhaseAfter the initial inflammation ends, the repair phase begins and lasts for six or more weeks. During this time, the swelling and inflammatory products are removed from the injured area and the damaged tissue begins to be repaired. Pain will reduce and function will improve, but if you put too much stress on the injured area, you will see the pain return and lose function and mobility again.The key in this phase is to gradually increase activity of the injured area. Increase stretching, exercise and resistance activity slowly. Let the pain guide you. When you are working the area, if it is painful, you reached the limit. Do NOT push into pain (“No Pain – No Gain is NOT your friend here). Pain means you are past the tissue’s strength limits and are thus re-injuring the area. This obviously slows the healing process in this phase.As the tissue heals it will become stronger and allow you to move further, push harder and work more. As this phase progresses you will regain function. The key here is patience and persistence.
Phase Three: - The Remodeling PhaseThis is the longest phase of healing as it can continue for up to two years! During this phase your body transforms the scar tissue built up in the first two phases into more functional tissue. The initial scar tissue fibers are laid down in a random fashion; during this phase the body re-orients those fibers along the lines of stress and increases the strength of the fibers.The key in this phase is to return to full activity and function. Your best rehabilitation at this point is to perform your normal daily activities, or your sport. Let pain guide you, but as time progresses you can push more into the pain threshold without fear of re-injury. It is important to understand that full recovery does take a long time. Don’t be discouraged by soreness or stiffness even months after the injury.Nutritional ApproachesThere are nutritional approaches that assist in injury recovery. I recommend Omega-3, Magnesium, Zinc and Vitamin C as the basic supplemental support. More advanced support involves Co-Enzyme Q10, and a product blend that contains herbs such as Ginger, Turmeric, Rosemary and the nutrient Bromelain.Addressing the CauseFinally, if you suffer an injury, try to determine why it happened and address that cause if possible. If you have structural imbalances, muscle weakness, tightness or strength imbalances that caused the injury, you need to address that problem. If you don’t, there is nothing to stop you from simply re-injuring the tissue again. Take the time to learn from your mistakes.by Dr. Barry Wahner
Getting "Hip" to It
Can Chiropractic Help Reduce Hip Pain?
Getting “Hip” to It
Getting the finest care, with a chiropractor who truly partners with you, can change the quality of your life. This article can guide non-athletes as well as ambitious cyclists and other athletes. So read on!
“I have no power in my leg!” “My hips ache.” “My back hurts.” “I think I pulled my groin.” “My pelvis is out.” “It just hurt,s Doctor!”
Of the different complaints heard from cyclists, the hip area is one of the most commonly involved. Cyclists (as well as all athletes) require strength and stability from the hip and pelvis. Without it they can’t transfer the power from the core muscles into the legs.
If you have problems in your hips or pelvis there is much to consider. Too often athletes are given a simplistic diagnosis without thorough consideration of all that could be involved. The diagnoses often given are: Bursitis, a pulled muscle or a pinched nerve. Oddly enough the treatment always seems the same: Anti –inflammatory medication and rest. The result of this type of “care” is predictable: Temporary reduction in symptoms and then symptom flare-up with return to sport.
Problems in the hip are often multi factorial. This essentially means there are several issues involved and all must be discovered and addressed for the best results. A proper evaluation must include:
- A history of the problem, a history of their training
- Description of any recent changes in equipment
- Description of the symptoms including where these symptoms are felt. It is best to have the athlete point or touch the areas involved as it is amazing where people think their hips are!
- Physical evaluation including posture, gait, mobility, palpation, strength testing and flexibility testing
Without this thorough evaluation you can’t properly treat the problem. We must also identify things that make your symptoms keep coming back, such as:
- Faulty mechanics in the pelvis, hip, spine or lower extremity such as tight muscles, restricted movements, weak muscles
- Structural imbalance in the feet such as foot pronation, hypomobile ankles, tight calves
- Compensation in movement patterns due to other injuries or problems
- Equipment issues such as improper bike fit or improper shoes
It may sound like a daunting task to get an evaluation that thorough, but the greatest challenge is really in finding a doctor or therapist who understands the mechanics of the hip and pelvis AND the demands of your sport. When you properly diagnose and evaluate a hip problem, you can then fully treat the condition.
With “cookie cutter” treatment you are destined to have chronic, recurrent hip problems that hurt your performance -- or prevent you from participating in your sport! As an athlete you don’t have time to waste when you are injured You need to get back to training and competing. To do that you must work with a professional who understands your sport and your athletic mindset.
Some common issues in cyclists that lead to pain and problems in the hip and pelvis are:
- Sacroiliac joint dysfunction
- Short/tight hamstrings and hip flexor muscles
- Weak gluteal muscles
- Weak lumbar extensor muscles
- Pronated foot
- Short/tight calf muscles
- Pelvic or spinal joint dysfunction.
The common denominator for these issues is they lead to imbalance in strength and movement in the pelvic and hip joints. This causes compensation patterns which lead to pain, inflammation and overuse injury. When the doctor looks only at the area of pain and does not fully evaluate the entire “kinetic chain” from the foot up to the spine these other factors are not accounted for and thus not treated. Treating only the painful area may provide temporary symptom relief with the symptoms returning or never fully resolving. The longer this goes on the more the athlete develops compensatory patterns of movement leading to deeper problems.
An elite level cyclist presents for treatment of right hip pain. He has no history of recent crashes or other trauma and no history of fracture or surgery to the pelvis, hips or legs. The pain began a couple weeks ago after a weekend of cyclocross racing. Thus far he has raced 8 times this cyclocross season.
Prior to this he raced a full season on the road without significant hip problems. When asked to point to the pain he touches a point on the upper right buttock. He feels the pain especially when remounting the bike but also when rising up from sitting or when climbing steps. He feels like he can pedal hard, but there is pain during these hard efforts.
Evaluation showed his pelvis to be low on the right side and rotated posterior. He had full right hip range of motion in all planes but there was pain in hip extension and hip external rotation. Low back range of motion was limited modestly in extension and there was pain in low back extension, rotation and flexion. Tenderness and tightness was noted in the right low back and the right hip flexor. Tenderness was noted in the right sacroiliac joint. Both hamstrings were short and tight. The hip flexors were tight and tender especially the right side. The gluteal muscles bilaterally and the right hip flexors muscles were weak. His gait was normal. Sit to stand was normal but reported as painful. Squat test caused both feet to collapse into pronation (with the right side more significant) and his lumbar spine went into flexion (he could not maintain a straight back). Intersegmental joint motion revealed restrictions in the sacroiliac joint on the right, the right lower two vertebrae and the lower thoracic vertebrae.
Diagnosis: Acute right sacroiliac joint pain and dysfunction
- Joint manipulation of the lumbo-pelvic area on the right to restore motion and posture of the pelvis
- Ice to the right lumbo-pelvic area to reduce inflammation and pain
- This treatment helps the acute pain and inflammation but does NOT address the underlying issues that generated the problems to begin with. If that was the only care provided, symptom relief is expected but pain will likely return upon the next race or hard training session
Underlying problems leading to the acute sacroiliac pain were:
- Tight and short hamstrings and hip flexors
- Weak gluteal muscles and low back extensor muscles
- Pronated feet
Therapy to address each of these problems brought balance to his hips and pelvis. He followed my therapy recommendations:
- Specific stretches multiple times a day to lengthen the hamstrings and hip flexors
- Exercises to facilitate and strengthen the gluteal and low back muscles
- Custom molded foot beds were made and he was instructed to use them in all shoes, including cycling shoes
By performing these exercises he gained the benefits that were top priority for him:
- Restored strength and balance
- He completed a full season of cross racing without any further pain or stiffness!
In your athletic life, and other daily life, you deserve the same kind of evaluation and care for your injuries and pains. Your health and happiness are important!
Work with a professional who understands you and the demands on your body of any sports you love. You'll want a complete evaluation to find not just the acute problem but also the underlying factors which led to the problem.
By taking this more thorough approach to your evaluation and your treatment, you will have better results and less chance of chronic issues that slow you down. Getting the finest care, with a chiropractor who truly partners with you, can change the quality of your life.
by Dr. Barry Wahner
Snow Shovel Safety
Shovel Snow Safely
Snow Shoveling is a challenging and repetitive activity that can strain muscles in the lower back and the shoulders. Injuries and pain due to snow shoveling are more likely to happen to people who may not realize that they are out of condition. Following these tips can help you avoid injury:
- Wear several layers of warm comfortable clothing that allows you to move freely. Wear water resistant boots with good traction. Slipping and sliding puts you at risk of a painful fall.
- Take a few minutes to stretch. Shoveling is a strenuous workout so you need to stretch to warm up your muscles. Stretching before and after shoveling helps prevent fatigue, pain and injury.
- Choose the proper shovel. Choose a light weight shovel with a long enough handle that you don’t stoop to shovel. A smaller blade is better than a larger blade as it avoids the risk of trying to pick up too heavy a pile of snow.
- Push the snow; do not lift it. Pushing puts significantly less strain on the spine than lifting. Use proper technique when pushing or lifting:
- Keep feet hip width apart for balance.
- Hold shovel close to body with hands spaced apart for better leverage.
- Bend from the knees keeping your spine straight.
- If you must throw snow, take only as much snow as you can easily lift. Turn your feet in the direction you are throwing – DO NOT twist your back or throw snow over the shoulder as this puts significant strain on your back.
- Take frequent breaks when shoveling. Stand up straight, gently arch your spine, pull your shoulders back and take a couple deep breaths. Take note of how you are feeling in general. If you have difficulty straightening up or are developing pain it is good advice to stop before you create a bigger problem.
- Pay attention to your surroundings particularly when digging your car out on the street. Pay attention to the traffic as the drivers may be distracted and won’t likely have good traction on snow and ice.
- Be a good neighbor. If others on your block are not healthy enough to remove snow, give them a hand. A few minutes of your time can make a world of difference for them.
- Recognize the danger signs. Stop shoveling and call 911 if you feel discomfort or heaviness in the chest, arms or neck; unusual or prolonged shortness of breath; a dizzy or faint feeling; excessive sweating or nausea/vomiting.
Follow these tips to reduce your aches and pain and avoid being injured while snow shoveling. If you do experience pain or loss of mobility in your back or shoulders, call our office (215-842-2227) right away. We will help you feel better and get moving again.