Category Archives: Pain relief

Chiropractic care for hikers with heel pain

We’re continuing our theme this month on hiking injuries. In the last video I talked about what can cause knee pain in hikers and how we treat it. Today I’m going to talk about another common hiking injury – heel pain. Heel pain is a very common complaint in both hikers and runners. A very common diagnosis for heel pain in hikers is Plantar Fasciitis, or inflammation of the connective tissue that supports the arch of your foot.

The plantar fascia attaches to the inside part of your heel, and that’s why this can be one cause of your heel pain. The problem is that not all heel pain is caused by plantar fasciitis. If you’re a hiker with heel pain, you may have tried or at least read online about several different methods of self treatment for heel pain – lacrosse balls, golf balls, heat, ice, kinesiotape, orthotic inserts, or special braces that stretch your foot while you sleep. If plantar fasciitis is not the cause of your heel pain, then perhaps none of those things will work. That is why it’s so important to see your healthcare provider for a proper examination and diagnosis, and your exam needs to include what we call the kinetic chain, or all the joints and tissues upstream from your foot. Your heel pain can be caused by anything from Achilles tendinitis, nerve entrapment at the ankle, peripheral neuropathy, stress fracture, or even a disc injury in your lower back.

Once we’ve gone through a thorough evaluation of a patient with heel pain, there are typically 3 areas we tend to focus on: The lower back, the ankle, and the foot.

If the lower back seems to be contributing to your heel pain, we have several different approaches to help with that. In the office, I can perform chiropractic adjustments as well as use a special table to apply traction to decompress your lower back and relieve pressure on irritated joints and nerve roots that can refer pain to your foot. I will also get you doing some stretches to relieve irritation on the same areas.

In the ankle and lower leg we typically see stiff joints, tight muscles and nerve irritation that contribute to heel pain and a potential diagnosis of plantar fasciitis. For that, we can do some adjusting and mobilization at the ankle, some neuromobilizations to help free up the nerves crossing through there, and deep tissue massage and stretching to loosen up tight muscles.

At the foot, we can also employ chiropractic adjustments, deep tissue massage to the plantar fascia, taping, orthotics, and strengthening exercises to improve the stability of the intrinsic muscles in your foot and reduce strain on the plantar fascia.

In the video above, I demonstrate a couple of mobility drills for the ankle and a strengthening exercise that, in addition to what we offer here at the clinic, can help you beat your heel pain and get back out on the trail.

Treatment for knee pain when hiking downhill


 

 

Hi this is Dr. Kip Thompson with Catalyst Chiropractic and Rehabilitation, your chiropractor in Beaverton, OR. We have a lot of hikers here in Portland. One of the most common complaints I hear from our hiker patients is knee pain when hiking downhill. The reason for that is when you are walking downhill you have 3-4 times more force on your legs than when walking on an even surface. We take 2 approaches to combat knee pain when hiking downhill: First, reduce the amount of load going through the joint. Second, make yourself more resilient by increasing your capacity to bear the loads placed on the legs when hiking downhill (strengthen your legs). 

There are three ways to reduce load while walking downhill. The first way is to just slow down. As you can imagine, the faster you are traveling, the more impact you will have on your legs and knees as you are stepping downhill. The second way to reduce knee pain while hiking downhill is to bend your hips and knees more. The straighter your legs are and the more upright you are, the greater the impact on your joints, particularly the knees. Putting a slight bend in the hips and knees as you are walking downhill helps your muscles absorb more of the shock, taking stress off the knee joint. Lastly, you can use a hiking stick or trekking poles. These tools have been shown to reduce impact on your lower extremities by up to 25% while hiking, and that is why they’re important, especially for hikers with knee pain while going downhill.

Here are some examples of things we’ve done with some of our patients suffering from knee pain to help them become more strong and stable in the knees. Again, these are just examples of exercise techniques. To find out what is right for your situation, we would need to perform a thorough examination and come up with an individualized treatment and recovery plan. On your first visit at Catalyst Chiropractic and Rehabilitation, one of the first things I look at is your ability to stand on one leg while keeping your hips level and not losing balance. It’s surprising how often we find someone who can’t stand on one foot for longer than 10 seconds, yet never even realized they have a balance problem. If you are not able to adequately stabilize your hips while standing on one foot, this can translate into abnormal stress on your knees and result in knee pain. What I could have you do is practice one leg stands. Stand on one foot for as long as you can without losing balance or letting your pelvis tilt to one side. The goal is to be able to do that for 60 seconds. If you can’t do it, you could work up to it by performing 3 reps on each side for as long as you can before losing control. Then repeat that daily to gradually improve stability and balance.

The second exercise I’d like to demo is called quad sets. This exercise is commonly used early in knee rehabilitation to strengthen the quadriceps muscles and add stability to the knee. Lie flat on your back and rest a pillow or rolled up towel under your knee. Then contract your quads, which will straighten your knee and push downward into the pillow. Hold this for 10 seconds at a time, performing multiple repetitions of 10 seconds each.

Ultimately you will need to progress to more functional movements that mimic what you will actually encounter on the trail. A more progressive way to strengthen your quads is to start doing some squats. We mimic the downhill motion by elevating the heels by placing an object underneath your heels. From there, slowly lower into a squat position, then quickly return to standing posture. I like to use the cadence of 2 counts going down and 1 count coming up to emphasize that lowering motion that happens with every step while hiking downhill.

One last, more difficult progression is a 1 leg decline squat. This is set up the same was as the two leg decline squat that I just demoed, but it is performed with only one leg in the lowering phase of the exercise. Then use both legs to come back to starting position. The lowering portion of this exercise is called an eccentric muscle contraction of the quadriceps. Eccentric strengthening exercises are great for rehabbing tendon injuries, which is much of the time part of the cause with knee pain in hikers.

For any questions or to set an appointment to see me, call 503-526-8782 or visit our website at catalystchiroandrehab.com

Chiropractic care for herniated discs

Herniated disc treatment Beaverton Oregon

Chiropractic Care for Herniated Discs

A guest post by Dr. David Bennett, DC

A herniated disc can cause pain and can progress into other issues, such as sciatica. Seeking treatment for a herniated disc as soon as possible can help to minimize the pain experienced and prevent the condition from worsening. Many patients that suffer from herniated discs wish to find treatment options besides surgery. In some cases, chiropractic care may be an effective alternative.

What Is a Herniated disc?

To understand how treatment for herniated discs works, it is important to first understand what a herniated disc is. The discs between the vertebrae are composed of a harder outer layer called the annulus fibrosus and a gelatinous center called the nucleus pulposus. A herniation occurs when the annulus fibrosus is cracked and the nucleus pulposus begins to spill out. The disc is no longer able to properly cushion the vertebrae, which causes pain and can cause misalignments to develop.

Diagnosing a Herniated Disc

Not all back pain is caused by a herniated disc, so a chiropractor will start by evaluating the entire spine. A chiropractor will test the reflexes, look for signs of muscle weakening or deterioration, and test sensory functions along the spine. Depending upon the symptoms, a chiropractor may also order scan tests such as MRIs or X-rays. If a herniated disc is identified, the placement and severity of the herniation will be assessed to determine the best treatment options.

Determining the Proper Care

Chiropractic care is not always the most practical or effective way to treat a herniated disc. If a disc injury is causing issues with reflexes, mobility, or sensory functions, it may be necessary to undergo surgery. If a disc injury is associated with incontinence, a different treatment approach may also be necessary. Aside from these issues, however, herniated discs can generally be treated using chiropractic techniques.

Chiropractic Treatment Options

Spinal manipulation is the type of treatment that is most commonly associated with chiropractic care. Spinal manipulation can sometimes be helpful for treating herniated discs, as it can help to ease pain symptoms and can temporarily alleviate some of the pressure on the vertebrae. If pain sensations associated with the herniated disc are extreme, a chiropractor may recommend that spinal manipulation be performed while you are under anesthesia.

Flexion-Distraction Treatment

A flexion-distraction table can be used to stretch and cushion the spine so that the herniated disc or discs can be addressed directly. A gentle motion is used to push on the affected disc. This motion can help to reposition the leaked nucleus pulposus within the vertebrae. This may temporarily correct misalignments and alleviate pain.

If you suspect that you have a herniated disc, contact your local chiropractor to schedule an evaluation and begin treatment as soon as possible.

Author, Dr. David Bennett, DC, is a practicing chiropractor in Altamonte Springs, FL, and the owner of Physical Health and Rehabilitation clinic.

Our new table is here!

Chiropractic table | Low back pain treatment in BeavertonIntroducing our new Flexion-Distraction table from Hilllabs.com! Our chiropractor, Dr. Thompson, will be using this table for all of the usual treatments and adjustments he does in his routine chiropractic visits, but he will now have the ability to provide flexion-distraction therapy to patients with certain conditions.

Flexion-distraction is a method of adjusting the spine by gently stretching the lower back or neck as the table flexes. This movement creates space between specific vertebrae in the back or neck, which can reduce pressure on any pinched nerves, decrease the size of disc herniations, lessen the effects of stenosis (a narrowing of the space around the spinal cord and/or nerve roots), and forces vital nutrients into injured disc tissue to facilitate healing.

Conditions that can benefit from flexion-distraction treatment can range from neck and radiating arm pain to sciatica, stenosis, herniated discs, failed back surgery, and even the everyday mechanical back and neck pain that almost everybody has had at some point in their life.

Many people consider chiropractors to just be “back crackers.” Flexion-distraction therapy is just one of the many tools in our tool belt in addition to traditional manual adjustments (the twisting and “popping” that most people think of). A typical treatment plan at Catalyst will include education about your condition and what to do/what not to do to aid in recovery; adjustments to joints that aren’t moving well or are misaligned; soft tissue massage to relax tight muscles; and therapeutic exercises and stretches to stabilize affected area and make you more resilient to re-injury. Research is showing us that this type of multi-modal approach achieves superior results when compared to treatment involving just adjustments. Take spinal stenosis, for example. This is a condition that is commonly treated in chiropractic offices. In one study posted previously on the blog, stenosis symptoms responded better to flexion distraction therapy combined with an exercise program compared to flexion distraction alone. In another study, flexion distraction combined with typical therapeutic modalities (heat, e-stim, ultrasound), achieved larger reductions in pain and disability than the therapies alone. Studies like these are important because they show that there is not one silver bullet that works better than all other treatments, but it is usually a combination of treatments that achieves the greatest effect.

At Catalyst Chiropractic and Rehabilitation, your treatment is guided by the best available evidence combined with our chiropractor’s clinical experience in order to deliver you the most effective solution for your individual condition. Contact us today to get started on your comprehensive path to recovery.

How to prevent back pain

Personal Injury Back Pain (2)

Around 80% of people will have a significant back pain episode at some point in their life. Once you have an episode of back pain, it is likely to recur, oftentimes within 1 year of first onset. What a horrible thing! It’s no wonder that billions of dollars are spent on back pain treatment every year, and that professions such as chiropractors have a good outlook for job growth in the near future – everybody is getting back pain and not getting rid of it very effectively. So, what about those billions of dollars? Are they being well spent? Are they curing the pain with the expensive drugs, surgeries, and devices they are paying for? In general, no. The rising costs of back pain treatment have not been directly associated with lower occurrences of back pain. On the contrary, the problem just keeps getting worse. Thus the need for studies such as this one, which investigates the usefulness of several methods of back pain prevention. It compared exercise, education, back belts, and shoe insoles and found that the only decent evidence of ability to reduce risk of low back pain episodes came from exercise combined with education. By education, I mean in-office education from the healthcare provider about what causes low back pain and strategies to avoid re-injuring the spine.

Knowledge is power. When you come to our office, our goal is not to just deliver expert, personalized treatment, but to give you tools through proper education to avoid what harms your back and help it to heal properly. I will not just put you on a table, adjust you, and send you on your way, because if I don’t tell you how to take care of your spine you will be right back in my office for the same reason wondering why treatment isn’t helping. I will help empower you to make better choices and start better habits to help you stay out of my office and stay feeling well. You’ll also notice that I don’t push a lot of products on my patients, or prescribe back belts and insoles very often. That is because they have limited utility in preventing back pain. We only use them when absolutely necessary. If you continue to injure your back time and time again and are looking for more answers, contact us to set up an appointment.

 

Photo credit: www.sandiegopersonalinjuryattorney.net 

Choosing the right mattress for lower back pain

Proper mattress selection for lower back pain

Which mattress is best for your back?

Sleeping on the wrong mattress can cause or worsen lower back pain. Lack of support from a mattress reinforces poor sleeping posture, strains muscles and does not help keep the spine in alignment, all of which contribute to low back pain.
Sleep comfort is also sacrificed if a mattress does not match one’s individual preferences. A mattress that provides both comfort and back support helps reduce low back pain, allowing the structures in the spine to really rest and rejuvenate during the night.
Choosing the right mattress can be difficult. The following practical guidelines are designed to help patients with low back pain choose the best mattress for both back support and sleep comfort:

  1.  Personal preference should ultimately determine what mattress is best. There is no single mattress style or type that works for all people with low back pain. Any mattress that helps someone sleep without pain and stiffness is the best mattress for that individual. Patients with low back pain should choose the mattress that meets their standards for comfort and support and allows them to get a good nightís sleep.
  2. Understand and inquire about the physical components of the mattress. The coils or inner springs of a mattress provide the support. Different mattresses vary in their number and arrangement of coils. Padding on top of the mattress comes in many different thicknesses. Mattress depths typically range anywhere from 7 to 18 inches deep. Choosing the number of coils, type of padding and mattress depth should be determined by individual preferences.
  3. Find a mattress with back support. A good mattress should provide support for the natural curves and alignment of the spine. The right amount of back support also helps the patient avoid muscle soreness in the morning. While there is not much clinical data about mattresses, one study found that medium-firm mattresses usually provide more back pain relief than firm mattresses.
  4. Achieve a balance between back support and comfort. Overall comfort while sleeping on the mattress is equally important as sufficient back support. Sleeping on a mattress that is too firm can cause aches and pains on pressure points. A medium-firm mattress may be more comfortable because it allows the shoulder and hips to sink in slightly. Patients who want a firmer mattress for back support can get one with thicker padding for greater comfort.
  5.  Know when it’s time to get a new mattress. If an old mattress sags visibly in the middle or is no longer comfortable, it is probably time to purchase a new one. Putting boards under a sagging mattress to keep it from sagging in the middle is only a short-term fix for the sagging; a new mattress is still needed.

Some Considerations

  • Shop for the best value and quality of the mattress, not price. Mattresses with more coils and thicker padding tend to be higher quality and also more expensive; however, a higher price does not guarantee that the mattress is more comfortable or more supportive. Mattress stores often have sales and promotions, so it is a good idea to comparison-shop for the best price after finding the right mattress.
  • Be aware of mattress advertising gimmicks. Claims that a mattress is orthopedic or medically-approved should be viewed skeptically. There has not been extensive medical research or controlled clinical trials on the topic of mattresses and low back pain. The individual must determine whether or not extra features on a mattress make it more comfortable or supportive.
  • Give the mattress a test-run before buying. To sample mattresses, people can try sleeping on different makes and models in hotels or at other peopleís homes before going to a mattress store. When shopping at the store, shoppers should lie on the mattress for several minutes to decide if it is a good fit. If two people will be sleeping on the mattress, both should test it at the same time to make sure they have enough space and are both comfortable on the same style of mattress.
  • Purchase mattresses from stores and companies that are trustworthy. Consider the customer service offered by the mattress store, such as delivery options, warranty, and removal of old mattresses and the store’s return policy. Look for mattress stores where customers can return a mattress if they are not satisfied with the quality or comfort after sleeping on it for a significant amount of time (i.e. a couple of weeks to a month).
  • To help preserve the quality of a new mattress, it should be repositioned every six months to ensure that the mattress is evenly worn. This includes rotating 180 degrees and flipping the mattress lengthwise on a regular basis. The Better Sleep Council advises against putting a mattress on a box spring/foundation that is not made to go with the mattress, as this may decrease the life of the new mattress.

Introducing our Back to Basics series

 

This is the first in a series of videos that we will be posting to introduce you to some simple spine-sparing strategies. These are designed to be used by those who are recovering from back pain, neck pain, headaches, or other ailments. In reality, though, these are basic skills to be used to form a foundation for a healthy spine and pain-free living.

The first step in the recovery process and one of my first goals when I first meet with a patient is to identify what is causing the pain. Sometimes it is a traumatic injury, other times it is due to repetitive stress, but no matter what the cause, your body needs the best chance it can get to heal correctly. In order to facilitate that, you need to learn which movements and positions to avoid  and which ones to adopt to take stress off of injured joints and tissues. I like using this explanation: Pretend your back injury has a scab, and try to avoid “picking” at that scab so that it can heal as quickly as possible. To avoid picking the scab, it is important to be able to learn how to maintain a “neutral” spinal alignment as you perform certain movements during your daily activities. As you well know if you have thrown your back out, even the simplest of movements can be extremely challenging .

The first basic movement covered in this video is getting into and out of a chair. This is perhaps the most common complaint I get from people with low back pain – that it hurts when getting up out of a chair. To make this movement less threatening, it is important to “preserve the curve.” In other words, don’t lose track of that little backwards curve in the small of your back. If you let it flatten out or flex it forward, that’s when you get into trouble. As the video shows, scoot forward to the edge of your seat, and stand straight up when getting out of the chair, and reverse the process when sitting down.

Stay tuned for more basic spine care tips from Dr. Kip Thompson at Catalyst Chiropractic and Rehabilitation. If you are reading this because you are in pain, don’t hesitate to contact us to schedule your first assessment with Dr. Thompson.

Research update – Chiropractic care for spinal stenosis

Stenosis research summary

Stenosis is a word that a lot of people have heard of and might even relate it to some sort of spinal condition, but it is not often well understood. In short, the word stenosis means “narrowing.” In the lumbar spine, it implies the narrowing of a canal where either the spinal cord itself runs or where the spinal nerve exits the spine to travel down into the leg. The canals that these neural structures run through can become narrowed either by overgrowth of the bone that makes up the canal or by a nearby bulging disc. It is not the stenosis itself that causes symptoms, but the pressure that the narrowed canal puts on the nerves. That pressure can cause pain, numbness, tingling, or weakness in the back and legs, or disturbed bowel or bladder function. Symptoms often worsen with prolonged standing or walking and may improve when sitting or bending forward. It occurs most often in people over the age of 50 and can have a significant impact on the quality of life.

In my practice stenosis is a particularly concerning finding, because it often discourages people from being active since they can’t walk or be on their feet for any significant length of time. It engenders inactivity, which further perpetuates poor health and physical fitness, which in turn lead to more back problems. The beauty of this study is that it gives hope to those who suffer from lumbar spinal stenosis. What I like about it is that it advocates a multimodal approach, attacking the problem from multiple directions to produce a long term, effective solution. It is similar to the way we approach each of our patients’ concerns – through education , simple, progressive home care stretches and exercises, and effective chiropractic adjustments and manual therapies. We believe that the best results are achieved when both the healthcare provider and the patient take appropriate action to treat pain and prevent further injury and disability and this study is a fantastic example of this approach.

A solution for chronic neck pain

Research brief June 2014

Many of our patients come in with pain that they have dealt with for years. Some have had treatment by other healthcare providers, even other chiropractors, that has not resolved their pain and have just gotten used to living with it. Others have written it off as a sign of aging and have just gotten used to it. At some point they throw in the towel or a friend/family member twists their arm enough and they decide to come in to our office for chiropractic care. After years of living with their neck pain or other ailment, they begin to feel better and will commonly tell us “I don’t know why I waited so long to get help for this.”

Ideally, people wouldn’t wait so long to get help. They would call their chiropractor at the first sign of pain. Or better yet, they would routinely visit their chiropractor to maintain optimal function of their spine and prevent back and neck pain. Unfortunately this isn’t always the case, and it is unfortunate because chronic pain can often take longer to resolve than an acute episode of pain. In other words, the longer you have been suffering the more difficult it can be to heal.

Chiropractic research has come a long way in the recent past. It is becoming more mainstream as it gains more and more evidence to support its efficacy and as more people open their minds to other options besides traditional medical care for their spine. This article is valuable because it shows good evidence that chiropractic adjustments can cause significant improvement in chronic neck pain. Much of the research that supports chiropractic care shows that it is effective for acute pain, or pain that began within the past month or so. Evidence for the value of chiropractic care for chronic, or long term pain, has been lacking. In my experience and that of thousands of other chiropractors, though, it seems as though the evidence has not quite caught up to reality. As a case in point, we recently saw a patient in their 20’s who complained of pain from the neck to the low back occurring daily for the last 6-7 years. After three weeks of care this patient reported 85% improvement and was no longer feeling pain on a daily basis. This is not representative of every patient we see, but it does show that chiropractic care may be a great option for you if you are in chronic pain.

 

Why chiropractic adjustments work

Research brief May 2014

 

This is a summary of an article that explored some of the proposed reasons why spinal manipulation (aka chiropractic adjustments) actually work. There are many theories out there, but the research backing those theories is somewhat limited. In quick and dirty terms, here is what they found:

1. Adjustments decrease spinal “stiffness.” Duh. They actually used a machine that pressed on the subjects’ backs and measured how stiff they were before and after and found, of course, that they were less stiff after their adjustments than before.

2. Adjustments activate the deep stabilizing muscles around the spine. These muscles tend to turn off and will actually start to degenerate in the presence of back pain. The quick movement of the vertebrae that occurs in an adjustment causes these muscles to wake up and start doing their job better.

These are not the only two benefits or mechanisms whereby chiropractic manipulation helps people feel better, but they are the two most significant findings in this study. The bottom line for you is this: If you frequently wake up in the morning feeling stiff in your back or if you have suffered acute episodes of low back pain after seemingly harmless tasks such as putting on your socks, then chiropractic adjustments will help you by loosening up the joints in your back and turning on the muscles that stabilize those joints to prevent future episodes of back pain.