Category Archives: Rehabilitation

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

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 

Is there a movement professional in the house?!

Caution sign | Consult your chiropractor

We’ve all seen the disclaimer on the exercise videos or the newest home gym that more or less reads: “Consult your healthcare provider before beginning this or any other kind of workout…” It’s your run-of-the-mill liability disclaimer and is usually suggesting that there is risk involved in physical activity and you should be checked for any medical indication that you shouldn’t be participating in this activity. Does anyone really ever consult their doctor before beginning a workout plan? Ok, I’m sure some do. If you did, you would surely be checked for any cardiovascular complications that could limit your activity and the doctor might perform a brief physical exam to check for range of motion and any pain in the extremities. Barring anything too serious, you’d be given a clean bill of health to begin your high intensity home exercise videos, your Bun-master, a Zumba class, etc.
Let’s say you get your clean bill of health, begin your workout, and somewhere along the way develop back pain, or shoulder pain. Did your doctor’s exam give you any indication that this might happen? Probably not, and here’s why. Your general medicine doc or internist are experts at the physical exam – as taught at medical school. You can trust them to pick up on potential cardiovascular issues, but if you are going from sedentary to exercising at a moderate intensity, you will be moving your body in ways it hasn’t moved in a long time. Your body doesn’t move like it used to, and as a result of a sedentary lifestyle, previous injuries, deconditioning, excess weight, poor posture, etc, your body has learned to compensate in order to get through your daily routine. When you go to the gym or do your home workout with your limited range of motion, poor movement patterns and compensations, your body will do what it takes to get the job done, but it might be at the cost of safety of the muscles and joints that are asked to do the job.
Here’s an example of what I’m trying to explain. Let’s say you go to a group exercise class and the instructor has you put a bar on your back and start squatting. The squat is a very good exercise and an important movement to master. It is something toddlers are great at, yet as we get older and more sedentary we lose the ability to squat safely and efficiently. If your glutes aren’t firing well, your knees will cave in. If your hips are stiff, or hamstrings tight, your low back will bend when your hips hit their limit. If your ankles are stiff, your heels will come off the floor or you’ll turn your feet out. These are all compensations, and possible ways to develop knee pain or low back pain while squatting. The devil is in the details, and these are details that might not be caught by your general practitioner.
 For that reason I believe that the medical disclaimers that come with workout equipment and exercise routines should encourage you to consult with a movement specialist as well. What is a movement specialist, you ask? A number of people can serve as a movement specialist to identify your inefficiencies and injury potential: Chiropractors (of course!), physical therapists, and personal trainers. These are all professionals who have been trained to spot poor movement patterns and prescribe exercises and stretches to improve how you move and help prevent injury as you begin your exercise plan. If you have questions about what kind of exercises you should or should not be doing and want to learn more about how to move better and safer, contact us at (503) 526-8782. Dr. Thompson has undergone post-graduate training in movement assessment and corrective exercise prescription and would be glad to help you on your way to a healthier you!

More evidence for positive outcomes for chiropractic treatment of lumbar disc herniations

Lumbar disc herniation and chiropractic adjustments

This study adds to the preponderance of evidence that chiropractic care is both a.) viable and effective as an initial option for conservative treatment of lumbar disc herniations, and b.) safe. Now, I’m not selling chiropractic as a magic bullet, one hit wonder, walk in the park, sure-fire quick fix for disc herniations. I try to give my patients realistic expectations and goals. The discs between your vertebrae do not heal quickly. They, like other ligamentous tissue, do not have a great blood supply, therefore they heal predictably slower than other tissues of the body. Thus recovery is inherently not as quick as most people would like. It is not realistic to expect a few adjustments to reduce a bulging disc or put a bone back into place and for all to be well again. Recovery is a process that involves multiple aspects, such as:

1. Education: Spine-sparing strategies are taught in order to avoid movements and positions that create more strain on the injured disc(s). This aspect of treatment is extremely important. When you have a herniated disc and a pinched nerve, there are some stretches that feel good in the short term, but in the long term are inhibiting the healing process. The first step is to educate to remove any barriers to a successful outcome.

2. Passive care: Passive care includes any external interventions, or those that don’t involve any effort on your part. This includes chiropractic adjustments (only one tool in our bag), joint mobilizations, traction, electrotherapy, low level laser, and kinesiotaping. Passive therapies are effective (as shown in the study above), but have their limitations and are not always as powerful as #1 and/or #3.

3. Active care: This includes anything that requires effort on your part, which is basically any of the stretches and exercises that you will be taught to perform in the office and at home to complement the passive portion of your treatment. This can make or break your recovery from lumbar disc herniation. No matter what condition we see in the office, the patients who see the best results and are happiest with the outcome of their treatment are those who are the most involved in their care and the most consistent with active care.

4 signs your glutes aren’t working for you and why it matters

Gluteus maximus

4 signs your glutes aren’t working for you and why it matters:

It never ceases to amaze me when I come across a patient who cannot consciously contract their gluteus maximus. You may laugh, but try it yourself before you make fun. It might be harder than you think. Here are a few more clues that your gluteal muscles aren’t working like they should and what that can mean for you. 

1. You have frequent hamstring cramps or strains: When asked, most people will cite dehydration or electrolyte imbalance as the cause for muscle cramps. Research on muscle cramps and hydration is very conflicted, though. One leading theory that has come to light is tissue overload. In the case of the hamstrings, they can be overloaded when trying to make up for lack of gluteal strength. They may fatigue more quickly when trying to play the dual role of hamstrings and glutes. This can lead to cramping and, even worse, muscle strains.

2. You sit for the majority of the day: Let’s face it; most of us use our rear ends for sitting more than for moving. When you are seated you place your glutes in a lengthened position and then sit on them for hours on end. The result is a lengthened, weak muscle that has forgotten how to be the workhorse it was designed to be.

3. You have pain and/or limited range when bending backward: This pain can be due to irritated joints in your back – a common result when your low back muscles have to make up for an underperforming gluteus maximus. G-max’s job is to extend your hip. When it doesn’t do that effectively, you must use muscles in your low back to extend your back to make up for lack of hip extension. The result? A grumpy lumbar spine.

4. You bend with your back when picking things off the ground: Watch a toddler pick toys up off the ground and you’ll see the way we were designed to bend. They throw their butt back, bend the knees and hips, and keep their spine relatively neutral. Fast forward 30 years and for some reason now we are bending over with straight legs and a hunched-over spine. Somewhere along the way we forgot how to bend properly. The most likely reason is because we’ve lost our butts from sitting on them so much, and without a butt it’s really difficult to bend properly.

Gluteus maximus is the largest muscle in your body. If all you are using it for is to sit on, then there is a very large void for other muscles to fill in addition to their own individual functions. For that reason I am always testing glute strength and activation in my patients. If their glutes are inhibited, we get a lot of bang for our treatment buck by focusing on gluteal activation exercises. Once they are back online and performing their dominant role, low back pain and lower extremity injuries can be much easier to treat and prevent.

Nutrition for the injured athlete


As an athlete sidelined with an injury, your goal is to heal as quickly as possible to return to play. Rest, anti-inflammatories, chiropractic care, soft tissue work, and physical rehab are all effective methods to heal the tissues and return them to optimal function in a speedy fashion. On a cellular level, though, what the tissues need to heal are the proper nutrients to rebuild what has been damaged. For your rehab to be effective, your body needs to be supplied with the proper building blocks through your diet and supplementation. Here is a list of nutrients that aid healing and some of the foods that will give you those nutrients*:

Protein (THE building block of life): Lean meat and poultry, fish, nuts, legumes.

Omega 3 fatty acids (reduce inflammation): Oily fish like salmon, mackerel, and sardines. Walnuts, flax seeds.

Vitamin C (antioxidant, aids in tissue repair): Oranges, lemons, limes, strawberries, watermelon.

Vitamin A (promotes cell growth): Carrots, sweet potatoes, bell peppers.

Zinc (helps with wound healing and immune response): Beef, fish, almonds, seeds.

Calcium and vitamin D (bone repair): Dairy, tofu, leafy greens, fish, eggs.

*Adopted from http://www.jissn.com/content/7/1/7

Are your glutes asleep?

I’ve recently begun implementing an evaluation tool called the Selective Functional Movement Assessment. This is a series of movement challenges that helps spot abnormal movement patterns that may be contributing to your pain. One common pattern that this assessment keeps revealing is that of weak gluteal (butt) muscles.
Unfortunately, most of us use our glutes more for cushions while we sit than for powerhouses while we move. Due to our sedentary lifestyles, the glutes become inhibited, or turned off, and other muscles have to pick up the slack.
Signs you might have a weak backside:
  • Most of the day is spent sitting
  • Frequent hamstring strains or cramps
  • Low back pain
  • Hip pain
  • Tight IT band (Iliotibial band syndrome)
  • Knee or ankle pain during activity
If these symptoms sound familiar, let’s do an assessment at your next visit and see if we need to whip your glutes back into shape.
In health,

 

My chiropractic story

Beaverton Chiropractor
Beaverton Chiropractor, Dr. Kip Thompson

I would venture to say that there are very few children out there who dream of becoming a chiropractor someday, and the ones who do are most likely children or grandchildren of chiropractors. I’ll be the first one to admit I didn’t even know what a chiropractor was until long after I realized my dream of becoming a pro baseball player was just a dream. If you talk to any number of chiropractors you’ll soon realize that most have their own chiropractic story – a turning point where their life was so profoundly affected by chiropractic care that they decided that’s what they wanted to be. So, without further ado, here is my chiropractic story. Please feel free to share yours as well.

Once I gave up on the pro baseball dream (I went as far as playing on the JV squad in high school), if you asked me what I wanted to do with my life I probably would give you a blank stare. It wasn’t until I was 3/4 of the way to a Bachelor’s degree in Neuroscience that I decided on a career. I spent four and half years in undergrad with future medical doctors, dentists, and neuroscientists. For three of those years all I knew about my future career was that it wasn’t going to be one of those. I was not interested in practicing medicine or working on lab rats for the rest of my life. All I knew was that I wanted to make people feel better.

One day I was eating lunch in the quad and perusing the school newspaper. There was an ad for a student discount at the local chiropractic office. Throughout my adolescence and into college, I suffered from frequent tension headaches and occasional bouts of sciatic pain after sitting too long in class or on a car ride. These were both conditions that the chiropractor in the ad said he could treat, so I thought I would give it a shot. I went into my first treatment somewhat skeptical, but also hoping something amazing would happen. I went through an exam that involved him checking my range of motion, poking and prodding in certain parts of my neck and back, and taking some x-rays of my neck. He mentioned that my neck was not aligned particularly well and I likely had been in an auto accident previously (4 to be exact). I then lay down on the treatment table and he went to work.

Starting with my low back, he used a combination of quick thrusts with his hands and some moving parts of his table to make the adjustments he needed. Then he turned me onto my back and with one flick of the wrist, he delivered a neck adjustment that rocked my world. I was speechless. All I could do was smile. I had no idea that so many joints could pop all at the same time. I left the clinic, still smiling, almost in shock because I had never felt anything like that before.  For the next day, to be honest, I felt sore. I questioned whether or not the adjustments had worked because they just seemed to amplify the pain I had gone in with. At the doctor’s advice, I stuck with it through the prescribed treatment plan, which was something like once or twice a week for a month or two. I never got the miracle cure adjustment I had hoped for, but after about a month into the process, I started to realize it had been a while since my last headache. The sciatic pain I occasionally felt after long hours of studying in the library had also not bothered me recently. It was working! It was not a one hit wonder as I had hoped, but a process in which small, incremental changes over time helped my joints and muscles to function more optimally. As a result I felt better, and subsequently decided I wanted to be a chiropractor so that I could make others feel better.

Now, several years into this profession that I now love and am passionate about, I continue to receive regular adjustments to keep my headaches and sciatic pain at bay, and get to see this same process repeat itself in my clients. Nagging problems like neck pain, back pain, and headaches that have persisted for years slowly fade away as we apply the catalyst of chiropractic adjustments and specific corrective exercises to set the body back on the right path. It’s a beautiful thing.

Now let’s hear your story!
In health,
Dr. T