Do you experience pain or discomfort in the shoulder?

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Is the pain aggravated when you lift your arm or reach for something? You could be suffering from a very treatable condition known as impingement syndrome-here is how Chiropractic can help you!

WHAT IS IMPINGEMENT SYNDROME?
Impingement syndrome of the shoulder is a very common cause of shoulder pain. It is friction or a pinching of the muscle tendons (or bursa) as they pass through the sub-acromial space (the space between the head of the humerus and the acromion of the scapula). Pain is typically exacerbated by arm movements such as lifting or reaching and especially overhead activities. It is typically a repetitive overuse injury often brought on by sports involving these actions such as swimming, tennis, golf, gym, etc but may be brought on by actions as innocuous as painting or sanding.

HOW DOES IMPINGEMENT SYNDROME HAPPEN?
It is typically due to a slight narrowing or compromising of the sub-acromial space due to :
•An inflammation of the tendons passing through the space-typically the supraspinatus and biceps tendons and the sub-acromial bursa, typically from overuse.
•An elevated humeral head (the ball of the ball and socket joint) in the glenoid cavity (the socket in the shoulder joint) due to over-developed shoulder elevator muscles( deltoids etc).
•Weak humeral head depressors causing an upward hiking of the humeral head in the glenoid cavity on arm elevation.
•Dysfunction in ANY of the surrounding joints which influence the shoulder biomechanics. The shoulder joint proper (gleno-humeral joint) is a shallow ball and socket joint with multiple other joints contributing to it’s normal biomechanics. These include the sterno-clavicular, acromio-clavicular, scapulo-thoracic, cervical spine and thoracic spine joints. Many muscles of the shoulder such as the levator scapulae, trapezius, and the rhomboid muscles attach directly into the spine. Logically any spinal dysfunction will thus directly influence these muscles and thus affect the shoulder biomechanics as well. The entire nerve supply to the shoulder also originates in the cervical spine (C3 to C6 primarily).
•In more serious scenarios, abnormally lengthened bones around the joint( acromion) or bony spur formation into the space may indicate surgical intervention.

HOW DO YOU TREAT IMPINGEMENT SYNDROME?


Thankfully Chiropractic adresses dysfunction in all of the abovementioned joints and muscles influencing the shoulder! Your Chiropractor will go about examining the joints for a normal range of motion. They will then perform a series of muscle flexibility/strength tests to isolate muscle imbalances which may be causing the problem (this very commonly includes weaker humeral head depressors due to excessive elevation/lifting actions, causing the humeral head to hike upwards causing impingement).
•Muscle spasm and muscle trigger points are released via soft tissue therapy, massage and myofascial trigger point therapy.
•Any joint dysfunction will be treated with specific mobilization/manipulation to restore normal movement patterns to the respective joints.
•Stretches are given to achieve normal joint capsule/muscle flexibility.
•Specific muscle strengthening exercises are prescribed to correct any imbalances and normalize the shoulder movement patterns (scapular rhythm).
•Habit patterns and incorrect techniques are replaced with correct form to avoid future relapse of the injury.

CHIROPRACTIC DOES NOT JUST TREAT THE PAINFUL POINT!

By addressing all the joints and muscles involved, Chiropractic offers a holistic, sustainable solution to impingement syndrome of the shoulder.
Please note that impingement syndrome is BEST TREATED EARLIER RATHER THAN LATER -before the formation of scar tissue, adhesions, calcific deposits etc.

SO SHOULDER UP AND GET YOUR PROBLEM SEEN TO! Written by Dr Etienne Greyling.

Do you suffer pain under the feet while walking?

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Is it worse in the mornings or after sitting for a long time? You could have plantar fasciitis and here’s how Chiropractic can help you!

WHAT IS PLANTAR FASCIITIS?
The plantar fascia is thick ligament connecting the heel to the front of the foot. It acts primarily as a shock absorber while walking,distributing pressure through the foot and propelling you forward. Plantar fasciitis is the inflammation of the plantar fascia due to excessive stress/strain being placed on the structure.It is often accompanied by micro tears which will progress if left untreated.Pain is usually experienced at the front of the heel but can commonly extend through the medial arch of the foot to the base of the toes.

HOW DOES IT HAPPEN?
Plantar fasciitis can occur because of direct trauma (landing hard on the feet) or a sudden increase in load like drastically increasing running distance. Even sudden weight gain and pregnancy has been shown to have an effect.
It is, however, most commonly described as a repetitive strain injury as a result of faulty biomechanics or imbalance, namely-
• Foot problems especially dropped arches (most commonly) or excessively high arches.
• Excessive foot pronation (rolling in when walking) or excessive supination (rolling out when walking)
• Isolated tightness/weakness of the muscles underlying the plantar fascia
• Excessive tightness/weakness in the muscles of the lower limb (especially the calf muscles)
• Excessive knee or hip internal rotation when walking due to a specific muscle weakness (causing increased foot pronation)
• Pelvic torsion syndromes causing a ‘tilted pelvis’ where one leg will present functionally longer (causing more foot pronation on that side to balance)
• Postural implications where a slouched or lazy posture shifts the body’s weight distribution off center -often incorrectly redistributing pressure on the feet.

External variables such as the incorrect footwear or running shoes also plays a massive role!

As one can appreciate by considering the above-the correction of these biomechanical implications are vital! THANKFULLY THIS IS CHIROPRACTIC’S SPECIALITY

HOW DO CHIROPRACTORS TREAT PLANTAR FASCIITIS?


• The acute phase of treatment often involves rest and icing the area. Some bracing may be used as well as light massage.

• Your Chiropractor will then assess the entire biomechanical chain (including the foot/ankle/knee/hip/pelvis/lower back and posture in general.)

• Your Chiropractor will identify any structural anomalies ,blockage or limitation of movement between joints, muscle tightness and weaknesses.

• Any dysfunction found will be corrected using specific joint mobilization/manipulation techniques, muscle release/strengthening procedures and habit/postural re-education via exercises. This is all aimed at reducing the abnormal stress on the plantar fascia!

The foot joints, in particular,respond very well to specific joint manipulation and the foot muscles are easily strengthened. If however, the foot’s biomechanics cannot be corrected using the above conservative approach (or if there are structural anomalies such as a structurally longer leg) referral for foot orthotics (insoles) may be indicated.

You don’t have to live with plantar fasciitis, it is a very easily treatable condition once you have corrected THE CAUSE OF YOUR PROBLEM, THANKS TO CHIROPRACTIC! Written by Dr Etienne Greyling

Patients are often confused whether to use ice or heat and at what stage of an injury to apply them-getting this wrong could have adverse effects!

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As a general rule ice is most effective in acute injury situations- where the injury has just occurred and for up to 72 hours thereafter (sprained joints, muscle tears, bumps, bruises.) Ice will reduce pain by minimizing inflammation due to the constriction of blood vessels, resulting in less pressure on nerve fibers and less tissue damage. Applying heat in this acute phase will only increase vasodilation of the blood vessels thus increasing blood flow, inflammation and pain! DO NOT APPLY HEAT TO ACUTE INJURIES!

Heat is generally applied after 72 hours and to more chronic (older) injuries and conditions. By increasing blood flow to the area it is often very effective in assisting healing and loosening tight tissues such as muscles, tendons and ligaments -thus freeing up stiff joints (frozen shoulder, chronic achilles tendinitis , chronic tennis elbow, chronic plantar fasciitis etc.) Heat can also provide relief in many arthritic conditions-if, however, you are suffering an acute arthritic episode and the joint is red and swollen(as in acute gout or rheumatoid arthritis) heat may best be avoided! It is generally safe to start applying heat after the acute phase of inflammation has passed(for any injury) to play it safe, three days after the initial injury.

Neither heat nor cold should be applied for longer than 10 minutes per application with at least a 1-hour break passing between each application. A minimum of 3 to 4 times a day may be adequate. Any application longer than 10 min may cause the body to register an ‘alarm’ at the part being treated and react with a reverse reaction.Ice/heat for too long may also cause local skin and tissue damage.

The above is a general rule of thumb and often the ideal intensity and amount of heat/cold will vary from individual to individual – depending on how they react symptomatically. LISTEN TO YOUR BODY AND IMMEDIATELY DISCONTINUE USE IF ANY AGGRAVATED OR ADVERSE SYMPTOMS BEGIN TO APPEAR.

Always place a thin cloth between the ice/heat pack and the skin to avoid skin irritation/frostbite or burns!

DO NOT USE ICE IN THE PRESENCE OF:
• A lowered body temperature, cold surroundings or a patient in shock
• Numbness or loss of sensation of the body part including peripheral neuropathies (such as diabetic neuropathy etc)
• Sympathetic dysfunction where there is an abnormality of the nerves controlling blood flow/sweat gland activity
• Vascular disease where the patient suffers bad peripheral blood flow (blood clots, Raynaud’s disease, vasulitis etc)
• Open wounds/blistered/burned skin
• if the patient is hyper-sensitive to cold (cold-induced urticaria where hives appear on the skin)

DO NOT USE HEAT IN THE PRESENCE OF:
• An elevated body temperature as in directly after exercise or during a fever
• Acute injury with inflammation for at least 72 hours
• Numbness or loss of sensation of the body part including peripheral neuropathies (such as diabetic neuropathy etc)
• Sympathetic dysfunction where there is an abnormality of the nerves controlling blood flow/sweat gland activity
• Open wounds/blistered/burned skin.

Remember that Ice and heat form only a part of the broader spectrum of treatment of any injury. Ice is generally applied as part of the P.O.L.I.C.E (protection, optimum loading, ice, compression, elevation) protocol for acute treatments. After 72 hours heat will form part of the rehabilitative phase. Corrective manipulation, muscle strengthening and balancing via specific exercises are vital and will prevent future relapse of the injury- ALWAYS TREAT THE CAUSE OF THE INJURY!

Hopefully this has answered some ambiguous questions around the ice vs heat debate! We will dive into more detail about the management of acute injuries at a later stage. So ice up, or keep it hot and remember-we’ve got your body and back! Written by Dr. Etienne Greyling