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22 Jun 2017
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Elbow Pain…What The Heck Is The Issue?

Elbow Pain…What The Heck Is The Issue?

June 22, 2017 | 0 Comments | , , , , , , , , , , , , , ,

The elbow…well, it certainly isn’t the ‘funny/crazy bone’ when we hurt it.

The elbow…when it hurts, it certainly isn’t so ‘funny’ or ‘crazy’.

We treat a LOT of elbow problems in our office.  Why is this?  Well, we have an active patient base and most all we do affects the musculature in our elbows.  It used to be that when you had medial, or inside, elbow pain, that would be called ‘golfer’s elbow’ and when the pain was on the lateral side, or outside, that was called ‘tennis elbow.’  Well, needless to say, times have changed and people in many sports get medial and lateral elbow pain and they certainly are not playing golf or tennis.  For that matter, not all golfers get medial elbow pain and tennis players lateral elbow pain anyway…sometimes, it’s the opposite.  As as far as that ‘funny bone’ issue we’ve all heard about, that occurs when we bang a certain part of the elbow that the ulnar nerve runs through.  The sensation we feel is irritation to the nerve and the distally affected tissues feel ‘funny.’ Continue Reading →

23 Mar 2017
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The Achilles and Two Reasons Why It Might Be Hurting You

The Achilles and Two Reasons Why It Might Be Hurting You

March 23, 2017 | 0 Comments | , , , , , , , , , , , , , , ,

Figure 1.:  The Calcaneal Bursa Sacs, picture from WebMD

The Achilles tendon is a rather avascular (lacking blood) thick tendon that is made up of two of your major back side calf muscles: the gastrocnemius and the soleus.  The tendon attaches into a part of your heel bone, the calcaneus, and this part is called the calcaneal tubercle. We have to major bursa sacs (bursa sacs are pockets that only fill with fluid when they are inflamed), the subcutaneous calcaneal bursa and the retrocalcaneal bursa (see figure 1 right). The subcutaneous bursa seldom presents as an issue, but the retrocalcaneal bursa can be a major headache. Continue Reading →

13 Mar 2017
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Why Your Back Might Not Be Getting Better

Why Your Back Might Not Be Getting Better

March 13, 2017 | 0 Comments | , , , , , , , , , , , , , , , , , , , ,

There are many reasons as to why people develop back pain and luckily, conservative treatment can help most all of them.  Only in the rarest of instances is surgery needed.  The problem with treating back pain is that all too often the practitioner focuses so much on the pain that he/she doesn’t actually address what is causing the pain.  We’ve all been guilty of this!

I could write volumes on contributing factors to back pain but this blog was written to address one common problem that we are seeing more and more: a hypermobile sacroiliac joint (SIJ).  Now, the naysayer will try to suggest that this does not occur, but with over 18 years of treating sports and back injuries, I can assure you that it does, and it does with frequency.  I’ve seen this problem in active kids to my professional athlete clientele base.  It is usually not properly diagnosed as few practitioners know how to assess it. Continue Reading →

06 Feb 2017
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The Dreaded DCO and What It Means To You and Your Shoulder!

The Dreaded DCO and What It Means To You and Your Shoulder!

February 6, 2017 | 0 Comments | , , , , , , , , , , , , , , ,

DCO, or Distal Clavicular Osteolysis, is a rather bad shoulder condition that all too many athletes suffer from.

DCO occurs when we have damage to our AC (acromioclavicular) joint and it goes unattended to for a period of time.  More-so than that, additional damage is done with further activity and the bones that make up the joint get significant damage.

The AC joint is made up of where the distal clavicle bone meets the acromion process of the scapula (see photo below).  A sprain of the AC joint tends to involve a macrotrauma (one significant injury) such as a bad fall or other form of side shoulder impact.  The AC joint tends to get hypermobile (or move too much) easily as it is not a very stable joint to begin with.  When the joint is injured, or sprained, care is needed to stabilize the joint and allow for it to heal.  In-office treatments can significantly reduce recovery time and this is important as a healing AC joint sprain is susceptible to further injury.   Continue Reading →

15 Dec 2015
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‘Leaner and Meaner’: How Much Protein Do You Need?

‘Leaner and Meaner’: How Much Protein Do You Need?

December 15, 2015 | 2 Comments | , , , , , , , , , , , , , , , , , , , , ,

There has always been a debate about how much protein an athlete needs.  ‘You need one gram per kilogram of weight’ or you need ‘one gram per pound of weight’ and some other somewhat random numbers are usually used to determine how much protein resistance training athletes need.  As a healthcare provider who works with athletes, I need to make sure my athletes have enough protein to ensure healthy soft tissue function and reduce the likelihood of injury. Without proper protein consumption, an athlete will not achieve his/her fitness goals, and if there’s an injury, the athlete will certainly need extra protein during the recovery phase to get better.  I won’t discuss the subject of sarcopenia in this blog but this topic too is a major crisis in our country.  So, how do we know where to really start?

A literature review study from 2014 in the International Journal of Sports Nutrition and Exercise Metabolism along with its follow-up study 3 years later gives us a good formula for determining the range of protein needed for caloric restricted, resistance trained athletes. Before we go any further, we should define who these athletes are…. they are…you and me.  Even if you are not utilizing caloric restriction, the protein needs remain the same.  If you work out, want to look good, and want a high level of lean muscle mass (highly desirable for good health), then this formula applies to you.  In fact, if you just work out and wish to have healthy muscle, this formula will help you achieve your goals.

The bottom line is that athletes tend to ingest less protein than they need and this is a major concern.  Not only that, but they also are unlikely getting the best quality protein they can. Oh, this study also mentions that total fat consumption should not go below 20% of total calorie intake.  So what are we looking at?  A sensible caloric restricted diet with adequate micronutrient ingestion and the proper ratio of macronutrients.  So, you want to be ‘lean and mean’?…here’s how to achieve it… Continue Reading →

06 Jul 2015
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Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

July 6, 2015 | 0 Comments | , , , , , , , , , , , , , , , , , ,

We have covered a lot of information about Dry Needling in our last 3 blogs.  We discussed the Radiculopathy Model, the Trigger Point Model, and the Spinal Segemental Sensitization and Pentad Model.  Already, we can clearly see how Dry Needling can help to break down myofascial trigger points (MTrPs) and reduce pain.  The fourth model will discuss another reason as to why Dry Needling can help you.

Central Model

Our final model, the Central Model, covers information about how Dry Needling and other physical interventions (including manipulation, massage, mobilization, etc…)  affect the spinal cord and brain.  This is a rather basic but powerful model.  The premise is that input stimuli will affect tracks in the spinal cord that will carry that information up to the brain.  The deeper the treatment, the more information that will be conveyed.  The hypothalamus will then take the stimuli and  communicate with the pituitary gland and affect other endocrine functions.

In regards to the hypothalamus, it has three primary functions:  1.  It supplies input to the brainstem, thus affecting autonomic regulation, 2.  It controls endocrine function, and 3.  It exerts influence on posture and locomotion.

With the Central Model, MTrPs along the spine will likely cause more autonomic issues (please click to read more about autonomic issues on the Trigger Point Blog).   Dry Needling causes an anti-inflammatory response that emanates from the hypothalamic-pituitary-adrenal axis.  This is deep stuff!

If we assume that the hypothalamus is directly or indirectly adversely affected by MTrPs, then we can conclude that such MTrPs create autonomic and endocrine problems in addition to postural and movement issues (this means it affects the way you work inside and outside).  Certainly, we would want to rid our bodies of such noxious stimuli, and since Dry Needling can eliminate such MTrPs, then this makes it a great option for restoring proper function of not only the musculoskeletal system, but also the autonomic and endocrine functions that are affected by an improperly functioning musculoskeletal system.

Any way you slice it, Dry Needling can help you to function better.  From simple pain and dysfunction to autonomic concomitants, Dry Needling offers a viable option for the treatment of trigger points and pain due to musculoskeletal causes.

Let’s take a look at some studies supporting the application of Dry Needling…there are a few here but many more in print:

We will start with the grand-daddy of them all…the landmark study performed by Karl Lewit, MD published in 1979.  This study broke down the effects of trigger point injections to determine if the analgesic/steroid that was the agent that helped the patient, or was it the needle alone that contained all the magic!  Please read study, and if you would like the full study (versus just the abstract), please let us know.

The Needle Effect In The Relief of Myofascial Pain

And the other studies…

Dry Needling Having Anti-Nociceptive (anti-pain) Effects

Probable Mechanisms of Needling Therapies for Myofascial Pain Control

The Influence of Dry Needling of The Trapezius Muscle on Muscle Blood Flow and Oxygenation

Dry Needling at Myofascial Trigger Spots of Rabbit Skeletal Muscles Modulates the Biochemicals Associated with Pain, Inflammation, and Hypoxia

The Effect of Dry Needling in the Treatment of Myofascial Pain Syndrome: A Randomized, Double-Blinded Placebo-controlled Trial

Dry Needling and Exercise for Chronic Whiplash – A Randomized Controlled Trial

Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players

04 Jun 2015
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Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

June 4, 2015 | 1 Comment | , , , , , , , , , , , , , ,

In our last two blogs, we went over models that help explain how Dry Needling works.  These two were the Radiculopathy and the Trigger Point Models.  The topic of this blog will involve the third model, or the Spinal Segmental Sensitization and Pentad Model.  As we have with the last two discussions, we will try to explain any difficult terminology or ideas.

Spinal Segmental Sensitization and Pentad Model

The Spinal Segmental Sensitization (SSS) and Pentad Model was proposed by the late Andrew Fischer, M.D. (Physiatrist…pain management and rehabilitation medical doctor).  This is a good time to discuss this model as it really incorporates both of the first two models.  Dr. Fischer proposed that the SSS is a ‘hyperactive’ state of the dorsal horn of the spinal cord that is caused by damaged tissue sending nociceptive (pain) input into the spinal cord.  This information then causes the over-sensitivity of the associated spinal level dermatome (skin), pain sensitivity of the associated spinal level sclerotome (bone, ligaments, joints), and Myofascial Trigger Points (MTrPs) in the associated spinal level muscles.  All this occurs because the nerve coming from the spine is over sensitized, and by being in this pathological state, it stimulates these changes listed above.  In effect, we have a pretty vicious cycle of pain and dysfunction. Continue Reading →

14 May 2015
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Dry Needling Support Models (2 of 4): The Trigger Point Model

Dry Needling Support Models (2 of 4): The Trigger Point Model

May 14, 2015 | 2 Comments | , , , , , , , , , , , , , , , , , , ,

In the last blog, we discussed the first model (The Radiculopathy Model) that helps explain why Dry Needling works.  Now we will continue with the second of four models.   This one is probably the most well-known one and there is a plethora of medical literature supporting it.  Again, we will try to explain any concepts that are a little difficult to understand.  These models really shed light into how our bodies work and they are great to learn about.

The Trigger Point Model

Myofascial Trigger Points (MTrPs, or TrPs for Trigger Points) are defined as ‘hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band’ (Travell and Simons).  The resultant pain/discomfort that one gets due to such points is referred to as myofascial pain syndrome (MPS).  Simply put, MPS is defined as ‘sensory, motor, and autonomic symptoms caused by myofascial trigger points’ (Travell and Simons).  Sensory symptoms refer to what you feel, motor symptoms refer to how the muscles work, and autonomic symptoms refer to the things that you do not realize.  This seems a little odd, but consider what happens when you bang your arm really hard.  You will feel the pain (sensory), the muscle might be painful and not contract properly (motor), and your heart rate goes up as does your respiration due to the ‘adrenaline rush’ (autonomic) of the injury. Continue Reading →

19 Feb 2014
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Mid-Atlantic CrossFit Challenge

Mid-Atlantic CrossFit Challenge

February 19, 2014 | 0 Comments | ,

 

April 19th and 20th are the dates for the Mid-Atlantic CrossFit Challenge. Luke Espe, owner of Syndicate CrossFit, is hosting this event. It will have over 600 competitors, making it one of the biggest CrossFit events on the East Coast. Dr. Manison will be there with a group of hand-picked healthcare providers to help with care for the athletes.

 

 

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