Hip pain is a well-known health issue which can be caused by a wide array of problems, however, the site of the patient’s hip pain can provide valuable information regarding the underlying cause of this common health issue. Pain on the inside of the hip or groin can be due to problems within the hip joint itself while pain on the outside of the hip, upper thigh and outer buttocks may be due to problems with the ligaments, tendons and muscles, among other soft tissues, surrounding the hip joint. Furthermore, hip pain can be due to other injuries and conditions, including back pain.
Contents
Abstract
Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears.
Introduction
Hip pain is a common presentation in primary care and can affect patients of all ages. In one study, 14.3% of adults 60 years and older reported significant hip pain on most days over the previous six weeks.1 Hip pain often presents a diagnostic and therapeutic challenge. The differential diagnosis of hip pain (eTable A) is broad, including both intra-articular and extra-articular pathology, and varies by age. A history and physical examination are essential to accurately diagnose the cause of hip pain.
Anatomy
The hip joint is a ball-and-socket synovial joint designed to allow multiaxial motion while transferring loads between the upper and lower body. The acetabular rim is lined by fibrocartilage (labrum), which adds depth and stability to the femoroacetabular joint. The articular surfaces are covered by hyaline cartilage that dissipates shear and compressive forces during load bearing and hip motion. The hip’s major innervating nerves originate in the lumbosacral region, which can make it difficult to distinguish between primary hip pain and radicular lumbar pain.
The hip joint’s wide range of motion is second only to that of the glenohumeral joint and is enabled by the large number of muscle groups that surround the hip. The flexor muscles include the iliopsoas, rectus femoris, pectineus, and sartorius muscles. The gluteus maximus and hamstring muscle groups allow for hip extension. Smaller muscles, such as gluteus medius and minimus, piriformis, obturator externus and internus, and quadratus femoris muscles, insert around the greater trochanter, allowing for abduction, adduction, and internal and external rotation.
In persons who are skeletally immature, there are several growth centers of the pelvis and femur where injuries can occur. Potential sites of apophyseal injury in the hip region include the ischium, anterior superior iliac spine, anterior inferior iliac spine, iliac crest, lesser trochanter, and greater trochanter. The apophysis of the superior iliac spine matures last and is susceptible to injury up to 25 years of age.2
The hip joint is one of the larger joints found in the human body and it serves in locomotion as the thigh moves forward and backward. The hip joint also rotates when sitting and with changes of direction while walking. A variety of complex structures surround the hip joint. When an injury or condition affects these, it can ultimately lead to hip pain.
Dr. Alex Jimenez D.C., C.C.S.T.
Evaluation of Hip Pain
History
Age alone can narrow the differential diagnosis of hip pain. In prepubescent and adolescent patients, congenital malformations of the femoroacetabular joint, avulsion fractures, and apophyseal or epiphyseal injuries should be considered. In those who are skeletally mature, hip pain is often a result of musculotendinous strain, ligamentous sprain, contusion, or bursitis. In older adults, degenerative osteoarthritis and fractures should be considered first.
Patients with hip pain should be asked about antecedent trauma or inciting activity, factors that increase or decrease the pain, mechanism of injury, and time of onset. Questions related to hip function, such as the ease of getting in and out of a car, putting on shoes, running, walking, and going up and down stairs, can be helpful.3 Location of the pain is informative because hip pain often localizes to one of three basic anatomic regions: the anterior hip and groin, posterior hip and buttock, and lateral hip (eFigure A).
Physical Examination
The hip examination should evaluate the hip, back, abdomen, and vascular and neurologic systems. It should start with a gait analysis and stance assessment (Figure 1), followed by evaluation of the patient in seated, supine, lateral, and prone positions (Figures 2 through 6, and eFigure B). Physical examination tests for the evaluation of hip pain are summarized in Table 1.
Imaging
Radiography. Radiography of the hip should be performed if there is any suspicion of acute fracture, dislocation, or stress fracture. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and a frog-leg lateral view of the symptomatic hip.4
Magnetic Resonance Imaging and Arthrography. Conventional magnetic resonance imaging (MRI) of the hip can detect many soft tissue abnormalities, and is the preferred imaging modality if plain radiography does not identify specific pathology in a patient with persistent pain.5 Conventional MRI has a sensitivity of 30% and an accuracy of 36% for diagnosing hip labral tears, whereas magnetic resonance arthrography provides added sensitivity of 90% and accuracy of 91% for the detection of labral tears.6,7
Ultrasonography. Ultrasonography is a useful technique for evaluating individual tendons, confirming suspected bursitis, and identifying joint effusions and functional causes of hip pain.8 Ultrasonography is especially useful for safely and accurately performing imaging-guided injections and aspirations around the hip.9 It is ideal for an experienced ultrasonographer to perform the diagnostic study; however, emerging evidence suggests that less experienced clinicians with appropriate training can make diagnoses with reliability similar to that of an experienced musculoskeletal ultrasonographer.10,11
These are numerous causes for hip pain. Although some hip pain may only be temporary, other forms of hip pain can become chronic if left untreated for an extended period of time. Several common causes of hip pain include, arthritis, fracture, sprain, avascular necrosis, Gaucher’s disease, sciatica, muscle strain, iliotibial band syndrome or IT band syndrome and hematoma, among others described below.
Dr. Alex Jimenez D.C., C.C.S.T.
Differential Diagnosis of Anterior Hip Pain
Anterior hip or groin pain suggests involvement of the hip joint itself. Patients often localize pain by cupping the anterolateral hip with the thumb and forefinger in the shape of a �C.� This is known as the C sign (Figure 1A).
Osteoarthritis
Osteoarthritis is the most likely diagnosis in older adults with limited motion and gradual onset of symptoms. Patients have a constant, deep, aching pain and stiffness that are worse with prolonged standing and weight bearing. Examination reveals decreased range of motion, and extremes of hip motion often cause pain. Plain radiographs demonstrate the presence of asymmetrical joint-space narrowing, osteophytosis, and subchondral sclerosis and cyst formation.12
Femoroacetabular Impingement
Patients with femoroacetabular impingement are often young and physically active. They describe insidious onset of pain that is worse with sitting, rising from a seat, getting in or out of a car, or leaning forward.13 The pain is located primarily in the groin with occasional radiation to the lateral hip and anterior thigh.14 The FABER test (flexion, abduction, external rotation; Figure 3) has a sensitivity of 96% to 99%. The FADIR test (flexion, adduction, internal rotation; Figure 4), log roll test (Figure 5), and straight leg raise against resistance test (Figure 6) are also effective, with sensitivities of 88%, 56%, and 30%, respectively.14,15 In addition to the anteroposterior and lateral radiograph views, a Dunn view should be obtained to help detect subtle lesions.16
Hip Labral Tear
Hip labral tears cause dull or sharp groin pain, and one-half of patients with a labral tear have pain that radiates to the lateral hip, anterior thigh, and buttock. The pain usually has an insidious onset, but occasionally begins acutely after a traumatic event. About one-half of patients with this injury also have mechanical symptoms, such as catching or painful clicking with activity.17 The FADIR and FABER tests are effective for detecting intra-articular pathology (the sensitivity is 96% to 75% for the FADIR test and is 88% for the FABER test), although neither test has high specificity.14,15,18 Magnetic resonance arthrography is considered the diagnostic test of choice for labral tears.6,19 However, if a labral tear is not suspected, other less invasive imaging modalities, such as plain radiography and conventional MRI, should be used first to rule out other causes of hip and groin pain.
Iliopsoas Bursitis (Internal Snapping Hip)
Patients with this condition have anterior hip pain when extending the hip from a flexed position, often associated with intermittent catching, snapping, or popping of the hip.20 Dynamic real-time ultrasonography is particularly useful in evaluating the various forms of snapping hip.8
Occult or Stress Fracture
Occult or stress fracture of the hip should be considered if trauma or repetitive weight-bearing exercise is involved, even if plain radiograph results are negative.21 Clinically, these injuries cause anterior hip or groin pain that is worse with activity.21 Pain may be present with extremes of motion, active straight leg raise, the log roll test, or hopping.22 MRI is useful for the detection of occult traumatic fractures and stress fractures not seen on plain radiographs.23
Transient Synovitis and Septic Arthritis
Acute onset of atraumatic anterior hip pain that results in impaired weight bearing should raise suspicion for transient synovitis and septic arthritis. Risk factors for septic arthritis in adults include age older than 80 years, diabetes mellitus, rheumatoid arthritis, recent joint surgery, and hip or knee prostheses.24 Fever, complete blood count, erythrocyte sedimentation rate, and C-reactive protein level should be used to evaluate the risk of septic arthritis.25,26 MRI is useful for differentiating septic arthritis from transient synovitis.27,28 However, hip aspiration using guided imaging such as fluoroscopy, computed tomography, or ultrasonography is recommended if a septic joint is suspected.29
Osteonecrosis
Legg-Calv�-Perthes disease is an idiopathic osteonecrosis of the femoral head in children two to 12 years of age, with a male-to-female ratio of 4:1.4 In adults, risk factors for osteonecrosis include systemic lupus erythematosus, sickle cell disease, human immunodeficiency virus infection, smoking, alcoholism, and corticosteroid use.30,31 Pain is the presenting symptom and is usually insidious. Range of motion is initially preserved but can become limited and painful as the disease progresses.32 MRI is valuable in the diagnosis and prognostication of osteonecrosis of the femoral head.30,33
Differential Diagnosis of Posterior Hip and Buttock Pain
Piriformis Syndrome and Ischiofemoral Impingement
Piriformis syndrome causes buttock pain that is aggravated by sitting or walking, with or without ipsilateral radiation down the posterior thigh from sciatic nerve compression.34,35 Pain with the log roll test is the most sensitive test, but tenderness with palpation of the sciatic notch can help with the diagnosis.35
Ischiofemoral impingement is a less well-understood condition that can lead to nonspecific buttock pain with radiation to the posterior thigh.36,37 This condition is thought to be a result of impingement of the quadratus femoris muscle between the lesser trochanter and the ischium.
Unlike sciatica from disc herniation, piriformis syndrome and ischiofemoral impingement are exacerbated by active external hip rotation. MRI is useful for diagnosing these conditions.38
Other
Other causes of posterior hip pain include sacroiliac joint dysfunction,39 lumbar radiculopathy,40 and vascular claudication.41 The presence of a limp, groin pain, and limited internal rotation of the hip is more predictive of hip disorders than disorders originating from the low back.42
Differential Diagnosis of Lateral Hip Pain
Greater Trochanteric Pain Syndrome
Lateral hip pain affects 10% to 25% of the general population.43 Greater trochanteric pain syndrome refers to pain over the greater trochanter. Several disorders of the lateral hip can lead to this type of pain, including iliotibial band thickening, bursitis, and tears of the gluteus medius and minimus muscle attachment.43�45 Patients may have mild morning stiffness and may be unable to sleep on the affected side. Gluteus minimus and medius injuries present with pain in the posterior lateral aspect of the hip as a result of partial or full-thickness tearing at the gluteal insertion. Most patients have an atraumatic, insidious onset of symptoms from repetitive use.43,45,46
In conclusion, hip pain is a common complaint which may occur due to a wide variety of health issues. Moreover, the precise location of the patient’s hip pain can provide valuable information to healthcare professionals regarding the underlying cause of the problem. The purpose of the article above was to demonstrate and discuss the evaluation of the patient with hip pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Data Sources: We searched articles on hip pathology in American Family Physician, along with their references. We also searched the Agency for Healthcare Research and Quality Evidence Reports, Clinical Evidence, Institute for Clinical Systems Improvement, the U.S. Preventive Services Task Force guidelines, the National Guideline Clearinghouse, and UpToDate. We performed a PubMed search using the keywords greater trochanteric pain syndrome, hip pain physical examination, imaging femoral hip stress fractures, imaging hip labral tear, imaging osteomyelitis, ischiofemoral impingement syndrome, meralgia paresthetica review, MRI arthrogram hip labrum, septic arthritis systematic review, and ultrasound hip pain. Search dates: March and April 2011, and August 15, 2013.
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
1.�Christmas C, Crespo CJ, Franckowiak SC, et al. How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey.�J Fam Pract. 2002;51(4):345�348.
2.�Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes.�Skeletal Radiol. 2001;30(3):127�131.
3.�Martin HD, Shears SA, Palmer IJ. Evaluation of the hip.�Sports Med Arthrosc. 2010;18(2):63�75.
4.�Gough-Palmer A, McHugh K. Investigating hip pain in a well child.�BMJ. 2007;334(7605):1216�1217.
5.�Bencardino JT, Palmer WE. Imaging of hip disorders in athletes.�Radiol Clin North Am. 2002;40(2):267�287.
6.�Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging.�Radiology. 1996;200(1):225�230.
7.�Czerny C, Hofmann S, Urban M, et al. MR arthrography of the adult acetabular capsular-labral complex.�AJR Am J Roentgenol. 1999;173(2):345�349.
8.�Deslandes M, Guillin R, Cardinal E, et al. The snapping iliopsoas tendon: new mechanisms using dynamic sonography.�AJR Am J Roentgenol. 2008;190(3):576�581.
9.�Blankenbaker DG, De Smet AA. Hip injuries in athletes.�Radiol Clin North Am. 2010;48(6):1155�1178.
10.�Balint PV, Sturrock RD. Intraobserver repeatability and interobserver reproducibility in musculoskeletal ultrasound imaging measurements.�Clin Exp Rheumatol. 2001;19(1):89�92.
11.�Ramwadhdoebe S, Sakkers RJ, Uiterwaal CS, et al. Evaluation of a training program for general ultrasound screening for developmental dysplasia of the hip in preventive child health care.�Pediatr Radiol. 2010;40(10):1634�1639.
12.�Altman R, Alarc�n G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip.�Arthritis Rheum. 1991;34(5):505�514.
14.�Clohisy JC, Knaus ER, Hunt DM, et al. Clinical presentation of patients with symptomatic anterior hip impingement.�Clin Orthop Relat Res. 2009;467(3):638�644.
15.�Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement.�Clin Orthop Relat Res. 2004;(429):262�271.
16.�Beall DP, Sweet CF, Martin HD, et al. Imaging findings of femoroacetabular impingement syndrome.�Skeletal Radiol. 2005;34(11):691�701.
17.�Burnett RS, Della Rocca GJ, Prather H, et al. Clinical presentation of patients with tears of the acetabular labrum.�J Bone Joint Surg Am. 2006;88(7):1448�1457.
18.�Leunig M, Werlen S, Ungersb�ck A, et al. Evaluation of the acetabular labrum by MR arthrography [published correction appears in�J Bone Joint Surg Br. 1997;79(4):693].�J Bone Joint Surg Br. 1997;79(2):230�234.
19.�Groh MM, Herrera J. A comprehensive review of hip labral tears.�Curr Rev Musculoskelet Med. 2009;2(2):105�117.
20.�Blankenbaker DG, De Smet AA, Keene JS. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip.�Skeletal Radiol. 2006;35(8):565�571.
21.�Egol KA, Koval KJ, Kummer F, et al. Stress fractures of the femoral neck.�Clin Orthop Relat Res. 1998;(348):72�78.
22.�Fullerton LR Jr, Snowdy HA. Femoral neck stress fractures.�Am J Sports Med. 1988;16(4):365�377.
24.�Margaretten ME, Kohlwes J, Moore D, et al. Does this adult patient have septic arthritis?�JAMA. 2007;297(13):1478�1488.
25.�Eich GF, Superti-Furga A, Umbricht FS, et al. The painful hip: evaluation of criteria for clinical decision-making.�Eur J Pediatr. 1999;158(11):923�928.
26.�Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children.�J Bone Joint Surg Am. 1999;81(12):1662�1670.
27.�Learch TJ, Farooki S. Magnetic resonance imaging of septic arthritis.�Clin Imaging. 2000;24(4):236�242.
28.�Lee SK, Suh KJ, Kim YW, et al. Septic arthritis versus transient synovitis at MR imaging.�Radiology. 1999;211(2):459�465.
29.�Leopold SS, Battista V, Oliverio JA. Safety and efficacy of intraarticular hip injection using anatomic landmarks.�Clin Orthop Relat Res. 2001; (391):192�197.
30.�Mitchell DG, Rao VM, Dalinka MK, et al. Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings.�Radiology. 1987;162(3):709�715.
31.�Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head.�J Bone Joint Surg Am. 2010;92(12):2165�2170.
32.�Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of osteonecrosis.�Semin Arthritis Rheum. 2002;32(2):94�124.
33.�Totty WG, Murphy WA, Ganz WI, et al. Magnetic resonance imaging of the normal and ischemic femoral head.�AJR Am J Roentgenol. 1984;143(6):1273�1280.
35.�Hopayian K, Song F, Riera R, et al. The clinical features of the piriformis syndrome.�Eur Spine J. 2010;19(12):2095�2109.
36.�Torriani M, Souto SC, Thomas BJ, et al. Ischiofemoral impingement syndrome.�AJR Am J Roentgenol. 2009;193(1):186�190.
37.�Ali AM, Whitwell D, Ostlere SJ. Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement.�Skeletal Radiol. 2011;40(5):653�656.
38.�Lee EY, Margherita AJ, Gierada DS, et al. MRI of piriformis syndrome.�AJR Am J Roentgenol. 2004;183(1):63�64.
39.�Slipman CW, Jackson HB, Lipetz JS, et al. Sacroiliac joint pain referral zones.�Arch Phys Med Rehabil. 2000;81(3):334�338.
40.�Moore KL, Dalley AF, Agur AM.�Clinically Oriented Anatomy. 6th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2010.
41.�Adlakha S, Burket M, Cooper C. Percutaneous intervention for chronic total occlusion of the internal iliac artery for unrelenting buttock claudication.�Catheter Cardiovasc Interv. 2009;74(2):257�259.
42.�Brown MD, Gomez-Marin O, Brookfield KF, et al. Differential diagnosis of hip disease versus spine disease.�Clin Orthop Relat Res. 2004; (419):280�284.
43.�Segal NA, Felson DT, Torner JC, et al.; Multicenter Osteoarthritis Study Group. Greater trochanteric pain syndrome.�Arch Phys Med Rehabil. 2007;88(8):988�992.
44.�Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome.�Sports Med Arthrosc. 2010;18(2):113�119.
The workstation is one of the most damaging places you can spend your day when it comes to your spine. Office chairs are not designed to promote good posture or spinal health while desks and computer monitors are notorious for being too low or too high. The result can cause pain in your neck and back, headaches, and a variety of other conditions.� A stability ball could be the answer.
However, if you have a job that requires you to sit at a desk for an extended period, what can you do? Are you stuck with an achy, stiff neck and back because your workstation doesn�t promote a healthy posture? You don�t have to suffer; you can work healthier and smarter. Using an exercise ball as your chair is a great way to combat the painful and even detrimental effects of the traditional desk and chair.
Contents
Stability Ball as an Office Chair
A stability ball, also known as a Swiss ball, exercise ball, or physioball, is a large, inflatable ball used for training. A stability ball helps to increase pillar strength, improve stability and have better balance. It is large, making it high enough that it can easily be used as a desk chair.
At least one company has combined the fitness benefits of a stability ball with some of the convenient features of an office chair (wheels, lumbar support, etc.). Gaiam Balance Ball Chairs are stability balls that are intended to be used as chairs. The ball needs to be inflated before use and may need to be reinflated from time to time. It also has a 300-pound weight capacity. It is a somewhat pricier alternative to the plain stability ball.
How Sitting on a Stability Ball Benefits your Spine
There are at least three outstanding benefits you can enjoy by using a stability ball as your chair. Try it for just 30 days and see the difference for yourself. In that time you will see:
Your core muscles are toned. As you balance on the stability ball, it forces you to engage your core muscles including those in your low back, abdominal, and pelvic floor. It will keep your muscles engaged for extended periods of time but also encourage you to move for little extra core work. This, in turn, will help to keep your spine correctly aligned and stabilized.
Your back pain is relieved. Sitting on your stability ball improves your circulation, encouraging blood flow throughout your body. An office chair, on the other hand, does just the opposite. This is helpful in relieving pain. It keeps your spine aligned which also helps with any back pain you may experience. This is in part to the core strength you develop, but also because you are less likely to slouch or sit in a position that puts a strain on your back.
You have better posture.�A better-aligned spine naturally leads to better posture. Sitting on the ball works your core, strengthening those muscles so that your spine is supported, resulting in better posture. You will find that you sit up straighter and over time you will walk taller. Better posture is perfect for your spine, making it more flexible and stronger.
It should be noted that it isn�t healthy to sit in any position for too long. Stand up and move about every hour or so. While the stability ball causes you to change positions throughout the day, you also need full body movement, which includes standing, stretching and walking.
Every new parent has experienced a fussy baby with colic � some more often than others. It is always the same, though, an inconsolable baby and frustrated, frazzled parents who only want to comfort their child but can�t. It hurts to know that your baby is uncomfortable, or worse, in pain, and there is nothing you can do about it.
Colic can leave parents feeling helpless. There is a treatment, though, that has given many parents hope and brought relief to their little ones. Chiropractic is an effective treatment for colic that is drug-free and gentle. Both infants and their parents reap the benefits because when a baby is happy, mom and dad are happy.
Contents
What is Colic?
Colic is a condition that occurs in healthy, well-fed infants, beginning when the baby is a few weeks old. By the time the baby is three months old, the condition usually improves, and by five months it is often no longer occurring. It is marked by inconsolable crying that meets three criteria regarding length:
More than three hours a day
Three days a week or more
For three weeks or longer
During these episodes, it seems as if there is nothing that can be done for the baby. The good news is, it is relatively short-lived, but while it is happening it can cause a great deal of distress to the baby and the parents.
Symptoms of Colic
All babies cry and even get fussy from time to time. That is just normal baby behavior; it does not necessarily point to colic as the culprit. When a baby that is well fed and otherwise healthy, symptoms of colic may include:
Episodes of crying that are often predictable. Colic usually occurs in the latter part of the day � late afternoon or evening � and at around the same time each day. So a baby with colic will usually get fussy at the same time and the period of distress can last a few minutes to several hours.
Baby is inconsolable with intense crying. The baby with colic will seem very distressed. The cry is very high pitched and no response to attempts to comfort. The baby�s face may become flushed, and near the end of the episode they may pass gas or have a bowel movement.
The crying does not seem to have a source or reason. Babies cry, all babies � but they are usually crying because they need something. They may cry because they are hungry, need a diaper change, or want to be held by mom or dad. A colicky baby will cry for no apparent reason.
There are Changes in posture. Several posture changes are relatively consistent with colic. The baby will often clench their fists, curl their legs, and tense the abdominal muscles.
Chiropractic for Colic
Childbirth is not easy, and it isn�t gentle. As the baby passes through the birth canal and emerges, it�s little body is stretched and compressed which can cause misalignment of the back and neck. If the labor was extensive, there was prolonged pushing, or if a device like forceps or vacuum extraction is used, the chances of misalignment are very likely. These misalignments can lead to difficulty nursing and even impede normal organ function. This can lead to digestive issues which may lead to colic.
Some parents may be uncomfortable at first when they consider getting chiropractic care for their infant, but it is safe and gentle. The popping and cracking that is associated with chiropractic is not a part of infant and child chiropractic. The doctor applies gentle pressure to areas on the neck and back, using his fingers. Many times the baby will completely relax during these adjustments.
Chiropractic for colic is very useful. Parents considering this type of treatment for their baby should look for a chiropractor who has experience providing treatment for babies. It can make a world of difference for a colicky, distressed baby.
There is no denying that water is an integral part of good health. Dehydration can cause problems with skin, digestion, and organ function. It can cause leg and foot cramps and impair cognitive processes. Staying well hydrated is vital to overall wellness. Because water is part of every cell in the body, and when we don�t drink enough water, the body suffers.
Good spinal health begins with proper hydration. The spine is constructed in such a way that dehydration can cause limited mobility, decreased flexibility, and pain. It can make the backbone to age faster than it should which impacts the entire body. As the natural functions begin to break down the body suffers, and it isn�t long and depression and anxiety often set in. The spine depends heavily on hydration.
Contents
Overview of the Spine
The spine of made up of vertebrae, a row of bones that sit on top of each other, connected by small joints. A disc sits between each vertebra, cushioning it and acting as a shock absorber. It allows the spine to flex, bend, and move about without the bones rubbing together.
Each disc has a fluid center (nucleus pulposis) that is surrounded by a flexible, sturdy ring. The ring contains a gel-like substance while the center of the disc is comprised of water. The outer ring protects the center, and the center protects the vertebrae, acting as a cushion for the bones.
If the fluid center does not have adequate water, it cannot do its job, and the spine begins to experience problems. Aging makes it more difficult for the discs to rehydrate and a sedentary lifestyle also complicates the process. It just cannot work without proper hydration. A healthy spine starts with adequate hydration.
The Benefits of Water for the Spine
From the time you get up in the morning, you are putting pressure on your spine and subsequently, the discs that lie between each vertebra. As you move the discs are compressed by the spine, and the water that is inside is squeezed out.
Even upright activities like standing, sitting, or walking can cause pressure on the discs as gravity causes compression in the spine. When the discs do not have enough water, it results in limited mobility, pain, and an increased risk of back injury.
If you don�t drink enough water, your body becomes dehydrated and is unable to replenish the water that the discs so desperately need. You may not even notice the typical signs of dehydration such as a headache and lethargy, but also lower levels of dehydration can cause severe problems in the body, especially if it is prolonged. Soda and similar beverages do not provide adequate water to the body.
How to Properly Hydrate the Body
Water is the best way to hydrate the body, but it isn�t the only way. Foods like watermelon, lettuce, spinach, and soups are excellent sources of hydration. H2O, of course, is the best way, but herbal teas are also good.
Drinks with caffeine are not as effective since the caffeine can have a diuretic effect. Traditionally, people have been told to drink eight glasses of water a day, and that is good advice. However, studies indicate that proper hydration can occur with an intake of just 30 to 50 ounces of water a day.
If you have constant or frequent back pain, the answer could be as close as your kitchen faucet. Dehydration could be the source of your back pain and immobility.
Water also affects the way the cerebrospinal fluid works and moves in the body. When the body is dehydrated, it doesn�t move as it should, and brain function, reflexes, and cognitive processing could be impacted. Don�t chance it. If your problems are caused by something as simple as not drinking enough water, that is something you can change today. Drink up! Your body will thank you.
Achondroplasia is a genetic disorder that leads to dwarfism. In those with the condition, the legs and arms are short, while the chest is generally of regular length. Those affected have an average adult height of 131 centimetres (4 ft 4 in) for males and 123 centimetres (4 feet ) for females. Other features include a prominent forehead and an enlarged head. Intelligence is typically considered normal in people with achondroplasia. The condition affects approximately 1 in 27,500 individuals.
Contents
Diagnosis for Achondroplasia
Achondroplasia is the result of a mutation in the fibroblast growth factor receptor 3 (FGFR3) gene. This occurs during early development as a new mutation. It is also inherited from the parents in an autosomal dominant way. Those with two affected genes do not survive. Testing if uncertain of diagnosis based on symptoms is often strongly encouraged.
Achondroplasia can be detected before birth�through the use of prenatal ultrasound. Moreover, a DNA test can also be performed to identify homozygosity, where two copies of the gene are inherited causing the deadly condition resulting in stillbirths. Clinical features include megalocephaly, short limbs, prominent forehead, thoracolumbar kyphosis and mid-face hypoplasia. Complications such as dental malocclusion, hydrocephalus and replicated otitis media may also develop. The risk of death in infancy may be increased as a result of the probability of compression of the spinal cord with or without upper airway obstruction.
Achondroplasia and Sciatica
Individuals with achondroplasia commonly experience back pain, which may often progress to sciatica symptoms, such as pain and discomfort, tingling and burning sensations in the lower extremities, and numbness, among other consequences. Both children and adults with achondroplasia have hip flexion contractures which have been found to be a contributing factor for sciatica and muscle fatigue reported by individuals with achondroplasia. Individuals with achondroplasia also typically demonstrate a mixed pattern of joint mobility, including joint contracture and joint hypermobility at characteristic joints.�
Achondroplasia Management
There is no known cure for achondroplasia even though the cause of the mutation has been found. Management for the condition might include support groups and growth hormone treatment. Efforts to treat or prevent complications like obesity, hydrocephalus, obstructive sleep apnea, middle ear infections, or spinal stenosis may be required for the management�of achondroplasia. Life expectancy of those affected is approximately 10 years less than ordinary.�The scope of our information is limited to chiropractic, spinal injuries, and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Alternative treatment options, such as chiropractic care, can help ease back pain through spinal adjustments and manual manipulations, ultimately improving pain relief.
Yoga has long been touted as a healing activity that extends beyond its known fitness benefits. It can help alleviate depression, relieve stress, and decrease anxiety as well as tighten and tone the body.
A 2016 study by Yoga Alliance and Yoga Journal shows that the more than 20 million people who practice yoga spend more than $10 billion on related classes and products. Chiropractors have picked up on the benefits of yoga and are recommending it to their patients. Why, because it helps to improve flexibility as well as spinal health.
Contents
Chiropractic and the spine�s role in the body.
Chiropractic is primarily intended to align the spine and balance the body. The spine is the primary support for the body. It houses most of the central nervous system and provides pathways for neural impulses to move throughout the body.
When the spine is out of alignment, it can affect how the central nervous system functions. It can also affect flexibility and even overall mobility as well as cause pain and stiffness.
Chiropractic treatment brings the spine back into alignment. It helps to balance the body and treat injuries as well as help with the changes the aging body experiences.
One of the best-known uses for chiropractic is to treat pain. It is a medication free, non-invasive treatment for chronic pain, sports-related injuries, and even automobile accidents. Many patients had reported finding relief with chiropractic when nothing else worked.
Combining yoga with chiropractic increases the effectiveness of the treatment while strengthening the body and making it better able to respond to it. It is the perfect complement to chiropractic care, and many patients are discovering tremendous health benefits from this winning, healthy combination.
What is Yoga?
In its purest form, it is an ascetic and spiritual discipline that comes from Hindu culture. It involves simple meditation, conscious breathing or breath control, and performing certain body postures.
While an ancient practice long used for spiritual and emotional healing as well as physical wellness, yoga has been adopted in western culture and widely accepted as a form of fitness as well as a therapeutic practice used for relaxation and overall good health. It focuses on inward healing for outward results.
People who regularly practice find they are more centered, handle stress better, and aren�t as likely to experience depression and anxiety. They also are more flexible, have better mobility, and have stronger leaner bodies.
What happens when you combine yoga and chiropractic care?
Because yoga helps to lower blood pressure, decrease stress, and strengthen the body�s core, it is perfect therapy for the chiropractic patient. While chiropractic care is working to align the spine and balance the body, yoga is helping to strengthen the muscles surrounding the spine, providing better support. The numerous health benefits, particularly regarding blood flow and relaxation help to increase chiropractic�s effectiveness as a pain management tool.
Patients who combine yoga and chiropractic will also often find that they see the effects of both treatments much faster than they would if they were only doing one or the other. Both chiropractic and yoga help with balance, flexibility, and mobility, but they come at it from somewhat different approaches. The benefit of this is that it provides a more balanced, well-rounded treatment in these areas as one supports the other.
Yoga also tones and tightens the body, preparing it for much more profound levels of healing, cleansing and releasing the body of tensions that may have been held�in for years. It also works to stretch muscles that have been restricted for years, or even for the patient�s entire life. It prepares the body to accept the full benefits of chiropractic and respond faster and more thoroughly.
Spondylolisthesis occurs when a�vertebra of the spine slips forward over the vertebra below it. Spondylolisthesis can be categorized as: congenital spondylolisthesis, which means the disorder is present at birth; isthmic spondylolisthesis, which occurs when a defect occurs in a supportive vertebral structure of the spine; and degenerative spondylolisthesis, which is more common and is frequently associated with degenerative disc disease, or DDD, where the intervertebral discs lose hydration with age.
Contents
Development of Spondylolisthesis
The spinal column is exposed to directional pressures while it carries, absorbs, and also distributes most of the fat of the body throughout physical activities and during rest. To put it differently, while the spine is consuming and carrying body fat, additionally, it moves in different directions (e.g., rotate, bend forwards ). This mixture of functions causes unnecessary stress to be placed onto the vertebra and the supportive vertebral�structures of the spine, and it might result in one of these slipping forwards over the ones beneath it, ultimately developing into spondylolisthesis.
Grading spondylolisthesis
Doctors “grade” the severity of spondylolisthesis utilizing five descriptive categories. Even though there are several factors your physician notes when evaluating your spondylolisthesis, the grading scale (below) relies on how far forward a vertebral body has slid over the vertebra beneath it. Often, the doctor uses a lateral (side view) x-ray to examine and grade�spondylolisthesis. Grade I is a smaller slide than Grade IV or V.
Grade I: Less than 25% slip
Grade II: 25% to 49% slip.
Grade III: 50% to 74% slip.
Grade IV: 75% to 99% slip.
Grade V: The vertebra has fallen forward off the vertebra below it. This�grade is the most severe type of spondylolisthesis and is medically referred to as�spondyloptosis.
Who Might be at Risk
If a family member has spondylolisthesis, your risk for developing the disorder may be higher. Also, some physical activities can make you more vulnerable to developing spondylolisthesis. Gymnasts, linemen in football, and weightlifters, all put pressure and stress on their spine. Picture the movements gymnasts perform on a regular basis: they bend backward and twist through the air, landing quickly and absorbing the impact through their legs and back. Those motions can place strain on the spine, potentially causing spondylolisthesis.�The scope of our information is limited to chiropractic, spinal injuries, and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Scoliosis Pain and Chiropractic
The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, other aggravated conditions can also cause back pain.�Scoliosis�is a well-known, health issue characterized by an abnormal curvature of the spine and it is subcategorized by cause as a secondary condition, idiopathic, or of unknown cause, or congenital. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain associated with scoliosis through the use of spinal adjustments and manual manipulations, ultimately improving pain relief. Chiropractic care can help restore the normal curvature of the spine.
Everyone knows that exercise is great for overall wellness, better health, and a healthy body. Many chiropractors will often recommend regular exercise to their patients who need to lose weight, want better mobility, or are seeking relief from depression. Some chiropractors are turning to Pilates to help their patients get stronger, more flexible, and more mobile.
Contents
What is Pilates?
In the early 20th century Joseph Pilates developed the exercise program to help World War I soldiers improve their physical fitness. It was used to rehabilitate patients who had been injured. By incorporating resistance, stretching, and target strengthening exercise, Pilates uses resistance bands, individual machines, and floor work to reshape and rehabilitate the body. Dancers, gymnasts, athletes, and celebrities use Pilates to stay in shape. However, anyone can do it for a healthier, more supple spine.
Care of the spine is at the core of Pilates. By keeping it in a neutral, or natural, position, this exercise can prevent back pain as well as help ease it. When done correctly, Pilates can:
Improve muscle control and movement efficiency through mental focus.
Make you more mindful of your body�s position, specifically, remaining aware of the spine�s position and keeping it neutral
Improve centering and mental focus through special, breathing techniques
Support and improve posture by strengthening the abdominal and back muscles.
Benefits of Pilates for Chiropractic Patients
The benefits of Pilates tremendous, but for chiropractic patients, it is even more so. By regularly incorporating Pilates into your exercise routine, you can enjoy these incredible benefits.
You can adapt Pilates to your fitness level and needs. Whether you are just starting a fitness program or you�ve been working out for years, Pilates can be tailored to your fitness needs and level.
It helps you strengthen your core. The deep muscles of your abdomen, back, and pelvic floor make up the core muscles of your body. Many of the movements focus on these muscles, making a body that is strong and the frame is supported.
Allows you to strengthen your muscles without bulking up. With Pilates your muscles get strong, but it also stretches the muscles so that they are lean and long. You will look toned and tight but not bulky and muscular.
It focuses on whole body fitness. Many types of exercise only work certain parts of the body, but this focuses on entire body fitness. It works every part of the body so that the muscle development is balanced.
It helps to improve your posture. It strengthens your body and helps to keep your spine in proper alignment due to a strong core. As a result, your posture naturally improves. By incorporating it into your exercise routine, you will find yourself standing taller, stronger, and more graceful.
You can become more connected through your mind and body by increased awareness. Pilates engages your mind and increases body awareness. It unites the mind, body, and spirit for complete coordination. Each movement is done with full attention.
It improves your flexibility. Pilates is a gentle but powerful exercise that works to safely stretch the muscles, making them longer, and increasing the range of motion in the joints.
It can protect you from injuries. By strengthening your body, Pilates can help protect you against injury. It conditions your whole body so that your muscles and strength are balanced. This reduces your risk of injury.
You get a natural energy boost. Just like with any exercise, it will give you an energy boost. However, it is increased even more thanks to the focused breathing and increase in circulation stimulating the muscles and spine.
It can help you lose weight and attain a lean, long, healthy body. It tones and strengthens the body, and if you do it regularly, it will reshape you. The body is more muscular and more balanced. It also helps you move with more grace and ease.
Scoliosis is a medical condition where an individual’s spine is diagnosed with an abnormal curve. The natural curvature of the spine is generally “S” shaped when viewed laterally, or from the side, and it should appear straight when viewed from the front or back. In many instances, the abnormal curvature of the spine with scoliosis increases over time, while in others, it remains the same. Scoliosis can cause a variety of symptoms.
Scoliosis affects approximately 3 percent of the population. The cause of most instances is unknown, however, it is believed to involve a mixture of environmental and genetic variables. Risk factors include having relatives with the same problem. It may also develop due to other health issues, such as Marfan syndrome, cerebral palsy, muscle spasms, and tumors like neurofibromatosis.� Scoliosis commonly develops between the ages of 10 and 20 and it commonly affects girls more than boys. Diagnosis is supported with X-rays. Scoliosis is classified as structural, in which the curve is fixed, or functional, in which the underlying spine is normal.
Treatment is based upon the level of curve, place, and trigger. Curves can be viewed periodically to record the progression of scoliosis. Bracing is frequently utilized to treat scoliosis. The brace must be fitted into the individual and used until the progression of scoliosis stops. Exercise is advocated towards the improvement of scoliosis. Other alternative treatment options, such as chiropractic care, can restore the natural curvature of the spine. The scope of our information is limited to chiropractic, spinal injuries, and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Scoliosis Pain and Chiropractic
The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, other aggravated conditions can also cause back pain. Scoliosis is a well-known, health issue characterized by an abnormal curvature of the spine and it is subcategorized by cause as a secondary condition, idiopathic, or of unknown cause, or congenital. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain associated with scoliosis through the use of spinal adjustments and manual manipulations, ultimately improving pain relief. Chiropractic care can help restore the normal curvature of the spine.
New Year�s Resolutions made by well-meaning but, unfortunately, less than 10 percent of people who make resolutions feel that they successfully achieve them and only 45 percent last past six months. Self-improvement goals like lose weight, eat healthier, quit smoking, and life improvement rank in the top five more popular resolutions. So, what is that 10 percent doing that makes them successful at achieving their goals? What sets them apart?
Contents
SMART Approach to Successful Goals
The SMART approach is a guide for setting realistic goals and attaining them. It is an acronym that outlines a success-focused strategy for goal setting:
Specific
Measurable
Accountable
Realistic
Timeframe
Each step will bring you closer to achieving your goals and improve your health.
Be SPECIFIC about your goals
Vague, ambiguous goals can�t stand up to time and temptation. Get specific.
Say you want to lose weight. How much do you want to lose? How do you plan to accomplish it? What are your reasons for setting this goal? Whatever goal you are setting, ask why and get specific about the details.
Set Goals that are MEASURABLE
If you set a goal that you can�t measure, how will you know when you reach it?
Any goal that you have can be measured in some way. Weight loss is measured in pounds, how your clothes fit, or how many inches you�ve lost. Eating healthy can be measured by what foods you incorporate into your diet, getting the junk food out of your pantry, and finding healthy recipes.
It helps to break your main goal into several smaller, attainable ones. It lets you see success very early, and you keep seeing success which spurs your motivation, making you less likely to abandon your efforts.
Hold Yourself ACCOUNTABLE
Accountability is a great motivator for helping you stick to your goals. Keeping a journal has long been a great way to keep yourself accountable, but there are many website and software programs that you can use to track your efforts that may prove to be even more effective.
Partnering up with a buddy is also a great strategy. Choosing someone who has a goal similar to yours allows you to hold each other accountable. Plus, success is always better when you can share it with a friend.
Keep Your Goals REALISTIC
Unrealistic or unattainable goals are motivation killers. Even goals that are too difficult or require high-pressure effort over a long period can be challenging to�see all the way through.
As you sit down, think about not only what you want to achieve, but what that looks like in your life. In other words, consider your personality and lifestyle, structuring your goals to accommodate those factors.
If your goal is to lose weight, setting a goal of 30 pounds in 30 days is not only unrealistic but unhealthy. On the other hand, setting a 2 pound per week loss is a goal that you will likely find to be much easier.
Set a TIME-FRAME, but Keep it Flexible
Creating a timeframe for meeting your goals gives your efforts structure which helps to keep you motivated. Make sure your timelines are realistic; give yourself enough time.
If the constraints are too tight, you could find that you veer off the path and even lose sight. Stay flexible, though. If you don�t reach a target within a given timeframe, don�t be afraid to move it a little.
As long as you are moving forward, toward your goal you don�t need to limit yourself just because you didn�t complete it within the time you allotted initially. It�s about meeting your goals�and making lasting changes that will affect your overall health for the better. Cut yourself some slack.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
