Athletes
Sports Spine Specialist Chiropractic Team: Athletes strive to achieve their body’s maximum performance by participating in numerous training regimens consisting of strenuous exercises and physical activity and ensuring they meet all of their body’s nutritional requirements. Through proper fitness and nutrition, many individuals can condition themselves to excel in their specific sport. Our training programs are designed for athletes that look to gain a competitive edge in their sport.
We provide sport-specific services to help increase an athlete’s performance through mobility, strength, and endurance. Occasionally, however, the excess workouts can lead many to suffer injuries or develop underlying conditions. Dr. Alex Jimenez’s chronicle of articles for athletes displays in detail the many forms of complications affecting these professionals while focusing on the possible solutions and treatments to follow to achieve overall well-being.
by Dr Alex Jimenez | Athletes, Complex Injuries
The majority of clients that present to the clinic with anterior knee pain over the coming year will more often than not have a patellofemoral (PF) problem.
It may be a slight bit of biomechanical mal-alignment that has stirred up the knee cap – this is the good, or they may have started to wear the cartilage behind the knee cap and as a result it has softened – chondromalacia � this is the bad. They may even have worn a hole into the knee cap cartilage and they now have a chondral defect, or worse still an osteochondral defect – the downright ugly.
These problems affect runners, cross fitters, group exercise enthusiasts (PUMP classes) and simple recreational walkers who spend a lot of time on hills and stairs.
How These Extremes Are Managed Will Differ
The biomechanical irritations and the chondromalacia versions can be managed conservatively with a combination of local treatment modalities and correcting the biomechanical faults. The more serious chondral/osteochondral defects often need some surgical intervention as often the pathology is too advanced to respond to conservative treatment alone.
Understanding the exact mechanical contributions of the knee cap in relation to the femur is critical for the therapist to effectively manage these problems.
At the local PF level, the fault is usually a malposition of the patella in the femoral trochlear groove. Often the knee cap is being pulled too far laterally and superiorly in the groove, creating an uneven contact situation between the knee cap and the femur. The PF compression force during loaded knee flexion (squats, lunges etc.) is no longer optimal and usually a smaller portion of the patella cartilage is taking all the load. This wears the cartilage down and creates pain and pathology. This is most noticeable as the knee flexes to 30 degrees and onwards as it is this knee flexion angle where the knee cap enters the femoral trochlear groove.
The more distant (but often dominant) faults lie at the hip/pelvis and at the feet. Below is a breakdown of common biomechanical faults that may contribute to PF pain syndromes.
1. Overpronation
If the foot pronates (rolls in) for too long or too much, the pronated midfoot forces the tibia to remain internally rotated. The femur follows the tibia and also internally rotates. This creates a mal-alignment at the knee whereby the PF arrangement is altered and the knee cap shifts laterally. We are all familiar with the Q angle of the knee and how this affects the PF alignment.
Common causes of overpronation may be structural flatfoot problems that can be corrected with orthotics and shoe selection. However, tight soleus (that limits dorsiflexion) or a tight and overactive peroneal system that everts the foot and flattens the foot can also be a cause.
Stretching and loosening the soleus and peroneals along with strengthening the anti-pronation muscles such as tibialis posterior, flexor hallucis longus and flexor digitorum longus may help fix this problem.
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2. Hip Joint FADDIR
FADDIR represents a flexed, adducted and internally rotated hip joint at foot strike. This is often caused by tight and overactive hip flexors such as TFL and the adductors and weakness in the abductors (gluteus medius) and external hip rotators (gemellus, obturator muscles). This hip posture forces the femur to roll inwards and as a result the knee is deviated medially and away from the vertical line drawn up from the foot. This also increases the Q angle and PF misalignment results and perpetuates the local knee imbalance of tight and overactive lateral quadriceps and lateral hamstrings along with ITB tightness. As a result the VMO weakens.
Loosening the overactive TFL, adductors, lateral quad, ITB and lateral hamstring whilst strengthening the gluteus medius, hip external rotators and VMO may help this biomechanical mal-alignment.
3. Pelvic Trendelenburg
Defined as lateral pelvic shift whereby at stance phase the opposite side of the pelvis drops down below the height of the pelvis on the stance side. This is usually caused by a weak gluteus medius complex that is unable to hold the pelvis stable during stance phase. The implications again are that this causes the knee to roll in and increase the Q angle. The solution is to muscle up the gluteus medius.
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4. Hip Flexor To Extensor Imbalance
This often forgotten about imbalance creates a situation whereby the individual finds it difficult to attain hip extension at the end of stance phase. The hip remains locked in a degree of flexion.
The knock on effect is that the knee also stays locked in some flexion. With the knee in flexion, the knee cap is now compressed against the femur, compression on the underside of the kneecap may result. To fix this the therapist needs to stretch/loosen the hip flexors and strengthen the gluteus maximus to promote more hip extension.
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by Dr Alex Jimenez | Fitness, Health, Wellness
This article originally appeared on Time.com.�
People who run marathons go through intense training before enduring the physically grueling 26.2-mile event�so it�s little wonder their health can sometimes suffer. But on marathon days, the event can also create unexpected problems for non-runners who need urgent medical care.
In a new report published in the New England Journal of Medicine, researchers found that road closures and traffic disruptions on marathon days can lead to delays in emergency care that can cost people their lives.
Dr. Anupam Jena, from the department of health care policy at Harvard Medical School and Massachusetts General Hospital, and his colleagues analyzed data from Medicare claims for hospitalizations for heart attack in 11 cities that hosted marathons from 2002 to 2012. They compared the death rates of these people on marathon days to those a few weeks before and after the marathon. People who had heart attacks on marathon days had a 13% higher rate of death than people on other days. Ambulances also took 4.4 minutes longer on days marathons were run.
�We were expecting to see there would potentially be delays in care,� says Jena, �but not necessarily increases in mortality. It�s difficult to influence mortality; you would have to have substantive delays in care.�
RELATED:�Is Running Good or Bad for Your Knees?
Road closures, detours and other changes in traffic patterns were dramatic enough to cause delays that could affect a person�s chance of surviving a heart attack, the team found. Over a year, marathons could contribute to an additional four deaths, based on the 30-day mortality rate calculations. The effect remained strong even after they adjusted for the possibility that more people visit a city hosting a marathon, and therefore statistically there may simply be more heart events. The researchers also made sure that hospitals and emergency services were not short-staffed or overburdened with the added volume of requests. All of these factors were similar on marathon and non-marathon days.
The disruption in traffic during a marathon is the primary reason for delays in care, Jena says. That�s good news because it�s a fixable problem; marathon planners can ensure that access to hospitals is not congested and affected by the race route.
The other lesson from the study is useful for people in need of medical attention. A quarter of the people in the study chose not to call an ambulance and instead drove themselves to the hospital�perhaps because they thought that emergency services were tied up with the marathon�and these people seemed to account for most of the higher mortality on marathon days, says Jena. That may be because they were forced to take more circuitous routes to reach the hospital, he says. �They don�t experience the four-minute delays of ambulance transport; they�re experiencing much larger delays because they are trying to drive themselves.�
Even with the delays, ambulances were the best form of transportation to the emergency room. �Anybody thinking of driving to the hospital themselves on the day of a major public event should pick up the phone and call 911,� Jena says.
by Dr Alex Jimenez | Chiropractic, Mobility & Flexibility, Power & Strength
I have been travelling through Athens and now Istanbul. My 11 year old is a Percy Jackson nut and has been filling me in with the who’s who of Greek mythology and I am learning Latin words every day. Quite an education!
I looked up the word syndesmosis and the Latin translation is “(New Latin, from Greek sundesmos) bond, ligament, from sundein, meaning to bind together”. As sports injury professionals, we know syndesmosis to be the joint articulation between the tibia and the fibula bones around the ankle. These two bones are �bound’ together with very firm and strong ligaments.
Syndesmosis comes to mind after I saw a girl sprain a syndesmosis at the Archaeological Museum in Istanbul today. This poor girl was preoccupied by the hundreds of cats and kittens running all over the place and did not see the uneven cobblestones on which she placed her foot. At the same time, she turned to change direction. This is a common mechanism of injury for a syndesmosis – a forced dorsiflexion and rotation on a fixed foot.
Rehab Masterclass Issue 140 Of Sports Injury Bulletin
Of all the ankle injuries, injury to the syndesmosis is the biggest pest to sports physios and the like. And unlike simple garden variety ankle sprains that heal quickly, the syndesmosis takes a LONG time to heal properly. If you deal with athletes that are susceptible to syndesmosis sprains, I’m sure you will agree that these are harder injuries to manage because of the severe consequences if done badly.
I go into a fair bit of detail in my Sports Injury Bulletin piece about syndesmosis injuries, detailing how they happen, how to identify them and then manage them. What I would like to highlight here are the implications of mismanaging a syndesmosis sprain.
In the current issue of The Journal of Sports and Physical Therapy, a group of Japanese researchers discovered that individuals who had chronic ankle instability (CAI) had a distal fibula that was positioned more lateral compared with healthy individuals with no CAI. In effect, those who had suffered serious syndesmosis injuries in the past and ended up with a wider distance between the fibula and the tibia, suffered more ongoing ankle pain than those without a tibfib separation.
Research shows that even a 1mm displacement of the talus within the mortise (due to a wider placed fibula) can reduce the contact area in the talocrural joint by 42% (Ramsey and Hamilton 1976). Mismanaged syndesmosis injuries, resulting in an excessive amount of opening, can lead to early onset arthritic changes and chronic ankle instability. The talus bone bounces around in the now wider tibfib articulation.
A Widening Of The Fibula Is Due To One Of The Following:
Poor initial management, whereby the athlete is allowed to weight bear too early and this weight bearing forces the fibula away from the tibia as the syndesmosis ligaments are trying to heal.
The degree of damage is so severe that proper tightening of these ligaments is not possible without surgical intervention such as a screw or similar being placed between the two bones to �force’ them together.
The key for a sports injury practitioner, is to properly identify a regular ankle sprain from a more serious syndesmosis injury. If you get this part wrong and allow the athlete to get back to weight bearing too early, then expect some complaints about a chronically painful ankle some time down the track.
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Kobayashi et al (2014). �Fibular malalignment in individuals with chronic ankle instability.’ JOPST. 44(11); pp 841-910.
Ramsey and Hamilton (1976). J Bone and J Surgery Am. 58(3); 356-357.
by Dr Alex Jimenez | Fitness, Health, Wellness
Yoga can be an effective way to prevent and ease aches and pains—but it can also cause them if you’re not careful. The key is proper alignment. Go from “ow” to “om” in seconds by making simple alignment tweaks to common poses. In this video, Yoga With Kirby founder Kirby Koo shows you quick fixes to take pressure off your knees, wrists, and neck. These basic principles can be applied throughout your practice to help prevent pain before it starts.
Warrior II
Once you’re set up in Warrior II, pay attention to the position of your front knee. Is it sticking out beyond your ankle? Is it collapsing inward? Pull your knee back into place, so it’s stacked directly above your ankle, and tracking in the same direction as the toes of your front foot. This protects the ligaments in your knee and prevents knee pain.
Related Content: Try This 15-Minute Yoga Flow for Stress Relief
Plank
Plank is a great core stabilizing exercise if you have proper alignment. But if your belly and hips sag in this pose, then your wrists are probably taking on the brunt of your body weight. In plank, engage your core muscles by imagining a zipper running up from your pubic bone to your belly button. This should help raise your hips so your body forms a continuous line from the top of your head to your heels, a more stable position that will help distribute your body weight more evenly and ease the pressure in the wrists.
Cow Pose
Cow pose can feel super satisfying, but it’s easy to go overboard and strain your neck while you’re enjoying the gentle backbend. When you’re in cow pose, it’s important to remember not to tip your head too far back, shortening the back of the neck. You’ll get a lot more out of the pose (and avoid neck strain) if you imagine your neck as an extension of the gentle curve of the spine. Lift your gaze only as far as you can without compromising the curve in your spine and the length in the back of your neck. The same concept can apply for Upward-Facing Dog, too!
by Dr Alex Jimenez | Exercise, Fitness, Health, Wellness
Maybe this will be the news that finally jolts you off the couch and into an exercise program. A new study suggests that being physically active increases the chances of survival after a heart attack.
Researchers compared exercise levels among 1,664 heart attack patients in Denmark, including 425 who died immediately. Those who had been physically active were less likely to die, and the risk of death decreased as exercise levels rose. Patients who had light or moderate/high physical activity levels were 32 percent and 47 percent less likely to die from their heart attack, respectively, than the sedentary patients.
The study was published April 12 in the European Journal of Preventive Cardiology.
“We know that exercise protects people against having a heart attack,” said study co-author Eva Prescott, a professor of cardiovascular prevention and rehabilitation at the University of Copenhagen. “Animal studies suggest that myocardial infarctions [heart attacks] are smaller and less likely to be fatal in animals that exercise. We wanted to see if exercise was linked with less serious myocardial infarctions in people,” she added in a journal news release. “One possible explanation is that people who exercise may develop collateral blood vessels in the heart which ensure the heart continues to get enough blood after a blockage. Exercise may also increase levels of chemical substances that improve blood flow and reduce injury to the heart from a heart attack,” Prescott said.
She added this caveat: “This was an observational study so we cannot conclude that the associations are causal [cause and effect]. The results need to be confirmed before we can make strong recommendations.
“But,” Prescott added, “I think it’s safe to say that we already knew exercise was good for health and this might indicate that continuing to exercise even after developing atherosclerosis [hardening of the arteries] may reduce the seriousness of a heart attack if it does occur.”
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
by Dr Alex Jimenez | Anti Aging, Seniors
The health benefits of exercise are well-established for people of all ages. But until now, little has been known about which type of exercise best counters the aging process in senior citizens.
The answer may be high-intensity interval training, suggests a new study published in Cell Metabolism by researchers from the Mayo Clinic.
High-intensity interval training (HIIT) alternates short bursts of intense aerobic activity such as biking or walking with short periods of easing up on the same activity.
This type of exercise, which originated in Sweden, is promoted as an efficient training method that avoids the risk of injuries associated with non-stop, repetitive activity.
Compared to other types of exercise, it appears to be dramatically more effective at boosting the activity of aging cells and even reversing age-related cellular damage.
The Mayo Clinic researchers recruited 72 healthy but sedentary men and women from two age groups: “young” subjects ages 18-30 and “older” subjects ages 65-80.
The researchers conducted baseline measurements of aerobic fitness, lean muscle mass, blood-sugar levels, and insulin sensitivity. After taking biopsies from the subjects’ thighs, they also assessed genetic activity in muscle cells and the health of the energy-producing mitochondria within those cells.
As we age, mitochondrial capacity gradually deteriorates. As a result, cells become damaged and weak.
The researchers randomly assigned subjects to one of three groups:
HIIT on stationary bicycles. Three days per week, they pedaled hard for four minutes, eased up for three minutes, then repeated the sequence three more times. On other days, they did a moderate treadmill routine,
Moderate-intensity training. Three days per week, they pedaled on stationary bikes for 30 minutes. On other days, they lifted light weights.
Vigorous weight training. Participants engaged in weight lifting several times per week.
No exercise. A fourth group did not engage in organized physical activity.
After 12 weeks, the researchers found that all three exercise groups experienced significant gains in fitness and blood-sugar regulation compared to non-exercisers.
As expected, they found that the high-intensity interval training group had the biggest improvement in endurance while the weight training group had the biggest improvement in muscle mass and strength.
But they were astonished to find that high-intensity interval training was most strongly associated with age-reversing changes at the genetic and cellular levels.
In the “younger” group assigned to high-intensity interval training, the activity level changed in 274 genes. That compared to activity-level changes in 170 genes in the moderate-intensity training group and 74 genes in the weight training group.
Genetic changes were even more dramatic in the “older” group assigned to high-intensity interval training. They saw activity-level changes in nearly 400 genes. That compared to activity-level changes in only 33 genes in the weight training group and only 19 genes in the moderate-intensity training group.
High-intensity interval training had a similar effect on mitochondrial capacity: a 49 percent increase in the “younger” group and a whopping 69 percent increase in the “older” group.
This type of exercise also led to improved insulin sensitivity, which is associated with a reduced risk of diabetes.
The researchers cautioned that their primary goal was to show how exercise works at a molecular level, not to provide prescriptive exercise for seniors or anyone else. They hope to learn more about how exercise benefits different tissues in the body.
For the time being, they say that vigorous exercise remains the most effective way to bolster health.
“There are substantial basic science data to support the idea that exercise is critically important to prevent or delay aging. There’s no substitute for that,” senior author Dr. Sreekumaran Nair said in a statement.
Most experts agree that many older adults can participate in an age-appropriate high-intensity interval training program that takes into account their physical limitations.
Older adults are more likely to have an underlying health issue such as osteoporosis, arthritis, diabetes, hypertension or a history heart disease, heart attack, or stroke.
So it’s essential for them to consult with their primary care provider and take a cardio-stress test before beginning a new exercise program, especially one that involves vigorous activity.
by Dr Alex Jimenez | Diets, Fitness
Local bans on artery-clogging trans fats in restaurant foods led to fewer heart attacks and strokes in several New York counties, a new study suggests.
The study hints at the potential for widespread health benefits from an upcoming nationwide ban, the authors and other experts say. The U.S. Food and Drug Administration in 2015 gave the food industry until next year to eliminate artificial trans fats from American products.
New York City enacted a restaurant ban on the fats in 2007 and several counties in the state did the same. Hospital admissions for heart attacks and strokes in those areas declined 6 percent starting three years after the bans, compared with counties without bans. The results translate to 43 fewer heart attacks and strokes per 100,000 people, said lead author Dr. Eric Brandt, a Yale University cardiology fellow.
His study was published Wednesday in JAMA Cardiology.
Trans fats, also called partially hydrogenated oils, enhance food texture and structure. They were once commonly used to make restaurant fried chicken, French fries, doughnuts and other foods and found in grocery items including cookies, crackers and margarine.
These fats can boost blood levels of unhealthy cholesterol, increasing risks for heart problems. The FDA in 2006 required them to be listed on food labels and the food industry has been switching to healthier oils.
The researchers examined hospital admissions data from 2002 to 2013 in 11 New York counties that adopted bans and in 25 counties that did not. Admissions for heart attacks and strokes declined in all counties, going from more than 800 to less than 700 per 100,000 people, but the drop was steeper in counties that enacted bans.
Alice Lichtenstein, a heart and nutrition specialist at Tufts University’s Boston campus, said the results are encouraging but that other changes could have contributed, such as smoking bans and mandatory calories on menus.
Dr. Mark Creager, former American Heart Association president, said the results echo previous studies “and are consistent with the thinking of most scientists” on potential benefits of these bans.
“Policies such as these when adapted on a nationwide level will be good for our entire population,” said Creager, director of Dartmouth-Hitchcock Medical Center’s heart center in Lebanon, New Hampshire.
