Back Clinic Complex Injuries Chiropractic Team. Complex injuries happen when people experience severe or catastrophic injuries, or whose cases are more complex due to multiple trauma, psychological effects, and pre-existing medical histories. Complex injuries can be serial injuries of the upper extremity, severe soft tissue trauma, and concomitant (naturally accompanying or associated), injuries to vessels or nerves. These injuries go beyond the common sprain and strain and require a deeper level of assessment that may not be easily apparent.
El Paso, TX’s Injury specialist, chiropractor, Dr. Alexander Jimenez discusses treatment options, as well as rehabilitation, muscle/strength training, nutrition, and getting back to normal body functions. Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, unwanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.
Shin Splint: Whether you are an avid exerciser, an exuberant shopper, or a small child chaser, you have probably felt tightening and burning in your shin at one point in your life. Sometimes, the pain stops when the activity ceases, but other times the pain remains. If shin pain continues bothering you, it may be time to face the fact you have shin splints.
The shin is a bone located in the front part of your lower leg. Shin splints commonly occur in athletes who have intensified or changed their training routines. They also show up in regular people who have changed or added activity to their routine.
The shin has a lot of responsibility during exercise, as it absorbs the shock of the steps, raises the toes, and support the arch of the foot.
A few main culprits play a part in shin splints:
failing to stretch properly before exercising
walking or running on hard surfaces, like pavement
wearing the wrong type of shoes during activity
over-exerting the body with strenuous activity
skipping periods of rest between exercise
Individuals who perform any type of exercise should take appropriate measures to alleviate the above risk factors of shin splints. If you notice pain and soreness in the front part of your lower leg, know how to treat this injury properly.
If rest and ice aren�t doing the job and you’re still suffering pain, it’s time to see a doctor. A thorough exam and possibly an x-ray will diagnose the problem.
Chiropractic care is a powerful choice for treating shin splints and reducing their recurrence.
Chiropractic Treatment Benefits Those Suffering From Shin Splint/s:
Reduction In Pain
Chiropractic is proven to relieve the pain associated with bodily injuries and medical conditions, including shin splints. Sometimes one visit is enough to relieve the pain, other times the pain decreases over a series of appointments. Being able to diminish a high degree of pain down to a manageable level is possible for shin splint patients through chiropractic.
Full Body Alignment
The premise behind chiropractic is that it treats the body as a whole, and, in doing so, promotes healing and health to the injured or diseased areas. A chiropractor may work on your neck to help your calf. With shin splints, he or she may align your spine and joints to lessen the impact of activity on your shins. Again, the entire body is treated in order to create the best environment for health restoration.
Healing Through Adjustments
Treating shin splints is a common procedure for chiropractors. Common practice is to adjust the calf, ankle, and foot to stretch and increase blood flow to the area.
Drug Free Treatment Option
A primary benefit of chiropractic care is it requires no over-the-counter or prescription drugs. Individuals who suffer from stomach issues, or simply prefer to avoid drugs, find chiropractic visits a productive alternative to manage pain and promote healing.
It’s routine for chiropractic treatment of shin splints to include a series of stretching and strengthening exercises the individual performs at home between visits. These exercises further expand on the positive effects of the chiropractic therapy.
If you are one of the many people dealing with shin splints, don’t despair! Consider chiropractic care as your main treatment option or in conjunction with other modes of treatment. Within a few visits, you will experience pain reduction, and enjoy a decreased risk of ever dealing with painful shin splints again.
Even if you have never stepped foot onto a court before, you may end up with tennis elbow. Occurring along the muscle that allows extension of the wrist, it is a painful condition that can linger for weeks or months.
Previously, tennis elbow primarily showed up in athletes. Due to the increased interest in physical fitness, tennis elbow is being found in everyday exercisers, as well as people who perform work-related repetitive motion.
Tennis elbow presents several symptoms. Pain will occur on the outside of the elbow an inch or so down from the bony part.
There may also be pain when the individual tries to extend the hand and fingers against resistance. Extreme weakness in the wrist is another symptom.
I Have Been Diagnosed With Tennis Elbow. Now What?
Tennis elbow is often difficult to diagnose, which can delay treatment. A correct diagnosis of tennis elbow is the first step towards being able to treat the condition and rehab the afflicted area. From there, a variety of treatments for tennis elbow are available.
Passive remedies like rest, ice, and arm braces are critical components to healing tennis elbow. Take measures to reduce the movements that aggravate the pain, and use ice at regular intervals to help minimize pain and inflammation.
An arm brace supports and stabilizes the area to promote healing. These remedies assist greatly in treating the condition, especially in the beginning.
Active remedies consist of stretching and strengthening exercises, and are vital aspects of improving the condition. Individuals suffering from tennis elbow should begin an exercise regimen as soon as the pain allows.
An individual dealing with tennis elbow may utilize a variety of medicinal remedies to manage pain and inflammation. Over-the-counter pain relievers and steroid injections are commonly used to treat the condition. Following doctor’s orders when taking medications is strongly recommended.
Untraditional remedies also provide vast improvements in tennis elbow, and these treatments have gained favor in the last few years due to their effectiveness. Regimens of massage therapy and acupuncture work on small areas contributing to the condition, and make significant strides in pain reduction and promote the body’s restorative healing process.
Another remedy that offers strong benefits to treating tennis elbow is chiropractic care. A chiropractor assesses the condition, then lays out a plan to promote healing.
Treatment often includes working to align the bones and treating the surrounding joints so they function at maximum capacity, and can “take up the slack” of the injured area while it heals. Chiropractic care serves the dual purpose of treating the condition directly, and healing the areas around the injury so that the body continues to strengthen and renew.
In a very small number of cases, the only remedy for tennis elbow is surgery. This is considered as the last straw, once all other forms of treatment have been exhausted.
The best way to treat tennis elbow is to avoid it in the first place. Be sure to stretch before exercising, consistently perform strengthening exercises, employ correct techniques and proper equipment during physical activity, and don’t overexert your arms (this goes for your entire body, by the way) during physical activity.
If you are diagnosed with tennis elbow, it’s essential to understand the variety of treatment options available. The best course is often a blend of more than one remedy. Chiropractic care should be part of your healing process, as it helps decrease pain, reduce healing time, and offers a non-medicinal approach to treating the body as a whole.
The Risks Of College Sports
This article is copyrighted by Blogging Chiros LLC for its Doctor of Chiropractic members and may not be copied or duplicated in any manner including printed or electronic media, regardless of whether for a fee or gratis without the prior written permission of Blogging Chiros, LLC.
As experienced chiropractors, we like answering the questions we receive from our patients. A common inquiry is “what is the difference between a sprain and a strain?” Sprains and strains are injuries to the musculoskeletal system that are commonly diagnosed conditions, and are two separate issues people frequently mix up. We will attempt to explain away some of the confusion today.
Let’s look at three ways sprains and strains differ from each other.
1. Sprains & Strains Afflict Different Parts Of The Body.
2. Sprains & Strains Are Most Often Caused From Different Actions.
Falling or twisting the wrong way typically causes a sprain, because the movement forces a joint into an awkward position and ends up stretching or tearing the ligament. Twisting an ankle, falling down the stairs, or trying to catch yourself on an icy walkway are all ways to end up with a sprain.
A strain often results from overexertion or trauma, and repetitive movement. Lifting an item that is too heavy, jumping into an exercise routine that is too strenuous, or performing repetitive movements in either a sport or work are ways an individual can end up suffering from a strain.
3. Sprains & Strains Generally Affect Different Areas Of The Body.
Sprains occur at parts of the body that are injured when falling or suddenly twisting. According to the U.S. National Library of Medicine, ankle sprains alone number around 2 million each year.
Ankles, wrists, knees, and fingers are all areas that are frequently sprained. Strains, on the other hand, commonly occur in the back, shoulder, or hamstring, as both of these areas are affected by overexertion or repetitive movement.
Although sprains and strains are different injuries, they do have some similarities. This is most likely why people get them mixed up.
Let’s discuss a few commonalities of sprains and strains.
Both share common symptoms.� Both injuries can bring on pain, swelling, and limited movement at the injury site. The pain can be moderate or intense, depending on the severity of the injury. Sprains and strains both benefit from ice packs, rest, and elevation.
They can require surgery.� Most diagnosed strains and sprains heal on their own with time, but a serious tear can require surgery to repair. With both injuries, it’s important to visit a doctor if an individual experiences severe pain and swelling, and decreased mobility.
Both can benefit from chiropractic care.� Chiropractors can work wonders on the neck and back, but chiropractic care can assist in lessening the impact of a strain or sprain injury, too.
The benefits of seeing a chiropractor for both sprains and sprains are twofold. Chiropractic treatments promote healing of the injured area as well as help strengthen the areas around the injury to decrease the chance of future injuries.
These types of injuries can sideline individuals from their activities, no matter if they are athletes or regular guys doing yard work. It’s vital to take steps to avoid sprains and strains in the first place.
Always properly stretch and avoid overexertion to prevent strains. Take pains to clear walkways and stairways to avoid falls or sudden twisting movements to decrease the risk of sprains.
Washington Cheerleader Talks Chiropractic
If you end up with a strain or sprain, contact us for a consultation. We have extensive experience in working with patients suffering from sprains and strains.
This article is copyrighted by Blogging Chiros LLC for its Doctor of Chiropractic members and may not be copied or duplicated in any manner including printed or electronic media, regardless of whether for a fee or gratis without the prior written permission of Blogging Chiros, LLC.
Chronic inflammation remains a confusing subject for many. One reason for this is that chronic inflammation does not resemble acute inflammation and is not associated with conditions that are normally treated with medications, spinal manipulation or surgery.
Chronic Inflammation Needs To Be Understood
DD Palmer wrote a chapter in 1914 entitled Inflammation, stating that, “inflammation is present in most, if not all diseases, in the acute if not chronic.” 100 years later, all chronic diseases are inflammatory conditions within local tissues . Chronic systemic inflammation and related pathophysiological changes involve structures and functions that are silent.
Chronic inflammatory condition alters the structure and function of a given tissue and is identified by symptoms and laboratory tests. This enables the application of a name, which describes the chronic state, such as osteoarthritis, fatty liver, tendinosis, diabetes, widespread pain, depression, osteoporosis, heart disease, Parkinson’s disease, Alzheimer’s disease and cancer.
Lifestyle Choices That Promote Chronic Inflammation
Loss of sleep, sedentary living, stress and diet all encourage inflammation.
Dietary interventions may appear confusing and complicated. The first step is to assess inflammatory markers during the examination, which will offer insight for a lifestyle change and management.
Markers For Chronic Inflammation
Laboratory tests are the best approach to spot chronic inflammation. High levels of glucose, triglycerides, hemoglobin A1c protein along with reduced levels of vitamin D and HDL cholesterol are the most reliable in identifying chronic inflammation.
Patients can also fill out a Health Survey Questionnaire (HSQ-12), which identifies health status, which directly correlates to chronic inflammation.�Without doing a lab test,� chronic inflammation can be indirectly measured.
Nutrition For Chronic Inflammation
Diet is a problem for most people with over two-thirds of the population being overweight. Obesity is known to be a chronic inflammatory state associated with chronic pain and degenerative diseases.
Do no focus on the food for a dietary change and instead focus on the inflammatory markers aforementioned. Food can be emotional, with the markers being objective. Avoiding emotion and stress is a way to deal with nutrition effectively, along with weight loss.
The most essential element in reducing inflammation is caloric restriction. Becoming overweight comes from eating too many calories, whether they comes from fat, flour or sugar. Americans, on average, acquire 60 percent of their calories from flour, sugar and oils. The solution is to replace the refined calories with vegetation calories that allow for greater food consumption with lower calories.
Dietary options that can help:
Vegan
Omnivore
Ketogenic
The important thing is to avoid extra salt, flour, refined oils and refined sugar.
Overview
One does not need to understand the chemistry of chronic inflammation to employ an anti-inflammatory lifestyle. It is crucial to understand that inflammation is the underlying cause of disease and most chronic pain.
Fibromyalgia Can Mask Chronic Inflammatory Disease
Core chiropractor, Dr. Alexander Jimenez continues from part I through the core stability routines.
Menu 6: Pulley, Standing
This menu challenges pelvic stability during unilateral standing upper body movements. The kinds of arm movements undertaken in many sports create strong rotational forces that have to be controlled by the trunk and pelvic muscles. The aim of these exercises, therefore, is to develop co-ordination and control of the pelvis.
Research has shown that unilateral exercises increase the recruitment of the core musculature. The core and pelvic muscles will all be using static contractions to hold the required postures, while the upper body muscles will be producing the limb movements. The resistance load on the arm is secondary to the stability challenge of the core. Overall this menu is intermediate.
Rear Sling
Overview: The challenge of this exercise and its pair (see opposite) is to establish perfect pelvic alignment, while standing on one leg, against a rotational force from the upper body.
Technique: Stand on one leg to the side of the pulley column. Handle is attached at below-hip height. Grasp the handle with the hand on the opposite side (opposite to standing leg). Set perfect posture and pelvic alignment.
Brace the core and then pull the weight up and around the body, keeping the elbow straight, so that the arm rotates up
and out. Finish with hand above your head and out to the side slightly. The aim is to maintain perfect balance and pelvic
alignment as you raise and lower the arm diagonally. Reposition to repeat exercise for opposite leg/arm.
Perform 10 reps each side increasing to 20 reps; 2 to 3 sets.
Progression: Increase the weight.
Front Sling
Overview: This is the natural opposite of the rear sling exercise. It involves a forward arm rotation, which must be controlled.
Technique: Stand on one leg to the side of pulley column. Handle is attached at above shoulder height. Grasp the handle with the arm nearest the column (opposite side to standing leg). Set perfect posture and pelvic alignment.
Brace your core; pull the weight down and around the body, keeping the elbow straight so that the arm rotates down and round. Finish with hand next to your hip across your body. The aim is to maintain perfect balance and pelvic alignment as you lower and raise the arm. Reposition to repeat with opposite leg/arm.
Perform 10 reps each side, increasing to 20 reps; 2 to 3 sets.
Progression: Increase the weight.
One Leg, One Arm Rowing
Overview: The challenge of this exercise is to maintain stability while standing on one leg and controlling against a pulling force from the upper body. The pelvis must stay fixed when the upper back and shoulder are pulling backwards.
Technique: Stand on one leg, facing the pulley column. Handle is attached at waist height. Grasp the handle with the opposite arm (same side as lifted leg). Your hand will be out directly in front of you in the start position. Set perfect posture and pelvic alignment, standing tall with shoulders back.
Brace your core; pull on the cable, leading with the elbow in a rowing movement Finish with hand by your side and elbow behind you. The aim is to maintain perfect balance and pelvic alignment as you perform the rowing movement. Reposition to repeat with opposite leg/arm.
Perform 10 reps each side; 2 to 3 sets.
Progression: Increase the weight.
Menu 7: Medicine Ball, Floor
The four exercises in this menu all involve throwing and catching the medicine ball while performing a trunk flexion or rotation movement. The action of throwing the ball during the muscle-shortening phase of each of the exercises increases the force production of the trunk muscles. The action of catching the ball at the start or during the muscle-lengthening phase of each exercise not only increases the force production but also the overall stability challenge.
The impact that the catch has on the upper limb has to be controlled by the trunk. You should be aiming to maintain good spine alignment and correct movement while making the catch. Only use a weight of medicine ball that will allow you to perform the exercises with good technique. If the ball is too heavy, you will sacrifice core stability, irrespective of your arm strength.
Overall these exercises are advanced. However they are also safe and effective for young athletes using light medicine balls to develop dynamic trunk movement and control.
Sit Up & Throw
Overview: An advanced version of a sit-up exercise, in which the throwing action makes the crunch phase faster and the catching action adds load to the return phase.
Level: Advanced
Muscles targeted: Abdominals (Plus upper body)
Technique: You will need a partner to receive and pass the ball. Alternatively perform the exercise in front of a wall and use a medicine ball that will bounce back.
Start in the sit-up position (knees bent) with hands up ready�to receive the ball. Catch the ball and begin to lower back down. Do not collapse back down, control it with the abs and keep hands above the head as you lower down.
Once shoulders are touching the floor (keeping head up and eyes forward), reverse the movement. Throw the ball forward and crunch up at the same time. Follow the throwing action and complete the sit-up as fast as possible. Make sure you crunch as you throw so that the abs contribute to the force of the throw and help you sit up faster. Men should start with a 5kg ball; women with a 3kg ball.
Perform 10 to 20 reps; 2 to 3 sets
Progression: Progress to heavier ball once 3 sets of 20 reps is comfortable
45-degree Sit, Catch and Pass
Overview: A very tough stability exercise that requires massive trunk musculature co-contraction to hold a good spine alignment against the impact of making the catch.
Technique: Sit up with knees bent and lean back at 45 degrees. Aim to hold a �lengthened� spine, with lumbar spine in neutral, shoulders back and neck long and relaxed. It takes a fair amount of control and strength endurance simply to hold this posture perfectly. Aim to get this right before progressing on to the catch and pass.
Raise hands in front of your face and receive a pass from a partner, around this height. As you catch the ball you must hold the long spine position. Do not flex the low back, or become round-shouldered. Gently throw the ball back. Men should start with a 3kg ball; women with a 2kg ball.
Complete a few passes, holding the position for 30 seconds. Perform 2 to 3 sets.
Progression: Raising the hands to above head height makes the stability challenge of the catch significantly harder. Catches made to either side of the head are also more challenging.
Sit & Twist Pass
Overview: A trunk rotation exercise involving catching and passing the medicine ball, which provides a challenge to the obliques to produce powerful rotation, but also pelvic stability, so that the sitting position is stable throughout the movement.
Level: Advanced
Muscles targeted: Abdominals, Obliques
Technique: Sit up with knees bent and lean back at 45 degrees. Aim to hold a �lengthened� spine, with lumbar spine in neutral, shoulders back and neck long and relaxed. Your feet, knees and hips should remain reasonably still throughout this exercise, the rotation coming from your waist and not your hips.
Hold hands to one side ready to receive the ball. Catch the ball to one side and absorb the catch by turning your shoulders further to that side. Reverse the rotation, turning back to the middle and release the ball. Continue rotating to the other side; receive the ball the other side and continue. Ensure you�can hold good posture throughout the movement, with a long spine and wide shoulders. Men should start with a 4 to 5kg ball; women with a 2 to 3kg ball.
Perform 10 to 20 reps.
Progression: Increase the weight of the ball once you can perform a set of 20 reps comfortably with perfect technique.
Kneeling Twist Pass
Overview: To perform the rotation movement in this position demands a greater range of motion, helping to develop strength through the full range of trunk rotation. It may also help to develop trunk rotation range of movement.
Level: Intermediate to advanced
Muscles targeted: Obliques
Technique: Kneel upright with good posture (lumbar spine in neutral, chest out, shoulders low). Start with the ball in hands and twist shoulders and head round as far as you can. Then, under control, twist around to the other side as far as possible, and hand the ball to partner. Turn back to the start position, receive the ball again and continue.
The aim of the movement is to rotate through the biggest shoulder turn you have. You can allow the hips to rotate a little with the shoulders, but not too much. You should feel a stretch in the side at the end of each twist.
As you gain greater flexibility and stability you will be able to�fix your pelvis square to the front and rotate through an increasingly full range of motion. Men should start with a 5 to 6kg ball; women with a 3 to 4kg ball.
Perform 10 reps then take the ball to the opposite side and repeat.
Menu 8: Medicine Ball, Standing
The aim of this menu is to perform trunk movements while standing on one leg. This is functional training for balance in sports and daily living activities. These exercises are advanced because of the requirements for lower limb balance and body movement awareness, which makes controlled performance of these trunk movements quite difficult. These moves also use the hip rotator and abductor muscles for control and stability.
One-leg Twist Pass
Overview: A trunk rotation exercise performed on one leg. This requires good pelvic stability at the hip of the standing leg, for the trunk rotation to be dissociated from the pelvis.
Technique: Stand on one leg with hips facing square to the front. Hold medicine ball slightly out in front. Slowly twist from side to side. The rotation comes from the waist only,�head turning with the shoulders. Keep pelvis fixed square and knee in line with second toe throughout. Men should start with a 5 to 6 kg ball; women with a 3 to 4 kg ball.
Perform 10 slow reps; 2 to 3 sets. Repeat on other leg.
Progression: Swap the ball for a pulley machine and add resistance, once you have mastered the controlled balance on one leg.
One-leg Deadlifts with Rotation
Overview: An advanced exercise for the posterior chain of muscles, which includes rotation to challenge control of pelvis.
Level: Advanced
Muscles targeted: Erector spinae, Gluteals (max and med) Hamstrings, Piriformis
Technique: Stand on one leg. Flex the free leg a little at the knee to lift it off the floor, but do not flex or extend the hip of the free leg throughout the movement, in order to keep pelvis in control. Hold the ball in front of you.
Bend down, flexing at the knee and the hip. Lower down until the ball touches the floor by your foot, all the time keeping your arms straight and without reaching excessively with your upper back (ie, maintain a reasonably flat back). Stand back up, pushing down through the foot to use your gluteals correctly to extend the hips.
Alternate between touching the ball down on the inside and then the outside of the standing foot. This means you are internally or externally rotating the hip on alternate repetitions, challenging control of hip rotation. Keep the knee in line with�second toe as much as possible throughout. Men should use a 5kg ball; women use a 3kg ball.
Start with 5 slow controlled reps, 2 to 3 sets. Build up to 10 reps. Repeat on the opposite leg.
Progression: Increase the weight of the ball or use a dumb-bell as you get stronger.
One-leg Catch & Pass
Overview: The main aim of this exercise is to control the impact of the catch without losing balance or rotating excessively at the hips. It�s all about how effectively you can anticipate the impact and produce the required stiffness throughout the body to retain good posture and control. This is a very useful �reaction�-type stability exercise.
Level: Advanced
Muscles targeted: Everything
Technique: Stand on one leg with good posture (lumbar spine neutral, chest out, shoulders wide) and with hips square to the front. Hold hands up ready to catch. Receive catches anywhere within arm�s reach. Make sure the passes are varied in their placement. Aim to restrict movement to arms and/or turning your shoulders, keeping the pelvis and lower limb stable. Use a 2 to 3kg ball that is not too big, so it is easy to catch.
Start with 30 sec bouts of catch and pass on each leg; 2 to 3 sets.
Progression: Receive more forceful passes so the impact of the catch is greater.
Menu 9: Resistance-Based
Menu rationale
The aim of these three exercises is to progress the loading in order to build high-level trunk muscle strength. These exercises can be performed in the 5- to 10-repetition range with a suitably high weight for this number of reps. As you get stronger, you should prioritize an increase in weight rather than an increase in the number of reps. Overall, these exercises are very advanced.
Crunch with Weight
Overview: The standard isolated abdominal exercise with increased load.
Level: Advanced
Muscles targeted: Abdominals
Technique: Perform the crunch in the usual way: knees bent, low back flat, head up and looking forward. Curl the shoulders up and down using just the abdominals. The weight (medicine ball, dumb-bell or barbell weight plate) should be held above or behind the head. Arms are fixed, all they do is hold the weight in place. Do not use arms to move the weight relative to head as the crunch is performed. Keeping the elbows out helps to achieve this.
Perform 5 to10 reps; 2 to 3 sets.
Progression: Increase weight, maintaining the range of 5 to 10 reps per set.
Reverse Hypers
Overview: An excellent hip and back extension exercise to which it is very simple to add load.
Level: Advanced
Muscles targeted: Erector spinae, Gluteals
Technique: Lie on your front on a horizontal bench, with hips just off the end of the bench. Grasp bench legs firmly for support. Your legs should be straight with a dumb-bell between the ankles for resistance. Squeezing the gluteals, extend hips and lift legs and the dumb-bell off the floor. Stop when your back is slightly hyper-extended and hips are fully extended. Lower slowly until feet are just off the floor and continue.
Perform 8 to 10 reps; 2 to 3 sets.
Progression: Increase weight, maintaining the range of 8 to 10 reps per set.
Reverse Crunch with Weight
Overview: This is a great exercise, as it requires good co- ordination and strength. Research shows that the obliques as well as the abdominals work very hard during this exercise, making it excellent value.
Level: Advanced
Muscles targeted: Abdominals, Obliques
Technique: Lie on back with hands behind head and elbows out to the sides. Knees should be bent and heels close to bum. Hold weight between your legs. Initiate the movement by curling the pelvis upwards (flattening the back into
the floor) and then continue to use the abs to pull the low back and pelvis off the floor. This is the bit that requires good co- ordination, as the temptation is to kick with the legs and pull the hips up with the hip flexors. Learn to focus on the abs before you add weight, as if you do this strictly it is very tough, especially for women (whose pelvises are relatively heavier).
Perform 5 to 10 reps; 2 to 3 sets.
Progression: Increase weight, maintaining the range of 5 to 10 reps per set.
Menu 10: Hanging Bar
Menu rationale
The aim of these three exercises is to work the abdominals as hard as possible with very advanced, gymnastic-style movements. Reasonable upper body strength is required for these exercises.
Hanging Leg Lifts
Overview: This exercise requires you to lift the full weight of your legs and (if possible) your pelvis, while hanging from a bar. Anyone who can perform these movements well through a good range of motion has achieved good strength.
Level: Advanced
Muscles targeted: Abdominals, Obliques, Hip flexors
Technique: Hang from a bar with arms straight. Lift knees, bringing them up as high as possible. At the top of the movement the knees should be near the chest and pelvis should be curled upwards (low back flexed). This extra curl of the pelvis ensures that the abdominals are working maximally. Do not kick legs up or swing the body excessively. Simply draw up knees, crunching as you lift. It is important to feel that the abdominals are doing the lion�s share of the work rather than the hip flexors or front of thigh muscles.
Perform 5 to 10 reps;, 2 to 3 sets.
Progression: Perform the same exercise with straight legs, lifting them up to 90 degrees in front of you, curling the pelvis at the top of the movement.
Windscreen Wipers
Overview: The ultimate ab-buster. Anyone who can do 10 reps of this exercise with good technique has a very strong core!
Level: Super advanced
Muscles targeted: Abdominals, Obliques, Hip flexors
Technique: Hang from bar with arms straight. Lift legs up in the air until feet are at approx head height. Maintaining the height of the lift, take the legs from side to side in an arc. The movement will look like a windscreen wiper, moving from side to side. Aim for at least 45 degrees of movement to each side.
Perform 5 to10 reps; 2 to 3 sets.
Progression: The straighter the legs, the harder the exercise. Increasing the range of movement to each side also makes it tougher.
Candlesticks
Overview: Another beauty! Lots of strength required to control this movement; only for the very strong.
Level: Super advanced
Muscles targeted: Abdominals, Obliques, Hip flexors
Technique: Lie flat and raise yourself up to a shoulder stand position, holding on to a bench/table leg/partner’s leg with your hands above your head. Establish a fully extended hip and leg position and then begin to lower your body down slowly to the floor. The body should move in an arc as a single unit (no sagging in the back, or bending at the hips or knees). Lower under control from vertical to just above horizontal.
Gripping firmly for stability, lift your body back up into shoulder stand, again keeping everything straight and aligned in a single unit.
Slow and controlled movement on the way down will help, and a maximal contraction of everything will get you back up.
For many athletes following any major endurance event they will return to their houses, to recover, celebrate, reflect and rebuild to their next career step. Some, like the athlete in this case study will need to now focus attention on delayed decisions concerning whether to go under the knife to sort out a chronic injury.�El Paso, TX’s Injury scientist, Dr. Alexander Jimenez takes a look at the study.
My client has been competing in triathlon for 10 or more years, although his career has included a range of serious injuries which have kept him from races for months on end. In the previous two to three decades, however, he’s enjoyed a sustained period of injury-free training and racing, and has climbed to the peak of the world rankings. But the emergence of hip pain has seen him once more return to the physio’s table.
The triathlete’s accident history highlights a common pattern among sportspeople: 2 tibial stress fractures, a femoral neck stress fracture and a serious ankle sprain — every one of these on his right side. The significant contributing element to the bone stress injuries is a 1.5cm leg-length gap (his right leg is shorter).
He’d first experienced comparable hip pain in 2004; it kept him from running for three months. At that time, nothing was detected on a bone scan or MRI, or so the pain went paralyzed. An intra-articular cortisone injection (CSI) elicited no improvement. The athlete remembers that he chose to train on his painful hip, never allowing the symptoms to settle. The nearest he ever came into an investigation was a hypothesis that he could have a little, undetected, labral lesion.
The present episode of hip pain began initially at night after a hard three-hour bicycle ride. Earlier this, however, he hadn’t cycled for five times. He described his initial symptom as a profound hip tightness (lateral and lateral), together with slight pain in his groin. He was able to continue to train however, was feeling that the hip tightness and pain following both cycling and running (swimming was symptom-free).
A week later his symptoms dramatically worsened when he flew from Australia to Singapore, on his way to a French high- altitude camp. As he got off the airplane, he felt deep hip pain as well as the tightness. As elite athletes tend to do, he coached anyway, running a tricky track session, which made the hip much worse: he was unable to ride or run without pain. He instantly started a course of anti- inflammatories.
I met him in Singapore and evaluated him in the airport, initially ruling out any prospect of a disease or systemic matter. He explained he had been feeling an ache during the night, lying in bed; on waking, the hip would be OK, but got worse the longer he walked.
On assessment, he had the following physical signs:
� walking with obvious limp
� pain on hopping (6/10)
�painful right hip quadrant/impingement test (full hip flexion/adduction)
� reduced right hip flexion (-10 degrees compared to left)
� reduced right hip internal rotation (-10 degrees compared to left)
� increased tone on palpation of TFL, adductors, hip flexors, gluteal, piriformis and deep rotators
� lumbar spine and SIJ were OK
� femoral shaft bone stress test was OK � leg length discrepancy (right side 1.5cm shorter)
� right innominate (pelvis) anteriorly rotated
� weakness in right hip abductors/extensors
� reduced calf endurance on right side (-5 reps)
� ankle dorsiflexion range of movement was OK
� reduced proprioception on right (single leg stance, eyes closed).
I thought the differential diagnoses were:
� femoral neck stress fracture
� labral tear, possibly with hip synovitis
� FAI (femoro-acetabular impingement), possibly with hip synovitis.
I initially treated the triathlete with soft- tissue techniques to reduce the tone around the hip joint. Trigger-point releases were performed on his TFL, adductors, gluteals, piriformis, deep rotators and iliopsoas.�This reduced his jump pain into 3/10. Manual long-leg grip further decreased the strain on hopping (2/10). He still had pain and stiffness on walking but it sensed “simpler. As he prepared to embark on his long run flight to Europe, I counseled him to not sit for too long and maintain his stylish as straight as possible to decrease any potential impingement from hip flexion.
Luckily, the hip didn’t get worse throughout the flight. On arrival at the French high-altitude training centre, we initiated a strategy of two swims and two intensive treatments a day, aiming at reducing muscle tone, restoring his range of hip movement and normal muscle control and stamina. We had been expecting that the problem was not a stress fracture, but just minor hip synovitis that could settle quickly. Following a week of conservative treatment, though, we were just able to keep his hop pain in 2/10, and that he still could not run 20 meters without any pain and limping.
In collaboration with medics, we flew to London to see a sports doctor and get MRI scans. The scans revealed no bone stress reaction, fracture or labral ripping — which was a big relief; however, it did show signs consistent with FAI (femoro-acetabular impingement). He had hip synovitis with a rectal lesion on his femur.
Hip injuries aren’t much reported among triathletes — in fact they are notably absent from reports on Olympic and Ironman triathlons, which mention knee, back, H/ Achilles, lower leg, ankle and shoulder as the most common accidents (1-3).
In this state, when the hip is in maximum flexion and internal rotation, the labrum and cartilage abut and impinge; damage to the articular cartilage and acetabular labrum results from this pathologic bony contact. The contact generally results in a structural abnormality of the femur (“camera impingement”) along with the acetabulum (“pincer impingement”) or a combination of both (“mixed impingement”). Over time, via repetitive micro-trauma, the aggravating motion hurts the hip cartilage or labrum (or both) during normal joint motion. This happens along the anterior femoral neck and the anterior–superior acetabular rim. FAI is a possible trigger of early hip joint degeneration (4).
Arthroscopic surgery is the direction of choice for FAI if symptoms do not settle; however as his next Competition was only three and a half a year off, surgery was not an option. Instead, over a five-day interval, the athlete had two cortisone (CSI) and local anesthetic injections into the hip joint (under ultrasound guidance) to settle the indicators.
Our aim was to grow the hip range of motion and extend the capsule to reduce any additional impingement, slowly returning to regular training. Following the competition, the athlete would then should see a hip arthroscopic surgeon to acquire a surgical opinion to the best option for long-term direction.
Injection Relief
After both shots my customer felt sore for five days. The initial CSI settled his pain on hopping to 1/10 and after seven days he managed to operate without symptoms. But minor hip stiffness and aching at the end of the day prevented him from progressing to optimal training, so that he then underwent a second steroid injection. This settled the hop pain into 0/10 and decreased the aching; so after five times he returned to mild cycling and after seven days he started running again, also.
The athlete admitted that, following the first shot, he had done more and gone tougher in training than directed, as he had felt “good. This mistake of “too much too soon — all too common in elite athletes — had led to excessive inflammation and aching in the hip nightly after training. After the next injection he returned to normal intensity slower and more gradually.
My client built his training up to regular levels by four months following the final injection (swimming five times per week, cycling four days and running six to seven days). He began with very easy cycling on a wind trainer for 30 minutes, building slowly to 90 minutes before cycling on the street. He cycled two days on and one day away and avoided hills to the first two weeks. He started jogging on the apartment for 15 minutes and slowly built up to 90 minutes after three weeks. He did not run hills or about the track; and as he ran only on every single day, he would diligently concentrate on technique.
From week six to week 11, my client remained on anti inflammatory medication and underwent two treatments a day.
The hands-on treatment continued to:
� increase hip range of movement
� stretch the hip capsule
� normalise pelvic symmetry and hip muscle tone
� improve muscle control and strength � improve proprioception
� ensure optimal biomechanics via video assessment (cycling and running).
Eleven weeks after he first felt his hip pain, the triathlete returned to racing; however he failed to finish the first race, partially because of minor hip stiffness but mainly due to “fitness. Fortunately there were not any prolonged symptoms after the race and a week after he successfully returned to competition, coming second in a really strong field. His very minor ongoing symptoms were handled with anti-inflammatory drugs and hands-on treatments.
If this athlete wants to pursue a long- term triathlon career up to the London Olympics, then he will now require surgery. The arthroscopic surgical technique initially assesses the cartilage and labral surfaces, debrides any abnormalities of the hip joint cartilage and hip labrum, removes the non-spherical segments of the femoral head�and any prominent sections of the anterior femoral neck and bony growths on the acetabular rim that may continue to contribute to hip joint impingement.�The alternative is early joint degeneration and onset of osteoarthritis.
References:
1. Wilk B et al: �The incidence of musculoskeletal injuries in an amateur triathlete racing club�. J Orthop Sports Phys
Ther 1995 Sep;22(3):108-12.
2. Collins K et al: �Overuse injuries in triathletes. A study of the 1986 Seafair Triathlon�. Am J Sports Med 1989 SepOct;17(5):675-80.
3. Korkia PK et al: �An epidemiological investigation of training and injury patterns in British triathletes�. Br J Sports Med 1994 Sep;28(3):191-6.
4. Ganz R. et al (2003): �Femoroacetabular impingement: a cause for osteoarthritis of the hip�. Clin Orthop Relat Res. 417:112�120. For more information see: www.hipfai.com
El Paso, TX. science based chiropractor, Dr. Alexander Jimenez looks at this uncommon problem � and how it can be treated.
The true incidence of obturator externus accidents is unknown, as frequently they may be misdiagnosed as hip joint pathology and/ or groin pathology as the website of symptoms as well as also the presenting objective signals may mimic other pathologies such as hip joint labrum pathology, anterior femoral triangle issues and perhaps even gluteal pathology.
Injury for this muscle gifts as a deep obscure groin/hip pain and functionally the muscle may still hide direct involvement as a pain generator since it is primarily a equilibrium muscle rather than a force-producing hip muscle.
This case study presents an unusual case of hip-related pain in a professional baseball player which also shown itself as an injury to the contralateral adductor longus.
The Player
As he was wrestled to the floor, his right hip was compelled at a rapid and loaded flexion/internal turning position. His first sensation was pain deep inside the anterior hip/groin area.
When he presented to the medical team with the accident, he complained of a profound catching sensation inside the hip joint location. It had been difficult to fully bend the hip and to also twist on the stationary limb (because he did whilst kicking a ball). His prior background consisted of a right-sided inguinal hernia repair five seasons before as well as a few gentle on again/off back osteitis pubis-type signs that would normally flare from the first period as his goal-kicking amounts have been increased. He was obviously a left- footed goal kicker.
On examination, he observed that the pain to become worse on passive flexion/internal rotation of the hip (hip walkway test). He was noticeably tight and irritated from the shallow TFL muscle, and also posteriorly across the greater trochanter around the insertion for the gluteals and deep hip rotators. He was also particularly high tone in the right iliopsoas muscle.
He was initially diagnosed clinically because of hip joint sprain due to the mechanism of harm being a pressured flexion/internal rotation type position that would always put pressure on the anterior hip joint capsule/labrum.
He was treated initially with deep iliopoas muscle sparks and hip joint mobilizations using a seat belt to gap the hip joint. He reacted reasonably well with the therapy and immediately felt more comfortable on a hip joint quadrant test. He was rested from coaching for 2 days and ran on the next day and played a match on the fourth day. But during the match, though his right hip did not create any pain, he’d notice pain on his left adductor source that was more pronounced during kicking.
Three days post-game he detected this ongoing left adductor origin pain and it was made worse by kicking again through training. An MRI was performed to Look at the left adductor origin and also the report noted:
Grade 1 left adductor longus strain deep in the
Grade 2 right obturator externus strain on its femoral attachment
Grade 1 right iliopsoas muscle strain in the MTJ.
The surprise finding on the MRI of a grade 2 obturator strain prompted the medical team to more formally assess the participant for ongoing hip joint disorder. The particular features to notice from this medical examination were:
Subjective
? A sensation of weakness and instability in the right hip whilst kicking with the left foot.
? No pain in the right hip with running, even with top-end speed. However, the left adductor longus was symptomatic on running and kicking.
Objective
? Pain on passive right hip internal rotation whilst in 90-degree hip flexion. This pain was deep anteriorly in the hip, almost presented as a groin problem.
? Some discomfort on resisted right hip flexion/external rotation deep inside the iliac fossa.
? Pain and weakness in the left adductor on adductor squeeze tests. These squeeze tests performed at 0/45/90 degrees of knee flexion with a pressure cuff between the knees. Usual pre-season scores measured 260/260/250. On current testing they measured 150/170/180. Pain was felt at the end of the squeeze.
? Discomfort with prone lie hip passive internal rotation. This pain was more focused around the right greater trochanter posteriorly.
Pathomechanics
It had been suspected that this player had endured a secondary injury to the left adductor longus (a muscle used a lot in goal-kicking) due to the inherent failure in bolstering the proper hip throughout the plant phase of the kick due to the inhibition of the right obturator externus, a muscle considered to be an important hip stabilizer and turning control muscle at the hip. With insufficient hip stabilization in kicking, the left hip was required to create more power to compensate for the unstable right hip to gain the length from the kick. Then the left adductor longus failed along with a strain injury led.
Management
The management of the matter initially centered on the two key features being the left-sided adductor strain and the right- sided obturator externus strain.
In the week following the accident, the player was sent to get a series of Actovegin shots to the left adductor longus. This was done according to protocol that was three injections every 48 hours — Monday/ Wednesday/Friday. In this five-day period the adductor longus was handled with deep tissue flush massage and gentle isometric adduction exercises at supine (chunk squeezes) in the three positions of examining — 0/45/90 levels of knee flexion — also as wall squat adductor squeezes in the same positions. The obturator externus was medicated with heavy tissue releases (obtained through the anterior groin region) and direct theraband strengthening of hip external rotation in sitting and in prone. Actovegin shots to the obturator externus are regarded as difficult because of problems with accessing this muscle through the superficial hip musculature.
The adductor exercises progressed into through array adduction with theraband resistance (equally with the left leg being the motion leg as well as the stability leg).
By 12 days post-injury it had been detected that the obturator externus strength had not improved and the player still had deep- seated right back pain pain. It was rationalised that perhaps the direct treatment to this muscle and also the direct open kinetic chain strengthening was possibly making the muscle texture worse. The choice was made to stop any direct hands-on therapy to the muscle and also to prevent any direct open kinetic chain strengthening. Instead the player lasted with bilateral theraband exercises of both hips into flexion and then abduction and expansion in addition to adduction. The avoidance of lead obturator externus soft tissue treatment and exercise appeared to improve the hip function immediately.
The participant started running 20 times post-injury and quickly progressed through running stages over a five-day period of conducting on alternate days. At this point the player’s adductor squeeze scores had improved to steps according to pre- season baselines. However, daily the player ran direct adductor strength operate using a Pilates reformer as a slider drill to immediately load into adduction in addition to hammering theraband adduction exercises in standing and in supine lying.
By 27 days post-injury the player managed to begin kicking, change in direction and rugby training. He played at 30 times post-injury with no ill effects.
Discussion
It arises immediately around the medial side of the obturator foramen, as well as the inferior ramus of the ischium; it also arises in the lateral two-thirds of this outer surface of the obturator membrane, and also in the tendinous arch which completes the canal to the passage of the obturator nerves and vessels.
The action of the muscle is to externally rotate the hip and also helps in hip adduction. It’s postulated to also work as a hip balance muscle in one legged stance along with the obturator internus, quadrutus femoris, piriformis and the gemelli muscles. In a practical activity such as kicking, the muscle acts to stabilize or hold the ball of the femur into the socket (acetabulum).
The incidence of harm to the obturator externus muscle is unknown because there are only a handful of case reports from the medical literature that highlight injuries for this muscle. Additionally, among the vexing issues is the difficulty in creating the correct clinical diagnosis based on the history and physical evaluation. MRI imaging is needed to correctly picture injuries to this muscle.
From the case study introduced, injury for the muscle was a direct result of forceful flexion/internal rotation mechanism to the hip joint. As the muscle primarily functions as a hip stabilizer during jogging, it is possible that a patient can mask symptoms during functioning as the muscle isn’t required to produce any hip skate for locomotion.
Nonetheless, in this event the muscle has a role in stability of the hip during kicking, and for that reason may have produced a poor pelvic/hip complicated during kicking that then led to an accident to the adductor longus on the other hand.
In addition, it seems that direct treatment to the muscle in the form of deep trigger point releases and also direct strengthening may actually delay healing in the muscle in case of injury. This may highlight the value of the muscle as a hip stabilizer instead of a legitimate torque manufacturer in hip rotation.
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3. Sprains & Strains Generally Affect Different Areas Of The Body.
DD Palmer wrote a chapter in 1914 entitled Inflammation, stating that, “inflammation is present in most, if not all diseases, in the acute if not chronic.” 100 years later, all chronic diseases are inflammatory conditions within local tissues . Chronic systemic inflammation and related pathophysiological changes involve structures and functions that are silent.
Loss of sleep, sedentary living, stress and diet all encourage inflammation.
Laboratory tests are the best approach to spot chronic inflammation. High levels of glucose, triglycerides, hemoglobin A1c protein along with reduced levels of vitamin D and HDL cholesterol are the most reliable in identifying chronic inflammation.
Diet is a problem for most people with over two-thirds of the population being overweight. Obesity is known to be a chronic inflammatory state associated with chronic pain and degenerative diseases.
