Scoop.it
Back Clinic Scoop.it. Scoop.it was founded in 2007 as Goojet, a widget platform for mobile phones, by Guillaume Decugis and Marc Rougier. Following the rapid rise of the Apple App Store which made its widget technology redundant, the company changed its strategy to focus on content marketing and rebranded as Scoop.it. The company launched its current content curation service in private beta at the end of 2010. Before opening to all users as a free service in November 2011.
The website enables its users to discover content on their topics of interest that they can curate and publish to their own web page and share to their social networks. Scoop.it received attention from influential bloggers who had identified a need for web content curation. The website rapidly grew in popularity, being ranked by Alexa among the top 1,000 websites globally in 2012, and as of July 2013, it had been visited by more than 75 million people according to VentureBeat. Inbound.org also ranked Scoop.it among the top 50 marketing technology companies in the world. Dr. Jimenez utilizes this platform to further his mission to help those in pain. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
![Causes of Piriformis Syndrome and Sciatica]()
by Dr Alex Jimenez | Complex Injuries, Scoop.it, Sports Injuries
Share Free Ebook
The piriformis muscle is commonly known among athletes and healthcare professionals as a significant muscle in the posterior hip. This muscle functions to control hip joint rotation and abduction and it is also a distinguishable muscle due to its inversion of action in rotation. The piriformis muscle also raises awareness as the various causes of piriformis syndrome, a condition suspected to be a potential source of pain and dysfunction, not only in athletes, but in the general population as well.
Anatomy of the Piriformis Muscle
The piriformis muscle originates on the anterior surface of the sacrum and it is securely held to it by three tissue attachments found between the first, second, third and fourth anterior sacral foramina. Occasionally, its origin may be so broad that it joins the capsule of the sacroiliac joint with the sacrotuberous and/or sacrospinous ligament. The piriformis muscle is a thick and strong muscle that travels out of the pelvis through the greater sciatic foramen, dividing the foramen into the suprapiriform and infra-piriform foramina. As it courses through the greater sciatic foramen, the muscle decreases to a point where it forms a tendon that attaches to the superior-medial surface of the greater trochanter, frequently integrating with the tendon of the obturator internus and gemelli muscles.
The nerves and blood vessels found within the suprapiriform foramen are known as the superior gluteal nerves and vessels, and those found in the infra-piriforma fossa are known as the inferior gluteal nerves and vessels, including the sciatic nerve. Because of its broad size in the greater sciatic foramen, there�s a risk the numerous vessels and nerves that exit the pelvis may become compressed.
The piriformis muscle is closely associated with other short hip rotators as well, such as the superior gemellus, obturator internus, inferior gemellus and obturator externus. The primary difference between this muscle and other short rotators is its connection to the sciatic nerve. The piriformis muscle passes behind the nerve while the other rotators pass before it.
Anatomical Variants
Several anatomical variations have been previously diagnosed among the piriformis muscle. First, there may be additional medial attachments to the first and fifth sacral vertebrae and to the coccyx. Second, the tendon may merge with the gluteus medius or minimus or with the gemellus. Also, in approximately less than 20 percent of cases, the piriformis muscle may be divided into two different segments, through which part or all of the sciatic nerve may travel. Then, the muscle may blend with the posterior hip joint capsule as a conjoined tendon with the obturator internus. Additionally, the distal attachment of the piriformis muscle has been demonstrated to vary in proportion and position on the supero-medial surface of the greater trochanter. It can stretch across 25 to 64 percent of the anterior-posterior length along the greater trochanter, with 57 percent of it attaching more anteriorly and 43 percent more posteriorly. Last but not least, researchers studied its insertion point broadly and discovered that four types of insertions existed and these were characterized based on the relationship to the obturator internus. The variation of placement and width of the distal attachment of the piriformis muscle may influence the effectiveness of the concept known as the inversion of action.
Furthermore, the connection between the piriformis muscle and the sciatic nerve has been a highly debated complication. It�s been previously concluded that there are several anatomical variations among the piriformis muscle and its connection to the sciatic nerve. The sub-types of this variation include: type 1-A, where the muscle is pear shaped with the nerve running anteriorly and inferiorly to this, found in 70 to 85 percent of cases; type 2-B, where the piriformis muscle is divided into two sections with the common peroneal nerve running between the two parts and the tibial nerve travels anteriorly and below, found in 10 to 20 percent of cases; type 3-C, where the peroneal portion loops over the top of the muscle and the tibial portion is found below, found in 2 to 3 percent of cases; and type 4-D, where the undivided nerve passes through the piriformis muscle, found in approximately 2 percent of cases.
Moreover, it is also speculated that two other, very rare variations may occur, demonstrated by letters E and F in the diagram. Type 1-A is the most common variation, displaying the sciatic nerve as it passes below the piriformis muscle.
Function of the Piriformis Muscle
The fundamental functions of the piriformis muscle are to provide hip external rotation and allow abduction at 90 degrees of hip flexion. During weight-bearing, the piriformis muscle restricts femoral internal rotation in the stance phase of walking and running. Also, it assists the short hip rotators in compressing the hip joint and stabilizing it. Because it can exert an oblique force on the sacrum, it may produce a strong rotary shearing force on the sacroiliac joint. Otherwise, this would dislocate the ipsilateral base of the sacrum forward and the apex of the sacrum backwards.
Since the piriformis muscle is the furthest behind of the hip external rotators because of its attachment on the anterior surface of the sacrum, it has the greatest influence to apply a rotation effect on the hip joint. Occasionally, healthcare specialists have found issues with the piriformis muscle where it appears to be tight and hypertonic, while the other short hip rotators which are found closer to the axis of rotation become inhibited and hypotonic.
Inversion of action
The most argumentative complication relating to the function of the piriformis muscle is its reversal-of-function role, best referred to as the inversion of action role. Researchers have suggested that as the hip approaches angles of 60 to 90 degrees and greater, the tendon of the piriformis muscle shifts on the greater trochanter. As a result, its line of pull becomes ineffective as a hip external rotator, however, it does contribute to internal hip rotation. Consequently, it reverses its rotation function at high hip flexion angles.
Nonetheless, more recent studies conducted through anatomical dissection have demonstrated that the attachment of the piriformis muscle onto the greater trochanter can change and, in some instances, it may insert in a position by which it may be unable to reverse its function, for example, in a more posteriorly placed attachment. Thus, stretching the piriformis muscle into external rotation when the hip is flexed beyond 90 degrees, based on the inversion of action role, would be ineffective as a treatment or misleading as an examination technique.
The role of the piriformis muscle at several joint angles is an essential consideration for healthcare professionals who evaluate and treat the causes of piriformis syndrome. Frequently, it�s recommended to stretch the hip into flexion, adduction and external rotation to stretch the piriformis muscle over the glutes by utilizing the reversal of function concept.
MSK Dysfunction and Causes of Piriformis Syndrome
Many decades ago, it was suggested that in some cases, sciatica symptoms may originate outside the spine as a result of the piriformis muscles. This hypothesis was supported soon after when specialists successfully improved an individual�s symptoms of sciatica by surgically dividing the piriformis muscle. Based on cadaver anatomical dissections, the researchers believed that the spasm of the piriformis muscle could be responsible for the irritation of the sciatic nerve.
The medical term piriformis syndrome then became associated to sciatica symptoms, believed to be caused by a usually traumatic abnormality in the piriformis muscle with a focus on ruling out more common causes of sciatica, such as nerve root impingement caused by a disc herniation. It soon became an accepted interpretation but with no consensus about the exact clinical signs and diagnostic tests to differentiate it from other sources of sciatica.
Understanding the Causes of Piriformis Syndrome
Piriformis syndrome can be defined as the interaction between the piriformis muscle and the sciatic nerve, where these may irritate the nerves and develop posterior hip pain with distal referral down the posterior thigh, resembling symptoms of true sciatica. Differentiating�the damage to this region typically follows exceptions of the more well-known causes of sciatica and buttock pain.
More specifically, reports of buttock pain with distal referral of symptoms are not unique to the causes of piriformis syndrome. Similar symptoms are prevalent with the more medically evident lower back pain syndromes and pelvic dysfunctions. Therefore, a complete evaluation of these areas must be performed to rule out any underlying pathology. It has been suggested that the causes of piriformis syndrome can be held responsible for approximately 5 to 6 percent of sciatica cases. In the majority of instances, it develops in middle-aged individuals, an average or 38 years and it�s more common among women.
Pathogenesis of Piriformis Syndrome
The causes of Piriformis syndrome can be associated to three primary causing factors: First, the referred pain may be the result of myofascial trigger points. Second, the entrapment of the nerve against the greater sciatic foramen as it passes through the infrapiriform fossa or within a variating piriformis muscle. And third, sacroiliac joint dysfunction causing piriformis muscle spasms.
Other researchers presented an additional number of factors behind the causes of piriformis syndrome as follows: gluteal trauma in the sacroiliac or gluteal regions, anatomical variations, myofascial trigger points, hypertrophy of the piriformis muscle or spasms of the piriformis muscle, secondary to spinal surgery such as laminectomy, space occupying lesions such as neoplasm, bursitis, abscess and myositis, intragluteal injections and femoral nailing.
Symptoms
The general symptoms described with the causes of piriformis syndrome include: a tight or cramping sensation in the buttock and/or hamstring, gluteal pain in up to 98 percent of cases, �calf pain in up to 59 percent of cases, aggravation through sitting and squatting if the trunk is inclined forward or the leg is crossed over the unaffected leg and possible peripheral nerve signs such as pain and paresthesia in the back, groin, buttocks, perineum and back of the thigh in up to 82 percent of cases.
Physical findings and examinations
It�s important to keep in mind that hip flexion with active external rotation or passive internal rotation may aggravate the symptoms of dysfunction. Additional findings for the evaluated causes of piriformis syndrome have demonstrated a positive SLR that is less than 15 degrees on the normal side. Other tests used to evaluate the causes of piriformis syndrome include, positive Freiberg�s sign, used in 32 to 63 percent of cases, involves the reproduction of pain on a passively forced internal rotation of the hip in the supine position, believed to result from passive stretching of the piriformis muscle and pressure of the sciatic nerve at the sacrospinous ligament. Pacers sign, used in 30 to 74 percent of cases, involves reproducing pain and weakness on resisted abduction and external rotation of the thigh in a sitting position. Pain in a FAIR position used to evaluate dysfunction, involves the reproduction of pain when the leg is held in flexion, adduction and internal rotation. Furthermore, an accentuated lumbar lordosis and hip flexor tightness predisposes an individual to increased compression of the sciatic nerve against the sciatic notch by a shortened piriformis. Electro-diagnostic tests may also prove useful to diagnose piriformis muscle complications.
When palpable spasm within the surrounding piriformis muscle occur and there is obturator internus pain and external tenderness over the greater sciatic notch, found in approximately 59 to 92 percent of cases, the individual must perform the Sims position to follow up an evaluation. The piriformis line should overlie the superior border of the piriformis muscle and extend immediately from above the greater trochanter to the cephalic border of the greater sciatic foramen at the sacrum. The examination will continue where the line is divided into equal thirds. The fully rendered thumb presses on the point of maximum trigger-point tenderness, which is usually found just lateral to the junction of the middle and last thirds of the line.
Investigations
Conventional imaging, such as X-ray, CT scan and MRI, tend to be ineffective in diagnosing the presence and causes of piriformis syndrome. However, some value may exist in electro-diagnostic testing. The purpose of these tests is to find conduction faults in the sciatic nerve. Findings such as long-latency potentials, for instance the H reflex of the tibial nerve and/or peroneal nerve, may be normal at rest but become delayed in positions where the hip external rotators are tightened.
It�s been confirmed that the tibial division of the sciatic nerve is usually spared, the inferior gluteal nerve that supplies the gluteus maximus may be affected and the muscle can become atrophied. However, testing of the peroneal nerve may provide more conclusive results as they�re more likely to be the impinged portion of the sciatic nerve. The H-wave may become inactive during the painful position of forced adduction-internal rotation of the affected leg.
Piriformis Syndrome Myths
Researchers discussed that piriformis syndrome is a commonly over-used term used to describe any non-specific gluteal tenderness with radiating leg pain. It was argued that only in rare cases is the piriformis muscle involved in nerve compression of the sciatic nerve which may then accurately qualify as one of the causes of piriformis syndrome. It was cited that there is only limited evidence and cases where the diagnosis of the causes of piriformis syndrome can be made, foremostly, where there is compressive damage to the sciatic nerve by the piriformis muscle. In several isolated studies, the sciatic nerve was seen to be compressed by the piriformis muscle in instances such as hypertrophy of the muscle, general anatomical abnormalities such as a bifid piriformis muscle and due to compression by fibrous bands.
Also, trauma and scarring to the piriformis muscle can involve the sciatic nerve. It is possible that rare cases of true piriformis syndrome have been caused by direct heavy trauma to the piriformis muscle due to a blunt trauma to the muscle. This is termed as post- traumatic piriformis syndrome.
Researchers supported this argument by stating that it is more likely that, given the anatomical relationship of the piriformis muscle to the various nerves in the deep gluteal region, the buttock pain�may be caused by an entrapment of the gluteal nerves and the hamstring pain may be due to an entrapment of the posterior cutaneous nerve of the thigh, rather than an entrapment of the sciatic nerve alone. This demonstrates the medically analyzed circumstance in the absence of distal sciatic neurological signs. Whether the piriformis muscle is the cause of the compression has not been clearly established. It is possible that the obturator internus/gemelli complex is an alternative cause of neural compression. The researchers have suggested utilizing the term deep gluteal syndrome rather than piriformis syndrome.
Treatment
When one of the several causes of piriformis syndrome is discovered and a healthcare specialist feels that an appropriate diagnosis has been made, the treatment will generally depend on the cause behind the dysfunction. If the piriformis muscle is tight and it spasms, then initially conservative treatment will focus on stretching and massaging the tight muscle to clear the piriformis muscle from being the source of the pain. If this fails, then the following have been suggested and may be attempted: local anesthetic block, typically performed by an anesthesiologist who has expertise in pain management and in performing nerve blocks; steroid injections into the piriformis muscle; botulinum toxin injections in the piriformis muscle; and surgical neurolysis.
Therapist-directed interventions, such as stretching of the piriformis muscle and direct trigger point massage, can also be used as treatment. It�s been encouraged that piriformis muscle stretches are done in positions of hip flexion greater than 90 degrees, adduction and external rotation to utilize the inversion of action effect of the piriformis muscle to isolate the stretch to this muscle independent of the other hip external rotators.
However, recent evidence utilizing ultrasound investigation determined that there was no connection between hip flexion angle and the thickness of the piriformis muscle tendon in both internal and lateral hip rotation stretching, which implies that the piriformis muscle does not invert its action. Furthermore, researchers who performed cadaveric studies concluded that the piriformis muscle insertion is different and a lot more complex than it was first believed to be. It is possible that the piriformis muscle may invert its action only in some individuals but not in others.
Accordingly�due to the disagreements and confusions over the concept of inversion of action, it is suggested that healthcare professionals should perform two variations of a piriformis muscle stretch: stretches in flexion, adduction and external rotation and stretches in flexion, adduction and internal rotation.
Pigeon Stretch for left piriformis muscle: hip flexion, neutral adduction and maximal hip external rotation.
Stretch for left piriformis muscle: hip is in flexion, neutral adduction and maximal external rotation.
Short leg posterior chain stretch for right piriformis muscle: hip is in 90 degree flexion, adduction and neutral rotation.
Trigger Points and Massage
The most appropriate suggestion to palpate the piriformis muscle trigger points is in the following recommended position. In this posture, the healthcare professional can feel for the deep piriformis muscle trigger points and apply a constant pressure to relieve the trigger points as well as apply a flush massage to the muscle in this position. In this position, the large gluteus maximus is relaxed and it is easier to feel the deeper piriformis muscle.
The piriformis muscle is a deep posterior hip muscle that is anatomically similar to both the sacroiliac joint and the sciatic nerve. It is a muscle that functions as a dominant hip rotator and stabilizer, with a propensity to shorten and become hypertonic. For that reason, stretching and massage techniques are best utilized and often recommended to reduce the tone through the muscle. In conclusion, it has also been implied in compression and irritation of the sciatic nerve, most frequently referred to as piriformis syndrome.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Sourced through Scoop.it from: www.dralexjimenez.com
By Dr. Alex Jimenez
by Dr Alex Jimenez | Chiropractic, Scoop.it
If you�ve never been to a chiropractor, you may have some questions about how it works. Basically, chiropractors believe that the body is a connected system. If your bones, ligaments, muscles, joints and tendons aren�t functioning properly then they can lead to an improperly functioning system. When your skeletal structure is strong, your body is strong. Chiropractors help restore the balance in your skeletal structure through adjustments, manipulations and stretches to eliminate the pain associated with fibromyalgia.
Patients with this syndrome have been turning to chiropractic care in increasing numbers over the years to treat the neck pain, back pain and leg cramps that often accompany fibromyalgia. Many have found that a few adjustments to the neck and spine can greatly relieve the chronic pain that they live with.
A lot of people who suffer from fibromyalgia are also afflicted with upper cervical spinal stenosis. This condition leads to the compression of meninges (the coverings of the upper spine) to become compressed. In turn, the patient is left with pain across their entire body. A chiropractor who is familiar with this syndrome can adjust the head and neck so that the spine isn�t compressed, which can help alleviate some of the chronic pain that is associated with fibromyalgia.
So, just how effective is chiropractic care at managing the pain associated with fibromyalgia? There have been several studies done to answer that question and the answer appears to be �Quite effective.� One study in particular, examined the effectiveness of the spinal manipulation done by chiropractors on relieving symptoms related to fibromyalgia. After only 15 treatments, patients reported a decrease in pain and fatigue, and an increase in the quality of their sleep.
If you suffer from fibromyalgia, talk to your primary care physician about the risks and benefits of chiropractic care. Then, take your time and search out a Doctor of Chiropractic who understands the unique symptoms that your body presents. While there is currently no cure for fibromyalgia, there is definitely treatment available that can make your life more manageable.
Sourced through Scoop.it from: www.thejoint.com
If you�ve been diagnosed with fibromyalgia you may feel as if there will never be an end to the tingling, pain and exhaustion that accompany this syndrome. However, help may be as close as your chiropractor�s office. Chiropractic care has demonstrated to be an effective treatment for individuals with fibromyalgia.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900�.
![Causes of Piriformis Syndrome and Sciatica]()
by Dr Alex Jimenez | Complex Injuries, Scoop.it, Sports Injuries
Share Free Ebook
Medial tibial stress syndrome, commonly referred to as shin splints, is not considered to be a medically serious condition, however, it can challenge an athlete�s performance. Approximately 5 percent of all sports injuries are diagnosed as medial tibial stress syndrome, or MTSS for short.
MTSS, or shin splints, occurs most commonly in specific groups of athletes, accounting for 13-20 percent of injuries in runners and up to 35 percent in military service members. Medial tibial stress syndrome is identified as pain along the posterior-medial border of the lower half of the tibia, which is active during exercise and typically inactive during rest. Athletes report feeling discomfort along the lower front half of the leg or shin. Palpation along the medial tibia can usually recreate the pain.
Causes of Medial Tibial Stress Syndrome
There are two main suspected causes for medial tibial stress syndrome. The first is that contracting leg muscles place a repeated strain upon the medial portion of the tibia, producing inflammation of the periosteal outer layer of bone, commonly known as periostitis. While the pain of a shin splint is felt along the anterior leg, the muscles located around this region are the posterior calf muscles. The tibialis posterior, flexor digitorum longus, and the soleus all emerge from the posterior-medial section of the proximal half of the tibia. As a result, the traction force from these muscles on the tibia probably aren�t the cause of the pain generally experienced on the distal portion of the leg.
Another theory of this tension is that the deep crural fascia, or the DCF, the tough, connective tissue which surrounds the deep posterior muscles of the leg, may pull excessively on the tibia, causing trauma to the bone. Researchers at the University of Honolulu examined a single leg from 5 male and 11 female adult cadavers. Through the study, they concluded that in these specimens, the muscles of the posterior section of muscles were introduced above the portion of the leg that is usually painful in medial tibial stress syndrome and the deep crural fascia did indeed attach on the entire length of the medial tibia. Doctors at the Swedish Medical Centre in Seattle, Washington hypothesized that, given the anatomy, the tension from the posterior calf muscles could produce a similar strain on the tibia at the insertion of the DCF, causing injury. In a laboratory study conducted using three fresh cadaver specimens, researchers determined that strain at the insertion site of the DCF along the medial tibia advanced linearly as tension increased in the posterior leg muscles. The study confirmed that an injury caused by tension at the medial tibia was possible. However, studies of bone periosteum on individuals with MTSS have yet to find inflammatory indicators to confirm the periostitis theory. The second theory believed to cause medial tibial stress syndrome is that repetitive or excessive loading may cause a bone-stress reaction in the tibia. When the tibia cannot properly bear the load being applied against it, it will bend during weight bearing. The overload results in micro damage within the bone, not just along the outer layer. If the repetitive loading exceeds the bone�s ability to repair, localized osteopenia can occur. Because of this, some researchers consider a tibial stress fracture to be the result of a continuum of bone stress reactions that include MTSS. Utilizing magnetic resonance imaging, or MRI, on the affected leg can often show bone marrow edema, periosteal lifting, and areas of increased bony resorption in athletes with medial tibial stress syndrome. This supports the bone-stress reaction theory. An MRI of an athlete with a diagnosis of MTSS can also help rule out other causes of lower leg pain, such as a tibial stress fracture, deep posterior compartment syndrome, and popliteal artery entrapment syndrome.
Risk factors for MTSS
While the cause, set of causes or manner of causation of MTSS is still only a hypothesis, the risk factors for athletes developing it are well identified. As determined by the navicular drop test, or NDT, a large navicular drop considerably corresponds with a diagnosis of medial tibial stress syndrome. The NDT measures the difference in height position of the navicular bone, from a neutral subtalar joint position in supported non-weight bearing, to full weight bearing. The NDT explains the degree of arch collapse during weight bearing. Results of more than 10 mm is considered excessive and can be a considerable risk factor for the development of MTSS.
Research studies have suggested that athletes with MTSS are most frequently female, have a higher BMI, less running experience, and a previous history of MTSS. Running kinematics for females can be different from that of males and has often been demonstrated to leave individuals vulnerable to experience anterior cruciate ligament tears and patellofemoral pain syndrome. This same biomechanical pattern may also incline females to develop medial tibial stress syndrome. Hormonal considerations and low bone density are believed to be contributing factors, increasing the risk of MTSS in the female athlete as well.
A higher BMI in an athlete demonstrates that they have more muscle mass rather than being overweight. The end result, however, is the same in that the legs bear a considerably heavy load. It�s been hypothesized that in these cases, the bone growth accelerated by the tibial bowing may not advance quickly enough and injury to the bone may occur. Therefore, those with a higher BMI may need to continue their training programs gradually in order to allow the body to adapt accordingly. Athletes with less running experience are more likely to make training errors, which may be a common cause for medial tibial stress syndrome. These include but are not limited to: increasing distance too quickly, changing terrain, overtraining, poor equipment or footwear, etc. Inexperience may also lead the athlete to return to activity before the recommended time, accounting for the higher prevalence of MTSS in those who had previously experienced MTSS. A complete recovery from MTSS can take from six months up to ten months, and if the original injury does not properly heal or the athlete returns to training too soon, chances are, their pain and symptoms may return promptly.
Biomechanical Analysis
The NDT is used as a measurable indication of foot pronation. Pronation is described as a tri-planar movement consisting of eversion at the hindfoot, abduction of the forefoot and dorsiflexion of the ankle. Pronation is a normal movement of the body and it is absolutely essential in walking and running. When the foot impacts the ground at the initial contact phase of running, the foot begins to pronate and the joints of the foot acquire a loose-packed position. This flexibility helps the foot absorb ground reaction forces.
During the loading response phase, the foot further pronates, reaching peak pronation by approximately 40 percent during stance phase. In mid stance, the foot moves out of pronation and back to a neutral position. During terminal stance, the foot supinates, moving the joints into a fastened position, creating a rigid lever arm from which to generate the forces for toe off. Starting with the loading response phase and throughout the rest of the single leg stance phase of running, the hip is stabilized and supported as it is extended, abducted and externally rotated by the concentric contraction of the hip muscles of the stance leg, including the gluteals, piriformis, obturator internus, superior gemellus and inferior gemellus. Weakness or fatigue in any of these muscles can develop an internal rotation of the femur, adduction of the knee, internal rotation of the tibia, and over-pronation. Overpronation therefore, can be a result of muscle weakness or fatigue. If this is the case, the athlete may have a completely normal NDT and yet, when the hip muscles don�t function as needed, these can overpronate.
In a runner who has considerable overpronation, the foot may continue to pronate into mid stance, resulting in a delayed supination response, causing for there to be less power generation at toe off. The athlete can make the effort to apply two biomechanical fixes here that could contribute to the development of MTSS. First of all, the tibialis posterior will strain to prevent the overpronation. This can add tension to the DCF and strain the medial tibia. Second, the gastroc-soleus complex will contract more forcefully at toe off to improve the generation of power. However, it�s hypothesized that the increased force within these muscle groups can add further tension to the medial tibia through the DCF and possibly irritate the periosteum.
Evaluating Injury in Athletes
Once understood that overpronation is one of the leading risk factors for medial tibial stress syndrome, the athlete should begin their evaluation slowly and gradually progress through the procedure. Foremost, the NDT must be performed, making sure if the difference is more than 10mm. Then, it�s essential to analyze the athlete�s running gait on a treadmill, preferably when the muscles are fatigued, such as at the end of a training run. Even with a normal NDT, there may be evidence of overpronation in running. � 
Next, the athlete�s knee should be diagnosed accordingly. The specialist performing an evaluation should note whether the knee is adducted, whether the hip is leveled or if either hip is more than 5 degrees from level. These can be clear indications that there is probably weakness at the hip. Traditional muscle testing may not reveal the weakness; therefore, functional muscle testing may be required. Additionally, it should be observed whether the athlete can perform a one-legged squat with arms in and arms overhead. The specialist must also note if the hip drops, the knee adducts and the foot pronates. Furthermore, the strength of the hip abductors should be tested in side lying, with the hip in a neutral, extended, and flexed position, making sure the knee is straight. All three positions with the hip rotated in a neutral position and at end ranges of external and internal rotation should also be tested. Hip extensions in prone with the knee straight and bent, in all three positions of hip rotation: external, neutral and internal can also be analyzed and observed to determine the presence of medial tibial stress syndrome, or MTSS. The position where a medical specialist finds weakness after the evaluation is where the athlete should begin strengthening activities. 
Treating the Kinetic Chain
In the presence of hip weakness, the athlete should begin the strengthening process by performing isometric exercises in the position of weakness. For example, if there is weakness during hip abduction with extension, then the athlete should begin isolated isometrics in this position. Until the muscles consistently activate isometrically in this position for 3 to 5 sets of 10 to 20 seconds should the individual progress to adding movement. Once the athlete achieves this level, begin concentric contractions, in that same position, against gravity. Some instances are unilateral bridging and side lying abduction. Eccentric contractions should follow, and then sport specific drills. In the case that other biomechanical compensations occur, these must also be addressed accordingly. If the tibialis posterior is also displaying weakness, the athlete should begin strengthening exercises in that area. If the calf muscles are tight, a stretching program must be initiated. Utilizing any modalities possible might be helpful towards the rehabilitation process. Last but not least, if the ligaments in the foot are over stretches, the athlete should consider stabilizing footwear. Using a supported shoe for a temporary period of time during rehabilitation can be helpful to notify the athlete to embrace new movement patterns.
MTSS and Sciatica
Medial tibial stress syndrome, best referred to as as shin splints, is a painful condition that can tremendously restrict an athlete�s ability to walk or run. As mentioned above, several studies can be performed by a healthcare professional to determine the presence of MTSS in an athlete, however, other conditions aside from shin splints may be causing the individuals leg pain and hip weakness. That is why it�s important to also seek the expertise of additional specialists to ensure the athlete has received the correct diagnosis for their injuries or conditions. Sciatica is described as a set of symptoms that begin from the lower back, generally caused by an irritation of the sciatic nerve. The sciatic nerve is the single, largest nerve in the human body, communicating with many different areas of the upper and lower leg. Because leg pain can occur without the presence of low back pain, an athlete�s medial tibial stress syndrome could really be sciatica originating from the back. Most commonly, MTSS can be identified by pain that is generally worse when walking or running while sciatica is generally worse when sitting with an improper posture. Regardless of the symptoms, it�s essential for an athlete to seek proper diagnosis to determine the cause of their pain and discomfort. Chiropractic care is a popular form of alternative treatment which focuses on musculoskeletal injuries and conditions as well as nervous system dysfunctions. A chiropractor can help diagnose an athlete�s MTSS as well as conclude the presence of sciatica as a cause of the symptoms. Additionally, chiropractic care can help restore and improve an athlete�s performance. By utilizing careful spinal adjustments and manual manipulations, a chiropractor can help strengthen the structures of the body and increase the individual�s mobility and flexibility. After suffering an injury, an athlete should receive the proper care and treatment they need and require to return to their specific sport activity as soon as possible.
Chiropractic and Athletic Performance
In conclusion, the best way to prevent pain from MTSS is to decrease the athlete�s risk factors. An athlete should have a basic running gait analysis and proper shoe fitting as well as include hip strengthening in functional positions as part of the strengthening program. Furthermore, one must ensure the athletes fully rehabilitate before returning to play because the chances of recurrence of medial tibial stress syndrome can be high.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Sourced through Scoop.it from: www.dralexjimenez.com
By Dr. Alex Jimenez
by Dr Alex Jimenez | Chiropractic, Scoop.it
If you have fibromyalgia, you know what it’s like to live with the chronic pain and stiffness it can cause. And while medication and therapy are key to controlling symptoms, incorporating physical activity can vastly improve your quality of life.
“Try to keep moving�that’s my motto for patients,” says Maura Daly Iversen, PT, DPT, SD, MPH, spokesperson for the American Physical Therapy Association. “The less you move, the more pain and fatigue you’ll feel.” Exercise can also help you sleep better and reduce your need for pain meds, as well as improve your mood: “So often, the pain of fibromyalgia leads to depression,” adds Iversen. “Working out is a great, healthy way to manage both conditions.”
Here are the top five fibro-friendly workouts, plus tips and tricks to help you ease in and hurt less: (Check with your doctor before starting any program.)
Walking
It’s an excellent form of light aerobic exercise, which provides a list of healing benefits: It brings oxygen and nutrition to your muscles to keep them healthy, helps rebuild stamina, boosts energy, and reduces stiffness and pain. In fact, a comprehensive research review found that low-impact aerobics is most effective for improving FMS symptoms. Biking is another good option: “The reciprocal, or back-and-forth, motion helps provide relaxation,” adds Iversen, who also chairs the Department of Physical Therapy at Northeastern University Bouve College of HealthSciences.
Other effective forms of aerobic exercise include swimming�and water aerobics in a heated pool (warm water relaxes muscles, and the buoyancy of the water helps with movement, whereas cold water can make muscles tense up) and using an elliptical trainer (which is lower impact than a treadmill).
Fibro-friendly tip: Do short bursts, not long stretches. Research shows breaking a longer workout into shorter chunks provides the same healthbenefits�and for people with fibro, the latter strategy is best: “If your goal is to walk for 30 minutes, start with three 10-minute walks a day,” says Iversen. “Just don’t leave your last walk for too late; that’s when fatigue is the worst.” Experts generally recommend doing aerobicexercises three to four times per week on nonconsecutive days. To help motivate you to stay on track, join a walking or workout group, adds Iversen.
Stretching
Do it at least once a day to help increase flexibility, loosen tight, stiff muscles, and improve range of motion�the combination of which will help ease everyday movements, like looking over your shoulder or reaching for a can on the top shelf of your pantry. Stretching duringworkouts may also help you to tolerate training better.
Fibro-friendly tip: Stretch to cool down, not warm up. The best time to stretch is after some form of light warm-up exercise, says Iversen; you could hurt yourself trying to stretch cold muscles. Start by positioning yourself until you feel a slight stretch in the muscle, then hold the stretch for a full minute for the most benefit.
Strength training
The trick is to use light weights (start with 1 to 3 pounds, says Iversen) and lift slowly and precisely to improve tone and make muscles stronger�stronger muscles use less effort than weaker muscles, which may leave them less fatigued. Plus, studies show strength training can help treat depression, even as well as some medications. Aim to work out each major area�legs, chest, shoulders, back, arms, and abs�two to three times per week, with at least a 1-day break in between. Start with a weightyou can lift comfortably for eight reps, then gradually up it to 10 and 12 reps. When you can lift the weight 12 times, two sessions in a row, you’re ready to increase the weight slightly (and start back down at eight reps.)
Fibro-friendly tip: Shorten the range of motion. Take a bicep curl, for example: There are two parts to that move�when you bring your hand up to your shoulder (the concentric phase) and when you lower it back down to your thigh (eccentric phase). That second part can be the problem�going down too far can cause discomfort and make pain worse for people with fibromyalgia, says Iversen. Studies show shortening that phase can help decrease muscle soreness.
Yoga
Practicing the Hatha kind�a more gentle combination of postures, breathing, and meditation�reduces the physical and psychological symptoms of chronic pain in women with fibromyalgia, according to a recent study published in the Journal of Pain Research. Participants reported significantly less pain; they were also more accepting of their condition and felt less helpless and more mindful.
Yoga also helps build endurance and energy and improves sleep and concentration. Tai chi, where you slowly and gracefully perform a series of movements, has also been shown to help relieve fibro pain and other symptoms�maybe even better than stretching, according to a recent study from Tufts Medical Center.
Fibro-friendly tip: Modify moves to reduce stress. If a particular position hurts, you can tweak it to still get the benefits with less pain, says Iversen. “With the downward dog, for example, the pressure on the wrists can be painful for someone with fibromyalgia, so rest on your forearms instead.” And don’t worry about extending your knees fully, she adds�as long as you can get into the basic position, and are comfortable in that position, that’s what matters. For beginners especially, it’s important to find an instructor who understands your needs�ask your physical therapist or doctor for recommendations.
Everyday activities
That’s right�studies show that playing with your kids, mopping the floors, gardening, and other things you do in daily life count toward increasing fitness and reducing symptoms.
Fibro-friendly tip: Plan your day to better manage pain. “Spread out your list of chores throughout the day, doing the tougher ones in the morning,” suggests Iversen. And give yourself a break: If you want to play with your kids, but you’re in pain, get on the floor with them so you don’t have to lean over and run around. Don’t clean your floors on your hands and knees; get a lightweight mop instead. And when you need a rest, take it.
Sourced through Scoop.it from: www.prevention.com
With fibromyalgia, exercise can improve your quality of life and reduce pain. As a chronic pain condition, the symptoms can often be impairing and debilitating. However, following an appropriate exercise routine along with ongoing treatment can help greatly reduce the individuals discomfort.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
by Dr Alex Jimenez | Chiropractic, Scoop.it
Fibromyalgia is a widely misunderstood and sometimes misdiagnosed chronic condition, commonly characterized by widespread muscle pain, fatigue, concentration issues, and sleep problems.
According to the National Fibromyalgia Association, it affects an estimated 10 million people, mainly women, in the United States alone. The severity of fibromyalgia symptoms can vary from one person to the next and may fluctuate even in a single individual, depending on such factors as time of day or the weather. Because it is a chronic condition, in most cases fibromyalgia symptoms never disappear entirely. The good news is that fibromyalgia isn’t progressive or life-threatening, and treatments can help alleviate many symptoms.
Fibromyalgia: The Symptoms
The symptoms of fibromyalgia and their severity vary widely, although pain and fatigue are nearly always present. Major symptoms of fibromyalgia include:
Pain. Some fibromyalgia patients report discomfort in one or more specific areas of their body, while others may experience overall pain in their muscles, ligaments, and tendons. Certain areas, such as the back of the head, upper back and neck, elbows, hips, and knees may be particularly sensitive to touch or pressure and are described clinically as tender points. The degree and type of pain can range from aching, tenderness, and throbbing to sharper shooting and stabbing sensations. Intense burning, numbness, and tingling may also be present.
Fatigue. If you’ve ever been knocked off your feet by a bad case of the flu, you have a general idea of how tired some people with fibromyalgia can feel. Though some fibromyalgia patients experience only mild fatigue, many report feeling completely drained of energy, both physically and mentally, to the point that exhaustion interferes with all daily activities.
Memory problems. Difficulty concentrating and remembering are common cognitive symptoms in people with fibromyalgia.
Sleep disturbances. Research has shown that the deepest stages of sleep in patients with fibromyalgia are constantly interrupted by bursts of brain activity, causing feelings of exhaustion even after a seemingly good night’s rest. Other problems such as sleep apnea, restless legs syndrome, and teeth grinding (bruxism) are also common.
Irritable bowel syndrome (IBS). Symptoms of IBS, including diarrhea, constipation, abdominal pain, and bloating, are present in many people with fibromyalgia.
Other common symptoms
- Headaches, migraines, and facial pain
- Depression, anxiety, or mood changes
- Painful menstrual periods
- Dizziness
- Dry mouth, eyes, and skin
- Heightened sensitivity to noise, odors, bright lights, and touch
The following factors can worsen the symptoms of fibromyalgia:
- Changes in weather (too cold or too humid)
- Too much or too little exercise
- Too much or too little rest
- Stress and anxiety
- Depression
Some patients also report that pain and stiffness are worse in the morning.
Causes of Fibromyalgia
While the exact cause of fibromyalgia remains a mystery, doctors do know that patients with the disorder experience an increased sensation of pain due to a glitch in the central nervous system’s processing of pain information. Studies have shown that people also have certain physiological abnormalities, such as elevated levels of certain�chemicals called nuerotransmitters that help transmit pain signals (thus amplifying, or “turning up,” the signals in the brain’s pain-processing areas).
In some cases, an injury or trauma, especially to the cervical spine, or a bacterial or viral illness, may precede a diagnosis of fibromyalgia. This has caused researchers to speculate that infections may be triggers as well.
Fibromyalgia Risk Factors
A number of factors can increase the odds that you may develop this painful condition. These include:
Gender. Fibromyalgia is more common among women than men.
Age. Symptoms usually appear during middle age, but can also manifest in children and older adults.
History of rheumatic disease. People who have been diagnosed with a rheumatic disorder � chronic inflammatory conditions � such as rheumatoid arthritis and lupus are at increased risk of also developing fibromyalgia.
Family history. Having a relative who suffers from the condition puts you at increased risk.
Sleep problems. Doctors aren’t sure whether sleep disturbances are a cause or a symptom of fibromyalgia � but sleep disorders, including restless legs syndrome and sleep apnea have been cited as possible fibromyalgia triggers.
Sourced through Scoop.it from: www.everydayhealth.com
Fibromyalgia is a condition which causes chronic symptoms of widespread pain. Although it’s been recorded to affect millions of people, it’s still largely misunderstood and often misdiagnosed among the medical field. Referred to as a condition without cure, the symptoms can be managed with proper care.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
by Dr Alex Jimenez | Chiropractic, Scoop.it
A number of studies have shown a link between anxiety and fibromyalgia, however, the nature of the link is not yet understood. Some experts, according to a report, “Fibromyalgia,” in The New York Times, “believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress.” Others believe that physical injuries, emotional trauma or viral infections, such as Epstein-Barr trigger the disorder.
Fibromyalgia causes widespread and chronic pain the joints and symptoms are similar to arthritis, however, unlike arthritis, there is no inflammation in the joints. Karen Lee Richards, a patient expert at HealthCentral.com, states the additional symptoms of fibromyalgia include:
- Fatigue
- Sleep Problems
- Cognitive Dysfunction
- Sensitivity to Cold and/or Heat
- Depression
- Anxiety
- Digestive Problems
- Headaches
- Hypersensitivity
The Anxiety Disorders Association of America indicates that approximately 20 percent of those with fibromyalgia also have an anxiety disorder or depression. Studies put this number anywhere between 14 percent and 42 percent. While dealing with a chronic disease is certainly stressful, there may be physical causes of the increased levels of anxiety.
Cortisol is a hormone produced by our bodies when we are under stress. However, when under chronic stress, our cortisol levels can become skewed. Patients with fibromyalgia may have lower levels of this stress hormone resulting in muscle aches, fatigue, high blood pressure and anxiety. Reducing stress can often normalize cortisol levels.
Serotonin, a chemical “messenger” found in the brain is linked to feelings of well-being, adjusting pain levels and promoting sleep. Some patients with fibromyalgia have lower than normal serotonin levels.
Sleep problems are also common in those with fibromyalgia. Lack of sleep can increase feelings of anxiety and depression.
The Role of Anxiety in Your Life and Illness
Because dealing with any chronic illness causes stress, you may believe that anxiety is simply something you must deal with, however, in fibromyalgia there is evidence that stress and anxiety actually increase symptoms and make it more difficult to cope with those symptoms.
If you are suffering from depression or anxiety, you may feel hopeless and helpless. You may be less apt to seek or follow treatment, believing there is nothing you can do to make it better. You may not be willing to make lifestyle changes that can help improve symptoms.
When you have a chronic medical condition, it doesn’t just impact your health. Often you can’t work or miss time at work, you may have financial problems. Relationships frequently suffer when one partner is sick. While these can be true for all chronic conditions, when you add in depression or anxiety, common in patients with fibromyalgia, coping is even more difficult.
It is important to talk with your doctor about how you are feeling emotionally as well as physically. Your doctor may recommend treatments including medication, physical and occupational therapy to treat the symptoms of fibromyalgia. He may also suggest antidepressants to help treat your anxiety symptoms.
Lifestyle changes including getting the proper amount of sleep and exercising. According to the Anxiety Disorders Association of America, a Harvard Medical School study indicated that strength training, aerobic activity and flexibility training were effective at helping women with fibromyalgia feel better both physically and emotionally.
Sourced through Scoop.it from: www.healthcentral.com
As a widely misunderstood chronic condition causing pain and fatigue among a number of people, fibromyalgia still remains a highly misunderstood condition. According to researchers, the painful condition not only causes the above mentioned symptoms, it can also cause symptoms of anxiety to develop.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900�.
by Dr Alex Jimenez | Chiropractic, Scoop.it
Many people who battle fibromyalgia symptoms also deal with depression. Discover five fibromyalgia therapy strategies that may help relieve depression.
Most fibromyalgia patients are exhausted all the time and suffer from painful muscles and joints. But these aren�t the only common symptoms of fibromyalgia � at least one fourth of fibromyalgia patients also have some form of depression. In fact, adult fibromyalgia patients are much more likely than those without fibromyalgia to be depressed.
The link between fibromyalgia symptoms and depression makes sense. First, coping with the severe pain and fatigue of fibromyalgia can be frustrating and disruptive to your lifestyle. And fibromyalgia symptoms can also lead you through unchartered territory as you work through a maze of health care providers.
How Depression Can Make Fibromyalgia Symptoms Worse
Like other people with depression, fibromyalgia patients often experience a loss of interest in their favorite activities and feel lonely, tired, and sad.
�Depression makes pain worse and causes lots of fatigue and functional disability in fibromyalgia patients,� says Roland Staud, MD, professor of medicine, division of rheumatology and clinical immunology at the University of Florida in Gainesville. There is a strong correlation, Dr. Staud says, between pain and depression: �Alleviation of one leads to alleviation of the other.�
�Elizabeth W. Carson, PhD, a clinical psychologist on staff at St. Joseph�s Hospital in Atlanta, Ga., says she sees many fibromyalgia patients who are depressed as well as frustrated with their disease process. �Depression makes the patient more aware of the pain of fibromyalgia.�
While depression may be common in fibromyalgia patients, Staud says it is not common for people with fibromyalgia to be substance abusers. In fact, �There is no empirical evidence of substance abuse in fibromyalgia patients,� Staud says.
Fibromyalgia and Depression Therapy Option 1: Antidepressants
�There is no analgesic [pain reliever] to jointly treat pain and mood disorders,� says Staud. However, antidepressants are often used to treat fibromyalgia symptoms, with or without the presence of depression.
Two classes of antidepressants used to treat fibromyalgia symptoms are selective serotonin reuptake inhibitors (SSRIs) and combined serotonin and norepinephrine reuptake inhibitors (SNRIs). �SNRIs are more effective for treating both depression and fibromyalgia symptoms,� says Staud. �SSRIs have a lesser effect on fibromyalgia symptoms.� SNRIs include Effexor (venlafaxine) and Cymbalta (duloxetine). Examples of SSRIs include Celexa (citalopram) and Prozac (fluoxetine).
Fibromyalgia and Depression Therapy Option 2: Cognitive Behavioral Therapy
Staud also recommends cognitive behavioral therapy for fibromyalgia patients who are dealing with depression. For fibromyalgia patients, the goal of cognitive behavioral therapy is to change how you think about pain and in turn change how you deal with the pain.
Carson says she uses this therapy to address negative thinking. �By retraining patterns of thinking, you can help the patient change his or her behavior and how they deal with their fibromyalgia.�
Fibromyalgia and Depression Therapy Option 3: Counseling
Counseling, another type of psychological therapy, can take place in group sessions, in which patients meet with a therapist and exchange experiences and ideas, or as one-on-one discussions with a therapist.
During these group or individual sessions, patients discover strategies for coping with pain or tackling other issues related to depression and fibromyalgia symptoms. �Group therapy is more economical and helps, but individual therapy is more effective,� says Staud.
Fibromyalgia and Depression Therapy Option 4: Self-Help
�Depression is a form of exhaustion,� says Carson. �With fibromyalgia, sleep is fragmented by pain, and circadian rhythms are disturbed.�
Getting into a regular routine of sleep and performing daily activities can help re-establish healthy circadian rhythms. �Sleep hygiene is really important in treating depression associated with fibromyalgia,� adds Carson.
Additionally, exercise such as walking, jogging, and riding a bike may benefit patients with depression. Exercise can help people feel better both physically and mentally.
Fibromyalgia and Depression Therapy Option 5: Easing Pain and Fatigue
Addressing the underlying fibromyalgia symptoms such as pain and fatigue may also help to relieve depression. Several prescription medicines are now available to treat fibromyalgia pain symptoms, including Lyrica (pregabalin) and Savella (milnacipran). Non-narcotic pain relievers such as tramadol are also prescribed for fibromyalgia pain.
By working with your doctor to find the right fibromyalgia therapy, you�ll be able to target all your fibromyalgia symptoms, including depression.
Sourced through Scoop.it from: www.everydayhealth.com
Fibromyalgia has long been characterized as a misunderstood condition which affects the normal function of the brain, spinal cord and nerves, causing widespread pain as well as fatigue as a result. Many individual’s frequently describe these prevalent symptoms, however, others experience symptoms of depression. Depression can be linked to a variety or conditions, in this case, recent studies have concluded that fibromyalgia may become worse with depression.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900�.
