Racquet sports have been increasing in popularity in recent years! They demand a high level of motor control through high volumes of complex shoulder mechanics. This often leads to players presenting to the clinic with shoulder pain, frequently on the outside of their shoulder. Patients often complain of being unable to put on a coat or reach for their seat belt. These two movements mimic an orthopedic test we use in the clinic called Apley’s Scratch Test. Being able to connect a patient’s experiences with our clinical findings gives us confidence in our diagnosis. When dealing with shoulder pain, we like to start with some soft tissue work on the scapular stabilizers and rotator cuff muscles. Stand with your back near a wall, and place a tennis ball or other soft rubber ball in the area between your shoulder blades. Lean toward the wall to trap the ball against your back, just to the side of your spine. Roll the ball up and down each side of your spine by bending your knees to lower and raise your torso with a gentle pressure. After doing some gentle soft tissue work, we like to move on to our stretches. Start by putting one hand on the small of your back. Then begin tilting your head to the opposite side of the arm behind your back, and use the same side’s arm to grab behind your ear and pull your head towards your shoulder. You should feel a firm put tolerable stretch that you hold for 10-15 seconds. Then slowly move your chin towards your chest while maintaining your tilted head position. Hold for another 10-15 seconds. Now that your shoulders and upper back are thoroughly warmed up, we want to move onto an exercise that challenges those muscles. An easy shoulder exercise you can do anywhere is a palm press. Place your palms together in front of you with your fingers aligned. Firmly press your palms together, putting pressure through all of your palm and fingers. You should feel a strong contraction in your shoulder muscles. Try moving your hand to point your fingers back towards your body, then again away from your body. Try starting with 10 second presses and increasing as your shoulders can tolerate. If your shoulder pain persists after trying our at-home recommendations, we have a variety of treatments we can use to help. Chiropractic adjustments and myofascial release techniques both can be helpful with shoulder pain. One of the techniques we have the most success with in shoulder pain cases is dry needling. Dry Needling that involves inserting very thin monofilament needles directly into sore/tender areas in order to help relieve pain and improve range of motion. If patients are failing to progress through our treatment protocol, a common next step we utilize in office is imaging. While x-rays can be useful, MRIs are often the better option when assessing the shoulder and the type of imaging we prefer to order in these scenarios.
Hopefully these tips help you navigate your shoulder pain!
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As chiropractors, one of the most common conditions we see in office is low back pain. There are a lot of causes of low back pain, one of the more severe conditions being a lumbar disc injury. A few things that patients notice while experiencing a lumbar disc injury is back and/or leg pain associated with coughing, sneezing, or going to the bathroom. This actually mimics one of the orthopedic tests we use in office called the Valsalva maneuver. In this scenario, a patient’s history matches our clinical findings, helping us to confirm a diagnosis. When we are confident in our lumbar disc diagnosis, one of our initial exercises we prescribe to patients is a nerve glide. The type of nerve glide given to the patient depends on where they are experiencing symptoms and what position is most comfortable. Typically we find that a seated sciatic nerve glide. To perform a seated sciatic nerve glide, begin seated in a firm chair with your hips and knees at 90 degrees and your head looking down at both feet on the floor. Next, fully straighten your affected leg at the knee until you feel a stretch in the back of your thigh. Do not move into a position that reproduces sharp or radiating pain. At the same time that you are moving your leg forward and up, extend your head to look at the ceiling as to nod “yes.” Then return to the start position. Another exercise we prescribe initially with lumbar disc patients is a directional preference exercise. To find a directional preference, we will first test have the patient perform repeated end range movements in either extension (bending backwards), flexion (bending forwards), and/or lateral bending (bending side to side), while monitoring symptoms. The direction that improves symptoms will be prescribed as part of the home exercise program! As patients progress and symptoms allow, we will begin adding in strength based exercises. One of our favorites for lumbar disc patients is the dead bug exercise! To perform a dead bug, lie flat on your back with your hips and knees bent to 90 degrees and your straightened arms reaching toward the ceiling, palms facing each other. “Tuck your tail” to flatten your lower back into the floor. Then, simultaneously slowly lower one arm and the opposite leg back down toward the floor. Return to the start position and repeat with your opposite limbs. Avoid arching your back, and keep your core braced throughout this movement! When dealing with a lumbar disc injury, it is important to stay aware of your symptoms. If you begin feeling any leg weakness, numbness in your hips/pelvis, or the inability to control your bowel/bladder you need to seek emergency help. These symptoms are what are considered “red flags'' and need to be evaluated by a healthcare professional. If you feel an increase in your pain frequency or intensity, or if you feel your symptoms begin going down/further down your leg, let your healthcare provider know. These are symptoms that need to be monitored to be sure your disc injury is not getting worse. When treating a disc injury in-clinic, one of our first lines of treatment is our spinal decompression table. The spinal decompression table provides a gentle stretch to the lumbar spine, improving range of motion and reducing radiating symptoms. As you progress and as your symptoms allow, we begin adding in more traditional techniques including chiropractic adjustments if indicated and tolerated.
If you or someone you know needs help navigating a lumbar disc injury, we’re happy to help! The holiday season is drawing to a close, and as the dust settles, you may realize you have developed some back pain! Between travel, sleeping in different beds, cooking/cleaning more than usual, and everything else that comes with the holidays, this is common. Thankfully, a lot of these aches and pains can be dealt with through basic movements and getting back into your normal routine. In this month’s blog, we are going to cover some of those basic movements! One of the more popular gift ideas around the holidays in recent years have been massage guns! Which in turn has led to one of the most common questions we get after the holidays being “how should I use my new massage gun”. Massage guns are fine to be used over any sore and stiff joints/muscles, and really shine when used as part of a warm up (although you can use them any time is convenient). It is important to be mindful of whether the massage gun is aggravating your stiffness/soreness, which may mean you need to reduce the time you are using the gun, the frequency you are using the gun, or need to set up an appointment with us for an evaluation. Once you have worked on your sore muscles with the massage gun, it’s time to add in some movement. Since we are covering general soreness in today’s blog, we are going to cover some general movements! One of our go-to’s is the Mad Cat/Old Horse (or Cat/Cow). To perform the Mad Cat/Old Horse exercise, begin on all 4’s with your hands under your shoulders and your knees under your hips. Extend your back upward into a “mad cat” position. Next, flex your back downward to sag into an “old horse” position. Slowly transition back and forth between these two positions. Another of our favorite movements is a thoracic rotation on all 4’s, done immediately following the Mad Cat/Old Horse. Place one hand behind your neck with your elbow pointing downward. Rotate your trunk to move your elbow towards your opposite knee. Rotate back, raising your elbow toward the ceiling. Neither of these movements should cause an increase in stiffness or soreness, so feeling worse immediately after doing them is a sign to set up an appointment to see what is going on. By this point in our routine, you should be feeling loosened up and moving a bit easier! This is where we pull out our number 1 back-pain relieving exercise: walking! Going for a walk has repeatedly been shown to be at or near the top of exercises for back pain. As a bonus, it takes no special equipment and can assist in burning off some of the extra holiday calories. If you already walk regularly, we recommend completing the first part of the routine beforehand to see if it helps! With Kansas and Missouri weather the way it is, we recommend keeping an eye on the forecast and only walking when it is safe to do so. The benefits of walking can be quickly eliminated with a hard fall on ice! The holidays can be stressful enough without having to deal with pain during or after them. This quick and easy routine can help your body make it through in good shape! If any of the activities increase your pain, stiffness, or soreness, give us a call, shoot us a text, or schedule an appointment online so we can get you feeling better as quickly as possible.
Summertime is golfing time for many of our patients! As the rounds start adding up, aches and pains can begin creeping in. One of the keys to staying healthy and maximizing performance in golf is maintaining your ability to rotate through multiple joints simultaneously. It may sound simple enough, but without consistent practice, maintaining the ability to rotate can be difficult! In this month’s blog, we are going to cover exactly how to do that quickly and efficiently. At Inside Sports Clinic, we prefer to start our sessions with some self-administered soft tissue work. In the case of rotation for golf, using a foam roller and targeting the lat muscles can provide a nice stimulus to the muscle and help you to create more rotation with the upcoming exercises! Spending 30 seconds to 1 minute on each side is plenty of time to create the desired effect, being sure to spend more time on any particularly tender areas. Once we have foam rolled the lats, it is time to begin moving through the complete range of motion. Thankfully, all you need is a golf club and a little space to get that accomplished! Grabbing the club as wide as you comfortably can, reach your arm out to one side, using the opposite arm to help push through the complete range of motion. After a few reps to each side, try reaching back by turning your shoulders, while still keeping your hips square. After a few reps of reaching back on each side, we can begin turning the hips with the shoulders. At this point, you should be rotating your whole body, reaching with one arm and using the opposite arm to help push you back further. Ideally, this should feel like a firm stretch from your shoulder, down through your torso, into your hips, knees, and ankles. After foam rolling and stretching, it is time to work on strengthening the core musculature to improve your ability to control your rotation. For this situation, our go-to exercise is a plank series. Starting with the basic plank everyone is familiar with, being mindful of the position of your head, neck, and hips. We prefer 10 seconds of a high quality plank over 60 seconds of holding a plank just to hold a plank! If you feel comfortable, we can then progress to side planks, where you are on your side using one elbow to hold the plank position (hence the name side plank). If you feel comfortable with both the standard plank and the side plank individually, we can then begin rolling from the standard plank, into a side blank, back to the standard plank, and then to the other side plank. If you can perform a high quality rolling plank, your golf game will benefit! Between foam rolling, our mobility drill, and our plank progression, you now have all the tools to develop and maintain rotation! Ensuring you can rotate means you can be confident in having the physical tools to have steady, consistent mechanics that allow for a more predictable swing from round to round while also reducing the likelihood of any overuse injuries that may arise from playing a lot of golf! If you or someone you know has pain with golf, schedule an appointment today.
High school baseball season has officially concluded, and the summer club season is underway! Younger and younger ages are playing longer and longer seasons, which leads to more and more strain on the athlete. Most associations have done a good job of implementing pitch counts and other protective measures, but the fact remains that baseball can be tough on the upper extremity. While we have covered it in the past, arm care is a complex topic that requires a complete and thorough strategy for management. In this blog, we are going to go over a simple way to begin your arm maintenance routine! When beginning an arm maintenance routine, soft tissue work is a nice way to get moving and warm specific muscles up. Our preferred tool of choice is the foam roller, because of their ease of use and low cost. For the shoulder, begin rolling on the lats (short for latissimus dorsi) with big, slow rolls across the full length of the muscle, being sure to hit each side for approximately 60 seconds. After rolling the lats, you can move up into the triceps muscle, again being sure to roll each side for approximately 60 seconds. Foam rolling is a great tool to create a temporary increase in a joint’s range of motion. After foam rolling, we want to push our joints through a full range of motion to maximize the effectiveness of both the foam rolling and our mobility drills! Baseball requires a ton of rotation through the torso and shoulder, and our favorite drill for upper body rotation is our quadruped thoracic rotation exercise. Getting on all fours, reach one of your arms across your body as far as you comfortably can, curling your wrist back towards yourself. Then pull your arm back through back across your body, and reach your hand towards the ceiling, trying to face your palm towards the ceiling. Perform this drill with each arm, with at least 10 repetitions per side! After completing the foam rolling and mobility drill, it is time to challenge your upper extremity musculature with a resisted exercise. Bands are a great form of resistance due to how portable they are, you can take them anywhere! For our baseball players we really like what we call a D2 Extension pattern. It relatively mimics the reverse of a throwing motion, allowing us to directly strengthen the muscles that assist with decelerating the shoulder in a throwing motion. Grabbing the band in one hand, secure the opposite end of the band under the opposite foot. Reach your hand across your body as if you were trying to put that hand in the opposite pocket, with your thumb pointing behind you. Begin the movement by bringing your hand back across your body, up towards your shoulder, and turning your hand so your thumb is pointing up all at the same time. Repeat this exercise for 10 repetitions with each hand! Like we said before, caring for the arm/upper extremity can be complicated. So while we have laid a foundation with this blog, it is important to have a thorough plan that addresses the other aspects of arm care. If the demands of the season do start to add up and begin affecting your arm, we have a variety of ways of helping get you back on track. Schedule an appointment with us to see if we can help! It is May, which means high school track and field is reaching its peak! The diverse nature of track and field makes the warm-up crucial for success. Over the course of a meet, an athlete may need to warm up and cool down as many as 4 times! This can be complicated further if the athlete has events that are close together. While a comprehensive and thorough warm-up is preferred, doing something is definitely better than nothing. Today we are covering the bare bones minimum track and field warm-up that requires minimal time and energy for those unique situations that only track and field provides! If you have been following along with our previous posts, you will know that we are big fans of foam rollers. A time crunch is when foam rollers really start to shine! All track and field events could benefit from a quick (~60 second) foam rolling of the hips. Once you have foam rolled your hips, we will take advantage of the foam rolling with a targeted mobility drill. A quick and easy mobility drill for the hips is the Hip 90/90 drill. This drill allows us to work the hips through internal and external rotation, as well as working on some flexion. By driving your knees into the ground at either end position, we can also work some hip extension! Track and field events do not only challenge the hips, so it is important to add in a mobility drill that targets just the hips. A lunge with rotation is a great option for building on the hip work we have already done, while incorporating the rest of the body. Both forward and reverse lunges can work here, and a mixture of both allows you to get the benefits of both! The rotational component should be smooth and controlled with the intention of working into the end ranges of motion of the rotation. Up to this point, our warm up has been slow and controlled. Now it is time to add in some speed to really prime your body for performance! One of our favorites is the squat jump, with a particular emphasis on achieving triple extension. Triple extension refers to extending the ankle joint, the knee joint, and the hip joint. Running, jumping, and throwing activities are rooted in triple extension at their core, making the squat jump a quick and easy way to generally replicate those movements anywhere, at any time. We would like to emphasize that a complete and thorough warm up is preferable to what we have put together here. This warm up is meant to serve as a way to serve as a “better than nothing” alternative for those unique situations where the complete warm up may not be feasible. The length of this warm up also makes it easy to add in another exercise or two more specific to the athletes event. If you or someone you know is dealing with a track and field injury, we can help! Call our office or schedule online today!
The weather is warming up, and while the cold has not stopped some of you die-hard runners out there, for many of you that means running outside again! With the increase in running frequency and intensity outside (let’s admit it, pushing yourself on the treadmill can be difficult), our clinic begins to see an increased rate of injury in our runners. Patellofemoral pain is defined as pain around the knee cap while performing an activity with a bent knee. Multiple studies cite patellofemoral pain as the top injury in runners, with an average estimate of 20% of recreational runners dealing with it at some point. Today we are going to cover our recommended strategy for reducing your risk of developing patellofemoral pain! Soft tissue treatments are a great way to start any session, and if you are familiar with our blogs, you know that we are fans of foam rollers. Foam rolling your quads helps to relax the muscle and ensure that our tissues have the ability to hit full extension easily. You can replace a foam roller with any soft tissue tool you prefer such as a massage gun. Now that we have our quads and knees prepped, we want to reinforce comfort in that fully extended position. Quad sets are a great starting point! Sit down with your legs straight in front of you. Squeeze your quads (the muscles on the front of your thigh) and gently push your knee cap towards the floor at no more than 70% of your maximal force. Hold this contraction for around 5 seconds, relax, and repeat. Placing a towel under your knee may make this exercise more comfortable. Be sure to perform this exercise on both knees! Now that we have reinforced that fully extended position, we want to incorporate the knee into a more complex movement. A reverse lunge allows us to generally emulate a running position while allowing for greater balance because the working leg is staying in a fixed position. If the reverse lunge becomes too easy, consider progressing to a forward lunge! This series of exercises is a solid starting point for reducing your risk of developing patellofemoral pain, but it needs to be combined with appropriate programming. Avoid increasing your weekly volume by more than 10% unless under guidance of a coach, and avoid increasing by 15% unless you are an experienced runner under guidance of a coach. In our office, one of our primary goals while treating runners is to maintain some degree of training as much as reasonably possible. We also take the time to identify the mechanism of injury. The most common issues we see leading to patellofemoral pain are lower leg mechanical issues and programming acquired issues. For mechanical issues, we perform a foot and gait analysis, re-establish any lost range of motion, and go through a rehab protocol to strengthen and stabilize the lower leg. For programming acquired issues, we establish that the training program being followed is sound, confirm that appropriate recovery measures are being taken, and manage pain symptoms to minimize the amount of time lost from running.
If you are dealing with persistent knee pain or planning on getting back into running soon, we can help! Give our office a call or schedule online today! March means the beginning of the high school boy’s tennis season in Kansas and Missouri! Combined with the weather beginning to warm up, tennis participation across age groups is going to really start to pick up. With our satellite clinic located inside of Overland Park Racquet Club, we see our fair share of tennis players of all ages and abilities. A study by the British Journal of Sports Medicine found that while most injuries in tennis are acute injuries to the lower extremity (think ankle sprains), that most chronic issues occur in the upper extremity! Of those chronic issues, approximately 25% of those issues were shoulder related, which held true across age groups. We have found with our tennis players that these issues arise from a combination of poor shoulder blade mechanics and poor mid back motor control. Today we are going to cover a way to improve both to keep your shoulders healthy! We like to start with some sort of soft tissue work to get your muscles and joints loosened up. When addressing the mid back and shoulder blades, foam rollers tend to shine, but really you can use any tool you feel comfortable with. Spending a minute or two rolling on your mid back and shoulder blades will create a temporary increase in range of motion that we can take advantage of in our next step. After we have created some extra range of motion with our soft tissue work, we want to reinforce that range of motion with a mobility exercise. There are a ton of exercise options to choose from in this case, but one of our favorites is what we call ‘mad cat/old horse’. Begin on all 4’s with your hands under your shoulders and your knees under your hips. Extend your back upward into a “mad cat” position. Next, flex your back downward to sag into an “old horse” position. Beautifully simple and exceptionally effective! Now that we have created more range of motion and reinforced it with our mobility exercise, we want to add some resistance. Similar to the mobility exercise, there are a ton of options for adding resistance to challenge the shoulder blades and mid back. Today we are going to cover a simple banded pull apart. Begin by gripping a light band approximately shoulder width apart at shoulder height. Simultaneously pull both arms apart until the band touches your chest. For maximal effectiveness, pull your shoulder blades together as the band gets closer to your chest, and actively reach your arms away from you at the start of the movement. This exercise teaches you to be aware of where your shoulder blades are in space while strengthening the new range of motion we created earlier! This simple set of exercises is a great starting point for developing healthy shoulders, but it is far from a complete program for such a complex joint. Combine the complexity of the shoulder joint with the highly technical nature of tennis, and it becomes all the more important to have access to professional help. We recommend our friends at Overland Park Racquet Club for help with your tennis game, but any qualified professional you are comfortable working with will be helpful!
While we see a lot of issues with shoulder blade mechanics and mid back motor control in our clinic, we also see shoulder pain stemming from a host of other issues as well. The key to shoulder injuries is appropriate diagnosis by a professional (like the providers in our office). Once a diagnosis is made, an appropriate plan of care can be established emphasizing complete ranges of motion with stability throughout those ranges of motion. If you are experiencing persistent shoulder pain, call our office or schedule online today! 913-888-4845 We are entering the thick of basketball season! Games are adding up, and each is becoming more important than the last. At Inside Sports Clinic, we believe one of the best athletic abilities is availability. It is tough to help your team win games if you are sidelined with an injury! Taking care of your body down the stretch is critically important to increasing the likelihood you are available to help your team. A study by the National Athletic Trainer Association showed that over 40% of high school basketball injuries are sprain-type injuries to the foot/ankle. This coincides with what we see in our clinic, with lateral ankle sprains being an injury we see A LOT in our basketball players. Today we are going to cover an effective strategy for strengthening ankles for basketball players! To start, we like to do some self-administered soft tissue work to loosen the muscles and joints we are targeting. We are big fans of foam rollers for this purpose, but you can use a massage gun, PVC roller, or any other soft tissue tool you have access to that you feel comfortable utilizing. Spending a minute or two working on the calves and ankles creates a temporary increase in range of motion, which feeds into our next step perfectly! After you have worked on the muscles and joints, we want to reinforce that temporary range of motion we just created with some simple stretching. In the case of the ankle, a top tier stretch choice is the ankle driver! By getting into a deep lunge position and driving your knee towards and over the big toe, we can begin to make our temporary range of motion into a newly acquired range of motion! Now that we have created a new range of motion and begun to solidify it, we want to add some resistance to create more permanent changes. The age old classic for strengthening the ankles is a simple calf raise. Beginning with the balls of the feet slightly elevated, push through the foot to raise your body up. Hold the position at the top for a second or two, then slowly lower yourself down. As you become more comfortable with the basic calf raise, adding in some variety could be useful for basketball players considering the dynamic nature of the sport! This could mean performing a single leg calf raise, bent knee calf raise, adding extra resistance, increasing the height of foot elevation, and more. When combined with a well rounded basketball and athletic development program, this trio of activities will lead to strong and resilient ankles. Unfortunately, injuries like ankle sprains are not totally preventable. Sometimes things just happen. If after spraining your ankle you cannot bear weight or lose feeling in your lower leg/foot, then be seen by a provider immediately as these are signs something could be seriously wrong. Tenderness and difficulty walking after 2-3 days are also indications to be seen by a provider. Lastly, if you do not feel confident rehabbing your ankle after a sprain on your own, be seen by a provider!
At Inside Sports Clinic, we begin our treatment protocol by managing pain and swelling with modalities like our NormaTec boots, GameReady cryotherapy, and interferential current therapy. If/when pain and swelling are under control, we utilize joint manipulations and soft tissue therapy treatments to improve joint range of motion. Once the joint’s range of motion has been restored, we begin loading the ankle to tolerance, culminating in balance and proprioception training to ensure the ankle is adequately prepared for a return to activity! Need help getting your ankles stronger or rehabbing an ankle sprain? Call our office or schedule online so we can help you out! (913)-888-4845 Your neck, or cervical spine, is made up of seven bones stacked on top of each other with a shock-absorbing disc between each level (same as in your low back as discussed in last month’s blog). Your neck is relatively flexible so it relies on muscles and ligaments for support. "Sprains" and "strains" are the result of these tissues being stretched beyond their normal capacity, much like a rope that frays when it is stretched beyond its normal capacity. The term, "sprain" means that the tough, durable ligaments that hold your bones together have been partially damaged, while "strain" means that your muscles or tendons that move your neck have been partially damaged. Symptoms from a sprain/strain most commonly develop gradually, but may begin abruptly. Complaints often include dull neck pain that becomes sharper when moving your head, with the pain generally centered in the back of your neck. Pain can sometimes spread to your shoulders or between your shoulder blades, with tension headaches commonly accompanying neck injuries. Rest may relieve your symptoms but often leads to stiffness. Be sure to contact our office if you have any unusual symptoms, including a severe or "different" headache, loss of consciousness, confusion or "fogginess", difficulty concentrating, dizziness, slurred speech, difficulty swallowing, change in vision, nausea or vomiting, numbness or tingling in your arms or face, weakness or clumsiness in your arms and hands, decreased bowel or bladder control or fever. These are signs that you may have a more serious injury and need to be evaluated by a healthcare professional as soon as possible. Sprain/strain injuries cause your normal healthy elastic tissue to be replaced with less elastic "scar tissue", which can lead to ongoing pain and in some cases even arthritis. Seeking early and appropriate treatment, like the type provided in our office, is critical. Depending upon the severity of your injury, you may need to limit movements or activities that cause pain. Avoid heavy lifting and take frequent breaks from prolonged activity, particularly overhead activity. Neck pain tends to respond better when you keep some aerobic activity in your daily routine, like walking, so it is important to maintain some activity. Following acute injuries, you can apply ice for 10-15 minutes each hour, and heat may be helpful in specific scenarios. Treatments we perform in our office for this condition include joint manipulation, specifically a chiropractic adjustment, myofascial release, therapy modalities, and therapeutic exercises. Our providers prescribe specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease the pain while patients are at home. Patients are also given guidance on activities of daily living, such as how to set up their work station or selecting a pillow.
If you or anyone you know are currently experiencing any of these symptoms, call our office (913-888-4845) and set up an appointment so we can help you get to feeling better! Special thanks to our partners at ChiroUp for providing the framework to today’s blog and assisting us in delivering our patient care. |
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March 2024
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