IT Band Syndrome

2018 is the year of running (at least for Dr. Emily). With this, Dr. Emily is spending more time with runners, and she is hearing more about aches and pains with runners. Enter this blog post about IT Band Syndrome! 

Definition and Causes of IT Band Syndrome

First things first – what is the IT Band? IT stands for iliotibial; the IT band runs from your ilium to your tibia. The ilium is the science term for your hip bone and your tibia is one of the bones in your leg. Check out this picture to better visualize the IT band.

Looking at this photo, you can see the white tendinous fibers if the IT band. The top part of the IT band is thinner and fanned out. It is made up of fibers from tensor fascia latae (TFL) in the front, gluteus maximus in the back, and gluteus medius on the underside. As you travel down the IT band, fibers from vastus lateralis (one of the 4 muscles to make up your quadriceps) contribute a bit. The lowest portion of the IT band is a narrow, thick band that you can feel just above your knee.

So now that we are familiar with the IT band, we can look into IT band pains. IT band pains can come whenever the IT band isn’t able to move and support your body the way it is supposed to. If any of those muscles we talked about get too tight/aggravated, it can pull on the IT band and alter the biomechanics of your hip, knee, and leg. But there’s even a bigger picture than that! The IT band is not only connected to those muscles but to the ilium and the tibia. Both of those bones also serve as attachement sites to MANY other muscles. That means that any number of muscles can affect the ability of the IT band to work as it is supposed to.

There are some activities that can put more stress on the IT band. These include running downhill, running on slanted surfaces, always running on the track in the same direction, or simply over exertion. Wearing shoes that are worn out can also change your biomechanics and put more stress on the IT band.

Signs and Symptoms

IT band pain presents differently depending on where the problem started. Some common symptoms are:

• Nagging pain on the outside of your knee
• Sharp pain at the outside of your knee
• Swelling pain around your knee
• Feeling a click, pop, or snap on the outside of your knee
• Pain up and down the outer part of your upper leg

Many times the pain around the knee comes on during a certain part of a run and gradually gets worse. Many runners will feel that this pain is worse while going downhill.

The pain may also be noticed while cycling. It can come and go during the downward pedal stroke and upward pedal stroke (when your knee is bent around 30 degrees).

Sometimes the pain will go away with rest, but it will return with activity.

Chiropractic Approach

First off, a chiropractic exam is performed to determine the cause of the IT band irritation. A series of orthopedic tests, movement assessments, and palpation of the muscles and joints give us a good understanding of what is causing your pain. Through this exam, we can usually identify what the cause(s) of the pain are. The cause of the IT band syndrome dictates the treatment. 

If the cause is any of the muscles whose fibers directly feed into the IT band, the treatment will likely be focused on soft tissue therapy to those muscles. Manual soft tissue treatments (like massage) and instrument assisted soft tissue treatments (see this page for more info) are often very effective in treating IT band syndromes caused by this.

If the cause is due to joint restrictions (either in your feet, ankle, knee, hips, pelvis, or low back), we can correct those through chiropractic adjustments.

If the cause is due to muscle imbalances pulling on the ilium or tibia restricting the natural movements, we will work on correcting that imbalance by strengthening/activating the weakened muscles and stretching the tight/overactive muscles.

Some patients may have multiple causes contributing to their IT band syndrome, so we treat all the causes. We are also a big fan of home stretches and exercises to help eliminate future flair ups. Many patients benefit from foam rolling or using massage sticks over the musculature of their thighs and legs. 

After your first treatment, we will go through specfic exercises and stretches that are targeted towards correcting YOUR causes of IT band syndrome. 

There is no need to live with insistent, irritating pain. Call us today! 

Plantar Fasciitis

Most people wouldn't think to go to their chiropractor for plantar fasciitis, but I'm here to educate you on the condition and why chiropractic care can help!

Definition and Causes of Plantar Fasciitis

Plantar fasciitis is a term often used for pain on the bottom of your foot or by your heel. We can start by defining it by looking at the parts: plantar means the sole of your foot, fasciitis (fascia + itis) means inflammation of the fascia. Fascia is the science word for the connective tissues that cover your muscles and tendons. The plantar fascia is the thick piece of connective tissue that runs from your heel bone (calcaneus) to each of your toes. Check out this anatomy pic below to see the thick band of plantar fascia. 

So now that you know the definition of plantar fasciitis and you can picture the plantar fasciitis, we have to figure out what CAUSES that inflammation of the plantar fascia. A likely cause is simply irritation either deep to the fascia or more superficially.

First we will look into causes of irritation deep to the plantar fascia (between the plantar fascia and the bones in your feet). Not to overwhelm you, but under the plantar fascia there are FOUR layers of muscles and tendons before you even reach the metatarsals! You have the abductor hallucis, flexor digitorum brevis, abductor digiti minimi; lateral plantar nerve and artery, medial plantar nerve and artery; quadratus plantae, lumbricals, tendons of flexor hallucis longus and flexor digitorum longus; adductor hallucis, flexor hallucis brevis, flexor digiti minimi; interossei. It's easy to look at your foot and go, "there's no way all of that is in there!" They are though. There are 26 bones in your feet! Your body needs to be able to control the movement in all of those joints. If any of those muscles get tight/spasm, they may alter the functioning of the joints in your feet. That may be enough to trigger the inflammation of your plantar fascia. 

Second we will dig in to a more superficial cause of irritation to the plantar fascia. What is more superficial than the superficial back line (well aside from skin)? Some of you may be thinking, the superficial back line? What does that even mean? Based on Thomas Myers and his book Anatomy Trains, there are fascial lines through out our body that work to support us and help us perform various movements/tasks. One of the contiguous fascia lines is the superficial back line. The plantar fascia is the first part of the superficial back line. The line consists of the plantar fascia, heel bone (calcaneus), calf muscles (gastrocnemius/Achilles tendon), hamstrings, sit bone (ischial tuberosity), sacrotuberous ligament, sacrum, the muscles that run along side your spine (erector spinae),  and the fascia on your skull. Many times when one of the parts of this fascial line isn't working properly, that imbalance travels along the fascial line, and pain/dysfunction follows. So a problem in any of those areas can present as plantar fasciitis.

Signs and Symptoms

Plantar fasciitis is often associated with walking, running, tennis, gymnastics, and basketball. This doesn't mean that it HAS to be a result of this or more problematic during those activities. 

People with plantar fasciitis usually have pain in their foot that is worse when they wake up in the morning or after long periods of rest. Pain often increases with toe rises or running. The pain can also increase towards the end of the day. The pain is often noticed along the inside arch of your foot close to your heel bone (calcaneus). There may also be pain/tenderness to the touch of the bottom part of the foot. 

Chiropractic Approach

First off, a chiropractic exam is performed to determine the cause of the plantar fasciitis. A series of orthopedic tests and palpation of the muscles and joints give us a good understanding of what is causing your pain. Through this exam, we can usually identify what the cause(s) of the pain are. The cause of the plantar fasciitis dictates the treatment. 

If the cause is deep to the plantar fascia, the treatment will be aimed at muscle release to the muscles in the foot and the muscles in the calf whose tendons run deep to the plantar fascia. After assessing the motion in the joints of the foot, often times adjustments may be performed on the foot. 

If the cause is along part of the superficial back line, the treatment will be targeted at the area causing the problem. Muscle release or work on the tendons and ligaments may be performed to help "slacken" the superficial back line and take pressure off of the plantar fascia. Adjustments may be performed on the back, pelvis, and/or the leg and foot. 

Some patients may have multiple causes contributing to their plantar fasciitis, so we treat all the causes. We are also a big fan of home stretches and exercises to help eliminate future flair ups. After your first treatment, we will go through those exercises and make sure that you are comfortable with your home care stretches. 

There is no need to live with insistent, irritating foot pain. Call us today! 

Sciatica

Sciatica is a common term that many people have heard. Low back and leg pain? Oh yeah, that’s just sciatica. Discomfort after driving for a long time? Oh that’s that sciatica acting up again. Sciatica has turned into a catch all phrase that’s casually thrown around. But what exactly is sciatica? What causes that irritating pain?

Definition and Causes of Sciatica

Sciatica is simply pain and tenderness at some point(s) along the sciatic nerve. Check out the image below of the sciatic nerve. (This anatomy picture is looking at the back side of a right leg. The sciatic nerve is shown coming out from under the piriformis muscle down to the back part of the knee.) 

There is a lot going on around the sciatic nerve. The pain can be caused by irritation of any part of the nerve.

Below is a picture of a healthy spine and nerve roots leaving your spinal cord. You can have irritation of the sciatic nerve starting here! The sciatic nerve is made up of nerve branches from the spinal cord from the L4 level to the S3 level. If any of the discs in this area bulge or herniate (where the inside material of the disc is pushed outwards), they can irritate the nerves exiting the spinal cord. If you have degenerative joint disease (DJD), the amount of space for the exiting nerve (aka the foramen for spinal nerve) decreases in size. The smaller space for the nerves to exit the spinal cord can lead to increases in nerve iritation.  

The pain can also be caused from irritation of the nerve as it travels through/in/around any of the muscles. A common site of irritation can be from the piriformis muscle. In most people the muscle passes underneath the muscle (as seen in the first anatomy pic), but in some people, the nerve travels through or around the muscle. The piriformis muscle is important muscle used in walking and stabilizing the hips and pelvis. If the piriformis muscle gets tight, it can lead to irritation of the sciatic nerve.  The nerve also travels along the hamstrings (which are actually 3 muscles--semimembranosus, semitendinosus, and biceps femoris). Strain on these muscles can also cause sciatic symptoms. 

Signs and Symptoms

Sciatica presents with increased pain and or paresthesia along the back part of the leg to the knee or even all the way down into your foot. This can lead to an altered walking pattern, which can cause even MORE pain. Pain can increase while bending forward like if you were going to touch your toes/tie your shoes/etc. Patients with sciatica can also notice pain in the back of the knee or in the gluteal area, especially when palpated. 

Chiropractic Approach

First off, a chiropractic exam is performed to determine the cause of the sciatica. A series of orthopedic tests, neurological tests, and palpation of the muscles and joints give us a good understanding of what is causing your pain. Through this exam, we can usually identify what the cause(s) of the pain are. The cause of the sciatica dictates the treatment. 

If there is disc irritation from DJD, the patient is usually treated with flexion and distraction. If there is muscle inflammation or strain causing the problem, we will perform muscle release techniques, electrical stimulation, or various other modalities to help relieve the inflammation, relax the muscles, and take pressure off of the nerve. Some patients may have multiple causes contributing to their sciatica, so we treat all the causes. We are also a big fan of home stretches to help eliminate future flair ups. After your first treatment, we will go through those exercises and make sure that you are comfortable with your home care stretches. 

There is no need to live with insistent, irritating low back and leg pain. Call us today! 

Golfer and Tennis Elbow

This week's blog post is brought to you by Dr. Keven Hagen. Dr. Keven is a sports chiropractor practicing in Rochester, NY. To learn more about his practice, check out his website. 

Elbow pain is all to common for most competitors. The feared golfers elbow, or the irritating tennis elbow tend to show up in all sports, not just golf and tennis. The elbow is commonly injured by repetitive movement or prolonged positioning, rather than a traumatic event. Most people think it will never happen to them, but if it does it can be very debilitating.

EPICONDYLITIS

The translation of epicondylitis is “inflammation of the epicondyle,” which translates to inflammation of the elbow tendons. There are medial (inside) and lateral (outside) tendons in the elbow that can become inflamed fairly easily.  The medial are generally called golfers elbow and the lateral are generally called tennis elbow, even though some literature has the opposite. Golfers are prone to tennis elbow, and tennis players are prone to golfers elbow. It just happens to be more prevalent within the sport. Repetitive overuse such as typing on a computer, manual labor, gardening, golf, tennis or any activity that requires repetitive hand and wrist movement can cause epicondylitis.

SYMPTOMS AND CAUSES

Lateral epicondylitis (tennis elbow) can be described as an ache which gets more severe with activities involving an open hand or extending your wrist. Medial epicondylitis, (golfers elbow) is generally described as an ache and gets more severe with activities that require a fist to be made.

Both are generally sore to the touch and can progress to a deep stiffness. It is not uncommon for grip strength to be decreased if left untreated.

CHIROPRACTIC APPROACH

By performing muscle release techniques, electrical stimulation, or various other modalities, we are able to have the inflammation relax, restoring normal function. We will provide you with home stretches to help eliminate future flair ups.

There is no need to live with insistent, irritating elbow pain. Call us today! 

Chiropractic and Scoliosis

What is scoliosis? Should you be concerned? Can chiropractic help? Should I get a brace? Do I need surgery?

I remember being in middle school getting screened for scoliosis every year in gym class. At the time, I don't think I even knew what scoliosis was. I just knew that once a year, I'd go to gym class, and they'd look at my back, have me bend forward, then look at my back again. June is National Scoliosis Awareness Month, so this week we'll be diving in to scoliosis. 

The simplest definition is that scoliosis is an abnormal curvature of the spine. Your spine is supposed to have curves when you look at it from the side but not from the front/back. Scoliosis is when you have curves that go to the side. 

 The curves you can see in the normal spine help with the natural physics and structure of the spine. In Scoliosis, you get an S or C shaped spine. In 80-85% of all cases the cause of scoliosis is unknown (aka idiopathic in science talk). 

The severity of scoliosis is determined by how big the abnormal curvatures are. The bigger the curve(s) the more drastic the side effects. Doctors will use radiographic imaging (x-rays) to measure the size of the curve. The standard measurement for scoliosis is the Cobb Angle. Using the Cobb Angle, scoliosis is defined by a curve of 10° or more. Using the imaging, the cases are defined as mild (10°-25°), moderate (26°-40°), or severe (>40°). 

When it comes to treating scoliosis, chiropractic care makes sense! Chiropractors are neuromusculoskeletal doctors. We work with keeping the body aligned. Since most cases of scoliosis have unknown causes, it can be tricky to treat them. What chiropractic can do is work with the musculature around the area of the curve. We can work on tight muscles which may be contributing to or a result of the abnormal curve. We can work on maintaining joint movement in the spine. We can also provide exercises to help strengthen the posture muscles and stabilize your body. 

The goal when it comes to patients with scoliosis it to catch it early. If you can catch it early and use chiropractic care to manage your scoliosis, you may be able to help stop the progression and even correct the curve. A study published earlier this year showed that 90% of patients that participated in a chiropractic rehabilitation treatment for idiopathic adolescent scoliosis had curve correction or stabilization. 

If the curve keeps progressing, and it gets to the moderate or severe stages, bracing becomes more pressing treatment option. If chiropractic care and bracing aren't helping, a surgical consult may be the next step. 

If you have questions, feel free to reach out to us at Select Chiropractic and Wellness.