Injury can occur from a specific incident usually associated with cutting and planting of the lower extremities at speed or with contact activities. However most often groin pain is of a chronic nature, occurring insidiously and is related to repetitive stresses incurred across the pelvis and associated muscular attachments. Common subjective symptoms may include pain with strenuous activity, resolution of or minimal pain with rest, and unilateral or bilateral inguinal (groin) and adductor (inner thigh) pain.
In a recent case report, six collegiate athletes were diagnosed with a sports hernia using five classic signs and symptoms which the authors referred to as the “cluster of five”. These include: complaints of deep groin/lower abdominal pain, exacerbation of pain with sports activity which is relieved by rest, tenderness with palpation of the pubic ramus, pain with resisted hip adduction, and pain with resisted sit-up test.

Conservative treatment has been found to helpful for numerous NHL players who suffer from sports hernia. I have found this particular treatment protocol to be very effective in treating this condition. The rehabilitation program can be described in three basic phases: Phase 1 – pain management/initiation of flexibility and stabilization, Phase 2 – strength and stability progression (including core stabilization) Phase 3 – functional progression and return to sport.

Prevention
A thorough warm up routine followed by a stretching routine performed before exercise is a good habit to instill in athletes to prevent injuries. Stretching should include the following muscles: adductors and hip flexors.
Hip flexibility and strength are specifically critical in prevention of sports hernias and recurrence. When weight training, it is imperative to use a sensible routine for both flexion and extension muscle groups. Finally, core stability and strength will assist with balance and can help prevent sports-related injuries.

Here are some groin stretches to try: Hold each stretch for 20 seconds, slight discomfort should be felt, but no pain. If  pain is felt try loosening up slightly on the stretch.

For more information please contact drremy@thechiropracticoffice.ca

Resources:
1. Int J Sports Phys Ther. 2012 February; 7(1): 85–100. NON-SURGICAL TREATMENT OF A PROFESSIONAL HOCKEY PLAYER WITH THE SIGNS AND SYMPTOMS OF SPORTS HERNIA: A CASE REPORT J. Scott Woodward, PT, MSPT, SCS, ATC,1 Andrew Parker, MD,2 and Robert M. MacDonald, MD, F.A.C.S.3,,4

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The rotator cuff is a group of four muscles that surround the humeral head (ball of joint). The muscles are referred to as the “SITS” muscles-Supraspinatus, Infraspinatus, Teres minor and Subcapularis. The muscles function to provide rotation and elevate the arm and give stability to the shoulder joint (glenohumeral joint). The supraspinatus is most frequently involved in degenerative tears of the rotator cuff. More than one tendon can be involved. There is a bursa (sac) between the rotator cuff and acromion that allows the muscles to glide freely when moving. When rotator cuff tendons are injured or damaged, this bursa often becomes inflamed and painful.

Rotator Cuff Tendonitis
Rotator cuff tendinitis is an inflammation (irritation and swelling) of any of the 4 tendons of the rotator cuff muscles of the shoulder.  The most common ones injured are supraspinatus and infraspinatus.  Often the patient can develop what is known as “impingement syndrome”.

Repeated movement of the arm overhead can cause the rotator cuff to contact the outer end of the shoulder blade where the collarbone is attached, called the acromion. When this happens, the rotator cuff becomes inflamed and swollen, a condition called tendonitis. The swollen rotator cuff can get trapped and pinched under the acromion. All these conditions can inflame the bursa in the shoulder area. A bursa is a fluid-filled sac that provides a cushion between a bone and tissues such as skin, ligaments, tendons, and muscles. An inflammation of the bursa is called bursitis

Causes, incidence, and risk factors

The shoulder joint is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula and secures the joint.

Inflammation of the tendons of the shoulder muscles can occur in sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head. Chronic inflammation or injury can cause the tendons of the rotator cuff to tear.

The risk factors are being over age 40 and participation in sports or exercise that involves repetitive arm motion over the head (such as baseball).

Symptoms

• Pain associated with arm movement; mainly overhead activities
• Pain in the shoulder at night, especially when lying on the affected shoulder
• Weakness with raising the arm above the head, or pain with overhead activities (brushing hair, reaching for objects on shelves, etc.)

Rotator Cuff Tears

Rotator cuff tears are a common source of shoulder pain. . The incidence of rotator cuff damage increases with age and is most frequently due to degeneration of the tendon, rather than injury from sports or trauma. Rotator cuff tears increase in frequency with age, are more common in the dominant arm, and can be present in the opposite shoulder even if there is no pain. The highest incidence occurred in patients who were more than 60 years old.

Causes, incidence, and risk factors

There are intrinsic and extrinsic causes of rotator cuff tears. An example of an intrinsic factor is tendon blood supply. The blood supply to the rotator cuff diminishes with age and transiently with certain motions and activities. The diminished blood supply may contribute to tendon degeneration and complete tearing. The substance of the tendon itself degenerates over time. Due to an age related decrease in tendon blood supply, the body’s ability to repair tendon damage is decreased with age; this can ultimately lead to a full-thickness tear of the rotator cuff.

An extrinsic cause would be damage to the rotator cuff from bones spurs underneath the acromion. The spurs rub on the tendon when the arm is elevated; this is often referred to as impingement syndrome. Bone spurs are another result of the aging process. The rubbing of the tendon on the bone spur can lead to attrition (weakening) of the tendon. Combining this with a diminished blood supply, the tendons have a limited ability to heal themselves

Treatment for Rotator Cuff Injuries

The injured shoulder should be rested from the activities that caused the problem and from activities that cause pain. Ice packs applied to the shoulder and non-steroidal anti-inflammatory drugs will help reduce inflammation and pain. Laser therapy and acupuncture are also great tools which can be used to reduce inflammation and pain. Muscle release techniques are also important to reduce stiffness around the joint and the spine.

Therapy to strengthen the muscles of the rotator cuff and the scapula should be started; attention to any causative factors such as poor posture should also be addressed. This is especially important because if left untreated frozen shoulder can set in which is a very painful and chronic condition.

For more information please contact Mississauga Chiropractor Dr. Nekessa Remy at drremy@thechiropracticoffice.ca

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Causes

Training errors appear to be the most common factors invovled in shin splints, especially as athletes attempt to do “too much, too fast” Common training errors include a recent onset of increased activity, instensity or duration. Running on hard or uneven surafaces is also a common risk factor. Individuals with previous lower extremity injuries and running more than 20 miles per week are especially predisposed to overuse injuries of the lower extremity, including Shin splints. Shin splints is most often found in runners, and also found in other ballistic sports, such as football, basketball, soccer, and dancing. Biomechanical abnormalities also play a rule including, irriated or very tight calf muslces, stress fractures of the lower leg bone and/or extremely flat feet can increase stress on the shin bone, the tibia.

Treatment

During the acute phase rest is the most important treatment. Ice is also important and should be applied to the shin for approximately 15 minute intervals Physical Therapy modalities including electrical stimulation, laser therapy, acupuncutre and soft tissue therapies are also beneficial. Active Rehabilitation is also important. This may involve strengthening weak calf muscles and increasing core muscle strength and endurance.

Prevention

As mentioned earlier very tight and weak calf muscles can increase the stress on the shin bone, resulting in shin splints. Literature has widely supported a daily regimen of calf stretching and eccentric calf exercises to prevent muscle fatigue. Other exercises focus on strengthening the tibialis anterior and other muscles controlling both inversion and eversion of the foot.

Mississauga Chiropractor calf stretch

Mississauga Chiropractor Eccentric Calf Strengthening

Patients may also benefit from strengthening core hip muscles. Developing core stability with strong abdominal, gluteal, and hip muscles can improve running mechanics and prevent lower-extremity overuse injuries. Developing muscle strength will improve endurance, but should not be done in the acute phase as they may exacerbate the injury due to increased strain on the tibia.

Reference: Curr Rev Musculoskelet Med. 2009 September; 2(3): 127–133.

For more information or if you suspect you may be suffering from shin splints please contact us at drremy@thechiropracticoffice.ca or 905-820-7746.

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What is Little Leaguer’s Elbow?

Little leaguer’s elbow is an overuse condition seen in adolescent baseball player’s, hence the name, that can be a cause of pain located on the inside of the elbow (medial). With too much repetitive throwing of a baseball the growth plate on the inside of the end of the elbow, known as the medial epicondyle, becomes inflamed. Little leaguer’s elbow is known as an apophysitis which refers to chronic inflammation of the growth plate. In adolescents, the growth plates are the weak link in the elbow during the throwing motion as opposed to the ligaments as in adults. Elbow pain in general in the adolescent pitcher is not uncommon and occurs in up to 40% of throwers.

How do you get Little Leaguer’s Elbow?

Repetitive overhand throwing of a baseball, most commonly seen in little league adolescent pitchers, can lead to cumulative traction stress being placed on the inside of the elbow. During the overhand throw, the inside of the elbow (medial) has traction placed on it while the outside of the elbow (lateral) has compression placed on it. This repeated traction on the medial elbow pulls at the growth plate and it becomes irritated and inflamed.

Who is most susceptible to Little Leaguer’s Elbow?

Little leaguer’s elbow most commonly occurs when an adolescent baseball pitcher throws too many pitches in games and does so on too often days. This leads to a cumulative number of throws that exceeds the forces that the growth plate on the medial side of the elbow can withstand.

What are the recommended pitch counts to decrease the chances of Little Leaguer’s Elbow occurring in the first place?

The USA Baseball Medical and Safety Advisory Committee makes the following recommendations for earliest age at which pitchers should begin throwing each pitch type: fastball, age 8; change-up, age 10; curveball, age 14; knuckleball, age 15; slider, age 16; forkball, age 16; splitter, age 16; screwball, age 17. Breaking pitches should not be thrown until skeletal maturity (growth plates are closed) is reached.

The recommended per game pitch counts are: 8 to 10 years, 50 pitches; 11 to 14 years, 75 pitches; 15 to 16 years, 90 pitches; 17 to 18 years, 105 pitches. Furthermore, pitchers should not compete more than 9 months per year and should avoid all overhead activities during those 3 months of rest. In addition, pitchers should be not participate in more than 1 league during overlapping seasons. Pitchers of all ages should be involved in year-round conditioning to promote endurance, core strength, neuromuscular control, and proper throwing mechanics.

How is Little Leaguer’s Elbow initially treated?

The patient should undergo a period of complete rest from throwing for 4 to 6 weeks at a minimum. During this period throwing of any kind is strictly prohibited. Laser therapy, acupuncture and soft tissue therapy can be used to reduce inflammation and help manage pain. A strengthening and endurance program should be initiated to maintain cardiovascular fitness and to focus on overall core strength. Often adolescent aged athletes have poorly developed core strength and overall body control which can make them susceptible to poor throwing mechanics and injury. Regular icing and anti-inflammatory medication should be used early on when the patient is symptomatic.

Following the initial 4 to 6 week period of no throwing and only when the patient is completely pain free, a structured throwing program should be initiated over the next 6 to 8 weeks. During this time, the pitcher should be assessed to evaluate and correct their throwing mechanics. Any pain during the rehab period should cause the athlete to temporarily pause their program for a short period until they can throw without symptoms.

What is the typical recovery from Little Leaguer’s Elbow?

Typically it takes about 12 weeks for an injured athlete to return to competitive throwing in a game situation. Special attention should also be paid to the number of pitches and to the types of pitches thrown by the pitcher. Higher stress pitches like a curve ball or breaking ball should be avoided until the pitcher reaches the appropriate age. Also, the athlete’s core and shoulder strengthening program should be continued year round to maintain and further develop their strength and muscle control.

For more information contact Mississauga Chiropractor Dr. Nekessa S. Remy at drremy@thechiropracticoffice.ca or 905-820-7746

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The good news is that UCS is easy for us to identify and can be corrected with time and a conscientiously applied program of chiropractic and rehabilitative care. Over time manipulation, stretching and progressive exercises re-establishes normal movements and normal muscular length and strength.

Here are a few exercises that you could try at home to help prevent the development of UCS.

Wall Angels

• Stand with your back to the wall with your feet apart (approx 12″ from the wall)
• Buttocks, shoulder blades and head are against the wall
• Rock your pelvis forward into a tilt so that there is a space between your lower back and the wall
• Raise your arms above your head with your palms facing outward.
• While maintaining the pressure t the wall with the back of your hands, slowly lower your elbows toward teh floor.
• Return to the start position

Brugger

• Sit on a chair with your “sit bones” at the edge
• Rock your pelvis forward into a tilt
• Tuck your chin and turn your hands outward so that your thumbs are pointing behind you
• Keep fingers as wide as possible
• Hold for 10 seconds and repeat

Chin Tucks

• While sitting in a comfortable position, slowly move your head straight backward so that your chin moves into a tuck position
• your eyes should stain in a position so that you are still looking straight ahead
• Use your hand on your chin to push your head further backward.
• Return to the starting position
• Perform 5-10 reps 3-5 times per day

The quality of posture can make a big difference in your life. Proper posture can make a person look and feel stronger, decrease the risk of injury, advance everyday performance, and over the course of a life, proper posture can prevent painful physical and mental strain.

It is advised that you consult your health care professionals before starting any exercise routine.

For more information please contact Dr. Nekessa Remy at drremy@thechiropracticoffice.ca or call 905-820-7746

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Most stress fractures occur in the weightbearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.

The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.

If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly.

Here are some tips developed by the American Academy of Orthopaedic Surgeons to help prevent stress fractures:

• When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.
• Cross-training — alternating activities that accomplish the same fitness goals — can help to prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility exercises to the mix for the most benefit.
• Maintain a healthy diet. Make sure you incorporate calcium- and Vitamin D-rich foods in your meals.
• Use the proper equipment. Do not wear old or worn running shoes.
• If pain or swelling occurs, immediately stop the activity and rest for a couple days. If continued pain persists, see your chiropractor.
• It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.

For more information on this injury please contact Mississauga Chiropractor, Dr. Nekessa Remy at The Chiropractic Office, 905-820-7746 or drremy@thechiropracticoffice.ca

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Anatomy of the Piriformis Muscle:
•Starts at the lower spine and connects to the upper surface of each femur (thighbone)
•Functions to assist in rotating the hip and turning the leg and foot outward
•Runs diagonally, with the sciatic nerve running vertically directly beneath it (although in some people the nerve can run through the muscle).

Causes of Piriformis Syndrome:
The exact causes unknown. Suspected causes include:
•Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip
•Tightening of the muscle, in response to injury or spasm
•Swelling of the piriformis muscle, due to injury or spasm
This injury is very common in runners due to the constant contraction of the pirirformis to support the pelvis during running.

Symptoms associated with Piriformis Syndrome:
Most commonly, patients describe acute tenderness in the buttock and sciatica-like pain down the back of the back of the thigh, calf and foot. Typical piriformis syndrome symptoms may include:
•A dull ache in the buttock
•Pain down the back of the thigh, calf and foot (sciatica)
•Pain when walking up stairs or inclines
•Increased pain after prolonged sitting
•Reduced range of motion of the hip joint
Symptoms of piriformis syndrome often become worse after prolonged sitting, walking or running, and may feel better after lying down on the back.

Treatment for Piriformis Syndrome:
At home therapies:
Ice
At the onset of pain, lie in a comfortable position on the stomach and place an ice pack on the painful area for approximately 20 minutes. Repeat as needed every 2 to 4 hours.
It may be more helpful to combine a gentle massage with the ice. Lie on the stomach and have someone gently massage the painful area with a large ice cube. If ice is applied directly to the skin (instead of a cold pack), limit it to 8 to 10 minutes to avoid an ice burn.
If specific activities are usually followed by increased pain, it may be a good idea to apply ice immediately following the activity.

Heat
Some people find it helpful to alternate cold with heat. If using a heating pad, lie on the stomach and place the heating pad on the painful area for up to 20 minutes. Be sure to avoid falling asleep on a heating pad, as this may lead to skin burns.

Chiropractic Treatment
Piriformis Syndrome is a very treatable condition. However if left untreated it can become chronic and lead to other issues like iliotibial band syndrome and patellar tracking issues. At the Chiropractic Office there are a variety of options available to treat this condition.

Acupuncture – will help to alleviate tension with the pirifiromis and surrounding musculature, if there is any inflammation acupuncture can also work to decrease inflammation while promoting healing in that region

Muslce Release Technique- will reduce any adhesions or “knots” within the piriformis which may be causing pressure on the sciatic nerve.

At home stretching – Very important to consistent stretch the piriformis in order to prevent continued tightening of the muscle. Each stretch should be held for 20 seconds and done at least 3 times per day.

If you suspect that you may be suffering from piriformis syndrome or would like more information, please contact our office at 905-820-7746 or send us an email at drremy@thechiropracticoffice.ca

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With these simple tips you may decrease your chance of injury:

1.) Dress Appropriately
Dress in layers as sweat can build up quickly
Wear gloves to avoid getting blisters
Wear well supported shoes with skid resistant soles to decrease the risk of falls

2.) Right Tools
Select a rake that is the proper height and size for your strength

3.) Be posture conscious
Watch your posture while raking. Raking while hunched over puts extra stress on your low back; this can lead to an increased soreness

4.) Proper technique
When raking use your legs rather than your back to shift your weight, twisting movements can strain the muscles in your back
Try varying movements and sides often to avoid overusing muscle groups

5.) Don’t overdo it
Raking leaves is an aerobic exercise. Don’t rush it! The leaves aren’t going anywhere!
Take regular breaks to rest and remember to hydrate yourself

6.) Use proper lifting technique
Try not to overfill your bags with leaves, especially if leaves are wet
When lifting bend your legs and not your back. Your legs are stronger than your arms use this to your advantage. Keep the load close to your body, pivot with your feet and don’t twist your body while carrying the load.

7.) Stretching
Stretching after your body has warmed up and then again after you are done can decrease your chances of injuries. Muscles to focus on include your back, neck, shoulders and legs.

8.) Contact your Chiropractor

If you have pain of discomfort following raking, consult your chiropractor to prevent chronicity of pain.

For more information please contact The Chiropractic Office at 905-820-7746 or email us at drremy@thechiropracticoffice.ca

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I found this great article by Barbara Russi-Sarnataro which offers 10 ways to start making the most of the season. And who knows? This year, you might be in great shape before that New Year’s Eve party rolls around.

1. Take advantage of the weather. These months are a great time to exercise outdoors and enjoy cooler temperatures.

“Walking, hiking and cycling are all awesome in the fall,” says Todd Durkin, MS, fitness coach and owner of Fitness Quest 10 in San Diego, Calif.

Discover park trails and take in some new scenery, whether you’re walking, biking, or in-line skating, he suggests. If you’re near a lake, try kayaking or canoeing, for an excellent whole-body workout and a great change of pace. And remember, it doesn’t have to seem like exercise to be a great workout.

Raking leaves or doing some fall outdoor yard work is a great way to get the heart pumping, and it’s great calorie-burning.

2. Think outside the box. Always wanted to learn to tap dance? Attempt to box? Master the jump rope? Ask any schoolchild: Fall is a great time to learn something new.

Many classes at gyms and elsewhere get started in the fall, so look around and see if something intrigues you.

And with the kids in school, parents have more time to check out those classes.

Fall is the perfect time to gain new physical skills, because you burn fewer calories when you begin a new activity (thanks to the learning curve). If you learn something new now, by next summer, you’ll have mastered the skill — and you’ll burn more calories doing it, just in time for swimsuit season.

3. Be an active TV watcher. Many people get geared up for fall premieres of their favorite television shows. If you’re going to sit down and watch hours of TV, get moving. Make a date with exercise and TV.

While you watch, you can walk or run in place, do standing lunges, do tricep dips off the couch, or lift weights. During commercials, do push-ups or sit-ups. In a one-hour show, you probably have close to 20 minutes worth of commercial interruption.

4. Integrate exercise into your life. You already know the obvious suggestions: park farther away from your destination; take stairs instead of elevators; take a walk during your lunch break. Here are a few that are less obvious:

• If you’re spending the afternoon taking kids to soccer practice, instead of reading a book or visiting with another parent, “why not walk around the outside of the field while they practice?
• Or try “walking meetings,” like those of Justin Price and his colleagues at Biomechanics often hold. ‘”We go for a walk, we brainstorm, and we figure out who’s going to take what responsibilities,” says Price. “‘Things get achieved much more quickly,” he says, and everyone feels better for doing it.
• You can even get moving while you get motivated — for fitness or other life goals. Get some inspirational music or find a motivational talk and download it to your iPod. Walk while you listen for 30 minutes.

5. Rejuvenate yourself. Fall is the time to rejuvenate body, mind and spirit. Get a massage after your run. Learn to meditate. Take an art class. Treat yourself not just with exercise but other activities that promote wellness, so you can feel good physically, mentally, emotionally, and spiritually.

6. Remember the 30-day rule. “‘It takes about four weeks for the body to adapt to lifestyle changes,” says Price. That’s why people who give up on their fitness programs tend to do so within the first 30 days.

So, when the alarm goes off in the morning and it’s darker and colder, don’t roll over and hit the snooze button.

“Try to stick with a program for a month,” Price says. “After a month, behavior patterns will have adapted and it will be much easier to stick with it after that.”

7. Strive for the 3 Cs. Commitment, Convenience, and Consistency will lead to a successful fitness program.

First, exercise takes commitment. When a client complains to Chris Freytag, a fitness instructor and fitness expert with Prevention magazine, about a lack of time, she responds: “Tell me something I haven’t heard before. We’re all busy; that’s just part of our lives.

“You have to start planning exercise, just like you do everything else,” like meetings, dinners, and getting kids to lessons and practice, she says. “Put in on the calendar, because later always turns into never.”

Convenience means choosing a gym that’s close by, or an activity you can do at home, or a time when you’re not likely to be interrupted.

Finally, there’s consistency. “I’d rather see a brand-new client work out for 10 minutes a day rather than one hour every month,” Freytag says

8. Deal with darkness. The best way to enjoy fall is to exercise outdoors. But it is getting darker earlier, and staying dark later in the morning, so be smart and safe.

Just because it’s 6 p.m. (or a.m.) and dark doesn’t mean you can’t work out. If walking or running outdoors, wear a reflective vest and carry a flashlight. When cycling, affix a light to your helmet or bike.

If possible, use trails or a local school track to avoid vehicle traffic. Try to work out at the same time every day, so drivers get used to seeing you.

9. Dress in layers. When exercising outside, layer your clothing. Before your body warms up, you may feel chilled, but once the blood gets pumping, you’ll feel overdressed.

These days, there’s no lack of great weather gear. Freytag and Price recommend clothing with wicking, often called “DriFit.”‘ This fabric wicks moisture away from your skin so you’re not exercising with wet fabric hanging on you.

Freytag suggests three layers: “The inner layer should be a moisture-wicking fabric, so it wicks away sweat and you’re not chilled. The second layer should be a warmth layer, and the third layer should be a protective layer (like a windbreaker or rain slicker, depending on the weather).”

“And don’t forget the sunglasses,” she warns. UV protection is important year round. Fall sun can be blinding at certain times of the day.

10. Find your motivation. People are motivated by different things. It’s important to first discover what your individual goals are, whether it’s losing weight, strengthening and toning, or preparing for a race or event..

But goals aren’t enough to get you there; you have to be motivated by the day-to-day workouts.So choose something you’ll enjoy doing and will be likely to keep up, whether it’s walking or hiking with a friend, working with a trainer, or taking part in a “boot camp” class.

Creating a challenge for yourself will motivate you, as will encouragement and accountability.Remember too, that anything worth having takes work.

Tell me something you can do three times a week for 10 minutes and be great at? It doesn’t exist. If it was easy to be great, everybody would be great.

For more information on how you can start your fall workout routine with The Chiropractic Office check out www.carpediemfitness.com

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