‘Frozen shoulder’ can be painful

A common problem we see in our chiropractic practice is a shoulder that is painful and not moving the way it should.

Often, this is what is called a “frozen shoulder” or “adhesive capsulitis.” Generally, this is a shoulder that is painful many times at night and has decreased motion. Causes are most often idiopathic which means that we do not know why it occurs.

Other common presentations are a minor shoulder injury that does not get moved right away by the patient after the injury; the patient holds the arm at their side and protects the arm and it becomes stiff and painful.

Many times after rotator cuff repair or other shoulder surgeries — during the early post-operative period when we are not allowing the patient to actively move their shoulder — this stiffness and pain can be present post-operatively.

Frozen shoulder seems to have a high association with patients who have diabetes. Other causes are hyperthyroidism, open-heart surgery and cervical disk disease of the neck.

The symptoms again are reduced motion, pain and stiffness, with pain being the most common. The pain that really brings patients in is the pain at night because they cannot sleep. Many times this pain is pronounced with overhead activity.

In these instances, patients cannot get to their back pocket very easily with their hand, and with their elbow at their side they cannot turn the arm out away from their body.

Treatments at our clinic include Active Release Therapy, Low level laser therapy and rehabilitation exercises. These non-surgical treatments often see progress that takes as long as six to nine months for complete recovery.

So if you suspect that you have frozen shoulder or adhesive capsulitis, you can be seen directly by calling 604-990-6676 and have this evaluated. Should you have early onset of stiffness and pain with your shoulder it is recommended to try to impose early treatment and seek medical attention.

Piriformis: A Key muscle

The piriformis is a small, triangular-shaped muscle in the hip. It is primarily responsible for controlling the rotation of the hip while we walk or pedal. Because of its location, pain in the piriformis can feel like it is coming from the low back, the sacrum, or even the hip joint itself. Piriformis issues are easily mistaken for other, more common back injuries.

It is estimated that almost 1 in 10 cases of back pain actually come from the piriformis.  Often, patients suffering from piriformis syndrome have been through multiple treatment approaches and sometimes have even had procedures performed on them without relief.

Cyclists and runners are especially prone to piriformis syndrome. Because the piriformis controls the rotation of the hip, it is called upon to work hard with each stride and each pedal stroke. Shoes with poor support and especially core weakness can overtax the piriformis, causing it to become painful and eventually dysfunctional.

Certain bikes, with their aggressive seat angles and aero handlebar positions, are notorious for placing stress on the piriformis. Seats that are ill-fitting or just worn out from miles on the road can also be a factor. A good early stop for cyclists and triathletes with hip or back pain is to take their bike to a bike fitter.

Because of its negative impact on core strength, pregnancy is a big setup for piriformis syndrome. Most athletes don’t feel the effects until months or even years later. When their training intensity increases, typically so do their symptoms.

Foam rolling, using a physio roll to massage the piriformis, and strengthening the core are all great ways to get a jump on treating moderate piriformis syndrome at home.

At Grande Chiropractic, I treat this condition successfully with Active Release Therapy (ART) to break up adhesions formed by repetitive stresses put on this muscle. Often the symptom relief is immediate but the patient is aslo instructed on home stretches.

New Treatment for Muscle Pain

Olympian Jeff Pain swears by active release therapy to get sore or injured muscles moving again, and to generally improve his athletic performance.

“There’s no better therapy out there,” says Pain, as chiropractor Conrad Tang uses his thumbs to work the quadriceps muscle of the 2006 silver medallist in skeleton.

So-called “manual release therapies” such as active release therapy, Graston technique and Kinesio Taping are all the rage -Jon Montgomery reportedly used active release therapy prior to his gold-medal win at the 2010 Olympics.

But there’s little scientific evidence to support the effectiveness of the therapies, says Tang, also a kinesiology researcher with the University of Calgary who is embarking on a study to determine if manual release therapies, at the cutting edge of injury treatment and performance enhancement for elite athletes, can help regular folks with kneecap pain.

He’s looking for 20 active people between the ages of 18 and 45 with patella pain femoral syndrome, a common problem that affects about 30 per cent of the population, to participate in a free, eight-week treatment program.

Pain and injuries often lead to muscles that shut down and become dormant, explains Tang. Weakness and pain further hampers a person’s ability to move. By manipulating and applying pressure, manual therapy techniques are said to “wake up” these muscles and improve mobility and range of motion.

“When a muscle is damaged, scar tissue forms and groups of muscles get stuck together. They’re supposed to freely move against one another. But when they get stuck, the muscles shorten and get stiff. This can produce weakness in and shrinking of the muscle,” he says of the downward spiral of injury.

“Patented techniques like Graston and active release are supposed to release the stickiness so that you have more movement and less stiffness and pain.”

Study participants will be treated with one of three therapies.

Graston is a technique where the therapist rubs a spoon-like stainless steel instrument over a patient’s muscles. With ART, the therapist uses his thumbs to stretch and apply pressure to muscles, tendons and ligaments while the patient moves the area being treated. Kinesio Taping involves using a new, flexible kind of therapeutic tape that can be worn for up to four days. It’s thought to work by lifting the skin and activating the muscles beneath.

As an athlete, Pain is curious about the study outcome. Because elite athletes train constantly at intense levels, they’re more prone to repetitive injuries, he says. He currently sees a therapist who uses all three techniques. “It keeps me pain-free, limber and performing well.”

Source: Calgary Herald

Considering Injections for Back Pain? Here’s the Research

Does injection therapy for back pain relief really work? Johns Hopkins weights the risks and benefits. 

Authors of a systematic review published in the journal Spine took a look at 18 randomized, controlled trials of the effectiveness of injection therapy in nearly 1,200 people with subacute (lasting longer than one month) or chronic (lasting for three months or more) low back pain. Epidural, facet joint, and trigger point injections were reviewed. The studies analyzed excluded people who experienced leg pain and/or muscle weakness due to spinal nerve compression (radiculopathy). 

That means that in nearly two thirds of the studies, there was little evidence to suggest that injections were any more effective than placebo in providing short-term pain relief. In addition, none of the studies evaluated long-term effectiveness. 

In spite of these findings, experts believe that it is still possible that certain subgroups of people with lingering low back pain could benefit from injection therapy. However, better-designed clinical trials are needed to determine just who those patients may be. 

In the meantime, since injection therapy does appear to benefit some people, your doctor may suggest it as an option, particularly if other conservative therapies such as physical therapy have not been helpful and surgery is your next step. 

Risks and benefits: Overall, injection therapy is a safe procedure, but adverse effects do sometimes occur. For example, nine of the 18 studies in the Spine review reported side effects, such as headache, dizziness, burning or tingling sensation, and nausea, in small numbers of people.   

Injection therapy is not suitable if you are susceptible to excessive bleeding or are taking anticoagulants (drugs that reduce the formation of blood clots). In addition, people experiencing pain due to infection or certain forms of cancer should not receive injections with steroids, since these drugs can weaken the immune system.