‘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.

Why do back surgeries fail?

All spine surgery carries with it a significant degree of patient risk but when the resulting surgery does not alleviate the problem, or creates even greater problems for the patient, the situation is referred to as a “failed back surgery syndrome (FBSS). Read More….

Back Surgery: What You Need to Know

Back surgery has been known for “leaving more tragic human wreckage in its wake than any other operation in history,” according to Gordon Waddell, MD, director of an orthopedic surgical clinic for over 20 years in Glasgow, Scotland.

“Low back pain has been a 20th century health care disaster,” said Waddell. “Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem.”

In 2010, researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in the hopes of resolving their low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, only 26 percent of those who had surgery had returned to work, compared to 67 percent of patients who did not have surgery. Of the lumbar fusion subjects, 36 percent had complications and 27 percent required another operation. Permanent disability rates were 11 percent for patients undergoing surgery, compared to only 2 percent for patients who did not undergo surgery. In what might be the most troubling finding, researchers determined there was a 41 percent increase in the use of painkillers, with 76 percent of surgery patients continuing opioid use after surgery. Seventeen surgical patients died by the end of the study.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs do not work, according to the study’s lead author, Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. His study concluded: “Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a workers’ compensation setting is associated with a significant increase in disability, opiate use, prolonged work loss, and poor return-to-work status.”

Commenting on the procedure in general, Dr. Nguyen said, “The outcomes of this procedure for degenerative disc disease and disc herniation make it an unfortunate treatment choice.”

In 1994, the conducted the most thorough investigation into acute low back pain in adults and came to the following conclusion in its Patient Guide: “Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back pain problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”

In his 2009 article, “Overtreating Chronic Back Pain: Time to Back Off?” Dr. Deyo speaks of the shortcomings of medical spine treatments in the U.S.: “Jumps in imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes. Even in successful trials of these treatments, though, most patients continue to experience some pain and dysfunction. Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels.”

Dr. Deyo is not alone in his call for reform in spine care. The editors of The Back Letter, a newsletter from the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, D.C., agreed with his frustration:

“The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate … There is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedical screws to fusion cages to artificial discs – there is little evidence that patient outcomes have improved … Many would like to see an entirely new research effort in this area, to see whether degenerative disc disease and/or discogenic pain are actually diagnosable and treatable conditions.”

Back pain can seem to take over your life.  Your every thought and action is centred around your back.  Patients come to me in pain, desperate to know whether Spinal Decompression is right for them.  To help answer this question, Web MD has put together a useful guide about Spinal Decompression.  Read more to find out whether Spinal Decompression might be right for you…