An incorrect diagnosis can mean unnecessary medication, treatment, or surgery while the underlying problem and pain will remain or return.

Function and Structure of the Piriformis Muscle

The Piriformis is a deep muscle that originates from the sacrum (the large bone that connects the spine to the pelvis), passes through the sciatic foramen, and connects to the greater trochanter of the femur (the head of your leg bone). In most cases about 80%-90% the sciatic nerve will pass underneath the muscle, however in other cases the sciatic nerve will pass directly though the belly of the muscle.

Image source: Piriformis Syndrome

The function of this muscle is to externally rotate the extended thigh and assist in abduction (bring outward) of the flexed thigh. Imagine a hockey player skating. He extends the leg to push off with his toes pointed outward. The Piriformis is the muscle that brings the leg back and turns the toes out. This muscle is especially important to keep a proper and more efficient stride.

Symptoms of Piriformis Syndrome

Some of the symptoms of Piriformis Syndrome are as follows:

• Sciatica- radiating pain down the leg
• Deep, boring pain in the buttock Tight and painful hamstrings
• Radiating pain in the calf
• Tightness and decreased mobility in the hip
• Pain in the hip
• Low back pain
• Generally one sided pain
• Numbness, weakness and tingling in the leg or foot however this is uncommon

Causes of Piriformis Syndrome

This painful and annoying syndrome can have several causes, such as a direct trauma, an over usage or repetitive injury, hormonal changes, or postural abnormalities. The cause of this injury that we see most often at Mountain View Pain Center is an over usage or repetitive motion type.

An over usage injury can be caused in two different ways: one from an athlete over training and straining the muscle, the other from pushing yourself to hard after a period of inactivity. If an athlete is constantly training they will develop a dominance in certain musculature. For example, a sprinter is focused more on explosive power in the legs to increase their push off power. This can cause a muscle imbalance and lead to increased strain on the piriformis. We often see this in our office in running backs and hockey players.

The other over usage injury is usually from an increase in activity over one day or perhaps a weekend. We often see this here in Colorado, when the weather begins to warm up families will decide to go for a hike or long walk in the mountains without proper training leading up to the increased length of the hike. This is also seen in athletes if they have a tournament weekend where you are playing several games in a short period, for example youth hockey tournaments. The athletes will be well trained and conditioned, however the increased stress over a short period of time can send the muscle into spasm.

A trauma to the area can cause increased swelling in the tissue around the muscle or in the actual muscle itself. This causes pressure on the sciatic nerve and can cause the muscle to spasm. After a trauma it is also common to see a restriction in the sacroiliac joint, which puts an increased amount of strain on the area leading to further inflammation.

Two great examples are of a trauma are a batter getting beaned with a pitch in the side of the glut muscle or a quarter back getting hit and falling back on his backside. After the initial injury, the body will go into the inflammation phase, drawing more blood to the area and causing a swelling around the Piriformis muscle and the sciatic nerve.  This pressure is what causes the radiation of pain into the leg, because the Sciatic nerve runs down the back of the leg. The body will also go into a protective mode and restrict motion to the sacrum. If the proper movement is not restored to the sacrum and pelvis, it can lead to a chronic stress to the area, leading to future episodes of the problem.

Hormonal changes are generally seen in women during pregnancy, due to the shifting of the pelvic basin to compensate for the baby. While in the early stages of pregnancy, the body releases a chemical called Relaxin, which relaxes the pubic symphisis (pubic bone), surrounding ligaments, and joints in the pelvis. This allows the area to widen and have increased space for the baby. This can put increases stress and strain on the sacrum where the Piriformis attaches. This is a very common ailment in pregnancy as well as low back pain.

Postural abnormalities can come from muscle imbalances, underlying structural defects or abnormalities, or simply poor posture. What we at Mountain View Pain Center see the most often is patients reporting with the symptoms from periods of increased sitting. We have treated trucker drivers, cyclists, and those who simply spend and increased amount of time at their desk at work. The reason increased inactivity in a chair can cause the symptoms of Piriformis Syndrome is that over time the muscle will shorten from its constant shortened position sitting. Once the muscle has become physiologically shorter you will lose range of motion in the area and experience tightness and discomfort.

Examination of Piriformis Syndrome

Although the cause and treatment of Piriformis Syndrome is very straightforward, this is a commonly misdiagnosed problem. The reason this is so commonly missed is the symptoms are similar to a nerve compression caused by a herniated lumber disc, which produces sciatica. What your doctor should do is a full history and physical examination to lead to the correct diagnosis.

In most cases, when a patient complains of radiating pain down the leg, the doctor will first think of a lumbar disc problem. A lumbar disc problem can be very painful, so it is good if the doctor investigates, and can rule this out if it is not the cause of the pain. At Mountain View Pain Center, we will take an x-ray of the lumbar spine to rule out any disc space narrowing, any fracture, or abnormality within the spine. If a disc herniation is still suspected after the examination, your doctor may order an MRI to see if there is any compression on the nerve roots or spinal cord.

Once your doctor has done the appropriate test to rule out the herniation he/she should investigate further causes of your symptoms. One indicator that will help clue in your doctor is a test you can even try yourself.

When lying on your back, look down at your feet. If the leg in question is rotated outward , that is a good indicator the Piriformis is in spasm (this is known as the positive Piriformis sign). The reason the foot will be pointing outward is the Piriformis muscle is contracted keeping the thigh rotated externally and will limit the internal rotation movements.

Another good indicator of Piriformis syndrome is through palpation of trigger points, for this test you will be face down on the table. The Piriformis muscle runs from the greater trochanter of the femur and runs at about a 45 degree angle upward and connects to the sacrum. If you reach down to where your hip is and feel the bone sticking out, that is where the Piriformis attaches and runs up from there. If there is a spasm of trigger points, then there will be two indicators.

When pressure is applied to the tendinous insertion over the hip then there will be a deep burning pain or sensation. Pressure over the middle of the muscle belly in (around the middle of the muscle in the gluteus maximus) there will a radiating pain down the leg or into the buttock, this point can be extremely tender to the touch.

Treatment of Piriformis Syndrome

As always go see your doctor first to determine if this is in fact Piriformis syndrome and not a disc herniation. You will need to determine the cause of the problem to determine the correct treatment plan.

At Mountain View Pain Center,  we often see a spasm of the Piriformis muscle and restriction of the sacroiliac joint. In a situation like this it is best to find a doctor or clinic that is able to perform physical therapy and joint manipulation to get the quickest and most effective results. This is suggested because if you only work on the spastic muscle and leave the joint restriction or vice versa the fix will only be temporary.

It is also important that your doctor is able to distinguish between a restricted sacroiliac joint and a hyper mobile joint. In the case of a hypermobile joint, your doctor may order the use of a temporary trochanteric belt to help stabilize the area and relieve some tension on the Piriformis muscle. The correct diagnosis in this area is very important. If your doctor recommends stabilization of a restricted joint or manipulation of a hypermobile joint, they may exacerbate the problem.

Before you go through any home treatment, we recommend you stick with your doctor until they suggest you begin home care. The reason for this is the spasm and inflammation needs to be under control, or you run the risk or further inflaming the muscle.

At Mountain View Pain Center, we will first try to stretch out the muscle through PNF stretches (proprioceptive neuromuscular facilitation). These stretches are done to not only release spastic muscle but to also aid in stretching physiologically shortened muscles. These stretches must be performed with assistance, preferably with a trained professional as you can cause injury or strain to the area. One effective stretch is to bring the muscle to it’s the end of its range of motion, without discomfort, and contract the muscle with only a few pounds of resistance for about 5 seconds. After relaxing we will bring the muscle further past the original end range of motion. This is preformed about 2-3 times to increase the muscle length.

Stretching and home treatment, after you have consulted your doctor, is very important for this condition. First of all, if you are suffering from this condition, do not use heat. Many people like to follow the rule of ice for the first 48-72 hours and heat after that. If you use heat on an inflamed swollen Piriformis, you run the risk of further inflaming the area and causing more pain. Heat will feel good while it is on, however a few hours later or the next day you could regret this move. Ice only in this situation. If you have chronic flare ups of this problem, ice after competition even if there is no pain.

Another very important rule for Piriformis syndrome is to stretch before and after your activities. We will discuss stretches that you can do at home or even at your desk at work, when you may feel the symptoms or tightness starting to creep up.

The first and easiest stretch can be done in your chair. Cross the affected leg over the opposite leg and slide the foot upward so it is resting on your knee. Simply lean forward from here until you feel a nice tight band like stretch across the buttock. You are stretching the Piriformis here. Be careful not to bounce or use ballistic stretching to go further as you will aggravate the muscle. Hold this stretch for about ten seconds, take a nice long deep breath and try to lean just slightly farther.

Image source: Piriformis stretch

A similar stretch can also be preformed when laying on your back. Simply cross the affected leg over the opposite side. Reach through the leg and pull upward. You will feel a band like stretch across the affected area. This is another great way to stretch the Piriformis muscle.

Image source: Piriformis stretch

This muscle can be stretched in several other ways, these are just two easy examples of how to loosen up the muscle when you start to feel the tightness. another treatment that we use to aid in a quicker recovery time from Piriformis syndrome is the application of Kinesio tape. We apply Kinesio tape over the spastic Piriformis to help reduce muscle fatigue, pain, and spasming. The tape is excellent for athletes, as the tape does not restrict the muscle or joint. The tape is more elastic and moves with the area, and can be worn for 2-3 days, even in the shower, and wont peel off from wetness or sweat.

Supplements to Aid in Inflammation and Muscle Spasms

Inflammatone – this is brand specific and contains multiple herbs and vitamins that aid in the decrease of inflammation, such as boswellia, ginger, and tumeric. The reason we use this specific brands is we have found it to be most effective, and also cuts down the amount of pills you have to take as it contains all necessary components in each capsule.

Calcium – if you suffer from recurrent muscle spasms you may be deficient in Calcium.

As always, remember to stay hydrated, and stretch before and after excersizing.

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This article contains the opinions and examples of treatment plans for whiplash injuries from Mountain View Pain Center in Centennial, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

Whiplash is a descriptive term used to describe the sudden snapping of the unsupported head. In a car accident, the seat belt will hold the body in place while the head is forced into hyperflexion and extension. This motion is also seen in many contact sports such as football and hockey.

When a quarterback is getting ready to make a throw and a 300 lb lineman hits him hard from the back, the head again is forced into hyperextension just as in a car accident. This is also seen in hockey when a player gets hit from behind. In both sports, the athletes have chest protectors to absorb the impact on the body and helmets to protect the head, but there is nothing to stop the movement of the head on the neck.

Whiplash is a serious injury that can occur in many different ways, but the effects are usually similar and can be chronic and intense if not properly cared for.

Whiplash is present in another serious form in infants, and is better known as shaken baby syndrome. This causes serious neurocognitive dysfunction and in some cases death.

Lateral whiplash injuries to the outer portion of the neck can also happen, usually from a blow to the side of the body as in sports or a car accident.

Photo source: whiplash sports injury

The technical name for a whiplash is a cervical acceleration/deceleration injury, or CAD. There are several structures involved in a CAD.

In the neck we have the ligaments, musculature, nerves, intervertebral disc, arteries, vessels, and boney structures. Given the complexity of the neck, there are many different types of injuries that are possible that are considered whiplash. We will highlight a few of these in this article.

At Mountain View Pain Center in Denver, Colorado we see whiplash injuries almost daily, and the speed of the impact often has little correlation to the pain and symptoms. Often after a small impact in the car or on the field, a player will feel fine and then the symptoms will show the next morning.

Those of you who are athletes can relate. One day you take a minor hit, continue playing with no problem, and wake up the next day feeling as if you were in a car accident.

Causes of Whiplash Injuries During Sports

Image source: Hyperextension/Hyperflexion

During a forced hyperextension, bending the head backwards can cause a multitude of neck injuries. The muscles of the front of the neck that are usually strained are the anterior scalenes and the SCM (sternocleiomastoid).

The SCM is the v-shaped muscle on the front of your neck that moves your head forward and side-to-side. Injuring these muscles makes it very painful to move the head, especially in rotation. A

long with the muscle injury there is also ligament damage. The anterior longitudinal ligament runs over the anterior portion of the vertebrae (the front of the vertabrae, deep inside the neck).  Whiplash can cause a sprain of this ligament or an avulsion fracture (tearing away of the bone, where the ligament tears off a small portion of the front of the vertebrae).

In between the vertebrae are discs that can rupture or herniate during the whiplash injury. At the rear of the neck we have the capsular ligaments (ligaments supporting the spinal joints), which can be injured form the compressive forces.  A compressive force can also damage the facet joints. These joints allow the vertebrae to move in relation to one another. Extreme hyperextension can cause crushing of the posterior portions of the vertebrae.

Hyperflexion injuries such as taking a hit straight to the chest may tear the ligament at the back of the neck (nuchal ligament), which runs from the base of the skull along the tips of the vertabre (spinous process) to the base of the neck. Hyperflexion injuries can also cause disruption to the capsular ligaments or even dislocate the facet joints.

The image on the left demonstrates stretching of the nuchal ligament
and the image on the right demonstrates the stretching of the SCM muscle.
Source: Whiplash Associated Disorder

There can also be neurological damage from whiplash injuries.  The force of the brain’s impact on the inside of the skull can damage the cortex or cerebellum. When the head is forced into hyperflexion the sudden force causes pressure on the brain, which causes a concussion. Concussion symptoms are very common in sports related neck injuries.

Even if you have no symptoms after a whiplash injury it is important to see your doctor to assess the level of possible damage. In many cases after a whiplash injury, a patient will show no objective symptoms nor will they show signs of physical damage on X-ray. Oftentimes, patients may not show symptoms until three months after the initial injury and there can be a fluctuation of symptomatology for up to two years. It is in your best interest to get checked out if you have taken a questionable hit.

If you decide to make the trip to your doctor after getting a whiplash injury be sure to fully describe how you were hit and all symptoms even if you feel they may be unrelated. Be sure to note if the head was rotated to the side, if your head struck the ground, if you lost consciousness, or anything else that may help your doctor set up an appropriate treatment plan.

Common Whiplash Injury Symptoms

Image source: whiplash injury symptoms

After an injury the two most common types of whiplash symptoms are pain and limited motion of the cervical spine (the neck). The pain can be described as a dull ache to a sharp stabbing pain. It is also common to have radiating pain or numbness into the extremities. Many patients describe intense pain in the upper and lower back. Headaches are also a very common symptom after a whiplash injury.

Patients most commonly experience pain from the facet joints in the cervical spine. These joints align the top of one cervical vertebra to the bottom of the vertebra above it. Their biomechanical function is to allow motion in the neck, and when injured, this results in a lack of motion, pain, and an increased chance of degeneration in the future.

Each facet joint has a specific pain pattern that is common in patients suffering from a whiplash injury. These patterns can cause pain in the back of the head, the shoulder and all the way down to the mid back. The most common area of the cervical spine to be injured is C5/C6 and C2/C3.

Pain referral for facet joints

If you have injured your…   then you will feel pain in your…

C2/C3 — middle of the neck to base of the skull
C4 — middle of the neck
C5 — middle of the neck to the shoulder, commonly following the trapezius muscle
C6 – across the shoulders down to the shoulder blade

Image source: pain referral for facet joints in whiplash injuries

Other symptoms related to whiplash include:

• Headache
• Numbness
• Impaired neck movement
• Radiating pain into the arms, hands, and fingers
• Low back pain
• Vertigo
• Ringing in the ears
• Nausea
• Jaw pain
• Pain between the shoulder blades
• Disc herniations
• Loss of proper motion to the cervical spine

Whiplash Injury Recovery

Whiplash injury symptoms often do not show up for three months or more and can last as long as three years; therefore, the sooner you begin treatment for your whiplash injury, the quicker the healing process can begin.

Whiplash Injury Recovery Phase 1 – Inflammation Process

This begins immediately following the whiplash injury and generally lasts up to 72 hours and in some cases up to five days.

It is common for there to be little to no pain after the hit. After a few hours or even the next morning after, the inflammation phase has begun. The muscle will begin to spasm, swell, become tight, painful, and look for range of motion to decrease. The decreased range of motion comes from the body trying to immobilize the tissue to prevent further injury.

During this time at Mountain View Pain Center our goal is to reduce pain and swelling and help control the inflammation process.

Whiplash Injury Recovery Phase 2 – The Repair Phase

This phase generally lasts from three days to three weeks. The importance of this stage of healing is the wound edges will begin to pull together to affectively reduce re-injury.

Whiplash Injury Recovery Phase 3 – Remodeling Phase

This phase lasts three weeks to two years. During this phase collagen begins to form and lies down to strengthen the wounded area. This is what is referred to as scar tissue, which is only about 80% as strong as normal tissue.

The importance of whiplash injury treatment in this phase is to allow the collagen to lay down in the correct area, and reduce scar tissue build up which can create decreased range of motion and lead to instability and pain in the future.

Image source: whiplash injury recovery

Treatment for Whiplash Injuries

After the injury, go to your doctor for an examination. Make sure to fully explain the injury and whether this happened in the car or on the field.

Your doctor will run a series of orthopedic tests to reveal if there has been any damage to the soft tissue or joint function. Your doctor should also run a series of neurological tests to determine if there is any underlying damage. These tests should be repeated as you progress in your treatment so that your doctor can adjust his treatment plan according to your symptoms and progress.

After these tests your doctor may take X-rays or an MRI if he suspects there may be soft tissue damage or the possibility of impingement to the spinal cord or nerves. Often after an injury to the cervical spine, your doctor will take X-rays with your neck in flexion and extension to determine if there is any instability in the spine.

Image source: whiplash injury treatment

After an injury to the neck many people feel they should be put in a neck brace and avoid any manipulation to the spine. Research has shown that wearing neck braces can be detrimental to your whiplash injury recovery. This does not mean, however, that if your doctor recommends a collar not to wear it. If there is any fracture or instability it may be in your best interest. However, long-term immobilization is not recommended.

After the whiplash injury one of the first symptoms is decreased range of motion to the cervical spine. If this is not restored, then there is a list of future injuries you may experience.

With the lack of motion in the lower cervical spine, the upper cervical segments will begin to overcompensate, causing early degeneration, loss of proper posture, and pain. Once the lower segments have begun to lose their motion, the head will begin to drift forward, due to tightening of spastic flexor muscles. As this occurs the muscle on the back of the neck, the extensor muscles, will become stretched and torn.

A good way to check if your own extensors are becoming weak is to have a friend check your posture. A good rule of thumb is to have the ears over the shoulders. If your head has begun to drift forward, press lightly on the trap muscle, if there is tenderness there, then you have weakened stretched muscles that are becoming tender from lack of oxygen and calcium deposition. This leads to further problems such as tenderness, pain, and can lead to shoulder and upper extremity dysfunction.

The reason that a lack of motion in the neck causes pain is because the spine has little sensors called mechanoreceptors which react to movement. If there is decreased motion, the mechanoreceptors receive less information, which increase the proprioceptors (pain receptors). In English this means with lack of motion you are more susceptible to pain.

This is a compelling reason to see your chiropractor or osteopath for cervical manipulation. Early manipulation to the cervical spine will restore motion, decrease pain, and increase the speed of recovery. The early manipulation will also decrease the buildup of scar tissue and future chronic pain syndromes.

Early manipulation does not mean to start stretching your neck and cracking it yourself. If you do this, you will probably cause more damage. Manipulation should not be performed without determining the stability of the cervical spine after such an injury. If you are popping your own neck, then you are moving the already hypermobile segments, or the areas compensating for the restricted ones. This can cause more pain, injury, and increase the degenerative process of the cervical spine. Seek out a professional, and let them treat you.

In the treatment process for whiplash injuries, the first stage should always be decrease pain and inflammation. How long you let this condition go without treatment can have a big impact on your recovery time. If this has become a chronic condition, don’t expect to be cured in one visit. You will have to take an active role in your own treatment by performing the exercises your doctor prescribes. It is important to remember that just because you are out of pain, you must continue the rehab to fix the underlying problems and help strengthen the area to avoid chronic pain or problems in the future.

At Mountain View Pain Center, we provide a series of treatments to assist in the recovery from a whiplash injury. As mentioned above, first order of business is to relieve pain and inflammation. This is done with cervical spine adjustments, electrotherapy, and soft tissue mobilization. At this time we ask our patients to be patient, take a break from physical activity, and allow the body to rest. There are many patients who decide they know best and continue with sports and workouts, which is your choice, just understand you will prolong your treatment process and heal at a slower rate.

Whiplash Injury Rehab Exercises

Once we have the pain under control we begin with the rehab portion of the treatment, which includes a variety of upper extremity and neck exercises.  Do not push yourself. If the exercise causes pain then don’t do it. “No pain, No gain” is not the method here. If you are having difficulty performing simple exercise, then listen to your body, continue with treatment and slowly advance as the body allows.

The series of treatments will be customized to you, depending on your specific injury. For example, if a quarterback visits our office that was struck in the back with his head turned, he may have different injuries than a hockey player hit in the back looking straight forward.

You can begin your own treatment at home by icing 20 minutes per hour on the cervical musculature. Do not use ice cubes directly on the skin as you can cause a burn. You may also find relief from rolling up a towel and placing underneath the neck while lying on your back. This will help relax some of the muscles in spasm.

The rehab portion will focus on the overstretched ligaments and tendons as well as the spastic muscles. Our goal is to release the spasm and lengthen the shortened muscles, and at the same time strengthen the weakened and stretched muscles. The reason we perform both is to stabilize the body, and prevent further injuries. If we just address the spasm, then over time the weak muscles will not be able to hold their resistance, and we will be back at square one.

Along with exercise, at Mountain View Pain Center we also install a stretching program. The stretches are provided to allow the body to elongate the muscle to their natural length, and decrease the buildup of scar tissue that will decrease the range of motion. Make sure you follow the instructions from your doctor.

If you have a spasm in the flexor muscle on the anterior portion of the neck, then we want to stretch that area, and not perform resistance exercises here. If the weakness is in the extensors, then you do not want to stretch an already stretched and weakened muscle. This may provide relief while you are doing it from the release of endorphins, however you will be causing more damage. By improving the range of motion and muscle strength to the neck we can restore normal posture and biomechanical function of the cervical spine.

Some exercises are too painful to perform so we begin with isometric exercises. Isometric exercises allow for contraction of the muscle without movement of the head. In most cases we are working on the lateral flexors or extensor muscle groups. An example of an isometric exercise for the extensors is to stand with your back against the wall, and press your head slowly into the wall and contract the muscles at the back of your neck, and hold for about 5 seconds. You can place a towel in between your head and the wall for comfort. As we progress you will be able to build up the movements and perform exercise with body weight and then resistance.  We also add a series of exercises with the upper extremities as well as a few hand eye coordination and balance programs.

After a whiplash injury, avoid sleeping on your stomach. Your doctor may provide a cervical pillow, as sleeping on your side or stomach may cause you to curl up into a flexed position for comfort. This holds the muscles we are trying to stretch in a shortened position for hours, which we need to avoid.

Whiplash injuries, whether in sports or in the car, can lead to serious complications, so your best bet after receiving such an injury is to go see your doctor to be on the safe side.

Supplements or vitamins that aid in diminishing muscle spasms and inflammation

My personal favorite is a Vitamin called Inflammatone. I prefer this as it is a combination of several herbs that benefit in decreasing inflammation and speeding up the healing process, which cuts down the amount of pills you have to take, which is always an added benefit. If you are browsing your local store or whole foods, keep your eyes peeled for ginger, boswellia, and tumeric, as these are great at decreasing inflammation, and are all ingredients in Inflammatone.

I would recommend avoiding cheap brands from your local grocery stores, as these are either synthetic or significantly lower dosages. The name brands are generally only a few dollars more, and when it comes to vitamins you get what you pay for.

Your best bet is to try to get these from your doctor. In many cases physical therapists and chiropractors will sell vitamins out of their own office, the brands they use are generally lab tested and have been researched extensively. Many doctors will sell these relatively cheaply to provide the extra benefit for their patients. If you know a good naturopathic doctor, they are great resources for brand or specific vitamin advice. Fish oils also work well to control inflammation, and are also good for your body’s overall health.

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This article contains the opinions and examples of treatment plans for whiplash injuries from Mountain View Pain Center in Centennial, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

In a ski boot, the foot and ankle are fairly locked into place, but the knee is unprotected and often bears greater pressure and is at a higher risk for injury. The most common skiing knee injuries for are sprains or tears of the MCL (medial collateral ligament) or the ACL (anterior cruciate ligament).

Biomechanics of the knee ligaments

The knee is a complex joint that supports the vast majority of the body’s weight. In a sport such as skiing, this joint is vulnerable do to the compression and rotation of the joint.

Image source: knee injuries to ACL and MCL

The knee joint is made up of three separate compartments: the medial, lateral, and patellofemoral. The bones that make up the joint are the femur (the superior portion), the tibia (the inferior portion) and the patella (anterior portion), also known as the knee cap, which is held in place by a tendon passing over the joint and connecting to the tibia.

There is no boney component that provides stability to the joint; the stability comes from a series of ligaments running through the knee joint capsule. There are also two menisci between the femur and tibia that provide stability and act as a shock absorber. Although there are many components that make up the joint, most knee injuries involve either the MCL or ACL, so this article will focus on those two ligaments.

The MCL is the ligament that runs on the inside of the knee from the femur to the to the tibia, and is the most commonly injured area in the knee. The ligament tightens during knee flexion and also prevents increased valgus stress to the knee. Imagine you have fallen on the ski hill and are sitting down with your planted skis shoulder width apart. When standing up, you bring your knees together. This places a valgus stress on the inside of the knee. Another common way to injure the MCL is to receive a blow to the outside of the knee forcing increased movement and stress to the medial portion of the knee.

The ACL is the ligament that attaches from the posterior medial portion of the lateral femoral condyle to the anterior lateral portion of the medial tibial eminence. In other words, the ACL attaches from the back of the inside portion of the outside femoral condyle and goes to the front of the tibia. The purpose of this ligament is to provide stability and prevent anterior translation, or forward slippage, of the tibia in relation to the femur. Whenever you see a football player go down on the field, the trainer will come out and grasp the knee to see if it slides forward. This tests the stability of the ACL.

Mechanism of knee injury

Skiing knee injuries to MCL

The most common cause of injury to the MCL is an inward blow to the outside of the knee. This forces increased movement and stress to the medial portion of the knee, and when this occurs, the medial joint or most inside portion of the tibia and femur become slightly separated, stretching or possibly tearing the MCL. There are a number of scenarios in which skiers can stretch or tear an MCL.

First, beginner skiers generally learn to control their downhill motion with the “snowplow” technique, where they bend their knees inward making a triangle with their skis facing down the hill. This places a stress on the inside of the knee. While this alone will not cause a tear of the MCL, it can cause a stress and some discomfort for a few days after skiing, depending on the condition of the skier and the hill.

However, if the skier picks up any speed or simply has a fall with the knees bent in, then the risk for a sprain or strain of the MCL is greater. Injuries to the MCL are generally isolated and have no further damage to the rest of the knee.

Injuries to this area are classified in 3 grades

• Grade 1- A slight sprain or stretching of the medial collateral ligament causing mild pain and tenderness over the area. This is a mild injury in many cases this will not necessarily keep the athlete out of competition. If the athlete is held out it is usually for less than 2 weeks.
• Grade 2- An incomplete tear of the MCL, there is more pain and some slight instability. After a grade 2 injury the time away from sport will be around 2-4 weeks to allow proper healing.
• Grade 3- A complete tear within the MCL causing pain and instability on the inside of the knee. The healing process for a complete tear can take up to 6 weeks or longer.

Skiing knee injuries to ACL

The ACL injury is the second most common injury to the knee for skiers, and is usually more serious.

The danger for skiers is the boot is locked into the ski and the ankle is also fairly motionless in the boot, which requires the knee to provide most of the motion for the legs. For beginning skiers, the bindings are set more loosely and the risk of damage to the ACL is decreased; however, the more advanced skiers have tighter bindings to allow for more aggressive skiing, which puts the knee at greater risk.

The ACL is at highest risk during a hyperextension or an accident with the foot pointed inward. This might happen on skis if the tips of the skis get caught in the snow or a tree root, forcing the forward tip of the ski to rotate inward. Even if the ski pops off, the motion of your body will continue forward and the knee could be hyper extended. This can also happen when turning hard and catching an edge. The ACL becomes tight with an inward rotation so a quick jolt and rotation can often cause an injury.

Unfortunately, many ACL injuries are the result of a collision between two skiers. If any of these things happen to you and if you hear or feel a pop in the knee during a hyperextension there is a good chance you have damaged your ACL.

Signs and Symptoms of Skiing Knee Injury to ACL & MCL

MCL

After the initial injury the most common signs and symptoms are pain, swelling, and tenderness on the inside of the knee joint right over the area where the MCL runs. It is also common to see slight bruising in the area. In some cases it is also likely to have slight instability, locking, or catching of the knee.

If the injury is a minor or grade one sprain, the athlete will still be able to walk with only mild discomfort in the knee in weight bearing situations. If there is a complete tear and a lot of swelling the athlete may have difficulty walking, and should be removed from sports until the injury has healed.

ACL

In many cases of an ACL tear or injury, the athlete will recall hearing or feeling a pop. With an ACL injury, there is usually immediate swelling and pain. The ACL is embedded deep in the knee joint, so an injury to this area will cause swelling of the entire knee instead of just the inside portion as an injury to the MCL would. It is also very unlikely to have an ACL injury without pain.

In most cases, especially that of a complete tear, the pain is moderate to severe. If after the initial injury the skier has a lot of swelling and feel as if the knee is giving out or unstable, that means you probably have an ACL injury.

Treatment for Skiing Knee Injury to ACL & MCL

The treatments of these two skiing injuries are fairly similar.

The beginning step is to immediately apply ice to the area. If you cannot get yourself to a doctor, continue to ice the knee as much as possible until you see one. It is best to use gel ice pack and apply it to the skin with a thin covering. It is usually not preferable to apply ice directly to the skin.

You should ice for about 20 minutes per hour, and no longer than 20 minutes at a time, as it is possible to over ice. If you keep the ice on the area for an extended period of time, then that portion of the body will think it is going into hypothermia, will pull more blood to the area, and will make the swelling worse. For the same reason, do not use heat at all. Even though the heat will feel good, you will cause further swelling to the area and will cause more pain later.

MCL Injury Treatment

Fortunately, most cases of MCL injuries can be treated without surgery. Only after conservative care has proven ineffective, or if there are multiple ligaments involved, is surgery recommended for MCL injuries. If you have a knee injury, go see your sports doctor. If you have a medical doctor or orthopedist you prefer, you can go to him or her for a diagnosis, however the treatment will more than likely come from a chiropractor or physical therapist, so you could save yourself a trip.

It is important to describe exactly how the injury happened to your doctor, as the history of the injury is one of the most helpful portions of the diagnosis. Your doctor will first perform an X-ray to rule out any underlying fracture or dislocation. A series of orthopedic tests will also be performed to assist in the diagnosis.

One specific test is to lock out the knee in full extension, and provide a slight valgus force (pushing from the outside of the knee inward). If this provides laxity or pain on the medial portion of the knee joint, then it is a very good indicator of an MCL injury. If your doctor believes there may be further instability or possible damage to the ACL, then an MRI will also be ordered, as x-rays do not reveal any soft tissue injuries.

Once the severity of the MCL sprain is determined, the length of treatment and time away from sports will be determined. It is possible not to miss more than a week, but a good rule of thumb is to expect about two weeks off after a grade 1 sprain. If you follow through with the treatment plan and give adequate rest you should be back to full strength within two weeks.

The most important step here is resting and icing. If you want to be back on the ski hill then take two weeks off and don’t push it, or else this could become a chronic issue.

Step two is dealing with the pain. During your therapy your doctor should apply some electrotherapy to not only diminish pain, but also remove swelling from the area. As the swelling goes down, the range of motion will increase and the stiffness and difficulty walking should improve.

At our office, Mountain View Pain Center, we prefer the use of interferential therapy as this provides both pain relief and removes edema (swelling). After the initial treatment, we also apply kinesio tape to the area. This tape is applied in a spider web fashion around the medial portion of the knee to assist in the removal of swelling. The tape can be worn for several days and will speed up the healing process.

The next step is to strengthen the area, and provide soft tissue release to regain the full range of motion. As with any ligament injury, there is scar tissue and restriction to the ligament after the healing process begins. To counteract the buildup of scar tissue we will strip out the ligament with soft tissue massage and other release techniques to free the ligament.

After this, micro-current therapy is used to allow the ligament and tissue to heal faster. Knee braces can be worn, but we often keep patients away from braces for long-term use, because some will use them as a crutch and not proceed with the proper treatment, and can even end up re-injuring the area. However after the injury it is advised to use a brace for around 2-4 weeks while in treatment and building up the area.

ACL Injury Treatment

If you suspect an ACL injury, immediately go to your doctor. They will perform specific tests to see if there is any ligament laxity or instability to the knee.

The two tests that are considered the gold standard for this type of injury are Lachman’s test and the anterior drawer test. The concept is to stabilize the femur or keep the foot planted with the knee bent and try to slide the tibia forward in relation to the femur. If the tibia slides then it is a great indicator of an ACL injury. (If you are trying to do this test at home to yourself, which is not recommended, then test both sides and compare your good leg to your injured leg, just as your doctor would.)

If your doctor thinks there is damage to the ACL he or she will order an MRI to determine the severity of the injury. If the ACL is torn completely through, you are more than likely headed to surgery. If you undergo ACL reconstruction, do not plan on getting back on the ski hill again until next year, as this is usually a season ending injury for any sport.

In minor cases of ACL sprains or non-complete tears, the treatment is very similar to the MCL; however, a different electric current, called Interferential, will be used to encompass the entire knee joint. The reason we use Interferential for the ACL is the pads are crossed around the knee to push the current deep inside the knee joint to treat pain and swelling.

ACL injuries usually have more pronounced swelling than that of an MCL and swelling abatement will generally take longer. If you have injured the ACL, it is highly recommended you do not compete in any sport unless cleared by your doctor, as the joint is too unstable. The most important thing in conservative treatment of the area is to ensure stability of the ACL so there is no reoccurrence of the injury. If you are a high level athlete or a more advanced skier, then it is important not to delay on treatment, or you will reinjure the area.

Exercises to Rehab from Skiing Knee Injury to MCL, ACL

These exercises can be performed for basic rehab or post surgical rehab. First step before your rehab of these injuries is to properly stretch to loosen up any tight musculature. Make sure to stretch the quads and the hamstrings, as well as the adductors and abductors.

The adductors run on the inside of the leg and can be stretched by spreading the legs far apart with your feet planted. Reach to one foot, hold for ten seconds, and then reach to the other foot. The abductors are on the outside of the leg and you can stretch these by crossing your feet and leaning over to one side. To stretch the right side, place the right foot behind the left and lean over to the left. It is important to note when stretching to not bounce to go further. This can cause further muscle injury. Just go to the point where you feel a good stretch and hold. As you progress over time you will be able to go further and further.

The important part of performing these exercises for the knee is full range of motion. We are not trying to bulk up these muscles right away, so start with low weight and high repetitions. If at any point the knee is in pain, then stop that exercise, drop weight, or don’t move the leg that far yet. If you cannot bend the leg all the way at the beginning, do not force it. Go to the full range of motion that your body allows without pain, and try to improve on that the next week.

For the first week we will contract the muscles without movement, these are called isometric exercises. You will start with leg extensions and leg curls. You can perform an isometric contraction of the hamstrings by bringing one leg up and placing the foot on a chair in front of you. Contract the leg as you would in a normal leg curl. Another simple way to do this is to sit on the floor with the leg flat in front of you and contract the hamstring by pressing the heel into the ground. For the quadriceps, place the foot under the couch or another object that will not move on contraction.

Perform three sets of 15 contractions holding for about five seconds each time. As we progress we will add weight, but make sure you are doing the exercises one leg at a time. Take your time, go slow, and perform the exercise correctly. If you do not have access to the gym then a simple method is to buy an exercise band and perform these in a chair. You can also take the band with you to work and do a few sets during the day.

As we advance in our rehab and the knee becomes more stable, the exercises will become more advanced, but be careful not to progress too quickly. If it hurts, don’t do it.

The next exercise can be performed daily. Sit in your chair and slowly stand without any assistance of the arms. This is a simulation of a squat or deep knee bend, but takes out the tension at bottom of the squat. As we progress, the next step is body weight squats, again slow and steady movements. Once these can completed without any discomfort and there is no residual pain the next day, begin single leg squats. These are performed by standing on one leg and then doing a deep knee bend.

It is always important, especially after the first few weeks of exercise, to ice the knee after the workouts, to prevent swelling and discomfort. If you have had an ACL injury, you should begin with a brace. The best type of brace you can get for an ACL will have hinges on the side. If it does not have hinges on the side then it is basically pointless to wear.

Another important note when getting a brace is to see if your insurance company will cover braces or DME products. If you are already paying for the insurance then you may as well use it. Most people are unaware that this is a covered service. If you decide to get one from your doctor, be sure to double check the product on line so you are not over paying for a product you can get on your own.

Supplements for ligament injuries:

• Glucosamine with MSM 100mg a day
• Vitamin C -1000mg a day
• Fish oils -as recommended
• Ligaplex and Cataplex ACP are herbal supplements we use at our office which promotes healing and helps strengthen the ligaments. These are brand specific; if you wish to look into them just email and I will point you in the right direction.
• Flavanoids -as directed on bottle. These are great for pain and swelling.

If you would like further information on supplements or vitamins for similar types of injuries, contact us or we can direct you to www.maxmusclehighlandsranch.com.

This article contains the opinions and examples of treatment plans for plantar fasciitis from Mountain View Pain Center in Centennial, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

* – B&W skier image credit: Skiing knee injuries

* – ACL image credit: Ski knee injuries to ACL

* – Valgus street test photo credt: Ski knee injury treatment

* – Lachman’s text photo credit: Treatment and rehab for skiing knee injury to ACL

After the game, the Sooners released a statement saying that Bradford had sprained the AC joint in his throwing arm, and may be out for 2-4 weeks.

Now, after several weeks on the sideline, it appears he may return as early as this weekend against Miami.

[Update: The latest word as of Thursday afternoon was that Sam Bradford would not start this weekend -- but could possibly play -- against Miami as he continues to recover from the ac joint injury that has kept him out of action since the opener.]

Photo credit: Nate Billings, The Oklahoman (via newsok.com)

The acromioclavicular joint  (AC joint) is a spongy tissue that connects the clavicle to the scapula, which makes an injury to this area extremely sensitive. In fact, the AC joint is the only area that connects the shoulder girdle to the rest of the body by forming a joint with the clavicle.

Mechanism of AC Joint Injury

Despite having full range of motion in the shoulder joint (the glenohumeral joint), the AC joint provides less motion.

The two most common ways to injure this joint are repetitive stress such as throwing a football or baseball, or an acute trauma to the lateral aspect of the shoulder joint, such as crashing to the ground after been tackled, as happened to Bradford.  

The AC joint is actually the second most commonly injured joint in the body, next to the glenohumeral joint.

In this article we will only be discussing the acute injury. When the force is applied to the lateral portion of the shoulder, the ligament connecting the clavicle to the scapula is either stretched, as in a sprain, or torn, as in an AC joint separation. 

AC joint sprains are typically classified into 3 groups:

• Grade 1 AC joint sprain: A partial disruption of the AC joint, simply a stretch or sprain of the AC joint ligaments.
• Grade 2 AC joint sprain: A partial injury to the AC joint capsule and coracoclavicular ligament (another ligament connecting the clavicle to the scapula)
• Grade 3 AC joint sprain: A complete tear or disruption of the AC joint capsule and ligaments. A disruption or the ligament will require surgery and you will have a noticeable separation of the clavicle to the scapula.

AC joint sprain grades image credit: Earthopod.com

AC Joint Sprain Symptoms and Diagnosis

Common symptoms of an AC joint sprain are pain and tenderness of the AC joint.

To find this area on yourself, use two fingers to feel along the clavicle towards the shoulder. You will feel a noticeable small separation between your collarbone and the stiff boney prominence just before you reach the the head of the humerus, which is the joint space. Press lightly on that area to feel the sponginess of the joint.

Pain in the joint because of touch or movements of the shoulder are the primary indicators of an injury to the AC joint. It is also common to see bruising and swelling of the AC joint after the injury. 

Someone with an acute injury to the AC joint will try to keep the arm close to the body, as if in a sling to avoid movement and pressure to that joint.

Other indicators of an AC joint injury are similar to orthopedic tests your doctor will run to identify an AC joint separation. Any overhead activities will exacerbate the pain, such as incline bench press, or simply getting something in the overhead cupboard.

Another self test you can do at home is to take the web of your hand on your uninjured arm and place it below the bicep of the injured arm and resist yourself trying to bring the injured arm across the body. If there is pain in the AC joint, this is a good indication of injury. 

If you have pain in this joint, it is best to see your doctor to determine if there is an injury to the AC joint, the severity, and the course of treatment. Your doctor will use orthopedic tests, feel the joint, and test your range of motion to come to a diagnosis.

The shoulder is a tricky joint and there can be a multitude of different injuries in this area, so a proper diagnosis is key for a quick recovery. Your doctor will also take x-rays of the AC joint to rule out a fracture, or complete tear of the ligament. It is not uncommon for the doctor to take an x-ray of both of your shoulders to determine if there is a difference from side to side.

Another common technique that we use at Mountain View Pain Center is to take a second X-ray of the injured joint with a weight in the hand to determine if there is laxity of the ligament.

AC Joint Injury Treatment and Recovery

The key to a proper recovery is rest. Dropping weights in your workouts, or simply laying off for a few days, will not correct the problem.

If you want this injury to heal then you must not be involved in any sporting activities at all for at least two weeks, if not more, depending on the severity of the injury.

You should not only avoid sporting activities but all strenuous activities for the shoulder, especially anything that involves lifting or reaching overhead.

When the initial injury occurs, get ice on it immediately. If you cannot get straight to your doctor, then try to keep the arm close to your side as if in a splint to avoid tension on the joint.  This is something you do not want to let go for very long. If there is a small tear in the ligament and you continue to play your sport or work out then you risk a complete tear, and a much longer recovery.

In many cases after an AC joint injury, you may receive a cortisone shot in the tissue around the joint, or directly in the bursa to relieve pain. This may get you on the field without pain for that game; however, for long-term treatment we do not recommend it.

Cortisone shots over time will actually weaken the tendons and ligaments. If we are dealing with an already weak ligament then the chance for further damage increases. Cortisone shots simply mask the pain but do not actually treat the problem.

If you are only planning on getting a shot and continue to work out and play, expect further problems down the road. At Mountain View Pain Center, we commonly work side by side with a pain management doctor to give a shot for the acute pain, while we work to rehab the area to stabilize the joint.

As with any acute injury, the two main problems are pain and swelling. To treat these both simultaneously at Mountain View Pain Center, we use a special treatment called Interferential Therapy around the shoulder joint. This works by removing not only pain, but also the edema (swelling) in the area.

Another therapy we use is called Microcurrent therapy to speed up the healing process of the stretched ligament. Coupled with the rehab exercises, this helps the stretched ligament to heal properly and regain stability.

The next step is to apply kinesio-tape to the area. We prefer kinesio-tape at our office because it will remove swelling from the area without limiting the range of motion.  We tape to hold the AC joint down, so the ligament will shorten and heal, thus preventing further or chronic injury to the AC joint.  This tape can be worn for several days, and even stays on in the shower. You can also apply any topical analgesic or pain relief gel directly over the tape.

For a Grade 1 or Grade 2 sprain, with proper treatment, you should be pain free within about three weeks.  Remember, just because the pain is gone does not mean the instability is gone. You must continue treatment for full rehabilitation.

At Mountain View Pain Center, once the initial pain is reduced, hopefully in the first week, we begin with exercises to restore normal motion to the joint and prevent the buildup of scar tissue. After the injury has begun to heal, you should start with light weight, high repetition exercises of the shoulder joint, such as external rotations, abductions, and retractions.

Do not by any means go straight back to the gym and start doing heavy lifts, such incline bench press, right away. While the initial workouts are a good way to test what you can and cannot do, we recommend staying away from any heavy chest, flyes, and shoulders for another month.

If you are a quarterback or pitcher, you can begin to lightly throw the ball at practice, starting with short passes. Give the shoulder ample time to rest and do not go straight into a game without proper warm up.

We encourage our athletes to return to our office before a game to be properly treated and taped. Also, ice after you are done playing, even if it does not hurt right away. You want to avoid pain and inflammation tomorrow.

If you have a Grade 3 sprain, or complete separation, you may need to be referred to an orthopedic surgeon. 

Nutrition for Soft Tissue Injuries

• Glucosamine Sulfate 1000mg or Glucosamine with MSM
• Max joint Relief
• We always recommend for any inflammation: fish oils, ginger, boswellia, and turmeric.

In any case, an AC joint sprain is not something you want to just let “heal itself” because you are constantly using this joint and the chance of a chronic sprain will increase the longer you go without treatment.

Although a nuisance and a painful problem, this is very treatable and generally you can be back in the game within 2-6 weeks. 

Look to see Bradford back in the game against Miami or Baylor. Depending on how the treatment has progressed and what Bob Stoops and Bradford’s doctors think is best for Bradford’s long term career, we will see. As a fan, I would like to see him back sooner than later; however, giving the shoulder ample time to heal is the most important thing.

It will definitely be a test for the shoulder in either case. Boomer Sooner!

**********

If you would like further information on supplements or vitamins for similar types of injuries, contact us or we can direct you to www.maxmusclehighlandsranch.com

This article contains the opinions and examples of treatment plans for plantar fasciitis from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described.

You should always consult your doctor before beginning any pain management or rehab program.)

______________________________

Plantar Fasciitis

After the recent foot injury suffered by Carlos Quentin, the White Sox’s left fielder, we have come to the topic of plantar fasciitis. Last year’s homerun leader for the White Sox was placed on the 15 day DL on May 29th for pain in the sole of the foot. Plantar fasciitis, one of the most common causes of heel pain, can keep a player sidelined for weeks, and if not properly treated will become a chronic issue. This injury is common in football, basketball, soccer, and running. This type of injury will inhibit a player’s ability to sprint.

Plantar Fasciitis Symptoms and Mechanism of Injury

Someone who suffers from plantar fasciitis usually experiences pain localized to the bottom of the foot on the inside of the heel. In an acute injury the patient may be unable to place weight on the foot due to the intense pain. With chronic plantar fasciitis the first few steps every morning will be painful, as well as any pushing off with the foot, including jumping.

Plantar Fasciitis Symptoms (image courtesy of Medline Plus)

The injury is usually a tear of the plantar fascia closest to the heel that causes an area of irritation or a lump to form on the inside of the heel. The plantar fascia is there to help attach the muscles to the bottom of the foot, provide protection to the plantar nerves and vessels, provide shock absorption, and create equal transmission to the biomechanical forces placed upon the foot. With an injury or inflammation to this area any movement that requires a push off of the toes will cause pain.

The injury itself comes from a muscular imbalance in the lower leg, ankle, and foot. The imbalance comes from a weak tibialis anterior (the muscle on the front of your shin) and plantar fascia, as well as a spastic or tight solues and gastrocnemius (the muscles of the calf). This imbalance causes increased tension on the Achilles tendon, which pulls on the plantar fascia causing the stretching and tearing of the muscle. As the micro tears set into the muscle, the pain will develop in the area. If the tears and chronic stretching of the plantar fascia are not treated then the area will become increasingly weakened. In many cases, an athlete will hear or feel a pop in the bottom of the foot followed by intense pain and swelling. This is from the tearing of the fascia.

Plantar Fasciitis Diagnosis

Here are some self tests you can do to determine if you might have plantar fasciitis:

1. Pain on the inside (medial) portion of the calcaneus.
2. Pain during the first few steps in the morning.
3. Localized swelling on the bottom of the foot, or along the plantar fascia.
4. Standing on the toes causes either a band like pain on the bottom of the foot, or increases the pain symptoms near the calcaneus.
5. Pain on the bottom of the foot when pushing of with the toe. Ex. sprinting or jumping

If you are experiencing one or more of these symptoms, it is a good indication that you might have plantar fasciitis. In order to prevent further injury and pain, this would be a good time to consult your physician and discuss your potential plantar fasciitis diagnosis.

Your doctor may take is an X-ray to rule out any underlying fracture, dislocation, or other abnormality. In about 50% of cases where there is a plantar fasciitis diagnosis, a heel spur can be seen on the X-ray. The spur is the body’s way of trying to protect itself. Over time with the chronic strain and stress on the area the body will begin to lay down calcium in the area for stabilization. Once the spur forms it is common to have pain directly over that area.

Plantar Fasciitis Treatment

The most commonly misapplied treatment of plantar fasciitis is to stretch and massage the area. As mentioned above the plantar fascia is already stretched and torn, which causes the pain.

Treatment for Plantar Fasciitis (image courtesy of Spectrum Wellness)

Common sense would tell us that if the fascia is already stretched and torn, that further stretching the area as part of a plantar fasciitis treatment plan would in fact cause more damage than good. When the injury first occurs, applying pressure to the area may actually cause some relief. The reason for this is the pressure on the inflamed, injured area will release endorphins, the body’s natural pain killers. The down side to the unfortunately common plantar fasciitis treatment approach of stretching and massaging is further damage to the injury and a higher probability of recurrent injuries. The stretched fascia is already depleted in oxygen. The increased pressure will further deprive the injured area of essential oxygen.

Plantar fasciitis responds very well to conservative care. If you notice any of these symptoms the best thing you can do is get plantar fasciitis treatment quickly. This condition can easily be resolved with the appropriate care. Many with plantar fasciitis think that they have to live with it, or they are one of the few that plantar fasciitis treatment will not help. This is simply not true. If you get on top of your plantar fasciitis treatment quickly, the pain will generally subside, and the incidence of chronic problems will greatly decrease.

There are several successful treatments for plantar fasciitis. We will now describe the treatments we have success with at Mountain View Pain Center.

Treatment for Plantar Fasciitis

First and foremost, after the initial injury you must get ice on the area immediately. If you wait and try to “walk it off”, the foot will swell and become increasingly tender over the next few days, making even the simple task of walking a real problem. After you have followed the steps of PRICE (protection, rest, ice, compression, elevation), get yourself to someone who deals with sports injuries for treatment. Making a trip to the emergency room for this will be an unnecessary and expensive trip. The treatment you receive there will be some sort of pain killer or shot to reduce the pain and swelling, then a referral to either a chiropractor, therapist, or sports medicine doctor.

At Mountain View Pain Center, when a patient first arrives with an acute injury of plantar fasciitis, we apply a therapy called Hi-volt to reduce pain and swelling to the area, and also wrap the foot with an ice pack during the therapy. The next step we take is to apply a taping method called Kinesio-tape across the bottom of the foot. This method we have found to be a integral part of our treatment program. As local doctors we have the opportunity to work with several sports teams and high school programs. When a player goes down from this injury we immediately apply the tape to the area not only for support to shorten the stretched and torn muscle, but to also pump out the edema and in turn decrease pain and increase plantar fasciitis recovery time.

Plantar Fasciitis Treatment (Image courtesy of Mountain View Pain Center – Denver)

We instruct the patient to leave the tape on for 2-3 days to continue the support and reduction of edema while the patient is at home. This tape can get wet, so the patient can still shower or even apply topical ointment over the tape to help with some of the pain.

At Mountain View Pain Center we have found that within a few weeks the patient will be out of pain and can begin the rehabilitation portion of the plantar fasciitis treatment. As we have stated before, the main cause of plantar fasciitis is from a muscle imbalance in the lower leg. Stretching is still important. However, remember not to stretch what is already stretched.

Part of the imbalance is usually a tight gastrocnemius, so we stretch the calf and Achilles tendon. If you stretch the calf only then the real problem still may not be addressed and a re-occurrence of the plantar fasciitis will occur. You must also address the muscle weakness to correct the problem. You can do this by performing simple toe raises while sitting at your desk at work or while watching TV. Toe raises are not the same as calf raises. This does not mean standing on your toes. You keep your heels on the ground and raise the balls of your feet and your toes off the ground.

If there is a heel spur seen on X-ray, then we can apply some ultrasound to the area to break up some of the calcification. For our athletes who continue to train during treatment for plantar fasciitis, or who have some chronic bouts of plantar fasciitis, we apply the tape to support the area during their events.

Many athletes opt for a quick pain relief and go for a corticosteroid shot in the bottom of the foot. You must be careful here as getting the shot will decrease pain temporarily, but it does not repair the torn tissue or fix the problem. The pain you are feeling is your body’s defense mechanism to protect you from further injuring yourself. If you cannot feel the pain and go out running then you risk damaging the area further. Research has shown that repeated corticosteroid shots actually weaken tendons, damage nerves, and decrease the bone density to the area, which is recipe for disaster.

Supplements as Part of Plantar Fasciitis Recovery and Treatment

• Inflammatone is a specific supplement that contains ginger, bosweilla, and other natural herbs that helps to decrease swelling and pain.
• Vitamin C has been shown to help improve the healing process and decrease scar tissue formation.
• Magnesium is another important supplement for plantar fasciitis as the magnesium helps absorb the calcium into the body and decrease the deposits into the heel(and elsewhere).

If you are interested in any of these supplements, please visit our website. Note: we are still updating the website, so the supplements may not be available immediately. If this is case, find our email address below or leave a comment and we’ll let you know how to get them.

This article contains the opinions and examples of treatment plans for plantar fasciitis from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described.

You should always consult your doctor before beginning any pain management or rehab program.)

______________________________

Sesamoid Bone Injury for Beanie Wells?

With the upcoming draft, questions have been raised about a potential sesamoid bone problem for former Ohio State running back Chris “Beanie” Wells. Peter King of SI.com got the ball rolling on the speculation in his recent Monday Morning Quaterback post, saying simply, “Some teams are scared off by a sesmoid bone problem in one of big back Beanie Wells’ feet.” Once the story of a potential sesamoid bone problem for Beanie Wells hit ProFootballTalk, there is a good chance everyone who follows the NFL was aware of the speculation. (Between the issue being raised in Peter King’s MMQB column and at ProFootballTalk, it would be hard for NFL execs and fans alike to miss it.)

To be fair, the player and his agent have denied that Beanie Wells has a sesamoid bone problem in his foot, calling the sesamoid bone concerns a “smoke screen.” As we all know, it is hard to trust any information disseminated about draft prospects this time of year. Teams picking later in the draft may want negative information out there about a player to increase the chances of the player not getting picked as high as he otherwise might be.

Either way, whether Beanie Wells truly has a sesamoid bone problem or not, last season the Buckeye standout was plagued with a foot injury that kept him out of three games and possibly hurt him in the chase for the Heisman. And now the information referenced above has surfaced about a potential injury in the fore foot.

The possible injury, described as an inflammation of the sesamoid bones below the first metatarsal (big toe – as pictured below), will no doubt remain a hot topic as we approach the first round of the 2009 NFL Draft on Saturday.

Under view of the foot

For the record, this article makes no claims as to whether or not Beanie Wells truly has a sesamoid bone problem, only that the speculation is out there. Rather, this edition of The Trainer’s Room is meant to serve as general information on sesamoditis, its similarity to turf toe, and methods for treating the injuries.

Sesamoiditis and Turf Toe

Sesamoiditis refers to any irriation of the sesamoid bones. The sesamoid bones are free floating bones throughout the body, encased in a tendon sheath. These can be found at the base of the first metacarpal (thumb), first metatarsal (big toe), and patella (pictured below – the largest sesamoid bone in the body). Their main function is to hold the tendon away from the joint slightly, protecting the tendon from wear and tear by decreasing friction and increasing joint function.

Patella encased in the tendon

Inflammation of the sesamoid bone is a very similar injury to another very common sports injury, known as turf toe. These two injuries have many common indicators and are often intertwined.Both sesamoiditis and turf toe produce complaints of sharp to very intense pain underneath the base of the big toe. Most of the pain comes from extension of the toe, which can cause difficulty walking and a tender and swollen joint.

Sesamoiditis is an inflammation of the sesamoid bones from overuse or chronic stress to the area. Sesamoiditis will begin as a more gradual ache and then increase in pain over time. Turf toe is an actual tear or injury to the soft tissue underneath the first metatarsal (big toe). Turf toe usually will be an immediate pain. The patient will often feel a pop in the area underneath the 1st metatarsal head. Remember that sesamoiditis and turf toe are similar injuries that have similar symptoms and may accompany one another. You may have a chronic turf toe problem from damage to the area, but the pain does not have to be sudden.

Causes of Sesamoiditis and Turf Toe

The most common way to receive one of these injuries is forced hyperextension of the toe, jamming the joint, or repetitive stress (common in sprinters and football players). For a running back like Beanie Wells this injury can be detrimental to their ability to get down the field by decreasing their ability to get in and out of cuts quickly and hindering their all-important burst through the hole.

Inflammation of the bones or a tear in the ligaments as in turf toe causes the pushing power to be greatly decreased. This will decrease the explosiveness and overall speed of any player. In severe cases athletes may not be able to run at all. This is a very common and simple injury, and the pain can keep you sidelined for weeks. In the past year several other athletes such as LT and Darren McFadden were out for weeks with toe injuries.

Sesamoiditis Treatment and Turf Toe Treatment

The acute stages of sesamoiditis and turf toe are painful and intense. Any additional pressure is going to increase that pain. When sesamoiditis or turf toe first occurs, ice the area to decrease the inflammation. You can use ice for either injury, whether it is chronic or acute. Ice is one of the best ways to decrease inflammation immediately following the injury.

The next step is pay a visit to your doctor. Neither sesamoiditis nor turf toe will just go away on their own. The longer you wait with an injury like this the longer it will take to get back on your feet. Your doctor will perform orthopedic tests to determine which injury you are suffering from. An X-ray will be taken to determine if there are any underlying fractures or dislocations. They may also take an MRI to determine if there is in fact any ligament or tendon damage. An MRI can also detect soft tissue swelling or inflammation to the bone which cannot be seen on X-ray.

Once the diagnosis is given, the first and most important step is to free the area of inflammation and swelling. This can be done by several different types of treatment. The big toe is not a great site to attach pads for any type of electrical modalities. For this reason, at Mountain View Pain Center in Denver we use ultrasound under water to remove the inflammation of this area. Note that the area is very thin, so ultrasound should not be applied directly.

After the first treatment it is important to apply tape or a specific brace to prevent the toe going into extension and thus creating extra pain. At Mountain View Pain Center in Denver we prefer to use a specific taping method to keep mobility in the ankle and allow for more comfort. The tape allows the toe to be held straight and decreases the amount of extension during push off. During your sport of preference wearing shoes with a stiff sole will also increase the stability in the area and decrease the amount of extension.

Once stability has been restored to the area, and the pain has slightly subsided, it is important to have the foot adjusted (manipulated) to restore proper movement to the foot, ankle, and metatarsals. After the area has begun to heal, soft tissue technique should be applied to the area. The importance of this step is to not only continue the removal of inflammation, but to also break up scar tissues and adhesions that have formed in the tendon sheath. At Mountain View Pain Center in Denver we use a combination of soft tissue stretches, as well as a specialized tools to work through the area.

Sesamoiditis Rehab and Turf Toe Rehab

There are also some exercises we use to aid in the healing process and to strengthen the area. They should only be done when you can perform them without pain.

Start simple with toe crunches, which will help build the muscle at the bottom of the joint and assist in preventing future occurences of sesamoiditis or turf toe. A toe crunch involves bending the toes as if trying to pick a ball of the ground with your toes.

The next rehab exercise is only to be done when there is no pain at all when standing, and should be performed after several treatments. You can go from a flat footed position to a toe raise (similar to a ballet move). This is an advanced exercise for these injuries so take it easy and do not try this exercise first.

What to Avoid

Things that are important to avoid during recovery from sesamoiditis and turf toe are any movements that involve a pushing off of the toe. What this means is cut out the plyometrics, hills, and stairs from your training regimen. If you insist on training, then get on a bike and push the pedal with the middle of the foot or heel. Another substitute can be the elliptical machine. Be sure to take long even strides and stay off the toes. This entire exercise can be done with the foot flat. If you find either exercise to painful then perform the one you can.

Although many think a toe injury cannot keep them down. This injury, year after year, keeps players on the sidelines for extended periods of time. The pain is intense and debilitating, yet although this is a very painful injury, if the correct steps are taken, you can recover and get back to full speed.

As for Beanie Wells and the speculation that he may have a sesamoid bone injury, only time will tell. If he does, in fact, have a sesamoid bone injury (and again, it is all purely speculation at this point) then if the toe is properly rehabbed and time is taken before getting into hard core training, we should expect to see him back on the field for training camp.

Now, whether his impact on the field will be similar to his college career, that is what hundreds of scouts and personnel people are trying to figure out leading up to the start of the draft tomorrow.

This article contains the opinions and examples of treatment plans for sesamoiditis and turf toe from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described.

You should always consult your doctor before beginning any pain management or rehab program.)

______________________________

Ankle Sprains

For this article we will discuss one the most common sports related injuries, the ankle sprain. This type of injury can happen in all sports, to any player, and makes any activity nearly impossible until the pain is gone and the ankle heals.

Inversion injuries, or acute lateral ligament sprains, are the most common form of sporting injury, accounting for 40% of all injuries and up to 85% of ankle sprains, which in themselves are responsible for over 15% of all time lost from sport.

The injury occurs when the athlete lands with the foot plantar flexed and slightly inverted. This position unlocks the joint. What this means is simply rolling your ankle.

Plantar flexion inversion sprain

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Sprained Ankle: The Ligaments, Ankle Sprain Grades, and Recovery Time

The lateral (outside) ankle ligaments are: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The medial (inside) ankle ligaments are the deep and superficial portions of the deltoid ligament.

The most commonly sprained ankle ligament is the ATFL, followed by the CFL. An isolated CFL tear is rare, and is almost always preceded by a tear of the ATFL. These injuries are caused by running on uneven terrain, stepping in a hole, stepping on another athlete’s foot during play, or landing from a jump in an unbalanced position.

A syndesmotic ankle sprain, or high ankle sprain, occurs as a result of forced external rotation of the foot or during internal rotation of the tibia on a fixed, planted foot. A common mechanism is a direct blow to the back of the ankle while the foot is externally rotated.

Classification of lateral ligamentous injuries is variable. Injuries are described as primary, secondary, or tertiary, or grade 1, 2, or 3, in order of increasing severity, as illustrated in the ankle sprain grade chart below. The grading of ankle sprains helps to guide treatment, rehabilitation, and prognosis. The ankle sprain grade is based on the number of ligaments injured, degree of ligament tearing (partial vs. complete tear), and amount of swelling and ecchymosis (bruising).

Please note this chart provides only a rough estimate of sprain ankle recovery time. Other factors must be weighed in such as previous injuries, age, weight, health status, and your sprained ankle treatment plan to give a more exact prognosis of recovery.

Two easy tests to determine when your previously sprained ankle is stable enough to get back in the game are to stand on the ankle in question for one minute with eyes closed, or jump up and down ten times in a row. If you can perform these without pain then you should be ready for action. However, even if you can perform these tests, your ankle may still be damaged, so take caution and protect yourself. Have the sprained ankle taped or wear some form of ankle support until it has healed.

Be aware there may also be an underlying fracture as well with an ankle sprain. This could contribute to the intense pain and swelling. It is possible to fracture the malleoli, cuboid, navicular, talus, or calcaneus. This is why it is important to see your doctor for an X-ray after an injury. An MRI might be needed because some fractures do not show up on conventional X-ray; MRI is also the best way to rule out underlying ligament damage.

Ligaments of the ankle

While most ankle sprains will heal without complication, 20% of all sprains will lead to further chronic instability. Ligaments and tendons are stretched and damaged in an ankle sprain, but with the appropriate treatments we can heal and strengthen the area. If the ankle is left to heal on its own, you run the risk of developing an unstable joint. This can leading to multiple ankle injuries and even more complications down the road.

Sprained Ankle Treatment and Rehab

Before we get into treatment, we must first understand what is happening to the ligament. In the initial injury for example, the inversion sprain, the ATFL is stretched and torn. When this occurs the area will hemorrhage and will become inflamed. The body’s natural healing process will kick in and lay down more collagen to the affected area. If the appropriate steps are taken the collagen will lay down in the correct fashion reducing scar tissue and decrease the risk of future sprains.

Lateral ankle sprain

Sprained Ankle Treatment

Initial treatment or the acute phase (0-24 hours) of the inversion injury/simple ankle sprain follows the usual regime of protection, rest, ice, compression, and elevation (PRICE). Although a very simple step, it is commonly overlooked, creating a longer recovery process.

Ice is most beneficial immediately after the injury, as it decreases swelling and helps with pain relief. Blood flow does not decrease significantly for about 10 minutes after the application of ice (but DO NOT ice longer than 20 minutes), by which time considerable bleeding may already have occurred, so the compressive element becomes equally important as an aid to restricting hemorrhage. The ankle should be taped in the opposite fashion of the injury. This will help to shorten the stretched ligaments and begin the healing process. If sports related, the athlete should be removed from the field of play without placing weight on the joint. The limb should be elevated as soon as possible and compression applied.

After you pick yourself up off the sidelines, go see your doctor. It is important to perform the appropriate orthopedics examination to determine the ankle’s stability and if there is any other underlying tendon ruptures or fractures. The majority of ankle sprains respond well to conservative care, and surgery is generally avoided in this type of injury. However it is recommended to see a doctor and let him/her make the call. You do not want to push an unstable ankle, or you can further damage the already weakened ankle.

Many think that because the ankle was injured the best course of action is to brace it and leave it alone. However, research shows that early mobilization of the joint will stimulate collagen bundle orientation and therefore stimulate healing. At Mountain View Pain Center we recognize the importance of adjusting and restore biomechanics to the joint while applying the other therapies. It is important to work with your doctor or trainer to properly rehab the area to strengthen and prevent from further sprains.

Early sprained ankle treatment will focus on moving out the edema (swelling) of the area, which will also promote healing. At Mountain View Pain Center we perform this process in several different ways. The first is an electrotherapy called hi-volt. Hi-volt is a direct current applied to the body through pads. In this type of injury the polarity should be set to positive (acts like ice). The hi-volt treatment has several benefits for an ankle sprain. The electric current will pump out the swelling and decrease pain.

The next step we take at Mountain View Pain Center is to apply kinesio-tape to the area. This allows the healing process to continue while the patient is at home. The tape also assists in the removal of inflammation and swelling. In the first 72 hours the kinesio-tape will be applied in a fan-like fashion across the foot with two strips, one facing towards the middle of the foot and one fanning out. This will open the lymphatic channels thus allowing the edema to move out of the area.

Another great way to move out swelling is a soft tissue technique aided with a specialized instrument. This specific technique is great for breaking spasms, removing adhesions (scar tissue), and in this case pushing out swelling. Your doctor should perform this to assist the lymphatic flow in the ankle. Adding this technique to our treatment has helped patients get back on their feet much quicker.

Sprained Ankle Rehab

After the removal of the pain and swelling, the next step is to begin rehab and work to prevent future ankle sprains. We do this by therapeutic exercises designed to strengthen the injured and weakened area. We also continue the use of kinesio-tape to help support the area, as well as allowing the patient the freedom to move the ankle, while still getting the therapeutic benefits. This is done with the same technique with tape to the outside of the foot, as well as stabilization tape up the calf muscle to aid the ankle in flexion of the foot.

Supplements

As mentioned in previous articles Omega fatty acids or fish oils help with inflammation in the body. Flavanoids, which give fruit their pigment, work exceptionally well with the reduction of inflammation, the increase of stabilizing collagen structures, and thus decrease pain. Collagen is a major protein in the tendons, so if you are trying to avoid future sprains, it is a good idea to take this supplement to help enforce the tendons.

Another important supplement to take for the prevention of future strains is vitamin C. Vitamin C deficiency is associated with defective formation of the tendons, making you more susceptible to an injury. (Side note: smokers are often deficient in vitamin C, so if you smoke you may be inhibiting your body’s ability to heal itself.)

Chronic Ankle Sprains

Without the appropriate care for an ankle sprain you may develop an unstable joint. When the joint becomes unstable the risk of further and more severe ankle sprains increases drastically. From here you must address the buildup of scar tissue as well as the instability. If you find yourself suffering from a chronic ankle sprain, let us know. We can help you develop a modified treatment plan.

These are the opinions and examples of treatment plans for sprained ankles from Mountain View Pain Center. If you have any further questions or concerns feel free to contact our office or leave a comment below. Additional home exercises can be prescribed by your physician to speed up the healing process.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described. You should always consult your doctor before beginning any pain management or rehab program.)

With the exciting end to the World Baseball Classic and Opening Day just around the corner, we have decided to discuss strained and torn abdominal muscles for this article. In fact, two players were recently plagued with similar abdominal muscle strains: Chipper Jones and Dustin Pedroia.

Chipper Jones, from the Atlanta Braves, had to be pulled out for a week from the WBC tournament after suffering an abdominal muscle strain. He even had to leave the game against Venezuela because of the injury. Dustin Pedoria from the Red Sox was also sidelined with a strained abdominal muscle.

Disclaimer: First, we must warn you that abdominal pain is an abnormal occurrence, and is not to be taken lightly; you must seek medical attention right away as this could be something more serious than a strained muscle. We advise anyone having any abdominal pain to please contact your medical practitioner right away.

Abdominal Muscle Strain Symptoms

It is important to know that this type of injury can take some time to heal (time will depend on the severity of the injury). Often in the case of a complete muscle tear the pain is instant and very intense. The pain description most patients give is knife-like or sharp pain at the site of injury. The pain results from micro-tears in the musculature that occurs during torsion (twisting) movements. Other common signs and symptoms of an abdominal strain or tear can be tenderness and inflammation over the area.

Unfortunately, basically everything we do during the day is aided with the contraction of the abdominal musculature, since it is an important muscle of core stabilization. As a result, an abdominal muscle strain can cause pain all day long, and any movement involving flexion of the trunk can also cause an increase in pain. Examples of this are as simple as sitting up or getting out of bed in the morning.

Muscle strain grades

• 1st Degree: Minimal damage to the muscle, tendon, or musculotendinous unit
• 2nd Degree: Partial tear to the muscle, tendon, or musculotendinous unit
• 3rd Degree: Complete disruption to the muscle, tendon, or musculotendinous unit

One of the reasons it can take so long to recover is because you constantly use the muscles while breathing; and, as we mentioned above, we use our abdominal musculature in basic stabilization throughout the day. However, it is possible to have a minor strain that can heal in a relatively short period of time, if the appropriate steps are taken.

Another result of abdominal muscle weakness is an increase of the lumbar curvature (hyperlordosis), which in many instances can lead to low back pain. If a complete tear of the musculature occurs there is also a possibility of a further complication, such as a hernia.

Abdominal Muscle Strain Treatment

Kinesio-taping, although fairly new, has been shown to have great results with this type of injury. The specific method of kinesio-taping depends on which muscle has sustained the injury and can be determined by your doctor.

The injury that Chipper Jones suffered from was an oblique injury. The external oblique muscle fibers run downward and medial (toward one another), and they cooperate in the flexion of the trunk by resisting one another. If the fibers on only one side are contracted, then the action performed is lateral flexion and rotation of the trunk to the opposite side.

The kinesio-taping method for this type of injury is fairly simple. For an external oblique injury your doctor would find the muscle in question and apply specialized tape in the direction of the fibers. Do not read this and think you can tape yourself. Remember you must use a specific type of elastic tape, and the application and direction of the tape is very important. If the taping is done properly it will provide increased stability to the area. If done improperly it can result in an ineffective treatment.

One of the other most effective types of treatment for this injury is everyone’s favorite advice: ice it and rest it. After the initial injury, apply ice to the area in question quickly to prevent it from further developing unnecessary swelling. The second part of the recommendation, rest, is of course the last thing any athlete wants to hear, but it is an important step in the recovery process. Remember that with an injury like a muscle strain, if you do not give your body time to heal then you can damage the muscle further or risk tearing the already weakened muscle all together.

Supplementation

There is no quick fix for an abdominal muscle strain. However, there are supplement protocols out there to help reduce inflammation and promote healing.

• Many studies have shown that ginger root has many benefits, one of which is the reduction of inflammation. Many traditional herbal practitioners use ginger root to aid in the treatment of arthritis, bursitis, and ulcerative colitis, all of which are inflammatory conditions.
• Omega Fatty Acids are also very beneficial in the healing process.
• Vitamin C and other bio flavinoids are also beneficial in the healing of connective tissues.

Abdominal Muscle Strain Prevention

The best things you can do to prevent an abdominal muscle strain is to properly train your body. You may ask yourself, then why do professional athletes suffer from this injury? Are they not properly trained? Well in most instances yes, they are properly trained; however, it is also possible to strain or tear the muscle from over training your body. The best way to prevent injury is to consult your doctor or trainer and set up a program that helps to strengthen your core. Some common exercises for this can be done on the physio-ball and many are free weight exercises such as the plank maneuver (pictured right).

Another important prevention method is to make sure you have the appropriate technique when performing your exercises. Whether you are swinging a bat or lifting weights in the gym, having the correct technique is very important to protecting the body from injury. If you want to take it a step further, you can see your practitioner or a sports therapist to see if there is a muscle imbalance or something altering your posture that may have a weakening effect on your core.

As far as Chipper Jones and other professional athletes with similar injuries, we predict that they should recover from their injuries within 1-4 weeks (depending on severity of their injury).

Disclaimer: Once again, we must warn that abdominal pain is not a normal occurrence. Please seek medical attention right way. This article is the opinion of the Mountain View Pain Center, for this particular type of injury. If you feel you have had a similar type of injury please contact your primary care physician and do not attempt to perform any of these treatments without the approval and supervision of your doctor.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

This week the injury we will be covering is the very common and often debilitating herniated disc. The athlete we will be using as an example will be Joe Crede. A new member of the Minnesota Twins, Crede has had a successful career, and has even appeared in an All-Star game. Unfortunately for Mr. Crede, the last two seasons have been haunted by back pain caused by a herniated disc in the lumbar spine.

History of Joe Crede’s Battle with a Herniated Disc in the Lumbar Spine

Crede’s battle with a herniated disc in the lumbar spine dates back to 2004, a season during which he played in 144 of the White Sox 162 games. White Sox fans know that Joe Crede’s back problems were an on-again, off-again topic through 2005 and 2006, two seasons in which Crede was generally healthy and played in 282 out of 324 games total. Obviously Crede was able to manage the lingering problems from the original injury as he turned in his two best seasons in 2005 and 2006, hitting 52 home runs combined.

In 2007, however, Crede played in only 47 games. After trying epidurals for the pain, he eventually had surgery, a microdisectomy, after being unable to manage the pain any longer. Despite a great first half to 2008, after which Crede played in the All-Star game, the back problems produced by the herniated disc came back in earnest. He again had a microdisectomy, after fluid from the same disc was pinching a nerve.

As mentioned, Joe Crede has tried both epidural shots and surgery to treat his back problems. The following is the opinion of the Mountain View Pain Center, and these are some of the options we offer our patients. It is important to start conservatively and measure the improvements before heading into the surgery. This means working with the body to begin the healing process, before using drugs, or removing something through surgery. Of course, there are several different ways this injury can affect someone, and surgery maybe the only option, but the philosophy of the Mountain View Pain Center is to explore natural ways to heal the body, using surgery as a last option.

Typical Causes of Herniated Discs

Now let us backtrack to the original injury suffered by Joe Crede: the herniated disc in the lumbar spince. The most common cause of disc injury is poor biomechanics (moving improperly, which we are all guilty of doing). Discs are most commonly torn by lifting a weight while twisting; getting something heavy out of the backseat of your car is an example. As we all know in the game of baseball, especially at the plate, the body goes through some twisting and contouring with a driving force.

Typical Symptoms and Non-Surgical Treatments for Herniated Discs

The first step is to determine what symptoms we have and address them accordingly. The most common types of pain from a disc injury are low back pain and/or radiating pain into an extremity. We are using low back pain as our example, but radiating pain into the leg is often experienced with this type of injury. In many cases you can just have leg pain and no back pain. The reason the pain is referred to as “radiating” is because the disc material will bulge out causing inflammation and put pressure on a nerve, and the pain will follow that specific nerve’s pattern. For example, a herniation of the L3 disc will put pressure on the L4 nerve, causing pain to radiate down the posterior (back) of a leg.

To determine if a herniated disc is causing you pain, your doctor will perform an examination and orthopedic tests. If your doctor determines that a disc is the problem, the next step is to take a simple X-ray to rule out any underlying problem with the bones or joints. The next step is an MRI; from here you will be able to see the level and severity of the herniation. It is also important to know that the size of the herniation does not necessarily correspond to the severity of pain. In fact, some people can have a large herniation with no symptoms at all, and some can have a very small lesion and experience immense pain. From the results, the doctor will be able to determine if your herniated disc can be treated with natural therapy or if surgery is required.

The initial phase of such an injury is often described as a patient saying, “I heard a pop and then all of a sudden I was in incredible pain.” The pop they heard is the tearing of the annular fibers of the disc. In the acute stage, or a few days after the injury, a patient can be in a lot of pain, and experience some inflammation and swelling. The patient comes in saying, “Doctor, just get me out of pain, please!” To immediately address the pain, the first step is to reduce swelling by cooling the area with ice, being careful not to put the ice directly on the skin. (Yes, you can get a burn from ice!) You can alternate ice on and off twenty minutes at a time. DO NOT use heat; it will increase swelling and you will regret it. At the Mountain View Pain Center, in this situation we like to use a therapy called Hi Volt, which is an electronic modality. The purpose of this modality is to decrease pain and move that edema (swelling) out of the affected area.

Once the initial pain is relieved, we can begin treatment of the injury. A treatment we often choose to begin with at the Mountain View Pain Center is a method called flexion distraction treatment, coupled with other therapies to reduce swelling. The flexion distraction treatment works by widening the disc space and causing the herniation to essentially get “sucked back into the disc”. This treatment can be done by utilizing chiropractic techniques to relieve pressure on the herniated disc.

Another technique we use is called traction therapy, otherwise known as long axis distraction. Here the doctor will use a DTS machine (decompression therapy) set to specific settings unique to each patient. The machine will gradually begin to pull and will slowly separate the two vertebrae pushing on the disc. The purpose here again is to relieve the pressure on the disc. Many patients have found that treatment with a DTS machine is a safe and cost-effective treatment, and have found relief without the need for surgery.

Once the patient is out of pain, the rehabilitation can begin. It is important to remember that just because the pain is no longer there, it does not mean the disc is back to normal. A full disc recovery can take up to 3 months. The purpose now switches to restoring the body back to its normal function. This is done by low back exercise and simple core exercises. A set of very popular exercises used for disc treatment are called Mackenzie exercise (extension exercises). Your physician will be able to instruct you on the proper way to perform these.

Another preventative step that can be taken is supplementation to strengthen the discs or joints, or supplements that help with inflammation. Check with your doctor or physician before taking any supplements to see what is right for you and make sure there are no risks to taking these vitamins.

Some supplements for simple joint care are:

• Glucosamine sulfate (500mg) with MSM (methylsulfonylmethane) (250mg): Glucosamine sulfate helps to stimulate specific components of your cartilage. MSM helps with pain and has been shown to be an anti-inflammatory
• Omega fatty acids: Many are known as fish oils, they have multiple benefits besides anti-inflammatory, they also build cell membranes, and help improve neurologic and cardiovascular function. Omega fatty acids are not just good for your discs, they are essential to life.
• Quercetin/Bromelain: Also have anti-inflammation effects. These can be found naturally in vitamins, but not usually in the amounts useful to aid in inflammation.

These come in several brands, and we are not here to recommend specific brands of vitamins or supplements, just to inform the sports fans on injuries they see in themselves or many of their favorite athletes. If you decide you would like to know more about a specific vitamin or advice on the supplements we use, feel free to call, and we can point you in the right direction.

At Mountain View Pain Center we have seen and experienced that for the most effective pain recovery, conservative treatments should be utilized first before epidural injections and back surgery. However it is important for your doctor to acknowledge the importance of co-treating patients in their best interest for recovery. At Mountain View Pain Center our primary care is chiropractic and physical therapy, however if we determine a patient can benefit from another provider’s care we will refer them with no questions asked. The goal is to get the patient pain-free and restore them to healthy function in the manner that is most suitable to the patient.

Epidural Injections for Treating Pain Caused by a Herniated Disc

Joe Crede had the option to get an epidural injection, what is that?

An epidural injection is the administration of medication that can cause both a loss of sensation (anesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disc and radiculopathy (radiating pain).

The injections themselves can be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed. Simply put, epidural injections do not produce long term results hence the patient has to keep getting them to reduce the symptoms they are having. Possible side effects of epidural shots can be increased pain, loss of sensation, infection, and nerve damage. Follow the link to learn more about the side effects of using epidural injections to treat pain.

Herniated Disc Surgery

When it became clear the injury would not heal on its own, or that natural methods would be unsuccessful in correcting the problem, the choices Joe Crede faced were epidural shots or surgery. Prior to 2007, Crede had been able to manage the pain through at least four epidural treatments. However, in 2007, Crede determined that the temporary relief provided by the epidurals was not enough. At that point he opted for the microdisectomy, and then unfortunately experienced a re-herniation of the same area. Thus, the microdisectomy had to be repeated again a year after the first surgery.

In some circumstances it may be determined that back surgery is the best option. However, surgery is not always needed, and unfortunately many surgeries are unnecessary and cause further complications. Studies have shown that more than half of lower disc surgeries do not successfully relieve symptoms. As mentioned above, at the Mountain View Pain Center we believe that surgery should always be a last-resort option. For Joe Crede, surgery finally came three years after the initial onset of the injury. Despite the relative lack of success Crede experienced with the first surgery for his herniated disc, both he and the Minnesota Twins are hoping that the second microdisectomy will allow him to move forward and have a healthy, productive season.

According to Crede, the early prognosis is that the second surgery appears to have been more successful. His first microdisectomy was performed in L.A., and he says that for 10 days he had to stay in L.A. and had trouble even walking. His second microdisectomy was performed in Dallas, and he says that he was able to go home in two days. Before signing his new contract with the Twins, Crede’s back was examined thoroughly by their medical staff, and “passed with flying colors.” Upon arriving at Twins Spring Training camp in Fort Myers, FL, Crede declared himself “pretty close” to full health

Joe Crede’s Recovery from a Herniated Disc

As for Crede’s recovery, it is hard to tell as we have not treated him, or monitored his progress or rehab program. As mentioned before not all surgeries are successful; however, many surgeries are. As an elite athlete I am sure he has the opportunity to see top-notch doctors, and receive many options of rehab techniques. Of course any fan wishes him a speedy recovery, and hopes to see him out on the field all season long.

Once again, the information and recommendations presented in this article are the professional opinion of the Mountain View Pain Center, and represent some options that we offer to properly treat you and your symptoms. Please contact your primary care physician for more information and what is best for you, and please do not try these treatment recommendations on your own; doctor supervision is required.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition. He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX.

A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

Dr. McNally and Dr. Erhuy are certified in chiropractic neurology and have a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Our goal with The Trainer’s Room will be to provide timely background information on relevant injuries as they occur in the sports world.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described. You should always consult your doctor before beginning any pain management or rehab program.

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Today we will focus on knee bone bruises. Carmelo Anthony of the Denver Nuggets bruised his knee on Wednesday, February 18th against Philadelphia and felt limited by it during Friday’s game at Chicago. Lamar Odom also suffered a similar injury to his right knee earlier in the year.

What is a Knee Bone Bruise?

A “bruised bone” typically refers to bleeding that occurs under the tough fibrous covering of the bone called the periosteum. It causes pain in the area of the bone but heals quickly as the blood is reabsorbed just like a bruise of the skin. The bruising may or may not involve the skin and soft tissues as well. The most painful bruises can sometimes take months to heal. What happens in a bone bruise is a compressive force pushes the femur and tibia on itself. When this happens the outer layer of the bone (most likely the femur), which is fibrous, breaks down. This leads to leaking of fluid.

Knee Bone Bruise Diagnosis and Treatment

After the initial onset of the injury beware not to jump to the conclusion of a bone bruise, even if you are experiencing similar symptoms. The knee joint can support a handful of injuries and it is important to reach the proper diagnosis and to come up with the appropriate treatment to avoid future risks of injury. This is done by doing a thorough exam of the joint. X-rays should be taken to rule out a fracture or any possible underlying pathology that could be masking the symptoms. After that, an MRI is necessary to rule out any ligamentous or meniscus injuries. This will also show the bone bruise if that is in fact the cause of the symptoms.

First – Assess Knee Bone Bruise Symptoms

Recognize the symptoms of a bone bruise. Common symptoms are severe pain and swelling. Sometimes a blackish-blue discoloration around the affected area may be visible. Along with the initial stage ice massage, another valuable step that cannot be overlooked is rest. This step may be very difficult for any athlete as they may be willing to push their body to the extremes to get back in the game. The reason we suggest rest in this stage is simple: the healing process is just beginning. To push or rush the injury could lead to further problems, and in the long run keep the athlete on the sidelines for an even longer period of time.

Second – See a doctor

Consult your doctor and get an MRI (Normally X-rays do not show bone bruises very well).

Third – Treatment of Knee Bone Bruise

At the Mountain View Pain Center we have seen many injuries to various athletes. A bone bruise can becoming a nagging injury leaving the player unable to participate due to lack of range of motion and often very intense pain. The methods with which we treat each player are specific to their needs. As we realize it is important for a player to get back into the game, our methods involve rehab and therapy to speed up the patient’s recovery time with as little pain as possible.

The first step of the knee pain treatment process for bone bruises is the application of an ice massage provided by your doctor of choice several times a day, for no more than 5 minutes per application. The purpose of the ice massage is to move the edema (swelling) out of the affected area, reduce pain, and also to promote the healing process.

The next step in the process is to apply microcurrent therapy to the affected area, in this case the knee. Many different therapies can be used to treat pain, break up adhesions (scar tissue), or stimulate healing. The reason the Mountain View Pain Center prefers to use microcurrent therapy for this specific injury is that this particular modality has all of these benefits, thus decreasing the amount of time and money the patient would need to spend.

Another important step in the healing process is to perform full range of motion, non-weight bearing exercises to the joint. Getting the player back to their original state of health is the upmost importance for them to return to the game 100% effective. The range of motion exercises will be performed to keep the joint in full motion and inhibit the chance of further development of scar tissue. This step can be done concurrently with the rest as it is a more natural approach and will assist the body in its healing process.

Additional treatment recommendations:

Start with

• Vitamin K – 500mcg: Vitamin K is a fat-soluble vitamin which is needed in the body to produce blood-clotting components and help strengthen bones.
• Vitamin C – 500mg 2-3 times a day: Ascorbic acid, known as vitamin C, helps support the immune system, acting as an antioxidant to hasten recovery.
• Vitamin A – 50,000 IU per day (not to be used by pregnant or women at risk of pregnancy): Vitamin A contains fat soluble compounds that help fight infection and speed recovery.
• Bromelain – 250-750mg: Bromelain comprises protein-digesting enzymes found in pineapple plants to reduce swelling, inflammation, and pain

Also, Kinesio Taping alleviates pain and facilitates lymphatic drainage by lifting the skin. The taped portion forms convolutions in the skin, thus increasing interstatial space. The result is that pressure and irritation are taken off the neural/sensory receptors. Then, slowly, pressure is taken off the lymphatic system, allowing the edema to drain more freely.

And finally, remember to be patient. Bone bruises can take a few months to heal.

Disclaimer: This article is the opinion of the Mountain View Pain Center, for this particular type of injury. If you feel you have had a similar type of injury please contact your primary care physcian and do not attempt to perform any of these treatments without the approval and supervision of your doctor.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Maintain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com. Click on the image below to visit their website.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition. He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX.

A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.