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

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.