This post is about Chiropractic West Palm Beach: Low Back Pain and Piriformis Syndrome.  Symptoms include buttock and posterior (back) leg pain.  And it comes on insidiously (gradual, subtle but with harmful effects) without any trauma. If you have Piriformis Syndrome, Chiropractic can provide relief! We’ve got some great information to share below.

 

Chiropractic West Palm Beach: What is Piriformis Syndrome?

Firstly, the piriformis is a flat, pear-shaped muscle located in the gluteal (buttock) region of the hip/proximal thigh.

Secondly, the sciatic nerve runs under the piriformis muscle where it may be compressed (pinched) by the piriformis muscle. As the biggest nerve in your body, it originates from several nerves in your lower back. These nerves branch outward from the spine and then come together at each buttock to form the sciatic nerve, which then travels down each leg. And sciatica is defined as irritation or compression of the sciatic nerve that causes pain in the buttock area with radiation to the lower leg. It is a condition characterized by pain along the course of the sciatic nerve.  This is usually a neuritis (inflammation of a nerve) and generally caused by mechanical compression or irritation of the lumbar and sacral spinal nerve roots.  However, piriformis syndrome is another cause of irritation of the sciatic nerve.

Thirdly, predisposition to piriformis syndrome may be due to an anatomically short leg (one leg is structurally shorter than the other due to bone length differences).  Other reasons could be due to excessive pronation (inward rotation of foot) of your foot or a pelvic rotation/misalignment.

Fourthly, in approximately 15 % of the population, there are two muscle bellies to the piriformis muscle.  In this case, the sciatic nerve courses between the 2 muscle bellies.

 

 

Chiropractic West Palm Beach: Piriformis Syndrome Treatment

 

Postisometric relaxation techniques or myofascial release soft tissue techniques to the piriformis muscle is important for treatment.  Indeed, chiropractic manipulative therapy (joint adjustment) without addressing the piriformis muscle would not produce a positive outcome.

Also, our other therapies, therapeutic exercise (e.g. stretching, strengthening), electric muscle stimulation, and ice/ heat therapies provide relief from piriformis syndrome. 

Dr. Natalie Meiri, your chiropractor in West Palm Beach will examine you and come up with a treatment plan to get you better. You can get fast pain relief and function better.  Moreover, you can improve your health through regular chiropractic care.

If you have back pain due to piriformis syndrome and chiropractic care is your choice, call us today at 561-253-8984!  Ask to make an appointment or find out more about: Chiropractic West Palm Beach: Low Back Pain and Piriformis Syndrome.

 

References:

Thomas Souza, (2018) Differential Diagnosis and Management for the Chiropractor

 

 

 

From Dr. Natalie Meiri’s Clinical Pearl Stories:

Chiropractic West Palm Beach: Chiropractic Care for Martial Arts Injuries in a Child 

 

This was a 13 year old patient with martial arts related injuries.  To be HIPAA compliant, I will call him Andrew instead of his real name.  Andrew was very happy, outgoing, enjoyed sports, and got straight A’s in school. He had joined a martial arts class for kids a year ago and was competing in contests.  His chief complaints were back and bilateral (both) shoulder pain.  He felt that his injuries were keeping him from competing at his best and he was always in pain.

 

Chiropractic West Palm Beach: Andrew’s mother finally brought him to see me after a visit to his pediatrician.

Andrew’s pediatrician had prescribed Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen along with rest, ice, immobilization, compression, bracing, and elevation for his pain and swelling. This seemed to help for a while, but then he was back to his original state of pain and dysfunction. 

Also, Andrew’s mother was concerned about the possible side effects including stomach upset, gastritis, and ulcers that may occur from the drugs. Furthermore, she even read on the list for the side effects of the drugs: The drugs may have a blood-thinning effect and can increase the likelihood of bleeding after a cut, deep bruise, muscle strain, or head injury. Long-term use can affect the kidney and liver.

Lastly, Andrew’s mother knew these drugs could mask pain, which can lead to further injury.

Chiropractic West Palm Beach: Andrew’s Examination at Meiri Chiropractic

Andrew presented to my office stating he had chronic pain in his neck, back and shoulders. His hyperkyphosis (severe forward curvature of the thoracic spine) was noted on observation and inspection.  And a further test indicated he had a structural kyphosis and not a functional kyphosis. 

 Additionally, upon examination, there were positive tests for his cervical (neck), thoracic (mid back) and lumbar (low back) spine and glenohumeral (shoulder) joint chief complaints. Andrew also had some tenderness and palpatory findings (examine by touching) in the muscles around the spine and both shoulders.

The thoracic x-ray of his spine taken in my office ruled out scheuermann’s disease and scoliosis.

Andrew’s neck, back and shoulder diagnoses were sprains and strains from his martial arts injuries.

What is a Sprain or a strain?

A sprain is a sudden or violent twisting injury of a joint with stretching or tearing of ligaments.  A strain occurs when a muscle is overstretched or torn. This usually occurs as a result of fatigue, overuse, or improper use. Furthermore, damage to your attached tendons can also occur with a strain.

Chiropractic West Palm Beach: Andrew’s Treatment for Martial Arts Injuries

Firstly, Andrew’s treatments consisted of chiropractic manipulation/ adjustments of the cervical , thoracic, and lumbopelvic spine, and bilateral glenohumeral joints. Secondly, soft tissue techniques (e.g. myofascial release, pressure point and post-isometric relaxation) was performed on all his tender and spasmed muscles. Thirdly, ice/heat therapy recommendations and exercises to continue his treatment at home were given. Finally, activity modification and recommendations for prevention of further injury were given.

 

 Chiropractic West Palm Beach: Andrew’s Out Come for his Treatment for Martial Arts Injuries

Andrew started feeling better within a few visits and his neck, back and shoulder conditions completely resolved within a few months.  Thereafter, Andrew continued the chiropractic care for supportive/ preventative care and he remained pain-free. Eventually, Andrew went onto win many martial arts competitions.

 

 Chiropractic West Palm Beach: Safety of Chiropractic for Kids 

The American Chiropractic Association cites a study done in 2014 confirming that chiropractic adjustments are overwhelmingly safe in infants and children. 

In 2009, a survey found that there were about 68 million pediatric visits to chiropractors. The National Board of Chiropractic Examiners’ most recent practice analysis, issued in 2010, found that about 17 percent of chiropractic patients were under age 18 — approximately 7.7 percent aged five years or younger and some 9.4 percent between ages six and 17. 

 

Dr. Natalie Meiri has helped babies and kids utilizing chiropractic adjustments, soft tissue techniques, cranial sacral therapy and therapeutic exercises. She has treated babies with ear infections, kids with ADHD, autism, scoliosis, sports/martial arts injuries and various growing problems.  Contact her at 561-253-8984 for further information on Chiropractic West Palm Beach: Chiropractic Care for Martial Arts Injuries in a Child or to make an appointment today.

 

From Dr. Natalie Meiri’s Clinical Pearl Stories:

Relief From Hip Pain and Osteoarthritis: Chiropractic Care is Effective

 

This is my clinical pearl story about Relief From Hip Pain and Osteoarthritis: Chiropractic Care is Effective. The patient was a 70 year old male patient.  His chief complaints were low back and right hip pain.  To be HIPAA compliant, I will call him Jacob instead of his real name. 

Jacob’s right hip pain had come on 6 months ago following a fall.  The low back pain he stated he had “on and off for over 30 years”.  Jacob had always been active.  In addition to physically demanding jobs, he had a history of many sports injuries and  several car accidents.  Jacob had been under chiropractic care previously for his low back pain.

Jacob came to see me when a course of physical therapy didn’t help his right hip pain after his fall.  The orthopedic doctor had told him he had a right hip sprain from the fall.  Additionally, the orthopedist’s x-ray report noted Jacob had moderate to severe osteoarthritis (wear and tear arthritis) in his right hip.  And Jacob had noticed his hip feeling “more stiff” when he got up in the morning or from prolonged sitting over the years.

 

Jacob’s Examination and Imaging

Upon examination, Jacob tested positive for his low back and hip pain conditions.  His x-rays from the orthopedist showed degenerative arthritis (osteoarthritis) in his lumbar spine and right hip.

Jacob had a right hip sprain complicated by Osteoarthritis.

Hip Anatomy

The hip, like the shoulder, is considered a ball-and-socket joint. It is formed by the head of the femur (thigh bone) which sits in what’s called the acetabulum, a part of the pelvis. The head of the femur is large (ball) and the acetabulum (socket) is deep.  The soft tissues (refers to non-bony structures that connect, support, or surround other structures) in your hip are:

• the muscles, which allow you to move.
• the tendons, which connect your muscles to the bone.
• the ligaments are bands of tough elastic tissue around your joints. They connect bone to bone, give your joints support, and limit their movement.
• the fascia – stretchy, thin, white fibrous tissue. All your muscles are enveloped in fascia.
• the bursae – fluid-filled pads that act as cushions at the joints. Bursae reduce friction between the surfaces of a bone and soft tissue.

What is a Sprain?

A sprain is a sudden or violent twisting injury (e.g. fall) of a joint with stretching or tearing of ligaments.  As opposed to a strain which occurs when a muscle or tendon is overstretched or torn.

 

What is Osteoarthritis?

Primary Osteoarthritis occurs usually in middle-aged to elderly people (>45 years old). It is more prevalent in women (female to male 10:1). Primary means this osteoarthritis develops due to aging and the wear and tear that comes along with it.

An example would be Jacob’s hip: primary femoroacetabular (hip) osteoarthritis. Typically, your symptoms consists of hip and possibly buttock, groin, or knee pain that was insidious (came on gradually) in onset. Additionally, you note a slow stiffening, specifically internal (inward) rotation. This often results in walking with the hip held in external (outward) rotation. You may complain of low back pain due to excessive extension with weight bearing. The low back pain is really due to compensating for limited hip movement due to hip osteoarthritis.

Common joints involved in primary osteoarthritis are the hips, knees, sacroiliac joint, acromioclavicular (shoulder and collar bone), first metacarpophalangeal (part of thumb joint), first metacarpotrapezium (part of thumb joint closer to wrist), and the distal interphalangeal joints (joints at tips of fingers).

Often initially asymptomatic, you will have a gradual increase in joint stiffness and pain. Moreover, deformity may be apparent such as  herberden’s nodes in the hands (bony bumps).  If not treated, primary osteoarthritis may eventually lead to joint subluxation (dislocation) and instability.

Cause of Osteoarthritis

Primary osteoarthritis is due to progressive degeneration of the joint or joints involved by an accumulation of microtrauma.  A microtrauma is an injury resulting from repetitive stress to tissues. 

 

Jacob’s Treatment and Outcome

 Treatment focuses on restoring normal mobility to the hip joint and pelvis. These treatments at Meiri Chiropractic include:

-Chiropractic manipulative therapy- to the hip joint, pelvis and associated regions. 

-Gentle myofascial release and/or post isometric relaxation techniques- to the soft tissues (e.g. muscles, tendons, ligaments, fascia) involved.

-Electric Muscle Stimulation, Ice and Heat Therapies for pain relief and inflammation reduction.

-Therapeutic exercise- with  gentle stretching and a long-term goal of restrengthening.

-Finally, recommendations for prevention of further injury for the spine, pelvis, and hip. 

Jacob went through a general program of corrective care for 2-3 months for his hip and low back. Thereafter, he came in for “maintenance of normal joint motion and function of the spine and extremities by adjusting/manipulation” (1).  

Furthermore, therapeutic exercises for strengthening of the osteoarthritic joints were ongoing throughout his supportive care.  Finally, recommendations on an anti-inflammatory diet were beneficial.

Jacob started feeling better within the first few visits. Indeed, Jacob made great improvement in the end becoming  pain-free and gaining increased range of motion in his right hip. Also, Jacob’s hip felt less “stiff” when he woke up in the morning or sat for long periods of time.

 

Research on How Chiropractic Adjustments Can Help With Arthritis

A 2017 review in the Journal of the American Medical Association, found that spinal manipulation reduces lower back pain. And a 2013 study published in Osteoarthritis and Cartilage found that patient education combined with 12 chiropractic treatments (twice a week for six weeks) were more effective for hip Osteoarthritis than a daily stretching program or patient education alone.

 

Are you looking for the best chiropractor in West Palm Beach? Dr. Natalie Meiri can definitely help you.  Find out more about Relief From Hip Pain and Osteoarthritis: Chiropractic Care is Effective.  Call 561-253-8984 today for an appointment.

 

References:

Thomas Bergman, David Peterson, Chiropractic Technique Principles and Procedures, 3rd edition, 2011 (1)

 

 

 

Do you have pain in the hand or medial (closer to the body) forearm? You may also have paresthesia (pins and needles) into the ring and little finger of the same arm/hand.   It could be due to Ulnar Nerve entrapment at the cubital tunnel of the elbow.  This post is about Chiropractic West Palm Beach: Ulnar Nerve Entrapment at the Cubital Tunnel of the Elbow.

Chiropractic West Palm Beach: Causes of Ulnar Nerve Entrapment at the Cubital Tunnel of the Elbow

Irritation of the ulnar nerve at the elbow can be due to compression, stretch or direct trauma. A stretch injury is typically due to a valgus (turned outward) force to the elbow. Moreover, compression may be at the two heads of the flexor carpi ulnaris muscle where the nerve can get entrapped.  Also, you may have arthritis and osteophytes (bony spur) at the cubital tunnel causing nerve irritation.

Often, you may have had throwing activities (e.g. Baseball) where the ulnar nerve was medially stretched.  So the pressure in the tunnel is increased with elbow flexed and wrist extension as in throwing. Additionally, you may have slept wrong with your elbow flexed causing compression and “sleep paralysis”. 

Less common causes include lipomas, ganglions, and abnormal soft tissue structures (e.g. scar tissue).

Research indicates the cubital tunnel syndrome is the second most common compressive neuropathy in the upper extremity (limb).

Anatomy of the Ulnar Nerve

The ulnar nerve is one of the 5 terminal (end) branches arising from the medial cord of the brachial plexus (network of nerves in the shoulder).  It supplies motor and sensory innervation to the upper extremity. The ulnar nerve originates from contributions of the C8 and T1 nerve roots of the spinal cord. The nerve courses along the medial arm and forearm, and then it passes into the wrist, hand, and fingers.

The ulnar nerve provides motor (voluntary movement) innervation to part of the forearm and a majority of the hand. It supplies sensory cutaneous (skin) innervation to the medial forearm, medial wrist, and medial fifth digit, medial half of the fourth digit, and the corresponding part of the palm.

In the hand, the ulnar nerve branches to give rise to a palmar cutaneous (relating to the skin) and dorsal cutaneous branch.

 

Cubital Tunnel Anatomy

The humerus, radius and ulna bones articulate to form the elbow synovial joint. The cubital tunnel is just distal to the medial epicondyle of the humerus (upper arm).  And the cubital tunnel floor is made up of the ulnar collateral ligament and the capsule of the elbow joint.  The cubital tunnel’s ceiling is formed by Osborne’s ligament (triangular arcuate ligament) and the cubital retinaculum (fascia).  This is a ligament spanning from the medial epicondyle to the olecranon process of the elbow. And the medial epicondyle and olecranon act as the walls on either side. Lastly, the ligament is continuous with the fascia connecting the humeral and ulnar heads of the flexor carpi ulnaris muscle.

 

Treatment at Meiri Chiropractic for Ulnar Neuropathy at the Cubital Tunnel of the Elbow:

Firstly, soft tissue techniques will be rendered to the contracted fibrotic muscle and collagen.  Specifically, Flexor carpi ulnaris may be an entrapment site.

Secondly, Chiropractic adjustments (chiropractic manipulative therapy) to the wrist and the associated restricted joints along the extremity/spinal kinetic chain as necessary.

Thirdly, physical therapy (e.g. electric muscle stimulation, ice/heat) to help reduce pain and inflammation are provided. 

Fourthly, ergonomic recommendations and modification and therapeutic exercise (e.g. stretching and strengthening).

 

Are your suffering from Ulnar Nerve Entrapment at the Cubital Tunnel of the Elbow?

We offer excellent Chiropractic care for Ulnar Neuropathy. At Meiri Chiropractic, we spend the time necessary to examine, diagnose and treat every neuromusculoskeletal condition and various ailments you have. Indeed, Chiropractic is a holistic and natural way to not only treat shoulder and arm pain, but to keep your body in its best working condition. We have been offering effective chiropractic care in West Palm Beach since 2006. Many of our patients reviews note our excellence. Call us today at 561-253-8984 to make an appointment or to find out more about Chiropractic West Palm Beach: Ulnar Nerve Entrapment at the Cubital Tunnel of the Elbow.

 

 

Do you have pain in the hand or forearm? You may also have paresthesia (pins and needles) into the ring and little finger of the same arm/hand.   It could be due to Guyon’s ulnar tunnel syndrome. This post is about Chiropractic Care in West Palm Beach: Ulnar Nerve Entrapment at the Wrist.

Chiropractic Care in West Palm Beach: Causes of Ulnar Nerve Entrapment at the Tunnel of Guyon of the Wrist

The ulnar nerve may be compressed in the tunnel of Guyon at the wrist. It could be due to a traumatic sporting activity.  For example, you may have slammed the ball while playing basketball against the rim of the hoop.  Also, prolonged pressure over the hypothenar eminence (base of fifth digit/little finger) can be a culprit. For instance, constant compression on handlebars, as with cyclists, may cause this problem (i.e. handlebar or cyclist’s palsy). Other causes include vascular abnormalities and/or a ganglion cyst.

Anatomy of the Ulnar Nerve

The ulnar nerve is one of the 5 terminal (end) branches arising from the medial (closer to mid line) cord of the brachial plexus (network of nerves in the shoulder).  It supplies motor and sensory innervation to the upper extremity. The ulnar nerve originates from contributions of the C8 and T1 nerve roots of the spinal cord. The nerve courses along the medial arm and forearm, and then it passes into the wrist, hand, and fingers.

The ulnar nerve provides motor (voluntary movement) innervation to part of the forearm and a majority of the hand. It supplies sensory cutaneous (skin) innervation to the medial forearm, medial wrist, and medial fifth digit, medial half of the fourth digit, and the corresponding part of the palm.

In the hand, the ulnar nerve branches to give rise to a palmar cutaneous (relating to the skin) and dorsal cutaneous branch.

Tunnel of Guyon Anatomy

The ulnar nerve enters the hand through Guyon’s canal.  This is a fibro-osseous tunnel formed by the pisiform and hook of the hamate (2 of 8 carpal/wrist bones). So the tunnel of Guyon relays the ulnar neurovascular bundle (ulnar nerve, ulnar artery/vein, lymphatic vessels) into the hand.

 

Treatment at Meiri Chiropractic for Ulnar Neuropathy at the Tunnel of Guyon of the Wrist:

Firstly, soft tissue techniques will be rendered to the contracted fibrotic muscle and collagen at entrapment sites.

Secondly, Chiropractic adjustments (chiropractic manipulative therapy) to the wrist, and associated restricted joints.  This would be along the kinetic chain and spine as necessary.

Thirdly, Therapeutic exercise will be given for stretching and strengthening.

Fourthly, if trauma or swelling is involved, ice, compression, elevation, and physical therapy modalities is utilized to reduce swelling. Ergonomic recommendations (i.e. protection with padding) and modification to change the inciting activity is necessary.

 

Are your suffering from Ulnar Nerve Entrapment at the Tunnel of Guyon at the Wrist?

We offer excellent Chiropractic care for Ulnar Neuropathy. At Meiri Chiropractic, we spend the time necessary to examine, diagnose and treat every neuromusculoskeletal condition and various ailments you have. Indeed, Chiropractic is a holistic and natural way to not only treat shoulder and arm pain, but to keep your body in its best working condition. We have been offering effective chiropractic care in West Palm Beach since 2006. Many of our patients reviews note our excellence. Call us today at 561-253-8984 to make an appointment or to find out more Chiropractic Care in West Palm Beach: Ulnar Nerve Entrapment at the Wrist.

 

 

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If you have knee pain from a posterior cruciate ligament injury, Chiropractic can provide relief!  This post is about Knee Pain and West Palm Beach Chiropractic Care: Posterior Cruciate Ligament Injury.

 

West Palm Beach Chiropractic Care: Acute Phase of  the Posterior Cruciate Ligament (PCL) Injury

If you are in the acute phase, you may have posterior (back of) knee pain.  You will have immediate impairment to that knee.  Furthermore, there may even be hemarthrosis (bleeding into the joint inside) causing swelling.  Typically, this occurs within the first few hours and then the inflammation will mostly be in the posterior capsule (the fibrous/synovial structure surrounding the joint) of your knee.

West Palm Beach Chiropractic Care: Cause of Posterior Cruciate Ligament (PCL) Injury

The most common way the PCL is injured is by hyperflexion trauma  This is when your knee is bent backward beyond its usual limit.  This can occur during a fall on the flexed knee.  Also, it can occur during a car accident when your knee hits the surface of the car (e.g. dashboard).  Additionally, you may have a sports injury such as in tackle football with a hyperflexed knee.

West Palm Beach Chiropractic Care: Knee Anatomy: Femur (thigh bone), Tibia (shin bone), Fibula (thin, outer long bone of the leg), and the Patella (kneecap)

There are three “articulations” (joint or juncture between bones or cartilages) at the knee: the tibiofemoral, patellofemoral, and tibiofibular articulations. However, only the tibiofemoral and patellofemoral articulations participate in knee joint activity. The tibiofibular articulation/joint does not actually contribute to the actions of the knee. Instead, it is part of the ankle joint complex moving the ankle in all the various ranges of motion. However, dysfunctional processes in the proximal tibiofibular articulation/joint can affect other knee functions and can be a source of knee pain.

So the tibiofemoral and tibiofibular are synovial articulations.  These are freely movable joints. And the bony surfaces are coated with hyaline cartilage.  It is unified by a fibrous articular capsule. However, the third articulation, patellofemoral, is a functional joint (non-synovial joint).   

 

West Palm Beach Chiropractic Care: More Anatomy of the Knee: About the PCL

First, the knee is supported by the joint capsule, its cartilage “thickenings”, and the collateral-ligamentous system.  And the collateral ligaments (band of tissue that connects a bone to another bone) are located on either side of your knee outside your knee joint.

Second, internally the knee is stabilized and the control of rotation is provided by the meniscocruciate system. There are two C-shaped cartilage like structures, each one called a meniscus. The menisci aid in shock absorption and help govern rotational movement at the knee.

Third, the cruciates, capsule, and collateral ligaments connect the femur to the tibia. The cruciates are a pair of ligaments that cross each other in the knee, connecting the tibia and the femur. The Anterior Cruciate Ligament (ACL) is smaller (size of the little finger) than the Posterior Cruciate Ligament.  It’s usually more readily injured  than the Posterior Cruciate Ligament (PCL) (size of the thumb). The cruciates allow tension to develop through most ranges of motion. 

 

West Palm Beach Chiropractic Care: PCL Injury Grade 1-3

PCL Sprain is grade 1– microscopic tears that stretch the ligament.

Partial PCL tear is grade 2– stretched and partially torn.

Complete PCL tear is grade 3- The PCL is a complete tear. At this point the knee is very unstable and cannot bear your body weight. A grade 3 sprain is often accompanied by damage to the other ligaments of the knee.  Unfortunately, with a complete tear you may need surgery. 

West Palm Beach Chiropractic Care: Evaluation, Tests and Management

After examining your knee, your doctor may order imaging such as an x-ray or/and M.R.I. Grade 1 PCL injuries may not require bracing.  However, grade II tears (without involvement of the meniscus) may require bracing. 

West Palm Beach Chiropractic Care: P.C.L. Injury Treatment at Meiri Chiropractic

Firstly, the knee and associated spine and extremity (limb) joints are adjusted. 

Secondly, manipulation of muscle contractures with soft tissue techniques is utilized.  Some Techniques include gentle PNF/PIR (e.g. post isometric relaxation) and/or myofascial release techniques.  

Finally, Therapeutic exercises for rehabilitation/ strengthening are prescribed.

 

Getting regular chiropractic treatment at a chiropractic center in West Palm Beach can help naturally relieve the pain and dysfunction of the knee. Chiropractic is a holistic and natural way to not only treat existing conditions, but to keep your body in its best working condition.

Contact Meiri Chiropractic today at 561-253-8984 to make an appointment or to find out more about Knee Pain and West Palm Beach Chiropractic Care: Posterior Cruciate Ligament Injury.

 

If you have shoulder pain from Subacromial Bursitis, Chiropractic can provide relief! This post is about West Palm Beach Chiropractic Care: Shoulder Pain and Subacromial Bursitis.

 

West Palm Beach Chiropractic Care: Symptoms of Subacromial Brusitis

With acute subacromial bursitis, your pain may be severe.  Also, your shoulder range of motion will be limited due to the pain. There may be swelling and there may or may not be an underlying calcific tendinitis.

In contrast, with chronic subacromial bursitis, the symptoms can be very subtle.  Your shoulder may only hurt following excessive “over head” activities.  Additionally, the shoulder pain may be a dull diffuse ache.  You may experience difficulty sleeping due to the pain. 

West Palm Beach Chiropractic Care: What is bursitis?

Bursae are fluid-filled, sac like cavities. Bursae are located where muscles and tendons move over bony joint areas. They reduce friction caused by muscles and tendons moving against skin and bones.  Also, they facilitate movement.

A shoulder bursa is like a cushion. So when one becomes inflamed, increased tension and pain can occur in a condition known as bursitis. The bursa in the shoulder increases with fluid and redness in the area it occurs.

 

West Palm Beach Chiropractic Care: the subacromial bursa

Firstly, the subacromial bursa is in the subacromial space. The subacromial space lies below the coracoacromial arch and above the humeral head and greater tuberosity of the humerus  (upper arm bone). And the coracoacromial arch is an osteofibrous structure resulting from the acromion (portion of the scapula or shoulder blade that meets the clavicle) , coracoacromial ligament, and coracoid process (also part of shoulder blade) with each other. 

Secondly, the subacromial bursa is inferiorly bordered by the rotator cuff muscles and the shoulder joint capsule.  Next, the bursa extends over the proximal (closest to body) humerus beneath the deltoid. 

Thirdly, the bursa’s function is to support normal movement of the shoulder.

West Palm Beach Chiropractic Care: Causes of Subacromial Bursitis

1.While there are many bursas (e.g. subdeltoid, subcoracoid, supraspinatus bursae) in the shoulder, the subacromial bursa most often develops into bursitis. 

2.Bursitis is usually preceded by a rotator cuff tendinitis (irritation of tendon connecting bone to muscle) or tenosynovitis (inflammation of the fluid-filled synovium within the tendon sheath). So the rotator cuff is a group of muscles (supraspinatus, infraspinatus, teres minor, subscapularis) that hold the shoulder joint in place and allow you to move your shoulder.  Additionally, a biceps tendinitis could precede the bursitis.  In other words, the tendinitis caused the bursitis.

3.There could be an inflammatory process going on in the shoulder joint.  Ultimately, the same inflammation would spread to the bursa and cause bursitis.

4.Repeated “microtrauma” due to repetitive activity (e.g. throwing sport) may cause injury to the soft tissue ultimately leading to subacromial bursitis. In fact, bursitis being a primary condition only occurs with: infection, rheumatoid arthritis, and gout.

West Palm Beach Chiropractic Care: Treatment for Subacromial Bursitis at Meiri Chiropractic

First, chiropractic manipulative therapy (adjustments)/mobilization is rendered to the shoulder and associated spine and extremity (limb) joints. 

Second, manipulation of muscle/bursa contractures with soft tissue techniques is utilized.  Some Techniques include gentle PNF/PIR (e.g. post isometric relaxation) and/or myofascial release techniques.  

Finally, therapeutic exercises for rehabilitation/ strengthening are prescribed.  Flexibility and strengthening are important.  And correction of posture and recommendations for activity modification maybe necessary.

 

Getting regular chiropractic treatment at a chiropractic center in West Palm Beach can help naturally relieve the pain and dysfunction of the shoulder. Chiropractic is a natural way to not only treat existing conditions, but to keep your body in its best working condition.

Contact Meiri Chiropractic today at 561-253-8984 to make an appointment or to learn more about  West Palm Beach Chiropractic Care: Shoulder Pain and Subacromial Bursitis.

 

 

The “throwing shoulder” in sports such as tennis, golf, or baseball is subjected to continuous microtrauma often resulting in overuse injuries. This blog is about West Palm Beach Chiropractor: Throwing Shoulder Injuries.

A study on baseball pitching found two phases during the throw when injury to the shoulder was most likely to occur.

Firstly, during arm cocking, the arm will have to internally rotate before externally rotating.  This internal rotation causes a compressive force at the anterior (front) portion of the shoulder.

Secondly, the arm is decelerating and the shoulder is internally rotating.  Again, a compressive force achieved at the shoulder can cause injury. 

Thirdly, even the short period between the above phases can cause injury due to repetitive movements over time.

West Palm Beach Chiropractic Care: Throwing Shoulder Injuries

Repetitive throwing, especially at the intense speed of motion per second performed by baseball pitchers eventually can result in shoulder impingement. 

West Palm Beach Chiropractic Care: Subacromial impingement

Due to the (flexed, horizontally adducted and internally) rotated arm of the throwing shoulder, a superior (upward) translation of the humeral (upper arm bone) head occurs.  This translation of the humerus impinges (pinches) on the rotator cuff  and biceps brachi muscles.  The muscles translate against the inferior surface of the acromion of the scapula (part of shoulder blade) or coracoacromial ligament. 

 

Throwing sports activities that constantly stretch the shoulder capsule, such as in baseball causes instability.  Therefore, an anterior (front) subtle or excessive laxity or looseness causes impingement on the anterior labrum (cartilage in shoulder joint). 

 

As a result of the above, Arthritis/degeneration occurs when grinding of the labrum anteriorly occurs. And this is because of failure of the supportive musculature needed during the deceleration phases. For example, there is fatigue of rotator cuff, deltoids and latissimus dorsi resulting in diminished support to the glenohumeral joint by the muscles.

West Palm Beach Chiropractic Care: What is shoulder impingement syndrome?

A shoulder impingement syndrome is defined as a compromise of the space between the coracoacromial arch (portion of top outer edge of shoulder blade) and the proximal (situated nearer the center of the body) humerus (upper arm bone). So several structures may get impinged (pinched): The biceps tendon, superior labrum (cartilage in shoulder joint), supraspinatus (1 of the rotator cuff muscles) tendon, and the subacromial bursa (a fluid-filled sac for countering friction at a joint ) are all vulnerable to being impinged.

Causes for shoulder impingement include both structural and functional reasons:

Structural reasons:

-variant acromial types that are hooked or lengthened (top portion of shoulder blade developed/grew abnormal)

-degenerative (wear and tear arthritic) changes on the undersurface of the acromion

-an inflammatory process in the subacromial space (which could be due to i.e. bursitis, rotator cuff tear, or/and all of the above)

Functional reasons:

-abnormal position of your spine or scapula (ie. thoracic kyphosis)

-tightness of your shoulder capsule (membrane around shoulder joint),

-decrease in the space between the coracoaromial arch and proximal humerus due to past injuries

-abnormal motion due to nerve related problems (i.e. nerve palsy)

West Palm Beach Chiropractic Care: Throwing Shoulder Injury Treatment

Chiropractic adjustments/manipulation to the shoulder (e.g. glenohumeral), and associated regions.  Associated regions may be the cervical (neck) and thoracic (mid back) spine. Additionally, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) and modalities (cold/heat therapy and electric muscle stimulation) will be administered as needed. Finally, therapeutic exercises to continue treatment at home will be given.

The first goal is to get you out of pain. Next, restore normal range of motion to the shoulder. Finally, to strengthen the rotator cuff and scapulothoracic (mid back where the shoulder is attached) musculature. The long-range goal is to stabilize your shoulder with a progressive rehabilitation program. Also, recommendations for correction/modification of posture and/or occupational/daily lifestyle activities is important.

West Palm Beach Chiropractic Care: Throwing Shoulder Injuries

Meiri Chiropractic serving West Palm Beach, Jupiter, North Palm Beach, Palm Beach Gardens and the surrounding areas offers excellent chiropractic treatment for throwing shoulder injuries. Call 561-253-8984 today to schedule an appointment or to find out more about West Palm Beach Chiropractic Care: Throwing Shoulder Injuries.

From Dr. Natalie Meiri’s Clinical Pearl Stories:

Chiropractic Care for Neck and Low Back Pain and Layered Muscle Imbalance Syndrome

This was a 58 year old patient who had neck and back pain. To be HIPAA compliant, I will call him Harry instead of his real name.  Harry had treated with another chiropractor prior to seeing me.  He had gone to acupuncture, an orthopedist and physical therapy for his chief complaints. However, Harry still had pain in his neck and lower back. Harry presented to my office after difficulty in activities of daily living due to his neck and back condition.

Harry worked as a truck driver for 20 years and attributed some of his neck and back problems to his daily work activity.  However, he also liked various sports and stated, “did injure himself from time to time”. Harry also had been in multiple car accidents which he had residual pain from even after care.

 

Harry’s Examination and Imaging

Upon examination, there were positive tests for his neck and low back pain.

Harry had X-rays from his previous doctor. The findings in his x-rays were moderate to severe osteoarthritis (wear and tear arthritis) throughout his spine. 

I would order a M.R.I. if he wasn’t improving in a month or 12 visits. Harry had osteoarthritis  (as seen on his x-rays) and Layered muscle imbalance syndrome was detected during my exam:

Harry’s gluteus maximus was totally inactive/weak and extension (of thigh) was performed almost exclusively by his hamstrings and thoracolumbar (midback and low back) muscle segments.  Moreover, he had dysfunction in his upper trapezius, levator scapulae, cervical (neck) flexors, (pectoral muscles, rhomboids, serratus muscles, and latissimus dorsi.  Additionally, his illiopsoas and hip flexors were overactive and shortened.

What is Muscle Imbalance Syndrome?

 Obviously, there are some differences in muscle strength which cause a normal imbalance. After all, not all muscles are equal. The smaller muscles tend to react rapidly and strongly to a stimulus and are called phasic. Similarly, the larger muscles hold our posture and are called tonic.  And then certain movement patterns are notable.  For example, internal (inward) rotation of the shoulder is stronger than external (outward) rotation of the shoulder.  Additionally, the size and number of the muscles used for the particular movement matters.  Alternatively, position also makes your balance of muscles stronger or weaker.  However, there is another point of view clinically in regards to muscle imbalance; weakness and tightness.  This type of muscle imbalance is dysfunctional and needs evaluation and treatment to correct.

Muscle imbalance Syndrome is when some of your muscles become shortened/tight and overactive or weak and inhibited.  Inhibition means that the neural connection is absent, bypassed, incomplete, weak, or overridden. Moreover, this often happens to specific muscles. Typically, postural antigravity slow-twitch muscles tend to tighten and shorten.  In contrast, the phasic fast twitch muscles usually weaken and elongate.

 

What is Upper Cross Syndrome?

Upper cross syndrome causes altered muscle activation and movement patterns of the head, neck, shoulders, and back muscles. The muscles involved can be shortened (tightened) and overactive or stretched, weakened and inactive. For example, muscles of the neck and posterior (back) upper back, such as the deep neck flexors, serratus anterior, rhomboids, middle trapezius, and lower trapezius, are weakened, stretched, and inactive. Additionally, the “tightness” of the suboccipitalis, levator scapulae, and Upper trapezius on the back side is crossed by the “tightness” of the pectoralis major and minor, SCM, and scalenes on the front side. The weakness of the deep neck flexors on the front side is crossed by the weakness of the serratus anterior, rhomboids, middle trapezius, and lower trapezius on the back side.

These muscle imbalances can cause bad posture, misalignments in the neck, mid back and upper extremities (limb) causing neck pain, chest pain, upper back pain, tingling in the upper arms and decreased range of motion in the same areas.

Postural changes due to upper cross syndrome include: Forward head posture, cervical hyperlordosis, thoracic hyperkyphosis, protracted and elevated shoulders (round shoulders), and scapular winging.

 

What is Lower Cross syndrome?

Lower cross syndrome is characterized by shortened hamstrings, overactive/tight hip flexors, iliopsoas and lumbar spinal erectors due to improper conditioning or from prolonged sitting. And the inactivity can result in weakness to the gluteal and abdominal muscles. 

Furthermore, it may promote a pelvic tilt of the lumbar spine.   And this will create dysfunction and back pain.  The overactive/shortened muscles can include in the kinetic chain: gastrocnemius/ soleus (calf muscles), hip flexors, hamstrings, adductors, tensor fascia Lata (t.f.l.) and piriformis.  The underactive/inhibited muscles could include the gluteus maximus, gluteus medius, quadratus plantae (foot muscle), peronei (shin muscle), and abdominal wall muscles.

For example, the gluteus medius becomes weak and quadratus lumborum takes over for gluteus medias to stabilize the body. When the quadratus lumborum becomes overactive, postural changes take place.  Continuation of the incorrect movement causes microtrauma throughout the mid and low back spine  and sacral areas.  Eventually it could even effect the hip joints patella femoral (knee cap) joints and shin/ankle/ arches of the feet.  Indeed it becomes a self perpetuating cycle of dysfunction and pain.

 

 

“Swimmer’s shoulder” is a term that can represent numerous shoulder conditions. These include impingement syndrome, rotator cuff tendinitis, labral injuries, ligamentous laxity or muscle imbalance causing instability, muscular dysfunction, and neuropathy from nerve entrapment. You will have weakness, pain and instability from the activity of repetitive swimming that causes any of these Swimmer’s shoulder injuries and conditions.  This blog is about Chiropractic W.P.B.: Swimmer’s Shoulder and the Shoulder Adjustment.

 

Chiropractic W.P.B.: What is Swimmer’s Shoulder?

If you are a swimmer, you are susceptible to shoulder injury due to the repetitive nature of the training/ exercise.  Even if you use different swimming strokes, this still can ultimately result in repetitive shoulder injury due to the high number of shoulder revolutions. 

In many cases, the swimmer will have developed a subacromial impingement syndrome.  It represents chronic irritation of the humeral head (top part of upper arm bone) and rotator cuff on the coracoacromial arch (top outer edge of shoulder blade or scapula or and consists of the acromion, coracoacromial ligament, and coracoid) during swimming.

 

What is shoulder impingement syndrome?

A shoulder impingement syndrome is defined as a compromise of the space between the coracoacromial arch and the proximal (situated nearer the center of the body) humerus (upper arm bone). So several structures may get impinged (pinched): The biceps tendon, superior labrum (cartilage in shoulder joint), supraspinatus (1 of the rotator cuff muscles) tendon, and the subacromial bursa (a fluid-filled sac for countering friction at a joint ) are all vulnerable to being impinged.

Causes for shoulder impingement include both structural and functional reasons:

Structural reasons:

-variant acromial types that are hooked or lengthened (top portion of shoulder blade developed/grew abnormal)

-degenerative (wear and tear arthritic) changes on the undersurface of the acromion

-an inflammatory process in the subacromial space (which could be due to i.e. bursitis, rotator cuff tear, or/and all of the above)

Functional reasons:

-abnormal position of your spine or scapula (ie. thoracic kyphosis)

-tightness of your shoulder capsule (membrane around shoulder joint),

-decrease in the space between the coracoacromial arch and proximal humerus due to past injuries

-abnormal motion due to nerve related problems (i.e. nerve palsy)

 

Chiropractic West Palm Beach: Mechanism of injury for Swimmer’s Shoulder/Impingement

Firstly, the swimmer’s stroke mechanics of freestyle, butterfly, and backstroke styles require the swimmer’s arms to reach over the shoulder and then enter the water.  Next, the arms pull through the water in a semicircular motion, propelling the swimmer in motion.  With the breast stroke, there are differences and similarities to the other styles. 

Second, in the pull-through phase (underwater), the muscles involved are: pectoralis major and latissimus dorsi. In the recovery phase (hands out of water), the muscles involved are the supraspinatus, infraspinatus, middle deltoid and the serratus anterior. 

Third, so depending on how the swimmer’s hand/arm is positioned when entering the water, it can create an excessive rotation causing repetitive injury.

Chiropractic West Palm Beach: Pectoral Muscles Overdeveloped compared to the Back Muscles Leading to Swimmer’s Shoulder/Impingement

The swimmer’s pectoral muscles may be overly developed compared to the other back muscles. Moreover, these back muscles are:

-scapular retractors (draws back the shoulder blades) such as the rhomboids and lower trapezius

-adductors and elevators of shoulders such as the middle rhomboids and upper trapezii, levator scapulae. And even the upper fibers of latissimus dorsi

When the above happens, the swimmer’s scapula may “wing”.  Furthermore, the scapula muscles that are too weak will become fatigued.  Additionally, the shoulder will be unable to rotate and move properly. Next, when the humerus is elevating, it will not clear the acromion and impingement occurs.

Lastly, the abnormal scapulothoracic (shoulder blade and mid back) motion ends in fatiguing the rotator cuff muscles (originating off the scapula). Similarly, the rotator cuff muscles which serve as dynamic shoulder stabilizers becoming fatigued effects the static stabilizers (glenoid labrum and associated capsuloligamentous components).  Ultimately, this results in humeral instability/traction type stress and rotator cuff tendinitis.

Chiropractic West Palm Beach: Pectoral Muscles Overdeveloped compared to the External Rotators Leading to Swimmer’s Shoulder/ impingement

The swimmer’s pectoral muscles may be overdeveloped compared to the external rotators (infraspinatus and teres minor) of the shoulder.  Because the shoulder external rotator muscles are weakened and fatigued, the greater tuberosity impinges the internal rotator muscles during abduction (raising arm at side) of the shoulder.  Basically, there is dysfunctional motion/rotation of the shoulder.  Therefore, the imbalance in strength between the external and internal rotator muscles of shoulder can cause a tendinitis.

 

Chiropractic West Palm Beach: Poor Swimming Technique and Posture Leading to Swimmer’s Shoulder/ impingement

Firstly, entering the water with the thumb first increases the amount of internal rotation in the shoulder causing abnormal motion. Entering the water with the third or fourth finger leading the arm, with your wrist slightly bent is better.

Secondly, as the swimmer “pulls” crossing the midline, this places the  shoulder in a position where the rotator cuff muscles aren’t as strong.

Thirdly, the swimmer’s improper posture (forward head posture) when not swimming also effects the shoulder.

Fourthly, Amount of rotation during freestyle is a common cause of pain. If the swimmer swims flat on the water, they must extend the arm farther back past the body to recover.

Chiropractic West Palm Beach: Treatment for Swimmer’s Shoulder/ Impingement Syndrome entails:

Chiropractic adjustments/manipulation to the shoulder (e.g. glenohumeral), and associated regions.  Associated regions may be the cervical (neck) and thoracic (mid back) spine. Additionally, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) and modalities (cold/heat therapy and electric muscle stimulation) will be administered as needed. Finally, therapeutic exercises to continue treatment at home will be given.

The first goal is to get the swimmer out of pain. Next, restore normal range of motion to the shoulder. Finally, to strengthen the rotator cuff and scapulothoracic (mid back where the shoulder is attached) musculature. The long-range goal is to stabilize the swimmer’s shoulder with a progressive rehabilitation program. Also, recommendations for correction/modification of posture and/or occupational/daily lifestyle activities is important.

Chiropractic W.P.B.: Do you know someone with Swimmer’s Shoulder?

Meiri Chiropractic serving West Palm Beach, Jupiter, North Palm Beach, Palm Beach Gardens and the surrounding areas offers excellent chiropractic treatment for Swimmer’s shoulder/ impingement syndrome. Call 561-253-8984 today to schedule an appointment or to find out more about Chiropractic W.P.B.: Swimmer’s Shoulder and the Shoulder Adjustment.