QuestionQUESTION: I apologize in advance for the length of this message, but knowing a little bit of history might help you understand my current problem.
It seems like I've spent the better part of the past year injured. In March '07, in the final weeks of training for a half marathon, I developed teninosis in the lateral side of my left knee. After 3 rounds of prolotherapy with platelet-rich plasma, it seemed to be healed completely and I made it through a marathon in October and a half in November without any further problems.
Then, halfway through December, I went for a 12 mile run (not long for me at the time). I started having left groin pain with a few miles to go. When I woke up the next morning, I could barely lift my left foot off of the ground because of the pain in my groin. I took more than a month off from running to allow it to heal.
I took it easy when I returned to running and my groin felt fine. Unfortunately, after only 2 very short runs, the outside of my right knee started hurting. I immediately recognized it as the same pain that I'd experienced in my left knee the previous Spring. I also noticed some pain behind my left knee, which seemed to be aggravated by long periods of standing. I wanted to get prolotherapy injections in both knees, but my doctor and I decided that we should treat one at a time. My right knee was causing the most pain, so we chose to treat it first. By the time I had finished the treatment on the right knee, the left knee pain seemed to have resolved itself.
I decided to try running again at the beginning of March. To my disappointment, I didn't even make it a full mile. This time, the issue was neither my knee nor my groin--it was my back. I'd been having pain in my mid back since Summer '07. I had tried chiropractic adjustments (which caused a painful slipping rib problem) and several rounds of prolotherapy injections. The injections helped the rib, but my back pain continued to get worse. I started physical therapy 5 weeks ago for the thoracic spine dysfunction and I've made significant progress. Last weekend, with the approval of my PT, I made another attempt at running. I ran a total of 3 miles. I ran straight through the first mile, and added 2-minute walk breaks after each subsequent half mile. I had no pain and felt like I could have gone farther, but I decided to stop because I didn't want to do too much too soon and re-injure myself. It wasn't until the next morning that I started to think I'd gone too a bit far. My legs were extremely sore when I woke up, but I wasn't too concerned, because it was an all-over soreness, and not a specific pain.
After about 3 days, the general soreness had subsided, but I was left with pretty significant pain behind my left knee knee, toward the lateral side (the same area that had become painful after running in March). The pain was constant throughout most of Wednesday and Thursday. It has improved slightly, but the pain gets much worse when I sit in a chair. The pressure of the chair on the back of my thigh sends pain shooting up my thigh and down the outside of my lower leg. The pain lingers for several hours after I stand up. Walking distances over a mile or standing for an extended periods of time also seem to make the pain worse. So far, I have not been able to find anything that provides significant relief.
I made an appointment to see my sports medicine doctor, but they couldn't get me in until the end of July. I'm worried that it could get worse between now and then. I am particularly concerned by the fact that the Celebrex I'm taking for my back does not seem to be helping my knee. This makes me fear that my knee pain is a result of degeneration, and not inflammation. If it is a degenerative issue, could taking NSAIDS impede my recovery? Could ART possibly help this type of injury? I know you can't diagnose me via the web, but do you have any suggestions?
Also, I can't stop wondering why I've been hurt so much over the past year. Is it possible that any of these injuries could be related? Could there be some underlying factor that might make me more susceptible to injury? I started running 5 years ago, and for the most part, I have been very careful. I increase my mileage very slowly, take at least 2 rest days per week, and stretch before and after each workout. I do overpronate, but I wear motion control shoes and custom orthotics.
Thank you so much for taking the time to read and respond to this. I'm only 18, but all of these injuries make me feel like I'm 80!
ANSWER: Hello Megan,
My home computer is out, I am answering you from work, between patients, sorry it has taken time to reply.
You have a few options. Certainly your 'sports medicine' doctor is a good place to go. This doctor may be an Orthopedic Medical Doctor, a Physiatrist (also MD), or perhaps a Doctor of Chiropractic with a sports injury specialty.
Any of the above three would be a good Doctor to go to. All should examine you, perhaps do some blood tests, perhaps some xrays, and evaluate your gait, posture, biomechanics, and the equipment you use.
Do not accuse me of gender bias, but often Megan is a female name, so I am assuming you are a young lady. If I am incorrect, please let me know.
Female skeletal structure is a bit different from male skeletal structure. Due to this structural difference, there are functional differences. Your PT should know this (and I am sure does know this), and should evaluate your "Q- angle", gait, posture, biomechanics of running, and your running shoes. Medical Doctors, medical staff do a great job. Medical oriented people often look for medical (organic, metabolic, chemical) type problems. After an exam, blood tests, even Xrays and MRIs, perhaps you have a structural or functional (ie alignment) problem somewhere in your kinetic chain that is causing your problem. Your symptoms, your pain seems to start in the knee,,, now that may be your PAIN point,,, and perhaps the problem is intrinsic to the knee, BUT- it could be a problem elsewhere- your foot/ ankle/ hip/ even the pelvis or low back. The problem may be poor running technique. Perhaps your equipment is worn or improper in some way. Maybe you have foot (arch) problems. Perhaps you ALWAYS run in the same direction on the same side of a sloped track or street ?, All of the above should be looked at.
".....Celebrex I'm taking for my back does not seem to be helping my knee. This makes me fear that my knee pain is a result of degeneration, and not inflammation. If it is a degenerative issue, could taking NSAIDS impede my recovery? Could ART possibly help this type of injury?....." As a Doctor of Chiropractic, I am acutely aware of medications side effects. Everything we do has a risk/benefit ratio. As a young (18yo) lady, celebrex and even nsaids would not be something to do for long ( ONLY a Doctor of Medicine can comment on/ recommend for or against medication - - as a Doctor of Chiropractic I would never recommend for or against medication). Anti-inflammatories and pain meds have side effects, often change joint chemistry, often kill pain and or inflammation- but actually hasten degeneration of joints. GastroIntestinal effects, liver problems also can occur with NSAID/ celebrex use. These medicines are chemical approaches to a mechanical problem. What is the cause of the pain, what is the cause of the inflammation, - what is the cause?- should be the question. Treat the cause and symptomatic treatment will not be needed. A sports trained Orthopedist, a sports trained Physiatrist (physical medicine MD specialist), a sports trained (DACBSP) Doctor of Chiropractic (of course my admittedly biased preference), are the disciplines I would look to for the evaluation and treatment for this case.
Could A.R.T. help, possibly, more important would be a sports trained Doctor of Chiropractic (DC, DACBSP, perhaps a CCSP, then perhaps trained in ART)( see www.ACBSP.com)
Could NSAIDS hurt?,,, possibly, if used for more than short term- of course ask your MD about this.
".....Also, I can't stop wondering why I've been hurt so much over the past year. Is it possible that any of these injuries could be related? Could there be some underlying factor that might make me more susceptible to injury?....."
----- Re-Reading your question, I see hidden in the history is some kind of back involvement,,,,,, CERTAINLY see a sports trained DACBSP Doctor of Chiropractic, this could be an '....underlying factor...' in all of your complaints. Only a Doctor of Chiropractic can evaluate you for the Chiropractic entity known as Vertebral Subluxation, This could be significant in your condition.
I do hope this helps. See your local Doctor of Chiropractic with additional sports injury training (DACBSP, CCSP).
As always- the disclaimer- this article is for informational purposes only. Conversation and education are the goal of this discussion. Specific evaluation, DX, TX, RX, PX can only be made by a treating health professional in person.
This is your Staten Island Chiropractor, a sports injury specialist chiropractor, Dr. Victor Dolan, DC, DACBSP, signing off. Good Luck and Good Health Naturally !!!
http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com
---------- FOLLOW-UP ----------
QUESTION: "Certainly your 'sports medicine' doctor is a good place to go. This doctor may be an Orthopedic Medical Doctor, a Physiatrist (also MD), or perhaps a Doctor of Chiropractic with a sports injury specialty."
-The doctor I was referring to is board certified in emergency medicine and sports medicine. I have also seen 2 physiatrists for my back, but neither has evaluated my knee.
"Anti-inflammatories and pain meds have side effects, often change joint chemistry, often kill pain and or inflammation- but actually hasten degeneration of joints. GastroIntestinal effects, liver problems also can occur with NSAID/ celebrex use. These medicines are chemical approaches to a mechanical problem."
-The plan was to actually correct the spinal problem through physical and manual therapy, but it caused so much pain that I couldn't tolerate the treatment. So my doctor prescribed the Celebrex to help me get through the rehabilitation.
"perhaps you have a structural or functional (ie alignment) problem somewhere in your kinetic chain that is causing your problem."
-That sounds likely. I just saw a copy of my initial PT evaluation, which contained the following observations:
"Bilateral feet pronated, increased thoracic kyphosis with rounded shoulders, mild right trunk rotation. Upon forward bending, she does have a slight rib hump. Rib spring for ribs 6-9 on the right with grade 2 hypomobility. Decrease thoracic P-A glides."
-I'm not sure exactly what all of that means, but it definitely doesn't sound desirable. I will ask my PT more about it when I go in on Fri.
You mentioned blood tests. What would they test for?
Thank you so much for your response. I'll probably be making an appointment with a sports chiropractor very soon.
AnswerHello Megan,
My home computer is down, so I am answering between patients at the office, sorry it took a while to reply.
You have seen at least three specialized medical doctors over more then a year, I am sure they have helped some. Perhaps it is time to include a Doctor of Chiropractic for an evaluation and perhaps treatment from another perspective.
This finding: ".....Bilateral feet pronated, increased thoracic kyphosis with rounded shoulders, mild right trunk rotation. Upon forward bending, she does have a slight rib hump. Rib spring for ribs 6-9 on the right with grade 2 hypomobility. Decrease thoracic P-A glides....", with spinal alignment, spinal movement problems indicated are right up the Doctor of Chiropractic 's specialty.
Go to your local family Doctor of Chiropractic with these findings.
Blood tests; perhaps you have some kind of metabolic arthritic problem. A test for rheumatoid arthritis or systemic inflammation may be a good test to take. This may be an underlying factor in why you are not healing or prone to injury.
From a Chiropractic perspective, I would probably fit you for foot orthotics, I utilize computerized evaluation through footl levelers in my office. A Flexible orthotic may be VERY helpful for you. Kyphosis, rib hump?- xrays to evaluate scoliosis are definitely indicated. Below, please see an informational handout I utilize in my office about spinal misalignment- known to Doctors of Chiropractic as Vertebral Subluxation Complex:
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Scoliosis
Everyone's spine has a natural front-to-back curve -- that's what produces the normal rounding of the shoulders and the sway of the lower back. However, some people suffer from "Scoliosis" ?an abnormal curvature of the spine, especially one characterized by a rotational side-to-side deformity.
In simple terms, what this means is that the spine is twisted side-to-side, often taking on an "S" shaped appearance and even resembling a corkscrew in some cases.
Almost three out of every 100 people have some degree of abnormal spinal curvature, and for some it never becomes a serious problem. But for many others, the curve gets worse over time and can cause considerable pain, frustration, and limitations on normal activities. Severe scoliosis can even complicate breathing and circulation.
The current medical approach to scoliosis is to react to symptoms of curve progression, not to prevent potential progression. It is mainly a "wait and see" attitude - yes, you have it, but we'll just watch it for a while and when it starts to get worse, we'll do something!" However, according to the Journal of American Family Physicians, 1999, underarm thoroco-lumbar-sacral orthosis (TLSO) braces have a 74 percent success rate in slowing curve progression.
According to the AAOS figures, almost all cases of juvenile scoliosis (in children ages 3-10) progress. This group accounts for 15 percent of the scoliosis cases. Fifty percent of the cases progress to a point of surgical intervention. Adolescence scoliosis (in children older than age 10) comprises 80 percent of scoliosis in children, and 5 percent to 25 percent of these cases progress. The AAOS further states that if the curve is greater than 20 degrees at 10-12 years of age, there is a 68 percent chance it will progress. The AOS also concurs that even after bone maturity, especially in curves greater than 30 degrees, some progression occurs.
Who suffers from scoliosis?
The most common form of scoliosis is called idiopathic scoliosis, which basically means that the cause is unknown. Anyone can suffer from scoliosis; the condition usually begins in childhood, although too often it is not identified until the teenage years or later.
Scoliosis tends to run in families, and it affects many more girls than boys. In fact, research indicates that girls are nearly eight times more likely than boys to have scoliosis and five times more likely to require some form of treatment for their condition than boys, and the curvature of their spine is more likely to worsen over time, especially if left unattended.
What are some of the symptoms of scoliosis?
Sometimes curvature of the spine is visible (the body tilts to the left or the right, or one shoulder blade is raised higher than the other. Some of the actual physical symptoms of scoliosis can include back pain, fatigue (especially postural fatigue -- feeling tired when standing, sitting, etc.), and in more severe cases, problems with circulation and breathing.
What can chiropractic do?
Doctors of chiropractic are trained to identify and manage problems relating to the spine and the back. An initial visit to the chiropractor will include a thorough physical and diagnostic examination (including range-of-motion tests and spinal x-rays) to identify any problems you may be having, including whether you or your children may be suffering from abnormal or dangerous curvature of the spine.
If you do show signs of scoliosis, your chiropractor can provide a variety of techniques to help your condition, including spinal adjustments to increase movement and biomechanical function, and advice on posture and exercise to help prevent further increase in the problem.
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Scoliosis and the Chiropractic Approach http://www.planetc1.com/chiropractic-articles/scoliosis-chiropractic.html
By Matthew Trull
Analysis of Findings
Scoliosis can be very serious. If detected early, the chances for stabilization and reduction of the curves are very good. In my family alone, we have two examples. My sister抯 Scoliosis was diagnosed when both her curves had already progressed to 45 degrees. She had Spinal Fusion surgery in Atlanta at Scottish Rites Children抯 Hospital. The surgery was successful; her curves were reduced to 20 degrees each. However, it was very dangerous, painful, expensive, and changed her life dramatically. My Scoliosis was diagnosed early, while I had only one curve that was 21 degrees. Following six months of Chiropractic care, I have been completely cured of Scoliosis. The approach was painless, inexpensive, and did not alter my life in any way. I believe Chiropractic care should be the first-line approach for all patients diagnosed with Scoliosis. My research has proven it has a very high success rate: 70% achieving stabilization and reduction, and 15% obtaining total correction!
Typical Treatment Options
Bracing: For curves 30-degrees or less, a Milwaukee brace is typically worn. It is a rigid brace that exerts pressure against the spine, in hopes of achieving stabilization. The brace is uncomfortable, unsightly, and is usually worn 20-24 hours per day, until the patient stops growing. It offers no correction, and is only marginally effective for stabilization. Surgery: An orthopedic surgeon performs Spinal Fusion surgery. The patient is placed on a spinal cord monitor to prevent paralysis. After performing an incision, the surgeon manually reduces the curves as much as possible, and inserts metal rods on each side of the spine, attaching them with special hardware. Bone splinters (either removed from the hip area, or donor bone) are applied between the vertebrae. Over time, these fragments grow together to create a solid bone. Surgery is very expensive, painful, dangerous, and requires the patient to alter their lifestyle forever. Surgery is very effective for reducing curves. Surgery should be considered a last resort.
Signs of Scoliosis
Most obvious signs of Scoliosis are: shoulders of unequal height, a 憆ib hump? which is caused by the ribcage on the back protruding more on one side than the other, and hips that appear unequal in height. Scoliosis clinics are conducted free of charge by health Departments and Chiropractors. A school or Health Department nurse or Physical Education teacher routinely screens students during the middle school years. It is extremely important to diagnosis and treat Scoliosis as early as possible.
Special Thank-You
I want to thank Dr. Marc Schnobrich, of Rincon Chiropractic, for all the many ways he has helped my family and me. He diagnosed my Scoliosis while treating me for an elbow injury. During the following months, he treated me weekly, always explaining what he was going to do. He provided excellent chiropractic care in many other areas, as well. Dr. Marc checked my spine often for progress. After six months of care, I was completely cured!
Dr. Marc has always been very kind, caring and helpful. He has been my friend as well as my doctor! During my research for this project, he loaned me books and other research materials. He patiently answered questions, and was never too busy to talk to me on the telephone between visits. He also answered my emails promptly and accurately. Thanks to Dr. Marc抯 care, I will be able to continue my normal lifestyle, which includes baseball and many other physical activities.
Thank you, Dr. Marc!
Conclusion
Spinal Fusion surgery is very painful, expensive, and will alter the lifestyle of the patient forever. Surgery should be considered the last alternative in treating Scoliosis. Wearing a Milwaukee Brace is uncomfortable, limits physical activity, offers no correction, and is mostly ineffective in stabilizing the spine. The Chiropractic approach is very effective at stabilizing the spine, preventing the curve from progressing. At least 70% of the patients achieve some degree of reduction in the size of the curves. Approximately 15% of Scoliosis patients achieve total correction, like I did! That means at least fifteen out of 100 patients will not have to face surgery, take medications, and change their lifestyle forever! All of this is done with a minimum of cost and no pain! Research and experience have proven Chiropractic care is definitely effective in the stabilization and reduction of Scoliosis! Chiropractic care should be the first-line approach for all Scoliosis patients.
Chiropractic Facts
The first Chiropractic adjustment performed on the North American Continent was in 1895, by Dr. Daniel David Palmer. His first patient experienced deafness following a back injury. Following care, the patient reported improved hearing. Dr. Palmer founded the Palmer School of Chiropractic in Davenport, Iowa, which continues to train Chiropractors today.
Spinal manipulation has been practiced since the beginning of recorded time. Over 2700 years ago the Chinese documented this form of treatment. Records indicate that ancient Japanese, Indians, Egyptians, Babylonians, Syrians, Tibetans, and Native Americans practiced a hands on approach to health.
An estimated 19.5 million Americans visit a Chiropractor each year.
There are over 50,000 licensed Chiropractors in the United States, and another 30,000 worldwide.
Chiropractic is the world's second largest health care profession. It promotes the body抯 own ability to heal itself. Chiropractic uses no drugs or surgery, and is all-natural.
Evaluation of Work
I believe whole-heartedly in Chiropractic Care for Scoliosis. I am living proof that it works! I thoroughly enjoyed researching this project. I was eager to find if others had similar success. I was delighted to find that more than 2/3 of the Scoliosis patients seeking Chiropractic care had very good results. It was fascinating to speak with Chiropractors who treat Scoliosis on a regular basis. I found them to be very caring, dedicated professionals. I accompanied my sister to Atlanta for her Spinal Fusion surgery, and remember the excruciating pain she suffered. I see her daily life changed. I wish my parents had been aware of Chiropractic when my sister was diagnosed with Scoliosis. Maybe next year I抣l research why more health care professionals don抰 offer Chiropractic care as an option to their Scoliosis patients. More public education is definitely needed in this area!
Scoliosis- is an OBVIOUS Misalignment of the spine. The spine compensates- like dominoes - - - one falls here, and the final domino may be far distant !, Like the old song- the toe bones connected to the foot bone, the foot bone to the ankle bone, the ankle bone is connected to the leg bone, the leg bone is connected to the knee bone, etc etc etc. the body is all interconnected and interdependent. A misalignment (subluxation) in the spine can cause a compensation elsewhere contributing to an abnormal curvature- known as a SCOLIOSIS.
Scoliosis: a misalignment of the SPINE often contributed to by:
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of joints, and can cause scoliosis, osteo-arthritic degeneration, Degenerative Disk Disease, degenerative joint disease, etc.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Inflammed Discs can easily bulge, herniate, tear, or degenerate. Other soft tissues may also suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Vertebral Subluxation may cause Spinal Scoliosis, Arthritis, Disk Herniation, Disk Degeneration, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment by Doctor of Chiropractic.
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I hope this helps. Please visit a Doctor of Chiropractic for a different perspective on your problems. Doctors in chiropractic also have continuing training in orthopedics, sports injury, rehabilitation, neurology, and nutrition- to mention some of our specialties. Look for a Chiropractor with 'Diplomat' status in sports injury, orthopedics or rehabilitation for your complaints.
As always, this discussion is for informational purposes only. Evaluation, DX, TX, RX, PX can only be made by a treating health professional in person.
Thanks,
Dr. Victor Dolan, DC, DACBSP (Diplomat, sport injuries)
http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com (email newsletter signup)
