4. Modalities like TENS, Ultrasound, E-Stim, Acupuncture will not
change the mechanical mal-alignment of your pelvic bones and will
benefit you superficially for a couple hours at best.
Q I was in a rear
end collision 1 week ago and have since developed pain in the left side
of my neck, left shoulder and distal portion of my upper left arm with
tingling into my left arm radiating into my left thumb. My x-rays
reveal a narrowing at C5, is this an injury that can be treated without
surgical intervention? I am a flight nurse and am extremely concerned
about the prognosis, can you give me further info?
I am 43, and was hit at approximately 60-70mph, my car was thrown 117
ft from the sight of impact. I am concerned because I cannot wear my
flight helmet without severe pain in my shoulder and tingling in my left
arm and hand. It has actually spread from the thumb to the entire hand
when lifting patients, bags etc. C5 and 6 reveal old arthritic changes
and a severe narrowing on the left. I am awaiting my MRI.
A
The symptoms are common. As you know muscles can mimic nerve root like
paresthesias. X-rays are limiting as they do not show disc or nerve
entrapments. The distribution of symptoms can be C6 involvement. The
speed of impact and your chronological age can be factors to predicting
the potential of a herniated disc.
Early radicular symptoms are a poor
sign of quick recovery. I suggest finding a good osteopathic physician
or chiropractor to initiate manual treatments and modalities. A MRI of
the cervical spine would be beneficial to assess disc abnormalities.
Your primary physician can order medications for symptomatic relief.
Q If someone has
a tight psoas will their pelvis be tucked or flat?
A I work with
elite athletes who have "six pack" abdominal muscles, but have tight
psoas major and minor muscles. As well, very deconditioned individuals
have very tight psoas muscles. Therefore, I cannot categorically
correlate "tucked or flat". One observation is that tighter psoas
muscle may in a side view show a slightly forward quadriceps muscle
(anterior).
Older individuals with a condition of spinal stenosis lean
forward across their waist line and develop compensatory psoas
tightness, but clinically they are leaning forward to relieve the
pressure upon the spinal canal in the lumbar region.
Q I would like to ask you the recommended
exercises that I can do for golf at home. I am a beginner at Golf
and after 2 months training I have broken a rib (6th & 7th), right side
under the right axila. I did it just playing, or better:
training! My doctor recommended to relax for 6 weeks - no Golf.
I am worried about returning to Golf (and I will). How can I
prevent a new accident (another broken rib) with exercises?
A
This is a rare situation that you present, but
occurs enough to be written about in golf injuries. Referring to the
biomechanics of the right sided 6th rib, this correlates with a muscle
group deep under the pectoralis muscle called the serratus muscle. More
specifically the serratus anterior.
Usually more than one muscle is
involved and you may have very tight pectoralis and latissmus dorsi
muscles. I apologize in advance for the technical terms of the muscles,
but this will give you a better reference when you search the internet
for rehab of these muscle groups.
The rib heals on its own in 6 weeks.
The muscles between the ribs are more susceptible to spasm and strain.
You need to find a resource on how to stretch and release these muscles
to functional flexibility in order to reduce the tension-torque that
could lead to re-fracture. Myofascial release techniques for these
deeper muscles may have to be done by a trained therapist as you may not
be able to get full flexibility on your own.
Try looking up Active
Isolated Stretching, Active Release Technique. PNF, and should you not
find a qualified therapist, find a good experienced massage therapist to
work on these muscles. Additionally, prior to your golf game, you need
to warm up with stretching exercises to prepare these muscles before
strenuous activity. Possibly a rib cage binder (wrap) may help
stabilize the rib cage in the early stages of healing. I hope this
helps you understand the mechanism of injury.
Q Is it true that babies should
not get their shots when they are born. That kinesiology will take care
of them.
A
Well, as I understand the question, does
kinesiology substitute for shots? Kinesiology is the study of
movement--biomechanical function. Shots for babies are for the purpose
of injecting a vaccine or medication to help the baby with a illness,
disorder or prevent diseases. The trauma of the needle may leave a
scar, that as a child grows is not noticeable, not interfere with
function.
There are incidences where an injection can be made near or
at a major nerve and cause damage to this nerve. This damage is just
bad luck or carelessness. The question may be from a natural
physician--are immunizations necessary for babies and newborns, but this
is quite a debated topic that I don't feel I am an expert to provide an
authoritative decision.
Q I am a college baseball pitcher interested in gaining
throwing velocity. I have already gotten two training baseballs,
one 4 oz and one 6 oz, 20% above and below the standard 5 oz weight of a
regular baseball. I am very interested however in the "Exergine" wall
pulley workout spoken of in this article, claiming an 8.1 gain in mph.
I'm familiar with surgical tubing workouts and the like but not with
this. Any information you could give me on where I could acquire
something like this or where they have them etc. would be great.
A
Thank you for your question. Sounds like you have been diligent in your
conditioning. You can get more information at
www.Exergenie.com .
Q I recently underwent a posterior
lumbar spinal fusion, L4/5, 12 weeks ago. 6 pedicle screws were
inserted, awoke with no power in left knee and loss of sensation down
left shin. It took a week for my surgeon to return me to theatre as he
had miss-aligned one of the screws and it was compressing a nerve,
resulting in my symptoms (I had no problems with my left leg prior
to surgery).
I now walk on two crutches since my left knee is
essentially a dead wait, and surgeon has told me only time will tell if
it will heal or I'm in this state for the rest of my life. Compression
over that length of time and due to nature of trauma to the nerve do you
think it will heal?
A
The answer is a difficult one. It sounds like you
had the L4 nerve root injured by the appliance--screw. This is a rare
event. Nerves do regenerate, but at a very slow rate. You may need
further studies, a nerve conduction test and possibly EMG to diagnose
the degree of injury and site of injury. An MRI may be helpful to
diagnose where the screw traumatized the nerve. I would also get a
second opinion to substantiate the findings.
Q
We
(Virtually Perfect Golf Inc.) have produced a Virtually Perfect Golf
Learning System that incorporates a level of virtual reality feedback
into tradition video analysis lessons. We are trying to find research
that: 1) supports our notion that virtual reality feedback is the most
effective way to of learning a motor skill or that it achieves the
highest level of motion retention, and 2) if there are statistics that
show what level of motion retention different teaching methods achieve
(i.e. visual, audio, full motion, demonstration, etc.).
Please see our
website for more information:
www.virtuallyperfectgolf.com
Your comments would be very much appreciated
A
Your method may prove to be superior in concept to fragmented golf
instruction. I have worked with biomechanics analysis with Univ.
Calgary, Univ. South Florida, and Univ. Tennessee in analysis of
learning styles in sports as well as specific body mechanics that
differ for men and women in athletics, most importantly in golf.
Recently,
I was invited by TaylorMade to meet with their research
team. TaylorMade has a goal of trying to develop
biomechanically/ergonomic club design, with a special interest in
women's golf. I have over 5 years of unpublished data that has been
based on 80 years of research information that has been applicable to
golf. My web site is just the basic knowledge that is acceptable to
the industry and does not hold any of our research developments.
I have reviewed your web site and find it
intellectually stimulating. As I had my residency training in
functional anatomy and physical medicine at McMaster in Hamilton, I
recognize your sites. I studied three years with Dr. Basmajian at
McMaster, who is the father of anatomical muscle function.
Q
I am a new personal
trainer. I have a client who strained her quad from doing
stationary reverse lunges. She was holding 20# dumbbells.
Seems like she was going basically nothing for this
to happen. She’s very fit, hikes a lot, so
not sure what happened. Anyway, my concern now is what to do
with her and how long it will take to heal.
We laid off for 4 days and then only did some
straight leg raises, no weight body squats and stretches. Any advice for
this newbie is greatly appreciated.
A
In the reverse lunge the quad muscle may strain
at two different attachment sites. If the pain is near the Anterior
Superior Iliac Spine, then it is the proximal attachment. If the pain
is suprapatellar, then the problem is distal quad. If the person had
a previous injury mid quad, either site is vulnerable. If the person
has had knee problems such as patellar tendonitis, ligament sprains,
or meniscal tears/sprains, the lower quad attachment is tight.
To
assess, place the person on a table and had them lay on their non
affected side (the knee that doesn't hurt. In a perpendicular line
have the person bend-flex the knee towards the buttock. Measure the
distance from heal to buttock. Then have the person roll on the
affected knee side and repeat this measurement. Look for dys-symmetry
in heal to buttock range.
Find a technique you prefer and stretch the
quad to complement the best range. This will accelerate healing and
functional strength. Please review the article on sports assessment.
For Active Isolated Stretching technique, you can visit the site of
www.stretchingusa.com.
Q Can you point me to
illustrations of the exercises to which you allude to in your article?
A
The Active Isolated Stretching exercises--I would
refer to to Aaron Mattes' website
www.stretchingusa.com
Q I have had two sessions
with AIS for chronic knee, hamstring and quadricep discomfort. The
quadricep discomfort is the most concerning in my running as the quad
just "turns off" and my leg feels "dead". Prior to AIS I had done the
traditional route with EMG and artieriogram secondary to a positive drop
in pressure during an ABI test.
Claudication symptoms without evidence
of sclerosis or thrombosis. So back to the muscular route. Negative
MRI for disk disease and other back ailments. This all started after a
hamstring injury 3 years ago with a Medial Menisci Tear resulting in
surgery 2 years ago this May.
The quadricep pain goes on- but is
improved with work on the semimembranosa/tendinosa and sartorius.
However, I still have numbness symptoms in my right glute/piriformis
with leg weakness and occasional foot numbness. The tightness around my
knee has not totally resolved, but my good days are more frequent than
my bad days. What would you suggest at this point? Where else should I
be looking for problems?
Should I be doing more AIS treatments than
every 2 weeks- like home therapy? Any and all input would be greatly
appreciated as I seem to becoming an enigma here and my elite running
career is at a standstill due to inability to tolerate training.
A
Interesting situation. In my experience, I think you had a
subluxation of the sacral-iliac bone that predisposes individuals to
gluteal, piriformis and hamstring strains as the shift in this bone
causes slight shortening of these muscle structures. The chronic
hamstring situation progressed to involve the posterior thigh muscles
as you described.
The referred pain into the foot is the irritation
of the sciatic nerve as it passes near or even through the pirirformis
muscle. The compensatory quad strain may have resulted from the
sacral-iliac malalignment which shifts anteriorly and superiorly
giving rise to the proximal attachment of the quadraceps and sartorius
muscles. The meniscal tear occurs as this sacral-iliac malalignment
can slightly externally rotate the femur and the patellar bone.
What I propose is that you find and experienced chiropractor or
osteopathic physician who performs manual adjustments to correct this
sacral-iliac subluxation. Then after the re-alignment would your
sessions with AIS be effective. Without the structural re-alignment,
your AIS sessions are limited without long term correction.
Q
I am a 40 year old male. I incurred an injury while playing squash 5
years ago. My right pelvic area is not right.
I cannot walk without having my right
leg feel as if it is dragging. I feel no pain while standing still or
lying down.
If I go from sitting to standing my
lower right ab area from pubic bone to iliac drest is tight and sore.
It bothers me in the hip area to
sleep on my right side. My right upper thigh and pelvic crease area is
tender, you can see swelling.
My right leg is noticeably weak when
raising it up while laying down
If I am very active the soreness will
encompass not only my lower pelvic and ab area, but also up into the
lower ribs and lumbar plexus area.
When I wake in the morning with a
full bladder from time to time my lower right ab area feels stiff.
A standing x-ray shows that my right
crest is approx. 22mm higher than my left and I am tilted forward a bit
I am now undergoing prolotherapy
treatments to the iliolumbar and sacroilic ligaments, etc.
If my psoas minor or major is the
problem ( how do you tell which?) how can it be fixed? How can I bring
my pelvis back in line?
A
Thanks for being so descriptive of your symptoms
as this does help. First of all you have a subluxed sacral bone on
the right that has caused an anterior superior shift. As a result the
sacroiliac ligaments are strained. Additionally, the psoas major
muscle is sprained.
By your description of the referral of pain into
the pubic bone suggests to me that you may have a psoas minor muscle
strain. The iliopsoas attaches in the proximal medial femur and may
account for the minor swelling. If the swelling is near the Anterior
Superior Iliac Spine, then the sartorius muscle may also be involved.
If the sartorius is involved, you may find difficulty crossing the
affected leg into a figure four position while sitting.
I would suggest the following:
1. Consult with a Chiropractor or Osteopathic
physician who does manual manipulation to correct the sacral
subluxation.
2. Find a myofascial therapist that can isolate
the iliopsoas muscle group. This may be a highly qualified Massage
therapist with a background of Active Release Technique (ART) or
Active Isolated Stretch (AIS) or even Reiki Technique.
3. I would not continue with Prolotherapy, as
the purpose of Prolotherapy is to "glue" and strengthen the ligaments
and muscle tendons. This causes increase scarring to a malaligned
muscle ligament bone position. Prolotherapy is popular and has its
purpose, but I don't feel that this approach is warranted as I would
like to have a therapist/chiropractor re-align your pelvic structures.
Q I have a muscle strain of my left forearm. The muscle
strained is my Brachioradialis muscle. I strained it back in March 2005.
I had an MRI done in July. I have not been exercising since the MRI.
What are the best options for recovery?
A
Brachioradialis strain. Usually related to either a repetitive movement
against resistance--such a using a screwdriver or hammer, of a resistive
pull of a weighted object with associated lateral elbow pain. Avoidance
of these activities helps the healing process. Additionally, the
traditional-- rest, ice, compression then specific exercises (RICE)
protocol should have helped.
Local analgesic creams help moderate the
pain. Anti-inflammatory can help reduce the inflammation. Having
undergone an MRI indicates that the pain was severe and prolonged. I
would venture to guess that the lateral collateral ligament was also
sprained in the injury.
Please refer to an anatomy book to identify
this ligament, then push on this ligament to see if it reproduces the
pain you experience. Elbow ligamentous sprains take longer to heal and
for the pain to resolve.
.....Q MRI results show the extensor carpi radialis muscle is
torn on my left arm. I am right handed. I have had these symptoms since
May of 2005. At the time when it happened I did not rest it and
kept on exercising, not knowing what I had done to my arm. I tore
the muscle doing wrist dumbell
curls on a swiss ball. Since my MRI on July 14, I have rested the arm as
much as possible. I do not know if I have an irreversible injury or not,
I have never had this before. I would say the injury is most likely a
grade 2 muscle tear.
A
A partial muscle tear will
functionally fuse itself together, but loss of flexibility and
functional strength will diminish. Before you start loading the muscle,
ensure that you receive appropriate stretching in Active Release
Technique, or Active Isolated Stretching.
Then after proper stretching,
start at low weights and work on increasing repetition rather than high
resistance loading in your work out routines. If the tear was worse,
you could have considered a surgical reattachment.
Q
I am a 41
year old woman who has been in right sided pain for 3 years. In 2003 I
found a bulge under my right rib cage almost sitting on the iliac crest.
(I am small and thin framed). Turns out it was my kidney...renal ptosis
or floating kidney. After many consults with urologists (at least 12) I
was told my condition was not the cause of my pain...I also have extreme
bowel pain...seems to me to be the colon and I continually have to lay
down to let the gas travel to the left side. My hip, knee and ankle all
snap and feels like the ligaments are "grinding". My pain is only when
I have been standing for prolonged periods, if I side sleep and after I
eat if I cannot lie down.
Despite compete GI work-ups...(colonoscopy, small bowel series and
endoscope), IVP's, spine MRI's and CT scans...(all supine I might add) I
am coming up negative.
I have spent a great amount of time learning about the abdominal wall
musculature and have compared normal anatomy to my scans. I have
extreme asymmetrical differences in both CT scans and "standing MRI
films. Most appear at the right iliac crest. The iliacus muscle seems
to have a huge bulge and is not smooth in cross sections as is the
left.
The transverse abdominus has thinned out so much, it does not
even look like it is attached to the iliac crest. My internal oblique,
in cross sections has shortened to half its length and does not reach to
the quadratus...which is also "short and squared off".
In my supine
images it looks as though I have bulge of fat protruding into the quadratus, yet in the standing MRI this disappears and my right side
seems to appear larger then the left when measured from the center navel
around to the spine. The psoas minor has seemed to completely vanish as
it is about 1/4 the size round compared to the left on the femur.
Although I point these asymmetrical differences to the doctors I
visit...they all tell me we are not symmetrical. Could I have some type
of sportsman hernia or groin hernia? No one can explain the extreme
bowel pain I have on the right side...its as if my whole digestive track
just stops until I can get supine.
I had a nephropexy in Oct. 04 where an endourologist "tacked" my kidney
to the psoas and a ligament of the liver...(my liver is also extremely
low). However, the procedure did not work and my kidney still falls to
the iliac crest and front abdominal wall.
Right now my only alternative is to "mesh" the kidney to the inside of
my rib cage. I don't think I am convinced this is the best option
because I have so much abdominal wall pain, groin pain and ribcage pain
which I am assured is not associated with a kidney that will not stay in
place.
Can you think of anything that can be causing my right side to fall
apart? I was in physical therapy for pelvic strengthening...it did
little help. I also should add all the pain started after I had my son
who was 8.5lbs...I am a size 2. Could giving birth have stretched my
pelvis so far that my right side just did not go back? Could I have
ripped muscle or tendons that did not heal right and now I have a
"snowball" effect of pain, ptosis, and muscle atrophy over 3 years.
A
This is a
most unusual case. The abdominal pain may be caused by the psoas or
ligaments, but I honestly don't know. The psoas minor appears in only
40 % of individuals and inserts into the pubic rami not the femur. Why
the dis-symmetry? I would ask for a referral to Mayo Clinic, Duke,
Cleveland Clinic, John Hopkins or equivalent to provide a more accurate
diagnosis to your problem.
Q
After reading the article about mobilizing the
wrist I'm interested in finding any information or help that I can
about my own condition.
8 weeks ago I had a colles fracture to my right
wrist and now I'm undergoing physio therapy to help with the movement
of my wrist ,unfortunately its not helping as much as I hoped.
Being a
plaster by trade and a fanatic golfer I'm starting to become concerned
about my ability to work and play again.
The 2 main problems are the ability to turn my
wrist to the full palm up position and also the ability to raise my
wrist above the horizontal position which in my profession is a must.
I would be grateful for any advice that you could give me or any
alternative medicines that you might be able to recommend .
A
The Colles fracture is either
stabilized within a cast or in the event of displacement, surgery may be
indicated. However, as I noted in the article that the eight small
wrist bones may shift with the injury that resulted in the forearm
fracture. This wrist bone malalignment caused limitation in wrist range
of motion and pain.
This is a structural-biomechanical problem that
alternative medications nor physician prescribed medications can't
help. Acupuncture may ease the discomfort, but unless you have someone
re-align these small wrist bones, optimal results will not be obtained.
Q
I'm a 41 year-old female. I had surgery last year (360 arthrodesis)
and lately I have been having terrible neck pain on the right side of my
neck. The pain shoots up into my head and down to my shoulder. I
recently visited a chiropractor who told me that my neck pain could be
caused by my optical righting reflex. Could you elaborate on this
subject for me?
A
Thank
you for taking the time to write in your question. Neck pain and
headaches are really complex as many different structures can mimic
similar presentations. Surgery just adds to this confusion.
First of all I am not an expert of the optical righting reflex.
Reflexes usually don't create painful symptoms. Additionally,
treatments for reflexes are not specific and are in low yield to
response.
However, you did have a neck
problem that required surgery. Surgery 360 degrees is very extensive.
There are a grouping of muscles--(anterior, middle, posterior scalenes,
levator scapulae, upper trapezius) that can all present with occipital
to shoulder neck pain. These are the first structures that come
to mind. If you have additional symptoms of dizziness, nausea (usually
without vomiting), difficulty with prolonged neck positions, slight loss
of balance-posture with swelling of muscles around the side of the neck,
then the culprit could be the sternocleidomastoid muscle. This muscle
is occasionally cut through inadvertently during surgery of the neck.
A good source of information can be gotten from a medical text called
Myofascial Pain Syndromes by Janet Travell and Dr. Simon. I am
recalling this title and authors by memory and may be slightly off in
the exactness of the title and name, but I wanted to return your email
quickly.
Please feel free to share this information with your Chiropractor.
Q
I am an airline pilot and am interested in your Muscle Memory Article.
I am really becoming more and more interested in this subject as I
try to make these changes. This has to be one of the subjects that Tiger
Woods and his staff must have studied a lot. But Tiger has no idea
what it is like to try to make the large swing changes that I have had
to go through. He has always had a solid swing and his muscle memory
changes were small.
Let me give you an example:
My initial take away of the club has been flawed for 20 years. When I
start the club away from the ball my muscles in my hands and arms tense
a little, the club hesitates a little and goes back on a slightly
incorrect path.
I think a lot of this has to do when I was 15, I started working out
with weights a lot and trained > these muscles to do something else.
I also believe that it is partially mental and that when I start the
back swing this is all my mind and muscles know to do. At this age
my game started going down hill and I lost confidence and starting the
club back became hard.
I can stand in front of a mirror or take a practice swing and make
the correct take away and movement easily. This is what makes this
interesting, I can make a perfect take away, just not on an actual shot.
When I look at trying to make a change to this muscle memory, I
wonder how long and how many repetitions would it take me to correct the
muscle memory. It sounds also that how I think and feel will affect the
progress.
There have been some swing corrections that I have successfully
changed and now are fairly ingrained in my muscle memory. I did not log
how long it took me to change this which I wish I did.
The particular take away move I talked about before I would like to
log and record details to see how long it would take to successfully
change. Any ideas on how to go about this?
A
A book to help you with muscle
memory Psycho Cybernetics by Dr. Maxwell Maltz. Apparently is addresses
habit changes by retraining the subconscious. In regards to
forming any opinion in swing biomechanics, I can't do this effectively
without examining you.
Q
If you were
involved in a rear ended motor vehicle accident (I was hit from behind
at a stop light) how soon should I have had an MRI of the cervical spine
done? I mean, when is the best time frame to achieve true objective
results of a disc herniation? And if my results were negative 3 weeks
after the injury, but they are positive now - (1 year after the injury)
how is it that in the first 3 weeks nothing showed up on the film?
A
It
is a great question. An MRI is done following trauma doesn't show any
disc lesion, but later a positive herniation. Multiple things can
explain this phenomenon. The first to come in mind is the activities
the person partakes in. Workers who lift, carry, twist, are at a
greater risk of disc protrusion-herniation following deep
muscle-ligamentous trauma than if no trauma occurred. Secondly, the
treatment--chiropractic, osteopathic, deep manual therapy, working
with weights, can induce an extension of the disc lesion.
A
cough, sneeze, forceful bowel movement can induce a disc lesion.
These are the most common. Finally, a radiologist's interpretation
can make a small protrusion into a herniation if he feels that he's
trying to help a litigated case to explain radicular or referred pain
sensations from the neck or back into the extremities (arms or legs).
A second
trauma could have occurred from a much lesser force, but once you have
a spinal injury, from a second trauma, the disc lesions are more
common (protrusions, herniations).
Q
We had a great season at Carmel. We went 31-4-1, won our league and
also the Central Coast Section D III Championships. We were also ranked
3rd in the state for schools our size. Actually >> worked with the
players in the dugout before the semi final and championship games at
San Jose Giants Muni field. It's not the majors but was just as fun.
I started depending on the players about 14 games in the season so we
had some great before and after numbers. The coach got me the stats and
I wrote a case study based upon those findings and the actual work with
the kids. I am sending you via snail mail a copy of the study. The
results were almost unbelievable and probably wouldn't be had it not
been for the actual stats and the letter from the coach detailing the
season. I'd love your feedback and any ideas about getting it published.
A
Great work. I would be glad to
review your study. Additionally, you are most welcome to visit and
spend time with us so that we can show you our work. Collaboration
yields to exponential successes.
Q
If you were
involved in a rear ended motor vehicle accident (I was hit from behind
at a stop light) how soon should I have had an MRI of the cervical spine
done? I mean, when is the best time frame to achieve true objective
results of a disc herniation? And if my results were negative 3 weeks
after the injury, but they are positive now - (1 year after the injury)
how is it that in the first 3 weeks nothing showed up on the film?
A
It is a
great question. An MRI is done following trauma doesn't show any disc
lesion, but later a positive herniation. Multiple things can explain
this phenomenon. The first to come in mind is the activities the
person partakes in. Workers who lift, carry, twist, are at a greater
risk of disc protrusion-herniation following deep muscle-ligamentous
trauma than if no trauma occurred.
Secondly, the treatment--chiropractic, osteopathic, deep manual
therapy, working with weights, can induce an extension of the disc
lesion. A cough, sneeze, forceful bowel movement can induce a disc
lesion. These are the most common. Finally, a radiologist's
interpretation can make a small protrusion into a herniation if he
feels that he's trying to help a litigated case to explain radicular
or referred pain sensations from the neck or back into the extremities
(arms or legs).
A second
trauma could have occurred from a much lesser force, but once you have
a spinal injury, from a second trauma, the disc lesions are more
common (protrusions, herniations).
.....Q
I did not
undergo any chiropractic treatment and I have a pretty sedentary
job--I sit at a desk for 8 hours a day. The only exercise I do is
30 minutes on an inclined treadmill.
Is there any
literature that would explain a time frame of the formation of a
disc herniation following the low impact rear ended accident? I
mean, I was very surprised to learn that a herniation had
developed. I was always under the impression that if it was a very
forceful trauma, then a disc herniation would show up immediately on
the MRI, but all that was noted was a loss of signal three weeks
after the accident.
So I guess
what I also want to know is given the lifestyle I described to you,
this herniation appears to have been very progressive in nature -
correct?
So while I
have back pain I am still able to function close to normal. Was
there any way that I could have prevented this herniation from
developing?
A
You
apparently have two MRI's one following the accident and then one a
few months later as I understand from your email. Trauma will
create a herniation and should be visible on MRI. First thought is
to take both MRI to one center for a comparison reading as
variations occur by radiologist's interpretation. You may discover
that it was present in a milder form on the initial reading and
possibly the second MRI was "over-read". This does happen on rare
occasions.
As I
explained earlier, a cough, sneeze, lift against resistance is
enough force to create a disc lesion. Golf can create herniations.
Occasionally, individuals who can't recall any trauma are discovered
to harbor a disc herniation. All in all it is easier to explain a
herniation associated with force.
I don't
recall if your herniation was in the neck or low back. Each one has
it's own specific reason for herniation.
Sorry I
can't be more helpful as I have not found any literature on the
progression of a herniation.
Q
Your article about golfers and muscle memory
was really unconvincing. You would use the same muscle groups in the
same order to chop down a tree, but how many lumberjacks do you know
that have made the transition from tree felling to professional
golf?
If you want to use your scientific expertise to
explain the perfect golf swing, you would be better advised to look
at the finger and palm print configurations of great golfers.
Right handed people that play a lot of golf,
quickly develop a callous on the second flange of the ring finger of
the left hand. over time the callous develops its own 'finger print'
pattern over an area covering a diameter of about a quarter of an
inch. Non-golfers do not have this area of super-developed finger
print.
I have no doubt that a comprehensive study of the
palm and finger prints of great golfers would reveal a particular
pattern of super developed areas that would shout 'golfer'. These are the areas that tell the brain how to
use particular muscle groups, in a particular order, with a
particular force, to produce a golf shot.
A
Thank you for your question.
I agree with your assessment of specific callous formation in high
level golfers. The ability to develop such callous' deems good muscle
memory. As in the waggle, the sensory input sets off a chain of
neurological signals to prepare the muscles into sequential
movements--a form of muscle memory.
Callous' are sensory epidermal stimuli that initiate a similar
phenomenon. I don't recall any specific research done to map the
callous formation in golfers, but it would be interesting to identify
differences in amateur and professional players. I hope I helped with
your astute observations.
Response: Thank you for
your prompt and very informative reply to my unsolicited and
bothersome e-mail, it was most kind. I had not properly thought of a
callous as providing sensory epidermal stimuli. It would seem by its
nature to be a natural precursor to the more sophisticated finger
print formations.
Thank you again.
Q
I found your muscle memory article interesting and on target for book
research I am doing. Could you recommend some sources for good
information along the line of muscle memory and sports.
A
Thank you for reviewing my web
site. Muscle memory is a relatively new concept and has many
applications. Sports and athletic ability is fascinating for my
work. The resources are recent and not well peer reviewed. Most
research is anectodal and not double blinded. This is a learning
concept which is hard to provide scientific procedures to validate.
Please write back, providing me with more specific needs for your
book, i.e. what sports, what age groups, what conceptual applications,
ect.
.....Q
I am part time professional golfer that is rebuilding my swing with
top instructors. When I say part time, I have a full time career. I am
learning just how hard it is to change muscle memory.
I am writing a book on how I am changing my swing for the better.
It covers a lot of what I have experienced over the last couple of
years. Muscle memory is turning out to be a huge challenge and factor
in these changes. It also appears it is going to be one of my
strengths when I obtain the correct swing. I have achieved great
changes in my swing but it is amazing how the old muscle memory will
still show up when I play, etc.
There really is not much information on muscle memory and any rules
on how many repetitions it takes to learn a new move. This subject
will be at least a chapter or two in my book. Any information or
help would be of great help.
A
So much has been studied in
golf, but little integration with the studies of biomechanics. The
present golf studies of biomechanics have only confirmed what the
researcher was trying to validate.
I on the other hand have no
golf experience and have an open mind to biomechanics. I work with
professional instructors and high speed cameras to observe motion and
muscle function. The golf swing is complex in that three different
swing mechanics are identified based on your biomechanical
make-up.
Some are born natural
swingers, some are born natural hitters and most fall into the middle
group. We have tested the muscles that make each swing unique and are
in the process of building and educational foundation for golf
instructors. Next month we have been invited by the
Japanese LPGA to do a special seminar to bring this information forward.
Our goal is to write a book on biomechanics that is functional and
understandable.
Next, muscle memory. If
you have instructors who tinker with your basic swing and not analyze
your natural movements--you have the phenomenon of trying to provide
wheel alignment to a car with a bent frame--the bent frame being the
historical experience of instruction. Not much will change, as you
need over 20,000 specific movements to encode into muscle memory.
Unfortunately, golf is not
the best suited sport to isolate new and repeatable movement.
Additionally, emotional input plays a major role in muscle
memory--your situational state of learning must mimic playing
conditions to be effective in creating memory.
This is just a short
overview of the complexity of golf. Equipment is extremely
important. You need proper swing weight, frequency. moment of inertia
balancing, loft, lie, and grip to provide you with the proper tool to
execute consistent and successful play. If you lack confidence in
your equipment, how good can your muscle memory be established?
We have spent four years analyzing vibrational engineering for club
making with some golf pros.
Unfortunately, I have held
back the new information and the research that we have "discovered".
It is probably an ego thing, but if I released it earlier in my work,
I would have made some mistaken analysis. Science proves what
athletic training shows to be successful.
If your in the Southwest
Florida area, please let me know and I will try to spend time with you
to give you our input to your re-established career goal.
Q
One year ago I
was in Bosnia as a civilian contractor and I suffered a severe fall
while carrying about 75-80 pounds. The Army doctors said I had a
widening of the Mortis space in my ankle. They put me in a walking
cast and had me on crutches completely for about 8 weeks. Here it is
now a year later and I am back in the states but I still have a lot of
pain when I try to do any kind of jogging or even sometimes when I am
sitting at a desk. Any idea why this should still be giving me so many
problems?
A
The ankle
is a complex compilation of small and medium sized bones arranged in a
precise matrix supported by many thick ligaments that allow for a
sophisticated muscle pulley mechanism for function. Additionally
greater than 500 pounds per square inch of pressure could be applied
through the ankle.
Widening of the Mortis space indicates that you have to some degree
torn the supportive ligamentous attachments that caused a disruption
to this complex structure. As a result, there is a high degree of
probability that the small and medium sized bones may have shifted
ever so slightly out of their functional position, leading to slight
loss of range of motion and resultant pain. Occasionally, minor
swelling can be associated with this problem.
Unfortunately, I don't know anyone who repositions the bones as I have
been fortunate to learn on my own. The ankle repositioning learning
was an extension of my work on the wrist for my son's fractured
wrist. If you haven't read this article, I would encourage you to
read it as the wrist has many similarities to the ankle joint.
I live
in Bradenton/Sarasota area on the Southwest coast of Florida just
south of Tampa. Should your travels take you here, I would be glad to
assist you in reassessing and hopefully providing some solutions to
your problem. Unfortunately, I have not yet written an article on how
to correct ankle malalignments of more specifically what we call in
healthcare as "subluxations".
Q
I am a female age 43 who injured my left wrist in
June2005 in a fall. I had fractures on the distal radius and ulna
styloid process. The doctor inserted fixation pins to stabilize the
fractures and my hand was in a half cast. ( In the x-ray, it would
look like a x-cross of two pins. ) After 4 weeks the fixation pins
were removed and my hand was put in a cast. After 3 weeks this cast
was removed. In total, my hand was in cast for 7 weeks.
Upon removed the cast, x-ray showed that the
distal radius had collapsed by about 1cm and also there was
subluxation of the radial Ulnar joint. My problems were weak grip,
flexing the wrist and turning my palm upwards. The doctor also noted
that I developed Reflex Sympathetic Syndrome. I have been going for
physiotherapy sessions for almost 4 months already. The grip and
flexing has improved but I can only turn my palm slightly. Upon doing
stretching exercises, I can turn more but once rested, my palm cannot
turn much. I also feel restriction at the Ulnar bone when I turn or
flex my wrist. The Ulnar bone (distal) also feels bigger than my
normal right. There's some slight similarity in the 'dinner fork'
deformity.
What is causing me so much problem and
recovery progress in turning my palm ? What does this subluxation of
the radial Ulnar joint meant? What options are available for me to
recover ? Will I have future difficulties or possible to develop
other complications ? I would like to know more so as to be more
informed. I appreciate your professional advice.
A
You
have a serious injury that required surgical stabilization.
Unfortunately, the wrist somewhat collapsed on the radial side. My
real concern was the development of Reflex Sympathetic Dystrophy.
That in itself is quite disabling.
Your
options may be limited. I am not an expert on surgery, thus I don't
have any opinion for further surgery. Surgery can be beneficial,
but comes with substantial risks and no guarantees. After surgery,
the biomechanical function of muscles and ligaments gets distorted
from secondary scarring. The nerves can become irritated and thus
lead to RSD. You may want to find a good manual therapist or
massage therapist that will work with you on trying to release the
tightness and improve range of motion.
My
intuition suggests that because of your age and loss of function,
you may need to attempt a second surgery. However, do you homework
and find a physician at a University teaching hospital, Mayo Clinic
in Rochester Minnesota, Duke University Hospital to see if there is
a specialist in this corrective hand wrist surgeries.
I tried
to answer your question, which has been difficult for me to provide
a more definitive answer.
Q
I read with great interest you article
"Assessment and Treatment of Motor Vehicle Accidents", as it has shed
some light on some of my long-standing problems. Here is my story:
On October 1994 I was involved in a rear end impact MVA. I
was stopped in traffic; I checked my rear view mirror and saw a car
coming at a high rate of speed. I had braced myself both arms "locked"
(for lack of a better word) and hands gripped on steering wheel and
both legs braced right leg "locked" on brake and left leg "locked" on
the floorboard. Head slightly tilted right and up (looking in the rear
view mirror). I was driving a 1980 Monte Carlo.
I should mention that, at the time of my accident I was 33 years
old. I am shorter in stature- measuring 5 feet and 3.5 inches in
height and weighed about 120 lbs. I was undergoing treatment for TMJ
and approximately 9 months prior to the car accident I had undergone
treatment for whiplash and concussion (injuries were not as a
result of MVA). I should mention that, unfortunately, I wore the
soft collar for months on end (not knowing any better) and developed
muscle atrophy.
After the MVA, I was treated for whiplash and soft tissue injuries
for my upper chest, upper back, right shoulder and hip soreness. I
participated in conditioning program with little improvement.
Approximately 1 1/2 months after the accident I started to experience
sharp pains running down my neck along my spine when I turned to look
over my right shoulder.
Finally in August 1998, after worsening of symptoms, right arm
weakness, tingling and pain I had a MRI. The MRI indicated I had 2
herniated discs, with nerve root impingement at the C4/C5 level and
C5/C6 level.
July 1999 I underwent an Anterior Cervical fusion. Approximately 8
months after surgery I started to develop "cold burning spots", first
on my right forearm (about the size of a silver dollar) then on my
right calf. These "spots" have grown in size and spread to my left arm
and leg. At times I have a 3 degree temperature change from my right
hand to left (right being 3 degrees cooler), which had been documented
by a physician. I also burned my right hand on an oven element. I was
putting the lid on a roasting pan and I did not feel the hot element.
These symptoms, cold spots/burning/ sensitivity to hold cold, are
intermittent and appear to be activity dependent. I also experience
occasional burning sensation on my feet.
My right hip/groin and low back area is very painful at times. My
right hip, at times, feels "out of line" and when doing certain leg
exercises my hip snaps. When my right leg is pulled straight back I
feel my hip is back in alignment.
I also experience headaches, migraines, chronic pain, fatigue as I
rarely sleep through the night without waking up 2 or more times per
night.
The above is just a snapshot of what has been happening with me
over the past 11 years since my MVA.
Despite attending 4 Neurologists, 2 Neurosurgeons and 2 Orthopedic
Surgeons, (I might add all referral to these Specialist were done by
my family GP or by the Specialists themselves) I have no clear
diagnosis. I have had one Specialist indicate "Failed neck Surgery
Syndrome".
I am extremely frustrated and frankly feed up! I am tired of being
thought as and treated as a malinger, I have been a hard worker all my
life and continue to work very hard… I should mention that during the
11 years since my MVA, I completed my University Honors Degree, with
Honors, and have worked steadily since 1998 (with the exception of 3
months when I had surgery). And have done this, despite of the pain
and fatigue I experience on a daily basis!
I am really hoping you can help me and shed some more light on my
symptoms….
A Thank
you for your information and reading the article. Let me add more
clarity to your situation.
The
first mistake you made was to brace for impact. The energy of the
impact was then transferred into your musculoskeletal system. With
the arms in a locked extended position, you may experience
subluxation of the wrists, elbow tendonitis, but more importantly
shoulder joint trauma especially in the acromial-clavicular AC joint
that is interconnected with the clavicle bone that attaches at the
sternum or top front of the rib cage.
In the
lower extremity one would mimic similar pattern of biomechanical
forces. Distally, the ankle can malalign, the outer aspect of the
lower and upper leg can absorb the force into the small muscle
called the tensor fascia lata, as well as the sacral-iliac joint can
become subluxed (malaligned).
Additionally the forward and back movement of the spine can result
to deeper disc lesion in the forms of a bulge, a larger bulge called
a protrusion and finally a disruption of the disc into a disc
herniation.
When
the skull moves forward and back rapidly, the gelatinous brain
swells as if jello was thrown about in a metal container leading to
concussions or if forceful enough to loss of consciousness.
When
one experiences pain while asleep, the pain awakens the person to
change positions.
You
have done with diagnostic tests such as the MRI to identify the
major traumatized areas and their causes. My recommendations is to
find an osteopathic physician who performs manipulations or a
chiropractor in your area to realign the minor joint Subluxations
(malalignments). Massage can be added to follow each manipulation.
If you have access to an AIS trained massage therapist AIS Active
Isolated Stretching or the Mattes Method, this technique is quite
good. If you live in the St. Louis area I know of an excellent
therapist with various manual techniques. Mark Frank is his name and
I can forward his contact number if you need it.
I hope
this helps you understand your immediate needs.
Q.. Thank you so much for
writing back and shedding light on my symptoms. It has been a 11
years since my car accident and no one has ever explained things
to me as you have in one email. I realize now that bracing for
the impact was not a very good idea....
I live in Canada, so finding professionals
who are aware and can treat my symptoms are rare if found at all.
I have tried attending a Chiropractor for
adjustments and Massage Therapist, but I do not believe he
specialized in AIS. Besides my Insurance company has advised me
they will no longer reimburse me for either treatments. I can not
afford the $60 per week to attend both treatments.
The massage did help with my pain control and
at times the Chiropractic adjustments helped with the alignment,
but adjustments on my neck, near the fusion, became to painful and
I became fearful. I try to keep active and exercise on a regular
basis, albeit at a much slower and less intense pace than before
the MVA.
No one has ever addressed my shoulder
soreness or why I am unable to work with my arms above shoulder
height. One theory is thoracic outlet syndrome. I do have a
dimished pulse when tested according to my Doctor.
I have also under went needling (deep
muscle), botox treatments, cortisone shots, embrol shots, deep
tissue massage and manipulation. At best, these treatments have
been of limited benefit and provide temporary relief. I typically
attend my doctor on a weekly basis for treatments.
I did forget to mention that the Insurance
experts estimated the force of impact to be 15-18 kilometers per
hour (9 -10.8 miles per hour) forward velocity.
Q
I think I have an upper ankle sprain on my
right leg. I have been icing it and it is still very painful. Is it
worth it to see a doctor or should I just keep icing it and take it
easy until it feels better? What is the exact location of an upper
ankle strain? About a third of the way down from the knee on the
outside part of the leg downwards? I am just curious because I am
leaving for a ski trip in a few weeks and want to be able to ski in
comfort if possible.
A The
upper ankle sprain is located above the proper ankle joint. This
implies muscular strain. Muscles that move the ankle, foot and toes
have their upper most attachment in the area. The location of the
attachment helps identify the muscle that a person overstretched and a
biomechanical mechanism of injury can be explained. These upper ankle
strains respond as any other tendonitis, initial ice to reduce the
area of swelling, then rest--which implies not to overuse this muscle,
applying a tension wrap to give a slight support to the muscle, then
after a few days or up to a week later, start to increase its use and
possible address attention of strengthening that muscle group. The
activity of skiing won't be as affected for upper ankle sprains as the
boot provides an excellent "brace" for the lower third of the leg.
You may experience discomfort from keeping the muscle contracted
within the boot, but it is unlikely that you would worsen the
tendonitis. After skiing, you may want to incorporate some isolated
stretching exercises for that specific muscle group. Over the counter
anti-inflammatories may also be beneficial or even aspirin if you can
tolerate aspirin and have no medical conditions that contradict its
use.
Q
Can you tell me if the breaking of an airbag in an auto crash
can cause labored breathing and pain in the chest. I can't seem to be
able to get out of bed without extreme pain. If I cough oh my god
forget it. The pain seems to be like a straight line right across my
chest and after two weeks it has not gotten any better.
A
Chest wall pain, even
difficulty in breathing are common occurrences following a motor
vehicle accident. The ribs are joints that "articulate" or connect in
the spine called the thoracic spine. All twelve ribs insert into
small joints. At impact, the force call shift these ribs slightly out
of position or a term we call in medicine as "subluxation". As a
result of this shift, the muscles that attach to these ribs change
their length and strain or spasm causing chest wall tightness. If the
trauma was more forceful, ribs may break or fracture, but not
displace. X-rays can miss these non-displaced rib fractures and a MRI
of bone scan are more sensitive. Frequently associated with chest
wall/rib injuries are the collar bones on each side called "clavicles"
that can also displace from their insertion into the sternum and cause
upper chest wall tightness and some shoulder pain--notably in the
acromion-clavicular joint (AC Joint). I agree with your plan of an
MRI. For readjustment of the ribs, a chiropractor or a DO (Doctor of
Osteopathic Medicine) be best trained to provide proper manual
adjustment and corrections in the malalignment.
Q
I have a few questions as I have been struggling with pain in
my wrists, hands, and fingers for 7 months now. I have also
experienced tingling in my fingertips and painful clicking and popping
in my fingers and wrists. I have had numerous tests and several
possible medical problems have been discussed, but none decided upon.
I was hoping to get some general information or at least be pointed in
the right direction to have my questions answered.
I am very curious about the volar anatomy of the wrist. I
notice that I have bumps (bilateral) on the volar side of my wrist,
just below my thumbs. These are the areas of my wrists that I have
pain in and the bump is there when my hand is in radial deviation and
then almost appears to shift distally when I move my wrist into ulnar
deviation. The left wrist has a slightly larger bump and they are
just above the most distal wrist crease. I have done a lot of
research, looked at numerous pictures on e-hand.com, and also used
friends and relatives for comparison.
There are similarities in some cases, but the other bumps I have
detected are much smaller in size than mine. I am not sure if this is
normal or if it is some sort of abnormality. My best guess, if this
is a bone, is that it is the scaphoid or lunate. However, I cannot
find a diagram or photo that indicates that there is a volar
protrusion, other than the scaphoid tubercle, of either bone. I have
also seen pictures of ganglion cysts in similar areas, but I am not
sure how likely bilateral and nearly symmetrical ganglion cysts are.
I am a 24 year old male and any problems without a previous history
of trauma or an underlying condition would be out of the ordinary
anyway. Can you give me more details on the volar wrist surface
anatomy or tell me how to find more information? I appreciate your
time, effort, and consideration. I am going to see a hand surgeon
next Thursday and I want to be as prepared as possible. I have a
fairly extensive background in medical research, but finding the
details that I am looking for has proven to be difficult.
A
It appears that you have a
good foundation in human anatomy which helps me explain at a higher
level of understanding.
Your approach to the
problem was very logical. Symmetry of bone protrusions is unusual in
trauma or disease state for your condition. Familial tendency is
more common. I have seen protrusion of the distal ulna and radius
that look like a deformity, but yet most of these variations were
non-painful and functional.
The problem lies in the pain
you experience and the numbness of the fingers. I seriously doubt that
the scaphoid is shifted out of its position. The area at the junction
of the wrist and thumb, the
metacarpalphalangeal
joint is the most common first area of inflammation for an individual
prone to osteoarthritis, especially if they use their fingers and
wrists against repetitive resistance. You may even have a slight
subluxation of this joint, malalignment, that allows the MCP bone to
shift out of the joint proper.
Another problem lies in the
tracking of the tendons that glide over these bony structures. In the
radial aspect, three tendons glide to give movement and strength to
the thumb. If they are inflamed, a condition of DeQuervain's
syndrome develops.
This is the consequence of
the tendons causing friction and resulting tendonitis. I usually try
to shift the carpal bones back into alignment and ensure that the MCP
joint is not subluxed, then myofascial stretching allows the
functional elongation of these muscles and tendons to return back to
their proper position and function.
The numbness of the fingers.
Compression of the sensory nerves in the wrist may lead to two
patterns of numbness. If the large median nerve is irritated by
compression, then the thumb, index and middle fingers become numb.
This is known as carpal tunnel syndrome.
If the ring and little finger
are numb, then the ulnar nerve may be irritated. If only the finger
tips are numb, I don't know, but I know a significant number of my
patients describe this, usually after some neck trauma, but I don't
know how it neurophysiologically is explained, or worse, how to
correct or fix it for them.
If you are a golfer, and you
carpal (wrist) bones have slightly shifted out of position, you will
experience pain with movement and hitting the club. At age 24, it is
doubtful that you have degeneration occurring. Sounds like your
doctors have eliminated or ruled out inflammatory diseases of
the small and medium joints.
Many doctors will give you an
opinion, even if they don't know the answer. Few state the
honest--I Don't Know. Therefore, before you agree to anything
invasive, such as surgery, make sure that is the definitive answer.
Before surgery, get at least one other surgical opinion from a doctor
the initial surgeon may not know. Hand surgery is great for those who
need it, but terrible for those they are "exploring" to find answers.
.....Q
Thank you so much for your response. I know that your time is
incredibly valuable. It answered a couple of my questions, but also
prompted another one. Can the Scaphoid and/or Lunate bone be felt on
the volar surface of the wrist? I have attached a few pictures of my
wrists. I am not sure if you can comment on them or not since we do
not have much of a relationship and you have not conducted an exam.
The pictures of my left wrist have the "mass" circled and there is a
deep crease between it and the thenar muscle nearby. My right wrist
looks very similar, but the mass is not quite as big.
A
Regarding your question. The
lunate bone is the only carpal bone that moves dorsally, whereas the
others are usually palmar shifters. Yes, you can palpate all the
carpal bones if you understand and have experience in anatomical
assessment.
Divers are the most prone to
lunate dislocations. They usually use taping as a measure to
prevent this carpal bone from subluxing. Another test is range
of motion. Do you have full range of motion of the wrist in all
planes? Is it symmetrical to both wrists, assuming that you did not
traumatize, fracture, or had surgery on one wrist?
.....Q
I do not want to bother you, but I came up with a few more
questions. I hope you don't mind, but no hard feelings if this is
asking too much. Where is the approximate location of the
scaphoid bone
on the volar side of the wrist?
Is the carpal tunnel just to the ulnar side of the scaphoid? In
a normal wrist, is there a visible protrusion of the scaphoid bone?
I followed up with my hand surgeon and he told me that he does not
believe that I have carpal tunnel syndrome based on the negative emg/ncv
study from May of 2005. I have had the same tingling in my
fingers for nearly a year now. I have no idea what else it could be.
I was a little upset this week because a co-worker of mine has been
having arthritis like pain in her left wrist for about a week and her
PCP ordered an MRI no questions asked. In 8+ months, I have only been
able to get 1 set of x-rays and some blood tests during a number of
very brief office exams with 4 different physicians. Am I doing
something wrong during my appointments? Would an MRI even be helpful?
A
Yes an MRI
is indicated. It could be the scaphoid bone, or it could be a
ganglion cyst. Symmetrical
on both palms usually a congenital condition rather than a
disease. I did get the pictures finally, but I can't give you a
definitive answer.
.....Q
Thank you for the information. I have an appointment with
my hand surgeon next Wednesday. I pleaded my case on the phone, but
they would not order the test until I go back into the office. What
do I have to say in order to make sure that they don't just say to
continue with NSAID's (which have not helped at all in 10 months) and
splints rather than ordering an MRI?
They also mentioned injections, but I am not willing to settle for
temporary relief and then have to deal with the same issue again in 6
months. I think injections are overused and the doctors do not
consider the possible complications. The injection site cannot be
seen and I know that an undiagnosed infection can lead to sepsis after
an injection. Also, what if a persons anatomy is different for
some reason and the landmarks traditionally used leads to a nerve or
tendon injury?
As always, I really appreciate your help. I want to be prepared for
my visit so that I get the treatment that I think I need. I think
that patients need to be their own advocate, but I do not want to be
threatening or hostile either. After all, this doctor may take a
knife to my hands at some point.
A
Your concerns are valid. The
most important aspect of medicine is the most precise diagnosis. The
MRI provides invaluable information that we as clinicians use to help
us make that diagnosis. To arbitrarily inject a substance into a very
complex area of ligaments, nerves, and tendons just to experiment is
flawed medicine. Additionally, you are paying for insurance for
situations like these. Why shouldn't the doctor utilize the
diagnostics for his benefit, it doesn't cost him anything? In your
visit, provide as concise of a history and also politely request that
other physicians have recommended and MRI. Possibly summarize our
ongoing email discussions. The successful outcome of your doctor's
visit is establishing a diagnosis.
Q
I have recently noticed and felt that my wrist is hurting. I
don't remember falling on it or anything. I don't know if it is just a
sprain or something else. Their is a protrusion of some bone in that
middle of my wrist when i bend it down at a 90 degree angle. I was
wondering what this protrusion was and how to treat it. The Protrusion
is more towards the thumb side of my right wrist but really almost
centered.
A
Your question is a good
example of a wrist bone malalignment. Out of the eight small
wrist (carpal) bones only one of them dislocates dorsally or to the
top of the wrist. This bone is the lunate bone, often seen in divers
(not scuba, but swim divers). As the divers hit the water, the wrist
bone shifts out of position and causes pain and discomfort.
Typically, these divers must use a taping technique to help stabilize
this bone from shifting.
If you were in my office I
would position your wrist in a neutral position an place my thumb at
the top crease of your wrist. Separating the small bones from the
large forearm bones, as I pull (or apply traction) on the hand away
from the forearm and body, my thumb would focus on pushing the
> small lunate bone downward into its anatomical position. You
can't perform this technique on yourself as you tighten up the muscle
and the bones can't shift. You need someone to apply appropriate
amount of traction. If you experience pain at the force of
traction--too much traction is provided.
Q
Can you list the muscles involved in the kinetic chain of
events for a baseball pitcher?
A
Thank you
for your question. It is a great question. Since the mechanics of
pitchers differ and differ for the type of pitch, I shall defer to a
better specialist to address your question. He is the former Cy Young
pitcher Dr. Mike Marshall. He is a PhD in kinesiology and has a great
website that explores many aspects of biomechanical explanation. Dr.
Marshall and I have worked alongside at Univ. of South Florida in the
High Speed Camera Analysis of various pitching motions, but he has a
greater expertise than me. His web site to address your question is
www.drmikemarshall.com
Q
I'm a middle-distance runner. Or rather I was. I have
chronic ITB tightness/pain, with weakness on the lateral aspect of my
knee that has prevented me from running for 18months, despite much
physiotherapy. I eventually found some straps that allowed me to play
basketball without much pain (but still couldn't run long distances).
(I don't know if this is normal?).
In playing this I have now developed what appears to be an equally
debilitating injury. It 'came on' following a new exercise in the gym
- a lunge and a particularly heavy playing week.
I initially thought it was a quad strain, with the middle quad (vastus
intermedius, I think) being the most painful. Then, following the
games, the 'point of pelvis' (anterior rim of wing of the ilium? - my
partner's a vet, trying her best with the human animal anatomy!
Anyway, it's the bony point at the front) was also painful. In 6
weeks the pain in the pubic area and quad has not gone away,
stretching makes it worse, and swimming/walking don't improve it,
situps and pushups exacerbates the pain. Worryingly, the quad area
has also been numb, even during exercise, for the six weeks. The
numbness is focused in the middle quad, but extends down to the
lateral side of the knee joint, and sometimes includes the whole quad
muscle and ITB.
I have seen an osteopath, who diagnosed and treated uneven leg
length and malaligned spine. This has improved the ITB problem, but
not the pain, weakness and numbness of the quad.
Any suggestions you can offer would be wonderful.
