FAQ

Q I have a question, or a dilemma actually. I suffered a high ankle sprain. It didn't really hurt much and I had no idea what a high ankle sprain was at the time. For two days it was painful, but no swelling really at all, and therefore I didn't think it was anything serious or worth going to a doctor for. So 6 weeks passed by, and then it started bothering me out of nowhere, so went to a doctor finally.

He took x-rays and diagnosed me with a high ankle sprain, and my pressure x-rays showed a mortis space. However, he told me that since it had been 6 weeks already, that surgery wouldn't really help because scar tissue had formed in the space. So he put me on crutches and a boot for 5 weeks. After this immobilization period I went back and the space had not widened and he told me I can start physical therapy and should be ok over time.

A The clinical picture is best when one has the opportunity to examine the injury. First, based on your description, the physician did choose appropriately, although, I am not an orthopedic surgeon to make that a expert medical opinion. Even though you have a high ankle sprain, other structures do get sprained, such as the small but vunerable ligaments that connect the smaller bones to the large tibia and fibula.

Although treatment was proper, you may need physical therapy to assess the ligaments and range of motion of your ankle. At my clinic we manipulate osteopathically the ankle bones into best alignment and that reduces the strain and secondary inflammation. If you are in the southwest Florida area, you are welcome to stop by and I could evaluate it for you.

Q If a trapezius muscle is damaged from injury if it can cause injury to the scaleane muscle group?

A Yes, frequently the scalenes are involved are the are closely linked with the scalene muscle group, especially in a neck whiplash injury. There is a simple screening test for the scalene muscle involvement. Extend your arm forward as if you were a policeman signaling someone to stop. Then "fold" your finger tips closed tightly with your hand in the open "stop" position. The distal finger tips should close tight. If you have a slight gap between your distal finger tips and your middle finger area, you may have a strain of your scalene muscle group. Hope this helps.

A The concern is valid. By slapping your thigh you can damage a superficial nerve in the thigh called the lateral femoral cutaneous nerve. I would look up this nerve anatomy and see if it corresponds to his description. Let's start here and write back if you have further questions.

Q I fractured my wrist 3 weeks ago breaking boards in Tae Kwon Do class. It is a non-displaced distal ulna - its right at the wrist joint - it caught the edge of the board. What is the normal healing time for this in a splint and will there be any long term complications from this?

The doctor would not really give me any straight answers - it may heal or it may not but you may not even experience any problems. He also gave me the option of a full arm cast or a splint 3 weeks ago and said the cast was the best option for healing but no guarantees and I would probably heal just fine with the splint with no problems. I'm 40 years old, in good health and never had a fracture in my life.

Can you give me some straight answers and treatment recommendations to help heal quickly as I want to get back to Karate class as soon as possible and at 100%.

A The healing occurs at three weeks for "normal" use, but six weeks before you can do strenuous activity. A non displaced spiral fracture is the best case scenario for a fracture as it will heal nicely. If you looked through my web page, there is a good article about
wrist injury that concerned my son.

You may have a similar result, the fracture site healed 100% but he lost movement of his wrist and experienced pain with movement and resistive force. In addition to a fracture, your carpal or wrist bones may shift causing friction and malalignment problems with persistent swelling and pain. Hope this helps.

Posted November 7, 2007

Q My son was involved in a car accident 11 months ago which resulted in an 80% compression spinal fracture. He had surgery on L-4 and L-5, two 9 inch rods, two crossbars and 9 screws put in. He has gone through 11 months of therapy. The injury effected his bowel, bladder and reproductive functions. He has regained bowel and bladder use completely.

The range of motion in his right ankle area is very limited. He has limited feeling in his toes. Therapy is soon ending except for what he is to do at home on his own. His balance has been effected and he isn't able to walk as a normal 25 year old should. He walks very slow due to the balance issue.

A Thanks for your inquiry, and I apologize for the delay in responding to you. Sorry about your son's injury. The spinal nerves do get damaged and do recover at the rate that you were told. My question is whether the nerve damage is at the level of the spin or lower in the leg or ankle. A neurologist can study nerves and their recovery patterns with a test called a nerve conduction velocity test and the muscles the nerve innervates with an EMG which are usually done together. The balance issue may be of multiple causes such as head trauma, hip-pelvic fractures, and a neurologist can help determine the cause of his balance problem. I know I wasn't as helpful as you may have wanted me to respond, but your son's case is a bit more complex for me to speculate of the origins of his deficits. Hope this is a start.

Q I have a quick question for you and I hope that you can help me out. I suffered a type 1 radial head fracture about a year and a half ago. I went through all the therapy and it has healed, however I am still not able to fully extend my arm. I am losing about 20 degrees from full extension.

Its a little painful, especially when I try to extend it and sometimes when I bend my elbow I can feel a popping sound. I haven't seen a doctor, but I plan to in the near future. I know from what I read that loss of motion is common with radial head fractures. I was wondering if surgery was possible to restore my full range of motion. I am a male and 40 years old. Any help you can give me would be appreciated.

A Thank you for your inquiry. First of all, I am not an orthopedic surgeon and cannot give you an opinion on any surgical correction. However, I think that you should have further diagnostic tests performed and reviewed by a competent orthopedic surgeon in your area. The concern lies in the positioning of the head of the radius in conjunction with proper joint alignment.

If the head is displaced, alignment through surgery may be necessary to obtain maximal range of motion. If you choose not to identify all your options, the available options of surgical correction may diminish the chances of success in restoring functional and optimal range of motion. An MRI may be the more definitive diagnostic test, but I would defer to the orthopedist that will assume your care.

Q Is there a isolated cervical stretch i can do x-rays say disk disease C6-7 chiropractor adjustments no help medical doctor no help physical therapy no help. I am tired of fooling with these people just want relief from stiffness from neck and shoulders. I am 48 year old male and an avid walker doctor says to keep walking but this doesn't help either.

A Isolated stretches that you can do for your self are Active Isolated Stretching developed by Aaron Mattes who has authored a book with illustrations for self stretching which can be effective. His web site is www.stretchingusa.com

Q Can the C2 make you have bad headaches? I have a bone spur at my C2. What can I do about it? The pain is so hard to bare at times.

A Your problem at C2 usually will cause headaches. The reason for the headaches are the many neuro sensors of ligaments, small muscles, and the attachment of supporting tendons that allow our skull to flex forward and backwards, along with rotating it to the right and left that have nerve sensors that refer pain into the back of the skull and result in headaches. Occasionally a chiropractor versed in C2 alignment may help or a neurologist may offer a nerve block of the occipital nerve that travels in this area in the back of the skull. Hope this helps.

A Falling down on the right side could easily injure the liver. You may want to ask for a CT scan of the abdomen to assess the liver. Blood work including liver enzymes may show injury to the liver as well. Bring this to the attention of your physician.

Q I had an L5 fusion 12-05, 1-06 a second operation to take out the pin out of my vertebrae, this didn't help, 12-06 third operation things were much better, now I beginning to get all the leg pain back, back pain, sometimes the back feels like a broken mirror, the worse pain was yesterday a "tuck and roll" to get out of bed.

Over the past 3 months as my systems from my back worsen, I began to get large multiple bruises on my thighs. They send me for blood test all comes out negative. Today Today Today I have 5-6 large bruises 1 1/2" to 3" in length. The bruising stopped for 2 weeks but came back when my back started. I do have some nerve damage that's apparent, like I can't feel the top of my foot. Are these symptoms related?

A Thanks for you inquiry. I am writing quickly as I prepare to make hospital rounds, but felt compelled to answer you. The bruises you describe are the disturbing part of this clinical presentation. Bruising occurs from trauma, force to the skin and tissues or a problem with normal blood clotting. Normal blood clotting can be impaired by liver inflammation or medicines that interfere with clotting factors.

Liver inflammation can be caused by excessive Tylenol usage, narcotic usage, as narcotics have a high dose of Tylenol within them. Alcohol can contribute to the problem or even Hepatitis A, B, or C and change the liver's ability to maintain normal clotting ability. Aspirin products can cause bruising or if you take blood thinners such as Coumading or Plavix. You should consult with your primary physician sooner than later. Secondly, I don't know of any direct correlation of bruising with the nerve damage or surgery. Let me know what they find

A Thank you for your question and it is a good question. In my education and training, I would have responded that throwing weighted balls that cause symptoms of pain should be discontinued. However. I have observed the training of a former Cy Young pitcher, Mike Marshall who also holds a degree in Kinesiology from Michigan State University who bases his training program on large weighted oversized balls. Additionally, he has a novel new unorthodox style of training that has not resulted in any worsening of injury as he has helped a few professional players rehabilitate via his program. In any case, he is readily accessible to communicate by phone or his web site www.drmikemarshall.com I would defer to his experience and training to address your question.

Q I was recently in a car accident. During the last couple of days I have had several new symptoms with my legs; not being able to walk without pain, shaking legs, weakness, etc. I went to visit my Dr. today and he diagnosed me with Arthero... Clauditis or something like that. In an effort to find out more about it, I came on line tonight to find out more. I cannot find anything about this. My Dr. referred me to an Oncologist and also a vascular surgeon to rule out things that would be causing this pain. I have been taken out of work now for the next couple of weeks because of my inability to walk, etc. Please write back if you know what this is or could provide more information on this. I may have spelled it wrong, etc. but basically, muscle pain, soreness coupled by not being able to walk long distances without being tired, etc.

Q I am experiencing significant swelling of the lateral aspect of the left knee, especially when the leg is bent to 90 degrees or greater. During extension swelling is visible on both the medial and lateral sides (lateral worse). The knee is very tight and is weak especially when during movements such as rising from a sitting position, the act of sitting down and going up and down stairs. Is this something I should have examined soon?

47 y/o WF. Hx of Osgood Schlatter’s, osteoarthritis. Surgery for medial meniscus tear and lateral retinacular release about 20 years ago on right knee. This is the first time I’ve had any symptoms from the left knee at all.

A You may have had similar symptoms on your right knee. Swelling inside the knee joint suggests some type in internal derangement, and with your symptoms, a meniscal (cartilage) problem is high on the list. I would suggest an evaluation by an orthopedic surgeon who specializes in knee operations, and an MRI of the knee may be the best diagnostic test to identify the problem. Hope this helps.

A The best individual to ask is Dr. Basmajian in Canada. He is retired, but lives near Hamilton, Ontario and is the pioneer of this type of research. I personally don't have objective nor conclusive studies to demonstrate this movement. However, as the supraspinatus does insert laterally into the proximal humeral head ever so slightly off center, it most likely has some rotational torque. Rotation should be reported as more inward or outward, inversion--eversion, but it is difficult to comprehend a "lateral rotation: therefore I share your confusion. Sorry I couldn't be of more help.

Q I am currently studying sports science and was wondering if you would help me with a query I have I was wondering what joint and joint actions are used during a golf swing.

A Biomechanical Engineers and Kinesiologists are best source to answer your question. If there is one or two specific questions you may have, I will try to answer them and please write me back.

I met with the surgeon yesterday. He doesn't know what the problem is. He can't do an MRI because of the plate and at first wanted to do an exploratory surgery but now he just wants to take that broken bone out to fix the problem. In addition to that problem, I had a nerve conduction test which showed that I now also have a pinched nerve in my left elbow but no one has told me with nerve it is.

I have been in physical therapy for that for the last month as well as calaflam anti-inflamatory and don't experience any lasting relief. I am applying ice once - twice a day but that is about it other than taking the anti-inflamatory. The surgeon said I am suffering from tennis elbow.

So my question is which one do I fix first? I am so frustrated by all the pain and discomfort. If I fix my right wrist first which is probably some of the worst pain then I am worried about making my left elbow worse which is a very close 2nd to my worst pain. The right wrist and left elbow switch back and forth to which is the worse. Or do I try and fix the left so that when the cyst is removed in my right my left won't be so bothersome. Do I get a 2nd opinion? Do I go to the chiropractor and see if he can try your joint mobilization directions to get me relief? My right elbow is certainly working on catching up with my left elbow and right wrist in the pain dept so I know I need to do something but I am just lost as to what.

A You have had a fall with both arms and wrists, but the fracture occurred on the right wrist. However, the right wrist problem is independent of the left elbow. The joints of our body do shift ever so slightly, and when they do, the muscles strain from this shift.

Tennis elbow results usually from a slight shift of the wrist (carpal) or elbow connection of the ulnar or radial bones. As your wrist situation is too complex to comment on with any degree of certainty, I will comment on your elbows. A chiropractor is a viable option to consult with to help provide a mobilization technique to "re-align" the elbow joint and release the pressure of the muscle and possibly the ulnar nerve that may be irritated.

I was at my pain clinic for a 90 day check up, and I was c/o pain in my neck, and feeling like I have sleeping in my right hand and arm. I have RSD bilaterally in my lets and feet.

I fell while I was shopping with my family, stepping down from a curve to the parking lot and hid my spine/neck area on a "handicap sign post"... it hurt!.. with help from my husband and two gentleman who were there at the store, I was able to get up.

Since then, I have pain and h/a at the base of my neck, and have numbness in my fingers, arm and shoulder. The clinic MD who was mostly interested in my progress with my RSD, just seem to "look over" my injury. I fell about a month ago, and the MD I saw at the pain clinic, said, well, it could be a c-6 strain.

I have strength in at area, but the pain and liminitation is remarkable. He said we would look at it again in Oct when I was there again. But it continue to bother me, it's the headache, and the hand problems that worry me. Am I feeling just too worrisome?

A Your state of health is complex with a diagnosis of RSD of your lower extremities. The neck muscles as well as the nerves from the cervical (neck) spine can refer pain down the distribution of the arm and hand.

The nerves and the muscles have their own specific pattern of numbness which helps the clinician diagnose the problem more specifically. As you describe a newer injury to the neck and spine with increased pain symptoms, you were correct to notify your physician and have the physician examine your clinical situation.

If your physician cannot reassure you in the diagnosis, you may want to ask for a second opinion with a neurologist or a physical medicine and rehabilitation doctor. MRI of the neck or a nerve conduction study may be considered by these specialists to objectively identify or refute certain causes of your referred pain into the upper extremity. Hope this helps.

Q Does the labrum attach all the way across the joint capsule and can you point me in the direction of a good diagram of the labrum and capsule. Sorry to bother you and thank you for your assistance.

A I have expensive human anatomy books, but I have found that using "google" is very accommodating to finding medical illustration. If you live near a medical school, you can visit their library, or even better yet, ask for their anatomy lab where they may have models or anatomical specimens of the anatomy you wish to view.

A Until recently, a total knee arthroplasty required a large incision to complete the surgery. Now smaller incisions are made in certain medical centers with innovative techniques. Unfortunately, knee surgeries do cut through the capsule, the question is how much of the capsule depends on the approach and technique.

Q I stumbled across your website while searching for information about Colles Fractures. I fractured mine ten weeks ago and it was displaced with ulnar styloid fracture, fixed with closed reduction and casting. At six weeks the cast was removed and I was told I probably also had a tear of the Triangular Fibrocartilage Complex.

I was put in a brace for four more weeks. So now I am at week ten and beginning physical therapy. The ulnar side is and always has been very painful, I have a hard time with supination, and very limited wrist extension. I really feel like my wrist looks out of place.

The bones just don't look right! It is also still very painful to supinate and extend with > frequent clicking sounds from the ulnar side. None of the doctors here seem very concerned about the pain and limited motion and just keep encouraging me to go to Physical Therapy. But I know that something isn't right, and feel that my carpals are not aligned properly as compared to the other side and how it feels to move my hand! I am concerned that if I don't get appropriate treatment, it will never heal correctly.

What would you recommend for someone who lives in a rural area of Alaska with limited resources? And do you have any suggestions on how I might be able to convince the doctors here that something isn't right. None of them have performed any sort of physical exam on my wrist, only looked at the XRAYS and said they look good. Thanks!

A Your description of your injury is almost identical to my son's Adrian's that led me to find a technique to mobilize the wrist in order to restore range of motion and eliminate his pain. The only test I could think of is an MRI of the wrist to describe the extent of the injury.

In regards to manipulation of the wrist, rural areas have limited resources and specializations. If your therapist has questions about my technique, the therapist can call my office and I will try to guide them in their attempt.

Q... Thank you so much for your reply! After I have received such minimal responses from my own doctors here, it was refreshing that you would write back all the way from Florida! I am going to print out your article on wrist mobilization and I think that the physical therapist I am seeing here would be interested.

He has most of his background in Sports Medicine. I am hopeful that he may be the only one here who can help. I will also give him your website if he needs any more information. Thank you again for taking the time to write back. I have had many frustrations here trying to get someone to take me seriously.

The Physical Therapist here did notice that my carpals do not seem to be aligned properly. I'm not sure he would know what to do about it, though.

Q I really enjoyed your article on energy medicine. I am getting trained in energy psychology and experiencing good results, both in myself and in my patients.

How detrimental is abdominal surgery (e.g. a big incision, the removal of an organ like the gall bladder or uterus, or even the spleen? How does the whole Chinese Medicine system work when one of its organs is removed. Is the energy flow disrupted forever or only temporarily?

A Thanks for your inquiry, but unfortunately I don't have the knowledge to answer your question, which is an excellent question.

Q Do you think it would help to strengthen the brachioradialis to improve the outcome of tennis elbow?

A Strengthening muscles around the affected joint and its ligamentous and muscular tendon attachments is favorable in most situations. However, tennis elbow --epicondylitis has many different circumstantial mechanisms of injury and inflammatory healing responses.

Q I was injured in a "Roll-over MVA two years ago. Cervical and low back pain since. Head trauma with negative brain scans. I am overweight. I have not been able to return to work and now I am experiencing leg weakness and falls and very difficult to ambulate. Much testing and herniations at L-4 through S-1 on MRI with nerve root compression. Any ideas?

A I have more questions than answers. Did you see a neurologist, if not you should be consulting with one. Secondly, did you have a nerve conduction test, you may need one. Thirdly, did they offer you an epidural corticosteroid injection to help reduce the size of the disc herniations. Fourth, spinal decompression may be a conservative measure that could help your condition. Please respond back, and I will try my best to guide you through this complex situation.

Q I'm a runner. It doesn't hurt when I run or jump. However, hurts to laugh or cough and sleeping is tough. Sharp pain 1 inch above groin on left side and travels down inside of left leg. Going from lying to standing also tough. I am a 38 year old female. Could this be a psoas minor strain? It has progressed for 4 months. Has CT of abdomen and pelvis due to pancreatic cyst which is holding steady. Just had hip x-ray today.

A The clinical symptoms you present are more characteristic of the psoas muscle, not so much as the psoas minor, but most probably of the psoas major muscle. If it is a psoas major strain, the hip X-ray should be unremarkable.

Q I am a 42 year old woman who enjoys equestrian riding. I like riding up to four to five times a week. Unfortunately, I injured myself and have hip pain, tight back, tight glutes, and loss of flexibility on my right hip. I believe it is a iliacus strain and psoas problem. I am going to a sports therapist and his treatment is ultra sound and pressing on the muscle. I don't think it's helping. I am tighter than before. I have had two treatments. I have previously seen a doctor and a sports therapist and they did not diagnose my problem. My range of motion on my right hip is not the same as my left side. I can feel pain if I press on the Iliacus muscle. I have had this injury for a year February. Please help! I am in Orange County, California. Is there any one you can refer me to or help my sports therapist treat me more effectively.

A The most likely cause of your clinical presentation is a shift of the iliacus with the sacral bones, a sacral-iliac malalignment that osteopathic physicians or chiropractors are trained to identify and provide manual treatment techniques. The muscles you describe and the loss of range of motion of the hip is characteristic of this malalignment.

Q... I have a follow up question please. I saw my regular Dr. today, I see an Ortho. next week, however, there was a marked decrease in muscle strength in my left leg, I'd lift it, and she could push it right down, kind of embarrassing for me. Is that normal with a muscle strain of the psoas, are there any nerves that run through there, any thoughts you have on this would be helpful until I can get to see the Ortho.

A...Medically, the most common weakness of specific muscle is a neurologic impairment of the innervation or supplying nerve to that muscle. However, if the movement of that specific muscle against resistance creates a painful condition, the muscle may simulate a "functional" weakness. To properly determine which is the case relies on the clinician who is examining you and they can make the clinical decision on how to proceed in diagnostic testing. They may refer you to a neurologist to make the definitive determination and clinical impression.

A Your questions are excellent physics questions. I would refer you to the best source, David Tuttleman a former NASA aerospace engineer who has written and studied the physics of golf. If you "google" his name, he has a telephone number to his home or web site and he can best answer your technical questions. Hope this helps.

Q My son is a 15 year old high school baseball pitcher. He did not pitch for two month because his arm bones were growing faster than his muscles. He was put into a program of exercises to strengthen the bones which are fine now. In the course of the therapy they made a correction to his pitching mechanics so as to reduce the chance of injury. He started to throw the ball and pain came to the front of his shoulder which was diagnose as a new muscle being used as a direct result of the new mechanics. What exercise or throwing program you recommend to strengthen that particular muscle. The arrow shows were it hurts.

A The arrow points to a most critical point in the shoulder complex, the area of the acromial-clavicle junction, the area of the anterior labrum. The pain may be a strain on the shoulder and with the amount of force in the pitching motion, he may be at risk of tearing his labrum, the rim of the shoulder capsule. Before I would instruct him to work through this pain, have him see an osteopathic physician or a chiropractor to align the acromial-clavicular joint with the clavicle. This will align the muscles anatomically and reduce the torque on the anterior shoulder. This is the first step and the most important in resolving his pain condition.

Q I was reading your website and the information that was presented was great. My situation involved what I believe to be a "fight or flight" syndrome. I had just given a presentation in class, when back to sit down and felt a nervous shake in my neck. The next day, I woke up with an incredibly sore neck and upper back. I initially attributed my "fight or flight" response to excessive caffeine use and stress from school, but after further analysis believe excessive physical exertion at the gym as a likely cause. My trapezius muscles always feel tight, and strained.

A The trapezius strain across the tops of the shoulders is more commonly caused from a strain in the lower cervical--upper thoracic vertebral area. I would start with consulting an osteopathic physician or chiropractor and have a spinal adjustment attempted. Let me know how you progress.

Q I have had severe neck pain for six months now. I have had pain on the right side of my neck extending to the back of my neck on the right side. I have tried everything from physical therapy, chiropractic, neurologist, and my regular doctor. I missed three weeks of work in March because of an exercise I did from physical therapy. I was doing the neck glide exercise and that caused me to have a constant pain in the right occipital area. The neurologist put me on neurontin for the pain but it has helped only slightly. I do exercise and try to do neck exercises as much as possible but the neck glide causes the most pain. Could you please tell me what that neck glide exercise might be doing to me? I have an appointment with my neurologist at the end of July.

A Reading your symptoms, you may have a strain of the suboccipital muscle called the splenius capitis. Use google to find the anatomical position and more importantly the referred pain patterns. This is a very difficult muscle to treat effectively. Let me know if this "fits" with your clinical picture.

Q I am a very fit, athletic 65 year old woman, 5'7", 122 lbs.. I took up golf two years ago and am passionate about it. My Index is 118. Last January, I adopted a more athletic stance to gain more distance. I believe this is the cause for the strain I am experiencing on the piriformis muscle in the lead (left) hip. The first incident was quite painful (no instant pain, but grew while warming up at the driving range).

At first, I thought it was the labrum. We were in Hawaii and I was researching it on the web. 21/2 weeks later, I was playing golf. This latest occurrence is not as severe, but non the less, keeping me from golf and walking fast. I can go up stairs, but not down. I can easily flutter kick my legs on my stomach - as well as lifting them. I saw a PT today and had stem and ice. We did some stretches that I have already been doing. It did not help. Am on antiflammatory. Any suggestions would be greatly appreciated.

A The symptoms you describe fit the diagnosis of a sacral-iliac syndrome. This is a very common problem and most often managed effectively by a competent chiropractor or osteopathic physician. The sacral-iliac shift changes the alignment of the hamstrings and quadriceps muscles and leads to strains of these muscle groups.

Pain is experienced with sitting over the sacral notch. The piriformis and gluteal muscles are also affected. If the piriformis if moderately severely strained, this may result in the irritation of the sciatic nerve and lead to sciatica. To review, start with chiropractic or osteopathic physicians.

Q I had my knee scoped 8 weeks ago and I can do light workouts but I still am having pain in running. Is this normal? Do i have anymore options as to rehabilitation?

A Arthroscopic surgery serves two purposes, one is diagnostic, and the second to "clean up" the joint space. To help you with your problem, I would need to know the symptoms, your age, the diagnosis and why the surgery was performed. I also need to know if the same symptoms persist or are these new symptoms?

A Grade one spondylolisthesis rarely requires surgery. Chiropractors usually aggravate it and as you found cortisone is only a temporary help. Decompression therapy may be of help as inversion tables. You can inquire on google or call some larger rehab centers and ask if they own a unit, if not if they know which facility owns one as you have a "prescription" for such a service. Let me know how you respond.

A You have an interesting presentation of turning on lead hip and creating a painful hip with weightbearing. I think that the problem is a sprain of tendon or ligament that attaches to the hip bone, the head of the femur. I don't know anyone in Fort Myers, but I have a practice in Bradenton, and would be pleased to evaluate your clinical problem.

Q My symptoms are knee pain below and behind the right knee. I just turned 31. The surgery was preformed because of a 20 to 30% tear of the petal tendon. The injury occurred when training for a tryout. The pain is not as bad but still there. I can do most everything I used to just without the weight. It has been more that 2 months since the surgery.

A The pain from a torn patellar tendon would be at the knee cap and below located in the front of the leg. The pain behind the knee could be one of many structures including but not limited to the posterior cruciate ligament, the posterior meniscus (cartilage), the attachment of the hamstring muscles, a posterior ligament or small popliteus muscle. If you find a large "sack" of fluid, this is called a Baker's cyst. A Baker's cyst is a benign condition, but large sacks that interfere with knee bending may require surgical removal. Hope this helps you.

Q In the study with over and underweighted balls, what was the routine. How many times was each ball thrown and how many days a week?

A The information you inquired about can be found in the original research paper published in the Journal of Applied Sports Science Research, 1990, Volume 4, Number 1, pp. 16-19. This was a study done at the Univ. of Hawaii HPER Department with the lead researcher being Coop DeRenne. Other articles from this group were accepted to the National Strength and Conditioning Association handbooks and resources. If you can't find the articles, write me back.

Q In your online article entitled Muscle Memory and Motor Learning In Golf you refer to research done at the University of Chicago "studying professional golfers and muscle memory". I would like to find out a great deal more about this research. Do you have a reference for this work? Has any of this work been published? Any help you could give me in finding out more about this work would be greatly appreciated.

A The University of Chicago study was done in the 1990's and I don't have the paper readily available. An extension of the study was done at the Univ. of Calgary with the article published as "Quiet Eye" phenomenon. But to answer your question, I don't have the article in my possession. The article could be found on "google" with typing words of EEG, golf, Univ of Chicago, ect. Hope you find it. I will look for it also to complete my reference papers.

Q I'm having a problem with my downswing sequence squaring the clubface is a chore. I also pull the ball frequently. I turn back with my shoulders ,then after that I am lost. Any help would be appreciated.

A Unfortunately, I am not a qualified professional golf instructor. There are too many variables to review on what would cause flaws in your golf swing. Consider finding a reputable pro who could advise you on your flaw and make beneficial corrections. Sorry that I couldn't be of more help.

Q I am experiencing extreme pain in my lower back, buttock, pain radiating down my right thigh, muscle spasm and calf pain. I have numbness and tingling in my big toe, as well as the sole of my right foot. So far anti-inflammatory, Tylenol 3 and neurontin seem to have no affect.

I am trying every morning to do a regime of stretching as well and also am using heat, My hip also is very painful and walking, rising from bed is difficult. I have already experienced back surgery many years ago (a laminectomy) the left side was the problem.

I am also experiencing pain in my neck, right arm pain, tingling in my fingers, wrist pain as well as shoulder pain and nerve pain down my right arm. My entire right side seems to be a huge problem. When I see my doctor, he attributes all symptoms to Fibromyalgia. Can you help?

A I have seen fibromyalgia present with this type of presentation. However, to assure yourself that no diagnosis is missed, you should consult with a neurologist to give you a thorough exam and possibly more testing. If you live near a medical school teaching hospital, that would be preferable to seek a consultation there rather than a solo practicing physician.

A Thank you for your inquiry. You are the active type. Not sure if you are participating in contact or non-contact boxing. Non contact boxing may be easier on your back than non-contact kickboxing. As you have had a compression fracture in the higher lumbar spine, your lateral spine flexor the muscle called the quadratus lumborum will be actively contracted.

The compression fractures do change the spinal heights and predispose to smaller muscle and intervertebral ligament increased tensions and more vunerable to strain and sprain. Your osteopath should diagnose the reason for your spinal spasm and identify what types of movements would predispose to recurrence.

Your question of whether this injury can recur, the answer is a strong probability. However, recurrent strains should not be immediately associated with harm or permanency in injury. You may also want to consider an effective pre-activity stretching program along with a soft flexible abdominal-low back binder as support during your athletic activity. I hope I have answered your questions.

Q My 14 year old son was hit by a pitch last night. He was struck on the ulna. We took him to Kaiser and an x-ray of the possible fracture site was taken. The x-ray was reviewed by a Physician's assistant who said that there was a "questionable" fracture right below the growth plate. When we went to the cast room, the attendant there said he didn't see a fracture. I have requested the x-rays and will be pursuing an outside opinion. My son is also a runner and is scheduled to run in a meet on Saturday (three days from today).

He is a very good runner and stands to win both of his events (mile and 800). He is in a fiberglass cast and wants to run. If this "fracture" is indeed questionable, wouldn't it make sense to first of all, have a radiologist review the films, and secondly, to put him in a splint rather than a cast? I'm tempted to remove the cast if I can't get the x-rays reviewed prior to the meet. What is the worst case scenario if he runs with a "questionable" transverse fracture?

A Quick answer, if he runs with no cast or splint and should fall, he would shift the fractured bone and require probable surgery and this would change the muscle lengths in his growth and take away from his potential in throwing. Get an opinion from an orthopedist, but do not jeopardize the fracture from getting worse.

Q I've had a problem with my left wrist as long as I can remember. I have only about 30% mobility when it comes to rotating it (I don't know the technical term for this motion). This has given me problems when I've tried to play lacrosse, and made playing the guitar almost impossible for me. I even tried playing left-handed (I'm right-handed) but ran into problems with my left hand trying to strum.

I saw a doctor 8 years ago who told me that it looked like one of the ligaments connecting my radius and ulna were too tight. They could stretch it out, but they wouldn't know how much to stretch it.

Also, when I do rotate my wrist if I flex it downwards towards my arm, a small soft-ish lump protrudes, I have no idea what it is.

I really want this problem fixed, do you have any guidance?

A First, the small lump over the wrist area. It is most likely a cyst, called a ganglion and is benign. If it interferes with motion or causes pain, surgery needs to be done to excise the entire cyst and permanently remove it. With movement and friction, this cyst can grow in size. Stabilizing the wrist or limiting use may shrink this ganglion cyst.

The other possibility is the lunate bone. Divers push this small bone, the lunate outwards from the back of the hand/wrist area and frequently tape it down during training. I would doubt the scenario of the ligaments being too tight and would get other surgical opinions before anyone operated on my wrists for tight ligaments. Do you remember having any injury or trauma to the wrist in the past?

Q Six years ago, I was involved in a car accident. I was hit from behind and pushed into the car in front of me. I had severe pain in my hip and leg immediately. This went away a few days later, but three days later I could not move my neck at all. I had no range of motion to the left side pain in my shoulder, and down into the top part of my arm.

I was first diagnosed with cervical whiplash with distonia. I have gone through pt for six months, pain management one year. including medications, trigger point injections cervical blocks Botox to no avail. I have extension forward but no backward movement of my neck. I have severe headaches under the occipital lobe which goes up the back of my head and into my eyes and into the left side of my face as well. This is severe pain. I never have a second that I am not in pain from this now.

The pain is starting to continue down my arm below my elbow and into my hand. They easily go numb and there is sharp pain in my thumb and first finger also. Six years later my diagnosis is chronic myofascial pain syndrome including referred pain. How can whiplash turn into a lifelong disability such as this. Should I have something that has not been done tried at this time or is this it. The pain doctor I had seen also said I did everything he would have tried.

A First of all, I would suggest cervical flexion and extension X-rays. Then I would suggest finding a competent osteopathic or chiropractic physician to manually adjust your cervical spine. You may have malalignments of the upper cervical vertebrae at C2 which cause headaches and attach to the scalene muscles. I don't think you have had much experience with manual techniques to realign your spinal segments.

Q I have a son who is the top 9 yr old golfer in the area. He loves to play soccer as well but golf is his love. Lately he been wanting to play baseball. The question is, will playing baseball and being taught how to hit a baseball slow down, have and effect or hurt his golf swing?

A This is a great question. The old school taught not to cross over in sports. However, biomechanics found that golf and baseball hold many similarities in swing motions. Eye hand coordination is different. I think that playing different sports can have similar movements is not a factor in so as much as him trying weightlifting which would increase bulk and interfere with his flexibility and agility. Finally, I have not seen any studies that studied crossover sports training.

A I don't have any one specific exercise a psoas as it is a deep muscle that acts as a hip flexor and rotator. How do you recognize that it is weak and differentiate it from the iliacus group? If you paraphrase what other muscle groups you are interested in strengthening or what condition, maybe I could be more of a resource.

Q I have an injury that has not gone away in 2 months. It is Kind of an ab strain (feels tight when i stretch all the way up) and kind of a groin strain (it only hurts when i adduct my leg standing and dragging the foot against the ground, and only in the Range of motion closer to the centerline) It also hurts when i drag it against the ground (leg straight again) in a roller blading t-stop kind of position.

I can squat ok, but the exercise that hurts is a HIGH box step up (mid thigh). I have been training around it with high box sq, and pulls.

The pain is only on one side (right) and exactly next to the ahem... pee pee. What are suggestions or experiences?

A Based on your history, you should see a physician to make sure you don't have an inguinal hernia or testicular torsion. These are the two most common presentations are you clinically describe in your question. The other possibility may be a sacral malalignment or subluxation. For this sacral-pelvic malalignment you may want to consult and osteopathic or chiropractic physician. Hope this helps.

A A grade IV Spondylolisthesis is very unstable and may require surgical rodding and fusion. It is unlikely you would change the clinical situation and may even make it worse. I would seek a neurosurgical opinion.

Q Having read your article re. Golfer’s back problems, I am having these conditions just now. I have seen my doctor, and he has given me pain killers and some physiotherapy, however after some 6 weeks I am still unable to carry out a golf swing without considerable pain above and to the back of my right hip. Have you any suggestions as to what I can do to improve my condition.

A Based on the information you provide, I think you have a slight malalignment of the sacral-iliac which causes increase strain of the low back muscles, the quadratus lumborum and the buttock muscles, gluteus medius and minimus muscles. Additional problems of this malalignment result in quadriceps and hamstring tightness. A consultation with an osteopathic physician or a competent chiropractor is probably your best choice.

A To find a physiatrist in your area, you may contact the American Academy of Physical Medicine and Rehabilitation either on the web site or their main office in Chicago, IL. Additionally, each physiatrist may have their own area of expertise.

A I would refer you to the expert Dr. Mike Marshall, former Cy Young pitcher and PhD in kinesiology. He has a web site devoted to pitching and answers all emails at his web page www.drmikemarshall.com

Q I fractured my right wrist Nov 1, 2006. The orthopedist satisfactorily pinned the radius, but the ulna is out of place making the circumference of the wrist 5/8” larger than the left. I have been in occupational therapy for about 4 months but the fingers don’t bend as tightly as they should. I can just forcibly bend them to touch the palm crease. I have been wondering if the tendons have shrunk to explain why this is happening.

Your site makes a lot of sense as I went to my chiropractor, who is also a kinesiologist. He checked the strength of the two little fingers, which had no strength, and manipulated the radius at the elbow. Complete strength to these fingers was re-established immediately, and has remained. I will see him every two weeks. With this sort of treatment, is it possible to hope for complete flexibility of those fingers and the replacement of the distal ulna back in alignment where it belongs?

A Your chiropractor provided you with an excellent result. Have his check to see whether the ulna is aligned at the elbow as this may correct the alignment. Additionally, have his manually shift the back row of small wrist bones, especially the ones closest to the ulna and the range of motion may improve considerably.

Q I broke my wrist in six places. have had to have a fixator attached for several weeks an another operation to add a plate and some screws and wire. I am now very limited with turning my hand with palm up or palm down. like it is fused and will not turn. Doctor is suggesting the karpunge method of cutting a small portion of bone and a picture shows a screw put in the other bone and low radation is used and extreme p.t. what do you think?

A Almost always I have an answer or recommendation, but your situation sounds very complex and I can't respond as I may influence your decisions and I have little basis for any opinion. I would ask your surgeon what are his recommendations and seek one other confirmatory opinion and then use your best options. If the second opinion is different, seek a third. Try to find a surgeon with the greatest specialization to what is your problem, even if it means to travel away from home. Sorry that I can't be of more help.

Q Could you please tell me if you feel physical therapy or other types of less invasive treatments would be effect or appropriate to treat a large paracentric disc protrusion/extrusion c4-5w/mass effect on the central and left hemicord. There are also numerous issues of spondylosis, two levels, mild stenosis, degenerative changes. T2-3 protrusion. I want to have as much knowledge as possible when speaking with my Rheumatologist. I do live locally and want to be very careful when making treatment decisions about my neck. Thanks for taking the time to answer my questions?

A Rheumatoid arthritis is a disease that can also affect the joints and ligaments of the spine, especially at the base of the skull. Your therapy must take this into consideration. Discuss with your Rheumatologist on what precautions he recommends you to adhere when seeking therapy. One consideration is a steroid injection called an epidural that may shrink the protrusion. Another treatment may be decompression therapy using hydraulic traction machine to take the pressure off the disc, decompression. You may want to start with these two options.

A Thanks for asking the question, but unfortunately I am not a qualified teaching golf professional. I would suggest to find a PGA golf professional in your area and have them review your swing mechanics and golf equipment.

Q I have problems with pulling the ball. I try to take the club straight back in backswing but the downswing is so elusive I am lost. Can you help me?

A I don't think I am the expert to guide you with your swing mechanics. You may want to seek out a top 100 teacher, or if you have the opportunity, Jim Hardy who presented the one and two plane swings to the golf world. I suspect you have a swing plane preference that is natural and you are not maximizing its potential. You may start by reading Jim Hardy's recently published book.

Q My son is a 16 year-old left-handed pitcher, 5'9" and 180 lbs. He attends a very large "Class AA" high school in upstate NY. He is a talented pitcher and was the only freshman to make the varsity squad last year and the only LHP to make the varsity squad in the school's history. He pitched 24 innings of varsity ball and had an ERA of .086 with 21 K's and only two walks. He is a very focused young man and always warms up and stretches extensively before he ever picks up a baseball to pitch.

Mid-way through last season he developed soreness in the tip of his left elbow. We took him to an orthopedic doctor who examined him (conducted x-rays also) and the doctor diagnosed the soreness as tendonitis of the tricep. The doctor said if my son were older he would just give him a shot of cortisone and tell him to rest his arm for a couple of days. Instead, the doctor put my son on rest and a heavy regime of Advil for two weeks.

The soreness quickly dissipated and we rested the elbow for a month -- my son had no pain or soreness. After a month, he resumed throwing very lightly and over a couple of weeks slowly increased his velocity and distance to where he was 100% again. He pitched all last summer on a travel team and did quite well. He would occasionally feel the same soreness in the tip of the elbow for a day or two after pitching. He would ice the elbow and take some Advil and the soreness would be gone within a day or two. We explained this continuing condition to the doctor and he explained that tendonitis of the triceps can be difficult to cure and sometimes take 6 months to a year to completely heal.

Travel season ended in July and my son then threw three games in the short Fall season without any soreness or pain. On the doctor's advice to rest the arm, my son did not pick up a baseball for three months this winter but instead lifted weights all winter (heavy weights with low reps for the lower body and light weights with high reps for the upper body -- he also does a modified "Dr. Jobe" shoulder workout three times a week). In addition, my son did aerobic training on a stationary bike 3X/week.

Last week we began to throw indoors at half-speed at a distance of 30-40 feet (for ten minutes, about 35 throws) and once again, the soreness in the tip of his elbow returned almost immediately after throwing. We contacted the orthopedic doctor and he examined the arm once again, he still believes it to be tendonitis of the tricep but has now, in addition to the original x-ray, he has scheduled an MRI. I routinely read your website forum with interest and would greatly appreciate your thought on this situation and in particular any therapy you would recommend to address this nagging injury. Also, what are you thoughts on the use of cortisone? Thank you very much for your time.

PS. I forgot to mention...... when my son recently felt the soreness return to the tip of this elbow, he mentioned, for the first time, that the soreness is felt when he follows-through on his pitching motion (after he releases the ball). I will also add that he occasionally drags his left foot (push-off foot for LHP) and does not allow it to turn over and immediately lift off the rubber during his pitching motion. With our focus now on his tricep soreness, I have just recently noticed on old videos that during his follow-through he sometimes seems to abruptly slow down his pitching arm across his hip area and not allow it to slowly decelerate lower to the ground (outside his stride leg in "elbow to knee" fashion).

I am starting to think that arm "recoil" may be at the root of this tricep problem. What are your thoughts? Also, I am still interested in your thoughts on a therapy regime to address this injury and also your thoughts on cortisone. Thanks Doc! We plan to utilize the "chair drill" to address the mechanics problem of dragging the push-off foot and also the arm recoil -- are there any other pitching drills that may be helpful?

A Yes your elbow can be injured as a result of the car accident. Frequently this occurs when the hands are on the steering wheel at impact. The energy forces are transmitted to the elbow and shoulder.

There may be a slight malalignment of the elbow joint, bone contusion, or even referred pain from the shoulder are possible causes of your elbow pain. Your orthopedic surgeon will be able to sort out the proper diagnosis. An X-ray may be the first step and even an MRI may be required to make a definitive diagnosis. I hope this helps.

Q Dr. Kochno we met at the Orlando show and I was very impressed with your research. I mentioned to you that my wife is a personal trainer and is heavily involved in the sports and fitness industry here in Canada. She to was impressed with Mind Drive and Flex Drive.

I used both products while golfing and training in Palm Beach after the show and found them both to be very remarkable. I am home now in Canada and would like to know how I could help bring these products to Canada? The Performance drink was also outstanding when my wife tested it. It allowed her to move beyond her maximum by what seemed to be a lowering of her heart rate, could this be possible?

A I'm pleased to hear that you had a similar beneficial response to Mind Drive. I will direct you email to the owner and he will contact you. Heart rate may not be related to Mind Drive, but I don't know for sure.

Q I am trying to locate a doctor /clinic in the central Florida area that uses Botox for muscle relaxation for stoke patients with permanent muscle spasms. My mother has muscle spasms in her toes that keep them turned under. Does your clinic use this procedure and if not, do you know of any that do?

A Thank you for the inquiry, but I do not do Botox injections. Your mother's clinical situation is one of which Botox may help considerably to relax her spastic toes. I would focus on Neurologists that specialize with Botox. I hope this helps.

Q I had a partial four point fusion to my left wrist 7weeks ago and I am now about to start physio. What exercises or new therapies do you suggest. Would ultra sound, acupuncture or any new therapies be helpful. I am an avid golfer and am looking for any suggestions that might help.

A A four point fusion is quite an extensive surgery for the wrist. A well experienced hand therapist should provide you with a effective rehabilitation program as two points are paramount to your successful rehabilitation. The first is not to compromise the surgical corrections with any forceful movements that would disrupt the fusion, nor any needling of the skin or dermal layers as this can induce an infection.

The second and as important issue is the quick facilitation of return of maximal range of motion and strength. Ultrasound may be too vibrational and disrupt early healing. Acupuncture may create an opening in the skin for local infection. You should consult your surgeon on his or her recommendations as they usually have experience with local rehab providers and alternative therapies and can safely guide you to where they feel that you would receive the most optimal therapy program.

Q I have a annular bulge at l1-2 and shallow protrusion at L5 both with minimally effacing the thecal nerve sac i also have sharp pain in my spine and numbness in my right butt cheek and stinging pains in my buttocks what does that mean?

A I assume that you have an MRI that shows the findings of a bulge and a shallow protrusion. You also describe a "stinging" pain in the cheek and buttock. Your question is what is causing the discomfort. Not knowing any history, I'll be general in my response. Bulges and shallow protrusions of the disc do not immediately signify pain or referred pain, but they can if close to the nerve root.

These levels such as L5 or L1 have classic, well recognized pain referral patterns. Less known referral patterns are the ones from the facet joints of these vertebra. However a focal stinging area is more likely an indication of an injury or inflammation of an underlying structure such as a muscle, ligament or bone. I will venture a guess.

Should your pain be reproduced by pushing on that localized area of pain, it should increase the pain intensity, supporting the diagnosis of inflammation of an underlying structure. The most common inflammation is from lifting against resistance or falling on the buttocks. This results in gluteal pain that may be a muscle called piriformis, or the gluteal muscles, most commonly the gluteus medius.

However, the pelvis bones are held together by a thick fibrous tissue at the junction of the large iliac bone which forms the crest of the pelvic rim and the more distal or lower spine segment called the sacrum. This junction is called the sacral-iliac area and can cause similar symptoms. In addition to a well trained physician, an alternative to consult an osteopathic physician or chiropractor may be of benefit.

Q I am a 45 yr old female diagnosed with a large herniated disc c-5c-6 with spurs on the left and narrowing of the discs also have nerve root compressed in c-6 c-7 now I have developed high blood pressure my doctor says it is from the pain in my neck is this true?

A A very good and commonly asked question. I work with many injured patients and find that when they are experiencing moderate to severe pain that their body responds with an increase in heart rate and blood pressure. Therefore I agree with your physician.

Occasionally, I have to add a blood pressure medications for my patients in pain short term until their pain is managed then I wean them off their medications. It is important for the patients to keep an accurate journal of their blood pressure at least two or three times a day for their physician to guide them on whether they need short term medication use.

Q I have been searching for some information on actual muscles being used during a golf swing. I was wondering if you could provide me with some additional information, or could you direct me where I could find some? I absolutely love your web site, I have recommended the site to all my fellow students, and I refer to it very often for information for my studies!

A Thank you for visiting my web site and recommending it to others. Golf muscles have been studied by Physical Therapists and physicians using electromyography (EMG). The earlier research has been done by Timothy Hosea and David Lindsay. Dr. James Andrews co-wrote a book on golf biomechanics published in the past 2-3 years. I hope this provides you with a direction to start.

Q I am writing in regards to the knee capsule strain article. I cannot seem to find much information in relation to knee capsule strain and therefore, what symptoms such an injury would produce. I noticed that in the article the person landed with their knee in a hyper flexed position. I believe what I did to my knee may be related to the hyper flexing my knee during lying leg curls at the gym. I was doing lying leg curls individually on each leg and leg in question is my right.

As I curled my leg it came up fast and forcefully and at the very top of the motion I felt a pulling/stretching sensation which caused some pain on the inside part of the knee. Currently I notice that when lying on my back I can bring my knee/leg to full flexion though if I pull it closer/tight to my body or extend my foot upwards (pointing my toes up) with my leg in this position that I can reproduce that pain.

I have no pain when I extend my leg or when walking or climbing stairs but the other day when I did my leg press I noticed that I had some minor discomfort on the inside of the knee that lasted less than 30 seconds once I finished the exercise though no pain during the exercise and again some minor short lived discomfort after riding stationary bike for 10 minutes.

My question is that does this fit within the realm of a knee capsule strain. I’ve seen an orthopedic specialist who did take X-rays with no visible findings and suggested a possible strain. Also I have been to a physiotherapist who specializes in sports related injuries and he suggested that there was possibly a strain or irritation of a sac that surrounds the knee joint. He performed the McMurray’s test and could not reproduce the pain with knee flexed at 90 degrees though when my knee was flexed beyond 90 degrees that and I did feel the pain I describe.

With all the other tests he performed he didn’t feel there was any cartilage damage though I’m not sure he was comfortable with his diagnosis. I am not sure what to expect from a cartilage/meniscus injury if one does exist. Could this be a meniscus tear is my greatest concern? Any input or actions to take in this matter would be appreciated.

A You sustained a knee hyperextension injury. The capsule is the protective fiber coating and usually that is not the main problem. The problem of the injury lies in the small supporting muscles and ligaments of the knee joint, most of them which attach to the posterior aspect of the knee joint. Commonly the popliteus muscle is the muscle that is strained.

This is the deeper muscle of the joint; whereas, the more superficial attachments are formed by the lower hamstring tendons. Unfortunately, X-rays do not visualize any ligaments, cartilage, muscles, tendons, or nerves. Thus, an MRI is more useful. My recommendations is to use your internet search engines to find articles on the popliteus muscle, how to diagnose and treatment options and bring this to the attention of your therapist.

Together, you both can arrive to a definite diagnosis, which is the key to medical care. I doubt that you have a cartilage tear, as these more often require a rotational injury to the knee with associated swelling. An MRI is needed to diagnose cartilage tears as well.

Q I was fascinated to see your article about mobilization of the wrist joint, because I am very concerned about how my wrist is not fully healing after a Colles' fracture five weeks ago. I am an avid figure skater, fell on the ice and hit the Right wrist. The x-rays seemed to show a fairly clean fracture which was not displaced. It was seen by an orthopedic surgeon who cast it, giving it a series of pulls and squeezes while the cast was still flexible, he said to lengthen it.

Two weeks later the bone had healed well and the cast was removed to give me a removable splint. However I immediately noticed my wrist looked dislocated, shifted sideways (towards the little finger) with great pain on the ulna side, and with any movement.

Three weeks further, with at first passive physiotherapy then active, the wrist is still enlarged at the ulna-head and very painful. There is no pain or loss of movement at the radial head, and I would guess the metacarpal bones are not displaced, though pressing the pisiform and the triquetrum I can feel a 'shift' of some sort. However the wrist is still swollen and it is not possible to play the piano without pain.

I thought the ulna might be displaced, or the triangular fibrocartilage complex was
displaced. Why should it hurt so much now, and not at all when broken? What is in the middle of the wrist pushing the radius and ulna apart? I am worried the rehab. exercises will simply get me used to a bad situation, not get the swelling down and the wrist re-shaped back to normal. I think it hurts because the ulna is in the wrong place. Do you have any recommendations?

A The wrist is complex. As you fell, not only did you fracture your bones, but in all likelihood you tore supporting ligamentous and fibrous structures. Once the support matrix is altered, then the smaller bones shift from their original positions and create
friction--inflammation. The body tries to reduce friction by creating fluid to lubricate bones such that they don't permanently damage themselves. If after or during therapy, you do not improve in range of motion without swelling, you may actually be irritating the underlying bones and ligaments.

The pivot bone of the wrist is the lunate in the middle of the wrist. This bone needs to be set in position first with manual manipulation. The outer small bones then will follow with appropriate manipulation . Usually, the large bones on the sides, the
ulna and radius are not out of position, but may influence the ligamentous tightness and limit optimal range of motion. The small bones of the wrist act as fulcrums over which the tendons of the forearm muscles glide to move the fingers in all their motions.

My recommendation is continue to work on the wrist and not give up. If you need to see me specifically, you can contact my office. Also a couple times a year I get out to New York where I have worked with students of the New York City Ballet and
their ankle and leg injuries.

Q I had a MRI done of my cervical spine in Nov. 2006 that showed herniated disc centrally off midline. There is mass-effect on the cord and extension to the Right Lateral Recess at C3-C4.At C4-5 Herniated Disc is seen. It is Central and slightly to the Left with Mass-Effect on the Cord. At C5-6 Herniated Disc is seen.

It is off midline on the left with Mass-Effect on the cord and compromise of the lateral recess. Disc protrusion is seen with compromise of Anterior Subarachnoid space. What kind or Kinds of Doctors do you recommend I see. I was referred to a Pain Management Doctor. How serious is it what is going on in my cervical spine. I have a lot of pain, numbness, tingling and I have been having these symptoms since Feb2005 when I was injured at work.

A Trauma induced cervical disc herniations are painful and most difficult to treat in comparison to other spinal areas such as the thoracic and lumbar spine. Single level or one herniated disc is easier than multiple. Since you have had an MRI, you have been seen by a physician you has now directed you to another consultant. As you were referred to a Pain Specialist, the clinical impression appears that surgical intervention is not a priority.

One problem with diagnostic reports is the variability of one center calling a disc lesion a protrusion whereas another calling the same bulge a herniation, but that in itself is another topic. The referral to Pain management implies to me that consideration of epidural corticosteroid injections is recommended in conjunction to appropriate pain medication schedule control.

Epidural corticosteroid injection is a injection near the herniation guided by X-ray to allow the steroid to "shrink" the disc protrusion at that area only. You may require 2-3 levels of injections. If you have a beneficial response with reduction of pain and referred pain, you will be offered two more series of the same injections. If you have no benefit or worsening of symptoms, then it is doubtful that any further injections would be recommended.

Surgery for the neck area is unpredictable with results. Surgeons are developing newer techniques to minimize the trauma of the surgery itself. Recently I saw that Cleveland Clinic in Ohio developed a less invasive surgical procedure for cervical fusions which looks promising as it allows for maintaining range of motion of the neck and opens up the channels where the nerve lies. I hope this helps you.

A One level disc herniation or three level herniation, as you describe an area of C2 thru C5? Disc herniations do improve and at times within a year or so reduce their size and occasionally heal. The concern is the stability of the cervical spine in relationship to the disc and the pressure if any it places on its exiting nerve root that causes loss of sensation and even loss of strength. Prior to surgery, one should consider a series of cortisone shots at the level of the disc herniation done under X-ray guidance called epidural corticosteroid injections. If surgery is indicated, the least invasive is preferred. Additionally, a center that performs these surgeries often at a major hospital center is desired. Recently I read of a modified surgery at the Cleveland Clinic in Ohio that chisels the bones that takes pressure off the nerve root without performing a fusion. A fusion is taking your bone, usually from the pelvic bone and attaching it as a "stick" above and below the herniated disc after the disc is partially removed to lend structural support to the spine, but will limit the range of motion in the spine. If your own bone is not used then bone banks have ":donated" bone from cadavers that are used. Before you agree to surgery, make sure you have two or three independent opinions on whether surgery should be considered. Also remember, all surgeons will tell you that there is no guarantee in pain reduction. I hope this helps and there is no cost for providing this information as I am pleased that you have visited my web page. Finally, I am not a surgeon and can not give any advice on the need for surgery.

Posted January 8, 2007

Q Six weeks ago I fell on my left hand and fractured my distal radius and ulna bones. The treating orthopedist felt I did not need surgery or "closed reduction" (is that the correct term? I mean "setting") and placed my arm in an above the elbow cast for four weeks. Two weeks ago, I went for another xray and cast. The doctor talked about one of my bones "shortening" one mm. and seemed concerned about more deformity and restricted movement than he originally anticipated. I have since gone to a hand surgeon for a second opinion and he confirmed that the radius shortened and caused the ulna to misalign as well. Well, the deformity looks freakish to me, and as a 45 year old woman who loves sports and yoga, I am sick over this. But, the prospect of hand surgery with bone cutting, grafts and plates, is just as frightening to me. Can you help or what do you recommend?

A This is very similar to the presentation my son had when he broke his wrist. I experienced the same frustration as you have. Unfortunately, I don't know of anyone who has the experience to manually realign the small wrist bones as I do, and I had to learn it for the sake of my son's well being. As you probably have read the article, it is a treatment of clinical knowledge and then experience. This technique is not one of tests, machines or able to "see" what is occurring in the manipulation process. I have had success in multiple situation like yours in athletes. If you'd like, I would be happy to work on your wrist at my office. Frequently I travel for business and teaching and if you contact me with your place of residence, I would be able to tell you my schedule in that area. If you have not read my article about how my son broke his wrist, I would encourage you to do so.

Q My daughter has been working out for a long time lifting weights and running track as a result she has a slight sprain in her right upper quadriceps, she can't complete a full stride what is the correct healing approach to this quadriceps injury.

A This seems like an easy question, but without direct trauma such as a hit in football, this is a more complex answer. First of all muscles follow their attachment points. In the quad muscle, proximally it attaches to the pelvic rim, and distally into the patella. A malalignment in the pelvis or patella leads to increased tension of the muscle an greater susceptibility to strain. The pelvis is made of 3 major bones or five bones that are connected by fibrous tissue. The pelvis can shift forward, upward, downward and backward. These are subtle shifts in position which the chiropractors are sensitive and provide adjustments. The medical physicians don't recognize nor a re taught about subtle changes. I would think a visit with a competent chiropractor may be your best avenue for a malalignment shift. If she fails to respond, consider physical therapy, massage therapy or stretching specific to the quad muscle. However, in my experience, as the problem did not correct itself quickly and you needed to write me and ask for advise, there is probably a structural malalignment problem that should easily correct and the secondary muscle strain resolve. Hope this helps, if not please feel free to write again.

Q My question is that I am suffering with bad terrible pain on my wrist with the tinnitus nerve going to my thumb and freezing it. What can I do?

A I would need more information, such as your age, occupation, incident of trauma or injury, date of injury, which wrist (right or left), which hand are you dominant or writing hand, if the pain is sharp and like lightning and disappears, or chronic - constant. The small nerves of the fingers and thumb pass through the wrist area and can create your symptoms. To be provided with a diagnosis is 90% then the remedy to heal or cure can be found. You may need to find a neurologist or physiatrist (physical medicine and rehabilitation) specialist, not to be confused with Psychiatrist who specializes in psychological conditions. These specialists can identify the problem of either nerve irritation or entrapment versus referred pain from a muscle or tendonitis. Hope this helps. If you provide me with more information, I may be able to give you more clinical possibilities.

Q My boyfriend used to box. He injured his elbows the last fight, 9 years ago, when he was 39, was told he over extended. He now has knots on the outside and cannot straighten them. He recently got the right one to straighten but there is still pain.

The pain is not in the joint but mostly when you touch the outside of the elbow. It almost looks as if it is twisted. He went to a doctor several years ago and they had no idea on what was wrong. He is wanting to force the right one straight and that concerns me. He thinks this will work because years ago when his daughter was young she jumped on him and at the time he could not raise his arms due to we assume frozen shoulders. He raised them and it broke it all loose and they are fine now.

Please, any help that you can offer is greatly appreciated.

A Boxers usually cause injury to their wrists, but with repetition, their elbows also absorb a significant amount of force. Mild shifts in position of the forearm bones, the ulna and radius into the elbow joint can create inflammation and over a period of time stimulate bone spur growth similar to calcium deposits.

The elbow is different than the shoulder and forced resistance may actually fracture the elbow joint which would lead to more problems. You need to start with an X-ray of the elbow. An MRI may be more helpful, but you should start with the plain X-ray first. If you suspect simple calcium deposits and prefer manipulation, an osteopathic physician or chiropractor may attempt to straighten the elbow joint.

However, long standing bone overgrowth may require arthroscopic surgery to debride or remove this excess bone growth. In regard to calcium channel blockers used to control high blood pressure, I don't know of any evidence that this leads to bone growth or spurring. I suspect boxing created this elbow problem. Hope this helps.

Bradenton FL 941.755.8819

Sports Medicine & Rehabilitation
INTERNATIONAL

Sports Medicine Home
About Dr. Kochno
Clinical Articles
Physiatrist
Services
Kinesiology
Patient Info
Contact Us
Referral Process
Professional Staff
Press Release
Gallery
Resources

Baseball
Baseball Pitchers and Hitting
Baseball Pitching Velocities

Boxing
Rehabilitation in Boxing
Concept of an Executive Medical Boxing Board

Golf
Golf Facts
Golf Conditioning
Swing Mechanics
Faults & Resulting Injuries
Shoulder in Sports
Age and Injury
Muscle Memory
Science And Golf
Golfer’s Spine
Spine Mechanics
Motor & Muscle Memory
Biomechanics Of Golf
Golf Mechanics - Questions

Football
Knee Capsule Strain
Psoas Minor Strain

Basic Anatomical Review
Spine
Shoulder
Elbow Joint
Radial - Ulnar Joint
Wrist Joint, Fingers and Hands
Hip Joint and Pelvis
Ankle & Knee

Sarasota Memorial Nursing Home Facility

New Patient Forms

Frequently Asked Questions 2007

Frequently Ask-The-Doctor Questions Asked

Bradenton FL 941.755.8819

Sports Medicine & Rehabilitation INTERNATIONAL

Sports Medicine Home About Dr. Kochno Clinical Articles Physiatrist Services Kinesiology Patient Info Contact Us Referral Process Professional Staff Press Release Gallery Resources

Baseball Baseball Pitchers and Hitting Baseball Pitching Velocities

Boxing Rehabilitation in Boxing Concept of an Executive Medical Boxing Board

Golf Golf Facts Golf Conditioning Swing Mechanics Faults & Resulting Injuries Shoulder in Sports Age and Injury Muscle Memory Science And Golf Golfer’s Spine Spine Mechanics Motor & Muscle Memory Biomechanics Of Golf Golf Mechanics - Questions

Football Knee Capsule Strain Psoas Minor Strain

Basic Anatomical Review Spine Shoulder Elbow Joint Radial - Ulnar Joint Wrist Joint, Fingers and Hands Hip Joint and Pelvis Ankle & Knee