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.

My question is how long does it take nerves to heal from the area of his spine to his ankle? He is 6 foot 2 inches. Is there a chance that he may not regain total recovery to the nerves to his ankle? Someone said nerves heal at a rate of a half of inch every month.

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.

Q Bike accident. Landed on right side. Painful ribs but x-ray does not show breakage. However, still severe pain after 4 days. Pain killers help a lot. Could it be liver damage because i get pain after heavy meal but I do have normal bowel functions.

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

Q A lot of athletics are complaining about their arms hurting after being taught in school to throw weighted balls. Is it appropriate to have this kind of training in order to be a pitcher in baseball? It is taking some several weeks to recover. I will appreciate your answer.

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.

A Some clinical information is missing for me such as your age and other medical health problems that you may have had prior to the accident. The reason I reflect on this is my concern on why you are referred to an oncologist a cancer specialist and vascular specialist.

Trauma of any kind to the spine with consequences of leg weakness should be investigated with an MRI of the low back, the lumbar spine. If nerve damage is suspected on the physicians examination, a nerve test should be ordered in the form of an EMG-NCS. This is a test of the nerves and muscles that these nerves control. Bruising of the nerve or pinching on the nerves can result in muscle weakness, numbness and pain.

The symptoms of fatigue of muscles with prolonged walking is more classic of claudication or obstructive blood vessel disease from risk factors of diabetes, smoking, and high lipids as the most common. Other medical conditions can also contribute to the narrowing of these large blood vessels that supply the blood to the muscles.

Based on what information you have presented, an MRI of the lumbar spine is the most important test to establish the cause or diagnosis of your problem. This test will find or eliminate the most serious and most urgent medical conditions. After this test, a consultation with a neurologist may be warranted if the problem is suspected to be of a nerve injury.

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.

On January 07 I had a severe radius displacement in my left wrist due to a snowboarding accident. A plate and screws were put in and a carpal tunnel release done as well. Several of the hand bones were misaligned and a small hand bone above the ulna was also broke. The surgeon said that it should heal just fine without anything else needed. According to the x-ray it has and looks to be in the right location. After several months of physical therapy I still am unable to rotate the left wrist.

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?

Q I have spondylolisthesis grade one with stenosis, degenerative disc. The pain has gotten worse the last 6 months. I am 61 years old and have had two surgeons tell me that I need surgery with fusion. I am trying to avoid that and have gone to different chiropractors. I just quit one chiropractor after 17 treatments because I felt worse. I would like to try Decompression therapy and was wondering if this would be a better move before surgery.

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.

Q I am having a problem with my left hip. This injury occurred while swinging a 7 iron. I am right handed thus when I made my swing and turn to hit the golf ball I hit the ground and instantly I had pain in my left hip. The pain is in the area were the thigh meets the pelvis. I applied ice as soon as I completed golf and I continued for several days.

Immediately after the injury I was not able to make a complete golf swing without have serve pain after I rotated the hip. I cannot put any weight on my left side. When I walk up stairs and place my left foot onto the step I immediately will feel severe pain in my left hip. Did I injury or strain a muscle? What should I do to rehabilitate my injury? Can you recommend MD in the Fort Myers, Fl area?

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.

I am a very active person who loves running, pilates, kayaking, boxing & kickboxing. As yet I have only been able to partake in pilates classes and have gradually built up from power walking to being able to run again (only for around 30mins per session at the moment on grass, not concrete at my Dr suggested)

I am craving to start boxing and kickboxing again but am lost as to how I should be training without hurting myself. 3 months ago I went to my boxing gym and as a result of 1 hour boxing training I put my back out for 2 weeks so I'm scared that this will happen again.

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.

Given that the injury occurred 9 Months ago, how long do you think I should give before I begin contact boxing classes? At my boxing gym they have both boxing cardio (on punching bags) and boxing technique (one on one with a partner) classes.

That is my last question!! I promise!

A....My response, why would you want to return to contact boxing, and risk other injuries. You already have compression fractures of the spine. Yes they heal, but they are never the same structure and prone to more micro fractures. In this case, I would ask you orthopedic surgeon for advice, but my advice is not to return to contact boxing. Sorry, probably not the answer you were seeking.

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.

Q I am a physiotherapist. I am informally trying to get some information regarding prognosis for patients with a Grade 4 Spondylolisthesis. The Grade 4 is a symptomatic Grade 4, progressed from a Grade 2-3 (asymptomatic) prior to the fall.

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

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