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Q &
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Posted April 5, 2008
Q
I found your explanation on the wrist interesting.
I was looking for information on bony growth on the wrist, because I
am having growing degrees of pain this last week, on my right wrist. A
tiny area on the base of the thumb bone, is growing outwards and may
be the culprit pushing on the nerves. Pain is mostly felt when I flip
the wrist in or outwards, and during rotation, esp downwards.
My mother used to have such a bony growth at around the same area,
when she worked as a clerk doing typing and paper work. Her growth was
so apparent, protruding almost 8mm from the base of the skin, on her
right hand too.
If I'm to lessen the use of this wrist in the next few weeks, do less
typing / computer work, will the bony growth stop?
Please offer me some advice what I can do about it.
A
The bone "growth" probably is
not an actual growth, but the shift of the bones outward, in response to
overuse. Secondary inflammation and swelling then occur that creates
osteoarthritis. I would have a good massage therapist, chiropractor
evaluate this condition. These specialists can keep the alignment of
the bones and thus reduce the progression of your condition. Also,
reconsider how hard you work with your hands and fingers.
Posted April 5, 2008
Q
What is your
opinion of boys that are 14 years of age and are in the early stages of
puberty pitching from 60 ft 6 inches the same distance a Major League
pitchers? Thank you for your time and I look forward to hearing back
from you.
A
It is a very good question. I
will direct you to Dr. Mike Marshall a former Cy Young pitcher with a
PhD in Kinesiology who would be best to answer this issue for you. His
web site is
www.drmikemarshall.com
Posted March 10, 2008
Q
I am a golf instructor and recently began
learning a little about the tremendous stress we golfers put on our
body. In the future, I am quite sure that biomechanics will be of the
utmost interest in my study of the golf swing. I look forward to that
day. But for now, I wanted to simply ask you about the "Therbo Robot"
or other robotic instruments that have been developed by companies such
as Meilus Muscular Therapy & Sports, Inc.
What do you think about these systems? I had an
opportunity to use the system at a convention and it appeared amazing
(I'm no expert, however). This was my first experience with any type of
physical therapy treatment and I was amazed at the results from one
sitting.
A
Although I do not have first
hand experience with the Meilus Muscular Therapy system, I have had
patients remark that it was beneficial to them. The skill still remains
in the clinician, diagnosing the problem and finding the most optimal
solution to correct it. Fortunately, I presume that you had the benefit
of both.
Treatments that have benefit
with minimal cause for risk are worth trying if recommended by a
qualified and trusted clinician. Other forms of alternative, holistic
and manual therapies are also quite successful.
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Posted March 10, 2008
Q
Finally, I think I found someone who knows
what I am going through with my right wrist pain. I just read your
website page about how you manipulated your son's wrist late at night
and cured him.
I am a golfer, and basically when I move my right wrist horizontally to
the right and then up - say 5 degrees - I have this weird numb pain.
The pain is mirrored of course when holding the golf club with the right
hand (as if addressing a ball) and swinging the club back about 2 feet
in its backplane arc. Right there at the 2 foot mark, the pain appears
again.
I go to a great chiropractor who has helped my low back pain, neck pain,
etc..., but he cannot seem to find the "right move" so to speak when
adjusting my wrist.
Guess I was wondering, is there anyway I could call you and you could
walk me through how to manipulate (if possible) myself to reset the
carpal bones. The pain seems to be right where the capitate bone
resides if that helps.
Or, can I have my chiropractor call you?
Frustrated but optimistic, appreciate your time!!
A
The wrist of a golfer sustains a
great deal of force in its swing motion and mis-hits. The carpal bones
do shift. Yes,you can have your chiropractor contact me at my office
number.
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Posted March 10, 2008
Q
I'm having pain in upper neck
, below the skull, which I would call the upper cervical part of the
spinal column. It could have happened doing lat pull downs on weight
machine. The pain is much less laying down. I have a second visit with a
chiropractor tomorrow. Been going on about 2 weeks. Any suggestions?
A
I think your evaluation by a
chiropractor is warranted. As I don't have the advantage of examining
you, I will assume that your chiropractor will ease your discomfort. If
your pain persists or you have questions about any imaging studies, such
as an MRI, I may be able to give more insight.
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Posted March 10, 2008
Q
I've been having abdominal and back pain for
2 months now, my doctor put the condition down to back pain , I get most
pain in my stomach when I sit down or drive my car, I get relief when I
stand up or lay down with a hot water bottle on my stomach, is these
symptoms common with psoas minor?
A
Your symptoms are generalized
and I can't say that they are psoas minor related. The circumstances of
your injury or timing of symptoms are important. Based on your general
symptoms, a clinical assessment by an osteopath, a physiatrist
(rehabilitation physician) or a myofascial therapist would be beneficial
to establish that diagnosis. There are some very good psoas major and
psoas minor muscle web sites that you can also visit and find diagnostic
presentations of pain and see if they correspond to your symptoms.
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Posted March 10, 2008
Q
I fractured my wrist almost 8 weeks
ago. The doctor took the cast off after 6 weeks. It still hurts
quite a lot and is still really weak. What can I do to get it back
to normal?
A
The best
advice I can give you is to find a specialized physical therapist or
occupational therapist who provides hand therapy. Aggressive
physical range of motion with strengthening exercises would enhance your
functional return of wrist function.
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Posted March 10, 2008
Q
My
daughter who is now 13, was diagnosed with Spondylolisthesis Grade II when she
was 9 years old. At that time she took part in gymnastics, complained of back
ache, chiropractor said she did not respond to his treatments, then went to
Orthopedic surgeon, who discovered the Spondylolisthesis.
He put her in a
brace which she wore for 3 months (was supposed to wear it for 1 year….she hated
it!) and was told to stop all sports, which she did for 2 years, during which
she received prolotherapy shots every 2 -3 months.
Prolotherapy helped with leg
pains disappearing as well as sudden weakness in knees. (She has received 14
treatments of prolotherapy) Unfortunately, she has developed stress knots in
shoulders and neck and is always very stiff, wanting to crack her body as soon
as she gets up from bed.
She seems constantly tired and also her right wrist
and arm are hurting. (I feel it’s all stemming from the fact that her spine is
out of alignment). The HMO primary doctor has no idea what to advise me to do
next.
When we visited the Orthopedic surgeons when she was 9, they both said
she should just take Tylenol if it gets worse and they can always operate if it
slips more (These are doctors at Children Hospital in Los Angeles, and Cedars
Sinai in Los Angeles)
My
question to you is what would you do as the next step? On
my own I have taken her for myofarcia massages to give her some relief for the
stiffness.
Can you also advise me as to what specific exercises she should do to correct
her lordosis? (The physical therapy from the HMO insurance was also not very
effective).
I
would appreciate any input you can give me. My search for help for my daughter
is not an easy one, especially not having any contacts in the medical
profession.
A
Your situation is rather
complex. First of all, a grade II spondylolisthesis is about a 50%
shift of the vertebrae from one another. Prolotherapy promotes scarring
of tissue, notably the ligaments around this weakened area.
Immobilization of the spine with a brace allows the growing spine to
functionally "fuse" its area of weakness.
The spondylolisthesis is a
greater concern when it reaches grade III where one considers surgical
stabilization, but this is an extensive surgery. Strengthening the
extensors of the spine may offer some protective benefit, but please
discuss this with your orthopedic surgeon.
Myofascial release may be
helpful, but only if it is done by a qualified and experienced
therapist. The therapist must caution on mild to moderate releases and
aggressive or strenuous release may exacerbate her symptoms. I would
ask the orthopedic surgeon on whether there is any benefit to further
prolotherapy as this is not an area of my expertise.
Physical therapy would not be
that beneficial with the exception of demonstrating spinal exercises,
along with reviewing precautions and contraindicated therapy exercises.
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Posted January 22, 2008
Q
Thank you for your reply. May
I ask a few follow-up questions? What is a lumbar pillow? And, is
'extension exercise' where my back would be 'hyper extended'. What is
'flexion exercises'.
I really don't understand the
science behind laxity of the fascial leading to progression of the
spondy... I thought the muscles and all that would keep it tight and
'stable'? I'm kinda 'struck' in what to do because everything is all
knotted up...I can see it and feel it through my back and now its
pulling on my siatica... so I was in the least looking into massage -
but now u are sharing your opinion with me....not quite sure!!
In any event, and in advance, I
thank you for taking time to share your knowledge with me.
A
A lumbar pillow is a reference
to a lumbar support that promotes the natural curve of your low back.
OBUS Forme has the best ones. The lower lumber support is better than
the larger entire spine support.
Flexion exercises are those that
hinge the joint areas upon themselves such as doing sit ups. Extension
is the opposite, where one opens the joint such as arching ones mid and
lower back.
Laxity of ligaments does occur
with repetition or trauma, especially during the growth years prior to
puberty in the spinal vertebrae. The muscles overlie these small
ligaments and provide support and promote spinal movement. The goal of
managing Spondylolisthesis is to help promote the back extensor muscles
to be strong and maintain proper posture.
Myofascial work has two
purposes, to promote maximal flexibility and optimize myofascial
response to muscle recruitment. Some techniques are less "traumatic" to
the muscle structure than others. The less traumatic ones are Active
Isolated Stretching or the Mattes Method and Active Release
Technique. Massage is the superficial movement of tissue mass and fascia
and usually is non specific, and unless you are receiving a massage for
wellness, in many cases of trauma, massage may exacerbate the tightness
and pain.
Sciatica has two types of
presentations, one of nerve irritation, the other a muscle group trigger
point. The most common muscular referred pain is from the piriformis
muscle in the buttock area, followed by the gluteal muscles, the most
common sciatica from the spine is the lower segments of the lumbar spine
and the disc material encroaching and touching the nerve fibers that
comprise the larger bundle of nerves that make up the sciatic nerve.
You may want to use the internet
to get more information of the material I have provided you.
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Posted January 22, 2008
Q
Quick history... Going to chiropractor for
shoulder stiffness.....as of now that is much better. During an appt
in Sept. doctor noticed my hips were out and adjusted that area. This
happened twice in one week. The following Monday, I had soreness in
the iliac crest area (anterior side).
In the past my daily regiment
consists of the following 5am gym....weights 7am bike to work(12 miles)
12pm run 3-5 miles 5pm bike home(12 miles). I haven't been able to
do any of the above, except the weights, since mid September. My
left hip is painfully when walking, turning in bed, getting in and out of
the car, standing for any length of time, running is totally out. I
had a x-ray done but it came back normal. Doctor put me on 2 weeks of
naproxin, but no change.
A
Reviewing
what you have written, I suspect that the chiropractic adjustment to
correct the posterior malalignment may have created an anterior shift. I
don't know if the chiropractor used a drop table technique, which I
usually don't like, or a hands on manual adjustment, which is less
traumatic, but you may want to return to him or find another chiropractor
or osteopathic physician who practices manual medicine and undergo another
adjustment for optimal alignment.
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Posted January 21, 2008
Q
I was reading your
article Overview of Sports Performance and I was wondering if you could
explain what role physique plays in sports performance.
“Three components that comprise
sports performance are physique, physical conditioning and psychological
attributes.”
A
Your question is a good one and
important. Recently golfers were analyzed in their performance based on
three body types and frames. They found that each body type, pear shape,
skinny, or cylindrical has specific limitations that interfere their
performance. This book is a start to understand physique.
As golf is the most studied
biomechanical sport, every aspect plays a role in developing an effective
swing plane. Other sports may cross-reference these studies, but they are
not as critical to other sporting activities as they are in golf. Hope
this helps.
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Posted January 20, 2008
Q
I have a quick question - can
you tell me if you have ever known of
anybody with Spondylolisthesis
at L5 S1 (at almost a grade 2 slip) to benefit from
Myofascial Release (John F.
Barnes)?
I'm 25, female, from the states but
living in Guatemala....I have had this problem and pain for well over 10
years. Used to be a fast-pitch softball pitcher, basketball player, and
now I swim (and occasionally run - about 2.5 miles a week only).
I'm looking to get the MFR
treatment before leaving the country again and cannot find any articles
on MFR and Spondylolisthesis...
Thank You for your attention in
this matter!
A
Grade 2 Spondylolisthesis is a
challenge. I have observed many myofascial techniques, active
isolated stretch, active release, Feldenkries, and I find that any
release that stretches this area usually increases laxity of this area
leading to a progression of the Spondylolisthesis.
Please understand that I am one
of the greatest supporters of these myofascial techniques, but I think
that you will find that avoiding manipulative motion in this area is
best. A lumbar pillow and support belt may also be better to
stabilize this laxity in ligaments. Back extension exercises should be of
benefit, but you should avoid flexion exercises.
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Posted January 19, 2008
Q
I have been looking for someone who can help
me with my young baseball player. I have a nine year old who basically
plays year around. Just so you will know I am also a coach on his select
team. I do not make him play however. He simply love to play.
He is a catcher but is also a very
good second baseman. He is small for his age and will probably always
since I am 5'8". He is very advanced (a very solid player). My problem is
all he wants to do is catch. He really believes he is going to be the
greatest catcher ever. At the end of our year (we only take off about
three months before we start practicing again) his knees were hurting him.
I took him to a very reputable bone
doctor who looked at him and did an MRI. Long story short he said he had
tendonitis in his knees and maybe some growing pains. My problem is I
can't find anyone who can tell me hoe many is too many games for a nine
year old to catch. He caught about eighty games.
Our head coach says it not to many
but I was somewhat of an athlete and I feel its to many and has
contributed to his knees being sore. Is there a rule of thumb on number of
games someone this age should catch. I'm hoping you could give me some
information on this.
A
Your question is unique. I don't
think anyone has studied the knee in this scenario. I am pleased that the
doctors had done an MRI to assure that there are no obvious structural
problems. I only thought that comes to mind is the anterior and posterior
ligaments.
I have seen a few major league
catchers who have had an anterior cruciate ligament tear and repair (ACL)
injury as they get up quickly from the crouched position and with their
knee flexed at 15 degrees, this angle is the most vulnerable for ACL
tears. This usually occurs when they try to throw back the ball quickly,
especially to second base to throw out the runner.
I suppose many great potential
catchers ruin their knees too early and miss out on a professional
career. I don't want to frighten you, but you should be aware of this
possibility. Hope this helps.
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Posted January 18, 2008
Q
Since I've begun sleeping on a slanted pillow
for GERD, my mild osteo-arthritic left knee has gotten worse, especially
when I awake.
I sleep with a pillow between my knees, but this
arrangement isn't addressing what I consider to be faulty position.
There's no pain when I sleep on my back, but I prefer sleeping on my
side.
I need help--perhaps only education or retraining.
A
Thank you for your inquiry. The
relationship of the pillow and knee pain seems plausible. The question
is why and what is the clinical impression. Is it a sacral referred
pain, a tightened hamstring, a pes anserine bursitis..... I am at a
disadvantage to provide any clinical direction.
I see that you reside in
Florida, how close are you to the Bradenton-Sarasota area? As both
knees have osteoarthritis, why doesn't the right one bother you? Is
there any visible swelling or fluid? Does the knee "lock-up" on you?
Is it difficult to ascend or descend stairs? Did you have previous
injury to that knee, but not the other knee? Do you have any systemic
joint inflammatory disease? These are questions to guide me to a
clinical impression.
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Posted January 17, 2008
Q
Joint mobilization as you have
done with your son-
My hand surgeon and therapists have read
your description of this technique and remain puzzled. Is there a video
or further instruction available please? We have run into a real block after
broken ulna, plates, pins, screws surgery- IMMOBILIZATION! Joints? Tendons?
Help!
I'm just about ready to drive the 1200
miles to see you in person if you can't communicate with my Dr. Clayton Peimer
at Orthopaedic Surgery Assoc. of Marquette. ph 906-288-7020.
A
Thanks for your inquiry. The technique was a result of a great desire to help
my son with an intensive review of the physics of movement in the wrist
compartment and much intuitive experimentation. The end result was a
"blessing" as I call it and the ability to "sense" the injury and the
malalignments that I "feel". I could do a video, but it would never
substitute the technique, as each wrist problem is unique. I have been able to
cross teach my therapists, as we see many wrists, and I am able to check their
work and results. Additionally, although a physician, I do manual adjustments
and alignments on all my patient's, which is not taught in medical schools.
However, if you have screws, pins or plates in the wrists, I am less
optimistic in an excellent result, but usually, I can improve the functional
range and strength of the hand and fingers. Please write back with more
information on your specific situation.
Q....You
are very kind to take the time to reply. If it would help to send X-rays we
could do that. But I think, as you say, that much of this would be educated
intuition that you would know more by feel. I am working with a naturopath, a
massage therapist with cranio-sacral and myofafial treatments, as well as
Sports Medicine. We are all learning by trial and error what works and what
doesn't with my particular break, immobilization, therapy and what-all. I have
greater function than when I wrote to you a week ago.
I am a 62 year old female, quite healthy
and active. Take no drugs except some pain meds for this problem (details
below). I take nutritional supplements and eat well. (more below on diet) I'm
5' 5 1/2" tall, 160 lbs. I run a small publishing/mail order company which
keeps me hopping between 3 x weekly trips to town for PT and massages and
such.
The thing that drives me nearly nuts is
the incessant burning electrical nerve-ending pain in my entire thumb and area
on down to the base. I believe this majorly results from constriction due to
the sewing up the incision. It pulled kind of a tight "rubber band" effect
around the base of my hand. From this has come from restricted tendons,
weakened muscle and tissue adhesions which we are all working at releasing.
There is a small spot on the inner side of my thumb near the nail that does
not constantly burn. Progress, I guess. Working on releasing the stuck tissue,
results in hot tissue-burn for some time following these exercises.
The actual wrist movement is slow to
come. Rotation is a bit better- up to 30 degrees- than the "bye-bye" movement.
(Don't the the term for that move.)
The best thing is hydrotherapy- with the
jet used as a massage- in about 105 degree water. This loosens things up more
than anything, then onto exercises.
I discovered a little trick a week or so
ago. While soaking in hot sink water, I gently massaged the back of my wrist,
and my stiff fingers curled right under nice as you please. Fore-finger and
middle finger are most restricted...with the fore-being the tightest. Thumb is
extremely restricted. The first joint is quite swollen and acting quite
arthritic. It's frustrating that the stiffness of my fingers so quickly
returns (in minutes!) after therapy that frees them up to some degree.
Speaking of which----I have studied
anti-inflammatory and inflammatory food listings, and have pretty thoroughly
eliminated all grains and sugar from my diet. I eat fruit, berries,
vegetables, fish and chicken.
Breakfast and lunch is my "morning
drink" of berries, Kefir, raw organic eggs, whey protein/aminos, and
blueberry or pomogranite juice. This diet has kept inflammation/swelling
down without having to take drugs. I also have ever-so-much less acid
reflux, no knee or other joint pain, and I've lost 20 pounds, and have less
mucous/runny nose, etc. Many benefits! For pain, I still take some
hydrocodone with ibuprofin zero-to-3 times per day, depending on intensity
of therapies.
This is more than you likely have time
to fuss with, but if we are still considerably wrist-restricted in a few
more weeks, I may just wish to drive to Florida to see you! It's been nearly
10 weeks since surgery, Oct 30th. some say this isn't so bad considering the
time so far.
If you'd like to speak with my doctor
on a consulting basis...if you think it would be of value, please tell me.
I'll see if my insurance would cover it. I think it would. I have $2,500
annual deductible...so I'm in for over 5 grand out of pocket now. Sure glad
I got the major medical last spring!
A.....You
are fortunate to have found such a team of healers that are focusing on your
condition. You are correct, my gift is the feel. Surgical stabilization has
succeeded in what it was intended to fix. However, as such a force created
did fracture the large two bones of your distal forearm, one can only envision
the ligamentous tears, the internal bleeding of the trauma, yet alone the
shift of the smaller eight wrist bones, the carpals.
You may have a valid observation of
surgical scar tightness at the base of the thumb, however, the base of the
thumb exerts the most force, or torque and needs to be stable. One could
consider an injection of a very small dose of cortisone into the scar tissue
to promote some movement, but I leave this to the discretion of the surgeon or
hand specialist. X-rays may not show the subtle shifts of the carpal bones,
again my blessing is the "feel" component of having worked with many wrists
over the years.
You are welcome to visit me at my clinic in Florida.
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Posted January 14, 2008
Q
In
August 2006 I had lateral epicondile on my elbow in continued to
experience problems with pain and found another surgeon.
My new
doctor explained that he felt other issues were going on and ordered mri,s
and emg,s which showed ulnar nerve damage.
And
failed tennis elbow surgery. In December I had tennis elbow, ulnar nerve
decompression and radial nerve decompression, I'm still in a lot of pain
please help.
A
Your condition underwent
comprehensive evaluation. The surgery was based on this finding.
Occasionally I have found that the elbow joint shifts slightly and causes
strains on the tendons and ligaments.
Usually this occurs from striking
the elbow, but can also occur through repetitive motion. You may start by
finding a local osteopathic physician or chiropractor that has experience
in elbow alignment.
Before you schedule a visit,
inquire whether they "adjust" the elbow joint. If they imply that the
elbow joint does not need adjusting, just move on to find a physician who
is familiar with elbow adjusting. The adjustment is very simple, non
painful and takes 2 seconds or less. Hope this helps.
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