Piriformis syndrome

Piriformis Syndrome is a common injury that we treat at Austin Family and Sports Chiropractic. It is defined as Sciatic neuritis due to piriformis contracture or spasm leading to mechanical and/or chemical irritation to the nociceptors resulting in pain and numbness in the distribution of the sciatic nerve.

Etiology

1. Predisposing factors
   
2. 1. Anomalous sciatic nerve
   
3. 2. Tight External rotators

3. Neurologic injury to L5 and S1

Injury

1. Trauma to the gluteals --> fibrosis & adhesions


2. Prolonged sitting [wallet]

Neurological insult to L5-S1

1. Radiculitis --> atrophy of the piriformis


2. Facet syndrome --> reflex spasm of the piriformis

Overuse and/or biomechanical fault

1. Fatigue or strain of piriformis muscle


2. Leg length asymmetry

Signs and Symptoms:

What you may observe

1. Foot flare, esp unilaterally on the involved side[due to piriformis tightness]
   
2. Overpronation
   
3. Palpation
   
4. Palpation of Piriformis recreates symptoms
   
5. May have low back pain

Range of Motion

1. Decreased active & passive internal rotation of hip which may reproduce symptoms


2. Decreased active & passive adduction - may reproduce symptoms


3. Tight hamstrings


4. Weak lateral hip rotators

To schedule an appointment with Dr. Laurie at Austin Family and Sports Chriopractic, call us today at 512-258-4425. Visit our website at http://www.austinfamilyandsportschiropractic.com/.

Treat your stress fracture/reaction

1. Prevention

a. Get rid of worn out shoes
b. Do you overpronate seek someone with experience to help you
c. Sudden increases in intensity or frequency of training
d. Over training
e. Poor biomechanics
f. Absence of menstrual cycle results in loss of bone mass
g. Restrictive diets
h. Muscle weakness or muscle imbalances

2. Training

a. Limit training to non-impact for 8 to 17 weeks
b. Gradually increase the frequency and intensity of activity over time
c. Focus on quality and not quantity
d. Do not train when tired

3. Increase your bone health
Note: Your bone can only make deposits of calcium along with other minerals until the age of 25. After 25, it is recommended that you take daily calcium supplements.

Stress Fractures/ Stress Reaction

The most common overuse injuries. Stress fractures are caused by repetitive activity such as running, dancing, basketball to name a few. These fractures are usually stable; and therefore, treatment is often only activity restriction.

Symptoms:
* Swelling
* Tenderness
* Pain

Walking is uncomfortable, but running and jumping are worse. The pain is deep ache and is localized anterior and posterior over the bone.

Most commonly seen:
* Metatarsals of the foot
* Bones in the ankle, shins [tibia], knees, and hips [neck of the femur]

Next month learn how to treat a stress fracture

Core stability

Core stablility is essential to maximize performance and prevent injury.

What makes up the core:
* Multifidus - Deep muscle which starts at the neck and ends in the low back
* Interspinales, Intertransversarii, Rotatores - Deep muscles which attatch to the spine
*Internal/External Oblique & Transverse abdominus - increase interthorasis pressure = stabilize the spine
* Paraspinal [Erector Spinae] - help to balance all forced involved when you flex your spine
* Quadratus lumborum - stabilizes the back
* Thoracolumbar fascia

All of these muscles help you stabilize the spine, pelvis and shoulders to provide support and stability.

Imbalances can weaken your core

Imbalances affect performance and can lead to injury or a decrease in your performance

Adhesions in any part of the kinetic chain can affect your performance and cause injury.
* Restrict motion
* Reduces circulation
* Inhibits nerve function

If not treated these adhesions causes more friction and pressure on the tissue which results in the production of more collegen and adhesions within the injured tissue

Exercise alone may not correct these imbalances

Exercises you may use to correct and strengthen the core
* Physioball exercises {bridge, bird dog, crunches]
* wobble boards to improve proprioception
* back extension

Why do they not help? You are not addressing the most important issue - soft tissue adhesions that formed due to the muscle imbalances

* Soft tissue adhesions along with repetitive motion causes the body to lay down more restrictive tissue which causes muscles, ligaments, tendons, fascia, nerves to stick together.

To fix the problem you must remove the soft tissue restriction first and then strengthen the muscles

Inflammation ? What can you do?

• Increase consumption of anti-inflammatory food

- Cold water fish [i.e. salmon, mackerel]

- Flax seed oil [1tbsp/day]

- Ginger 2-4 grams of dried or 20 grams of fresh

- Olive oil

- Grapes

- Blueberries

- Tea

• Avoid foods which increase inflammation

- White past

- Breads

- Bagels

- Cookies

- Muffins

- Cakes

- Crackers

• Sleep [lack of sleep may stimulate an increase in chronic inflammatory response]
• Avoid Omega-6 oils

- Safflower, Sunflower, corn, syobean.

- Potatos, tomatos and eggplant

• Drink in moderation [Drinking alcohol reduces inflammation]
• Take Vitamin C & E [antioxidants supress inflammation]
• Stress increases inflammation [ Stress increases Cortisol in your body. When your body is in a state of inflammation your adrenal glands put out high levels of cortisol. Cortisol also increases insulin resistance which will cause you to gain weight and more inflammation. It also decreases your immune system and nervous system]
• Use Olive Oil [has similar properties to Ibuprofen in its ability to decrease inflammation]

Herniated Disk?

Can cause nerve compression syndrome that can be difficult and be painful and difficult to manage.





Symptoms

• mild tingling



• dull ache



• burning sensation



• severe pain which is enough that you are unable to move

Low back

• painful with movement of low back



• sharp pain, numbness and muscle weakness and pain in one leg, hip or gluteals

Neck

• painful with movement of neck



• pain that radiates to the shoulder blade, arm, forearm or fingers



• numbness and weakness to your from your shoulder to the fingers

Onset is gradual and usually have a history of low back and neck pain which gets worse. The majority of cases caused by the nerve compression do not require surgery or medication to heal. But, you still need to watch for red flags. These red flags require immediate medical attention:

• Loss of bowl and bladder



• Loss of sensation to buttocks and perineum



• Trauma or fall with severe pain



• Loss of sensation and muscle weakness

Most cases can be treated with manual therapy [ART, Manipulation], decompression therapy, lifestyle changes and exercises [McKenzie protocol for disc]

Plantar Fascitis

Inflammation of the plantar fascia hurts! When the connective tissue that runs from your heel to your toes gets irritated, it swells and can become painful. Sometimes bone spurs can form on your heel. If you receive the proper treatment for plantar fascitis, you can heal this injury. Some of the causes of plantar fascitis have to do with your foot structure or gait or other tissues like a tight Achilles Tendon. When you walk you pronate and supinate the foot.

• Slap the ground or push off?


• Your foot absorbs the shock of your motion


• This force goes right into the bottom of the foot

Conventional therapy may involve rest, steroid injection and usually requires six weeks to 3 months to heal. Surgery can take even longer.

ART and Graston have shown complete resolution of the plantar fascitis symptoms in 90% of cases. With marked improvement in just one to three treatments. I have seen great results even with patients who have developed chronic plantar fascitis.

ART and Graston protocols work on the foot muscles that become affected by the injury. The muscles that help the foot flex such as the Flexor digitorum Brevis muscle, and the Quadratus Plantae muscle are often involved. They run very deep within the foot and seem to respond to the deep tissue release abilities of these techniques.

1. Structures Involved

• Gastrocnemius/Soleus


• Tibialis Posterior


• Flexor digitorum longus


• Flexor hallucis longus muscle

Any alteration in these muscles will affect the way you pronate and supinate your foot.

2. Repetitive motion

• Worn out shoes?


• structure stressed = inflammation = cross fiber adhesions = friction syndrome = scar tissue formation

3. Follow up with Exercises

• Stretch Gastronemius, Soleus, Tibialis anterior, Hamstrings


• Walk on your toes and heels with feet straight, out and in for 20-30 times


• Calf raises 20-30 times

Active Release Technique

This technique was developed by a Chiropractor Dr Michael Leahy, of Colorado Springs, Colorado.

Essentially, ART is a hands-on soft-tissue technique that can simultaneously locate and break up scar tissue. The power of ART lies in how it combines patient motion with practitioner techniques to release the adhesion's between tissue layers. This process

* restores mobility and relative motion to the soft tissue layers

*increases circulatory function, and

* increases neurological function by breaking restrictive adhesion's.

Effectiveness of Active Release Techniques

There are people who say they are ART certified but are not. So, take the time to check out the certification levels of your ART doctor. ART offers many courses:

• Upper extremity
• Lower extremity
• Spine
• Long nerve entrapment's
• Biomechanics
• Master classes
  

Great book I recommend is "Release Your Pain" by Dr Abelson, DC. Would recommend this!

Healthy eating for Triathletes

1. Which food has the most selenium?

• whole wheat flour [1 cup]
• cousous [1 cup]
• halibut [1/2 filet]
• brazil nuts [1 ounce]

2. Which food has the most magnesium?

• spinach [1 cup]
• halibut [1/2 filet]
• black beans [1 cup]
• buckwheat flour [1 cup]

Which has the most Vitamin C?

• Sweet red pepper [1 cup]
• papaya [1 whole]
• strawberries [1 cup]
• orange [1 whole]

4. Which food has the most calcium?

• nonfat yogurt, plain [8 oz]
• skim milk [1 cup]
• ricotta cheese [1 cup]
• spinach [1 cup]

5. Which food has the most sodium?

• miso soup [1 cup]
• salt [1tsp]
• sauerkraut [1 cup]
• McDonalds quarter pounder

6. Which food has the most fiber?

• barley [1 cup]
• whole wheat flour [1 cup]
• broccoli [1cup]
• blueberries [1cup]

7. Which food has the most potassium?

• potato [medium]
• banana [1 large]
• raisin [1 cup]
• cucumber [1 large]

8.Which food has the most iron?

• black beans [cup]
• white mushrooms [1 cup]
• clams [3 oz]
• prune juice [1 cup]

Answers: For more detail email me @ lauriebuob@gmail.com

1. brazil nuts. Selenium assists the activity of enzymes in the body.

2. Buckwheat flour. Magnesium assists with muscle and nerve function.

3. Red peppers Vitamin C is an antioxidant that fights free radicals and damage to cells. It also helps your body absorb iron.

4. Ricotta. Calcium necessary for building bones, also needed for nerve and muscle function, blood clotting ad blood pressure

5. Miso soup; Salt is related to high blood pressure, heart attack and stroke. It is also an important electrolyte that should be replaced after exercise greater than 1 hour.

6.Barley. Fiber reduces the rise of heart disease, decreases cholesterol and helps regulate bowl movements.

7. Raisins. Potassium is needed for heart contraction, it is an electrolyte that assists in preventing muscle cramps, and can help counteract salt affect on Blood pressure

8. Clams. Myoglobin carries the iron to our muscles. If not enough iron is consumed and/or absorbed, you may feel fatigue during exercise, which will cause you more time to recover post exercise

Tip for the Week...Muscle cramps how to aviod!

Muscle cramps and dehydration can occur from a combination of hot and humid weather conditions as well an improper hydration. To avoid these heat-illness related symptoms drink lots of fluids 2 hours prior to activity, as well as throughout the activity. Never wait until you are thirsty to drink fluids!

Graston Technique

Graston Technique another technique I use to treat soft tissue injuries. It has changed the way I practice, increased success rate of my treatments and helped me treat conditions that did not respond well. I have helped several patients with shoulder pain, post surgical knee pain, and back pain. GT allows me to repair and rebuild soft tissue injuries consistently and effectively.



From the Graston site: [http://grastontechnique.com

• Designed to treat any soft tissue dysfunction
• Effective with chronic and acute injuries
• Resolves effects of post-surgical scarring
• Maintain normal activity during treatment

Achilles Tendonitis

Is an inflammation of the achilles tendon. The Achilles Tendon joins the gastrocnemius and the soleus muscles. Initially your symptoms are a dull ache in the tendon after you run.

Improper treatment of Achilles tendonitis can lead to Achilles Tendinosis a chronic condition.

Proper treatment include:
* ART treatments to remove the soft tissue dysfunction
* Ice for the 1st 72 post injury and after a run
* Heat the calf
* Use your TP kit 2 times a day if have or the foam roller to provide some manual therapy

* A Physical Therapy evaluation and treatment plan to correct the problem

Stretching
Strengthening
Balance work

DO YOU WANT OR NEED PAIN RELIEF?

FREE CONSULT

Dr. Laurie Buob, DC, ART/Graston certified

NO MORE PAIN?

When: Monday, Wednesdays, Thursday and Friday

Where: 1120 S. Capital of TX Hwy, Bld 1, Suite 120
More information: http://austinfamilyandsportschiropractic.com
Dr. Laurie Buob is offering Free Injury Evaluations for all new patients. Please call the office to make an appointment

Dr. Laurie A. Buob graduated cum laude from Los Angeles College of Chiropractic in 2004 and has a M.S. in Exercise Science/Cardiac Rehabilitation from Northeastern Illinois. Before entering chiropractic school in 2001 she was an Exercise Physiologist/Fitness Intructor at Canyon Ranch in Tucson, AZ for 7 years.

As she developed and grew her practice, Dr. Laurie note that most of her patients came to her with a common complaint: they were forced to return to other doctors for multiple visits and repeat adjustments, none of which truly alleviated their pain for a substantial period of time. In contrast, Dr. Laurie has created a system that shifts the focus of patient care to rehabilitation- in essence, to locate and address the weakness that creates instability in the body.

Dr. Laurie's technique blends several different philosophies to create a system that is highly effective in providing patients with long term pain relief and improved health. Most patients enjoy dramatic improvement in as little as six weeks.

Dr. Laurie continues to hone and refine her techniques through post-graduate studies in rehabilitation. Having a lifelong passion for sports, she is also very involved in the local running and triathlon community. She has been involved in these activities for over 25 years and it has led to an equal passion in the treatment of soft-tissue injuries.

You can also come by the office to set up a future appointment! To set appointments over the phone, or if you have any questions, please call 791-6693 or email lauriebuob@gmail.com.

Great news I am opeing my own clinic

Starting Feb 1st 2010 I will be in my new office:

Austin Family and Sports Chiropractic, P.A.
1120 S. Capital of TX Hwy
Bld. 1, Suite 120
Austin, TX 78746
512-258-4425

HURT LESS
PLAY MORE

Dr Laurie Buob, M.S., D.C.
Active Release Technique and Graston Certified

Advise for Runners

1. Warm Up and Stretch after- Always warm up and cool down. Start out walking or very slow running, give your core a chance to warm up. This will help prevent injuries. After the run remember to cool down this will also help to prevent numerous injuries.
2. Extreme Pain No Gain - Never try to run through intense pain. If you body is giving you signal to stop because of an injury listen to it.
3. Train as You Race - Your training should mimic your race. You can only expect to do as well on race as you did during your training. The closer the training conditions are compared to the race course the better off you will be.
4. Do not make any last minute Dietary Changes – On race day never, I mean never eat or drink anything new. Its best to avoid muscle cramps, nausea and a host of other complaints if you can. Not to mention that race you have been training for could be sabotaged just by the wrong drink.
5. Increase your weekly mileage by no more than 5-10 percent per week. Any more than this and you are setting yourself up for injuries.
6. Repair and Recovery takes time– For ever mile you race, allow yourself one to two day post race before returning to hard training. But, do not stop all activity think of it as Active Rest. Just do not over do it.
7. Restore Your Fuel – Take a combination of protein, carbohydrates and electrolytes within 30 – 60 minutes after your runs, you will see a big difference in your recover time.
8. Cross train – Cross training will prevent injuries, increase performance and give your muscle a rest while still keeping active.
9. Old Running Shoes Are Dead Shoes – Running shoes have a life of about 400-500 miles after that you are setting yourself up for injuries.
10. Rest– you need one day off for every day of hard training this prevents injuries and burn out.
11. Efficiency Counts – The more effective your running biomechanics are the less energy you will expend. Concentrate on your running form: Stay upright with your head, shoulders and hips are lined up over the feet. Your chest should be forward and up. Try not to land too heavy on the heels or too far on the toes. Your arm action will vary from athlete to athlete, but they should swing naturally from the shoulders, relax. Do not allow your arms to cross the midline of your body. In stead of lengthening your stride develop a faster turnover, stride length will come.
12. Develop a Strong Core - The core of your body is where you derive your power; it provides the foundation for all arm and leg movements. Your core must be strong, flexible, and unimpeded in its movements to achieve maximum performance. Having a strong core will greatly improve your running. Training long hours does not guarantee that you have core stability. In fact, spending too much time working within one plane of motion often creates core imbalances. Add these imbalances to stresses caused by poor posture during running, and you have an equation for the development of a weak core. Try Core Ball exercises combined with a free weight program.
13. Remember to stretch - The importance of stretching within a workout routine cannot be over-emphasized. Stretching brings our body back into balance, prevents injuries, enhances performance, changes our posture, and even changes how we age, and the way people perceive us. Yet stretching is often neglected because the average person (and many runners) do not understand why it is so important to not only be strong, but also flexible. Consider the basic biomechanics of how our body performs. Our bodies are designed to work in balance - every time a group of muscles contracts to perform an action, an opposing group of muscles (antagonist) must relax and lengthen. These muscles can only contract as forcefully as their antagonist can relax. For example, the quadriceps muscle can contract more quickly if the hamstring muscle group is able to easily lengthen and relax. Without the lengthening of the antagonist, we lose our power, balance, and endurance, we become susceptible to injury, and waste our energy.

Heel pain

CAUSES OF HEEL PAIN

1. Overload of physical activity [excessive running, jumping, or other activities repetitive or excessive stress on soft tissue which leads to tears and inflammation]
2. Arthritis
3. Diabetes
4. Incorrect shoes [improper fit or support]
   
5. Mechanics of foot [flat feet, high arches, pronation, abnormal gait]
   
6. Age [tissue tends to get weaker and more likely to tear and become inflammed
   
7. Weight [pregnancy]
   
8. Hormonal changes [pregnancy]
   
9. On feet all day
10. Wear high heels shoes or boots that do not provide support

HOME CARE

• Change physical activity
• Rest foot
• Apply ice/heat to heel and calf muscle as much in your day as can 4-5 times
  
• OTC medication [Ibuprofen to decrease inflamation and Acetaminophen to decrease pain
• Orthodics - Bill Stone @ Run Tex is great! Tami @ Sports performance I hear good things
  
• Night splint
• TP Kit 2 times a day
  
• Foam roller
• Stretch after exercise for minimum of 20 minutes - holding each stretch for 2 minutes
• Yoga....1-2 times a week. If you do not like it..find a fitness yoga..class
  

If the pain continues for longer than a week, you should visit a sports specialist:

• ART/Graston certified Chiropractor
  
• Podiatrist
• Myofascial massage: Holly Odom, Renee Schroeder
• Physical therapist: Dr Phil Davis, Suzanne Trotter, MS
  

If symptoms persist longer than 3 months, it will take longer to repair and rebuilt the dysfunctional tissue. Want to discontinue activities that causes the fascia to become overstretched resulting in tears and inflammation.

DIAGNOSIS: PLANTAR FASCITIS