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April 15, 2008
I joined a running group last November to train for a half marathon. I knew that I could reach my goal, but I wanted to do it in an environment that offered coaching, encouragement, and other people who were striving for the same goal. When one of my patients told me about Runner’s Edge of the Rockies I was psyched. The first Saturday group run was so much fun. I felt like part of the family from day one. What I didn’t realize is that a lot of the people in my pace group were first-time half-marathoners AND doing my same race! I chose the Phoenix Rock and Roll half marathon ( I am no dummy, I wanted my first half-marathon to be flat, low in elevation, and warmer than Denver in January).
I started training and followed a pretty rigid training schedule that was provided by Coach David Manthy. He was there via email for all questions and concerns, but after the group runs on Saturday he was there to chit chat. He was always checking in to make sure the training was going well. We trained from Thansgiving to mid January. At the time for signing up the race I thought that training for a half marathon would be the perfect way to prevent the holiday weight gain however, that meant training in ice and snow and getting up in the pitch black to get a morning run in before the sun came up.
But it all paid off…. On a Sunday morning in January, I successfully completed my first half-marathon! And I did it with the help of Runner’s Edge and Coach Manthy.
If you are thinking about training with a group for a race goal, I highly encourage it. It is fun, exciting, and worth every step.
Dr. Clark
March 24, 2008
Now an in-network provider with Pacificare. Pacificare was added to the American Chiropractic Network (ACN) as of January 2008. I now accept and am in-network with United Healthcare, Great West, and Pacificare. If you have these insurances, call our offices today an initial consultation. It is never too late to take responsibility for your health.
I am here to help.
Dr. Clark
February 4, 2008
T. Grace Steinley, D.C.
Source: Her Sports Magazine
YOU KNOW THE ROUTINE. YOU’RE MID WORKOUT WHEN SUDDENLY YOU GET that twinge on the outside of your knee or back of your thigh. Your gut says “stop” but your determination says “run through it.” Moments later you find yourself at a dead halt. The pain has localized, your muscles have cramped, and bam, you’re on the injured list.
Athletes find themselves injured for a number of reasons: overuse being chief among them, with approximately 50 percent of sports injuries stemming from overuse. And while it’s best to prevent injury before it occurs, we all know it doesn’t always happen that way. The good news is there are alternative treatments that, in many cases, are proving markedly more effective than traditional therapies.
What’s changed? For decades, overuse injuries have been treated with anti-inflammatory methods. These include non-steroidal anti-inflammatory drugs (NSAIDs such as Advil and Motrin), electric stimulation, steroid injections and ice therapy. However, research, including a 2000 study in The Physician and Sportsmedicine and a 2003 study in Clinics in Sports Medicine, indicates that most overuse conditions are not inflammatory in nature and that treating them as such may delay or prevent full recovery.
If inflammation isn’t responsible for chronic conditions like tennis elbow and iliotibial band syndrome, what is? There’s a good chance it’s scar tissue. Repeated or sustained muscular contractions in any athletic endeavor increases tension on soft tissues (muscles, tendons, fascia and nerves), which in turn decreases blood and oxygen supply to the area. With muscles, nerves and fascia, the result is a build-up of scar tissue. In tendons, decreased oxygen leads to degeneration. Scar tissue and degeneration are the common cause of chronic overuse injuries, whereas inflammation is predominant in acute injuries such as muscle and ligament tears.
Although the understanding of overuse injuries has improved with continued research, most traditional medical paradigms have not yet adapted, partially explaining why some injuries seem resistant to treatment. Karim M. Khan, M.D., Ph.D., a primary researcher on overuse injury, affirms, “Treatment needs to combat (scar tissue) breakdown rather than inflammation.”
Following is a look at some common sports injuries and the alternative treatments that may help you get back in the game.
Sciatica
What is it: Sciatica is a general term describing pain in the buttock and back of the thigh. A herniated (slipped) disc and piriformis syndrome are two of the most common causes of these symptoms. More often runners experience the latter. In piriformis syndrome, pain originates from a nerve entrapment between the hip rotator muscles and the sciatic nerve, which runs down the back of the thigh. Traditional treatment: Reduce symptoms by limiting activity. Use stretching and ultrasound to increase flexibility and decrease inflammation, respectively.
Alternative treatment: Active Release Technique (ART) is a manual therapy (involving only the practitioner’s hands) that breaks down scar tissue while the muscle and/or joint is taken through the natural range of motion. As muscles accumulate scar tissue with overuse they lose strength, flexibility and joint motion. In the case of sciatica, scar tissue “glues” the sciatic nerve to the piriformis muscle, preventing normal motion between the structures. This irritates the nerve and results in pain. ART breaks down the scar tissue between the nerve and muscles, freeing the nerve and restoring normal motion.
What’s the word: A 1998 study at the University of California at San Diego found that 71 percent of patients reported improvement after four weeks of ART treatment. While little other research is available, plenty sing ART’s praises. “The bottom line is that anything that works is good, as long as it’s not detrimental. (ART) is not detrimental, and it does work,” says Andrew Feldman, M.D., an orthopedist and author of The Jock Doc’s Body Repair Kit.
Tennis Elbow/Lateral Epicondylitis
What is it: Grasping activities such as climbing and paddling stress the muscles on the back of the forearm leading to lateral epicondylitis. Pain is caused by degeneration in the tendon that attaches the overtaxed muscles to the elbow.
Traditional treatment: Reduce inflammation with ice and steroid injections. Use forearm braces to dampen load on the degenerated tendon.
Alternative treatment: Acupuncture has proven to be effective in treating tennis elbow. In the modern scientific explanation of acupuncture, tiny needles inserted into certain pressure points stimulate the nervous system to release chemicals in the muscles, spinal cord and brain. Endorphins, the body’s natural painkillers, are one type of chemical released. Other chemicals stimulate the body’s natural healing abilities by increased hormone and blood flow. Additionally, as they are inserted into the problematic area, the needles themselves physically break down scar tissue.
What’s the word: After a 1997 conference to determine acupuncture’s validity in Western medicine, the National Institutes of Health concluded, “Promising results have emerged showing efficacy of acupuncture in (treating) tennis elbow.”
Iliotibial Band Syndrome (ITBS)
What is it: Runners and cyclists with knee pain may be experiencing ITBS. The iliotibial band, which connects the hip to the knee, can become tight and produce friction, pain and swelling on the outside of the knee.
Traditional treatment: Reduce inflammation with NSAIDs and electric stimulation. Stretch the iliotibial band to increase flexibility.
Alternative treatment: Prolotherapy, a method of healing degenerated tendons. Typically a dextrose (sugar water) solution is injected into weak and damaged tendons. The injection causes inflammation, swelling and pain, effectively tricking the body into thinking a new injury has occurred. The body responds by increasing blood supply to the area and promoting tissue regeneration. Treatment frequency and number vary greatly from doctor to doctor, so search for a provider with extensive training and experience.
What’s the word: For the past 20 years C. Everett Koop, M.D., former surgeon general has been an advocate for prolotherapy. “I myself am able to be pain-free because of it,” he has said. And while other MD’s have touted its benefits, little research is available to back up the claims. Explains Northern California-based sports medicine specialist Warren Scott, M.D., “Prolotherapy is a nonproprietary mix of sugar and alcohol. No drug company owns it, so almost no research has been done.”
Rotator Cuff Tendonitis
What is it: Rotator cuff tendinosis is degeneration of one or more of the tendons that make up the rotator cuff, usually the supraspinatus tendon. Overhead activities such as swimming, climbing and improper weightlifting overload the shoulder muscles, causing scar tissue and degeneration.
Traditional treatment: Decrease inflammation with NSAIDs. Strengthen muscles to restore balance. Perform surgery to remove degenerated tissue.
Alternative treatment: ART is also a good bet when treating rotator cuff problems since they often result from scar tissue in the subscapularis, the muscle beneath the shoulder blade. This muscle is designed to stabilize the shoulder, and when it fails, the supraspinatus tendon becomes overloaded, degenerated and painful. Treating only the tendon degeneration may decrease symptoms but will not correct the underlying problem. ART reduces scar tissue in the subscapularis, restoring normal shoulder motion and decreasing excess load on the supraspinatus tendon.
If symptoms remain, acupuncture may be used to decrease pain and to increase blood flow, which promotes tendon regeneration. Prolotherapy, the most invasive of the three treatments, may also be used to promote regeneration in stubborn cases.
What’s the word: Michelle Clark, D.C., of Denver’s CorePower Chiropractic and Yoga, encourages athletes to be persistent when searching for effective care. “There is no single miracle treatment for overuse injuries. For many, ART is enough to fix the problem, but for others, acupuncture or prolotherapy is more effective. These are only three of the many alternatives, so for an injured athlete, perseverance and an open mind for treatment options are necessary to fix difficult problems.”
T. Grace Steinley, D.C., specializes in overuse injuries at Soft Tissue Diagnostic and Treatment Center, a health-care facility in Boston. Contact her at www.softtissuetreatment.com
January 19, 2008
CAROLINE ALPHONSO
From Saturday’s Globe and Mail
TORONTO — A Canadian study indicates there is no increased risk related to chiropractic treatment in the heated debate about whether neck adjustments can trigger a rare type of stroke.
Researchers say patients are no more likely to suffer a stroke following a visit to a chiropractor than they would after stepping into their family doctor’s office.
The findings, published today in the journal Spine, help shed light on earlier studies that had cast a cloud on the chiropractic profession and suggested that their actions resulted in some patients suffering a stroke after treatment.
“We didn’t see any increased association between chiropractic care and usual family physician care, and the stroke,” said Frank Silver, one of the researchers and also a professor of medicine at the University of Toronto and director of the University Health Network stroke program.
“The association occurs because patients tend to seek care when they’re having neck pain or headache, and sometimes they go to a chiropractor, sometimes they go to a physician. But we didn’t see an increased likelihood of them having this type of stroke after seeing a chiropractor.”
A rare cause for stroke, arterial dissection occurs when one of the neck arteries supplying blood to the brain is torn. A stroke can occur when a clot, formed on the torn membrane, is dislodged and subsequently travels to the brain, blocking circulation.
The two neck arteries are susceptible to compression with neck rotation. But it is rare. It occurs spontaneously, or after minimal neck movements, such as looking backward to reverse a car.
Critics charge that the twisting and pulling of the neck frequently done by chiropractors can damage arteries, leading occasionally to stroke.
However, a research paper published in 2001 in the Canadian Medical Association Journal found there is only a one-in-5.85-million risk that a chiropractic neck adjustment will cause a stroke.
In this study, the Canadian team looked at nine years of data in Ontario, and found only 818 patients with this kind of stroke. Unlike the previous study in 2001 that investigated the relationship between chiropractic visits and vertebral artery stroke, researchers in this study also studied visits to family doctors that preceded this kind of stroke.
Dr. Silver said researchers were looking for an increased association between chiropractic care and stroke. Although they found this association, they also discovered it to be the same as when patients visited a family doctor.
The researchers say the association is likely explained by patients seeking medical or chiropractic services for their neck pain rather than these services causing the stroke. In other words, patients had already damaged the artery before seeking help from either a medical doctor or a chiropractor, and then the stroke occurred after the visit.
The research paper says the results should be interpreted cautiously. Although the study provides the best data to date on the relationship between neck manipulation and vertebral artery stroke, researchers have not ruled out that in rare circumstances neck manipulation can be a potential cause of some strokes.
Co-author David Cassidy, a senior scientist at the University Health Network and a professor of epidemiology at the University of Toronto, said: “If someone says ‘Has it ever happened that a chiropractor has caused a stroke?’ I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is in a GP office.”
Looking for symptoms of a stroke caused by a tear inside a neck artery can be difficult. Just because a person has a neck pain or headache doesn’t mean it’s going to lead to a stroke, Dr. Silver cautioned. Some of the symptoms include double vision associated with pain, droopy eyelids, numbness down one side of the body and dizziness.
December 4, 2007
Source: American Chiropractic Association
A new study finds that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. A group of chronic low-back patients who underwent chiropractic treatment showed higher pain relief and satisfaction with the care and lower disability scores than a group that underwent medical care, according to an October 2005 study in the Journal of Manipulative and Physiological Therapeutics (JMPT).
Although several cost-effectiveness studies outside the United States have favorably compared chiropractic to medical care, this new study is one of the first to compare low-back treatment costs and outcomes within the structure of the American health care system. In the United States alone, back pain associated costs are estimated to reach $48 billion this year, and, at any given time, 80 percent of the U.S. population suffers from back pain statistics that make this study especially pertinent, according to the authors.
Specifics of the study:
The study involved 2780 patients with mechanical low-back pain who referred themselves to 60 doctors of chiropractic and 111 medical doctors in 64 general practice community clinics in Oregon and one in Vancouver, Wa. Chiropractic care included spinal manipulation, physical therapies, an exercise plan, and self-care patient education. Medical care consisted of prescription drugs, an exercise plan, self-care advice, and a referral to a physical therapist (in approximately 25 percent of cases). The costs of treatment and patients pain, disability, and satisfaction with their health care were assessed at 3 and 12 months after the initial visit to the doctor.
The office costs alone for chiropractic treatment of low-back pain were higher than for medical care. However, when costs of advanced imaging and referral to physical therapists and other providers were added, chiropractic care costs for chronic patients were 16 percent lower than medical care costs. The differences between medical and chiropractic total costs were not statistically significant for acute or chronic patients. The study did not include over-the-counter drug, hospitalization, or surgical costs.
Both acute and chronic patients showed better outcomes in pain and disability reduction and higher satisfaction with their care after undergoing chiropractic treatment. The advantage of chiropractic care was clinically significant in the chronic patient group at 3 months follow-up, but smaller in the acute group. Improvements in patients physical and mental health were comparable in both the chiropractic and the medical group, with the exception of physical health scores in the acute patients in the chiropractic group, which showed an advantage over the medical group.
“With their mission to increase value and respond to patient preferences, health care organizations and policy makers need to reevaluate the appropriateness of chiropractic as a treatment option for low-back pain,” concluded the study authors.
The Journal of Manipulative and Physiological Therapeutics, the premier biomedical publication in the chiropractic profession and the official scientific journal of the American Chiropractic Association, provides the latest information on current research developments, as well as clinically oriented research and practical information for use in clinical settings. The journal’s editorial board includes some of the world’s leading clinical researchers from chiropractic, medicine, and post-secondary education.
November 4, 2007
October 24, 2007
A deep venous thrombosis is essentially a blood clot in the calf that when dislodged can travel to the lungs and even eventually to the brain if it mobilizes from there. This is a very serious condition never to be taken lightly as it can lead to a stroke and can cause permanent damage possibly even death. I bet you are wondering why I would write about this.
To be quite honest, I never thought I would see this condition in anyone in my practice but in the past year I have had two very scary cases and thus I thought it was important to share with you. The first case was a massage therapist who called me on a Saturday to see if I would meet him at my office to adjust his rib. I started asking him questions because not only did it sound weird, but I also didn’t want to go to the office on my day off. As I investigated things further I realized that this patient was not suffering from a musculoskeletal ailment, even though it seemed like that to him. He was having chest pain of cardiopulmonary origin and needed immediate attention. I advised him to go straight to the ER. He begrudgingly did so, and then about a month after this all happened he called to give me all the details. He said that not only was it pain coming from his lungs, but that a few days before his chest pain began he reported pain in his calf that he had massaged. His massage therapist loosened the knot in his calf and by morning the pain was in his chest.
What he described to me was a deep venous thrombosis that he had dislodged by getting an aggressive massage of the calf. The chest pain was the loosened clot, or embolism, and the only place that this clot could now go, was his brain. He was lucky, I scared him and he went to the hospital.
The second case I saw was last week and it was a member of my own family. The patient was adamant that his complaint was purely biomechanical and there was not any cause for alarm. I never actually saw this person in my office, but the next morning when he said that his calf was swollen I knew that things were much more serious than originally thought. I urged him to go straight to the ER. He didn’t listen to me; he made an afternoon appointment with his doctor instead. By the time he got in to see his doctor, the doctor sent him to the ER. He did have a clot, fortunately not a deep venous thrombosis, but a clot none-the-less.
Another lucky one. The moral of the story, calf pain and swelling should never be taken lightly. PLEASE have it evaluated to rule out a possible life threatening affliction.
I’m here to help.
Dr. Clark
September 5, 2007
What is chiropractic and how can a local Denver Chiropractor help me?
What is Soft Tissue?
Soft tissue is any structure in the body that is not comprised of organs or bones. More specifically it is typically referred to as muscle, ligament, tendon, and fascia. These are the tissues that get damaged by repetitive overuse and postural abnormalities. Nerves and blood vessels travel through these tissues and can become compromised by them. These aliments will not appear on x-rays, but will only be evident on an MRI.
The Relationship between Soft Tissue and Chiropractic
- Muscles and tendons attach directly to bones.
- When muscles are tightened, injured, or in spasm they have a profound effect on the bones and joints they attach to.
- Injured muscles work harder to accomplish less all while getting less nutrients to them.
- When injured muscles get decreased nutrients, they also have less cellular debris removed from them.
- With more cellular debris, the body lays down scar tissue to protect itself.
- Scar tissue decreases range-of-motion, produces pain and edema.
- Scar tissue, if found in muscles that nerves travel through, can cause numbness and weakness.
What is Active Release Technique (ART)?
ART is a patented, state-of-the-art soft tissue system that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. These conditions all have one important thing in common: they are often a result of overused muscles.
Every ART session is actually a combination of examination and treatment. The ART provider uses his or her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements.
How Active Release Technique ART Can Help You
- Reduces scar tissue is soft tissue.
- Promotes blood flow to injured tissues and removes cellular debris.
- Allows more blood flow and thus nutrients to tissues.
- Increases range-of-motion limited by scar tissue.
- Reduces numbness caused by nerve adhesions.
- Decreases pain.
- Enhances athletic performance.
These are the techniques that I use to help my patients.
I am here to help.
Dr. Clark
August 22, 2007
A term that most of my patients that are avid runners throw around from time to time is <em>Shin Splints</em>. I often here the term and dismiss it not fully understanding why they use that term in such a derogatory way. I did a little research and this is what I came up with. The feared shin splints are perceived as a much worse condition than it actually is. I think it got this stigma however, because it is very painful and it WILL prevent you from running and training up to your fullest potential.
Let’s start with anatomy
Usually a shin splint is a strain of a muscle on the front of the lower leg called that tibilais anterior muscle. This muscle attaches to the top of the foot and functions to flex the foot toward the ceiling, so you can imagine that it gets quite the workout during a run (especially a long one). This muscle can in fact become overworked and endure a repetitive overuse injury, which can potentially cause micro-tearing in the muscle and promote scar tissue formation. If this scar tissue gets to be too problematic, it will be felt EVERYTIME you contract that muscle (like during a run). So you see, this can be a very limiting condition and hence the fear in a runners’ eyes when they mention they have the dreaded <em>shin splints</em>.
The good news
Shin splints, whether they are mild, moderate, or severe respond extremely well to Active Release Technique (ART). Although a painful procedure with very angry shin splints, significant difference is noticeable after the first few sessions. And if this is a matter that needs imaging and more aggressive care, I can get you to the proper practitioner. There is no reason why you should let shin splints get in the way of your recreation or training. Get your shin pain evaluated before it really affects your activities.
I’m here to help.
Dr. Clark
July 7, 2007
The psoas muscle, otherwise known as the hip flexor, is probably one of the most underestimated muscles in the body. It is very powerful and is usually the cause of long standing issues when relating to recurrent back pain.
The psoas originates at the lumbar spine and crosses the pelvis at the sacroiliac joint, terminating on the front of the femur (or thigh bone). It functions to flex the hip (raise the knee from a standing position) or bend the trunk forward at the hip. The problem with this muscle is that when it becomes tight, the erector muscles compensate and the body begins a tug-of-war of sorts (the front of the body is fighting the back of the body).
The hip flexors are notoriously tight in today’s society. Let’s face it. We are a society of sitting. We sit at our jobs all day long, after that we get in ours cars and drive home. When we get home, we sit for dinner and then possibly even for the latest episode of Grey’s Anatomy. The longer the psoas muscles remain tight, the more your body will do to compensate for this. For example, your low back muscles will become tight and quite possibly your core muscles will become weak in response because you are always using your hip flexors instead of your core. The point is, we unintentionally do everything to keep the psoas muscles shortened and tight. Coincidentally, we do virtually nothing to stretch them out. Even if you are a yoga practitioner, you understand that in yoga you do a lot to stretch the back of the body and not much to stretch the front. if you are a runner or a cyclist, you are especially at risk for some tight hip flexors because of the repetitive nature of those sports.
Psoas strains are the great imitator of low back pain. How so? When you have a tug-of-war occurring in your body, your hip flexors may or may not be hurting, but your low back muscles (the ones that are compensating) probably are. And thus your psoas muscles are mimicking your back pain. If you feel pain in your low back when going from a sitting position to a standing one, your hip flexors may in fact be the problem.
How do we rectify this situation? Stretching is a start, especially if you take part in some of the sports that I mentioned above. Above that, if you need help figuring out the cause of your pain and you think that your psoas muscles are the culprit.
I’m here to help.
Dr. Clark
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