Do this for sciatica!

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sciatic stretch

 

Hamstring injuries are one of the most common injuries in running sports. Most injuries involve the lateral hamstring (biceps femoris) , followed second by the semitendinosus). The injury typically occurs where the tendon inserts on the pelvis and causes buttock pain radiating into the posterior thigh.

Tendons heal slowly because of poor blood supply and few cells.Typical recovery involves eccentric strengthening of the hamstring and stretching. Steroid injections are not recommended because steroids can weaken tendons, leading to rupture.

Most hamstring stretches focus on the distal attachment. However, the hamstrings (semitendinosus, semimembranosus, biceps femoris) work by extending the hip or decelerating hip flexion, and work by flexing the knee or decelerating knee extension. Therefore, proper recovery and prevention of future injury requires stretching of the distal and proximal portion. Check this video to see an example!

To learn more, visit us in Blacksburg, right next to Christiansburg, or visit us at:

www.valleyactive.com

www.valleysportsandspine.com

 

Good Luck!

What Your Hip Pain is Trying to Tell You

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Pain in your hip can be a symptom of an injury in another location of the body. The kinetic chain links the joints of the body together to keep the body moving.  

 

 

Are you suffering with hip pain? Does your hip ache day and night for no apparent reason? Do you remember a specific activity that initially brought on the pain, or did it seem to come out of nowhere? The truth is that the pain you are feeling in your hip may not signify that anything is actually wrong with your hip. What you may be experiencing is something called referred pain, and you can blame the kinetic chain. Referred pain is pain felt in one area of the body that has actually originated in a completely different area of the body. You may not feel pain, or any symptoms at all, in the point of origin, but your hip sure feels something!

What is the kinetic chain?

The simplest way to describe the kinetic chain is to think about the division of responsibility. If you have a job to do and four workers to do it, the job will get done efficiently as everyone knows their role and works together. If you take away one of these people and now only have three people to complete the task, the job will still get done but not as quickly and with a greater burden placed on each worker. Now let’s put that in terms of the body. The joints are an interconnected system that all work together to allow the body to move. If one joint suffers a set-back such as stiffness or injury, the other joints will absorb the extra stress in order to keep the body moving.

How does pain relate to the kinetic chain?

When speaking in terms of the kinetic chain and your pain, try imagining a pebble dropped into a pool of water. Think of how the ripples in the water are larger where the pebble hit the water and smaller the further away they get until they disappear. This is what many physiatrists, or function specialists, call the kinetic chain ripple effect. The body spreads out the stress that it endures as it compensates for the area actually experiencing complications.

What this means for you?

The next time that you go to see your physiatrist do not expect the examination to be focused solely on your hip. You can expect your provider to ask you several questions about your daily activities and what aggravates the pain or makes it better. You can also expect radiological imaging of your hip as well as your entire back and possibly a knee.  Through the use of x-ray, your doctor can identify any underlying stressors or injuries along the kinetic chain.

It’s hip to be informed.

For more information about the kinetic chain and how it relates to your pain, please see our webpage at www.valleysportsandspine.com.  Asking questions and getting involved in your care are great ways to get your pain under control because knowing what causes your pain can also help you prevent it.

Good Luck!

Dr Ethan Colliver

 

Sitting is Bad for Your Health

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A new meta-analysis shows that sitting too much increases your risk of early death from any cause.  The other important finding is that this increases your risk even if you exercise.  Further, the study showed that the less active you were, the more likely you were to die prematurely.

Previous studies have also showed that you should get get up 35 times a day or get up about every 15 minutes throughout the day.

For many of our patients in the Christiansburg, Radford, and Blacksburg area, the struggle after successfully completing physical therapy has been finding a way to continue to exercise and keep moving afterwards.  Valley Sports & Spine Clinic and Valley Active are committed to finding a personal exercise plan to keep you regularly moving for a healthy lifestyle.

 

Good Luck!

 

Dr Ethan Colliver

What do I do next?

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Rehabilitation is a continuum of care.  As someone goes through the three phases (pre-rehab, rehab, and post-rehab) of recovery from an injury, the goals change and so should the rehabilitation provided.

Pre-habilitation is the exercise, conditioning, and education someone may go through prior to undergoing a hip replacement or other major surgery.  For example, patients who are stronger and more functional before they have a hip replacement will recover quicker and be more active after a their surgery.

Rehabilitation is the phase of training, education, and recovery from an injury or surgery which often occurs with a physical therapist and may last for several months.  This is a very critical time for many patients as it may be the first time they have had a major injury or have participated in a formal exercise program.  The physical therapist and physician work closely to help the patient establish goals, create a home exercise program, and help the patient envision how they will return to their normal everyday activities.

Unfortunately, 75% of patients stop doing their home exercise program within 6 months of stopping physical therapy.

rehabInsurance companies usually only cover physical therapy until a patient can carry out normal activities in the home; however, insurance will not cover rehabilitation aimed at the goals of returning to a sport or to a demanding work environment.

Post-rehabilitation is the phase afterwards, focusing on helping you maintain a home exercise program and establish new goals.  This is important for an athlete who needs to continue getting stronger and faster to meet the demands of his/her sport.  But it is also important for an industrial worker who has a demanding job or for a 65 year old grandmother who needs to pick up her grandchildren.

Having the patient create a personal exercise routine, under the supervision of a therapist helps you successfully stick to a healthy lifestyle and decreases your chance for recurrence of many painful conditions, and improves overall health.

Valley Sports & Spine Clinic and Valley Active help people through all phases of rehabilitation.  We are committed to helping people improve their function and return to their life.

What is Really Causing Your Back Pain?

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 Back pain can be a result of height, weight, or posture. Treatments are available for symptoms, but core exercise is the proven method to relieve pain for good.

 

Most people will experience back pain at some point in their lives. Back pain can be caused by an acute injury or from long-term wear and tear on the spine and joints of the back. During evaluation by a physiatrist a holistic approach frequently uncovers the root cause of the pain, and the answer is much simpler than many would suspect.

Frequent Causes of Back Pain

  • Height – While it may seem surprising, your height has a lot to do with your lower back pain. The spine is stabilized by your core muscles which sit in your abdomen. For a tall person, or anyone with an especially long torso, these muscles have to work harder to hold up the spine than the core muscles of a shorter person.
  • Weight – People gain weight differently, and much of this is attributed to genetics. While many women gain weight in the lower half of their bodies, creating what is known as the pear shape, more frequently men gain weight in their trunk or abdomen. Protruding abdominal weight can throw off the body’s natural center of gravity and cause it to be more forward and further away from the spinal column. As a result, the back has to work harder to stop from pitching forward. This is also a common source of lower back pain in pregnant women as their muscles work to hold up the spine and support the weight of the growing womb.
  • Posture – Your mother was not kidding when she would tell you to stand up straight. Posture affects the entire body, whether it is good or bad. Good posture helps to reinforce spinal alignment and connective tissue. This is especially important when exercising, as poor posture can cause over- or under- development of a muscle group and uneven muscle tone which can make posture worse and add more stress to the back.

Correcting the Problem

  • Medications – While many people would like to use a medication to fix their pain, the recommendation for medication is minimal. Non-Steroidal Analgesics (NSaids), such as ibuprofen or naproxen, are effective at relieving pain associated with inflammation, but that is the extent of their usefulness. The pain can only be temporarily relieved with medication therapy.
  • Helpful Therapies – Spinal Manipulation Therapy (SMT) has proven to be an effective method of pain relief for many patients suffering from low back pain. SMT is the practice of applying controlled pressure to a joint in the spine and is commonly performed by a Doctor of Osteopathic Medicine (DO), physical therapist, or chiropractor.
  • Massage can be very effective at relieving back pain associated with stress.  Massage helps to normalize muscle tone and joint alignment, can normalize blood and lymphatic flow to an injured area, and can help release built-up toxins in tense muscles. An added bonus of massage is the overall mental stress relief it can provide which can directly correlate to feeling pain in the body.
  • Acupuncture is the application of pressure to specific points in the body that may relieve pain associated with the nerves. People who use acupuncture regularly find that their pain is greatly reduced over time.

The Cure   

The only proven method of preventing future back pain is with regular exercise and strengthening. It is important to consult your physiatrist before attempting any exercises as certain exercises may be better for you than others.

For more information about back pain, please visit our website at http://valleysportsandspine.com and learn how Valley Sports & Spine Clinic can relieve your pain for good.   

Introducing our newest team member, Shannon

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IMG_4074I love my staff. We have had many of the same faces at Valley Sports & Spine since the beginning. Their dedication and knowledge are an integral function of the clinic and I am finally getting around to writing about them on the blog.

A recent addition to our Medical Assistant position is Shannon. Shannon recently graduated from VT and is now in a Masters Program with an ultimate goal of Public Health work. She has a passion for Africa and desires to work in West Africa where the Ebola outbreak is exploding.

She recently completed the Eagle Man triatholon with three generations of her family, her mother and grandmother in a team named TriGenerational.  Their team placed 2nd in the relay division.  Her mother swam for 1.2 miles, her grandmother biked for 56 miles, and Shannon finished with a 13.1 mile run.  Shannon called the experience “Awesome!” and looks forward to more races with her family.

Her family has always been into competing and exercise.  Shannon’s grandmother, who was born in 1939, has competed in the Iron Man triathlon at least 5 times and stars in her own Spinning training videos.  Shannon has been a competitive swimmer since 5 years of age and participated in District and Regional swimming competitions in high school.  She admits she likes the competition more than the practice, and always try to beat her best time in any given sport.

Shannon has an upcoming 1/2 marathon and continues to swim and run regularly. She wants to master bicycling next so she can compete in triathlons, like her grandmother.

Good Luck, Shannon!

What’s in a breath?

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Put simply, a lot!

Next to the heart, the diaphragm is the most important muscle in the body. Recent research shows that dysfunction of the diaphragm is associated with low back pain.  The diaphragm is a large muscle separating the chest from the

abdomen, is the primary breathing muscle, as well as part of the core muscles.

The core muscles are a spherical boundary of muscles that surrounds the abdominal cavity. They include the: diaphragm, pelvic floor, lumbar musculature, abdominal muscles and rectus abdominis. These muscles work together to stabilize the spine, pelvis, hips, and support the function of chest and abdominal organs.

 

Gray's picture of diaphragm. Note the circumferential attachments to back, ribs, and sternum.

Gray’s picture of diaphragm. Note the circumferential attachments to back, ribs, and sternum.

Proper breathing requires the diaphragm to flatten and descend into the abdomen with inspiration, and doming upwards into the chest cavity with exhalation (there is much more, but to keep it simple we will stop there).  Because the diaphragm connects from the back to the front of the body, it requires coordinated muscle activity from the anterior abdominal muscles and core muscles, in order to function efficiently.

Dysfunction from the diaphragm can occur from a problem with the muscle itself or from any of the components of the core musculature; examples include: smoking, prior abdominal or pelvic surgery, deconditioning, abdominal hernias, open heart surgery, etc.  A less efficient diaphragm leads to overactivity of the secondary breathing muscles (intercostals, scalenes, and sternocleidomastoids), and back muscles.  Dysfunction of the diaphragm can also lead to core dysfunction.  This cascade of events can then lead to back pain, neck pain, pelvic floor problems, hip problems, etc.

Without addressing the function of the diagphram, exercises to treat neck pain, back pain, pelvic floor problems, and hip problems can fail.  Treatment should be aimed at restoring the function of the diaphragm through special breathing exercises that work on coordinating the activity of the diaphragm with core musculature and restoring balance to the secondary breathing muscles.

Valley Sports and Spine Clinic has trained alongside select physical therapists from Blacksburg, Christiansburg, and Radford to develop techniques, adapted from the Postural Restoration Institute, for evaluating and treating diaphragm problems.  If you have neck pain, back pain, urinary incontinence, bowel difficulty, or hip problems, you may need to have your diaphragm function evaluated and treated. We can help!

Good Luck,

 

Ethan Colliver, DO

Valley Sports & Spine Clinic Giving you Back your Life

 

Top 7 Rants on Exercise

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In general, I will say that movement is good.  For example, if all you can do is walk 20 minutes a day at lunch, then that is better than not exercising at all.  However, in my experience, I have heard a lot of excuses or false reasonings on why someone having a musculoskeletal problem doesn’t need advice on exercise.

  1. “I don’t need to work out because I work hard at my job.”  Exercise is different than work.  At work, you are focused on completing a task.  You don’t have the time to focus on how you move or what muscles you are using.  Exercise is when you can focus on yourself, how you move, and what muscles you are using.
  2. “I don’t have time to workout.”  The American College of Sports Medicine recommends 1.5 hours of exercise a week.  There are 168 hours in a week.  That is less than 1% of hours available in a week.  This is the equivalent of a little over 20 minutes a day.  That could be a lunch break at work, before work (my preference), or a family walk after dinner.
  3.  “I can’t afford a gym membership.”  Did cavemen have a gym?  No.  I am a huge believer that exercise should be accessible to everyone.  That is why I design exercises that can be done without extensive exercise equipment.  Walking and running is free.  So are pushups, burpees, step-ups, etc.  In fact, if you have a chair, you can exercise most major muscle groups with this article.  
  4. “Exercise machines are better and safer.”  This myth came out of the thought that exercise machines can isolate muscle groups are strengthen them more efficiently without increasing your risk of injury.  In fact, most experts now propose functional exercise (exercise that emulates the way that we move in real life) because we do not do tasks with a single muscle group.  We need to train muscle groups to work together so that when we do a demanding activity in real life, the muscles have “seen” this similar movement during exercise and can say “oh yeah, I know how to do this”, and get the job done.  Also, exercise machines do not decrease the risk of injury.  In fact, many machine exercises put the person in a sitting position which is known to put excessive stress on the spine and increase your risk of injury.
  5. “NO PAIN, NO GAIN!”  THIS IS THE WORST! This myth comes from the idea that it must hurt to break down muscles in order to build stronger muscle.  First, although exercising muscle to fatigue can accelerate the build up of new muscle, given adequate recovery time, however, pain is not the same thing as fatigue.  I know of no research that shows pain is needed to build muscle.  Second, this gives the exerciser the false expectation that they must feel pain in order to get stronger.  In fact, pain can be a warning sign that you are injuring tissue, like a disc in your spine; and when patients are new to exercise, they are often times afraid of pain (who isn’t?) and so hearing this oft quoted phrase scares them away from the much need rehabilitative exercise program that will help them, ironically, out of their pain.
  6. “Physical therapy doesn’t work for me.”  This myth often comes from past experiences when patients have experienced physical therapy only involving electrical stimulation, TENs stimulation, therapeutic ultrasound, heat packs, ice packs, etc. This feels good temporarily but wears off after you remove the treatment. We call this “Shake & Bake” shops.  None of these treatments do anything for chronic low back pain and if a clinic is only offering this, that is a warning sign that you need to find a new clinic.  Physical therapy is great for showing a patient how to start an exercise program that works on increasing your flexibility and strength, without increasing pain.  If you have difficulty, they can show you ways to personalize exercises for you.  They may utilize some modalities (listed above), along with massage, manipulation, traction, etc, but all this is geared towards helping you tolerated rehabilitation exercise.  In short, who treats you is more important than what they treat you with.
  7. “Just give me a list of exercises to do.” For the most part, no exercise program is dramatically better than another, especially today when there are so many options: pilates, yoga, CrossFit, P90X, Zumba, etc.  Research shows that none of these programs are more risky at causing injury than another program.  However, I view exercise programs as tools. Some tools work better for some jobs than others. Furthermore, not all exercise programs are good for everyone.  For example, when you have an injury, you need to find the right exercise that works for you; this often takes some trial and error to find an exercise that targets the right muscles without causing pain (see #5).  That is why a standard exercise sheet doesn’t work, especially in people recovering from an injury.

Well, that is enough ranting for now.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life

Dr Ethan Colliver

 

 

Muscle & Bone Health in Aging

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The muscle and bone systems are constantly changing and reacting throughout our lives; and the effects are different for men and women, but remarkably similar. Both muscle and bone will undergo a normal decline as we age; somewhere around the age of 25 in men.  Muscles lose strength and power for various reasons:

1. muscles lose mass: there is a decrease in muscle fiber size and a decrease in muscle fiber quantity, starting at the age of 25, due to decreases in estrogen, testosterone, and Insulin-like Growth Factor-1 (IGF-1).
2. loss of motor units: the number of motor nerves that innervate muscle cells decreases
3. less muscle protein synthesis
4. loss of aerobic capacity: this is multifactorial in itself
5. loss of synchronization of the firing of motor units: also, multifactorial, such as with prior sciataca or disc herniation

Bones lose mass as we age because of several reasons:
1. loss of sensitivity of bones to muscle: loss of testosterone, IGF-1, and estrogen decreases bone response to mechanical stimulation by muscles and result in loss of muscle mass.
2. loss of muscle mass, area, and strength: due to loss of IGF-1, estrogen, and testosterone and this loss of muscle can also decrease the stimulation on bones.
3. increased bone resorption: due to loss of estrogen and testosterone

You can counteract this decline in bone and muscle health with strength and endurance training. Regular strenuous exercise (20-60min, 3-5 days/week)increases muscle strength and power, aerobic capacity, and bone density. Currently, no medications are approved for the treatment of muscle loss that occurs with aging and some treatments, including testosterone, can have dangerous side effects. For bone loss, exercise can increase the stimulation on bones by muscles and improve power and balance to decrease your risk of falls. Many medications exist for treating thin bones, including testosterone in men, but it appears that exercise can be as effective and both treatments should be implemented.

If you are concerned about your bone and muscle health, you should check with your doctor to see if an underlying medical condition is present, or if this a natural process with aging. Your doctor may prescribe medications and exercise to treat your issues.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life

Dr Ethan Colliver