Articles in Category: Chiropractic

Dizziness: What are the causes and when can Chiropractic help?

on Wednesday, 11 November 2015. Posted in General Health, Chiropractic

Dizziness: What are the causes and when can Chiropractic help?

By Jakob van Vlijmen

M Chiro, DC

 

There are very few complaints as difficult as dizziness. Even though most types of dizziness do not have a sinister cause, they can lead to certain risks. As you can all imagine, being in a car or on the top of a flight of stairs are dangerous places to become dizzy. The following article will discuss the different causes of dizziness, the different ways it can present and when a visit to the chiropractor can be helpful.

 

Light headed or vertigo?

Dizziness is used to indicate a sense of instability, movement insecurity or light headedness. The term vertigo indicates a sense of spinning or whirling when the patient isn't actually moving. Light headedness is usually caused by low blood pressure, especially when it comes on after getting up too quickly. Low blood sugar however can also be a cause. If you experience these kinds of dizziness on a regular basis it might be a good idea for you to discuss this with your GP.

 

The 3 systems involved in processing movement information.

To be able to explain the different causes of dizziness we will have to discuss some of the mechanisms responsible for our sense of balance, the ability to register movement and our sense of positioning. These are the 3 different systems we need to discuss:

 

The Eyes - Among other things we use horizontal and vertical lines within our surroundings to determine our position and register movement.

 

The Organs of Balance - Situated deep within the ear. These organs are specialised in registering movement, acceleration and the position of the head.

 

Proprioception - This is information concerning the position of joints, the length of muscles and the force exerted by muscles.

 

By gathering and analysing the information from these systems numerous of times per second our brains can determine if anything or anyone is moving, what needs to be done to achieve movement and if we are in a balanced position.

 

Perfect collaboration between the 3 systems is required.

It is important to realise that these 3 systems have to work together in sync to prevent problems occurring. For example, when you turn your head to the left, the balance organs in your left ear is moving backward relatively speaking and the one in the right ear is moving forward. At the same time the position of several neck vertebra change, certain muscles are active in order for you to perform the movement and the eyes are registering the change in your surroundings. As long as all the information that your brain receives aligns with each other things will go smoothly, but if there is a discrepancy in the signals the brain receives it can lead to dizziness.

 

Different types of dizziness.

With the use of this background information a lot of common causes of dizziness can be explained.

 

Labyrinthitis (inflammation of the balance organ) With Labyrinthitis one or both of the balance organs becomes inflamed, most often this is caused by a virus infection. The afflicted organ is sending abnormal or incorrect information to the brain that doesn’t correspond with the other balance organ and other systems. This cause’s severe acute dizziness often accompanied with nausea and vomiting, sometimes the patient also experiences deafness or tinnitus. The symptoms can be so severe that the patient becomes bed ridden as every movement aggravates the symptoms. No real effective treatment exists but luckily most symptoms subside after a few days, although full recovery can take several weeks.

 

Meniere’s disease is an affliction of the inner ear, in which both the hearing organ and the balancing organ are affected. Meniere’s disease causes dizziness, tinnitus and deafness. These symptoms can come in waves and can persist for any length of time from a few hours to days. In some cases the deafness can be permanent. Meniere is usually treated with medications, but the success the medication has varies greatly case to case.

 

Benign Paroxysmal Positional vertigo (BPPV) The balancing organ registers the position and movement of the head with the use of 5 fluid filled canals. Movement of the head causes these fluids to move which is registered by little hairs within the canals. BPPV occurs when tiny particles break loose and fall into the canals stimulating the nerves that detect head rotation. The brain receives the message that the head is spinning when this isn’t the case. BPPV usually comes on after a fast head movement and disappears after 15 to 30 seconds. BPPV usually comes on at a later stage in life after an ear infection or bump to the head. Your chiropractor will be able to determine if the dizziness that you are experiencing is indeed BPPV by taking a full history of your complaint and performing several tests. If you indeed have BPPV it can usually be treated successfully within 2 to 3 treatments. During these treatments your chiropractor will be moving the head in a very specific manner in an attempt to relocate the particles that have broken off. Of all forms of vertigo BPPV is probably the most easily treated.

 

Cervicogenic dizziness is dizziness cause by problems in the joints or muscles in the neck. As explained earlier the brain also uses the information from muscles and joints (proprioception). Injuries or movement difficulties to the neck can cause dizziness for that reason. A good example is dizziness as a consequence to a whiplash caused by a car accident. This kind of dizziness is often seen in a chiropractic office and usually responds very well to treatment.

 

Sinister Causes

Besides the relatively benign causes mentioned above dizziness can also be caused by more serious afflictions luckily this is rarely the case, however if your dizziness is continuous and present for long periods at a time, uninfluenced by movement and accompanied by other symptoms. Such as headache, vomiting, problems with your eye sight it would be best to visit your GP.

 

 

 

The Knee

Written by Don Williams BSc, MChiro, ICSSD. on Thursday, 15 October 2015. Posted in General Health, Sporting Injuries, Training and Performance, Chiropractic

The Knee

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA

 

Knee pain and dysfunction is a common presenting complaint to our team here at the clinic.

On a daily basis we see a wide range of knee injuries ranging from overload injuries to developmental disorders and from trauma to serious pathology. Generally, knee conditions can be grouped into a these categories. This article aims to clarify and describe some of these issues and strategies to deal with them.

 

The Knee is an important link in our biomechanical chain for all of our standing activities. Injuries to the knee will affect our ability to stand, walk, run, ride and even sit and work. When you have suffered a severe knee injury you start to realise just how vital they are for our sport, recreation and normal daily activities.

 

Knee 

 

Traumatic Injuries

Any time there has been an impact, fall, major twist or other traumatic event. Pathology including ruptures, tears and fractures should be eliminated.

 

Ligament Ruptures (ACL, PCL, Collaterals)

ACL or Anterior cruciate ligament ruptures are probably the most well-known and are particularly prevalent in ball sports, although they can occur in a range of circumstances. The ACL prevents the lower leg (tibia) from sliding forward in regards to the upper leg (femur). Complete ruptures require graft stabilisation, partial tears can be conservatively managed with rest and rehabilitation exercises. Some theories suggest that if the person is not young, then a complete rupture does not need to be repaired, however, it appears to us that there is a higher prevalence of knee replacements and marked degenerative changes in the ruptured side compared to the normal side. We are fans of having a graft and effective rehab.

The PCL (posterior cruciate) prevents backwards movement of tibia and is less frequently injured, and usually in combination with the ACL and/or Collaterals.

Collateral ligaments prevent side to side movement of the knee. They will sometimes be repaired and once again, full ruptures are more often in combination with ACL and or PCL ruptures.

 

Meniscal Injuries

Often called cartilage injuries. The meniscii are little “C” and “J” shaped rings of cartilage, wedge shaped that help locate the knee for effective movement. The inner 1/3 is poorly vascularised and tears can cause a “flap”, which gets caught. These may require debridement (arthroscopic clean up) to remove the flap and stop the catching and jamming. The outer 1-3 to 2/3 does have blood supply and sometimes tears in this area will heal. Conservative management is certainly worth trialling and if not successful progression on to surgery to “stitch up” the tear can be indicated.

Bursitis

 

Articular Cartilage injuries

The articular cartilage is the smooth hyaline cartilage that covers the ends of the bones and allows the knee to glide smoothly through its movements. Injuries to the articular cartilage are less common and are usually traumatic. They are very difficult problems to manage and often don’t recover well. Optimising joint mechanics can be helpful. Different surgical interventions are aimed at trying to grow new cartilage, transplant cartilage and remove jagged edges with varying success.

 

Degenerative changes

Frequent presenting complaints. In severe cases knee replacement surgery will have a profound impact on the mobility and ability to enjoy life. In less severe cases, addressing footwear, improving mechanics around the knee and hip can be very helpful.

Research does not support the theory that running specifically speeds up degeneration of the knee. We are big fans of optimising gait mechanics in runners and wearing appropriate footwear. Really, the more active we keep people, generally the better they do.

 

degenerative change knee

 

Fractures

Knee fractures, whilst not being very common, do occur and there are a range of different types of fractures. Mostly they require a period of immobilisation and the use of crutches. Some cases will require surgery. We do see these at times but regularly refer on for orthopaedic assessment and management in the early stages, then reconnect again after the fracture has healed for rehabilitation.

 

Overload injuries

There are a range of overload injuries which occur around the knee. These can be simple injuries of the calf, hamstring and quad muscles which in turn effect the mechanics of the knee, causing pain and dysfunction. Additionally, we will see issues develop as a result of dysfunction in the ankles or hips. Poor footwear choices and foot mechanical issues will overload the knee leading to problems. Weakness in the gluteal muscles and poor hip mechanics will also cause problems. Differentiating what the deficiency is and how to address this is the important point.

 

Patellofemoral/patella tracking syndromes

These issues present usually with pain behind the knee cap or near the new cap. Usually the issues are with the patella tracking laterally or too far to the outside of the knee. This causes increase pressure on the “groove” that the knee cap runs in causing pain in the back of the knee cap or in the groove itself.  More often worse with flat footed people or people who drive their knees together in squat and lunge exercises. These are usually simply managed and if addressed relatively early will normally settle relatively quickly with homework.

 

Bursitis

There are little fat pad with sit on top of the patella, above and below the patella and on the medial (inside of the knee) a couple of centimetres down from the joint.  Direct impact or trauma can cause these to become inflamed or irritated, although they more frequently become sore from overload from poor mechanics or movement patterns of the lower limbs. Early management may include ice and anti-inflammatory regimes, although a long term outcome is usually best achieved by addressing the weaknesses and dysfunction which cause the problem.

 

Developmental disorders

These conditions may be regards as histological disorders. The usual onset for these conditions is in the early teenage years and often coincide with growth spurts. Essentially the insertion point of the tendon on the bone starts to pull away and becomes inflamed and painful. In rare cases they can completely snap off. They are more commonly associated with explosive sports (sprinting, jumping, and kicking) and are usually conservatively managed. They can recur over a number of years, although good compliance with homework makes them quite manageable.

 Osgood Schlatters occurs where the patella tendon inserts on the tibial tuberosity (on the upper shin bone) whereas Sinding Larsen Johansson disease occurs at the bottom of the patella (knee cap).

We usually incorporate activity modification in a flare up with management of the inflammatory process. Then incorporating stretching and strengthening exercises to improve the mechanics and flexibility to manage the presentation and prevent future flare ups.

 

Pathology

There are a number of pathologies of the knee ranging from low force fractures through to malignancies (tumours) and other weird and wacky complaints. Developing complaints for no apparent reason may be a serious problem but it may be an overload issue, so certainly don’t panic until it has been assessed and identified.

 

When we assess new knee injuries are first point is to eliminate major pathology then address the issue if it falls within our scope of practice

 

Management of Knee Injuries

The management of all of these injuries can vary but the principles remain the same; effectively assess the injury and the causative factors, identify the problem, protect the knee from further injury, treat the problem, progress the knee back to normal function.

 

Inappropriate footwear is certainly a common contributing factor. Generally speaking, flat/ low arch feet need stability and control in footwear, high arch/rigid feet need cushioning. Less commonly we see feet that require complex combinations of cushioning and support. These unusual foot types are not normally well managed by the shoe chain stores.

 

Poor mechanics in running gait and exercises (squats, deadlifts, leg press etc) can also be a big factor. It is not easy to simply describe how to do these activities appropriately. However, if you have issues and want them assessed, book an appointment with Don Williams or Martin Cooper and they will be happy to assess your movement patterns and show you how to improve any deficits.

 

At Institute of Sports and Spines we pride ourselves on doing comprehensive assessment of presenting complaints, using advanced imaging, such as MRI to confirm and identify the problem and then develop effective strategies to address the issue. At times this requires referral to orthopaedic surgeons for complex cases. If surgery is required we are well equipped you help you work through the problem and progress back to normal.

 

With almost all knee injuries Rehabilitation exercises are usually an important factor in achieving a good outcome, whether an overload or mechanical issue caused the issue or whether a traumatic injury caused weakness in the controlling muscles, addressing these deficiencies will improve your long term result.

 

We also offer a range of treatment modalities from Acupuncture and Massage to Chiropractic to help you through the symptomatic phase.

Tendinopathy - What Is It?

on Thursday, 15 October 2015. Posted in General Health, Chiropractic

Tendinopathy - What Is It?

As we are all aware pain can be a debilitating thing to live with and manage. In past months I typed some overviews on understanding discal pain, shin splints and neck pain. Today we'll be covering something a little trickier to manage, Tendon irritation and pain, often known as either tendinopathy, tendonitis, or tendinosis (these terms differentiate the pathophysiological mechanism of the injury – we won't go into that today).

 

Tendons are the tough fibres that connect muscle to bone. For example, the achilles tendon connects the calf muscle (gastrocnemius and Soleus) to the heel bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle, although the can also occur in the buttocks (gluts and hamstring insertions) and other areas.

 

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or aging. Anyone can have a tendon injury. But people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon. A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time – this may be related to previous traumas, injuries, or surgeries (which may have not been managed as well as they should/could have in the past -we all have those little gremlins in the closet unfortunately – me included!).

 

Symptoms of tendinopathy can include:

  • Pain, tenderness, redness, warmth, and/or swelling near the injured tendon. Pain may increase with activity. Insertional tendon pain may affect the local area where the injured tendon is, or can radiate out from the joint area along the associated muscle's distribution.

  • Crepitus, or a crunchy sound or feeling when the tendon is used. This can be uncomfortable or painful.

  • Pain and stiffness that may be worse at the night or when getting up in the morning.

  • Stiffness in the joint near the affected area.

 

Movement or mild exercise of the joint usually reduces the stiffness. But a tendon injury typically gets worse if the affected tendon is not allowed to rest and heal. Too much movement may make existing symptoms worse or bring the pain and stiffness back.

As mentioned above, The joint areas most commonly affected by tendinopathy are the shoulders (rotator cuff), elbow (and forearm/wrist), hips (gluteal), knees (knee cap), and ankles (achillies).

 

More chronic tendinopathies can be caused by inflammation around calcium crystals in or around the tendon (calcific tendinitis). The cause of the deposits often isn't known. These crystal deposits can be very painful, and a little more difficult to manage.

Tendinopathy pain may be similar to those of inflammation of the bursa (bursitis) and are often diagnosed concurrently because of the proximity and function/role of both structures

 

Diagnosis, Treatment and Management Considerations

Early diagnosis and treatment of a tendinopathy is important for recovery times as the turnaround for an acute tendinopathy to progress to a more degenerative chronic tendon injury can be as rapid as 6 weeks. Often orthopaedic assessment and provocation testing is necessary to identify the problem. Though if the injury is more complicated (obviously depending on the location and mode of injury) further assessment may need to be made, or if the problem is not responding to conservative treatment. Often xrays, ultrasounds and occasionally MRI is the most commonly used imaging tools for assessment and diagnosis.

 

Initially the focus on an acute tendinopathy is primarily based on reducing load on the tendon, stabilising the pain and protecting the area. Often topical applications of ice/heat and taping methods can be utilised, as well as the use of anti-inflammatory medications. In more severe cases the administration of a guided cortisone injection may also need to be considered. This can only be referred by your GP and performed by a specialist medical practitioner.

 

Understanding the mechanism of injury can go a long way towards recovery from a tendon injury. The tendon is the primary structure that deals with the load and force to move a joint (via muscle contraction) the primary focus of exercises for tendinopathies has to be based on reintroducing load onto a tendon gradually – thereby strengthening the tendon to adapt with load. Studies support the use of isometric exercise initially. (Isometric being defined as a contraction of any muscle without a change in the length of the muscle – thus performing isometric contraction of a muscle over a progressively increasing period of time allows the tendon to strengthen over time.)

 

Other more dynamic loading of the tendon can occur once clinical markers have been reached during treatment. These include less pain, improved strength and functional capabilities in more everyday tasks depending on the location of the tendon injury.

 

Do you have unusual pain in the shoulder, knee, hips ankles that seem to worsen with trivial tasks then assessment and diagnosis is always the first step. Problems such as these can lead to more sinister and traumatic problems which we would hope to avoid. These could be anything from chronic disability, tendon ruptures, and Adhesive Capsulitis (frozen shoulder) which can take anywhere from months to years to improve. Please contact the team at IOSAS and we'll help you find a plan forward for problems such as these.