Although the 1949 discovery of cortisone was considered a medical landmark and breakthrough, there has NEVER been a study to prove the long term benefit to the injections. While cortisone does do a fantastic job at eliminating inflammation, the presence of inflammation also signals other dysfunction in the body that MUST be fixed before even considering cortisone injections as options! Otherwise, the effectiveness of cortisone is negligible and often detrimental.
Studies have proven time and time again that while most cortisone injections provide pain relief – often up to 3 to 6 months – patient clinical outcomes after a year are WORSE than those that did absolutely NOTHING! Think about that for a second…..people who did NOTHING for a year were actually better off than the patients trying to fix themselves! This is alarming and anyone who has been recommended a cortisone shot as a first line option for treatment prior to seeing a musculoskeletal expert NEEDS to seek a second opinion.
So why is this?
Cortisone overrides the pain response. This allows you to do the things you want to do pain free. While this sounds nice, pain is a signal something is wrong – a sign of dysfunction and something MUST be fixed. Since the pain signal is essentially shut off, the body builds more dysfunction and problems. When the cortisone wears off – the body is left in a WORSE condition!
I have written about this subject before, including what you should do if you have already received a cortisone injection. You can read the article on our website here ====> So You Got A Cortisone Shot: Now What?
If you or someone you know is thinking about getting a cortisone injection, I urge you to consider our office and finding the right SOLUTION to your problem! Feel free to call us at our office at 319-423-0925 or fill out an appointment request on this page. If you know someone that you think could benefit from this information, PLEASE forward this on!
At least that’s the question you should ask yourself. You see, cortisone works great at eliminating inflammation – that’s the point of the injection – but inflammation is just the result of an underlying problem. Cortisone does nothing to fix that! The result, as some of you may know, is having to go back multiple times for more the cortisone just to get relief.
What you may not be hearing is that while cortisone may be of benefit in pain relief in the short term, studies are now showing that patients have a worse clinical outcome when compared to patients that did absolutely nothing for their pain and injury over the course of a year. That should be startling information for those out there that have had a cortisone injection.
If you would like to see more on this information click here.
If you are someone who is debating getting a cortisone injection, or have already had one or several, there are some very important questions that you should answer.
The most important thing being – “What is your diagnosis?” This should be a tissue-specific diagnosis! Tennis elbow, plantar fasciitis, and tendonitis are NOT good enough!
The next question should be, “What are you trying to accomplish by getting the injection?” Are you looking for pain relief, or are you looking for a permanent fix?”
If you have been diagnosed with tendinitis, this may seem like a simple solution, but being that a LARGE majority of tendinitis cases are NOT inflammatory and instead degenerative, cortisone will actually make this worse, as referenced here.
This brings us back to our original question – “What is your tissue-specific diagnosis?”
If you are debating another shot, “How long do you think this one will last?”
If it’s your first, the average cortisone injection will provide 6-12 week’s worth of relief. Some are lucky enough to get more relief than that. People who already have had one, should expect similar results as before or less.
The last question to ask yourself should be, “What do you do after this shot wears off?”
If there was a tissue-specific diagnosis, there should already be a plan in place. If there was no plan in place it’s time to get one! You deserve better answers, you deserve better solutions!
At Thrive Spine and Sport, we answer your first question! Your body does not care what technique or treatment the provider is trained in. It simply cares, what it needs to fix the problem! If what your body needs is not a treatment we perform, we will refer you to where you need to be.
Thrive Spine and Sport specializes in the diagnosis and treatment of overuse and sport injuries, specifically the diagnosis and treatment of adhesion. Adhesion is one of the most common, most misdiagnosed condition in the body causing pain, inflammation, and restricted range of motion. Most of our patients have tried numerous providers before finding relief in our office. If you or someone you know is currently struggling with pain, we invite you to call our office to get answers to your problem today at 319-423-0925!
Unlike many of articles and blog posts we write, this one takes a different theme! Instead of talking about how to get out of pain, we take a look at how to STAY out of pain! It is important to note that this is not for those reading that are currently experiencing pain. If you are reading this and are struggling to get out of pain, you need an expert diagnosis and the best treatment to fix your problem. If you are looking to get to the bottom of your problem, I invite you to call our office at 319-423-0925 today for an appointment or find out if you are a candidate for our care.
Now for those of you still reading that are currently NOT in pain….CONGRATS! You are most likely already doing a lot of things right to take care of yourself. I think we can all agree that being in pain is a horrible, no good, very bad thing! Pain either limits what we can do, or stops it all together, and when it is present, we want it gone just as fast as it came! Unfortunately, that isn’t always the case, as most cases of pain often contain layers of dysfunction that must be worked through. Treatment is not always a “one hit wonder.”
Rule #1: STOP ABUSING YOUR BODY. This isn’t just for the gym rats. Sitting all day long has the same detriment on your body as grinding away at the gym for 3 hours every day at 100% effort. In both situations it is only a matter of time before things break down! At the office make sure to take frequent breaks (once or twice an hour). Get up from your desk and move around! At the gym it’s ok to back down the effort level sometimes or skip a workout if you are feeling beat up. Feeling stiff and tight all the time is an early warning sign of a bigger problem.
Rule #2: CHANGE THINGS UP. Unless you’re training for competition changing things up in your training routine helps to keep you healthy. Same goes for sitting all day and not getting up (see above). The body needs variation of activities and movements. Prolonged positions and frequent repetitive motions is the most common reason for all overuse injuries. Change your activity up to avoid this.
Rule#3: SELF-MAINTENANCE. Maintenance for your body should be no different than brushing and flossing for your teeth, or an oil change for your car. Stretching, yoga, foam rolling, mobility drills, maintenance exercise, and self-evaluation to monitor your health are all great tools to use. We recently wrote an article over some basic movements all runners should have – these same tests apply to everyone else. I invite you to check it out here. The other tools mentioned are all designed to increase blood flow through the body and allow you to move better. It is VITAL to note that stretching, yoga, foam rolling, exercise, and mobility drills are NOT treatment and should not be treated as such. Do these things regularly though and these decrease your probability of struggling through pain.
Staring at your computer screen, you realize you need to take a break.
Deciding to get a drink of water, you stand up from your desk and head to the water cooler. While getting up from your desk, the phone that previously sat on your lap drops to the floor.
You bend down to pick it up, when … bang!
Pain in your low back has frozen you in position and you fight to stand back up. You find yourself hunched forward and to the side. Your low back is in spasm and barely lets you do even the tiniest of movements.
After work, you go home, take a shower, and try to relax and get ready for bed. You can’t get comfortable and you sleep terrible. The next morning is even worse. Pain killers and muscle relaxers aren’t touching it. You go to work and move around a little more and things begin to finally loosen up. A week later you are almost back to normal with only a little bit of pain in the mornings that gets better with a little movement.
You dodged a bullet. Phew.
A couple months go by and things are going great. You go to hunch over a fellow co-workers computer screen and all of a sudden, low back pain strikes again. Same pain — maybe worse this time. You go through the same process and just over a week later things are almost back to normal. But now you’re worried. What is going on? Is it a sprain or is it a disc herniation?
While many people are familiar with low back pain and disc herniation, disc herniation or disc bulges account for only one to three percent of all low back pain cases. According to research, half of the patients similar to the one above will be diagnosed as having a sprain/strain – this is wrong!
Internal Disc Derangement, or IDD, is probably something you have never heard from your doctor. Shockingly, this accounts for almost 40 percent of all low back pain sufferers. Far too many times this is misdiagnosed, and mistreated!
Symptoms of IDD include:
antalgia (forward, hunched posture) with severe pain
guarded movement with muscle spasm
worse pain in the morning or with rest
worsening, multiple previous episodes and relief from symptoms within one to two weeks.
Odds are if you have ever hurt your low back and continue to struggle with pain, even on the rare occasion, this is you. It is important to note that the muscle spasm and guarding is a protective mechanism of the disc to try to prevent further damage to the disc.
If left untreated the right way, IDD can develop into bigger problems, like disc herniation. The muscle spasm and pain is NOT a sprain, and your hips are NOT out of alignment! These are two of the biggest misconceptions with this problem that I see.
So what can you do? With any pain and injury like this, it is best to get evaluated by a doctor that specializes in treating musculoskeletal conditions sooner rather than later. With Internal Disc Derangement, the disc is injured – nothing can reverse time and fix that. Usually, with each incident of pain, symptoms will get worse!
Whether you have been suffering from this condition weeks or months, you will have soft tissue dysfunction, like adhesion, in structures that alter joint mechanics and ncreases stress on the disc. If you are unfamiliar with adhesion, click here for our most recent article discussing it. Adhesion is one of the most common and misdiagnosed conditions in the body that restricts motion and causes pain.
If you have IDD, you must get the surrounding soft tissues fixed to unload the disc to hopefully prevent and reduce future incidences of pain and progressing disc injury! In other words, adhesion must be corrected in order to reduce the likelihood of this problem from returning.
Not fixing this issue will only lead to more problems down the road. As always when symptoms are present, you have two options — ignore it or fix it.
At Thrive Spine and Sport, we are the only full body certified Integrative Diagnosis clinic in the state of Iowa. The Integrative Diagnosis system is a diagnosis and treatment system to gain a clear picture and full diagnosis of what is causing your low back pain. By obtaining a full diagnosis, then applying the correct treatment, resolution for your pain is possible!
Simply fill out the appointment request on this page or call our office at 319-423-0925 to get to the bottom of your pain today! Any questions can be sent to Dr. Cody at email@example.com.
Let’s be honest, your problem isn’t going anywhere! In fact it’s getting worse.
You’ve tried rest, ice, stretching, pain pills, adjustments, cortisone, braces, exercise, and the list goes on. Still your problem persists. What is going on?
Adhesion is a term you probably haven’t heard about. Adhesion, or scar tissue, is one of the most common conditions in the human body, but also, BY FAR, the most misdiagnosed. Adhesion, when present, limits flexibility and decreases strength. The good news is that adhesion is completely reversible if treated correctly!
Adhesion develops primarily in two different ways – overuse, from either repetitive movements or prolonged positions (think working out, running, or sitting at a desk all day), and from trauma (think sports injury or car accident). Adhesion acts like glue on a muscle by sticking muscles and surrounding soft tissues together. When this happens your body has to work harder than normal to move or function normally. You may feel “tight” or weak at first, but eventually develop inflammation and pain.
When adhesion is present, it has to be physically broken down by a provider certified to find and fix adhesion in order for it to go away. Stretching and exercise wont help! Neither will a foam roller or a lacrosse ball. These may make you feel good for a few hours or even a few days, but they are not long term solutions!
Adhesion is at the root of many common problems like low back or neck pain, sciatica, most tendinitis cases, carpal tunnel syndrome, and even headaches!
Unfortunately, if left untreated long enough, adhesion can lead to other problems like disc herniation, stress fractures, labrum tears, muscle tears/sprains/strains, and early arthritic changes. How can that be?
Adhesion makes muscles work harder. When muscles work harder they become overworked sooner. Instead of the muscles absorbing most of your day to day activities, the body transfers the load into the cartilage, bones, and joints instead. This begins a very bad cycle of chronic pain. The sooner you fix adhesion the better!
At Thrive Spine and Sport, we are certified through the Integrative Diagnosis system for the diagnosis and treatment of adhesion. Currently, Thrive Spine and Sport is the only full body certified Integrative Diagnosis office in the state of Iowa! Integrative Diagnosis is the premiere system for diagnosing and treating musculoskeletal problems.
If you, or someone you know is continuing to struggle with pain, we invite you to call our office today at 319-423-0925! Most patients have tried numerous providers before finding relief in our office. If you have any questions, or not sure if we can help you or not, feel free to send an email to Dr. Cody at firstname.lastname@example.org.
One of the most common misconceptions in health care is this principle – “weak and tight” means “strengthen and stretch.” If there is one problem or complaint I hear the most it’s, “I’m always tight.” Usually, in the same breath, the same person will report that they just need to stretch, or they don’t stretch as often as they should. It usually comes as a surprise when I then tell this person that stretching won’t help them, and if you’re reading this and you always feel “stiff” it probably won’t help you either.
Stretching is the most overprescribed treatment in healthcare, and also the least beneficial. Now, don’t get me wrong there is a time and a place for stretching – yoga is fantastic – but fixing your stiffness and pain, it’s not going to happen!
Allow me to explain.
Our bodies were not programmed to handle the modern day lifestyle. Whether you work in a 9-5 desk position or work in a factory doing manual labor 40+ hours a week, both will have the same thing in common. Overuse. Overuse happens when we sit in prolonged positions or do repetitive activities, if we are not taking care of ourselves.
When we overuse our bodies, and fail to take care of it with proper rest, recovery, nutrients, this will often create a phenomenon called protective tension. Protective tension is created to help the body adapt to overuse. The body will make muscles spasm and contract to help protect any overloaded structure from further injury. Over a period of time, this gradually leads to adhesion formation.
If you are unfamiliar with adhesion, adhesion is the most common problem in the human body, but also the most misdiagnosed. Fortunately, it can be fixed easily with the right diagnosis and treatment. When present, it acts like glue on soft tissue structures like muscles, ligaments, and nerves. This glue then binds muscles and nerves together and decreases your flexibility and strength. Overtime, adhesion leads to altered joint mechanics and pain. Without the proper treatment, adhesion will eventually lead to chronic pain, chronic muscle sprain/strains, arthritis, and or spinal disc injuries (think herniation).
Check out this video below for a better demonstration and explanation.
We have been conditioned since elementary school days to think weak and tight means to strengthen and stretch. In reality, weak and tight is often a result of a problem! All of the stretches and strength exercises in the world will not help adhesion, in fact, it may make things worse. The most important thing that you can do is figure out why a muscle is weak and tight!
If this sounds familiar, it’s time to get some answers! At Thrive Spine and Sport, we are trained through the Integrative Diagnosis system to provide the most accurate and advanced diagnosis and treatment to chronic pain and overuse injuries. Many patients of our office have tried numerous providers before finding relief in our office.
Simply fill out the appointment request on this page, or call our office at 319-423-0925 to start feeling better today!
Cortisone. We have all heard the name. Some of you probably know someone who has been treated with it – It may have been you. But what is cortisone and what does it actually do? Could cortisone actually make things worse? Let’s dive in and find out.
The emergence of cortisone started in the late 1940’s and it was immediately heralded as the safest and most reliable means to treat pain and inflammation. Cortisone shots very quickly became the standard for overuse injuries, like “Tennis Elbow,” Achilles “Tendonitis,” “Bicep Tendonitis” and “Plantar Fasciitis.” Cortisone remains the standard today.
Cortisone, closely related to cortisol and also produced naturally in the body by the adrenal glands in response to stress, acts to suppress the immune system resulting in reduction of inflammation, pain, and swelling at the site of injury. Cortisone is primarily used in the short term and typical results provide several weeks to months of relief. Sounds good, right?
Not so fast. A recently published review examined the results of several randomized trials, involving thousands of participants with overuse injuries. These studies did find that, in the short term, cortisone did work to relieve pain better when compared to doing nothing (no shock there) or physical therapy. But what the review also states is that when the same participants were reexamined 6 and 12 months later, not only did they have a LOWER rate of recovery than the other test group, they also had a significantly HIGHER chance of RELAPSE!
So why is this? Cortisone shots are used for the treatment of INFLAMMATION! Overuse injuries do not involve INFLAMMATION! More research is now showing overuse injuries (“Tennis Elbow,” “Golfer’s Elbow,” “Achilles Tendonitis,” “Plantar Fasciitis,” etc.) to be DEGENERATIVE! That means that the tendons of the involved structures actually begin to fray with overuse.
But why does cortisone work in the short term then? Cortisone has an undeniable effect on the nervous system. Cortisone increases the body’s pain threshold, increasing it in the short term. This is why you no longer have pain and can return to regular activity. But this is also why the pain returns after the cortisone wears off! Pain is a protective mechanism of the body. Pain is the body’s way of telling you to stop doing what you are doing. When pain is overridden, the degeneration of the overuse injuries continues to occur leaving you worse off than when you started.
So what should you do? With any degenerative injuries, the tendons and other soft tissues must be restored. The best way to do this is by getting a proper diagnosis! Far too often these injuries are misdiagnosed.
Once a proper diagnosis has been established, you can begin the right treatment for your problem. Most often this treatment includes, manual therapy and at-home exercises. Bracing and load management are possible options for those responding to care slower than usual. Cortisone injections should be the LAST place to start with treatment!
At Thrive Spine and Sport, we pick up where others have failed. If you have been debating on whether or not to get a cortisone injection, and you live in the Cedar Rapids or surrounding areas, I invite you to fill out the appointment request on this page or call our office today at 319-423-0925 and get to the bottom of your pain! If you have any questions, please feel free to reach out to Dr. Cody Scharf at email@example.com.
If you have ever been in pain, chances are you were told to stretch. For some of us it helped, others it didn’t. Why did it work for some, while others stay in pain and are left thinking they just need to stretch more? Could stretching actually make the pain worse?
To understand this topic, we have to talk about some complicated subjects; anatomy, physiology, and kinesiology. Please don’t run away, we will make it easy for you to understand.
To start lets agree, that as humans, we all have the same parts, and should, therefore, all move the same and respond similar when exposed to common environments. Let’s also agree that our modern day lifestyle leaves us in poor postures for most of the day. Be honest with yourself right now and assess your posture. Is your head forward into your computer or flexed down to your phone trying to read this? Is your low back rounded and flexed while at your desk right now or on your drive home? Chances are it probably is, and you’re like this for most of the day without realizing it. These positions are already lengthened or stretched positions, so why isn’t it helping?
We walk a very fine line everyday balancing between what our body was designed to handle, and what we actually put our body through. We must understand that when we overload or overwork our body either through training, work, or sitting at a desk all day, the body will have to create compensations to better accommodate the stress being placed on the body. In the initial phases of compensation, the body will feel “weak and tight.” This serves as a protective role on the body, and is commonly referred to as “protective tension.”
Protective tension serves a purpose to protect the body from injury by providing stability to an unstable area. While it may feel good to stretch really all that is happening during this time is that a bunch of stretch receptors are getting fired off and overriding the current symptoms. This is why you may feel better in the short term but relief never lasts more than a few hours. This is also why it can lead to long term pain, as stretching often leads to more cumulative damage in already lengthened tissue!
If we fail to recognize why the protective tension is occurring and continue with our regular activity without modifications, friction, pressure, and tension, will eventually lead to the development of dysfunction in the body.
Having already agreed that as humans we will mostly have the same parts and respond similar given the same situations, we know that in muscles, or where nerves come into contact with muscles, adhesion will ultimately form in structures with continuous overload from repetitive motions or prolonged positions! Adhesion is the most common pathology found in muscles, but unfortunately, one of the most misdiagnosed conditions in the human body. I am going to go out on a limb and guess you haven’t heard this term before. Fortunately, it can be easily fixed!
Adhesion, or scar tissue, when present, acts like glue on the muscle and nerves. This further leads into the continuous cycle of feeling “tight” but will also start to cause pain and injury. If left untreated, this relatively easy problem to fix only gets worse and leads to bigger complications down the road. Weakness, pain, and even tingling, burning, and numbness, when present along a nerve, can all be caused by adhesion.
Stretching, unfortunately, will not fix adhesion. In order to fix adhesion, adhesion must be broken down through manual therapy by a certified practitioner that is trained to diagnoses and treat adhesion. When adhesion is removed, the “need” to stretch is removed. By removing adhesion, the body can then move better, and function better on a day to day basis without the need to stretch! Stretching can help to prevent adhesion from coming back in the future, and keep you healthier, but will not fix adhesion in the present.
At Thrive Spine and Sport, we are currently the only full body Integrative Diagnosis provider in the state of Iowa. Integrative Diagnosis providers are trained to find faulty movement patterns, diagnose, and treat adhesion to fix your pain or movement problem! If you are constantly feeling “tight” or having pain, weakness, or numbness and have failed to find anything that has fixed the problem, I invite you to get to the bottom of your problem! Simply fill out the appointment request on this page or call our office at 319-423-0925 today!
Let’s face the facts. Runners are one of the most injured group of athletes. Some studies suggest, as much as 70% of runners this year will suffer an injury that will either limit the runner’s mileage,or stop them from running completely! The complications of running arise primarily from overuse.
Now I don’t want to paint a picture that running is bad for you, because it isn’t! There are tremendous health benefits to running. The problem is that most runners like to push their limits – often coming very close – several times a week. This is where injuries start.
Runner’s knee, IT band syndrome, plantar fasciitis, Achilles tendinitis, sound familiar? These are all examples of overuse injuries. These don’t develop after one run but after miles and miles of pounding the pavement. Generally, the problem isn’t that we run too much, so much as these, are often the result of biomechanical imbalances and deficits which lead to added stress on muscles, joints, and other tissues.
None of us want to stop running or have pain. Wouldn’t it be nice to know what is causing our current pain and problems? Or better yet, wouldn’t be nice to know if we were at risk for a specific injury? Fortunately we do have these things! Below are 5 at-home assessments that can test and assess for some of the most common running injuries!
Ankle dorsiflexion may be the most important assessment for a runner. The feet and ankles are our foundation! Plantar fasciitis, Achilles tendinitis, shin splints, and eventually stress fractures can all be caused by limited dorsiflexion.
To test this start by standing arm’s length away from a wall. Place one foot close to the wall with the big toe touching the wall. Place a ruler along the lateral foot. While keeping the heel on the ground, bring the knee to the wall. Continue to slide the foot back and bring the knee to wall until you can no longer get the knee to touch the wall without the heel coming off the floor. Normal range is 5-6” and anything short of this makes you more likely for any running injury!
Reduced knee flexion directly leads to one of the most frequent injuries for runners – Runners knee.
To try this assessment, stand upright. Grab and pull an ankle until the heel comes into contact with the glute on the same side as the ankle. Anything short of pulling the ankle to the glute is placing you at higher risk for Runners knee.
While the hips are not given the label of the most commonly injured sites for a runner, a lack of hip flexion can lead to bursitis, IT band syndrome, muscle/labrum tears, and other problems downstream of the hips.
To test hip flexion, start by lying flat on the floor with the legs straight in front of you. Try to bring the knee to the chest while keeping the opposing leg flat. The front of the thigh should be flat against the chest. Test the other side the same way. Any pinching in through the front of hip, in the groin, or lateral hip is also a positive test and putting you at risk for injury.
Hip Extension is another assessment that has a direct role in stride length. Limited hip extension shortens the stride. When putting in the final kick to finish our race, we can’t be held back! By altering our stride, hip extension can cause any issue in the low back, hips, or knees directly.
To test this assessment is a little trickier and may require a partner. Start by getting into a lunge position. Lean as far forward as you can on the hip while staying upright. There should be no forward lean! Place a ruler under your back leg – this is the side we are assessing. Then find your ASIS – it is the bony part in the front of your hip. Place a level or a plumb line directly against the ASIS, directly over the ruler. Where the plumb line or level hits the ruler is your measurement. Note symptoms as well. Test both sides. Normal range of motion is 11-13” for most people although it can get much more. Pain with this movement, inability to stay upright, or any measurement short of 11” is a positive test.
The toe touch is an “all-inclusive” assessment. The toe touch is one of the most basic, functional movements anyone who is an active runner should have. Inability to touch the toes, shows reduced mobility in the low back and hips putting you at more risk of any injury, including low back pain.
Hopefully, you found all these assessments to be in normal range, but I’m guessing a few of you out there found some tests that were a little short or painful.
So why don’t you have the mobility? The two most common reasons these movements are restricted are due to adhesion and joint shape issues.
Adhesion is a buildup of scar tissue through overuse in the soft tissue like muscles, ligaments, or around nerves. This is the most common dysfunction in the human body, but also the most commonly misdiagnosed condition. The good news is that it can be easily fixed by a professional trained to diagnose and treat it! When present adhesion restricts range of motion, decreases strength, and causes pain.
Joint shape issues are either genetic or degenerative. This is not nearly as common as adhesion is, and degenerative joints are often the result of years of bad soft tissue, use, and abuse.
So what can you do?
If you find yourself falling short in some of these assessments but were pain free, start a routine of some stretching and mobility. Stretch and foam roll the restricted areas daily to try to get within normal range.
If you currently find yourself in pain, or any of the assessments painful, it’s too late! You need to seek out a healthcare professional to get examined. Find one that is trained to break up adhesion and properly evaluate these movements. If you chose to continue to run with these restricted movements and pain, it is not a matter of if, but when, more significant injury will happen!
If you live in the Cedar Rapids/Iowa City area and struggling with any of these tests, call our office today at 319-423-0925! At Thrive Spine and Sport we specialize in the diagnosis and treatment of overuse injuries caused by adhesion.
Pain and injuries are a part of running, just like any other sport, but that shouldn’t be the reason they stop you!