Knee Pain In Cedar Rapids

Are your knees bugging you?

If so, here is what you should know:
• Knee pain is estimated to affect upwards of 25% of the population
• Knee pain is most often caused by overuse
• Knee replacement surgeries are on the rise!
• You do not HAVE to live with knee pain!

Most think that as we age aches and pains are normal. Knee pain can be added to this list! As mentioned, knee pain is most often caused by overuse. There are 2 consequences of overuse in the body; adhesion and degeneration.

1. Adhesion. Adhesion is the primary result of overuse. It acts like glue on soft tissues to make joints weaker and less flexible. Adhesion is the most common, most misdiagnosed, and most mistreated condition in human body. Fixing adhesion restores range of motion, increases strength, and eliminates pain.

Adhesion
2. Degeneration. Degeneration (think arthritis) gets most of the attention. Unfortunately, adhesion precedes degeneration and ultimately leads to faster and further progress of the degeneration in the joint. If your doctor has told you have arthritis there is nearly a 100% chance you also have adhesion! Fixing adhesion will not only improve joint function but slows the progression of your degeneration!

If you can’t tell from the above, adhesion and fixing adhesion is a very, big deal! Fortunately, if you have knee pain there is a simple test you can do at home to check for it!

To start the test, stand upright. Grab your ankle and attempt to pull the heel into butt. Make sure that the thigh being tested is inline with opposite leg and has not moved in front of it. If you cannot pull the heel to your butt, or if pain is present you have failed the test. Adhesion is the most likely result. I am guessing if you have knee pain most of you out there that tried the test did not do so well! This puts you at a much higher risk for future degeneration, cartilage damage, and other major knee injuries.

The heel approximates just short of the butt. This is a failed test and you should seek help!
The heel approximates just short of the butt. This is a failed test.

The good news? We can help!

The doctors at Thrive Spine and Sport are experts at finding and fixing adhesion. We are the most experienced office in the state of Iowa to deal with this issue! By performing specific bio mechanical tests to check function and correlate your prior history and other relevant findings during the exam we can determine your level of success from our treatment.

If you or someone you know is currently suffering with knee pain, we encourage you to call our office today at 319-423-0925 or go to www.thrivespineandsport.com/appointment-request to schedule an appointment today!

Thanks for reading!

Low Back Health Exam

Over 80% of the population will be affected by low back pain at some point in their life.  25% have suffered low back pain in the last 3 months alone!  Low back pain is one of the leading causes of disability and lost production in this country.  Solutions to the problem aren’t often easy and far too many people are left looking for answers for why their back always hurts.  Low back pain is a REALLY BIG DEAL!  Keeping your low back HEALTHY should be a PRIORITY!

If you struggle with low back pain, wouldn’t it be nice to know WHY your back always hurts?  Or maybe, if you’re one of the lucky ones not currently in pain, wouldn’t it be nice to know your low back pain risk and what you need to do to prevent it?

Now you can by taking the test and trying these 5 tests at home!  Why these 5 tests?  These 5 tests are the most basic, functional movements of the low back.  Every healthy person should be able to perform these tests!

So here’s how it goes.  Perform each test below – some may need the help of a partner.  Rate yourself by the grading chart for each test.  Add the scores together at the end to get your score.  Follow the directions to fix your low back!

Let’s get started!

TEST #1:  Straight Leg Raiser

You will need a partner for this.  Download a “bubble level” app on your phone.  Make sure the app measures angle as well.  There are a ton of free ones out there that work well for this.  I recommend “Clinometer” for Android and “iHandy Level Free” for iPhones.

Lie on your back with feet extended out in front.  Place the phone with the bubble app open in the middle of the shin.  One leg at a time, have your partner lift the leg with the knee straight.  Move the leg until it can no longer stretch or the hip or opposing leg starts to lift off the ground.  Record the degree.

20160706_182837

85-90 Degrees = 2 Points          75-84 Degrees = 1 Point          Less Than 74 degrees = 0 Points

 

TEST #2:  Knee-To-Chest

While still laying on your back, one leg at a time, pull your knee to your chest.  The front of the leg should touch the bottom of your rib cage without any pinch in the anterior hip.  If you cannot get the front of your leg to touch your chest, measure how far away by placing fingers between your chest and leg.  Record the distance.

20160706_183142_001

3 Finger Restricted Knee-To-Chest
3 Finger Restricted Knee-To-Chest

Leg Flat On Chest W/ No Anterior Hip Pinch = 0 Points        Leg 1-3 Fingers From Chest = 1 Point          Leg  More Than 4 Fingers From Chest = 0 Points

TEST #3: “Cat Stretch”

You will need a partner and a pencil.

With hands and knees on the floor arch your low back as much as possible by trying to bring your hips to your chest.  Have your partner place a pencil on your lower back.  What does it look like?

Healthy "Cat Stretch" Test
Healthy “Cat Stretch” Test

                                            Pencil Ends Off Back = 2 Points                                              

Flat Pencil Test
Flat Pencil Test

Pencil Flat = 1 Point

Severely Restricted "Cat Stretch" Test
Severely Restricted “Cat Stretch” Test

Pencil Ends Touching, Middle Not = 0 Points

 

TEST #4: Lunge

Standing up, take a large step forward and drop the back knee to the ground.  Keep your body upright.  Place a ruler under your back leg.  Measure how far the front of the hip extends out from the ruler.

Lunge Test
Lunge Test
Overhead View of Healthy Lunge Test Of The Ruler
Overhead View of Healthy Lunge Test Of The Ruler

More Than 12” = 2 Points          9-11.5” = 1 Point          Less Than 9” = 0 Points   

 

TEST #5: Toe Touch

Standing upright bend forward and try to touch the floor in front of your toes.  Use a ruler to measure how far away the tip of your finger is away from the floor.

Healthy Toe Touch Test
Healthy Toe Touch Test

Finger Touching Floor or Palming Floor = 2 Points

Fingers Less Than 2” From Floor = 1 Point

Limited Toe Touch Test
Limited Toe Touch Test

Fingers More Than 2” From The Floor = 0 Points

 

Now that you have gone through all of the tests, add the score of each test together.  What did you get?

9-10 Points = 90-100% Low Back Function = Congratulations!  You have a VERY healthy back!

7-8 Points = 70-80% Low Back Function = Chances are you may not have low back pain now, but you should try to improve the tests that are lagging with some simple daily mobility, stretching, and exercise.  In pain currently?  See below.

Less Than 6 Points = Less Than 60% Low Back Function = Your back is in trouble!  Most of these tests are limited or restricted.  You have less than 60% function of your low back!  That’s a failing grade in school!  Just like in school when you failed a test and you looked for some help to get better grades, you should seek the help of a local musculoskeletal expert for solutions to fix these movements and solve your low back pain!

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It is important to note these 5 tests above are assessments used in the Integrative Diagnosis system.  The most common cause of limited range of motion and pain for these tests are due to muscle adhesion.  Integrative Diagnosis is the most advanced diagnosis and treatment system for solving musculoskeletal problems.

At Thrive Spine and Sport, we are currently the only full body Integrative Diagnosis providers in the State of Iowa. Our treatment fixes adhesion!  If you have been looking for answers to your low back pain, click the appointment request here, or call us at 319-423-0925.

3 Easy Tests To Help Figure Out Low Back Pain

According to the National Institute of Health (NIH) lower back pain will affect 8 out of every 10 people at some point in their life.  On top of being the leading cause of disability worldwide, lower back pain will cost Americans $50 billion dollars this year!  While some cases of low back pain will go away after a couple days on its own, a majority of cases will become chronic in nature!  So why do some cases go away, while others become chronic? Let take a look!

If you do any kind of research online, you will likely find the same recommendations for pain relief repeated – rest, ice, stretch, warm up better prior to activity, NSAIDs, maintain good posture, get better shoes, etc.  While this may sound like sound advice, none of it really works, otherwise we wouldn’t find so many of us in pain.

Since most people start treatment of low back pain by visiting their PCP, or Primary Care Provider, they are often recommended rest and NSAIDS.  After a couple weeks of inactivity, these same people often find themselves right back where they started once they get back to their daily routine.  Sound familiar? So what went wrong?

The problem is that the rest and NSAIDs temporarily raised your symptom threshold, but did nothing to address the real issue. Stretching may provide temporary relief but no long term benefits. The shoes may have taken some stress off your feet, but didn’t touch the low back pain.  None of the above recommendations address long term fixes!

The problem with all of this, and why your pain has become chronic, is that there was not a single, specific diagnosis made to identify the real problem initially!  In my experience, most people with low back pain have some limiting range or motion in their low back, hips, or both. This limited range places extra stress on the low back, causing weakness and pain!

So how do you know if this limited range affects you and your low back pain?  Fortunately, there are some at-home tests that you can do right now to find out where you’re limited and options to finally get your low back pain under control!

The first test is the Standing Toe Touch.  While this may seem simple, most people with low back pain are unable to bend at the waist and touch the toes to the floor without pain or tension in the back of the knees and calves.  The test should be effortless and without pain.

SLPF
Full Standing Toe Touch

 

Knee-to-chest is the easiest way to test hip flexion.  Lie flat on the floor with both legs extended out in front of you.  Bring one knee up to your chest until the front of the thigh is flat with the chest.  If the opposing leg raises up, pinching is felt in the front of the hip, groin, or outer leg, or the thigh falls short of the chest, the test is limited and a possible cause of low back pain.

Hip Flexion Test
Hip Flexion Test

Hip Extension is vital to the stability of your spine.  To test, start in a lunge position, leaning as far forward onto one hip.  Place a ruler in line with the rear leg just in front of the knee.  Drop a plumb line from the front of your hip to the ruler below.  Normal range should fall between 10-12 inches.  Decreased range or pain with this test is a positive finding for this test.

Kneeling Hip Extension
Kneeling Hip Extension

If you or someone you know suffers from low back pain and cannot perform these very simple tests, there is a good chance they can find relief in our office.  At Thrive Spine and Sport, these tests, and a few others from the Integrative Diagnosis system, are used to gain a clear picture and full diagnosis of what causing your low back pain.  By obtaining a full diagnosis and 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 dr.cody@thrivespineandsport.com.

Thanks for reading!

 

 

***Special thanks to Ally Thompson of Heat Yoga and Dr. Carl Nottoli of Functional Spine and Sport for the photos****

5 Must Have Movements For Pain Free Running!

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

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!

Clean Ankle Dorsiflexion
Clean Ankle Dorsiflexion

Knee Flexion

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.

Positive Knee Flexion (Heel Short of Glutes)

Hip Flexion

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 Flexion Test
Hip Flexion Test

Hip Extension

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.

Hip Extension (Measure from under the back leg)

Toe Touch

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!

 

Thanks for reading!

Some Help With Foot Pain and Plantar Fasciitis

You don’t have to be a runner to experience foot pain, but 10 percent of runners this summer will at some point!

We have all heard of plantar fasciitis. It is the most common cause of foot pain in runners, after all. Surprisingly, it is also one of the most misdiagnosed and mistreated.

Pain on the bottom of the foot often gets the diagnosis of plantar fasciitis, but this diagnosis neglects to take into account literally every other structure in the foot as a potential cause of pain.

For those who begin to experience foot pain, beginning to fix the problem can be a bit overwhelming. Far too often rest, ice, stretching, and pain medication do nothing for the pain!

So where do you start? What do you do? Is it just a soft tissue problem or is it a bone and joint problem? In order to answer these questions, you need to start with some assessment.

A simple test used to rule out bone spurs or more serious joint complications is toe walking. Although, not 100 percent accurate, plantar fasciitis or soft tissue problems will be made worse by toe walking. Other assessments include testing dorsiflexion and plantarflexion. Muscles in the posterior and anterior calf insert on the foot. They cannot be ruled out as part of your foot problem.

In order to test dorsiflexion, stand by a wall a few inches away. Place your hands on the wall for support and bring the affected foot forward to the wall. Bring your knee to touch the wall without the heel lifting off the floor. Continue to slide your foot backward until you find the furthest place from the wall your knee can touch the wall while keeping your heel on the ground. Normal, healthy range is five to six inches.

To assess plantar flexion, kneel with both shins flat on the ground. Sit back until your buttocks touches the heels. The shin and anterior foot should be flat on the ground without pain. Any space between your ankle and the floor, or pain with the movement, is a positive test.

These two movements are great places to start. Most problems found with these assessments can be fixed. If you find yourself with any of the above assessments positive, you must return these assessments to normal, healthy movements.

Mobility techniques like basic calf stretching and foam rolling the anterior and posterior are great places to start. Rolling a golf ball on the bottom of your foot for a couple minutes also can be of beneficial. Using your toes to curl up a towel can add some strength to the bottom of your foot.

The above assessments should be used to measure your progress with these techniques. If these do not clear up and you continue to experience pain, the problem may be more severe.

Plantar fasciitis and many cases of foot pain are caused by overuse. The result of overuse injuries are microtraumas and tears that eventually lead to the formation of adhesion. Adhesion acts as glue to prevent further injury to the tissue, but it restricts proper movement and function, and causes weakness and pain for those who continue activity. In order to fix adhesion, the above mobility techniques may help, but treatment from a licensed professional is often necessary.

There are many different causes of foot pain and the solutions are never easy. If you’re struggling to get to the bottom of your foot pain, start with the above mentioned assessments. Work to improve and return these tests to normal. If pain or dysfunction persists, reaching out to your local health care provider is the next best step.

If you are in the Cedar Rapids area, and struggling with foot pain, I invite you to fill out an appointment request on this page or give our office a call at 319-423-0925 and get to the bottom of your problem!  

Struggling With Carpal Tunnel Syndrome?

Carpal tunnel syndrome, or CTS, is something you are probably familiar with.  Affecting approximately 3-6% of the general population, CTS is usually linked to highly repetitive tasks like heavy manual labor, or typing and desk work.  Characterized by numbness, tingling, or burning sensations in the thumb and fingers, carpal tunnel syndrome is the most common nerve entrapment found in the body.

While there is a lot that we do know about CTS, unfortunately it hasn’t made fixing it any easier.  Successful conservative treatment of carpal tunnel syndrome have been estimated between 3 and 70%!  That is quite a wide range of success to say the least!  The problem in successful treatment may lie in the diagnosis.

Most commonly, CTS is characterized as entrapment of the median nerve in the carpal tunnel of the wrist.  Often times this is not the case.

The median nerve forms in the axilla (armpit) by joining nerves that originate in the neck.  After forming, the median nerve continues its path through the upper arm, into the elbow, through the forearm, and finally through the carpal tunnel and into the hand.  Along this path, the nerve passes through multiple structures before arriving at the carpal tunnel in the wrist.

Median Nerve Pathway
Median Nerve Pathway

When healthy, the nerve glides along other muscles, tendons, and other soft tissue structures without problem.  With overuse and some other conditions, the nerve can become glued and entrapped by adhesion to these structures.  When nerves become entrapped, they cause tingling, burning, and numbness symptoms.  This is where the problem lies in most cases of classic CTS!

Overuse Cycle

While the carpal tunnel, itself, gets most of the recognition for this problem, the median nerve can become entrapped anywhere along its path to the wrist and hand.  The difficulty with treatment is finding where this entrapment exists.

Therapies like drugs, injections, and splinting may offer short term relief, but do nothing to actually fix the entrapment.  The same holds true for stretching and exercise.  Surgery should always be used as a last resort.

In order for resolution of CTS, the nerve must be freed from the entrapment, if present, in the soft tissues of the neck and arm. Fortunately, there are some at home movements for carpal tunnel to see where the entrapment may exist:

Cervical Flexion.  To start, stand with your back flat against the wall including the head.  Start by tucking the chin to the neck without moving the head off the wall.  Note any symptoms into the neck, shoulders, or arms.  Next move further into flexion by tucking the chin to the sternum.  Inability to tuck the chin to the chest, or symptoms into the shoulder or arm can be a sign of entrapment in the neck.

Healthy cervical flexion.
Healthy cervical flexion.

Shoulder Abduction.  Stand upright with the arms along the side.  Slowly bring the arms up to the ears by moving the arms in a motion similar to a “jumping jack.”  The upper arm should touch the ear.  Anything short of this motion or pain or numbness into the hands may be a sign of entrapment.

Shoulder Abduction
Shoulder Abduction with right side more restricted than left. (Note upper arm proximity to ears)

Wrist/Finger Extension.  Place the forearm flat along the wall with the elbow 90 degrees to the shoulder.   Pull back on the wrist until it is 90 degrees to the forearm.  Now, pull back on the fingers.  They should be roughly 65 degrees to the wrist.  Note symptoms. Any motion short of the noted ranges is positive, along with pain, tingling, or burning sensations can be a sign of entrapment in the forearm or wrist.

Wrist Extension
Healthy Wrist/Finger Extension

As mentioned earlier, most conservative treatment fails to diagnose properly, and thus, fails to provide proper treatment to fix carpal tunnel syndrome.  Manual therapy has been shown to be effective for treatment of nerve entrapment.  Carpal tunnel syndrome is progressive in nature, and ultimately leads to surgery in far too many cases where it could have been prevented.  For those suffering with CTS symptoms it is highly recommended to seek proper treatment as soon as possible.

At Thrive Spine and Sport, we focus on finding and fixing nerve entrapment!  If you have been struggling to find relief from carpal tunnel syndrome, call our office today to set up an appointment at 319-423-0925, or fill out the appointment request on this page.  If you have any questions, feel free to email myself at dr.cody@thrivespineandsport.com.