A lot of the aches and pains that we experience in daily life can be solved with Chiropractic care. If you haven’t visited a Chiropractor yet, here are some signals that it may be time to pay a visit.
1. Daily Troubles
You are having trouble with your daily activities: getting dressed, preparing meals, taking care of children, shopping, getting through your workday without pain, exercise and sports are limited.
2. Medication Avoidance
You want to avoid opioid medication. Patients who see a chiropractor are 50% less likely to fill an opioid prescription than patients who don’t.
3. Prolonged Pain
You might need to visit a chiropractic professional if you’ve had pain for longer than 3 weeks without seeing improvement in symptoms.
4. Usual Remedies No Longer Work
Your pain is not responding to more conservative treatments like over-the-counter medications, hot packs, or topical pain relievers.
5. Unusual Bodily Changes
You have increased pain at night, unexplained weight loss, changes in bowel/bladder function related to your back pain, visual disturbances, trouble speaking/swallowing, neck stiffness with a fever, progressive weakness, saddle paresthesias. If you have any of the above symptoms you should see your healthcare provider immediately. These are red flags and suggest a serious condition.
Looking for a Chiropractor in Charlottesville, VA? Contact us to book an appointment.
You may have some preconceived ideas about Chiropractic Care that have been built up over the years. We’re here to bring you 4 truths that can help to separate facts from fiction.
1.Chiropractic adjustments or spinal/joint manipulations align the spine.
It’s just not true. This is a very old explanation used by chiropractors, physical therapists, and osteopaths because it is simple to explain to the patient. But spines and joints are not so fragile and manipulation doesn’t put you back into alignment. And I’ve got good news — you’re not out of alignment. So what does joint manipulation do? Joint manipulation provides short-term improvements in pain, range of motion, and proprioception. A course of manipulation can be an effective tool as part of a care plan for musculoskeletal conditions.
2.You have to go forever.
This is not true. While healing is a process and seeing a chiropractor or a physical therapist often involves several visits over several weeks (more or less depending upon your condition/injury) it should not be forever. Now, some patients like manipulation because it feels good and like to go on a regular basis, in much the same way that some people like to get regular massages. And that’s totally fine. But it isn’t a requirement and it isn’t medically necessary. It is fine to go regularly if you enjoy it. But it is also fine to see your clinician until your injury is resolved and then not see them again.
3.Chiropractic care is dangerous.
While no treatment is without risk, chiropractic care is very safe. The most common adverse side effects are soreness. There is no evidence that chiropractic manipulation is correlated with strokes (this has been looked at repeatedly) and no evidence that chiropractic manipulation is correlated with a vertebral disc injury.
4.X-rays are necessary to diagnose and treat your condition.
This is also not true and we believe this may be more harmful than helpful due to the effects of radiation on the body. Most people hurt when they move, not when they are sitting still. That being said, how much can a static picture tell us about your condition? Not much. There is also a very poor correlation between imaging and the amount of pain a patient experiences, further debunking the need for imaging. Of course imaging is required when red flags are present: when fracture or serious illness is suspected but in absence of that, we don’t recommend it.
When an injury begins to develop, the amount of options to enter the healthcare system can be daunting. It’s almost as bad as choosing where to get takeout from for dinner, which can sometimes lead to cooking at home due to the overwhelming amount of choices in Charlottesville. When talking about healthcare, these options may lead to the wait and see what happens method. Wait and see is something almost all of us have done with our healthcare, but it often results in negative consequences. When it comes to our healthcare, it’s best to tackle our problems before they cascade out of our control.
When asked WHERE to begin in the healthcare spectrum following an injury, the answer should be up to you and where you feel comfortable starting. All healthcare professionals have been through extensive schooling to help patients and clients. Obviously, we’re a little biased towards chiropractic and physical therapy for all musculoskeletal issues. Here are a few of the reasons why:
- We have been trained to rule-out red flag conditions like fractures and other significant issues, so this is a safe starting point for most injuries
- You should never receive imaging unless it is necessary
- We do not order imaging, unless fracture or other serious pathology is expected, saving you time, money, and exposure to radiation
- We have been trained to diagnose and treat most musculoskeletal injuries and conditions to help our patients get better
- Our entire curriculum focused on conservative care for musculoskeletal injury, making us experts in diagnosing and caring for these injuries
- We have been trained to treat your condition without medications or surgery
In general, you do not need a prescription from your doctor to see a chiropractor or physical therapist in Virginia. This can help to save you time and money, as well as help you get to the route cause of your symptoms without having to cut through all of the red tape.
Now that you have a general understanding about where to start following an injury, now we’ll address WHEN to start. The sooner you seek care, the better for almost every single condition out there. Although money can always be an issue, I can almost guarantee you you will save money if you come in sooner in the injury process. Coming in early allows us to:
- Educate you on what is causing the condition and help you understand why it likely happened in the first place
- Address your injury early on before it gets worse. If you are not aware of what is causing your pain, we can help identify it
- If you have a sprain or a strain, we can address it and counsel you on how to promote healing
- We generally don’t recommend stopping activity, but teach you how to work around it and load it properly to stimulate recovery
- Sprain and strains will generally get worse if frequency, intensity, time, or type of training is not adjusted: We can help you find the right balance
- Prevent injuries from manifesting in different areas. When something hurts, it usually leads to suboptimal movement or guarding of the injured area. If this is prolonged, an ankle injury can progress to involve the knee, hip, and lower back.
- Reduce your costs of treatment. If we see you early on in the injury process, we can usually treat it in 2-3 sessions with education and a home program instead of a full course of treatment (10+ visits requiring more supervision). This will help to save you money so you can spend it on new fitness gear!
We are here to treat you and not recommend unnecessary care. We want you to get better as quickly and fully as possible. By accessing our care early in the injury process, you can help us achieve our goals and your goals for care. There is always the option of consulting with one of our providers to see if we are the right place to start for your care. This is just another way we are working to break down the barriers to care. SO, next time you face an injury, please don’t “wait and see” and see your provider early to get back to 100% quickly.
Have you ever experienced anterior knee pain? The likely answer is yes, and it can be quite debilitating! There are a variety of causes for anterior knee pain including patellar tendinopathy (tendonitis), chondromalacia patella, patellar tracking issues, and more serious injuries like ACL tears. This blog with focus on patellar tendinopathy.
What is Patellar Tendinopathy
So, you may be wondering how this condition starts in the first place. It is usually the result of overloading the tendon before it has time to adapt. By not allowing for a gradual increase in training load, the tendon faces more stress than it is capable of tolerating. Generally it affects the adult population ranging from 16-40 year olds, but can affect anyone if a training schedule is not properly developed. Once the condition has developed, it can take anywhere from 2 weeks to 2 months to fully resolve.
Biological signs of the injury include up regulation of cells that create the tendon, ground substance, nerves, and blood vessels. One hypothesis for why the tendon becomes painful is the in-growth of nerves and blood vessels; picture packing all of these substances into a compact area. The brain and central nervous system may also play a big role in sensitization of the tissue. Pain with this condition like serves more as a “danger signal” to allow the human to know something is happening in that area of the body, and is likely not a signal of tissue damage. Think of this as a warning sign to slow down and let the tendon adapt.
Diagnosis of Patellar Tendinopathy
Functional movements that usually become painful with patellar tendinopathy:
- Going down stairs hurts more than going up
- The deeper the squat, the more the pain
- Sitting for long periods
- Running, jumping, and walking hills hurts
Other hallmark signs of the condition:
- Pain in the front of the knee just below the kneecap
- Pain “came out of nowhere and progressively got worse”
- Recent change in training load
- No catching, locking, or giving-way
Real Life How it Happens
Now that we’ve gone through all the logistics of this condition, lets look at a real life example of how this can happen with running. Picture this: It’s winter, the weather isn’t great for running so you’ve been inside running on a treadmill. You have been consistently running 5 miles with no pain throughout 4x’s a week.
Then BOOM. March hits and its 60 degrees out with the sun shining. New shoes are unboxed and you can’t wait to get outside and hit the pavement. You start running outside with the same mileage, but now you’re running 5-6x’s for 6-7 miles a week because you can’t resist how nice its been outside. One morning you wake up to walk to work or class and you notice that as you’re walking down hill your knee is bothering you a little (nothing serious 1/10 pain). Over the next few days you notice the pain is getting a little worse (2-3/10 pain with stairs, hills, and now its even bothering you a little with running). Now you’re concerned because its starting to affect running.
So let’s break that story down and see how training may have overloaded the tendon before it was able to adapt:
- The obvious, moving from 4x’s a week to 5-6x’s a week and increasing mileage
- Moving from a treadmill which absorbs some shock to pavement
- Flat to hilly terrain
- Even to slightly tilted or cracked sidewalks
- Going from a consistent speed or cadence to one that is likely more varied
- Change in temperature
As you can see, outside of the obvious, there are a lot of other variables that need to be accounted for to allow the tendon to adapt properly. No matter the activity, it is important to allow adaptation to training volume, load, surface, or equipment. The importance of ramping-up training or allowing appropriate time for tissue adaptation can not be overstated. This is why this injury is usually more prevalent at the beginning of a sporting season or training regimen.
As always, better outcomes are seen with more timely interventions versus the wait and see method. Treatment is generally aimed at reducing pain, promoting tissue adaptation and healing, and improving proprioception in the joint and surrounding tissues. Eccentric and heavy slow resistance exercises have been shown to be the most beneficial in treating this condition and some protocols have been established. Since everyone’s tendon quality and pain levels may be different, it’s essential to ensure you are starting at the right level for your level of tissue irritability. If the tendon is stressed too much during recovery, the tendinopathy cycle may repeat itself and may become worse.
Remember, there is no established time frame for recovery, so being patient with recovery is important. The good news is that you can usually continue training during rehab, but it is best to consult your physical therapist about adjusting impact training, training load, or training volume.
Bryan Esherick PT, DPT
Did you catch our last blog? If so, you’ve probably got a pretty good idea about what FAI and labral tears are. Hopefully this will make it easier for you to talk to your physician and physical therapist about your healthcare. There’s a lot of options out there, but everyone involved – patients, surgeons, and rehab professionals alike – agrees that targeted sport-specific physical therapy is essential to a full recovery, with or without medical intervention.
“Calm stuff down, then build stuff back up”. This quote from Greg Lehman, a dual-doctorate physical therapist and chiropractor, basically sums up how a physical therapist works to help you get past your hip pain and back to your sport. First – and we know athletes in particular need to hear this – the rehab process generally needs to start with a de-load. Taking time away from the activities that aggravate your hip is necessary to allow the joint to calm down and get out of an inflammatory state. However, it’s important that you stay active in ways that don’t aggravate your hip to avoid weakness and deconditioning (and to keep you sane, of course). If you have pain with running, for instance, try swimming or cycling; If you’re struggling to play a full 90 minutes of soccer, try decreasing your time on the field or avoiding drills that you know will flare things up. The decrease in load through the joint will help it calm down. If your physical therapist is familiar with your sport, they can take a look at your training plan and/or talk with your coach to determine what might look like for you, and for how long.
A physical therapist can also help decrease joint irritation with manual therapy. Especially when FAI is at play and stiffness is present, a PT can use their hands to move the head of the femur away from the acetabulum, creating space within the joint. This allows fluid to pass through the joint more easily – carrying in nutrients and carrying out waste and inflammatory cells (movement does this too, hence staying active!). Painful joints can also cause muscles to tense up, so a physical therapist can help release and relax those muscles. On the other end of the spectrum, some labral tears occur due to too much motion of the joint versus an impingement. In these cases, joint mobilization is not a good idea, but soft tissue work can be great as the muscles around the joint tense up to protect it.
Manual therapy (and similar adjuncts like dry needling and cupping) feels good, but the secret sauce of physical therapy is targeted strength training. This is how we “build stuff up”. Pain tends to shut down muscle function around the joint. This is your body’s way of protecting yourself (“it hurts, so don’t move!”). Strength training can get those muscles activated again, and research shows that strength training can actually help control pain. Your PT should be working one-on-one with you to find exercises that feel good, and don’t aggravate your symptoms.
Once you have a baseline of pain-free strength behind you, you and your PT will work together to gradually progress you back to your sport. We call this “graded exposure” to movements that become more and more sport-specific as your pain decreases and you get stronger. For most sports this means increasing the range of motion you move through, increasing the load you’re using during training, and progressively increasing your impact activity. We monitor how you feel for 24 hours following an increase in activity to make sure your hip is happy with the load, and just keep climbing the ladder from there. This is why it’s so important, as an athlete, for you to see a clinician who specializes in sports rehab. They are the only ones who understand the demands of your sport and know how to appropriately progress you back to meeting those demands on a regular basis.
If you are struggling with hip pain that’s significantly impacting your ability to train and compete, contact our sports specialist, Dr. Kate. She’s been through this too, and is here to help!
You can email Kate with any questions or comments: [email protected]
If you’re young and athletic and are experiencing pain at the front of your hip, know that you’re not alone. Anterior hip pain is actually a very common experience among runners, triathletes, soccer and hockey athletes, as well as dancers and gymnasts.
Like other parts of the body, pain at the front of your hip can mean a lot of different things. For runners and soccer players especially, repetitive impact activity can lead to a stress fracture of the femoral neck or shaft – which presents as pain at the anterior hip with running, walking, and jumping. Soccer and hockey players are also susceptible to groin strains, or pubic bone pathology due to the strain on the inner thigh during that sport. A diagnosis that’s common among all of these sports, and many more, is femoroacetabular impingement (FAI) and labral pathology.
The hip is a ball and socket joint, formed by the acetabulum – the “socket” – on the pelvis -and the head of the femur, on your thigh bone. The joint is surrounded by a rim of cartilage called the labrum (heard this term before? There’s one on your shoulder joint too!), which helps the joint absorb shock and also deepens the socket, creating more stability through the joint.
Femoroacetabular impingement – FAI – can be diagnosed with an x-ray. Essentially what impingement means is that ball-and-socket joint isn’t fitting together perfectly, and there are three ways this can occur. First is “pincer” impingement, which means that there is an outgrowth of bone on the socket. This leads to the acetabulum and femur coming into contact too early in the range of motion. Second, there is “cam” impingement, which means there is a bony growth on the head of the femur, meaning that it cannot glide in the socket without “catching” or “pinching” on the labrum. Lastly, it is actually most common to have a combination of these.
FAI can occur without labral pathology, and labral pathology can also occur without FAI; but, frequently, they do occur together. Labral tears can cause a significant amount of pain, however it must be said that just because a tear is seen on imaging does NOT mean this is the source of pain. There have been several studies showing that when imaging the hips of young, active individuals who don’t have hip pain, up to 70% of them have labral tears.
SO…you’ve been diagnosed with FAI and/or a labral tear. Now what?
Luckily, there has been an explosion of medical interventions for hip pain, as well as significant improvement in the way rehab professionals treat.
Injection Therapies: An orthopedic surgeon may choose to inject the joint with a corticosteroid to decrease any inflammation in the joint. Alternatively, some surgeons can do “regenerative injections” – either Platelet-Rich Plasma (PRP) or bone marrow aspirate concentration (BMAC), both of which serve to stimulate healing of the labrum and cartilage.
Surgical Interventions: There are several arthroscopic surgical techniques that can be used to correct FAI and repair labral tears. For FAI, the surgeon may perform an osteoplasty – essentially shaving down the bony outgrowths so that the joint surfaces can roll and glide on each other smoothly. Surgeons can also use sutures or anchors to secure torn portions of the labrum back to the acetabulum; this can significantly decrease painful clicking and catching. In more involved cases, the surgeon can also take cadaver tissue and create a brand new labrum for the patient.
It is important to note that these medical interventions, advanced as they are, do not guarantee pain relief. Surgery in particular CAN be extremely helpful, and as such it is still considered the gold standard treatment – but like we talked about earlier – pathology does not always equal pain. Therefore “fixing” or eliminating the pathology does not guarantee elimination of pain. Surgery should be considered a last result option, if injection therapy and high-quality sports rehab do not help.
Speaking of sports rehab….stay tuned for our next article to learn how we help our athletes with hip pain back to the playing field – with or without surgery!
What is it exactly, and how can you get back to the things you love? Unfortunately, we hear the phrases above far too often. If you have arthritis and have had an x-ray to confirm your diagnosis, you’ve likely heard one or two of these troubling phrases. The truth is, sometimes these are a poor choice of words. I hope aim to provide you with some peace of mind, by explaining what arthritis is, the reasons why it develops, and what you can do about it.
What is Osteoarthritis?
Osteoarthritis (OA) is a condition that has been affecting an increasing amount of the aging population. It typically affects the larger, weight bearing joints in the body, but can also be found within the smaller joints of the hands, feet, wrists, etc. Development occurs when the cartilage begins to wear down over time. This can lead to increased loading of bony tissue, poor movement mechanics, or even the growth of new bony tissue usually called bone spurs.
Since arthritis usually becomes painful, it is typically associated with a decrease in activity level. This decrease, which I’m sure most of you can attest to, is out of fear of making things worse due to something a doctor or friend has told you. Interestingly enough, reductions in activity can actually increase symptoms, pain, and progression of the disease. Although it is counter-intuitive, it’s true!
Whats the deal with my cartilage?
Cartilage helps our joints absorb forces and move smoothly. Did you know that the cartilage in your joints is actually 10x’s more slippery than ice?! This is what allows our joints to flex and extend without much effort. So, whats the number one thing you can do to keep your cartilage healthy? Move! Every tissue in our body is highly specialized and needs certain stimuli to thrive and survive, and cartilage is no exception.
Lets think about the knee for example: Compression and sliding of the joint surfaces create a sponge-like mechanism for the cartilage. When compressed, metabolites are squeezed out and when relaxed the cartilage expands again taking in nutrients. It’s just like a living breathing tissue! When activity is stopped or avoided, this process no longer occurs which can exacerbate the degenerative process leading to worsening arthritis. So what can movement do for your cartilage?
- Movement stimulates the cells that make cartilage to reproduce, which allows these cells to create more cartilage.
- Movement promotes tissue nourishment.
- Movement reduces the amount of metabolites within the tissue.
Why else should you exercise for arthritis?
Just like cartilage, muscles are important for protecting joints as well. They function to not only help us move and stabilize our joints, but also to help dissipate forces going to the joints. Without adequate strength, these forces need to be absorbed by other structures (think cartilage in our joints). This is another reason why avoiding activity with arthritis can actually make the pathology worse.
People with OA are often told to avoid certain activities including squatting, running, etc. However, I believe this is the opposite of what should be done (see above). OA develops over a long period of time, not after one set of squats. Continuing to squat, run, or any other activity is not going to independently speed up the degenerative process.
That said, there are some ways to begin activity to help set you up for success:
- Slowly ramp up activity within your pain tolerance to allow the cartilage to mature and adapt
- Build a strong base of muscles to be able to dissipate the forces being placed on the joint
- Find activities that may be lower impact to build strength before loading the joint (water aerobics, swimming, etc.)
- Find a great PT to help you along the path to recovery and improvement of function
You should always discuss your options and activities with your healthcare provider before starting any new regimen or treatment. If your skeptical, we challenge you to try increasing your activity slowly, stick with it for one month, and see how you feel. I’m willing to bet you may find you have less pain.
If your not sure where to start, feel free to call to book and appointment or reach out to me at [email protected] to get started!
Here’s a great article that discusses the benefits of exercise for OA and may be a good reference for where to start. I promise it is an easy read!
Chronic back pain is caused by a number of different contributors, and is defined as back pain that lasts longer than three months or that occurs episodically. It can affect people of all walks of life, regardless of age or physical condition.
The medical community doesn’t understand everything about chronic back pain yet. Questions persist on why some people have it and others don’t; or why some episodes last longer than others; and why imaging results don’t always paint the correct picture. Imaging and blood work may even show things like lumbar degeneration or disc herniation, though these findings don’t prove useful because these positive findings often don’t come with pain or other symptoms at all. On the other hand, so many people with chronic back pain will receive no positive findings from blood work or imaging at all.
The good news is that backs are just like any other body part, and the will heal.
We do have a good understanding of some common causes of chronic back pain as well as an understanding of how pain can manifest itself. Many people experience going to bed feeling fine and waking up with significant back pain. This can be caused by swelling of a disc as it re-hydrates during the night. Another common trigger is doing something simple like reaching for the milk carton and the back suddenly spasms. This is the result of poor motor control and the spasm is a protective mechanism. Sometimes it is more obvious and we experience pain during an effort of some kind like sneezing or lifting something heavy. However focusing only on the possibility of what has been “damaged” can lead us into unnecessary imaging, inappropriate treatments and much higher healthcare costs while still not solving the underlying problem.
Pain is defined as an unpleasant physical and emotional sensation that we experience when injured OR when there is a threat of injury and no actual tissue damage present.
It is a protective mechanism our brain uses to keep us from getting hurt. It has biological components, psychological components and sociological components. Unfortunately, we can get stuck in a loop where we get very good at experiencing pain and our brain tells us our back is hurting even when nothing has been done to injure it. This short video does an excellent job of explaining further.
If you experience this, here are some things to consider.
- Your back will heal- just like an arm or an ankle. If you twist your ankle one year, and then several years later you do it again, you don’t become fearful of having a ‘bad ankle’. The same holds true for your back.
- Move around as much as you can as pain allows. Moving is better than resting. If it isn’t resolving quickly, considering seeing a chiropractor or physical therapist. They are trained to help relieve your symptoms and give you the tools needed to reduce the likelihood of future episodes, and help you learn to better manage such things on your own.
If your chronic back pain is constant and not episodic, then a multi-modal approach is best, especially if it hasn’t responded well to individual treatments. There is excellent evidence for a multidisciplinary approach as well as solid evidence for exercise therapy and spinal manipulation. You can read the full guidelines from the American Academy of Family Physicians here.
You should have a team that includes a pain management physician, a chiropractor or physical therapist and a mental health therapist that work with you to help with your symptoms. A psychologist trained in Cognitive Behavioral Therapy can be very helpful in these situations. If you’re having chronic back pain and have questions, please feel free to email me at [email protected]
Samuel S. Spillman, DC
Frozen Shoulder is real, and doesn’t only occur in the winter! Generally the condition doesn’t have a definite start point, ie. patients often can’t think of an injury that started the pain. Some warning signs to look for include pain and a loss of motion in multiple directions.
Medically termed adhesive capsulitis, frozen shoulder is a condition that affects the capsule surrounding the shoulder joint. The capsule is a sheath of tissue that maintains fluid within the joint and maintains pressure, ensuring relative stability. Inflammation causes the capsule to become more fibrous and thicken. This causes limitations in range of motion and pain. If your shoulder is feeling stiff and painful, with loss of motion in multiple directions, you may be facing frozen shoulder. Identifying it early is the best
way to help effective progress.
Who gets it?
Although anyone can get this condition for a variety of different reasons, there are a few predisposing factors:
- Most prevalent in women ages 45 to 65
- Diabetes and Thyroid disease
- Previous episode on opposite shoulder
- Immobilization of the shoulder following certain surgeries
- This condition can also develop after a minor shoulder injury
There are 3 overlapping stages of the condition called the freezing; frozen; and thawing phases. Each stage has certain treatments that may be beneficial to help speed recovery, which will be discussed below.
Recovery from the condition generally takes anywhere from 6 months to 2 years, and has the following stages and interventions that can help at each stage:
The Start (months 0-3)
What to expect:
- Pain begins with no initial injury, can be sharp and/or dull in nature
- This is when inflammation occurs, but adhesions haven’t formed
- Pain most notable at endrange movements, but can be present at rest
- Trouble sleeping is common
In this stage, you should see a physical therapist for a few visits to learn exercises to maintain range and slow the loss of motion. You will also be educated on the condition and general progression through the stages.
A few tips:
- Use the shoulder as normally as possible without exacerbating symptoms.
- Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain.
- Listen to your body, if your causing a significant increase in pain you’re doing too much
- Keep contact with your PT during this stage; activity or exercise modifications are often needed
Freezing (months 3-9)
What to expect:
- Loss of motion in all directions, with external rotation and raising the arm to the side are usually most affected
- Range of motion becomes progressively worse
- Daily activities (reaching, dressing, bathing, workouts) can become more uncomfortable
- Increased inflammation and blood flow present within tissue
Physical therapy continues to be beneficial in this stage to maintain ROM and function. PT interventions will be tuned to the amount of tissue irritability the patient is experiencing.
A few tips:
- Continue using the shoulder as normally as possible
- Performing range of motion exercises will be helpful in maintaining range
- Listen to your body, if there is an increase in pain with activities and exercising, there may also be an increase in inflammation
- Keep contact with your PT during this stage; activity or exercise modifications are often needed
Frozen (months 9-15)
What to expect:
- Increased fibrosis = increased loss of motion
- Your joint will be much more stiff, but pain will begin subsiding
- Your shoulder is likely to have large range of motion deficits in this stage
You will likely be working with a home program for care at this point. Let your PT know if you have any changes that you have questions during this stage.
A few tips:
- Once again, continue using that shoulder as normally as possible
- Try to avoid movements that are too uncomfortable to complete
Thawing (months 15-24)
What to expect:
- Pain will begin improving, and eventually resolve
- Significant stiffness will remain, but will improve slowly
- Minor range of motion loss may persist after resolution
- Fibrosis of joint capsule, but decreased inflammation
The shoulder will begin During this stage you should begin appointments with your PT for more intensive stretching and manual therapy. Functional strengthening exercises will be used to begin returning the shoulder to normal.
A few tips:
- Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain
- Begin a strengthening program that challenges your range of motion as well
- Be sure to work with your PT to develop a comprehensive program to return your shoulder to normal
Treatment of frozen shoulder can be long and arduous, but arming yourself with information can be one of the most effective tools. Make an appointment with your physical therapist or chiropractor to learn more about the condition and how you can manage it effectively. Remember, early intervention and education is essential for recovery.
Bryan Esherick PT, DPT Have questions? Email me at [email protected]
Information adapted from the clinical practice guidelines Shoulder Pain and Mobility Deficits: Adhesive Capsulitis from the JOSPT.
CBD oil is gaining in popularity and is showing up everywhere – across the web and on store shelves everywhere. But, many of us are just hearing about it and have some questions – so let’s take a closer look.
CBD stands for cannabidiol – and it is a compound found in both cannabis and cannabis sativa (better known as hemp).
While both plants have hundreds of compounds that may be pharmacologically active, the best known is THC, which has a psychoactive component. However, both plants also contain CBD which also has pharmacological effects but NO psychoactive component. The CBD products at health food stores, grocery stores, and doctor’s offices are sourced from hemp and have no psychoactive properties.
OK, but why is it suddenly all over the place?
There are a number of reasons. It has been found to help with certain seizure disorders and recently the Virginia board of medicine has added it to the legal formula and it can now be prescribed for this purpose. But it is also available over the counter. The recent Farm Bill in 2018 among other things, designated CBD products to be “generally recognized as safe” or GRAS, which means it can be added to food stuffs and sold. For the time being the FDA and DEA have not taken any steps to change that, although they could at any time. Common side effects may include tiredness, diarrhea and changes of appetite/weight.
What can CBD oil do and why would anyone take it? Well in addition to the above mentioned anti seizure properties, there is some limited research that suggests that CBD oil can help people with chronic pain, as well as with sleep, and anxiety. Now the research is far from conclusive and there are many more double blind random control trials that need to be performed before the science and medical communities are going to get behind this being a new cure-all. However, as it has been generally recognized as safe and there are anecdotal reports popping up everywhere with people touting its benefits, people are flocking in droves to try it. We began carrying these products after a few patients requested them and they’ve proven to be very popular with patients for pain relief.
Samuel S. Spillman, DC