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Chiropractic

Chiropractic

Chiropractic

The chiropractic page at Camp4 Human Performance has a detailed discussion about the benefits of spinal manipulation. Our doctors have the skills and experience to know when this is a therapy for your complaint.

DRY NEEDLING

DRY NEEDLING

DRY NEEDLING

In order to better control pain at Camp4 Human Performance we utilize the more modern form of western medical acupuncture, also known as dry-needling. This is the most researched method of controlling muscle aches, pain, and dysfunction.

Rehabilitation

Rehabilitation

Rehabilitation

Everyone at Camp4 Human Performance gets physical rehabilitation. We understand the importance of training the nervous system to function better after we get you out of pain. Learn more about rehabilitation and its importance here.

BYU chiropractors

BYU chiropractors

BYU chiropractors

Both Dr. Tyler and Laney Nelson are the official chiropractors for the BYU athletic programs. Dr. Laney has over 20 years experience doing sports medicine with BYU and the past 8 years with the University of Missouri.

How Relaxation Benefits Pain Management

relax

 

Relaxation is a great coping strategy for pain management. It reduces fear, anxiety, and emotional stress, all of which increase chronic pain symptoms. Relaxation is like any other “skill” in life. You need to practice it in different contexts to make sure your coping strategy is there when you really need it. Finding your quiet space to relax is only good when you’re in that quiet space, however that does little for you when your at work or around loud children. Don’t be afraid to move and don’t let fear manage your life. Here are some, but not limited to, general relaxation exercises:

1. Breathe deeply
2. Take a walk and be present in the moment
3. Decompress by adding heat to your neck or back
4. Get moving by doing a favorite workout
5. Take a bath
6. Be grateful

If some of these techniques don’t work, come in for a visit and we’d love to give you a plan to help you with pain management. Get educated now!

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Shoulder pain and manipulative therapy

 

shoulder pain and manipulative therapyThis article is aimed at discussing the importance of the thoracic spine in shoulder pain and dysfunction. At camp4 Human Performance we understand the link between shoulder pain and manipulative therapy, and it is well supported in the research literature. In fact, we have observed that the upper-thoracic spine (upper back right below the neck) is the most commonly restricted area in the spine. The direct link to biomechanics in the shoulder, the upper back is a primary target for those with shoulder pain. The upper-thoracic spine is from the bottom of your neck, C7 all the way down to the 5th thoracic vertebral body. Since this is such a predominant area for patients to experience restrictions, it should be a primary target for manipulative therapy, regardless of where patients present with pain. In fact lack of proper extension, spine moving backwards, at the cervico-thoracic (neck to upper back) junction leads to a loss of your cervical curve, a jutting of your chin, and improper loading on your shoulder. 

When discussing shoulder mechanics at Camp4 Human Performance, we will educate you as to the importance of this extension motion on clavicular rotation, subacromial space widening, and improved overhead motion as to eliminate classic shoulder problems such as rotator cuff tears, bursitis, frozen shoulder, and thoracic outlet syndrome to name a few. Also, having a stiff upper-thoracic spine also decreases our ability to activate the deep neck flexors and the abdominal muscles. There has been demonstrated a significant association between decreased mobility of the thoracic spine and the presence of patient reported complaints associated with neck pain as well. When motion is restricted in this key transitional area, we force rotation into segments that are not designed for this task which leads to breakdown. 

What happens is that we develop more movement in segments of the lower cervical spine when faced with upper-thoracic spine restrictions. The movement has to happen somewhere for us to keep our eyes level with the horizon. This is why shoulder pain and manipulative therapy go hand-in-hand, and patients respond so well. Patients who present with lack of thoracic extension also have tight latissimus dorsi, tight pectoralis major and minor, and poor postural stabilization of the diaphragm.

 the shoulder jointAt Camp4 Human Performance, we believe that shoulder pain and manipulative therapy are tightly linked and recognize this as a primary focus of our clinical practice. Remember, The true source of musculoskeletal strain in the cervical or lumbar spine or shoulder girdle is upper-thoracic spine stiffness. 

 

 

References

  1. Faye L Motion Palpation and Chiropractic Technic, 2nd Edition. Huntington Beach: The Motion Palpation Institute, 1990.
  2. Lewit K. Manipulative Therapy in Rehabilitation of the Locomotor System, 3rd Edition. Boston: Butterworth-Heineman, 1999.
  3. Kolar P. Facilitation of Agonist-Antagonist Co-activation by Reflex Stimulation Methods. In: Liebenson C. Rehabilitation of the Spine, 2nd Edition. Baltimore: Lippincott/Williams and Wilkins, 2007.
  4. Boyles RE, Ritland BM, Miracle BM, et al. Man Ther, 2009;14:375-380.
  5. Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in

    patients with neck pain: a randomized clinical trial. Man Ther, 2005;10:127-135.

  6. Cleland JA, Childs JD, Fritz JM, Whitman JM, Eberhart SL. Development of a clinical prediction rule

    for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation,

    exercise, and patient education. Phys Ther, 2007;87:9-23.

  7. Norlander S, Nordgren B. Clinical symp- toms related to musculoskeletal neck- shoulder pain and

    mobility in the cervico- thoracic spine. Scand J Rehabil Med, 1998;30:243-251.

  8. Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy

    for patients with shoulder impingement syndrome. Journal of Orthopaedic and Sports Physical Therapy, 2000;30:126-37.

9. Bergman GJ, Winters JC, Groenier KH, Pool JJ, Meyboom-de Jong B, Postema K, et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Annals of Internal Medicine, 2004;141:432-

  1. Liebenson CS. Treatment of mid-thoracic dysfunction: a key link in the body axis. Part 1: overview and assessment. Journal of Bodywork and Movement Therapies, 2001;5(2):90-98.
  2. Cook G. Movement: Functional Movement Systems. On Target Publications, Santa Cruz, CA: 2010.
  3. Janda V, Frank C, Liebenson C. Evaluation of Muscle Imbalance. In: Liebenson C. Rehabilitation of

    the Spine, 2nd Edition. Baltimore: Lippincott/Williams and Wilkins, 2007. 

 

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Knee osteoarthritis: sports rehabilitation Taylorsville UT

Knee osteoarthritis (a sports rehabilitation approach)

At Camp4 Human Performance’s sports rehabilitation Taylorsville UT, we understand the importance of rehabilitating our middle aged patients with Knee osteoarthritis. Commonly abbreviated as OA, it is steadily becoming the most common cause of disability for the middle aged population and has become the most common cause of disability for those over the age of 65. The desire to remain physically active for an aging population has led to an increasing need to prevent and rehabilitate the patient with degenerative joint disease. A common location for osteoarthritis in active patients is the hips and knees. This blog post discusses the rehabilitation of patients with knee osteoarthritis.Common in all OA conditions is an overload of a focal area of joint cartilage which leads to failure of the load-bearing capacity of the cartilage and bone below.

Did you know that forces of 3 to 8 times the body weight act on the knee with weight bearing activities, and muscular imbalances can lead to focal joint overload over time and predispose the joint to osteoarthritic changes.

The goal of rehabiliation: ‘‘building a better shock absorber’’

The goals of sports rehabilitation Taylorsville UT at Camp4 Human Performance is to improve function, minimize discomfort, and limit further injury. This is a multifactorial process consisting of patient education, pain control, optimizing range of motion of the entire kinetic chain, functional strengthening of the involved extremity, aerobic exercise, and the potential use of assistive devices and orthoses.

It has been noted in the literature that this rehabilitation process is more of a marathon than a sprint. 

An important piece of patient education is that osteoarthritis is at times unpredictable, and having patients take an active role in their rehabilitation process both enhances compliance, and helps reduce pain. Due to the fact that OA is often asymptomatic in its initial stages and only later becomes symptomatic as the disease process progresses means that many are not seen until they have significant wear on their knees. This is dangerous because once the knee becomes symptomatic, the degeneration as occurred and the prognosis is much worse.

At Camp4 Human Performance’s sports injury clinic we understand the common signs and symptoms of advanced OA: severe pain, loss of motion and movement of the involved joint and limb, deformity, joint swelling, abnormal gait, changes in activities of daily living, and muscle recruitment compensations.

Pain control is an early goal. Medication, acupuncture dry-needling, laser therapy, ice, heat, and foot orthoses all assist in minimizing discomfort. Furthermore, the use of intra-articular injections, acetaminophen, anti-inflammatories, and glucosamine all have been shown to reduce pain.

The coordination of these therapies for pain conjoined with activity and exercise rehabilitation offers a far more productive therapy.

Patient education also contributes in this area as reviewing the fact that exercise increases circulating endorphins which allows patients to understand that exercise can reduce the discomfort rather than increase pain. These therapies that block pain allow for the initiation of a therapeutic program as the next step.

 

To decrease the risk of further joint injury and degeneration to the knee, several interventions should be implemented.

  1. Sporting or recreational activities and exercise programs should be low impact and not include significant rotation loading to the knee.

            (recreational swimming, stationary cycling, low-impact aerobics, golf, walking)

It has also been suggested that the activities be alternated in a manner that decreases repetition of the same movement patterns and joint loads.

2. Exercises should be implemented to improve muscle strength, normalize joint range of motion, stability, and endurance to the trunk and lower extremities to help the muscle’s own ability to absorb impact and loads to the involved joint.

Patients need a range of motion program that emphasizes a three-times-a-day program of stretching for seven sets of 15 to 20 seconds that includes the hips, knees, foot, and ankle. Range of motion is necessary for subsequent strengthening program.

  3. General conditioning should be performed to help maintain the patients desired weight, which decreases the risk of joint injury due to fatigue.

This last point is very important. It has been demonstrated that patients with knee OA who participated in a weight loss program while performing a rehabilitation program had significant pain reduction, weight reduction, and improved walking speed.

It is generally accepted that weight loss can occur with sustained aerobic activities lasting more that 20 minutes at a target heart rate in the range of 50% to 85% of maximal heart rate at least 3x per week. Also, improved range of motion has been shown to improve discomfort and result in an increase in function. At Camp4 Human Performance, as a chiropractic sports medicine clinic, we take very seriously the benefits of increased exercise, and have all the tools necessary to educate, as well as rehabilitate patients with knee osteoarthritis. Call now to schedule your appointment and see how we can decrease your pain and improve your function. 

Camp4 Human Performance

1951 West 4700 South

Tayorsville, UT 84129

801-878-7356 

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Hyperkyphosis, chiropractor Taylorsville UT

Age related hyperkyphosis, chiropractor Taylorsville UT, and conservative therapy

 dowager's humpThis post is important for everyone however, it is especially important for our elderly patients. If you remember from the spinal anatomy blog post, the thoracic spine has a curvature which is concave to the front, called a kyphosis. It is important to understand that this curvature is natural due to the shape of the vertebral bodies as well as the intervertebral discs in the thoracic spine. The vertebral bodies as wells as the discs are taller in the back than the front creating a stacking shape that develops a curve.  A complication that is common as we age is the exaggeration of this curvature which can develop into a condition called hyperkyphosis, chiropractor Taylorsville UT, sometimes also referred to as a dowager’s hump, or gibbous deformity. In childhood and through the third decade of life the angle of kyphosis averages from 20° to 29°. After 40 years of age the kyphosis angle begins to increase, and more rapidly in women than men. There is reported to be a mean of 43° in women aged 55 to 60 years to a mean of 52° in women 76 to 80 years of age. The same reports of prevalence and incidence of this condition in older adults varies from approximately 20% to 40% among both men and women. thoracic curve

ico_infoIt has been demonstrated that as this kyphosis angle increases, physical performance and quality of life decline,  making early intervention a priority. Lets discuss in more detail  what the literature says about the negative consequences that have been associated with hyperkyphosis on physical performance.

Women with hyperkyphosis have demonstrated

  • difficulty rising from a chair repeatedly without using their arms
  • having significantly poorer balance and slower gait velocity
  • having a wider base of support with stance and gait
  • difficulty reaching and performing heavy housework
  • decreased stair climbing speed.

These impairments have been demonstrated to impair mobility to the point where they increase the incidence and risk for falls and fractures in the elderly population. Also, it has been documented that an increase in mortality is the result of these patients having a reduced vital capacity, which is predictive of increased incidence of pulmonary death.  It has been suggested that hyperkyphosis development is predominately from muscle weakness and subsequent degenerative disc disease which leads to vertebral fractures and worsening of the condition. This however is not as conclusive as it might sound, for there is no real proof to identify which of these factors happen first and it is most likely that the muscle weakness and disc disease happen simultaneously. It has also been documented that individuals can generate this condition of the same magnitude from different processes.

Regardless of the cause, it has been suggested repeatedly in the literature that the significant negative consequences of hyperkyphosis indicate early conservative intervention.   The gold standard orthopaedic technique for assessing the kyphosis angle is a standing lateral xray of the thoracic spine. The measurement of choice is called the cobb angle, which is the same measure used to detect scoliosis. There is also a more conservative measure called the debrunner kyphometer measurement which has been shown to be relatively accurate as well.

Some of the consequences to your musculoskeletal system from this accentuated curve are pain and risk of dysfunction in the shoulder, pelvic girdle, and  spine. The forward head posture, scapula protraction, reduced lumbar lordosis, and decreased standing height which is common in postural decompensation syndromes has a negative domino effect on your body. This type of deformity increases the flexion bias of the hips and shoulders which both promote further exacerbation of the problem.

Older women with hyperkyphosis have a 70% increased risk of future fracture, independent of age or prior fracture, and the risk for fracture increases as hyperkyphosis progresses.

Risk factors that have been associated with hyperkyphosis are vertebral fractures (wedging of the anterior vertebral body), muscle weakness, degenerative disc disease, sensory deficits, and decreased mobility.

Lets discuss each of these in a bit more detail. It is important to note however that compression fractures, although a risk factor, are not as common as it would appear without the data.

studies of older adults report only approximately 40% of men and women with the most severe hyperkyphosis have vertebral compression or wedge fractures.

A common radiographic finding associated with hyperkyphosis among older adults is degenerative disc disease. As the anterior disc height is decreased the angle of kyphosis is increased. The majority of older adults 50 to 96 years of age with hyperkyphosis had degenerative disc disease and no evidence of vertebral fractures or osteoporosis, suggesting that hyperkyphosis does not predict fractures or osteoporosis.

Several studies do confirm that hyperkyphosis, chiropractor Taylorsville UT, is associated with spinal extensor muscle weakness. There is also an inverse relationship between grip and ankle strength and kyphosis, suggesting that age related hyperkyphosis may be part of a larger geriatric syndrome associated with adverse health outcomes. Decreased spinal extension mobility occurs with aging, interfering with the ability to stand erect and maintain normal postural alignment. Furthermore, shorter pectoral and hip flexor muscles are linked to severe hyperkyphosis, Age-related deficits in the sensory, visual, and balance systems likely contribute to the loss of upright postural control.

With a loss of proprioceptive and vibratory input from the joints in the lower extremities in elderly adults compared with young adults, the perception of erect vertical alignment becomes impaired. This problem is further increased among older adults wearing bifocals during stair descent.

There is a lack of efficacious medical interventions for hyperkyphosis and exercise rehabilitation should be a first-line approach, particularly because many of the causes of hyperkyphosis are of musculoskeletal origin.

Lets discuss the current treatments for hyperkyphosis. While osteoporosis treatments help to prevent incidence of spinal fractures, no medications have been shown to improve hyperkyphosis, Chiropractor Taylorsville UT. Vertebroplasty and kyphoplasty are surgical procedures primarily used to treat refractory pain following vertebral fractures and they have been shown to reduce kyphosis angle in select patient populations only. The current evidence suggests that physical disability and pain relief may be improved after vertebroplasty and kyphoplasty compared to medical management but only within the first 3 months after the intervention.

flexion:extension imageResearch suggests that forces applied to the spine during exercise can alter the occurrence of subsequent vertebral compression fractures in women with prior fractures. In one study, 68% of the women who performed flexion (bending the trunk forward) exercises developed a subsequent fracture within the following 6 months, compared with only 16% of those who performed extension exercises, suggesting that flexion exercises increase fracture risk. It is important to train individuals with age-related hyperkyphosis to avoid flexion stresses on the spine during exercise and activities of daily living, regardless of whether they have had a prior fracture. Trunk stabilization should avoid curl-up exercises to reduce flexion bias on the spine.

Now lets discuss the importance of thoracic spinal extension.  A large randomized trial of prone trunk extension exercises in 60 healthy postmenopausal women, the angle of kyphosis and back extension strength improved among women with the most severe kyphosis and significant weakness of the spinal extensor muscles at base- line, suggesting that hyperkyphosis may be modified by spinal extensor muscle strengthening exercises.

Patients treated with 10 repetitions of prone trunk extension exercises 5 times a week for 1 year while wearing a weighted backpack, at 10- year follow-up showed a significant decrease in the number of compression fractures in the intervention group compared with controls, regardless of kyphosis or strength.

Kyphosis as well as forward head posture were significantly reduced among the compliant exercise groups compared with the noncompliant group in another study that employed respiratory muscle exercises combined with back extensor muscle strengthening and aerobic exercises in a study of 14 women with osteoporosis. They found that respiratory pressures improved 12% to 23%, exercise tolerance increased 13%, and thoracic curvature was reduced 5%

Additional therapies such as myofascial, spinal, and scapular mobilization techniques improve postural alignment in patients with hyperkyphosis. Some active therapeutic movement techniques such as self-mobilization lying on your back on a foam roller has been used successfully in a multidimensional exercise program that reduced kyphosis among hyperkyphotic women.

What does the research say about stretching the kyphosis away? A randomized controlled trial among 118 men and women 60 years and older with kyphosis greater or equal to 40°, participation in modified classical yoga 3 days a week for 24 weeks resulted in a 5% improvement in kyphosis index and a 4.4% improvement in kyphosis angle measured from the flexicurve device. This intervention did not result in statistically significant improvement in kyphometer angle, measured physical performance, or self-assessed health- related quality of life.

Other common treatments are the use of spinal orthosis. The research done on orthosis consisted of a wearing of  2 hours a day for 6 months which did result in an 11% decrease in kyphosis angle, improved standing height, increased spinal extensor strength, and decreased postural sway. Although the orthosis appeared to be beneficial, passive bracing does not provide the beneficial effects of exercise on bone. While not yet studied, bracing used in combination with therapeutic exercises may provide additional beneficial effects. Therapeutic taping may also reduce kyphosis angle according to preliminary research in 15 women with osteoporotic vertebral fractures; those with the greatest initial kyphosis had the greatest reduction in kyphosis with taping evidence supports the use of exercise, bracing, and taping interventions to reduce hyperkyphosis, improves quality of life, and reduce risk for future fractures for men and women. Relatively simple, available, and inexpensive conservative interventions may have a beneficial effect.

Here is a helpful list of Do’s and Don’t’s of postural alignment during exercise and activities of daily living.

Lets start with the Do’s.

  • Maintain good postural alignment during exercise.
  • Strengthen core stabilizer muscles, such as transversus abdominis, obliques, and multifidus
  • When bending or lifting objects, keep the lumbar spine (low back) neutral and bend with your hips and knees while keeping the load close to your body.
  • When getting out of bed, roll onto the side before sitting up (log roll)
  • When coughing or sneezing, stabilize the trun in neutral by hugging a pillow, or placing both hnds on your knees while hip hinging, or place hand in small of back to help keep neutral.
  • Maintain natural curves in your neck and back while sitting and standing. Imagine that you are lengthening the crown of your head.
  • If you use a walker, adjust the height to stand up straight and stay within the confines as you walk.

Dont’s

  • Avoid seated rowing machines or upper body ergometers
  • Avoid crunches, curl-ups, or flexed position (traditional sit-ups)
  • Don’t twist or bend your spine when lifting objects
  • Don’ sit straight up from a horizontal position
  • Avoid forceful trunk flexion while coughing or sneezing
  • Avoid leaning over towards your work, or standing in pelvic tilt, bending to reach or push walker

At Camp4, we specialize in functional movement assessment and treatment with manual therapy as well as exercise rehabilitation. If you are a patient who are concerned about this particular condition call the clinic for your appointment.

Primary reference

Wendy B. Man, PT, DPT. Linda Wanek PT, PhD. John A. Shepherd PhD. Deborah E. Sellmeyer MD. Age-Related Hyperkyphosis: Its Causes, Consequences, and Management Journal of orthopaedic & sports physical therapy. June 2010 vol 40(6)

 

 

 

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