"Baby hip" pain: smart tool solution

https://www.walmart.com/ip/Baby-Hip-Carrier-CPC-Certified-Extender-Lumbar-Support-Multiple-Pockets-Adjustable-Waistband-4-Positions-Newborns-Toddlers-44lbs-Black/5746450135?wmlspartner=wlpa&selectedSellerId=101684497&gQT=1

Those of you who have known me for many moons know that I'm not a big fan of gadgets, however I do recognize that there are some incredibly useful tools that help manage chronic condition and prevent injuries in the 1st place.

I came across this product at a social gathering recently. Apparently it's been around for a while but must be a well kept secret because I've never seen one of our mom patients show up with one of them, and I've not heard it bragged about as it probably should be. There will many many months during which a child is likely to be held and carried on one hip while the other dominant free arm is tending to things, when a child is fussy and needs to be held. From a chiropractic standpoint, this results in chronic distortion patterns in the pelvis involving rotation and translation that seem to be very refractory to treatment until the child grows into a toddler that no longer gets picked up. (And sometimes that can last until a child is 3 or 4 ).

The hip belt prop has a little platform that can hold a child's bottom, and if the supporting belt associated with the platform is pretty broad and snug, distributes the weight of the child pretty evenly without requiring the trunk to lean the opposite direction. In that manner, you get the best of both worlds: a happy child being held and supported with a loose hand, while mom has a free hand, and  spine and pelvis maintaining pretty neutral alignment. This would incidentally be a great gift to any new parent, if you find yourself staring at one more cute onesie likely to be outgrown in a few weeks on a baby registry.

PAIN AND EXERCISE: GOOD PAIN VERSUS BAD PAIN

“GOOD PAIN” VERSUS “ BAD PAIN” PAIN FROM ACTIVITY AND EXERCISE

A question that arises commonly as we tackle the rehabilitative phase of a patient’s treatment plan, is what level of discomfort is to be expected and tolerated when patients start resuming normal activities or pursue exercising when being treated for an acute or chronic condition. In other words, what is the defining line between good and bad pain?

First, we should talk about when we start introducing therapeutic activities in the first place, especially when patients are acute, as some patients are pretty eager to start exercising to get better faster. As a general rule, I may not add much beyond in office treatment and light walking, breathing, general movement and active range of motion stretching in the first week or two of treatment. You cannot inherently strengthen or stabilize something that is completely dysfunctional or structurally misaligned.

Usually by the end of the second week at the latest, we can start adding more specific activities. With the input of the patient, we look to find the right balance between pushing the patient enough to make gains, and not pushing so hard as to reinjure. It can be a bit of a balancing act, and I give the patients three guidelines to stay in the safe zone:

-          There is a difference between pain and soreness. Soreness is a normal reactivation reaction that is more of a generalized discomfort. Sharp pain is normally to be avoided as a sign that you are pushing too far too fast.

-          I like to use the 2 points on the 10 scale rule: during the therapeutic activity, it can be OK to have a little more discomfort than at baseline. For example, if youR pain at rest is a 2 on a 10 scale, it can be at a 4 on a 10 scale, but really you should not let it get much higher.

-          The discomfort associated with the activity should not significantly outlast the activity itself, ideally returning to baseline within 30-60 minutes.  If post activity related pain lasts into the rest of the day, if it interferes with sleep, if it is still present the following day, these would all be indications that you are pushing too hard, too fast, or that the exercise is not right for you.

There is not a one size fits all solution to what discomfort is OK in your situation, and you ultimately need to discuss that with your provider. Some people have underlying conditions that will carry a little more baseline pain during the rehab phase ( inflammatory arthritis, meds, fibromyalgia), that will require creative accommodations. But in the end, where there is a will, there is almost always a way to get stronger.

Photo courtesy of Freepik

Gluteal Amnesia: when your butt muscles forget what they are supposed to do

I have a running joke with a couple colleagues that doing quick strength and stability assessment is trying to find the biggest slacker among our major stabilizing muscle groups. And when it comes to lumbar pain, the gluteals seem to win the prize.

The buttock muscle is a very large muscle group comprised of three major superficial muscles and a couple of smaller deep muscles that are involved more so in guiding movement. They are supposed to fire first and foremost doing a variety of trunk activities including forward flexion, which is when a lot of injuries to the lumbar disc seem to happen. In doing so, the gluteal muscles bear the the load and prevent the smaller lumbar muscles from being overloaded. I do recall from my days of doing dissection anatomy how surprisingly thick they were even in older cadavers, while the lumbar paraspinal muscles were comparatively so thin. As such, the gluteal muscles are really engineered to bear the brunt of the muscular stabilization process. 

When gluteal muscles fail to engage properly and sufficiently, the lumbar paraspinal muscles and associated lateral groups like the QL have to take over. Two things will happen: first, they are not engineered to bear that kind of load and can easily get into an acute or repetitive injury cycle. Second, they tend to create distortion pattern in the lateral curve with hyperextension, chronically loading the lumbar facets. It's a loot lose situation. 

The reason gluteal amnesia is so problematic and so prevalent is because muscles tend to down regulate their normal activity and firing pattern when exposed to prolonged pressure. Such as sitting on your butt the majority of the time. It's a scourge of the modern lifestyle that is probably driving the majority of the gluteal amnesia problem, much more so than direct injuries. The average American spends more of their wake up time sitting at home, work, in their vehicle, than they do ever being up around and moving. There are a few different ways to test for the firing pattern of the gluteal muscles, including the prone swimmers test, bridging, and standing squatting. It's usually pretty obvious. Treating gluteal amnesia involves a combination of trying to decreasing the amount of sitting time, changing the sitting posture to center the lumbar spine over the pelvis rather than posterior to it, which tends to increase pressure over the buttock muscles, frequently engaging gluteal in a variety of functional activities such as squeezing your butt muscles every time you get up and down from a chair, and more structured exercise routines such as bridges and squats.

Walking safely when the ground is icy

The conditions of the last few weeks often reminded me of this important seasonal resource that I never get tired of posting with great delight. Several of my patients enjoy getting some mild cardiovascular activity doing outdoor walking, and while there is nothing that will fully replace that, it's really not a safe option when we have a persistent layer of ice that may be with us until April.

The walk from home free YouTube channel allows you to get a good cardiovascular routine using a small amount of space, a huge variety of videos of different durations and complexity, and a lot of fun music and coaching. Please remember that you have alternatives, and really no excuse, to continue getting a little bit of cardiovascular endurance during the winter months.

https://www.youtube.com/@LeslieSansonesWalkatHome

Asthma medications and mood disorders

To take a break from more neuromusculoskeletal topics, I thought to insert this blurb on confirmatory research on the psychiatric side effects of a very commonly prescribed asthma medication, since it's been recently seriously affecting a loved 1 of mine, and potentially some of your loved ones as well.

Monteluskat/Singulair is a hugely popular medication to control reactive airway disease/asthma. It's effective at doing that indeed, howeve I have noted some really remarkable mood side effects in several people in my life as a result of taking the medication, to the point that it's on the verge of cutting off our social relationships. This most recent release research confirms that is just not my imagination unfortunately. So it's something to be on the lookout if someone in your life is having a sudden change in behaviors, especially children and young adults. Controlling asthma does require at times a more integrative approach, looking at the drivers of airway inflammation, which can include environmental toxicities, nutrition, and sometimes chiropractic issues in the neck and upper back. As always, it's never a good idea to quit your medication abruptly and on your own without working with your prescribing provider since you can have some significant asthma rebound episodes, which are not safe. Think of it as a long-term plan to get healthy and decrease your dependence upon some prescription medications.( photo courtesy of Freepik)

https://www.biospace.com/drug-development/mercks-former-asthma-blockbuster-singulair-could-be-linked-to-mental-health-problems-reuters?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%27s%20Friday%20Favorites&utm_term=new%20molecular%20evidence&utm_content=new%20molecular%20evidence&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

Obturator syndrome: some nasty groin pain

I was joking with a colleague that there are some "sexy muscles" that seem to be popular from time to time, but the one I'm about to blog about is definitely not in that category. Which is unfortunate because it can be an absolute source of misery.

The obturator externus, later referred to as OE is a muscle that is deep in the groin, connecting the anterior inferior part of the pubis to the inside of the upper femur. It's involved in a combination of adduction stability of the leg (and thus can be injured in sharp abduction sprains), with lesser degrees of rotation and flexion. It's not easy to palpate unless you know exactly how to locate certain origin and attachment landmarks, and it connects different parts of our anatomy that make it involved in activities of the leg, trunk and pelvic floor at the same time. The pain pattern usually involves the inside upper thigh, groin, but can also radiate to the perineum and lower abdomen. Mechanism of injury include leg abduction and flexion sprain, slip and trip injuries, weightlifting injuries, and more repetitive type overload injuries such as anterior position of pregnancy and long-distance running.

The reason that the OE is worth talking about is that it can be a source of continued pain even when other parts of an injury have resolved. I have encountered that in many cases where we successfully treated and rehabed sacroiliac and upper thigh injuries for example, but the patient continued to have some very pinpoint groin pain that continue to prevent them from resuming their previous activities. It's often an area that the patients are hesitant to talk about because it will radiate into the genital and pelvic floor area, as well as deep in the inside of the thigh, both areas the patients don't necessarily like to have examined. And an area that many health care providers don’t like to dig in.

Treating and resolving an OE painful syndrome can be a game changer for patient. I'm grateful for my ART training 15 years ago to give me the confidence to properly locate the muscle and perform the appropriate myofascial release on it. The OE responds surprisingly quickly to therapy, usually clearing up within 2 or 3 treatments. It's a little tricky to stretch at home unless you know how to combine the 3 motions to isolate it. I have found my best results with the modified unilateral elevated cobbler with some butterfly flexion.

WHAT ARE THE SCALENE MUSCLES AND WHY DO THEY MATTER ?

It's a question that came up a couple of times this week, always an omen that it's time to blog about it.

The scalenes are a group of 3 muscles, small, but mighty. They are located in the front of the neck, attaching to the anterior lateral aspect of the vertebra and traveling downwards, with one group attaching all the way to the 1st rib just behind and below the clavicle. They are involved in fine motion of the cervical spine such as rotation and lateral bending.

The scalenes are important in many regards:

– as 1 of the primary middle layer of the anterior neck muscles, they are easily injured with rapid extension injuries to the neck which can happen during motor vehicle accidents, falling backwards, and sports. Without involving any additional neurovascular compression, which I'm going to touch on below, the scalenes stem cells can be the source of significant chronic posttraumatic pain, anterior neck posture, and vague radiating pain in the throat and anterior chest

– probably 1 of the most significant contribution of the scalene muscle group is the ability to cause compression over the neurovascular bundle, which is the combination of nerves and arteries and veins that travel between the anterior and middle scalene, just above and then behind the 1st rib, into the arm. This will often result in a sensation of vague pain, tingling, prickly achy sensation in the upper extremity, which does not seem to follow a single nerve root pattern from the cervical spine because the brachial plexus bundle of nerve is comprised of several cervical nerve roots.

https://www.bwclinic.com/blog/2024/11/21/what-are-the-scalene-muscles-and-why-do-they-matter-

CHIROPRACTIC ADJUSTMENT, COORDINATION AND DEXTERITY

I have recently renewed my enthusiasm for digging into chiropractic basic sciences research, especially in the area of neurological efficiency, as my husband discovered the index to chiropractic literature as part of his fellowship in integrative medicine through the Weil Institute in Arizona.

There have been a series of research conducted using very sophisticated tools to measure the efficiency of intracranial signaling speed in patients receiving spinal manipulation. I am extremely grateful for a pioneer Canadian researcher who spent quite a bit of her research career in New Zealand and inspired a whole generation of younger researchers to expand on her earlier work using transcranial magnetic stimulation. To boil it down, the technology has allowed the use of an external magnetic device applied to the skull to modulate speed of transmission between incoming sensory output and outgoing muscular signaling. The technology also allows the researcher to very accurately measure the speed of transmission and the brain. As a general rule, faster transmission results in much more efficient human motor activities such as decreased response time (think athletic performance but also daily activities such as slamming on the brakes to avoid an oncoming vehicle), and overall improved speed and dexterity. This particular study was quite interesting in that it looked at how neck pain affected the speed at which an affected patient could type a series of letters (patients with neck pain were much lower than their counterparts without neck pain), and how a chiropractic adjustment not only restored typing speed to normal in patients with neck pain, but those adjusted individual actually outperformed the control group who had no neck pain and no adjustment.

We often talk about chiropractic for pain alone, but it's important to realize that pain is only a small fraction of our overall neurological functioning. Our earlier chiropractor pioneers were much more interested in the overall neurological function of their patients than pain alone. The study would certainly have reinforced their pursuits, reminding us that chiropractic can be a powerful tool to help humans perform their best, including much more efficient speed dexterity and coordination of the upper extremities for important modern human tasks such as typing.

https://www.researchgate.net/publication/323463302_Subclinical_recurrent_neck_pain_and_its_treatment_impacts_motor_training-induced_plasticity_of_the_cerebellum_and_motor_cortex