The Dreaded High Shoulder

Have you ever woken up in the morning with one of your shoulders sort of sticking up, unable to relax, and painful to move?

I haven’t, but plenty of my patients have.

I’ll be honest: I’m not sure why on Earth this happens to people most of the time. Even the person with the high shoulder usually doesn’t have any idea why they can’t relax their shoulder, and why it hurts so much. Most people shrug the good shoulder and say something like “Well, I guess I slept wrong”.

Which brings up a great question: How is sleeping so complicated that adults are still doing it wrong? Beats me!

Still, this dreaded high shoulder exists and it inflicts millions of Americans every year (that is a crude estimation based on nothing more than guesswork, by the way).

What I do know is that your nervous system controls and coordinates all the activity in your body, including your neck and shoulder muscles. And I also know that an adjustment to the area in question usually gets that shoulder to settle down and relax and become much more comfortable. So, if you are dealing with this problem, give us a call and maybe we can make that shoulder go back where it belongs.

Numbness in Fingers

so, you’re getting some numbness or tingling in your hands and fingers? This article will briefly explain some of the reasons you may be experiencing this discomfort, which can feel like a mild pain, pins and needles, numbness, tingling, or a heavy feeling in your hands or arms.

Vascular Cause – the blood supply to the arms passes through the shoulder area. An important location to consider outside of what people typically consider is the area underneath and behind the clavicle bone. It is this area where most of the anatomy going into the arms originates. Problems there will likely cause arm problems.  With vascular causes, look for swelling or discoloration.

Some of the main causes of vascular insufficiency leading to arm, finger or hand numbness or tingling include:

-traumatic – when an injury or accident causes damage to the arteries feeding the arm or hand.

-compressive – when a blood vessel is compressed causing decreased blood, such as when sleeping with your arm under your head and waking up with your arm “asleep”. Other times, muscle spasm can squeeze a blood vessel, or postural distortions can stretch (traction) a vessel and decrease the diameter enough to decrease blood flow.

-tumors/malformations – tumors or deformed blood vessels can block blood flow.

Vascular problems may occur more commonly in individuals with certain diseases such as diabetes, hypertension, or kidney failure, or in dialysis patients. Occupational exposure (vibrating tools, cold) can be a factor, and smoking also can aggravate and cause vascular disease. – Source

Neurological Cause – damage or interference to the nervous system can cause symptoms like pins & needles, numbness or tingling. Quite often the area to look to is the same as with vascular issues – the area behind and underneath the clavicle bone. It is here that many nerves exit the spine to innervate the upper extremities. Problems here,  or right at the spine, often show up as pain or numbness in the hands or arms.

Some of the main causes of neurological numbness or tingling include:

-trauma / disc injury – if the vertebral discs of the cervical spine (the part of the spine that comprises the neck bones) are injured or inflamed, this can irritate delicate nerve roots and cause pain or numbness in different parts of the arms. Other traumas, such as bending the head and neck sideways too much (especially by impact with something) can tear the nerves or completely sever them, and cause paralysis or neurological deficits in the arms.

-tumors – tumors on or near nerves can pinch the nerves.

-vertebral misalignments – commonly called “subluxations”, these spinal misalignments put either direct or indirect pressuree on the nerves that feed the arms, and cause pain or numbness into the arms or fingers.

-muscle spasm – hypertonic, spastic muscles can put pressure on nerves.

 

If you have symptoms like there, consult your doctor. If you live in Frederick, give us a call. Take care.

Baby, you were born to run, barefoot?

Lately there has been a lot of interest in barefoot running, or running with minimalist footwear on. I think it would be really great to provide some quality general information about this for those considering the idea of running either barefoot or in something minimalist like Vibram Five Fingers.

In general I am a big fan of the concept that getting “back to the basics” is usually the healthy thing to do. I prefer my food unprocessed and whole. I like my exercise to be simple and functional. The idea of running barefoot has a certain appeal to it – after all, our ancestors managed to flee from man-eating predators without the benefit of $100 running shoes. But, does running without shoes on (or with minimal footwear) actually do us any good, or is it a dangerous fad that leads to injuries?

Before I delve into the topic at hand – running without traditional running shoes – I will quickly discuss the options available. You can either drop the footwear entirely and go barefoot, or you can go with a minimalist option like Vibram footwear. The minimalist choice will provide some protection to the soles of your feet, but will rob your body of the biggest form of feedback as you run – the feedback from the soles of your feet. Being barefoot will give your body and nervous system more input and more control, which is great for mastering something new like ditching the running shoes. So there is a trade-off you must make between the protection that minimalist footwear provides and the neural feedback and increased neuromuscular control that being barefoot provides. Also, being barefoot allows your feet to breathe and sweat more freely, and develop more strength and control in the small intrinsic muscles of your feet.

Some proponents of barefoot running claim that running barefoot as our ancestors did is healthier for our feet. One reason is that when running without shoes the outside front of the foot takes a lot of the impact, while running with shoes on leads to high-impact heel strikes, with the person placing all their weight on the heel and then pushing off from the forefoot. Without shoes on the runner will not land on their heel with such force, as this would be painful to do without shoes, and will instead use the front of the foot to provide most of the immediate shock absorbing and ground contact.

One way in which the foot is marvelously designed is the ability of it to absorb impact from running with minimal force being transferred to the knees, hips, or low back. This process of shock absorption built into our bodies was built in when we were evolving and when there was no such thing as modern footwear with thick cushioning. Now that we tightly encase our feet and provide padding underneath, we are able to land on our heels and run like we do currently. Unfortunately, this heel-striking that shod running promotes bypasses the natural shock-absorbing that occurs between the toes and heel, and transfers increased force up the legs to our knees. Being barefoot involves the entire foot to a greater degree than wearing shoes does, and allows our feet to work as designed and dissipate forces right there at the level of the foot. Put simply, being barefoot allows the body to function as designed with regard to shock-absorption.

Now, while words are great they are certainly no substitute for real world experience. So, if you are interested in the topic of barefoot running then you should stand up and go outside and run a hundred feet or so with shoes on. Really focus on how your feet are meeting the ground. You will notice that your heel is what hits the ground first, and then you push off with the front of your foot. Now, take your shoes off and find somewhere without too many rocks (or any dog poo or broken glass) and run a hundred feet barefoot. You might notice that landing on your heel hurts when you’re barefoot, and your feet might be more comfortable with you landing on the front of your foot and not even having your heel touch the ground at all.

This is a completely different biomechanical situation. Running with shoes means your heel strikes and then your foot flattens briefly as you transition weight onto the forefoot, and then you push off the front. Without shoes the heel strike shouldn’t occur to such a degree, and the force with which your foot strikes the ground will feel less forceful. It will seem a bit like “tip-toeing” as you run.

When your foot hits the ground, heel first, this causes all the muscles, bones, and joints in your leg and hips to react in a specific fashion to maintain stability and provide speed and strength. Running without shoes changes that biomechanical process so that there are different forces and stresses on your entire body, from your toes all the way to the top of your spine. As in any change in life, it is important to take it slowly and safely.

This is an important concept to focus on for a moment. Think of the force that is transmitted up your legs and into your spine as you run with a high-impact heel strike, and then think of the force transmitted up your body with the lower-impact forefoot strike that running barefoot promotes. Decreased mechanical forces putting load on our spines is a good thing. The benefit of diminished force being places on our skeleton and our joints is something that, as a runner, you will need to weigh carefully against the ability of your body to adapt to running without shoes and the different biomechanical forces that your feet and legs will be exposed to. If you can run without shoes on and gradually decrease shoe-usage in order to prevent injury, then it is certainly a good possibility that ditching the shoes and letting the feet breathe will be good for your body.

You don’t need to go from shoes to no shoes, though. There is a middle ground. Different shoe companies are all introducing minimalist footwear. One major brand is the Vibram Five Fingers. They provide barely anything in the way of support for your ankle and foot, but they do have a decent amount of padding on the bottom to protect you from sharp rocks or glass without providing so much padding that it’s like wearing shoes.

If you are going to try out barefoot running, or running with minimal footwear, then it is important that you do it correctly to avoid injury. Some tips include:

  • It might be a good idea to just go barefoot at home, or as you do your day-to-day activities, to accustom your body to the lack of protection and support.
  • Start slowly – if you normally go 3 miles each time you run, do only the last ½ mile barefoot.
  • Slowly (and I do mean slowly) add distance or time to your routine, so that you do not shock the body and cause an injury. Taking a month or more to transition to barefoot is a minimum, in my opinion.
  • Stop at the first sign of pain!
  • When running barefoot pay special attention to lifting your feet off the ground as opposed to throwing your feet into the ground in front of you. Run “lightly” without plodding or slamming the foot down.
  • You might notice yourself taking shorter strides – this is normal.
  • Be aware of how your entire body feels after running barefoot – that mans the soles of your feet, your ankles, your knees, your hips and low back, and anything else that feels different.

If you don’t get into barefoot running slowly, you may very well get sidelined by an injury that will make running – with or without shoes – painful and difficult. Some possible injuries include:

  • Pain in the calf or Achilles tendon – because shoes raise the heel off the ground a bit this chronically shortens the calf muscles, and when running barefoot this can overstretch this muscle before it learns to become more stretched naturally. Achilles and calf problems can then lead to…
  • Plantar fasciitis – pain at the sole of the foot that is worse when stretched, or worse n the morning when you first step out of bed.
  • Soreness on the topside of the foot – likely from shifting conditions of muscles, bones and joints in the feet as you get used to running without shoes.
  • Bruising or other injuries from pebbles or other things you may step on.
  • Sprained ankles – keeping your ankles surrounded by padding is good for preventing sprains, but is bad for developing neuromuscular control of the ankle, so transitioning too quickly to non-traditional footwear may lead to sprains if you aren’t careful.
  • Stress fractures – some people have reported getting stress fractures in their foot bones from jumping into barefoot running without proper preparation.

So, to summarize, running barefoot can be a great way to strengthen your feet and legs and to develop the small muscles of your feet. This can benefit your entire body by providing a more stable base and by decreasing wear and tear on your knees and other joints. It also carries risk, though, because you must ease into this new style of running slowly and deliberately, being mindful of pain and always listening to your body as it adapts to the world of barefoot running.

At Park Bench Chiropractic we adjust the spine first and foremost, but we also pay attention to the joints of your arms and legs – including ankles, knees, hips, shoulders, elbows, and wrists. Before you transition to less footwear, or throughout that transition, we encourage you to come in and have either Dr. Matt or Dr. Rob evaluate your lower extremity for joint imbalances that could make it more difficult for you to make the change, or to see if the change is even something that is right for you.

Feel free to call or stop by Park Bench Chiropractic if you want to talk about this with one of the doctors.

The Cycle of Injury to Joints

Why joint injuries need to be addressed in order to make sure they don’t become chronic.

When you injure a joint (for example, common places to injure a joint include your spine, your shoulder, hip, knee, wrist, elbow, or ankle) there is also damage to the ligaments that help that joint function properly. Before I explain what exactly ligaments do, let’s quickly go over some terminology:

Joints – this is a place where two bones meet and they can move in relation to each other.

Muscles – these go from one bone to another bone, and when a muscle contracts it brings the two bones closer together.

Tendons – muscles attach to bones with tendons. As the muscle nears the bone it transitions into tendon, which physically attaches the muscle to the bone.

Ligaments – ligaments go from one bone to another bone, but they do not have the ability to stretch like muscles and tendons. They are used to reinforce a joint, to prevent motion in certain directions, and to guide movement in the correct direction.

So, when a joint is injured there is a good chance that the ligaments that hold it together were also injured. To illustrate this, when you sprain your ankle, the actual injury is to the ligaments of the ankle joint. When there is a sprain it is an injury to a ligament.

That injury to the ligament always initiates a process beginning with two things: joint instability and proprioceptive deficit.

1.       Joint instability – as explained above, the ligaments guide and limit the movement of the joint, and without stable ligaments you will not have a stable joint.

2.       Proprioceptive deficit – this is a fancy way of saying that your nervous system will have a decreased ability to monitor and control the movement and position of that joint and the bones that the joint includes.

a.       This proprioceptive deficit then causes decreased neuromuscular control. That means that your body has a decreased ability to properly control your muscles. It is called decreased “neuromuscular” control because the nervous system deficit means that the brain and body aren’t properly communicating and that perfect control of your muscles you usually have is lost. Your brain and the nerves in your joint just can’t get the messages across with 100% accuracy if there is an injury to the joint.

Now, all the issues I mentioned above lead to a common result: functional instability. An unstable joint and a decrease in nervous system control over that joint will combine to cause a loss of functional stability. Functional stability is the overall stability of your body or your body part as it does what it is supposed to do. Using the example of the ankle again, functional stability would show itself as trouble with walking correctly, putting more weight on one foot, or tip-toeing around to avoid pain. These are all changes in how the joint is functioning due to the injury.

We are talking about a cycle, and this is the important part. If you are getting by with an injured joint, but it is not healed correctly, then you are forcing your brain and body to utilize coping strategies like limping or leaning (or avoiding activity altogether). All these strategies are meant to help you avoid re-injuring the joint, but they all predispose the joint to re-injury quite often.  After all, using a joint or a body part incorrectly is a good way to injure it in a new way or just plain exacerbate the existing injury. As a chiropractor I quite often have patients who describe things like severely injuring a disc in their back because they were trying to shovel snow without standing up straight all the way…because they already had back pain to begin with!

So, now we have an injured joint become a repeat injury. Once you re-injure the joint it is typically more difficult to resolve and get back to 100% pre-injury status. You can see this entire process I just described in the picture below:

Cycle of Injury to a Spinal Joint

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So, why is a chiropractor talking about this? Because chiropractors manipulate joints. At Park Bench Chiropractic we work on all the joints in your arms and legs as well as adjusting spines. By locating and correcting vertebral subluxations we help your entire body function better. When we find problems in how other joints are working, such as wrists, ankles, and jaws, we will manipulate those areas as needed. Call our office at (01) 378-0334 to schedule an examination or consultation with Dr. Matt or Dr. Rob in our friendly Frederick office.