Is it okay to crack my own back?

Posted on May 15, 2012 by jgagnon

You either do it yourself or know someone who cracks their back, neck, etc. multiple times a day to get some temporary pain relief or just purely out of habit. While the actual cracking and popping most often is not harmful, the repetitive forcing of joints in such a manner may produce chronic, future problems.

The popping sound with joint manipulation is simply a release of gas from the joint. To understand what is going on through the phases of motion, reference the chart below. The physiological zone encompasses both active and passive range of motion until a soft, elastic end feel is felt. The paraphysiological zone is after the physiological zone but just before tissue disruption (i.e. sprains and strains) occurs in the pathological zone. The paraphysiological zone is where manipulation of joints takes place. Just past the limits of passive range of motion, a quick force in the joint into the paraphysiological range usually produces the audible “pop” heard with adjustments (whether it is a self-adjustment or done by someone else). Too forceful of an adjustment or just a traumatic injury puts the joint in the pathological zone causing injury to the surrounding tissues.

That being said, the development of hypermobility is the prime concern with chronic bone crackers. The surrounding ligaments gradually develop laxity allowing joints to move too easily. In response to the hypermobility, the muscles surrounding the joints tighten up to help stabilize the area. When the muscles are tight, the apparent need to crack the joint is there. After the joints are “cracked”, there is temporary relief until the muscles then tighten up again. It is a vicious cycle.

The goal of chiropractic care is to target the hypomobile joints (joints that do not move well) by adjusting these specific areas to get them moving properly again. When there is hypermobility, the goal is to stabilize the area with strengthening exercises. Self-adjusting typically effects the already hypermobile joints, further perpetuating the need to continue to crack the same places over and over again every few minutes.

So in short…is cracking your own spine bad? Yes and no. Occasionally is not bad as long as there is not a lot of force applied. Long term can cause problems created by joints that are too loose and muscles that become chronically tight.

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A brief overview of the types of arthritis

Posted on April 17, 2012 by jgagnon

Osteoarthritis: The most common. This can happen at any joint of the body and usually occurs with age in places with increased stress due to biomechanics or injury. http://www.arthritis.org/osteoarthritis.php
Rheumatoid arthritis: Onset is usually between 20-60 years old and more predominant in women if it begins early but equal if it begins after 40 years old. There is symmetric joint pain in the extremities and eventually causes deformity. http://www.arthritis.org/rheumatoid-arthritis.php
Gout: This affects males more often in their 40s and 50s. Flare-ups occur due to deposition of uric acid crystals in joints which cause severe swelling in joints, usually in the lower extremities. http://www.arthritis.org/disease-center.php?disease_id=42
Juvenile rheumatoid arthritis: Begins most often in females less than 16 years old. Signs and symptoms include joint pain, fever, and rash. http://www.arthritis.org/disease-center.php?disease_id=38
Psoriatic arthritis: Begins between ages 20 to 50 usually and equal among sexes. Scaly skin lesions often present (psoriasis). Pain and eventual deformities are seen in peripheral joints. Nail changes occur in 80% of patients. http://www.psoriasis.org/
Ankylosing spondylitis: Onset is between 15 to 35 years old and is predominantly found in males. Pain and stiffness usually starts in the low back (sacroiliac joints). This can be seen on x-ray in later stages and can be detected with blood tests. http://www.spondylitis.org/
Systemic Lupus Erythematosus: Found most often in women of child bearing age. This is a generalized connective tissue disorder that involves multiple organ systems of the body. There is a rash often looking like a butterfly on the face that is present and often brought on my sunlight. http://www.lupus.org/newsite/index.html
Diffuse idiopathic skeletal hyperostosis (DISH): Often older than 50, predominantly male, up to 20% have diabetes, most common location is in the spine. http://www.mayoclinic.com/health/diffuse-idiopathic-skeletal-hyperostosis/DS00740
Reactive arthritis (Reiter’s syndrome): Age of onset 18 to 40 years old and almost always in males. Arthritis is usually found in the lower extremity. Pain is often accompanied by urethritis and conjunctivitis. http://www.arthritis.org/disease-center.php?disease_id=23
Scleroderma: More common in females from 30-50 years old. There is initial peripheral pain and swelling with a high correlation to Raynaud’s phenomenon. http://www.scleroderma.org/
Hydroxyapatite deposition disease: Most often occurs 40 to 70 years old. This involves calcification within soft tissue most commonly found in the shoulder, hip, and spine. http://en.wikipedia.org/wiki/Calcific_tendinitis

Information was obtained from Youchum and Rowe’s Essentials of Skeletal Radiology.
This list is not exhaustive. It simply represents some of the more common arthritides.

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Various Knee Conditions

Posted on April 6, 2012 by jgagnon

*For more information on the knee in general, refer to a previous blog titled “The Knee Explained”.

PATELLAR TENDONITIS: Also known as jumper’s knee, this condition is caused by inflammation of the patellar tendon. Usually the person who suffers from this is involved in activities that require jumping of some sort. Pain is usually elicited with jumping and with direct pressure over the tendon. Treatment includes rest, ice, stretching of the surrounding musculature, anti-inflammatories (either natural or synthetic), and a brace called an infrapatellar strap that goes around the leg just below the knee.

OSGOOD-SCHLATTERS: This occurs mainly in children and adolescents who play sports and are growing rapidly. The quadriceps tendon attaches to a point just below the knee and when there is stress on that bone area, the pulling can cause pain, swelling, and even a bony bump that forms. Treatment includes rest, ice, using a knee brace or patella strap, and stretching muscles that cross the knee joint.

PLICA SYNDROME: The synovial plica is a remnant of fetal material that in some people, are more prominent “sleeves of tissue” in the knee joint. These flaps can become irritated either with a direct hit or with overuse. Pain is similar to meniscus tears and patellar tendonitis. Swelling is usually more prominent with plica syndrome. Treatment includes ice, anti-inflammatories (natural or synthetic), rest, and getting the knee adjusted to all for proper movement and function.

BAKER’S CYST: These are protrusions of the synovial fluid in the back of the knee. They can be caused by most any type of knee injury or arthritis. Symptoms include pain or tightness behind the knee and a palpable and sometimes visual bulge behind the knee. There may also be no pain at all. Treatment often includes aspiration (removing with a needle) of the cyst and local anti-inflammatories.

DISLOCATED PATELLA: This is a displacement of the knee cap out of its groove. This can be caused by direct trauma or when there is a sudden change of direction when the leg is planted. These tend to be obvious as the knee cap may wrap around to the side of the knee. Immobilization is necessary initially and an x-ray is often done to see if there is any damage to the bone. Physical therapy is necessary to help stabilize the joint and prevent future dislocations.

*This list in no way covers all problems with the knee joint. It is simply a quick guide to the most common conditions in the knee. For proper evaluation and diagnosis, seek care from a medical provider.

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Patellofemoral Pain Syndrome

Posted on March 30, 2012 by jgagnon

*For a description of general information about the knee, see the blog titled “The Knee Explained”.

The patella, or knee cap as it is more commonly known, has a layer of cartilage on the part that contacts the femur. Damage to this cartilage due to various reasons may cause pain in the knee. The cartilage acts as a natural shock absorber so any time there is damage to it, there is risk of pain.

CAUSES: Misalignment of the bones in the leg, muscular imbalance (especially of the quadriceps muscles), overuse or repetitive stress, and trauma to the knee cap are the most common causes of patellofemoral pain syndrome. Weakness in one part of the quadriceps and tightness in another part may cause the patella to track out of the normal groove causing undo stress on the under part of it contacts the femur.

SIGNS/SYMPTOMS: Usually this condition causes a dull achiness in the front of the knee. Certain movements such as walking up or down stairs, squatting, kneeling, or sitting with a bent knee for an extended period may aggravate this condition causing a more sharp pain. Usually there is little to no swelling with this and pain comes on gradually.

DIAGNOSIS: Usually diagnosis can be made with a simple physical exam, history, and possibly x-rays.

TREATMENT: Avoid activities that increase pain, have your knee and/or foot adjusted by a chiropractor to make sure there is proper alignment in the lower extremity, ice, rest, and strengthening and stretching that targets muscles such as the quadriceps, hamstrings, and gluteus medius and maximus.

COMPLICATIONS: The pain can interfere with everyday activities and may go undiagnosed or misdiagnosed for a long time.

PROGNOSIS: When patients continue to do the activities that aggravate this condition, the prognosis is fairly poor. The above treatment usually resolves up to 90% of all cases. There are occasional cases of surgery needed when the conservative forms of care are not helping.

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Arthritis of the Knee

Posted on March 26, 2012 by jgagnon

*For more information on the knee in general, refer to a previous blog titled “The Knee Explained”.

Arthritis is just a broad term with several different types ranging from osteoarthritis to gout to rheumatoid arthritis. This blog is just going to focus on the most common type of arthritis: osteoarthritis, also known as “wear and tear arthritis”. The cartilage that surrounds the bones of the knee joint and the meniscus both wear down and result in rubbing of bone on bone leading to deterioration of the bone.

CAUSES: Most often this osteoarthritis develops secondary to previous injuries, poor body mechanics, poor health, and/or being overweight. This typically begins occurring in the 40s and 50s and is progressive with age.

SIGNS/SYMPTOMS: Pain with activities, decreased range of motion, stiffness in the joint (especially upon initial movement), tenderness along the joint line, a feeling of instability, and variance throughout the day and throughout the year.

DIAGNOSIS: A physical examination and x-rays are usually enough to make a confident diagnosis of osteoarthritis. Blood tests may need to be performed to rule out other conditions, including other types of arthritis.

TREATMENT: Weight loss, improve the diet, activity modification, chiropractic adjustments of the knee to establish proper alignment and motion, heat, physical therapy, anti-inflammatories (either natural or synthetic), glucosamine and chondroitin, and ultimately, knee surgery (there are various types of these).

COMPLICATIONS: Once arthritis has begun to develop, it is likely to continue to progress until something is done to stop progression. Ultimately, osteoarthritis can become debilitating to the point where normal activities are impossible to perform.

PROGNOSIS: When action is not taken to improve the health of the body, prognosis is not very good. Many people will continue to experience pain and deterioration. However, studies have shown that not all cases of osteoarthritis progress. With proper steps, people can reduce pain and increase function of affected joints.

Picture taken from www.orthopedics.about.com

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MCL/LCL Tears

Posted on March 16, 2012 by jgagnon

*For a description of ligaments of the knee, see the blog entitled “The Knee Explained”.

The medial collateral (MCL) and lateral collateral ligaments (LCL) are tough fibrous material that connects the femur to the tibia (MCL) and fibula (LCL). They are support ligaments that help prevent excessive medial and lateral movement. The MCL is located on the inside of the knee and the LCL is on the outside of the knee.

CAUSES: The MCL is sprained more often than the LCL. The MCL is usually injured when there is a blow to the outside of the knee causing excessive motion to the inside of the knee. Chronic MCL pain can result from flat feet, poor joint alignment, and even hip problems. LCL sprains are far less common and usually result from a blow to the inside of the knee which forces excessive stretching of the outside part of the knee.

SIGNS/SYMPTOMS: Signs and symptoms correlate to the extent of injury. Grade I tears are mild with only some fibers torn. Grade II tears are also considered partial because this involves approximately ½ of the ligament fibers. Grade III tears are complete tears of all the ligament fibers. Signs and symptoms include pain over the ligament site, swelling, possible bruising, and in more severe sprains, instability.

DIAGNOSIS: Done by physical exam, history of the injury, and MRI to see the extent of the damage.

TREATMENT: Rest, ice (about 15 minutes at a time), compression, and elevation (RICE), physical therapy, adjustment of the knee to align the joint for proper healing, bracing for support, and rarely surgery in more severe cases. Sprains to these ligaments are treated more conservatively because unlike the ACL, they have a direct blood supply which helps with healing.

COMPLICATIONS: Poor rehabilitation of the knee can result in excessive scar tissue formation and loss of normal function and movement of the knee. Future arthritis may also develop if the knee is not properly lined up when it is healing. Also, many times there are other injuries in addition to a collateral ligament sprain that need to be dealt with.

PROGNOSIS: Very good. These ligaments tend to heal themselves and so with proper rehab and treatment, people with collateral ligament injuries tend to recover and go back to their respective activities in anywhere from 1 to 12 weeks depending on the severity.

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Bursitis of the Knee

Posted on March 12, 2012 by jgagnon

*For a description of the bursa, see the blog titled “The Knee Explained”.

Bursitis is when the normally slippery, smooth bursa becomes inflamed. When this happens, it loses the ability to aid with smooth gliding and the extra size when it becomes swollen causes an already cramped area to become more cramped.

CAUSES: Bursitis is usually caused by chronic pressure or repetitive movement. Acute forms, however, may be triggered when a bursa is injured from a direct blow. Chronic bursitis usually develops over time while acute bursitis develops immediately.

SIGNS/SYMPTOMS: The knee will be painful to the touch, swollen, and warm over the inflamed bursa. There will also be pain with movement of the knee.

DIAGNOSIS: Usually examiners can diagnosis bursitis with a physical exam using the above signs and symptoms. An MRI is a more definitive way to diagnose the exact location and severity.

TREATMENT: Since bursitis is from inflammation, basic protocols for inflammation such as rest, ice (about 15 minutes at a time), compression, and elevation (RICE) help with the problem. To avoid chronicity, the patient should avoid the activity that causes the bursitis. Chiropractors may need to adjust surrounding joints to prevent the bursa from continuing to become inflamed. Any kind of anti-inflammatory (whether it is natural or synthetic) can also help. There are some circumstances where the bursa may need to be drained. Learning proper stretching and strengthening can help to avoid future flare-ups and chronicity. Antibiotics need to be given if the bursa becomes infected.

COMPLICATIONS: Occasionally the bursa may become infected. In rare cases, chronic bursitis may need to be treated with surgery.

PROGNOSIS: The outcome after treatment is good if the patient takes the steps necessary to avoid the causative action. Without further steps taken, the bursitis will most likely continue to return.

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ACL Tears

Posted on February 23, 2012 by jgagnon

*For a description of ligaments of the knee, see the blog titled “The Knee Explained”.

The anterior cruciate ligament (ACL) is one of 4 main ligaments of the knee. It runs diagonally in the knee joint and prevents the tibia from sliding forward and also provides rotational stability of the knee.

CAUSES: Most ACL injuries are sports-related, non-contact injuries. Only roughly 25% of sports ACL tears are due to direct contact to the knee. Mechanism of injury usually involves deceleration with cutting, pivoting, or awkwardly landing. Female athletes are more likely to sustain these injuries, possibly due to decreased strength in the surrounding musculature.

SIGNS/SYMPTOMS: The knee usually gives out immediately after a tear. Swelling, pain, and decreased range of motion are present. Often, the person hears a pop when the ACL is completely torn. A feeling of instability occurs leaving the patient often unable to bear any weight.

DIAGNOSIS: Physical examination and MRI are the most conclusive diagnostic procedures.

TREATMENT: Rest, ice (about 15 minutes at a time), compression, and elevation (RICE), physical therapy, adjustment of the knee to align the joint for proper healing, bracing for support, and surgery in some cases to reconstruct the ligament. For athletes who are trying to get back to a competitive activity, surgery has been shown to be the best way. The key whether you get surgery or not is to properly rehab the knee.

COMPLICATIONS: Other injuries often occur with an ACL tear such as meniscus tears, MCL tears, or even fractures of the tibia or femur. With chronic instability due to an ACL tear, upwards of 90% of patients may exhibit meniscus damage years after the initial injury.

PROGNOSIS: Once a ligament is torn, it heals with scar tissue which is inflexible and weaker than the original tissue. Little or no rehab will almost certainly lead to future problems. Prognosis depends on the severity of the tear. Full tears rarely, if ever, heal on their own. Partial tears will heal with scar tissue. Surrounding muscular strength is necessary to protect the injured ligament.

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Meniscus tears

Posted on February 16, 2012 by jgagnon

*For a description of the meniscus, see the blog titled “The Knee Explained”.

The menisci in the knee help to distribute weight and allow for proper mobility of the knee. Some of the outer parts of the meniscus are nourished by small blood vessels but a majority of it does not have a direct blood supply. This leads to the inability of the meniscus to heal on its own.

CAUSES: In older patients, changes in the structure of the menisci make it more brittle and susceptible to tearing over time. In younger patients, the most common type of tear comes from a traumatic event that usually involves the knee being bent, the foot planted, and then twisted.

SIGNS/SYMPTOMS: Signs and symptoms vary depending on the severity of the tear. In the older population, the pain may come without a known cause and gradually get worse over time. With mild tears, pain and swelling are minimal and may last up to about 2 weeks. Moderate tears have pain usually at the side and center of the knee. Swelling gets worse over the first few days. Pain is made worse with walking and there may be a sharp pain with twisting. Severe tears present with severe pain, potential inability to walk, joint swelling, and due to a possible piece of torn cartilage, joint locking or inability to straighten the knee may occur.

DIAGNOSIS: Physical exam, history of the injury, x-ray (to see bone changes), and MRI to see the actual menisci are the most common ways to diagnosis a meniscus tear.

TREATMENT: Rest, ice (about 15 minutes at a time), compression, and elevation (RICE), physical therapy, adjustment of the knee to align the joint for proper healing, and surgery in some cases to remove or repair the torn meniscus.

COMPLICATIONS: It is not uncommon to see meniscus tears along with other knee injuries such as MCL and ACL tears. This is called the “terrible triad” and is usually done in contact sports or with activities such as skiing.

PROGNOSIS: This depends on the age of the patient, the severity of the tear, and whether surgery is needed to repair the injury. Proper rehab is needed to ensure strengthening of surrounding musculature.

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The Knee Explained

Posted on February 10, 2012 by jgagnon

The knee is a hinge joint that is made up of the femur, the tibia, and the patella (knee cap). It is a synovial joint meaning there is a joint capsule that contains fluid called synovial fluid. The synovial fluid nourishes and lubricates the joint. This blog is the first of a series of blogs discussing the basic anatomy and injuries to different parts of the knee joint.

BURSA: A bursa is a fluid-filled sac that is located in the body in areas of high friction. The knee has a large bursa above the patella, a few small ones behind the knee, a few in front of the knee, and others that are sometimes present.

CARTILAGE: There are two types of cartilage in the knee: fibrous and hyaline. Hyaline cartilage covers the surface of bone along which the joints move. Fibrous cartilage (also called the meniscus in the knee) is strong and helps to protect the bone and allows for pressure resistance. The menisci in the knee wear and tear over time and has limited ability for healing.

LIGAMENTS: Ligaments are non-contracting tissues that connect two bones to each other. They help stabilizes the knee and limit movement. The knee has 5 main ligaments and a few smaller ones for stability: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), patellar ligament, oblique popliteal ligament, and arcuate popliteal ligament.

TENDONS/MUSCLES: Tendons are on the end of muscles where they connect muscle to bone. There are several muscles and tendons that cross the knee joint. Anytime a tendon/muscle crosses a joint, it plays a role in the movement of that joint. The more a joint moves, the more susceptible it is to getting injured.

The knee can be bent and extended (flexion and extension) and can rotate slightly. Injuries often happen when one of these motions is forced too much. The following blogs will talk specifically about the different structures of the knee and different types of injuries that may occur.

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