When The Kneecap Goes Awry

The kneecap (patella), which is embedded in the tendon of the quadraceps (quads) muscle(s) on the front of the thigh, “tracks” in a groove on the front of the femur, or thigh bone. The quadraceps tendon attaches below the knee to the tibia.

As the knee bends back & forth, the kneecap, which effects a mechanical advantage of 30% increase in the power production of our quads, slides in the bony groove.

If the kneecap becomes misaligned, as it slides there is abnormal wear & tear against the groove, and this can be the beginning of arthritis in the knee. There may be an audible “crunch” in the knee with squats. 

As an Activator Chiropractor, I have an effective adjustment for this condition, and I give the patient exercises that will help the kneecap stay in alignment. 

5 Key Facts About the Shoulder

(1)  It is the most complex and most mobile part of the body.

(2)  It consists of 4 articulations---the glenohumeral joint (top of the arm connects at the shoulder), the sternoclavicular joint (the collarbone connects near the throat), the acromioclavicular joint (outer end of the collarbone connects with a bony projection off the shoulderblade, and the scapulothoracic articulation (the scapula, or shoulderblade, contacts the rear chest wall).          

(3)  Pain in the shoulder may not be a shoulder problem, but be referred pain from 3 common sites---the heart, the lungs, and the neck. 

(4)  Shoulder dislocation involving the humerus (bone in the upper arm) is common because of the shallowness of the “cup” holding the humeral head. 

 (5)   Bursitis is common in the shoulder, caused by inflammation due to repetitive motions (e.g. painting, drywalling, throwing sports).

Services Medicare Doesn't Cover

       As it currently stands for chiropractic services, Medicare only covers adjusting the spine.

No coverage is provided for extraspinal treatment, e.g., for knee, shoulder, wrist, ankle, etc., problems. This is expected to change; chiropractors anticipate Medicare will eventually cover extraspinal problems.

Other essential services provided by chiropractors, also not currently covered by Medicare, are exercises; supports; home care, nutritional, or ergonomic counseling; stretches; and supplements.

Your chiropractor may prescribe / provide these services for you because they are essential to resolving your problem(s), but Medicare will not reimburse; you are responsible for payment.

Sacral Vertebrae

  An occasional variant in the anatomy of the lower spine is the failure to fuze of the 1st sacral vertebra with its neighbor below.

This results in an additional vertebra inferior to L5, where normally the sacrum is one bone consisting of several fuzed, no longer separate, vertebrae.

In some patients with this anatomical variant, it presents no problems, whereas in others the anomaly creates a vulnerability to low back stresses. 

These patients may need more frequent intermittent spinal balancing to maintain comfort and normal function. 

Is It the Meniscus??

  Pain in the knee may be due to any one or more of various possible misalignments or articular aberrances. 

The knee is a hinge joint, and as such it is not meant to move in other than an approximate sagittal plane.

However, slight rotation of the tibia at the joint with the femur, posteriority or anteriority of the proximal tibia, misalignment of the fibula, medial or lateral tibial-femoral joint compression, etc., can occur. These aberrances, even to the slight extent of millimeter(s), can cause discomfort or affect the knee’s range of motion.

If pain persists after all the “usual suspects” of misalignments / aberrances are screened & corrected, an Activator chiropractor looks to the medial and / or lateral meniscus. Often a carefully-vectored Activator adjustment on the inside or outside of the knee solves the problem and stops the pain.

Unilateral Head Pain

  Pain on just one side of the head, in the jaw region or near the ear or cheekbone, can be a simple headache, a TMJ problem, or a dental issue.

However, for these patients it is important to include a condition called vasculitis in the list of possible diagnoses.

Vasculitis is an inflammation of blood vessels. When this occurs in the side, or temporal, region of the head, it is called “temporal arteritis,”  an inflammation in the temporal artery. There may be swelling as well as pain, and the area may be tender to the touch. Often there is a fever.

This is a serious condition, and can have serious consequences. It can spread to the blood vessels of the eyes and possibly cause blindness. If suspected, the patient should immediately be referred to an M.D.

Medicare--Allowed # of Visits

  Medicare typically allows 12 chiropractic treatments (visits) per year.

However, certain things that often go along with aging are considered by Medicare to justify an extended, or longer term, of chiropractic care.

These conditions, called “co-morbidities,” may complicate, or impede healing, making the number of treatments necessary to resolve a chiropractic problem greater.

A common co-morbidity is spinal disc degeneration, usually associated with spondylosis, or bony spur formation around vertebral edges. Another term for this is DJD, or degenerative joint disease. 

Sciatica, spinal stenosis (narrowing of the spinal canal), and foraminal encroachment (narrowing of the opening(s) where the nerves exit the spine) are also co-morbidities, as are health conditions which may complicate or impede healing such as diabetes and osteoporosis.

Unrelenting Rib Pain

  Pain that starts in the front of the chest or in the back, near the spine, and develops along the path of a rib, and that is unresponsive to chiropractic treatment, may be an outbreak of shingles.

The patient will describe no injury or trauma, no upper respiratory infection or cough, which might be affecting the region. Yet the pain persistently worsens.

A shingles viral outbreak follows the path of the related sensory nerve, called a “dermatome.” Dermatomes wrapping around in the thoracic region resemble the paths of our ribs, so initial symptoms of shingles are often misinterpreted as rib pain.

Anyone who has had chicken pox carries the herpes zoster virus in the nerve ganglia alongside their spine. The virus is dormant until conditions such as hyperthermia or stress trigger an outbreak.

Low Back Compression

  Patients who present with central low back pain, especially if the lumbar curve is accentuated, often exhibit compression between the sacrum and the 5th, or lowest, lumbar vertebra.

The patient will often say they “just can’t get comfortable,” even in bed. Sometimes pulling the knees to the chest is relieving, but standing, as well as sitting, cause worsening of the pain.

I relieve the compression by appropriately-vectored adjustments with the Activator instrument, and give the patient stretches & exercises. 

Ergonomic counseling for correct sitting & standing postures is helpful to prevent recurrence of the compression.

OUCH!!--I've Got Gout!

  You wake up with severe, burning pain in the joint at the base of your big toe, and it’s swollen and red.

Chances are, you may have gout!

This is a type of arthritis that is of metabolic origin---too much uric acid in the blood causes sharp crystals to collect in a joint, usually the big toe, and more commonly in men than in women.

This happens because you consume too many foods high in purines, organic water-soluble compounds that oxidize to form uric acid. 

Meats are high in purines; so is beer, seafood such as scallops & sardines, beans such as garbanzos or lentils, vegetables such as asparagus or mushrooms, & wheat bran & wheat germ. Inflammatory foods such as sugar and wheat (all wheat in the U.S. is highly hybridized, thus containing foreign polypeptides that are highly inflammatory) are also culprits.

Your chances of getting gout are higher if you are overweight, drink too much alcohol, eat too many foods containing purines, or drink beverages sweetened with fructose (fruit sugar) or foods with high-fructose corn syrup (soft drinks, ice cream, sports drinks, breakfast cereals).

Gout is successfully treated by changing what you eat and drink. It is important to drink lots of pure (devoid of chlorine or other chemicals) water to help your body flush out waste products and toxins. 

Plantar Fasciitis

   Pain in the bottom of the foot, usually in the arch further back toward the heel, may be plantar fascitis. It is caused by injury or inflammation of the plantar (bottom of the foot) fascia. The plantar fascia is a band of fibrous connective tissue on the sole of the foot.

The pain may come on slowly, related to chronic pronation (a falling inward of the inside of the arch) combined with a “fallen” arch, or be more acute, due to an injury---landing hard on the sole of the foot, quick acceleration / deceleration when walking or running, or repetitive shock of hard heel strike during the gait cycle.

My treatment includes carefully aligning the bones of the foot with the Activator instrument, support of the arch with orthotics, exercises to strengthen the arch, stretches to maintain flexibility, and ice and other applications for inflammation.

The patient must not go barefoot---there must be NO weight-baring without orthotic support.

Could It Be My Pillow??

   No, not the My Pillow advertised an infinitum on TV---I seriously doubt those provide proper and adequate support for the cervical spine.

If you aren’t sleeping on a proper pillow, one that correctly supports the curve of the neck, this may be the reason you have persistent neck and upper back pain.

When the pillow you sleep on allows your head to tilt downward toward the mattress, or pushes your head upward at an angle, it is not serving you. Your neck should be parallel with your mattress when you are lying on your side, and if on your back, your head should not be angled abnormally up or down.

The right pillow gives consistent, resistive support to the spine throughout the night.

It doesn’t compress, as does a pillow filled with down or feathers. 

It doesn’t deform, as a buckwheat pillow will.

It doesn’t squash down where your head and neck press on it, creating a depression that discourages movement during the night, as a memory foam pillow does.

Look for an orthopedically-designed pillow, such as the one I sleep on----I have them available in my office for patients.

Bench Pressing / Ergonomics

   Dropping the elbows too low while bench pressing heavy weight can cause stress injuries to the acromioclavicular joint in the shoulder.

The outer end of the collarbone, near the front and top of the shoulder, articulates with the acromion process, a bone projecting forward from the scapula. The clavicular part meets the acromion part, forming the “acromioclavicular, or AC, joint.

One of several joints making up the shoulder complex, the AC joint is particularly subject to injury because it is essentially two bones butting together, held by ligaments.

Recently a patient who had come from working out at the gym presented with shoulder pain due to over-stressing the AC joint while bench pressing.

Precise adjustments with the Activator instrument, combined with home care & ergonomic counseling, were the solution.

It's a Veggie! It's a Fruit! It's Full of Vit. C!

         Often thought of as a vegetable, red bell peppers are actually classified as a fruit, because they have seeds.

        Red bell peppers are an excellent source of Vit. C---one cup contains 117 mg---and they are low in sugar.

They also contain multiple antioxidant compounds---a single red bell pepper has 30 different antioxidants. They are one of the most nutrient-dense foods one can eat.

https://www.organicconsumers.org/news/veggie-thats-a-fruit-more-vitamin-c-than-an-orange?utm_medium=email&utm_source=engagingnetworks&utm_campaign=OB+673&utm_content=OB+673

Got Toxic Oils??

If you have grapeseed oil or rice bran oil or canola oil in your kitchen cabinet, you have TOXIC OILS. 

     "Designer oils" such as rice bran and grapeseed oil, commonly promoted as "healthy," are, in fact, extremely toxic. Here's why: these oils are highly processed. Canola oil, which many people assume is healthy because, like olive oil, it is monounsaturated, is also in the HIGHLY PROCESSED category. 

     Processing is necessary to extract the oil from rapeseed (canola), rice bran, and grape seeds, and may include extraction with heat and solvents, as well as chemical bleaching, degumming, and deodorizing. 

     Because the raw oils have monounsaturated and polyunsatured components, when exposed to heat, they readily oxidize. Oxidized oils are toxic and very inflammatory to our bodies.

     Avoid these oils, and use cold pressed, extra virgin olive oil instead.

A Secret to Relieving Sciatica

 Sciatica, pain down the leg, is caused by nerve impingement. Location of the impingement is commonly thought to be in the lumbar spine, where the nerves exit between the vertebrae and travel down to the legs, forming the large nerve “trunk” called the sciatic nerve.

If there are degenerative changes in the lumbar spine, and / or if there is history of injury, the lumbar region may indeed be the site of impingement.

But another, often overlooked, site of impingement that causes sciatica is in the gluteal region, where the sciatic nerve passes between the muscles, specifically underneath a muscle called the piriformis. If the piriformis is in spasm, it can cause sciatica.

Episodes of pressure on the piriformis, such as from sitting on hard surfaces, can also impinge of the sciatic nerve where it passes under the muscle, resulting in sciatica.

Orthopedic tests and X-ray can help discern the origin of impingement, but often a trial treatment of precise Activator Chiropractic adjustments, specific stretches, and home care counseling can solve the problem, making X-ray unnecessary. 

Fire Safe Council of Santa Cruz County

   

  I am proud to be a  Community Partner 

      with

Fire Safe Council of Santa Cruz County

A 501(c)(3) Nonprofit Corporation

Whose Mission is to Educate and Mobilize the People of Santa Cruz County

to Protect Their Community, Homes, and Environment from Wildfires 

Learn how your tax deductible contribution 

to become a Community Partner can help at:

https://www.firesafesantacruz.org/community-partners-2019

The Helpfulness of Hedgerows

    Throughout millennia, farmers have used linear plantings of trees and shrubs, or “hedgerows,” to create windbreaks to protect their crops. A “bonus” benefit was the plants’ roots holding the soil and protecting against erosion.

Today’s farmers know that these plantings of vegetation among their crop fields have multitudes of other benefits to the farm. 

With the right mix of plants, including flowering ones, hedgerows attract beneficial insects that prey on crop pests. They also serve to suppress weeds, because over time they out-compete the weed “seed bank,” and help keep out wind-blown weed seeds.

Hedgerows can be of linear, or other configurations, and can also include grasses and herbs. The root systems improve water quality by acting as filters to catch sediment and filter surface water before it drains into aquatic habitats such as ponds, creeks, or rivers.

Hedgerows create a sheltering habitat for wildlife, such as birds that feed on crop insect pests, and pollinators which fertilize crops.

California native plant hedgerows are said to be easy to establish, and once mature, are drought-tolerant.

Learn more at www.HedgerowsUnlimited.com 

  

Mysterious Shoulder Pain

 There are times when pain in the shoulder may not be due to a local problem in the shoulder, but may be originating somewhere else. To ease the pain, its specific origin must be determined.

Often a patient presents with an unimpeded range of motion, no soreness or tenderness to palpation of the shoulder, and no history of injury or stress to the involved shoulder. Yet the pain is unrelenting; the patient is unable to get relief by changing position or posture.

With this scenario---no signs of local trouble in the shoulder---my attention goes to the neck, where impingement of the nerves going into the shoulder region can cause “referred” pain. Referred pain shows up in one place, but its actual cause is somewhere else. 

My treatment for this kind of shoulder pain includes precisely clearing misalignments in the cervical vertebrae, appropriate neck stretches, and postural counseling. 

        Often a better cervical pillow is also key to lasting relief.

Excessive Extension in the Low Back

 The normal curve in our low back is an “extension,” or forward-facing curve.

In some people, this curve is abnormally pronounced, which can be due to chronic locking back the knees when standing, or the accentuated curve may be part of the congenital anatomy of the low back.

This excessive extension can cause chronic low back discomfort, partly due to posterior compression between the lumbar vertebrae and / or compression between L5 and the sacrum.

My treatment plan for these patients includes precise, gentle adjustments to the spine and pelvis with the Activator instrument, accompanied by exercises to strengthen the abdominal muscles, specific stretches, activities of daily living (ADL) advice, and postural counseling.