A Piriformis Predicament

When there is pain, or numbness / tingling going down the leg, a patient’s first thought is often, “Uh-Oh. It must be a disc.”

Impingement of nerve(s) by a bulging disc can be the cause of these symptoms, but in the absence of any history of injury, such as a lifting strain or a fall or accident, or of disc problems, it is not necessarily the first thing suspected.

A common cause of such symptoms is impingement of the sciatic nerve underneath the piriformis muscle in the buttock. The piriformis may be in spasm, or the patient may have been sitting for prolonged times, or on hard surfaces, causing pressure on the sciatic nerve.

I release a piriformis spasm with the Activator instrument, and give the patient home care instructions and stretches to alleviate the problem.  

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.