https://www.youtube.com/watch?v=JFF81LG6ZUM
As we are setting up patients more and more frequently for home exercises using our collection of 20-30 minutes free videos vetted from several good Youtube channels, I am fielding lots of requests for accommodations and modifications. When it comes to yoga, wrist modifications are commonly needed. Here is a short recorded video on the subject-
https://www.nature.com/articles/%20s41574-021-00553-7
This recent bit of medical news came as no surprise to me. As someone who treats a fair amount of pregnant patients, I often see them presenting in the first trimester stating that they are unable to manage any of their usual pain symptoms because they cannot take the NSAIDs during pregnancy any more, and that Tylenol, still available to them as “pregnancy safe”, does not cut it. I have never felt comfortable with the recommendation for Tylenol getting a free pass during pregnancy and I am glad to see some growing evidence supporting that hunch. I am always thrilled to be able to help a pregnant patient manage symptoms during pregnancy to remain drug free whenever possible.
Just about everyone has experienced an injury that involved significant swelling. In most cases the swelling will resolve on its own. Some cases, however, will not recede and become chronic. There are several reasons why this can happen. We are going to dig into the three most common causes, in addition to what acute swelling treatment involves. If you have not yet read Common Questions About Lymphedema, I would recommend it as a pre-read to this blog.
Traumatic edema is the result of a blunt trauma, surgery, infection, broken bones, torn muscles, sprains, strains, etc. It is characterized by pain, heat, redness, and swelling. When an injury occurs, the blood vessels in the surrounding area dilate to increase available nutrients and oxygen to the damaged tissue. This causes an increase of local fluid in and around the injury, also known as swelling. Various types of white blood cells leave the blood capillaries to go into the injured tissues. These damage control cells then devour the injured tissues and cells, starting the tissue repair cycle.
In normal cases, after the damage control cells have cleaned up the tissues, swelling should slowly start to recede. There is a range in the duration of swelling reduction, based on how severe the injury originally was. Some injuries, however, continue to remain swollen, even though the pain associated with the original injury has subsided. Of the causes of chronic swelling, three are the most common.
Cause number one: the damage control cells in charge of clearing away injured tissue can accidentally damage surrounding healthy tissue. If they do not stop ‘eating’ the good tissues, the inflammatory reaction can spread to the surrounding structures including local lymphatics. For people that like to know the names, this is called lymphangitis. Damage to the local lymphatics can result in permanent disfunction, usually in the area of the original injury. In some cased the area below the lymphatic damage may swell since the area above it is unable to drain lymph properly.
Cause number two: Occasionally, an injury is severe enough that the lymphatic vessels were permanently damaged in the event. This is more common when large essential vessels are impacted. In most cases of traumatic swelling, the damage to the lymphatic vessels is slight enough that they are capable of regenerating and reconnecting.
Cause number three: Some people are born with an underlying malformation in their lymphatics. Often the person is unaware of this until an incident occurs that puts more strain on the lymphatic system, whether it is an illness, surgery, physical trauma, etc. Swelling will start to accumulate and will often involve a whole limb. Sometimes more than one limb is involved if the malformation is present elsewhere. This is called primary lymphedema.
The best treatment for acute swelling is the application of Manual Lymph Drainage (MLD). Compression Therapy may also be indicated depending on the injury. MLD is a hands-on technique that stimulates the lymphatic system to absorb edema more quickly. A 1989 study(1) showed that MLD promotes lymphatic vessel regeneration. It can be applied immediately after a traumatic event. Prompt treatment for post-traumatic swelling is important to lower the risk of chronic long-term swelling.(2)
(1) Hutzschenreuther P, Bruenmmer H, Silberschneider K. Die Vagotone Wirkung der Manuellen Lymphdrainage nach Dr. Vodder, LympmhForsch. 2003 7(1):7-14
(2) Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach
Giampietro L Vairo, MS, ATC, ACI,a,∗ Sayers John Miller, PhD, PT, ATC,b Nicole M McBrier, PhD, ATC,c and William E Buckley, PhD, MBA, ATCd
Images used courtesy of Wikimedia Commons
Two years after graduating from chiropractic school and while already working full time in Cannon Falls, I received a strange phone call from a person who identified as a chiropractic student working at the same school clinic in South Minneapolis where I had worked as an intern. She seemed to be relieved to have tracked me down and explained to me that she needed me to urgently answer one simple question: how the heck did I resolve Linda’s breast pain?
As it turns out, Linda was my second official patient in my budding chiropractic career. She was assigned to me as I was kicked out of the student clinic and into the “real world”, real green and real scared. She was a hairdresser with chronic neck pain and hands that frequently fell asleep at the end of her workday. She did well with her chiropractic care, which incorporated manual adjustments to the neck and upper back and lot of soft tissue work to the anterior shoulder.
The funny thing is that Linda never told me that the breast pain she had had for years had also resolved with her care. I found out about it from the frazzled student who called me that day. Linda had apparently had multiple breast imaging, examinations, some pretty invasive stuff for persistent breast pain. It went away along with her neck pain and arm tingling but she never bothered to tell me that. A year later, it returned, and the new intern assigned to her case was struggling to get a handle on it and Linda had suggested she track me down.
Breast pain can obviously come from many places, not the least one being of course the breast itself. I would never work up a case without getting breast tissue pathology ruled out (being married to an oncologist, the stats are always vivid in my mind). But once breast tissue pathology has been ruled out, and the patient is still struggling, we need to put on the detective hat and start looking the source of the pain.
Referred pain to the breast is not that uncommon. If you look at the basic anatomy and neurology of the area, there are a few common sources that are easy to evaluate:
Midthoracic spine at the rib junction: The intercostal nerves exit that area and are subject to irritation from a spinal functional lesion. Patients may or may not have thoracic pain along with breast pain. Most commonly, the area around T4-6 is involved.
The brachial nerve plexus, originating from the cervical spinal nerves, will radiate in the upper breast area just below the clavicle. Pressure over the area of the plexus entrapped by the scalenes will usually reproduce the pain. There is often a history of cervical anterior injury.
Myofascial soft tissues of the anterior shoulder and pectoralis group. If you look at charts of trigger points, you will see a surprising number of points that radiate to the breast area. This is common in patients with shoulder injuries, repetitive use injuries of the arm and shoulder or occupations origin. Incidentally, this was the problem causing Linda’s breast pain.
Anterior rib cartilage to sternum injuries. The cartilage junction between the anterior rib and the sternum is just underneath the medial aspect of the breast tissues. Those are often easy to palpate when you move the overlying breast tissue out of the way.
The moral of the story: once you have ruled out breast tissue pathology, get your rear to your chiropractor and see where the breast pain is coming from.
https://studio.youtube.com/video/2pBC0qgtme8/edit
I field a lot of questions from folks who are trying to get through their yoga exercise practice (especially since many are now doing it from home without the support of a seasoned teacher at their side), without aggravating their lower back pain. The forward fold maneuver is a foundational move of all vinyasa yoga flow, and that can be a barrier for folks with certain lumbosacral mechanical problems that do not tolerate any weighted flexion of the lower lumbar spine. This simple modification to transition downward without losing flatback position should allow folks to still enjoy a good yoga workout.
With a recent influx of pregnant women and as I, myself prepare for #2 in a few weeks, I wanted to create some videos for those that are pregnant can follow at home on their own. We have 5 different sections and it is ideal to pick one exercise from each section to perform daily. Just like most things physical, labor and delivery require some training.
January of 2020, here at the Body Works Clinic, we hosted a Pregnancy Workshop in which we discussed each of these at home exercises as well as baby mapping and positioning. The following are some of the at home exercises we went through. Follow the attached links for the YouTube videos.
1. Pelvis: Cat/Cow, gym ball hip circles, standing hip circles, clamshell, bird/dog hip circles
2. Abdominal Wall: “Hammock” the belly position, quadruped position “rock the baby”, side lying release, rebozo
3. Mid Pelvis Ligament: side lunges, hip opener, stool frog squat, isolate one sacrotuberous ligament with tennis ball release
4. Pelvic floor: low squat, posterior leg flexibility
5. Lower uterus ligaments and cervix: inversions, downward dog yoga position, progress to forward leaning inversion
https://chiro.org/Low_Back_Pain/Influences_of_Lumbar_Disc_Herniation.shtml
I came across this really interesting article on the effect of lower back pain, in particular when generated by a lumbar disc herniation, shortly after a patient asked me if there was a correlation between an injury they suffered at work a year ago, and a variety of new problems cropping up in multiple areas of one leg. Apparently, this is a question that folks around the world must be asking and prompted Chinese colleagues to methodically investigate by taking controlled measurements of what happens to the pelvis rotation and leg function during several common daily activities.
The effect of lumbar disc herniation on the lower extremity is especially two-fold: rotational stress from the pelvis is transferred downward, and the knee in particular is not equipped to deal with the constant shear force on the meniscus ( a problem I see commonly ). Second, the leg is maintained in a slight state of flexion at the hip and knee, resulting in increased weightbearing stress on the midfoot and plantar fascia and malposition of the patella. If the lumbar problem is not resolved, the structures of the knee and foot will start breaking down over time. This is true even if the lower back pain starts improving , since the protective posture of hip rotation and leg flexion can persist long past the original acute lumbar pain.
The moral of the story: yes, you absolutely can develop lower extremity repetitive injuries from an acute lumbar disc and those injuries can outlast the acute low back pain. But treating those injuries without addressing the compensatory postural adaptation is doomed to give you paltry results
With summer quickly coming to a close, this may come as a little late, but always worth looking into. What were you using to protect your littles (and yourself) this summer with long hours out in the sun? Many sunscreens tend to protect you from the sun, but at the expense of some very toxic chemicals. I challenge you to check out the sunscreens that you have been using through this database. The lower the ranking (1/10) the better the product. If you’re surprised by the ranking of your sunscreen, check out the rest of your everyday products and see how those rank. I have also created a quick search on some products with the kiddos with ranking reference.
https://www.ewg.org/sunscreen/about-the-sunscreens/?category=moisturizer+with+SPF
Kids/ Babies-
Badger Baby Sunscreen Cream, Chamomile & Calendula, SPF 40 (1)
In general Badger Sunscreen does not have a “bad” option
Banana Boat Simply Protect Baby Sunscreen Lotion Spray, SPF 50+ (3)
Banana Boat Simply Protect Baby Mineral- Based Sunscreen Lotion, SPT 50+ (3)
Were you surprised with your findings?
