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Messages - Dr.M

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1
Injuries - Discussion / Re: Knee Injury (suspected sprain)
« on: May 05, 2010, 03:03:35 AM »
Ice is still a good thing because it is helping to manage the inflammation, which if there is pain, likely there is inflammation. Also, just because you can't see the swelling does not mean it is there. It sounds more like it is the patellofemoral joint, which does not have great blood supply for healing. Ice helps to increase the blood supply to the area and you should be icing at least morning and evening for 2 weeks (this is my usually suggestion to most of my patients). I know that Eat Move Improve (check resources tab) has some great information on dealing with patellofemoral issues and you can check through some of the older posts that have more details to see if it matches with what you are feeling.

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Injuries - Discussion / Re: Knee Injury (suspected sprain)
« on: May 04, 2010, 05:20:08 PM »
As Steven said there could be a possible meniscal injury. There could also be the possibility of the patellofemoral joint being inflamed and the popping coming from that joint. Where do you feel the popping and where is it tender to the touch (pictures would help greatly). Also, how are the bones sticking out more and which ones are sticking out (again picture would be great). Additionally, if it is swollen then you have a decrease in muscular control and that can compromise the position of the knee cap as well as control over the knee. I would definitely be resting and icing (check resources sticky), but if the pain continues and you are not able to get it completely straight, then you are much better off seeing someone sooner rather than later because you do not want the joint to start tightening up. Tightening up of the knee may result in a decrease in the mobility of the capsule and that will require a lot more work to heal and restore normal range of motion.


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Injuries - Discussion / Re: Broken metatarsal, twitching?
« on: May 04, 2010, 05:12:42 PM »
Depending on which metatarsal that you broke and where, you may be impinging on nerves or the inflammation in the area is causing swelling that causes neural impingement. Also, swelling around a muscle results in decreased neural recruitment of that muscle. If the neural recruitment is intermittent that could also result in twitching. Definitely have it checked out and you can also work on icing (check the commonly asked questions and resources sticky).

Was the fracture displaced or stable?

4
With massage you want to work all of the areas around the bursa, but not the bursa itself. In my experience greater trochanteric bursitis is not something to easily permanently resolve. You definitely want to work the IT band, but stay south of the greater trochanter. Also you want to work the gluteals, quads, TFL, and piriformis to decrease tissues restrictions that may be pulling more tension on the greater trochanter and IT band. I would work both vertically and across the fibers of the above mentioned areas. You can also use a direct pressure release by placing your body weight on those areas onto a tennis ball or foam roller. Definitely continue to ice the area and if you check the commonly asked questions stick you can find a link to an article I wrote about how to properly ice and injury.

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Injuries - Discussion / Re: Commonly asked questions--resources
« on: April 22, 2010, 06:29:57 PM »
Thanks so much for creating this topic. I hope there can be more sources gathered to create a comprehensive resource for the community.

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Injuries - Discussion / Re: Stomach Pain
« on: April 22, 2010, 06:28:32 PM »
A picture or a better description of the level where you get the pain would be helpful in giving possibilities for what may be causing your pain. From your brief description I am inclined to think that it is a muscle tear or damage to the intermuscular septum (spaces between muscles of the abdomen), but there are many many things that can cause abdominal pain with contraction of the muscles. I would definitely have it checked out by a doc because there are more serious things than a muscle tear that should be cleared first.

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Injuries - Discussion / Re: Burning Nerve Pain in Trapezius Muscle
« on: April 20, 2010, 03:06:11 PM »
Cardio and exercising everything around the area (grip strength, legs, core (hold only, no motion)). This will allow for increases in blood flow overall that will assist with increased delivery of oxygen and nutrients to speed healing. I would ask you chiro about other possible ways beyond rest to speed healing. Try to have him approach it from the stand point of dealing with an athlete. Athletes are almost never told to just stop for a month. That would be insane and devastating to their careers. Why should non-pro or elite athletes be treated any differently.

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Injuries - Discussion / Re: Pain during climb-ups
« on: April 19, 2010, 05:56:15 PM »
More on the injury management side, I think that by placing your right arm up on the wall you are resulting in an upward shift of your arm bone into the shoulder resulting in mild impingement of the tissues above your arm bone (humerus). When repetitively done results in inflammation of those tissues that is accompanied by pain.

For climb ups you want to try to be more explosive in your ability to push off with your legs and basically perform an assisted muscle up on to the wall. This lets the pressure remain through both hands instead of through the forearm and elbow that is compromising the shoulder. I usually don't advocate looking up parkour things on youtube unless you know the source, but if you type in "climb up tutorial" you will get multiple hits on descriptions and demonstrations of climb ups. I recently looked at one by 3Run that did a decent job at describing how to properly perform a climb up.

Hope this helps.

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Injuries - Discussion / Re: Spine Problems
« on: April 19, 2010, 05:47:03 PM »
Cure it? Probably not on a forum. I would suggest going to a good chiro or PT for an exam. Too many things can happen in the spine to fit the description of your pain. For a better idea about a possible cause I would suggest posting a picture of the area of the spine marked with where you feel your pain; what specific exercises that you do for the upper body that result in pain reduction, any specific exercises or movements that cause an increase in pain. You can also post full body pictures (shirtless is easiest) from the front, side, and back to look at postural alignment that may be helpful for pointing you in the right direction.

Sorry for not being more helpful, but there is a lot involved with diagnosing, let alone treating the spine.

10
Injuries - Discussion / Re: Pain during climb-ups
« on: April 17, 2010, 09:08:04 AM »
It does sound like overuse with a little bit of impact if your right shoulder is going onto the wall. Icing (search forum for "Best Icing Method" would be helpful with healing. I would rest and ice for a few days and focus on core and lower extremity training so that you can continue to train without losing progress.

Without an exam there is no way to give a specific cause, but it sounds like a tendonopathy of the shoulder with possible impingement through overuse. If you rest and it goes away, great! If it continues to bother you I would go to a PT or chiro for an assessment. You may also want to consider someone watching you do the climb-ups for errors in form, or video tape it and post it here for the more experienced people to watch and comment on the form.

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Injuries - Discussion / Re: Burning Nerve Pain in Trapezius Muscle
« on: April 17, 2010, 09:00:10 AM »
Its sounds like you are on the right track, but I would go have a second opinion from a PT or chiro to see if there are any vertebrae out of alignment that could be resulting in a pinched nerve. A picture of the location would be helpful in determining the muscles that could be associated with the nerve that may be the culprit. If you can take a picture of your back with your arms resting in the normal postion, and then take a picture with you shoulder blades squeezed together in the middle of your back. Sometimes you can see rotations if the body is positioned correctly.

In my experience, muscles in the back typically do not impinge on nerves and cause nerve pain. More often you have an alignment issue that impinges on the nerve, or the alignment issues results in a change in muscle position and then impinges on the nerve. Its not likely that the nerve is damaged, more likely to be impinged, but nerves do not like to be stressed and do not recover the same way that muscles and joints do. I would try to stay on the more conservative side of treatment with rest until you are able to get more information from a professional.

I think that stretching is a good thing, but useless if its not the right muscles or if the muscles are not the cause. I would recommend icing the area to work on speeding blood flow to the nerves and surrounding tissues to increase oxygen and nutrient delivery. I posted on the injury forum a while ago under "Best Icing Method".

Hope this is helpful.

12
Injuries - Discussion / Re: My Hip Adductor(s)
« on: April 16, 2010, 05:20:11 AM »
To me it sounds more like you have have inflammed an possibly damaged the hip joint or capsule itself and the muscles around the hip are guarding against motion. From your comments you have weakness and/or of half of the surrounding muscles of the leg (adductors, gluteals/ITB, hamstrings) and have been having foot/ankle pain along with pain with transitional movements like getting into a car. Also you mentioned when you play foot bag and rapidly move from a flexed and externally rotated position to a flexed and internally rotated position you experience pain. The adductor muscles are certainly involved, but I think you may want a PT or chiro to perform a good orthopaedic assessment of the hip to see if there is damage to the cartilaginous ring called the larbrum. Furthermore, you mentioned that your g/f sat on your lap and you had a twinge of pain. Downward pressure through the thigh could possible place stress on the capsule of the hip and result in pain.

I personally have experienced a labral problem with capsular (balloon of tissue surrounding each of your joints) tightness and restrictions and it has led to many of the symptoms that you have described as well as problems with back, pelvic, ITB, adductor pain with weakness of the gluteals due to nerve restrictions progressively caused over years of built up restriction. Thankfully I am in PT (imagine a PT in PT :P ) and working on resolving the issues. Typically pain and problems in the hip joint tend to refer pain directly to the groin. An MRI could be helpful at examining the hip joint, but MRIs are not perfect and have a definite margin for error with the hip.

I hope that this is helpful, but also realize that this is only speculation on my part from the information that you have provided and I cannot actually provide a diagnosis without performing an exam.

Cheers to your health,

Dr. M

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Injuries - Discussion / Re: Lower Calf/Upper achilles Tendon pain
« on: April 15, 2010, 08:22:21 AM »
It sounds like you strained a muscle. Ice would be a good thing to start doing regularly over the painful area in the calf to modify pain as well as increase blood flow. Is there any redness or swelling? A picture of the area would also be helpful to provide possible answers to what is injured. If you are going to see a doctor I would suggest a sport orthopaedic doc or a good chiro or PT.

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Injuries - Discussion / Re: Bruised Pinky Knuckle on Palm
« on: April 15, 2010, 08:01:19 AM »
Try using ice massage (dixie cup 3/4 with water, freeze, tear off the top and massage injured areas for 3-5 minutes consistently morning and evening and after training that causes pain). The hand has a lot of fascia and thick connective tissue that has decreased blood flow. You can also work on keeping the hand mobile by working through the full range of motion with opening and closing. This will work the tissues in the area to stay mobile and also increase blood supply. Bruised hands and feet tend to take longer to heal also because we use both of them so much. Hope this helps.

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Injuries - Discussion / Re: QM hurts my shoulder
« on: April 15, 2010, 07:25:50 AM »
I would look at strengthening of rotator cuff muscles (google images and exercises), look for a resource from a physical therapist or sports orthopaedic specialist. Additionally you want to ice the shoulder morning and evening with bagged ice and a wet paper towel for 7 minutes without fail for 2 weeks or after training sessions when it bothers you. I will send you a private message with another resource.

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Injuries - Discussion / Re: Asthma and carpal tunnel
« on: March 25, 2010, 12:05:06 PM »
Things that I have recommended to asthma patients of mine is the balloon thing where you blow up 10 balloons per day to work on increasing lung capacity and elasticity. I also suggest working on breath holding, building from 10 second hold of a deep breath, and then build up from there to increase the hold time as tolerance builds. This works on increasing the elasticity of the lungs. Diaphragmatic breathing (google) is critical for any development of the lungs and surrounding muscles involved with respiration. You may also want to consider visiting a good chiro or PT. I have run into multiple cases of asthma being caused by rotations and incorrect alignment of the spine and or rib cage that is restricting motion. Tai chi, Qigong and yoga have some good resources for different breathing exercises that can be done to strengthen the respiratory muscles.

For the carpal tunnel, it sound more like a possibility that you have damaged the cartilage and the inflammation from that could cause the carpal tunnel syndrome. The fall that you had onto your hand possibly caused damage to the carpals/joint of the wrist. For stabilizing the wrist, try performing push ups on your fists. Scar tissue from the injury could also be restricting the tissues in the wrist (including the nerve) This can then be progressed to unstable surfaces like a pillow. The muscles that control the wrist are primarily used for stabilization, so training them that way could be helpful. I would recommend going to a good PT or OT for more exercises to stabilize the wrist.

Hope this helps.

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Injuries - Discussion / Re: Overworked my right arm
« on: March 24, 2010, 02:24:41 PM »
What part of your arm begins to ache? (picture?) Is it more in the muscle bellies or the joints?

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Injuries - Discussion / Re: Lower calve pain
« on: March 22, 2010, 11:10:59 AM »
If it is still bothering you now, I would wonder if there is a possible muscle tear. Have you noticed any swelling or painful areas to the touch on the calf ankle or foot?

A lot of pressure is put through the muscles of the calf with a wall run, especially since when your weight is put into the foot, the ankle is usually full dorsiflexed (toes up), placing further stretch on the muscles. This is advantageous because a quick stretch applied to a muscle allows for a more forceful contraction (idea of training with plyometrics for strengthening), but it also places the muscle at an increased risk of injury. I would have it checked out by a good PT or chiro to rule out any muscle tears.

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Injuries - Discussion / Re: Lower leg pain/hardness
« on: March 18, 2010, 06:09:48 PM »
If the problem is scar tissue, then its possible for massage or other types of manual therapy to help. Good luck and I hope it turns out ok. Feel free to message me if you have more questions after you see the podiatrist.

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Injuries - Discussion / Re: Lower leg pain/hardness
« on: March 18, 2010, 05:54:57 PM »
Medically I can't advise you on what you should be doing for training because I only have a fraction of the information that I would need from an exam.

If it was a calcium build up it would likely show up as an abnormality on X-ray and bone scan. If it is sometimes soft, then it could be more related to a muscular spasm or scar tissue. The muscle spasm could be caused by a variety of things and scar tissue would be something that could be worked on with manual therapy.

Your hip hurting could be related if there is a weakness of some of the specific muscles in the hip or a leg length discrepency (or a ton of other things that should be cleared). I would recommend going to a good PT or chiro for an evaluation. They would be able to perform an assessment and possibly give you a better idea of what is going on.

I would check out a very lengthly, but good EMI article for reference for lower body dysfunction http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/.

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