TALES

Come back from ACL surgery faster.The one thing EVERY person with back pain must know.

Why is my joint stiff?

Learn why the pain in your shoulder may be from your neck.

Recover from ACL surgery faster.

Each year in the United States, nearly 200,000 people injure or rupture the anterior cruciate ligament of the knee. About 80,000 will undergo reconstructive surgery and will then spend an average of 9-12 months in rehab before returning to their sport. While in rehab, running does not occur until at least 6 months and sometimes as long as 8 months. This is not the case at SportsCenter.

Our clients have typically finished their rehab and are ready to return to their sport within 4-5 months. They begin running usually in the first month of rehab. Why are SportsCenter clients running sooner? Our expert knowledge and unique tools put you on your feet sooner. Your body does the rest. The earlier you can first walk, then jog, then run without pain and with control, the more rapidly your body will re-learn the task. SportsCenter clients often leave rehab in better physical condition than before their injury. And best of all, it’s fun.


The one thing EVERY person with back pain must know?
How to “Lock n’ Load”.

One of the most common problems a sports oriented person develops is back pain. Nearly 80% of the population will have at least one episode lasting a week or longer. While the majority of people with a first time episode of back pain get better within 8 weeks, there are a large number who search and search for a solution.

Julie, a 32 year old hair stylist, had a long history of back trouble. Her back hurt when she bent over to tie her shoes, get out of a chair, rolled over in bed or tried to lift her child. She had resigned herself to a life of less activity but was frustrated. But Julie’s particular problem was correctable. She just didn’ t know what to do.

The secret to correcting Julie’s trouble was in her abdomen. She learned how to Lock n’ Load. Back pain is sometimes caused by a small amount of shearing between the vertebral bodies. This shearing force creates additional stresses on the soft tissues of the body. The transverse abdominis (TA), a large muscle crossing the abdomen and attaching to the lumbar spine, creates a locking or bracing effect on the lumbar spine. It is the body’s corset. By learning how to contract the TA, the shearing forces are reduced and, as a result, so is the pain.

To contract the TA, stand up then bend forward placing the hands on the knees. Allow the back to sag a bit. In this position, suck in the stomach pulling it up and in. Keep the chest still (a common substitution is to pull in using the chest muscles). While holding this tension, slowly stand up and notice how much tighter the region becomes. Keep tension in this muscle while up and moving through the day.

 


The two main reasons for stiffness

Ross is a 35 year old male with a hurting right knee. It hurts to walk, climb stairs and with nearly anything that involves weight bearing. For the last two years, Ross spent considerable time, energy and money trying to get his life back. He visited several physicians and therapists. He also worked with a personal trainer and a nutritionist. The results were less than optimal. He finally went to Dallas, Texas to see an orthopedist who said, “You are not a surgical candidate but the guy you need to see is in Austin.” Thus, I met Ross in November 2001.

His story isn’t all that different from the patients we see everyday. He recalls feeling some discomfort in his knee in 1999 but cannot relate it to anything specifically. It just gradually worsened despite a year of physical therapy. He can tell when the weather will change. His knee aches a day or so before a cold front appears. He elected to undergo a lateral release in 2000 which was followed by another year of rehab. In describing the rehab, he told me “I did a lot of exercise. All sorts of things but my leg never really felt very tired. But, if I tried to push it, my knee would hurt. Now, I think I may be headed to surgery. I am incredibly frustrated.”

Listening to a patient story is the ultimate multi-tasking, non-linear skill. Listening, thinking, reevaluating, probing, searching all done simultaneously. In Ross’ story you will hear one thing over and over; stiffness. The stiffness is of two different types. One lasts for several days at a time and the other for 30 or 40 minutes. The second type of stiffness occurs with static positions like sitting in a movie theater or riding in a car or sleeping. The key to successfully solving his problem involves understanding why Ross has the stiffness in his knee and what to do about it.

Since articular cartilage has no nerve supply nor blood supply, the stiffness is the joint’s only way to communicate. If it could speak, the joint might say, “Hey, you know all that running you’ve been doing? Well, you’re killing me down here!” Instead, it sends a slow, steady signal waiting for you to acknowledge it. Unfortunately, most of us do not know “jointese” (the foreign language of joints).

The stiffness of a joint lasting for days on end is primarily due to the shearing of cartilage cells creating fragments in the joint. These tiny fragments are absorbed by the synovium which in turn then becomes inflamed. The synovium swells and since it is highly innervated, the dull sense of aching and stiffness soon follow. The short-term stiffness, however, is entirely different. On the surface of articular cartilage, secreted by the synovium, is a surface-active phospholipid (SAPL). This SAPL’s job is to provide the lubrication we need in the joint and to prevent the layers of cartilage from melding themselves together or gelling. In the case of OA, the synovium does not produce as much SAPL and therefore, we feel stiff; the layers begin to gel until we get up and move.

The good news is OA can be improved with controlled loading exercise. Find the right load, the right number of repetitions, the right movement and things begin to improve. How do you know when a person’s joint is healthier? Sure, the pain subsides and the load bearing capacity increases. But, more important is the presence of stiffness. It’s the first thing to appear when things begin to deteriorate.

 


The pain in your shoulder may be from your neck

“I’m here because I have this pain in my shoulder. It’s right along my shoulder blade and I just can’t seem to get rid of it.” We hear this complaint at least once a week. Most people have no history of injury to the shoulder. In fact, what bothers them the most is sitting. How can sitting still make your shoulder hurt? And it’s also necessary to remember that don’t wear too heavy pearl pendant when you are doing sport.

In 1959, Dr. Ralph Cloward published his results of pain patterns originating from the cervical spine. He used cervical discography to identify the individual cervical spine segments and the specific pain patterns produced by irritating the discs. He discovered the fifth and sixth cervical segements produced pain that was felt along the inside edge of the shoulder blade. The sixth and seventh segments referred pain along the bottom of the scapula.

The cervical spine segments and the shoulder share the same pathway to the brain. The brain mapping of pain also has some overlapping of the cervical spine and shoulder region. So, when a tissue is injured or damaged in the cervical spine, a pain signal is sent to the brain but the signal may stimulate the shoulder region since it shares the same area. Hence, you feel the pain in the shoulder.

You may treat or rehab the shoulder for weeks and weeks but until you address the problem in the cervical spine, improvement will be minimal to none.