Rehab and Sports Chiropractic Corner
with Dr. Jan Corwin


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Chiropractic OnLine Today is proud to feature Jan M. Corwin, DC, CCSP as a contributor to COT's Teaching Corner. Dr. Corwin has been involved in Chiropractic Sports and Rehabilitation for over 17 years, and was a chiropractor with the US Olympic Team Sports medicine Staff (3 years).

If you have any Sports / Rehab related questions you would like more information on, please send it to Chiropractic OnLine Today. Your information will be forwarded to Dr. Corwin, and will be posted to future editions of Chiropractic OnLine Today.

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This Week's Question ....

Triocia Chappin Asks Dr. Corwin....

Subj: Hip Pain
From: tricia_chappin@bc.sympatico.ca

Dr. Corwin

Dr. Corwin, I am a 51yr old female in excellent health. I took 6 months of Tae Kwon Do and had to give it up in January due to hip pain.

I am told I have acute bursitis in both hips. I work out with weights and have given up some of the exercises in order to allow my hips to heal (ex. squats), but I am not seeing any improvement thus far. Is there something you can advise (other than cortisone) that will help? There is family history of Osteoporosis so I am nervous about giving up my weight training altogether and the walking I do. (3 miles - 5 days a week).

Thank you!
Triocia Chappin.

Dr. Corwin responds:

My first question to you, who told you have Bursitis? I would cast doubt on the diagnosis and therefore seek another opinion. You should not be having symptoms this long. Get a Sports Chiro or PT who is much more aggressive with therapy.

I see patients with hip pain all of the time who have been told it is bursitis, when in fact it isn't more than musculoskeletal problem with the pelvis, low back and hips and legs.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician


Previous Questions

....

Stacy L. Martin Asks Dr. Corwin....

Subj: Sacro-Iliac Joint Problems
From: stacy.martin@mail.dss.mil

Dr. Corwin

Last year I sprained the ligaments surrounding my SI joint lifting weights. I did rehab and stretching exercises. I still continue these today, though not everyday. I sit at a desk all day and I know that doesn't help the situation. My lower back (both SI joints and above the sacrum) still hurts. Every night I go home and lay on a rolled up towel to relax my back and help with alignment. I take ketoprofen for the pain, but I don't want to take it all of the time. The pain isn't unbearable, just annoying. Do you have any other suggestions as to how to relieve this pain?

Thanks!
Stacy L. Martin.

Dr. Corwin responds:

Everything you are doing is fine. I would really see a sports chiropractor who could mobilize those SI joints for you. The ligaments and surrounding tissues may be experiencing fibrotic changes which would benefit from some specific manipulation.

Also, try hanging from a chinup bar and bring your knees to your abdomen. That would be a good stretch for the involved area.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

Roy M. Wagener, D.C. Asks Dr. Corwin....

Subj: Chiropractic Sports Sponsorship
From: Roy M. Wagener, D.C.

Dr. Corwin

This is a little off the subject of rehab directly but certainly concerns the matter on a large scale. I am a chiropractor and am just getting a fledgling motorcycle racing team off the ground, track racing that is. This was totally a spontaneous impulsive act on my part but I can see an enormous benefit to chiropractic and the motorcycle racing/enthusiast community at large. It is also clear, as I attempt to financially support the venture, that long term financial support is going to be necessary. There-in lies my question, are you familiar with any concerted efforts within the chiropractic sports community that deals with sponsorship issues? A contact would be appreciated or any advice otherwise.

The brief background on my team is I am currently the sole sponsor of an expert class rider in the Championship Cup Series (national sanctioning body), middleweight sportbike class (600cc displacement). This is a venture that as of today is 22 days old.

Envision the untold thousands of people who are associated with motorcycles (go to motorcycle speedwell in Daytona someday) and it certainly seems to me that the beneficial impact for chiropractic and motorcyclists/patients is tremendous.

Thankyou for your time!

Roy M. Wagener, D.C.

Dr. Corwin responds:

Roy,

Congrats on what you have undertaken! Your needs are well understood. I don' t know if you are a member of the ACA Council on Sports Injuries, but we deal with this question from DC's in the field all of the time. There are other DC's who work with Motorcross and Race Car Teams that I have met at our annual convention.

Any sponsorships you will have to initially create and hopefully will then be able to guide others through the process. Unfortunately in chiro we don't have rich drug companies, etc to fall back on for support. You should try a local business.

I would recommend getting involved in the Sports Council and speak with some of the others who are doing exactly what you are doing.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

Virginia Asks Dr. Corwin....

Subj: Spina Bifida in Volleyball
From: Virginia de Burmester

Dr. Corwin

Dear Sirs:

I have a 16 year old daughter who plays volley ball, four hours a day trainning. Since last year she started with a pain in her back and gradually it increased. She stoped playing and examinations were done. The only thing that came about was an occult bifid spine (L5 and L6).

I would like to know what you reccommend in this case.

Thanks a lot in advance

Regards,

Virginia de Burmester

Willie

Dr. Corwin responds:

Dear Virginia:

I am very familiar with this type of athlete and case. I work with a number of high school athletes here in CA. My daughter is a 16 yr old who practices 4 hrs a day, also.

The spina bifida is an anatomical finding and is most likey not related, only an incidental finding.

Your daughter probably has a facet syndrome, from diving for the ball. That is where the joints in her low back get irritated, swollen, in some cases endure stress fractures, and cause a great deal of discomfort on lumbar extension or arching her back.

She should see a sports chiropractor and undertake back exercises that flatten her low back. Also try and avoid arching the low back.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

Willie Asks Dr. Corwin....

Subj: Hamstring Cramping
From: danwilson@wwdc.com

Dr. Corwin

My son is a varsity polevaulter who has recently developed post-competition hamstring cramping. He stays hydrated and stretches/warms up well but for some reason the hamstring starts to tightenup form the insertion all the way up to his hip after he vaults. Ice and massage provide relief after 1-2 weeks.

Would you have anything to suggest? Salt tabs? Chiropractic?

Willie

Dr. Corwin responds:

Dear Willie, It sounds like your son is doing all the right things. In addition to what he is doing, I would: not add salt tablets, but make sure he is getting adequate calcium, magnesium and potassium in his diet or with supplements. A good sports chiropractor can help you with this nutritional management.

I would also find a sports chiropractor who does some deep tissue work, and have your son get some, along with some pelvic balancing. I believe this will help. Your son's problems are not unique. I have had track athletes with similar complaints and used the above approach with success.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician Subj: Stairmaster wrist
From: christina.ferrigno@Eng.Sun.COM

Dr. Corwin

Recently I heard about something called 'stairmaster wrist' which afflicts people who use the stairmaster incorrectly, i.e. hanging onto the side rails habitually instead of just using for balance.

My sister is 36 years old and she experiences very shakey hand- writing, which she has been unable to attribute to any prior injuries. She was an avid softball, basketball and volley ball player in her high school and college years. Her Drs. have been unsuccessful diagnosing what is causing this shakiness. Have you heard of 'stairmaster wrist' and could this possibly be the cause? The shakiness has been going on for at least 4-5 years, and she has been using the stairmaster for at least six years.

Her hands do not have a palsey when performing other functions, this seems to be isolated to writing.

Thank you for your time.
Tina

Dr. Corwin responds:

Tina,

People can get a form of Tendinitis, or Carpal Tunnel Syndrome from the Stairmaster.

It is totally treatable and preventable. Varying the height of the stairmaster and the angle of hand position will be of tremendous help. Wearing a wrist support/slpint can also be used.

Hope this is a start.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

Mike Andrew Asks Dr. Corwin....

Subj: Ankle clicking
From: JOHNCHRISTY@prodigy.net

Dr. Corwin

I am a 25 year old male who plays ice hockey in the summer. In order to prepare for the season I have been skating 3-4 times a week. I purchased new skates about 4 weeks ago and they seem to fit well. This however is completely overshadowed by the fact that when I am done skating (one- one half hours) I am in some real pain. I can tell you I do like to tie my skates pretty tight because I like little play in them.

The pain I am suffering from is coming from the top inside section of my foot in a small concentrated area. The best way to describe it is that it feels like a severly sore muscle. When I lean forward and put pressure on on my foot is when it starts to ache real bad.

The reason I used "Tendonitis" in the subject line is that I had a wrist injury that seems real similar to this. I would like to continue skating, I can play through the pain, but I am concerned with future problems in addition to any solution for this annoyance.

Thank You,
Mike

Dr. Corwin responds:

Problem: After skating for a half an hour a 25 yr old male experiences pain at the top of his foot.

Possible Diagnosis: You are experience compression of the venous system in this area causing a pooling and irritation and it is producing a tendonitis like pain.

Solution: You need to make room in your for the top of your foot. You can accommodate this by: - getting a bigger skate and wearing more socks, take any inserts out of the skate, change from laces to Velcro closures, get one skate a half size bigger for the involved foot.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

John R. Aultman Asks Dr. Corwin....

Subj: Ankle clicking
From: JOHNCHRISTY@prodigy.net

Dr. Corwin

When I run both of my ankes click LOUDLY, and they don't miss a beat. It also occurs any time I move my foot in an extreme direction. It doesn't hurt, but it is embarrasing enough that I do not jog in populated areas. I have had this problem since adolescence, at least. I haven't been able to find any information on this problem.

Dr. Corwin responds:

Your concerns about clicking ankles are common. Fortunately, the problem is not serious. What you are experiencing are hyperelastic or loose ligaments that slide over the many bony prominences of the foot. One quarter of all your bones are in your feet and they all have at least 2-4 ligaments attaching to each bone. So simply, you have very elastic ligaments that slide and move causing the clicking. Think of it as flicking a guitar string. Don't stress over it, nothing you can due and there are no side effects from this problem that are functional.

Happy Running.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

Kris Shiffer Asks Dr. Corwin....

Subj: Knee Problem
From: fatcat@pa.net

Dr. Corwin

My name is Kris Shiffer. I am a 22-year-old male who since around July has had a problem with my right knee. It happened playing basketball. There was no "popping" sound or even a snap. I only noticed that I did something to my knee after we had stopped playing and everything started to stiffen up. The knee did not swell, but remained stiff and a bit tender on the outside right side of the knee. The stiffness and pain goes away if I rest my knee for a couple of days, but as soon as I run or use my knees for any kind of power, it begins to have the same symptoms as before: stiffness and pain on the outside right side. Can you please help me find a cure for this frustrating injury? Thank you for your time. Please reach me at this email address.

Thank you
Kris Shiffer

Dr. Corwin responds:

Considering that you are a 22 yr old and probably have been a very active basketball player, my first impession is:

From years of wear and tear you probably have some lateral meniscus fragmentation and that is what is causing the stiffness and soreness. It also makes sense that it loosens up after awhile, as any fragments are probably only mm in size.

I also am proposing that type of injury because of your BB history.

Suggestions: Get an arthroscopic evaluation to evaluate and possibly clean out the joint.

Rehab treatment would be to refrain from running and BB and concentrate on weight training, bike riding, stairmaster, etc. i.e.,Controlled movements that strengthens your thigh muscles.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician


Tim Lee Asks Dr. Corwin....

Subj: Use of Electric Therapy
From: doclee@worldnet.att.net

Dr. Corwin

Have you come across any literature on the affects of microcurrent or ultrasound on heel spurs.

Thank you
Tim Lee, D.C.,C.C.S.P.

Dr. Corwin responds:

Off the top of my head, I can't recite the articles. But, I can refer you to the answer.

You should contact the microcurrent and ultrasound manufacturer, as I am sure they both have articles that would be helpful to you. You may also want to ask a Podiatrist friend who most likely has done extensive work the with heel spur syndrome?

I can also tell you that in my 20 years of practice, I have treated many heel spur cases with ultrasound and microcurent. Some have responded and some have not. As always, each case presents with its own set of parameters, which in turn determines the success of the therapy.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician


William Jackson Asks Dr. Corwin....

Subj: Problems after ACL reconstruction
From: wjackson@transystems.com (KCB-)

I am a thirty year old male. I had reconstructive surgery in June of 1994 to repair a torn ACL in my left knee. After surgery, I was placed in a knee brace for eight weeks, and did not begin physical therapy for six weeks. At that time, my leg was severly atrophied.

Subsequently I have not been able to achieve full extension in the leg since the surgery. Despite three manipulations (one open, and two closed), and numerous days of physical therapy, I still lack 15 degrees of extension. My question to you is what would the acceptable method a postoperative treatment have been at the time of my surgery?

Also, what can I do at this time to help control my pain. Every step I take is extremely painfull. I have arthritis in the knee and cannot do much in the way of physical activity. I have been told by my current doctor that total joint reeplacement will be needed prior to my 40th birthday. Given that fact, what is the length of time given for knee replacements and is there any limitations on the amount of replacements that can be done to this area during my lifetime?

Any answers you can give me would be greatly appreciated and immensely helpful.

Thank you

William Jackson
wjackson@transystems.com

Dr. Corwin responds:

A 30 yr old male asks multiple questions concerning his ACL surgery and rehab and future.

Postoperative treatment varies with surgeon and patient. What should have been done and could have been done is hindsight at this time. Obviously, successful rehab is possible if you have access to it and you are committed to it as a priority in your life. Just watch any NFL game and you will most likely here about a successful ACL rehab. Living in the Bay Area, the SF 49'ers , William Floyd is an active player who has overcome ACL injury. Hopefully, Jerry Rice will also. But, for every success story there are failures.

Reading your story, it sounds unfortunately typical and knee replacement will probably be in the cards for you. This surgery is improving all of the time and its success rate is quite impressive. You can live an active lifestyle with knee replacement, observing its limitations and boundaries.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

Karlene Epp Asks Dr. Corwin....

Subj: Back pain and Soccer from KEEPFIT@bc.sympatico.ca

Doc, I play competitive soccer most of the year. Our serious season is starting soon, and my question is about my back. I am only 5'9", 145 lbs and frequently get in collisions with my oppenents. I do not shy away from bigger players and subsequently, my back takes a beating regularly.

The problem is in my upper back and neck. My back usually "cracks" or "spazzes" out and leaves me with limited mobility for about a week. Is there anything I can do to prevent my back and neck from "popping" out so much. The knots and pain are sometimes very hard to take. A couple of car accidents from behind I'm sure haven't helped, as sometimes my back goes nuts on me even when I'm not playing sports. Any help would be appreciated.

Thanks!

Rick

Dr. Corwin responds:

Your complaints of your neck and back "spazzing out on you and cracking" after collisions in soccer, could be considered part of the game. Be that as it may, you need to undertake a plan to avoid these incidences. Obviously, your neck and back may not be as well suited for these collisions, as they were at one time. Your history of car accidents were not therapeutic for your soccer career.

I would get under the care of a good sports chiropractor who can treat you and help prevent these "injuries from becoming so severe". You should also involve neck and back strengthening exercises as a preventative measure. Chin ups for your upper back and a neck machine are two that come to mind.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician


Mr. Savoie Asks Dr. Corwin....

Subj: Costochondritis from Masavoie@aol.com

I am a 19 year old cross country skier who has recently been diagnosed with costochondritis. It is a syndrome kind of like arthritis, only in the chest wall. Some days it is bad, others worse. The doctors have told me that the best way to stop or aleve the pain is to stop training. They have also advised me to take ibuprofin for the pain and inflammation. What possible remedies could be made with a chiropracter. I heard of some procedure that sounded very complicated, and that few Dr's actually knew how to perfom.

Thanks

Mike Savoie

Dr. Corwin responds:

A 19 year old cross country skier recently diagnosed with costochondritis.

Treatment to date has consisted of ibuprofen given by his MD and the recommendation to stop training.

My recommendation is to try massage, manipulation and acupuncture.

The "other" alternative you mentioned, that you heard about is most likely sclerotherapy.

Obviously, this condition is persistent and resistant to many therapies. In my experience, I would add that for each patient with this condition, a different response to therapy presents itself. You obviously, have had a poor response to therapy to date, which only means that you must still explore treatment options. You may have to experience multiple approaches to this condition and may have to repeat some therapies as different stages of the condition present themselves.

You can and should maintain training for prevention of losing your VO2 max capabilites. Try swimming, stationary bicycle, running in a pool. Obviously, pain is going to be a limiting factor in your exertion level.

Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician


Mr. Jeffeman Asks Dr. Corwin....

Subj: Groin Injury from Jeffeman@bigfoot.com

34 yr old Male recovering from left ACL reconstruction -1 yr ago. Now he experiences chronic -2-4 months of left abductor muscle pains with running, cycling, treadmill, stairmaster.

The pt wants an aggressive tx program or course of action.

Dr. Corwin responds:

The problem: Because of the ACL surgery, there are always some biomechanical and neurological imbalances that will predispose you to further imbalances- thus your abductor problem. Also, you donít describe your surgery, "did the reconstruction involve the TFL or abductor of the thigh as part of the surgery?" Some ACL reconstructionís by definition involve altering of the normal biomechanics of the lower extremity because aspects of the abductor musculature are utilized or moved during surgery. This would obviously be a major factor in your case. Check with your surgeon.

For treatment I would find a good sports chiropractor or sports physical therapist who could provide analysis of your gait or foot positions when cycling or stairmastering. This trained observation may recommend anything from orthotics, heel lifts, to a new running style. You obviously to date have sustained an overuse injury. Therefore you must alter your training. I would undertake weight training and swimming as alternatives.(non weight bearing activities). I would also get aggressive therapy on your injured abductor that would include massage, ultrasound, manipulation, etc. Good luck.

Dr. Jan M. Corwin CCSP
Chiropractic Physician

Dr. Lee Pierce Asks Dr. Corwin....

Subj: Rehab for Hamstring Tear
From: DOCPCO@aol.com

Hey Doc! What would you recommend for rehab of a twice torn hamstring? Thanks much Lee D. Pierce, D.C.

Dr. Corwin responds:

Dr. Lee,

A good stretching and weightlifting program that encompassed passive, isokinetic, and and eventually controlled dynamic training. Also, rethink your activity and approach that has allowed a hamstring tear twice.

Good luck,

Dr. Jan M. Corwin
Chiropractic Physician
http://www.oakbaychiro.com

Gary L. Green Asks Dr. Corwin....

Subj: Rehab with active athletes
From: jiajen@pc.jaring.my

Recently I had the opportunity to work with one of the members of the Malaysian professional basketball team. His problem was one of RSI of the wrist which in average patient I would treat with wrist mobilization, splinting and rehab including strength work and stretching.

In this case we have an athlete who must practice hours every day and has limited time for rest and, I imagine, would have difficulty wearing a support during practice and play.

Any suggestions for care are greatly appreciated.

Thank you.

Dr. Corwin responds:

Wrist Care for the Professional Basketball Player -
by Jan M. Corwin, DC, CCSP

A recurrent wrist injury in any athlete who is essentially practicing six days a week and playing at the professional level is going to be difficult to manage, since down time is an issue.

The one advantage this basketball player is time during the day to properly care for his injury.

I would manage like this: Complete and supportive taping of the wrist for each practice and game. You can experiment during practices which taping procedure and type of tape combination work optimally for him.

After each practice remove the tape and soak in ice water for 10-15 minutes.. Then provide electric stimulation to the area to ensure muscle / tendon activity for 20-30 minutes then re ice. (this should be repeated throughout each day) As strength increases and pain permits - increase resistance exercises.

There are no shortcuts and playing will be somewhat hampered, but if rest is not an option, try the above.

Good Luck,

Jan M. Corwin, DC, CCSP

Gerry Holland Asks Dr. Corwin....

Subj: fractured ankle
From: holland@sk.sympatico.ca

My 15 year old daughter has fractured her ankle playing hockey. She has had two pins inserted and now has a cast on for 6 weeks. She would like to know if she will be able to play hockey when the cast is removed and how long do the pins stay in?

Another daughter sprained her ankle in November and still suffers pain when she skates. She never was seen by a Dr., is it too late for any treatment?

Thank you

Dr. Corwin responds:

This is a two part question. The first involves return to play (Hockey) after a severe ankle fracture involving pins in the ankle.

An injury of this sort is very complicated. Return to play involves proper healing, stability, and rehabilitation to insure against further injury / damage to the ankle area. I seriously doubt that any further competition this winter season is feasible. Since your daughter is only 15 she will heal quickly, and most important she needs to heal correctly so that she grows and matures with an ankle that allows her to enjoy all activities.

You definitely need the okay to begin hockey from the surgeon who put in the pins and the PT who is directing your rehabilitation. They are best in this scenario to evaluate your daughters progress and full return to hockey.

As far as your other daughters chronic ankle sprain (since 11/96). Since she never had anyone treat it, I am going to assume it still hurts because she returned to soon to competition without proper support. I would take this daughter to your 15yr old daughters PT / MD for an opinion about her ankle and suggestions for rehab. It sounds like both daughters can be involved in complimentary ankle rehab programs.

Good Luck,

Jan M. Corwin, DC, CCSP


Colleen Kellock Asks Dr. Corwin ....

Subj: Sports Injury Question
From: ckellock@ns.sympatico.ca

Good day Dr.

I am a 41 year old female and very active. Presently working out 3-4 times weekly with weights and tred mill and a fair amount of outdoor walking. In the fall I was walking up to 40kms a week amd suffered severe foot pain. so much so I would limp in the mornings when getting out of bed the it would subside with exercise and then return again. Now that winter is here I am not walking as much but still have the pain in my heel. I also will be skiing a lot and in the past have had excruiating pain in my arch area , what can I do for these pains.

Thank you
Colleen

Dr. Corwin responds:

Your history of walking up to 40 kms a week and description of heel pain is not uncommon. Your history presents classic bursitis type pain with possible heel spur involvement.

You should see a sports podiatrist and/or sports chiropractor immediately. You may require orthotics, heel cups, injections in the heel area and stretches for the plantar fascia in the bottom of your foot. You may also have to have your shoes, and or gait evaluated.

The good news is that your problem is very classic, and the bad news is that this problem can be very nagging. I would suggest you address it immediately, so that you can return to your favorite activities as quickly as possible.

Good Luck,

Jan M. Corwin, DC, CCSP


For more Questions and Answers:

Part Two
Part Three


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