Rehab and Sports Chiropractic Corner
with Dr. Jan Corwin


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Rehab and Sports Chiropractic Corner: Part Three

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 Sportsmedicine 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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Subj: Sports Injury Question
From: marym@AAMVA.ORG (Mack, Mary)

I am a 32 year old female runner suffering from left leg heaviness, weakness, and loss of coordination during running since January 1994. The problem came on suddenly at mile 14 of a marathon, but then disappeared after I stopped running. Over the next several months, the problem would appear earlier and earlier during runs. It is alleviated by running slower, shorter distances, and on soft uneven surfaces such as dirt and grass. Prior to the problem occurring, I had run about 2000 miles per year for 7 years and had run 19 marathons with a PR of 2:53:17. I ran 5 marathons in the year preceding the injury (probably too many).

A lumbar spine and upper left leg MRI proved negative. Also did several EMGs, a PVR, and other more extensive nerve conduction tests. I have been seeing a chiropractor once a week for a year with some improvement at first which leveled off after the first few months. The chiropractor diagnosed internal rotation of the left ilium.

I now run 15-20 miles per week at between a 7:45 to 9:00 pace. I also swim and bike to make up for the lost running.

Any advice would be greatly appreciated. Thank you.

Dr. Corwin responds:

Initially I would suspect some type of lumbar stenosis. Best diagnosed by a CAT scan not MRI.

  • Next I would suspect a vascular problem aggravated by the effects of gravity from running.

  • Next I would suspect a compartment syndrome in either the lower leg or upper leg.

    My hypothesis is supported by the fact that biking and swimming are much more antigravity than running and wouldn’t cause as much as a dramatic effect as running would. Your history of extensive running could produce a functional stenosis or compartment syndrome. I have seen both. All the above can and does produce the history you describe. The chiropractic treatment would have cleared the problem by now if it was strictly biomechanical.

    I would pursue further diagnosis by a sportsmedicine clinic that could perform the tests that I outlined above.

    Good Luck,

    Jan M. Corwin, DC, CCSP


  • Subj: medial collateral ligaments
    Date: 96-09-24 17:40:21 EDT
    From: sarah.bennett@xtra.co.nz (Sarah Bennett)

    Hi, my name is Helen Orsler and I am a Sport Science Student at the University of Auckland, New Zealand. I am doing an assignment on the rehabilitation of a 24 year male rugby player with a second degree sprain to the medial collateral ligament. What rehab programme would you recommend?

    Pls reply to me at
    sarah.bennett@xtra.co.nz

    Thank you very much

    Dr. Corwin responds:

    The rehab for the above is pretty universal. I would recommend 9 months of weight lifting. This would include multiple resistance exercises that involve the quads, hamstrings, abductors and adductors. I would also teach him stretching for the lower extremities. After 6-9 weeks of weights, I would add swimming (no breatstroke). Doing butterfly and backstoke kicking exercises would be best. After 6 more weeks, I would add jumping rope, boxing, and bike riding for cross training. Then I would add running drills that would include figure eight running, hills, and sprints. Keep increasing as his strength and flexibility progresses. The above is not complete. There are more exercises that can be added.

    Good Luck,

    Jan M. Corwin, DC, CCSP

    Subj: Groin Injury from Jeffeman@bigfoot.com

    Dr. Corwin's Response: 34yr 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 patient wants an aggressive treatment program or course of action.

    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 don’t describe your surgery, "did the reconstruction involve the TFL or abductor of the thigh as part of the surgery?" Some ACL reconstruction’s 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
    Chiropractic Physician
    Email: jcorwin@dnai.com
    Web Page: http://www.oakbaychiro.com


    From: 96-08-25 Jenflem@aol.com

    Dear Dr. Corwin,

    My name is Jennifer Fleming and I am currently a fourth trimester student at LACC. I am a former division 1 swimmer that is very interested in chiropractic and the sport of competitive swimming. I am very interested in watching or volunteering with a chiropractor that works with swimmers from the age group level to the national level. This because, I believe that a chiropractor can be an important part in an athlete attaining peak performance. Unfortunately, I am from the east coast and I know few chiropractors in the Los Angeles area that work with swimmers. As a memeber of the student ACA sports injury council at LACC, I have been looking and asking around, yet with little progress. I was wondering if you could help point me in the right direction.

    Thank you kindly,
    Jennifer Fleming
    Jenflem@aol.com


    Dr. Corwin Responds:

    Your question is very timely. The last two weekends of August 1996, I had the opportunity, as I have had for the last three years, to provide chiropractic care at the Championship Swim meets here in Contra Costa County, in northern California. I wish you had written your question a few weeks earlier and I would have invited you to assist me. I had the opportunity to treat many swimmers , primarily under the age of 14.

    Therefore the answer to your question is yes, Chiropractors can and do provide care at swim meets. I also know that Dr. Grusky in Miami, FL, has provided care at the Ft. Lauderdale International Swim Center for some prestige events. I don’t know of any DC’s first hand who are treating at swim meets in the LA area. You can contact a local US Swim club and volunteer at their home meets. This would give you valuable experience. Your background in swimming is a valuable asset and you should pursue interests that you enjoy and have expertise in. Water Polo is another aquatic sport that is very much in tune with chiropractic and is one you should also look into for making yourself available to provide chiropractic care. Feel free to contact me, if I can be of any further help.

    Best of luck,
    Jan M. Corwin, DC, CCSP


    JC LeBlanc Asked Dr. Corwin:

    I recently injured my hamstring for the first time. The activity that I was doing at hte time was leg curls. I did'nt properly warm up this time(I usually due) and I was trying too much weight.

    I knew right away that I was hurt and dropped the weights i felt a king of strong twing like feeling at the back of my leg from behind the knee to my butt, although it did'nt hurt right away it certainly hurt after. There is no bruising or swelling at the site but it is painful to walk and sit. My doctor prescribed me rest and Ibuprofen 600 mg x3 daily. I will also start chiropractic rehab in the near future. My questions

    1. What can I do in the meantime? My Dr. just said to rest,
    2. Should I apply heat and cold?
    3. Elevate my leg?
    4. Walk with cruches?
    5. What is the future of an injury of this nature?

    -----------------------------------

    Dr. Corwin Replies:

    It sounds like your injury is a hamstring injury. Hopefully just a partial tear.

    Treatment should be aggressive: Ice - 10-15 minutes 2-6x/day for 1 week. Also combine with jacuzzi baths, epsom salt baths, hot tubs, start walking in Pool in waist deep water. Start gentle stretching up to the point of pain. Use crutches only if neccessary. Wear hamstring support athletic wear.

    After two weeks, start light weight training - 3x/wk. Continue this ad infinitum. Your prognosis is excellent. This type of injury heals well.

    Good luck,

    Dr. Jan Corwin
    Sports CHiropractor


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    Subj: Chiropractic and Diplomates
    Date: 96-05-14
    From: PrIbno@msn.com
    To: InterAdCom@AOL.COM


    Dr. Corwin: I am currently a student at Parker College of Chiropractic ans was wanting some outside information about getting a diplomat in Chiropractic Sports. Please Email me with someone I might want to talk to.

    -- THANKS

    SEAN HUBBARD


    Dr. Corwin's Reply

    Sean-

    The route to take in continuing your postgraduate education in Chiropractic Sportsmedicine is the following: Enroll in the CCSP course (Certified Chiropractic Sports Physician) then continue into the Diplomate course. These courses are only offered through the postgraduate Departments of a few CCE certified schools.

    For example NCC, Logan, NWCC, NYCC, & LACC, to name a few offer the courses. You can contact these schools directly for schedules and also follow the schedules in the new CJSR journal, etc. Good Luck. I would strongly encourage your continuance in postgrad education in sports chiropractic.

    Jan Corwin, DC, CCSP
    Past President, ACA Council on Sports Injuries


    Subj: Chronic Injury
    From: jefft@saturn.relia.net (jefft)

    Dr. Corwin:

    I do not mean to ask the same question, but feel it is significantly different. Last October I pulled my hamstring running full speed (flat on my face) in a game we call frisbee football. Because there were no substitutes, I limped around running on it for the rest of the game. It was sore to do a normal walk for 2 days. After that I stretched and jogged lightly until I felt I could play again 1 month later.

    Well, I pulled the same hamstring and couldn't continue playing. Since I needed arthroscopic surgery and I knew my leg needed rest, I had my knee surgery right before Thanksgiving.

    My knee is now fine and I swim 3-4 times a week for a half an hour, but my hamstring continues to give me trouble (and also my groin now a little bit). It doesn't hurt too bad from swimming (still once in a while), but mall walking (10-15 min) or 1 lap jogging, it will give me that pulled hamstring feeling for that day and sometimes the next (on the inside of the leg going back to between the leg and the buttocks). When I really aggravate it, I'll feel the pull on a separate muscle on the top of the front leg and the hip.

    Additional info:
    31 year male. Like to be somewhat active. Leg that has hamstring problems is also the knee I had surgery on. Started stretching consistently since last week of January, but my right hamstring is still so tight in my stretching, I'm not sure what to do.

    Additional questions:
    1 Is it possible my hip is misaligned? if so what doctor would I go to and what test would I ask for?

    2 Can a misaligned hip be corrected? Again who would I see?

    3 If your answer is rest, does that mean only stretching is allowed and for how long? Is stretching twice a day okay?

    4 Should I heat or cold pack it, when I feel the pull?

    Please help me if you can. I really desire to run and walk again. I would gladly pay $10 for the advice too.

    Sincerely,

    Jeff Theurer


    Reply from Dr. Corwin

    Jeff:

    Answers to questions related to a chronic hamstring injury and its sequalae:

    Yes it is possible your hip is misaligned and you may also have a leg length discrepancy and pelvic unlevening since your knee surgery.

    You should see a sports chiropractor, who can manage these problems and work with you on a good stretching and rehab program for your hamstring problem. Let me know where you live and I could refer you to an excellent sports chiropractor or you can check the directory on the Chiropractic Referral Directory Page.

    Good Luck,

    Jan Corwin, DC, CCSP
    Oakland, CA


    From: bein@netheaven.com (Ed Bein)

    Dear Dr. Corwin,

    I have a patient, 16 yr old male. 125 pounds, 5'10". Straight A student. Used to be a runner. 4:28 mile, 10:00 2 mile, 2:00 800 meter. Started in pain June 1995. Pain of groin in testicular area. Spread to inner thigh, more on the left. pain radiates toward ischial tuberosities. Describes pain as if kicked. Patient has been a dedicated stretcher for a while and can easily press his chest to his thighs. Pain present when walking, worse up or down stairs.

    Leg length measured from ASIS to medial maleolus 92 left, 95 right. Wears a foot leveler orthotic with 1/4" lift in left shoe. Some tenderness and hypertension of muscle fibers at upper medial thigh.

    Bone scan, diagnostic US, x-rays all negative. Uroligical work up, negative.

    Driving was very painful but has resolved somewhat. Painful when sitting and improves when standing. One episode of playing with a hackey sack resulted in severe setback.

    Has undergone stretching and adjustment at chiropractor with home exercises with some relief. Now going to PT with US and micro current stim. Also some help. Patient feels better after therapy but not much overall improvement.

    Any ideas?

    Ed Bein, DC
    South Glens Falls, NY USA


    Dr. Corwin Responds:

    Chronic Groin Pain in 16 yr old Runner

    Summary:
    This 16yr old, runner has had chronic pain radiating from the groin to his testicular area and ischial tuberosity. Bone scan, xrays, and urological workup -all negative. No tx to date proves beneficial.

    Obviously, a frustrating one. I have also seen this scenario in track runners, both male and female. I have no magic tx. I can tell you that the pain is most likely from involvement with the obturator muscle and nerve.

    Everything you have done to date in tx is appropriate. Most likely some subacute muscle fiber tearing and or nerve entrapment or osseous scalloping of the ischial/obturator periosteum is the culprit. Unfortunately, this athlete is a victim of bad luck, biomechanics and anatomy that is not ideally suited for his type of running, etc. It will probaly take extensive time to resolve. In the meantime, I would pursue cross training that involves no pain in the involved area.

    Best of luck,
    Jan M. Corwin, DC, CCSP


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    Important:

    As with any advice, Chiropractic OnLine Today always recommends that any injury be evaluated by a qualified health care professional


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