Questions and Answers:
I have been dealing with osteoarthritis and tendonitis for the past 3 years in my wrists and thumb areas. My rheumatologist and orthopedic doctors treat it as a condition of Sjogrens Syndrome, which I have had for several years. The areas have been X-rayed. I have been taking cortisone injections every 4 months, in addition to useage of Diclofenate cream, wrist braces, lanocane, and KT tape. I have regular exercises I do daily from my hands up my arms and into the neck lymph node area. After about 4 months I receive the cortisone injection, and my wrists are good for another 3 or 4 months. I am on a daily dose of plaquenal and a yearly infusion of Fosomax. I have had 12 weeks of physical therapy from Twin City Orthopedics, from which I was give treatment and home exercises. Any other treatment worth our time for an appointment? Thank you.
We can look at the mechanics and fix the movement at the joint level to give you relief. When we have Osteoarthritic changes the surfaces of our joints begin to change and therefore we move differently at that joint and are then vulnerable for a mechanical dysfunction. Our thumbs have the most movement in our body, minus our shoulders, and therefore are vulnerable for a mechanical dysfunction anyway. We can fix the mechanical dysfunction. You state that you have bilateral tendonitis. Because it is bilateral, both hands, I would wonder about your history of inflammatory disease. Did you get an MRI or ultrasound? Has tenosynovitis and synovitis been ruled out? Tenosynovitis and synovitis, when bilateral and when the gut inflammatory diseases are ruled out, are symptoms of Rheumatoid Arthritis, another inflammatory disease. Rheumatoid Arthritis can be seronegative. If there is evidence of tenosynovitis or synovitis I would recommend a second rheumatology opinion to make sure your Sjogren's is being treated fully and to make sure that other autoimmune diseases are ruled in or out so that nothing is missed. One autoimmune disease can lead to a second. If there is no tenosynovitis or synovitis evident, then fixing the mechanics will take away the secondary spasm and allow the tendons to move and heal. We are good at fixing this. Hope this helps. We would be delighted to meet you.
On Dec. 28th I had a right hip replacement. The procedure in someway aggravated my right knee. At first it swelled up a great deal and hurt. The swelling has gone down but I have pain in that knee and it does not seem to be improving. Is this normal? Is there anything you could do for me to address the problem?
Yes, this can be par for the course and can be very fixable if it is mechanical. We can have definite answers for you if we assess your movement. Because your hip had limited motion for quite a while your knee was also limited in the amount it could move. It is called your Kinetic Chain, everything is connected and influences movement above and below. Your new hip suddenly gives you so much motion and you are expected to be able move that much at your knee too. When you can’t the end ranges of tissue get irritation as you hit them over and over again trying to rotate at your tibia. You did not need that rotation at your knee when you had limited hip motion. We can assess your knee motion (and your hip and low back if you like, as it is all connected) fix the mechanics to resolve the irritation and swelling at your knee. If we do differentiate an issue other than mechanical we will refer you for the appropriate care, but most of these situations are mechanical and very fixable.
I have terrible heel pain in both feet. I have foot leveler inserts in my shoes. I can hardly walk in the morning. As the day goes on my feet still hurt, I feels it's affecting my gait. I do stretch out my calfs and ham strings. Any suggestions?
Heel pain can be quite intense. Mornings can be significant because our tissue tightens up anyway when we sleep, and when we have a significant movement dysfunction, the secondary spasm is exacerbated. The movement at your feet can be assessed and addressed. You have 33 bones and joints in your ankles and feet that all have to be able to move to have full, pain-free foot movement. When a joint can not fully move in its preferred path, a secondary muscle spasm occurs. This is then exacerbated in the morning when our tissue is already tight. You can use heat in the morning to loosen up the tissue and make up a bit of the difference. When the movement dysfunction is resolved, you should have no foot pain, full movement.
My daughter has been having problems with wrist and lower arm (right). We went to Summit Orthopedics and the doctor said it's De Quervains Tendonitis. He said there's nothing you can do for it but it will possibly go away on its own. He did suggest a steroid shot but we thought we would try physical therapy before doing a steroid injection. Have you seen anyone with this and is this something that someone in your clinic could help with possibly.
Yes, we can look at her wrist and elbow movement, fix the mechanical dysfunction and the secondary spasm. This will allow the tendon to calm. Sometimes we need cortisone if the inflammatory process as been there quite a while, but fixing the mechanics first is very appropriate. Usually we can avoid the cortisone but if it is needed when the mechanics are resolved, then the results are positive.
About 10 years ago I herniated my L5/S1 disc. It seemed to resolve but gradually over the years there has been increasing numbness in a spot under my right foot and around the little toe. A neurological exam showed minor neuropathy. A recent MRI showed degeneration in my L5 disc with narrowing the opening for the S1 nerve root. I have pain when sitting and lying down, but standing and walking is ok. Can anything help degenerated discs?
The numbness under your right foot and little toe can correlate with the narrowing at the S1 nerve root. Your reflexes and muscle strength correlated with the S1 nerve root can be assessed to give you a full picture of the neurological dysfunction. We can not change the degenerated disc itself but we can assess and address the movement at the joint level. Fixing the mechanical joint dysfunction does change how we move and has the potential to take the pressure off that S1 nerve root. If the joint mechanics are addressed but you still have numbness and neural signs, then you would look at interventions to take pressure off the nerve root- a visit to the neurosurgeon would be recommended. The quicker a neurological dysfunction is resolved, the better the outcome.
My daughter Melody is 2 years and 6 months old but was born premature. She has limited movement/coordination in her right arm and leg. She has been diagnosed with cerebral palsy. We have seen improvements in her arm and hand’s range of motion and muscle tone but her leg development is concerning. We live in Madison, WI and my brother in law referred us to you. We are currently receiving PT and OT therapy in WI but are seeking additional options for Melody’s therapy. Any additional information would help.
I would be delighted to meet you and your daughter. What we can do is look at Melody's movement and address the joint movement gently. The cerebal palsy gives Melody a bit of a movement disadvantage in that the messages from the brain to the joints to the muscles are not as smooth as they could be. These disrupted messages make her a bit vulnerable for a movement dysfunction at the joint level. This is what I can fix very gently and actually quite quickly. As she can move easier, then she can build her movement control and her power so that she can keep more and more of her movement. I can not fix the cerebal palsy diagnosis but I can fix her joint movement, increase her ease of movement and play, and get her right side catching up to her left.
Experiencing trouble with a pinched nerve in lumbar area. Radiating pain in bursa and down my right leg into my calf. Cannot be on my feet for more than a few minutes. In 2005 & 2006 I had two micro discectomy's. You have been recommended by a friend. I also had a cortico steriod shot about 9 days ago.
Current doctor, Dr. Steven Noran, he has retired from practice this last week. Do you think you can help me find relief? Really do not want to have the surgery again if that is my only option.
I would have a few questions for you. Do you have numbness? Can you walk on your toes? Can you walk on your heels? Did the cortisone shot help?
What we can do is dissociate the difference between mechanical joint dysfunction and true neurological dysfunction. Neurological dysfunction leads to three specific signs - numbness, decreased strength and decrease reflex. We can also look at your movement and fix the joint dysfunction that leads to pain, a secondary muscle spasm and inhibition (false weakness). The sciatic nerve does cross through the Piriformis muscle ten percent of the time. When this muscle, that crosses over the Sacraliliac joint, is in spasm it can squeeze the nerve and cause secondary neurological complications and irritation radiating into the calf. We can assess your neurological signs and fix the mechanical dysfunction gently. Yes, if you have neurological signs and the mechanics are correct, taking the pressure off the nerve is important to do sooner than later. We would be happy to assess and address this for you.
My 12 years-old daughter and hockey goalie just suffered her 2nd concussion in a year. All of her symptoms are fine except for when she skates. Would your services help her get back on the ice sooner? Thanks.
I do see that the limited mobility and a significant amount of the pain and headaches post a concussion are due to a movement dysfunction. She hits so hard a locking mechanism at the joint level, a secondary muscle spasm and pain results. We can take a look at her movement, fix the movement dysfunction and monitor the true neurological symptoms. She can return to skating when all her symptoms have resolved. Concussions do add up. One concussion is too many and two becomes a bit harder to recover from. Having two concussions does need to start a conversation about life long brain health and decisions about sport. My dad always said "It is your brain that will keep you successful." We would be delighted to meet your daughter and fix the mechanical dysfunction and get her back on the ice.
Do you have experience helping people with restless leg syndrome/rls.
Yes. We can take a look at your lower quadrant movement, right and left, and fix the joint dysfunction and related spasm and irritation. Our tissue tightens up anyway at night so we can get quite an exacerbation of a secondary muscle spasm. This can exacerbate the restless leg symptoms that are already quite irritating. I can not fix the true neurological dysfunction leading to the neurological restless leg syndrome, but I can fix the secondary movement dysfunction.
Hi, somebody recommend your clinic to me . I have a herniated disc in my neck at c6-c7 with nerve impingement and I have been using a neck track traction devise ) one that you use laying down and use pump) and it has helped some but I think I did something to cause it to flare up. Anyway I'm tired of the pain and strain I feel in my shoulders and was wondering if this is something that you could possibly help me with?
We can look at your movement. You need full movement at the joint level to have full neck movement. You have six to eight joints between each of the seven cervical vertebra. These joints actually rotate so that you can bend your head forward, backwards and side to side. This is why a traction machine has its limits. We can fix that rotational movement for you very gently and precisely.
I have had some nasty experience with gout, and have developed bone spurs on my right big toe joint. The spur is on the top and side of the joint and has limited the toe movement and thus effected my gait. Long walks and certain exercises are no longer possible. This effected area is always tender to the touch. Is this something that may be addressed by you folks, or is the physical change of the joint just something I will have to learn to live with?
Bone spurs do change your movement at a joint as you are experiencing. We can change the movement at your forefoot to make up a bit of the difference. You have 23 bones and joints in your foot. We can also look at the movement of your big toe and see how much we can change and what is left over. Get you back to more walking.
I got back surgery back in 2010 to fix my SI joint but still have pain in my lower back on my left side , I am supposed to get my right side done but I'm afraid because my first surgery was painful and recovery took about a year and 4 months. How can you help?
I would ask you a few follow-up questions. What was fixed at your SI joint in 2010? Was it fused? Was it 'cleaned out?" Do you have pain at right side? I think your reaction of being skeptical about a second surgery when the first one sounds like it was not help is a healthy one. You do have the option of evaluating your movement and treating the movement dysfunction and related spasm and pain. You can then monitor change and see if anything is left over. Your SI joint moves about 47 different ways. It is where all your movement begins. To move at your trunk and your limbs you have to first move through your pelvis. Treatment of an SI joint dysfunction needs to be precise. It can also be very gentle. Tissue is a reactor to joint movement. So, when you have full SI joint movement, then you will have full tissue pliablity and no pain. Pain is a perseption from your brain. It is very real and can be very intense when it is a joint dysfunction because all your pain receptors are at your joint capsules and your blood vessels.
I had a total right knee replacement in December 2015, (35 years after having it reconstructed). Through the years my left hip has taken a beating, it is now arthritic. Prior to the TKR I think my left leg was longer than the right, now if feels like the right leg is longer. (X-rays show that my hip is slightly lower on the left side with the arthritic hip) I have lost range of motion and the hip started hurting when I would ride horses a few years back. This spring I began having pain when I walk and it has become hard to go for walks. I feel that I may have some soft tissue problems along with the arthritis. I have been planking and doing some light biking the past month. I did get a cortisone shot two weeks ago to give me some relief, for my son's wedding. Do you think there are viable PT/chiropractic options that I can pursue before replacement surgery.
You are correct; when you start to see a pattern of decreased activity level, something needs to change. Sleep is also something to monitor. When sleep and activity level are both decreasing and the hip is arthritic, a THA needs to be considered. The more conditioned you are when you have a surgery, the easier the recovery. Now, before surgery, yes we can fix the movement: lumbar and pelvic, hip and knee. We can resolved the mechanical joint dysfunction and related pain and spasm. This will specify the pain and limitations of the arthritic change, if there are any. We can have significant arthritic change without pain. So, yes, the treatment of your mechanical dysfunction and a look at your movement control and your hip movement is very appropriate at this time. Your leg length difference and change over the years can be very mechanical rather than arthritic. You will be able to compare your leg lengths before and after the mechanical dysfunction is resolved. The gold standard to comment on anatomical leg length difference is CT rather than x-ray anyway and is not necessary in this situation. We would be delighted to help you with your movement, recovery and increasing your activity level back to your normal.
I have been battling ulnar wrist pain for about two months. The pain only occurs with pronation of the wrist and is worse with the elbow bent opposed to elbow straight. No pain in the wrist otherwise. I saw an orthopedic specialist but stumped him on what could be causing the pain. What are your thoughts? Do you think you could help me figure out what is causing the issue?
We can definitely look at your movement. There are 26 bones and joints in the wrist. All these joints need to be moving fulling to have full wrist pronation. Wrist movement is also influenced by the elbow. The Ulnar-humeral joint is shaped like a saddle and the radial head needs to be able to fully rotate to have full forearm pronation and wrist movement. When joint movement is limited, a secondary muscle spasm kicks in, the Arthokinetic reflex. We can change the joint movement very gently, resolve the secondary muscle spasm and pain and assure full, pain-free wrist pronation.
Was diagnosed with anterior tibialis tendonitis. Podiatrists recommendations did not help. Have been to several sessions of acupuncture and it has gotten better, but still not gone. My foot feels really weak and still occasionally feel pain. Can you help?
Yes. We can assess and address your movement. You have 26 bones and joints in your ankle and foot. The tibialis tendon crosses over these joints. When we are unable to move fully at a joint we get irritation, a secondary muscle spasm and a secondary inhibition, a false weakness. Muscles are reactors to joint movement. As the mechanical joint dysfunction continues, the tendon becomes quite irritated as it lacks movement and pliability resulting in tendonitis, an inflammatory process. We can fix the joint movement to resolve the secondary spasm and the inflammatory process will settle with a bit of time. The inhibition will resolve when the movement and full muscle contraction is restored. You can then build back the ankle control and power we just loose when we cannot move. Full activity level will follow the resolution of movement dysfunction.
I have been battling heel pain for about 2 months. I was starting to believe it was caused by plantar fasciitis, but was never completely convinced because it came on very suddenly after a stretch of running (probably too much), and running on concrete floors in hallways while turning sharp corners. I'm self-diagnosing, but I believe I actually have Fat Pad Syndrome based on the location of my pain. I'm wondering if I should be seen, or if I can treat this somehow myself? I'm thinking about rest, ice, heel cups, and taping. Advice??
You are correct we can hit our limit of control and get a bit mechanically vulnerable. We have 23 bones and joints in our feet. When we hit our limit of running and we cannot control the movement at our joints we get a secondary muscle spasm, our protective reflex kicks in. All those muscles that attach at the edge of your heel run along the bottom of your foot and attach at your toes. As that muscle spasm pulls at your heel you get pain. This is very fixable by fixing the movement which then resolves the secondary spasm. The tissue then settles over 2 or 3 days (10,000 repetitions of movement through the new end range). Yes, you can also inflame that fat pad on your heel by heel striking on concrete. If this is the case, then ice for a few days post the injury and a cushion under your heel to let the tissue settle will resolve the issue. If the pain has not fully resolve in a few days, we can always fix the movement and secondary spasm and pain quite quickly- get you back to running.
Margie, I am very encouraged about my neck since I saw you on Tuesday. How frequently do you suggest for visits?
Wonderful to hear that you are encouraged. Give yourself enough time for recovery. Tissue takes about 10,000 repetitions to change. This is as simple as your daily activity and your walking at this new end range of movement. I suggest a week or two between appointments to begin. You will see frequency decreases over time. You will not need us for long as you build your movement control and your power. You will get to keep the results.