We’re currently offering Active Release Technique (ART) and Chiropractic and Orthotic services, with plans to add physiotherapy, massage therapy, naturopathy, nutrition services and osteopathy to our clinic.

Clinic hours are as follows:

Mondays, Wednesdays –> 7:30 – 11:00 am

Tuesdays, Thursdays –> 3:00 – 6:00 pm

Looking forward to seeing everyone soon!

When you hurt a muscle or ligament, the body’s natural response is to heal the area by laying down scar tissue. However, this scar tissue can shorten the muscle’s range of motion, therefore causing pain or stiffness. While scar tissue or adhesions may heal the muscle temporarily, eventually it becomes a nuisance if it isn’t broken up. Once the soft tissue is damaged, injury can lead to altered biomechanics for compensation.

Active Release Techniques was founded by P. Michael Leahy, DC, CCSP. Leahy used his engineering and chiropractic skills, and combined them to treat triathlon injuries. Now fifteen years later, ART is common to treat injuries of all athletes and even every day injuries. ART is set apart from a normal sports massage because it engages the same muscles that are active when you go through the running motions. It is highly effective and often leads to immediate results that are faster than simple icing, massaging and resting alone. According to Dr. Alan Gilenson, Chiropractor of Suwannee Georgia, “We all have adhesions, and little by little they get worse and worse if they’re not broken up.” Since runners are constantly dealing with minor aches and pains, they often ignore the little pains to focus on the major ones. However, these minor aches eventually turn into bad adhesions in the soft tissue. Injury then occurs do to the accumulation of adhesions without treatment. To prevent this, Dr. Gilenson recommends getting active release treatment early on, or even having serious athletes make an ART appointment at least every six weeks to break up the adhesions before they get worse. Dr. Gilenson says ART has two advantages; the 500-plus individual motions that therapists are trained to perform, along with hands on accuracy. Another benefit is that ART works on the exact area of the problem, along with the surrounding muscle groups, therefore its more beneficial than a full body sports massage that may briefly touch on the injured area.

If you have a soft tissue injury that has been a nagging problem, or is continuing to get worse, consider finding a doctor or chiropractor certified in ART. Expect a typical session to last 10 to 15 minutes. Sessions are typically scheduled for twice a week, and foam rolling the injury is often encouraged between visits.  In the last several years, ART has become increasingly popular and you can easily find a provider of active release treatment by looking on activerelease.com

• acute conditions (pulls, tears, collisions, etc),
• accumulation of small tears (micro-trauma)
• not getting enough oxygen (hypoxia).

What is an ART treatment like?

What is the history of Active Release Techniques?

Many pregnant women experience low back pain, hip pain, and pubic symphysis. These discomforts are the result of the stresses put on the body by the rapid growth of the baby and the changes the body must undergo to accommodate those adjustments. As her belly gets bigger, the woman’s center of gravity changes. The growth is so quick that it is often difficult for the low back and pelvis to adjust to this change. This causes stress in those areas, resulting in misalignments, (or subluxations as they are called by chiropractors) which then causes pain and dysfunction. If a woman’s low back and pelvis was out of alignment before her pregnancy it is even harder for her back and pelvis to adjust. When the pelvis is subluxated (misaligned) it affects the uterus and the position of the growing baby.

The uterus is connected to the pelvis by ligaments: the broad ligament, the uterosacral ligaments, and the round ligaments. Like a hot air balloon tethered to the ground, these ligaments work to keep the uterus in the proper place in the pelvis and allow support as the uterus grows to accommodate the growing baby. If the pelvis is subluxated, these ligaments can become torqued. When the ligaments are affected, they directly affect the position of the uterus which can result in the baby not being in an optimal position. This type of situation may result in a breech baby or a transverse (sideways) baby.

The goal of the chiropractor is to correct the subluxations in the pelvis to help balance the uterus and allow the baby to get into a better position. Chiropractic adjustments for a pregnant woman are specific, gentle, and safe. Some chiropractors are certified in the Webster Technique which is a technique that is used to relieve intrauterine constraint caused by imbalance in the pelvis and the pelvic ligaments. Webster certified chiropractors adjust the pelvis and also feel for and relieve tension in the round ligaments.

Besides increasing a pregnant woman’s comfort level, an aligned pelvis can result in a quicker, safer, and easier birth. When a baby is in breech or transverse position a cesarean section is almost always performed. Because they are so common many people forget that a c-section is a major abdominal surgery and can be risky. Helping the baby to get into a proper head-down position by balancing the pelvis and ligaments helps to avoid c-sections due to baby positioning. Other variations in baby position such as a tilted head or a “sunny side up” baby (face up during delivery) can also be caused by pelvic imbalance and may result in a more difficult, painful, and longer labor and delivery.

Like many procedures performed for unremitting pain when neither the medical nor the chiropractic profession is able to relieve the patient by other means, it is important for our patient’s sake that we become familiar with the validity of these procedures.

The main reason epidural steroids are used is for neuropathic pain. Since 1953, epidural steroid injections have been used for lumbar radiculopathy to reduce proinflammatory chemical agents.¹ However, “[t]hirty-five controlled studies on the subject have failed to provide a definitive answer regarding the efficacy of epidural steroid injections and it is unlikely that future trials will do so.”² In short, the evidence recommending steroid injections is still unclear.

Before discussing the value of these injections, it is important first to distinguish between neuropathic (may benefit from epidural injection) and mechanical causes. Mechanical back pain can be defined as pain occurring from the spine and its supporting structures. The pain may radiate to the upper thigh and buttocks, but seldom below the knee, and typically is aggravated with movement and relieved with rest. Patients often describe their pain as “throbbing or aching.” Mechanical causes considered to constitute 80-90 percent of back pain may include nonspecific back pain due to muscle strain, ligamentous injury, degenerative disc or joint disease, vertebral fracture, congenital deformity (scoliosis, kyphosis, transitional vertebrae), spondylolysis and instability.³

Neurogenic pain is symptomatically described as “shooting or stabbing” pain caused by nerve root involvement. Pain usually extends below the knee. For disc problems, prolonged sitting or forward flexion may be more aggravating. Spinal stenosis is included as a neurogenic problem and is usually relieved by forward flexion and aggravated by lumbar extension. Stenotic patients can often ride a bicycle and walk up hills. If a patient complains of a specific abrupt-onset event causing neuropathic pain, a herniated disc is considered over a lumbar stenosis.³

Chronic lumbar radiculopathy is defined as a clinical syndrome of back and leg pain accompanied by sensory, reflex or motor deficits in a nerve root distribution lasting for more than 12 weeks.⁴ Neurogenic causes account for 5-15 percent of low back pain and also include osteophytic nerve root compression, annular fissure with chemical nerve root irritation, and failed back surgery (arachnoiditis, epidural adhesions, recurrent herniation).³

Regarding epidural injections, while the evidence is weak, there appears to be some benefit.² A 2008 article found that transforaminal injections, i.e., depositing the steroid directly over the affected nerve root into the ventral epidural space, were superior to caudal injections.5 However, in a 2011 article published in the British Medical Journal,⁴ the authors concluded that “neither caudal epidural steroid injections nor caudal epidural saline injections are effective for chronic lumbar radiculopathy and are not recommended as an adjunct to recovery in patients whose symptoms have extended beyond 12 weeks.”

In an editorial discussing this article,² the author states that epidural steroids should be considered as part of a multidisciplinary treatment plan, especially with acute or subacute radiculopathy secondary to a herniated disc when more conservative measures have failed. He also recommends the injection for chronic or unremitting pain, non-radicular pain and spinal stenosis, although he feels more numbers of these types of patients are needed for validation in future studies.

So, what do you tell your patient? Frankly, when I am unable to relieve a patient from severe neuropathic pain and the subject comes up, I tell them I have had patients experience relief from one week to three months, and that in some cases (not many), the pain resolved completely. Often up to three injections are recommended. Yes, there may be side effects, such as temporary numbness of the bowels and bladder, infection and a puncture of the dura with a severe headache.

Chiropractic is a drugless healing method always looking for causation rather than symptomatic relief, but as we must realize, there is a time and place for medical relief. In those unresolved cases with unremitting pain, I would recommend the procedure.

References

1. Goupille P, Jayson MI, Valat JP, Freemont AJ. The role of inflammation in disk herniation-associated radiculopathy.Semin Arthritis Rheum, 1998;28:60-71.
2. Cohen SP. Epidural steroid injections for low back pain. (Editorial) BMJ, 2011;343:1-2
3. Cohen SP, Argoff CE, Carragee EJ. Management of low back pain – clinical review. BMJ, 2009;338:100-106.
4. Iversen T, Solberg TK, Romner B, Wilsgaard T, et al. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomized controlled trial. BMJ, 2011;343:1-15.
5. DePalma MJ, Slipman CW. Evidence-informed management of chronic low back pain with epidural steroid injections. Spine, 2008;8:45-55.