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New Concepts in Managing Achilles Tendinopathy: Why Improving Tendon Pressure Dynamics and Interfascicular Sliding Are Essential for Recovery.
Achilles injuries are common, and the most frequently prescribed exercise interventions have relatively poor long-term outcomes. New research shows heavy-resistance long-duration isometric contractions accelerate tendon repair by increasing the outflow of fluid from...
Good Balance and Strong Toes: The Most Under Appreciated Components of a Great Golf Stroke
Whether you’re on the fairway or the green, the ability to hit a golf ball so it moves at the desired speed and trajectory is one of the most difficult, complex movements in all of sport (1). To be successful, the skilled golfer must maintain a stable base of support...
Balance Buttons
How Stimulating Specific Locations on the Bottom of Your Feet Can Improve Balance and Prevent Falls
Like it or not, as we age, most of our sensory systems begin to break down: our hearing worsens, our vision gets blurry, and our reflexes slow down. An under-appreciated sensory system that also worsens with age is the ability of cutaneous receptors located along the...
NSAIDS and Osteoarthritis: Are the Rewards Worth the Risks?
Osteoarthritis (OA) is the most common of all joint diseases, affecting more than 30 million Americans. In the next few decades, the number of people suffering with osteoarthritis is expected to skyrocket, as people are living longer and the percentage of the...
Anteromedial Ankle Impingement Syndrome
Originally referred to as “athlete’s ankle” and later “footballer’s ankle” because of the high prevalence in soccer players, this condition occurs when osteophytes on the anteromedial tibia and dorsal talus collide during ankle dorsiflexion, pinching the soft tissues...
The Diaphragm: The Overlooked Core Muscle
Every chiropractor knows that a strong, well-coordinated core is essential for maintaining spinal health. The core muscles work as a unit to increase intra-abdominal pressure providing just the right stiffness to unload the spine during lifting and loading tasks....
Focal Muscle Vibration: An Overlooked Tool for Diagnosing and Managing Low Back Pain
Initially discovered in the 1960s by Eklund and Hagbarth (1), a surprising body of research has shown that plac- ing small vibrating motors over the belly of a muscle can produce presynaptic inhibition of the muscle’s spindles, which can reduce muscle tone by as much...
The Treatment and Prevention of Anterior Cruciate Ligament Injuries
The anterior cruciate ligament (ACL) is a powerful stabilizer of the knee, possessing 2 different bundles (Fig. 1) that help stabilize the knee against anterior shear force, valgus collapse, and excessive internal tibial rotation. Despite its overall strength, the ACL...
Managing Sesamoid Injuries
Published in Dynamic Chiropractic, Vol. 30, Issue 3 The word sesamoid is Latin for "sesame seed." These small bones are located inside specific tendons, where they improve mechanical efficiency by pulling the tendon farther away from the joint's axis of motion....
Popliteus Tendinitis: Biomechanical Factors
and Conservative Treatment
The popliteus muscle originates from the lateral aspect of the distal femur and inserts along the posterior aspect of the proximal tibia. It is comprised of three separate fiber bundles that are under different degrees of tension, depending upon the degree of knee...
The Strong Connection Between
Low Back Pain and Weak Multifidi
(and the Best Ways to Strengthen these Important Muscles)
In any given year, nearly 40% of the US population will develop a low back injury severe enough to limit activity (1). Once injured, there is a 22% chance of reinjury within three months, and a nearly 80% chance of reinjury within the next three years (2). The cost of...
The Surprising Connection Between Tight Hip Flexors and Painful Hip Arthritis
You would think that the connection between hip arthritis and pain would be pretty straightforward: people with the greatest degree of arthritis as measured on x-rays should have the greatest amount of pain. Surprisingly, this is not always the case as many people...
Gait Retraining for Knee Hyperextension
Unlike the hip joint, which possesses a deep ball and socket that provides inherent stability to reduce stress on the restraining ligaments, the knee is particularly prone to injury because the flatness of the tibial plateau provides little protection against...
Managing Limb Length Discrepancies
Excerpted from his book, Human Locomotion Limb length discrepancy (LLD), which is divided into functional and structural categories, is a common cause of injury. In a study of 3,026 subjects with radiographically confirmed LLD, Harvey et al. (152) determined that...
Managing Achilles Tendinitis
Excerpted from his book, Injury-Free Running, Second Edition Despite its broad width and significant length, runners injure their Achilles tendons with surprising regularity. In a recent study of 69 military cadets participating in a six-week basic training program...
Three Reasons You Should Be Wearing Triple Stick Straps While Training
Fig. 1. The Triple Stick Strap Summary: The latest research confirms that blood flow restriction training using lighter cuff pressures can markedly increase the production of growth hormone, allowing you to substantially increase muscle mass while exercising with...
Does a Torn Rotator Cuff Really Require Surgery?
Summary: Tears of the rotator cuff tendons are extremely common, and the vast majority of these tears involve the supraspinatus tendon. Because small to moderate thickness supraspinatus tears respond so well to conservative care, where- as massive full-thickness tears...
The Latest Stretches and Exercises to Make Sure Your Plantar Fascial Injury Never Returns
Summary: 44% of patients with plantar fasciitis will have pain 15 years after the original diagnosis. The most common treatment protocols, including orthotics, corticosteroids, and short-term stretches have not been proven to alter long-term outcomes. The majority of...
The Overlooked and Underappreciated Soleus Muscle
Summary: Soleus is the largest muscle of the leg, producing force of nearly 8 times body weight during pushoff. The world’s fastest marathon runners have the largest soleus muscles, and weakness of the soleus correlates with the development of Achilles tendinopathy....
Novel Exercises and Stretches for Managing High Blood Pressure
According to the World Health Organization, hypertension is a leading cause of stroke and cardiovascular disease, which cause more than 15 million deaths annually (1). Affecting more than 1.3 billion people worldwide, arterial hypertension is diagnosed when systolic...
Blood Flow Restriction Training: An Interesting Method for Maximizing Muscle Remodeling
The process of applying thigh and arm tourniquets to impair blood flow while strength training was developed more than 50 years ago in Japan, where it is referred to as KAATSU training (1). Original advocates of this training technique wrapped straps around their...
The Positive Wink Sign: A New Diagnostic Test for Evaluating Toe Flexor Weakness
Weakness of the intrinsic toe flexors, specifically the flexor digitorum brevis muscle (FDB), is a common and underappreciated cause of a wide range of injuries. In 2015, Sullivan et al. (1) examined 202 people with chronic heel pain and compared them to 70...
How a Few Simple Changes in Your Running Form Can Improve Speed, Efficiency, and May Even Reduce Your Risk of Injury
Given the popularity of running, it’s surprising how much controversy exists over which style of running is best for improving performance. Some coaches advocate that all you need to do to achieve the ideal running form is to run with a cadence of 180 foot strikes per...
The Peel and Stick Interdigital Neuroma Balance
Summary Interdigital neuromas are common, poorly studied, and notoriously difficult to treat. By offloading the third and fourth metatarsal heads throughout propulsion, the new Peel and Stick interdigital neuroma balance allows you to effectively treat interdigital...
The Peel and Stick Sesamoid Balance
Summary Sesamoid injuries are extremely common, especially in high-arched individuals. The new Peel and Stick Sesamoid Balance is thicker than most sesamoid balances, and is made of a blend of urethane rubber, PPT, and synthetic suede designed to significantly reduce...
Varus and Valgus Insole Posting: An Inexpensive and Effective Alternative to Orthotics
Summary People with low arches are 20 times more likely to be injured than people with neutral arches, while people with high arches are nearly 80 times more likely to be injured (1). Although effective at controlling motion and reducing injury rates, recent research...
Five Simple Exercises to Prevent Age-Related Muscle Loss
It’s a depressing fact but shortly after age 50, you begin to lose nearly 2 percent of your muscle fibers each year. Figure 1 is a graph of the average number of quadriceps muscle fibers present in adults aged 18 to 82 (1). Looking at the center of the graph, you can...
In-Office Screening to Rule Out Vertebral Artery Dissection
In any given year, nearly one in 100,000 adults will develop a vertebral artery dissection (VAD) (1) (Fig. 1). Factors that increase the risk of dissection include elevated homocysteine levels, Marfan’s syndrome, family history of stroke, migraines, and even seasonal...
Forget Stretching and Foam-Rolling:
New Research Shows the Best Way to Warm Up May be to Lengthen and Strengthen Your Tendons
Twenty years ago, when a group of runners got together for a workout, a few would casually be stretching either their hamstrings or calves, but the stretches seemed pretty random and inconsistent. It was almost as if the runners knew they were supposed to stretch, but...
How to Rehab a Sprained Ankle
Ankle sprains are surprisingly common. In the United States alone, 23,000 people sprain their ankle each day (Fig. 1). The medical costs associated with treating ankle sprains exceeds $1.1 billion annually (1,2). To make matters worse, these numbers do not take into...
The Best Ways to Prevent Age-Related Muscle Loss
Shortly after age 50, the rate at which a person loses muscle mass begins to accelerate (1). Figure 1 is a graphical representation of the average number of quadriceps muscle fibers present in adults aged 18 to 82 (2). Looking at the center of the graph, it is clear...
Hip Strength as a Percentage of Body Weight: Using a Modified ToePro Dynamometer to Predict Knee Injuries
In any given year, nearly one in 25 athletes will tear their anterior cruciate ligament (1). More commonly, one in 10 recreational athletes develop patellofemoral pain annually, and once diagnosed, more than 90% will continue to suffer with chronic knee pain years...
The Importance of Toe Strength in Preventing Falls in the Elderly
In any given year, nearly 40% of senior citizens aged 70 and over will fall at least once (1). Each fall significantly increases the risk of not only sprains, strains, and contusions, but also fractures. The resultant injuries often begin a downward spiral of weakness...
Managing Heel Pain: The Overlooked Role of Peroneal and Toe Flexor Strength
Each year, nearly 2 million Americans seek medical attention for a painful heel. In the US alone, the annual economic cost for managing this common condition is in excess of $300 million (1). While the majority of patients with painful heels respond favorably within 3...
Managing Greater Trochanteric Pain Syndrome
Next to osteoarthritis, greater trochanter pain syndrome is the most frequently encountered hip injury, and it is estimated that it will eventually affect between 10% and 25% of the population (1). The typical patient complains of pain with single-leg stance and the...
Neuromotor Coordination and the Prevention of Running Injuries
For more than 30 years, researchers have been trying to identify specific risk factors that can predetermine whether or not a runner is likely to be injured. With an annual injury rate exceeding 50%, runners could save them selves a lot of time and frustration if they...
Is There An Ideal Running Form?
Making a few small changes in the way you run can make you faster, more efficient and possibly less injury-prone. But how do you know which changes to make?
The best running coaches in the world continually have their athletes work on their running form, either through daily drills or through significant biomechanical adjustments. Nike Oregon Project coach Alberto Salazar is famous for changing everything from the tilt of...
Strength and Stress Fractures
In any given year, more than one in five runners will sustain a stress fracture (1). In the U.S. alone, this trans- lates into nearly 2 million stress fractures annually (2). In a study of 320 patients presenting with stress fractures, Matheson, et al., (3) note that...
The Real Cause of Iliotibial Band Syndrome
Iliotibial band syndrome is a common injury, occurring in up to 12% of all runners (1). The pain associated with this syndrome is often described as “burning” and is reproduced clinically with Noble’s test, in which the examiner compresses the distal band against the...
The Conservative Management of Hamstring Strains
Of all the gait-related muscle injuries, hamstring strains have the highest rate of recurrence, with as many as one third of injured athletes suffering reinjury within the first few weeks following return to sport (1). Because their stride lengths may exceed 3.5...