Ask Dr Shana

10/02/2021

Hi all, future content will be posted directly to the website www.askdrshana.com, stay-tuned for the e-book on self-care of common musculoskeletal injuries (i.e back issues, etc). I'm exiting FB so the page and group will close in a few days.

09/19/2021

Sciatica--Lumbar radiculopathy

Sciatica is one of the most common and most painful back issues. It commonly results from a disc herniation in the back. The herniation compresses or irritates the nerves at that level. The pain from sciatica (radiculopathy) shoots down the leg and into the toes. It is described as painful numbness and tingling or burning. Fortunately, lumbar radiculopathy improves in three to six months for most people. For some, symptoms are more persistent. Treatment involves 1) managing nerve pain and 2) spine rehabilitation.

Nerve Pain
Nerve pain is often excruciating. It feels different than muscle or joint pain and is treated differently. While joint pain responds well to over-the-counter medications such as ibuprofen, nerve pain does not. Nerve pain responds better to “neuropathic agents” such as gabapentin, duloxetine, or cannabidiol. When these agents are not adequate more aggressive interventions include steroids, injections, even surgery.

Spine Rehabilitation
Since nerve pain arises from a nerve, exercise won’t make it go away per se. What exercise can do is improve motor control and range of motion that reduces stress and improves support for the back thereby reducing irritation. Spine rehabilitation key principles include:
1) stretching
2) core strengthening

Role of stretching
When muscles don’t have enough range of motion they can pull the back out of alignment. The suboptimal position then puts abnormal forces on the back, increasing the risk of irritation and injury. Stretching restores the range of motion. Key muscles to stretch for the low back are the back of the legs (hamstrings), hips (front and side muscles), and low back. A great active stretch for the front of the hip is a lunge.

Role of Core Strengthening
The core includes the muscles in the abdomen and back. The core muscles support and protect the spine. A key core muscle to strengthen is the transverse abdominis. It works reflexively to protect the spine when moving. To activate it, simply pull the belly button towards the spine. Practice doing this laying down, then while walking.

09/11/2021

Plantar fasciitis--a common cause of foot pain

Hallmark symptom is pain on the bottom of the foot and heel with the first few steps in the morning

Treatment
1. Frequent stretching of the plantar fascia and leg muscles; massage of the arch and insertion point

2. Arch supports to support the plantar fascia, some use night splints for a prolonged stretch
*my favorite over the counter insoles are SOLE active medium, SOLE softer response, and Abeo 3D3 premium orthotic

3. Reduce aggravating activities, including walking barefoot

Prognosis- about 80% of people improve after 1 year but it can be stubborn to resolve

08/12/2021

Anterior Knee pain--Rehabilitation

Patellofemoral pain is a common causes of knee pain in adults. People typically describe the pain as under or around the knee cap.

TREATMENT
1) Reduce overuse or overtraining
Since overload is a common precipitant, reduce training frequency and intensity. For example, with milder symptoms a reduction in training of 50% may work. For more severe symptoms, greater modifications may be needed.

2) Rehabilitation
Focused hip strengthening, quadricep strengthening, and stretching are key. Specifically, hip strengthening is important because these muscles stabilize the pelvis during activities. Likewise, the quadricep muscles support and stabilize the knee joint.

3) Optimize biomechanics
Proper arch support to enable good foot and ankle alignment is significant. This is especially crucial for those with foot pronation, where the foot rolls too far inward.

REHABILITATION--a closer look...
Rehabilitation of anterior knee pain focuses on hip strengthening, quadricep strengthening, and adequate flexibility.

Hip strengthening, especially the hip abductors, centers around their importance in stabilizing the pelvis during walking and single-leg stance. Key exercises to strengthen this muscle group are side-lying abduction and single-leg stance exercises.

Additionally, the muscles supporting the knee, the quadriceps, benefit from strengthening. Quadricep strengthening progresses from very basic exercises that work on control and muscle activation to more advanced compound movements like squats. Key exercises to strengthen this group include control and activation focused exercises such as knee extensions and leg lifts to more advanced squats. A key point to keep in mind with squats is they can be progressed as well starting from a ¼ squat, then progressing to a ½ squat and a full squat as the knee can tolerate greater loads.

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07/30/2021

Pain in the front of the knee--patellofemoral pain

Patellofemoral pain is located on the front part of the knee around and behind the knee cap (patella). It is a common cause of knee pain in young adults.

Activities that stress the knee joint aggravate symptoms. Specifically, symptoms worsen with stairs, squats, or running. Prolonged sitting can also be irritating.

The knee cap helps the thigh muscles (quadriceps) extend the knee and balance compression forces. Overuse/overtraining, poor patellar tracking may contribute to its development.

Treatment includes:
1) Reduce overuse/overtraining (i.e. reduce training volume, frequency, intensity)

2) Rehabilitation (strengthen hip abductors (pelvic stabilizers) and quadriceps)

3) Biomechanics (proper support for foot/ankle/knee alignment)

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07/27/2021

07/17/2021

Mechanical Low Back Pain

Mechanical low back pain refers to back pain coming from the bones and muscles of the spine. It is very common and increases in frequency with age. Many people start experiencing back pain in their 30’s and 40’s.

Fortunately, exercise helps most people with back pain feel better. More specifically, functional exercise that includes core strengthening and stretching gets people back to the activities they enjoy.

*Core strengthening helps treat low back pain. The core consists of the muscles in the abdomen and back. The core muscles support and protect the spine. If the core muscles are working correctly, fewer injury-inducing forces are transmitted to the back. This means fewer back injuries and less back pain.

One key core muscle is the transverse abdominis or TVA. Studies have shown that the TVA works reflexively to protect the spine with movement. Core strengthening improves reflexive function of the TVA.

To activate the TVA muscle, pull the belly button in towards the spine. Practice doing this while laying down, then while walking. Next, incorporate core activation into daily activities and exercise.

*Stretching helps treat low back pain. Stretching restores the range of motion to muscles. For example, extended sitting shortens muscle groups, such as the hip muscles (hip flexors). When muscles are shortened they pull the back out of neutral position. The suboptimal position predisposes to back pain. Stretching restores the range of motion to the shortened muscles.

The foundation of a back care workout includes core strengthening and flexibility. For instance, key exercises that strengthen the core include plank work and kettlebells while key workouts include yoga and pilates. Key muscles to stretch for low back care include the back of the legs (hamstrings and calves), front of the hips (hip flexors), sides of the hip (hip abductors), and low back muscles. Trufusion is one fitness studio that emphasizes these movements as a foundation in their workouts.

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07/06/2021

Posterior tibial tendon dysfunction (PTTD) and acquired flat foot

The posterior tibialis is the key stabilizer of the arch of the foot. With progressive damage to the tendon, such as from repetitive overload, the tendon can break down, resulting in collapse of the arch of the foot and a flat foot. A flat foot places greater stress on the surrounding structures of the foot and ankle.

Posterior tibial tendon dysfunction presents with pain and tenderness on the inside of the foot and ankle.

Treatment for mild PTTD:
—Relative rest- decreasing activities that worsen pain
—Arch support- proper arch support such as supportive insoles or a custom foot orthosis
--Rehabilitation- ankle/foot strengthening exercises and flexibility with a focus on the posterior tibialis muscle and ankle range of motion.

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06/26/2021

Chronic inflammation can lead to weight gain and disease. This article lists 13 foods that have powerful anti-inflammatory effects.

06/23/2021

Carpal tunnel syndrome—the great masquerader

Carpal tunnel syndrome classically presents with numbness and tingling in the first three fingers of the hand. It can, however, have many variations in its presentation earning it the reputation as the “great masquerader.” Variations include the entire hand being numb, wrist pain, and pain moving up the forearm.

People often report shaking their hands to “wake” them up. Also, they report increased symptoms with driving or heavy lifting.

Treatment for carpal tunnel syndrome starts at home
1. Positioning: proper positioning when working with an ergonomic workspace
2. Activity modification: reducing strain from repetitive movements and irritating activities
3. Bracing: wrist brace resting the wrist in a neutral position at night during sleep and during aggravating activities. A wrist brace should be the correct size, provide adequate stability, and rest the wrist in a neutral position.

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Carpal tunnel syndrome treatment can be done at home and includes proper positioning, relative rest, and bracing.

06/21/2021

Pain on the side of the hip—Greater trochanteric tendinopathy involving the gluteus medius and minimus muscles.

These muscles are key in STABILIZING the pelvis during walking, running and single-leg weight-bearing.

Hallmarks are lateral hip pain and disrupted sleep. It is painful to lay on the affected side.

Treatment
1. STRENGTHEN the gluteus medius and minimus.
Exercises include: clamshells, standing hip abductions, and single leg squats

2. STRETCH the abductors. Figure 4 stretch or pigeon pose

3. Reduce irritating activities and Reduce inflammation (ICE and/or anti-inflammatories)

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06/13/2021

Peroneal tendinopathy--pain on the side of the leg

The peroneal muscles run along the side of the leg and ankle. They help Stabilize the foot and are stressed while running on uneven surfaces.

Tenderness is noted just behind the ankle bone and may extend up the leg.

Treatment
1. Supportive shoewear--adding insoles may help (I like the brands SOLE and Abeo 3D3)

2. Stretching the calf muscles, soleus muscle, and peroneal muscles.

Peroneal muscle stretch
*Sitting on a chair with the affected leg crossed over your other knee. Hold the bottom of the foot with your hand, slowly tilt the sole of your foot toward the floor.
Hold this position for 10 seconds and then pull your foot toward you, tilting it to the ceiling.

3. Strengthening exercises
-Ankle eversion exercises with band

-side walking with band around toes

-calf raises

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