Dr. Colt Andrea is a Chiropractic Physician that looks forward to enhancing the Jacksonville Arlington area and being of service to the community and surrounding areas. We look forward to helping you and your families. Please take some time to check out the site as we will be regularly updating blog posts with topics relevant to you and your health! If you like what you learn, and we hope you do, please share with your friends!
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Is your shoulder giving you problems? Have you tried seeking treatment for your shoulder to no avail? Are you sick and tired of dealing with that constant nagging ache? Maybe you thought you’re getting older, and your shoulder will never feel fully healthy again. It’s time to take a second look at that shoulder and what may be causing your pain!
The prevalence of shoulder pain in the general population is estimated to be 15.4% in woman 24.9% in men according to a recent epidemiology study (Pribicevic, 2012). Injuries and dysfunction of the shoulder falls into four categories; fractures, joint injuries, muscular injuries, and functional imbalances. Fortunately the first three categories are easily identified with orthopedic testing, x-rays, MRIs, and most often can be successfully managed. The problem is that when you fall into the fourth category, functional imbalances, you shoulder problem can be easily overlooked. The medical community at large has focused mostly on pathologies of the shoulder and less on imbalances. It is these functional imbalances of the shoulder that can plague a lot of us, sending us in circles from one treating provider to another with no help. It’s time to understand what is going on!
Let me first start by giving you a brief anatomy lesson of the shoulder region. The shoulder is comprised of three bones, the humerus, scapula, and clavicle. The humerus, the upper arm, fits like a ball and socket into our scapula aka shoulder blade. This is called the glenohumeral joint. The scapula connects to our backs and forms the scapulothoracic joint. The clavicle, aka collarbone, connects to the scapula at the acromion, a bony process that extends outward from the scapula. This union between the acromion and clavicle forms the acromioclavicular joint, better known as the AC joint. At the other end of the clavicle is the sternum, aka breast bone. This makes up the bones and joints of the shoulder. Then you have your rotator cuff muscles that provide stability and mobility to upper arm at the glenohumeral joint. The glenohumeral joint, has more mobility that any other joint in our body.
Surprisingly, most shoulder functional imbalances are not located at the shoulder but the muscles surrounding the shoulder. Commonly people have what is known as upper cross syndrome. The shoulders that are rolled inward, a head that protrudes forward, and a rounded back. It’s no surprise with today’s culture of tablets, cell phones, and increase work at a desk, we are seeing a rise in the prevalence and early onset of this functional imbalance. When you carry your body this way, you chest muscles, the pectoral muscles, become contracted pulling the shoulders forward and inward. You muscles in the front portion of your neck become inactive and your head slumps forward. You actually decrease your lungs capacity and the ability for you to breath deeply. Your back muscles, rhomboids and serratus anterior, which are responsible for holding the scapula firmly against the back turn off. The traps and levator scapula become tight, and the scapulae migrate up, outward, and internally rotate. This is what we call an anterior tilted, lateral translated, internally rotated scapula. This is functional imbalance of the shoulder, it’s a problem, and many of you reading this are experiencing this to some degree now.
The joints of the shoulder, the glenohumeral and acromioclavicular are now wearing at each other. The space under the acromion has become diminished and inflammatory processes, swelling, and degeneration start to set in. Left uncorrected the degenerative changes continue to erode at the shoulder and rotator cuff repairs, acromioplasty, and shoulder arthroscopy may become common procedures for some. Most of this can be avoided if the problem is address early and restorative measures and begun to return the shoulder and body back to balance. Corrective exercises, stretches, adjustments, and myofascial release can reduce and correct these functional imbalances. Having a knowledgeable physician, doctor, or therapist familiar with treating functional imbalances is key when choosing a provider. We are especially good at identifying and correcting functional imbalances of the whole body at our chiropractic office here in Jacksonville, Florida. It’s what we do.
Some great first steps to take if you suspect you may be suffering from upper cross syndrome is start some corrective exercises. You can see some being demonstrated here; https://youtu.be/7l2TLBkFnP0. If you feeling extra charged up, you can also try these scapula mobility exercises done here; https://youtu.be/hzozw2Aso3M. Doing these will help not only help you stand up taller, but also reposition the scapula and shoulder, reducing the functional imbalance and providing some much needed relief.
Remember there are many conditions that can affect the shoulder, but in summary, if neither of the first 3 categories are an issue, you fall into the fourth category of functional imbalance. Please see someone familiar with treating these type of issues and at minimum start trying some of the exercises I have linked above. There are may other videos on YouTube you may find useful for correcting functional imbalances of shoulder and body. Kelly Starrett’s channel is a great place to start. I hope you enjoyed learning about the shoulder and remember to enjoy the day!
-Dr. Colt Andrea D.C.
National Board Certified Chiropractor located in Jacksonville Fl.
Mario Pribicevic (2012). The Epidemiology of Shoulder Pain: A Narrative Review of the Literature, Pain in Perspective, Dr. Subhamay Ghosh (Ed.), ISBN: 978-953-51-0807-8, InTech, DOI: 10.5772/52931.
Ever have aching pain in your muscles that seems to never go away? You tried taking pain medications, but realize you are only getting temporary relief. Maybe you’ve been adjusted by a chiropractor or seen a physical therapist and yet the pain keeps coming back! You might have even had X-rays or MRIs, yet the source of your pain remains a mystery. You might have myofascial pain syndrome.
Did you know that myofascial pain could be the root cause of most chronic pain cases! Researched showed that among 283 consecutive admissions to a comprehensive pain center, 85 percent were assigned a primary organic diagnosis of myofascial syndrome (Fishbain et al., 1986). This diagnosis was made independently by a neurosurgeon and a physiatrist based on physical examination for soft tissue findings as described by Travell (Travell and Rinzler, 1952; Simons and Travell, 1983). Another study suggested that 31% of visits to internal medical group practices for acute pain were actually myofascial pain (Skootsky, 1986). So what exactly is myofascial pain syndrome?
Simply stated, myofascial pain syndrome is a chronic pain disorder. Pressing on sensitive spots within your muscles causes pain locally and or pain in areas that appear to be unrelated. Anatomically speaking, myofascial is a strong, dense, flexible, connective tissue that covers all the muscles and bones of our body. It aids in support of our musculoskeletal system. Underneath this fascia covering, trigger points can form. A trigger point is a localized contraction of muscle fibers in the muscle belly. To explain this further, if the whole muscle was to contract, we would call that a cramp or muscle spasm. When just a small portion of the muscle spasms, we call it a trigger point. They usually range from the size of a pea to a large marble and can be felt just underneath the skin, palpable in the muscle. When this small patch of localized muscle contracts, it cuts off its own blood supply and becomes toxic, full of lactic acid and metabolic waste, unable to release. Nerves located at the surface in and around the area become hypersensitive and create large amounts of noxious pain. When a collection of these trigger points form in a given area, we now call this myofascial pain syndrome. Cumulatively, this generates feelings of aches, burns and other strange sensations that generally make you feel a surprising amount of discomfort, irritation, and overall yuck.
You may be asking yourself why we get trigger points in the first place? The formation of trigger points can come from repetitive strains, poor posture, overloading a muscle, and injury. A lot of us have jobs where we perform repetitive motions daily, not to mention, while spending large amounts of time in a seated position.
Fortunately, treating myofascial pain syndrome can be quite effective if the doctor or therapist is knowledgeable and utilizes a hands on approach. All too often, patients will end up having trigger point injections done when a more simple and cost effective therapy could have been done. When in the right hands, the release of trigger points can be done with myofascial release and other soft tissue techniques. An example would be a combination of direct pressure, and moving a particular muscle through its full range of motion. This will cause the trigger point, that focal tight constricted muscle, to release and resume normal healthy function. This can be done several times in an area to help remove the trigger points and resolve myofascial pain syndrome. It can also be done at home once the patient has a understanding of the basics and what they are trying to accomplish. Typically a few sessions will resolve most myofascial pain syndromes. In cases where more work is needed, outside exacerbating factors may need to be addressed.
Like always, I hope this read has been a informative and entertaining. If you or someone else you know is suffering from what you suspect is myofascial pain syndrome, please refer them to us or someone else capable of helping them. And always, if you liked this article please share! Thank you.
-Dr. Colt Andrea D.C.
National Board Certified Chiropractor located in Jacksonville Fl.
Fishbain, A.A., Goldberg, M., Meagher, B.R., Steele, R., and Rosomoff, H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 26:181-197, 1986. [PubMed]
Skootsky, S. Incidence of myofascial pain in an internal medical group practice. Paper presented to the American Pain Society, Washington, DC, November 6-9, 1986.
Travell, J.G., and Rinzler, S.H. The myofascial genesis of pain. Postgraduate Medicine 11:425-434, 1952. [PubMed]
Chiropractic is a great health care profession with lots of stigma, misinformation, and controversy surrounding it! I hope to explain and present a clearer picture for you about what Chiropractic is and what a Chiropractor, a practitioner of Chiropractic does.
Chiropractic got its roots in Davenport, Iowa 1895, when a healer named Daniel David Palmer stumbled onto an amazing discovery. D.D. Palmer, as he is commonly referred to, was working with a patient named Harvey Lillard who had been deaf for 17 years. D.D Palmer had Harvey Lillard lay on a table with his back facing up so that he could examine him. D.D. Palmer made an observation that one of the bones, a thoracic vertebrae, was much more prominent relative to the other vertebra, so much so that it was “out of place.” D.D Palmer instinctively pushed on that vertebrae and in his words “wracked it back into position” and made what we call today an Adjustment. What happen next gave birth to a new health care profession, Chiropractic, as Harvey Lillard came up from the table, he commented on hearing a horse drawn cart down the street! This was the first time Harvey Lillard had heard anything clearly in 17 years, pretty amazing stuff!
D.D. Palmer recognizing what had just happened, the connection between one’s spine and health, began to dig deeper and founded the profession of Chiropractic (Latin for “done by hand.”) D.D Palmer and later his son B.J. Palmer continued to evolve and develop the understanding of this connection between one’s spine and their health. They recognized very early that the misalignments in the spinal column, commonly referred to as vertebral subluxation by Chiropractors, can influence the nerves located at the vertebral level and adversely affect your health. At that time, Chiropractic was an emerging health field, unfortunately, the American Medical Association (AMA) did not approve. They systematically and deliberately tried to destroy and discredit Chiropractic and Chiropractors by locking up Chiropractors in jail in the early 1900’s to 1950’s, and instructing Medical Doctors not to refer or associate with them. This was a massive smear campaign that can unfortunately still be felt today by the attitudes of people who have never been to a Chiropractor, yet refer to them as a quacks. Fortunately, the practice of the AMA came to a halt in a historic verdict against the American Medical Association by 10 Chiropractors when On September 25, 1987, Judge Getzendanner issued her opinion that the AMA had violated Section 1, of the Sherman Act, and that it had engaged in an unlawful conspiracy “to contain and eliminate the chiropractic profession.” (Wilk v. American Medical Ass’n, 671 F. Supp. 1465, N.D. Ill. 1987). She further stated that the “AMA had entered into a long history of illegal behavior.” She then issued a permanent injunction against the AMA under Section 16 of the Clayton Act to prevent such future behavior. You can read more about it here.
Today, Chiropractic has grown to be the largest healthcare profession outside traditional medicine! It is becoming more mainstream everyday with athletes wanting a more hands on approach, people looking for medical options outside medication or invasive procedures, and health conscious people dissatisfied with today’s current health care system. Chiropractors attend a 3-4 year postgraduate program, rigorous in the health sciences such as anatomy, biology, physiology, biochemistry, and many more just to name a few and then spend the last year or two learning patient care, management, and the art and science of Chiropractic. They must then pass a series of national boards examinations to earn a Doctorate of Chiropractic degree.
Chiropractic is widely accepted in today’s current health care system as a leader in treating musculoskeletal disorders of the body with a focus on the spine. Chiropractors treat issues arising from nerve entrapments, sprain/strained muscles, joint stiffness and pain, headaches, faulty biomechanics, and much more. Chiropractors, are being utilized more and more as the first line of defense for issues surrounding the musculoskeletal system. Some Chiropractors have a more focused practice around Nutrition, Pediatrics, Neurology, and other specialties to better serve their patients needs. In fact, Sidney Crosby, regarded as one of the best players in the NHL and Captain of the 2014 Canadian Olympic Ice Hockey Team at the Sochi Olympics, sustained a concussion as a result of hits to the head in back-to-back games. The injury left him sidelined for ten and a half months. However, after playing eight games in the 2011–12 season, Crosby’s concussion-like symptoms returned in December 2011, and he did not return until mid-March 2012 after extended treatment by neurologists at UPMC and Chiropractic Neurologist Ted Carrick, whom Crosby credits with helping him return to hockey. You can watch a press conference about it here.
What to expect when being seen and treated by a Chiropractic Physician? If you have never been to a Chiropractor, this may not be what you have been used to in the past when visiting your primary doctor. A Doctor of Chiropractic will usually first engage with you about your primary concerns, typically many people see a chiropractor for back and neck pain, but Chiropractors can treat the entire body. After conversing with you, an examination usually follows that involves range of motion observations, gently palpating the affected and surrounding areas, and a few specialized orthopedic test to elicit signs and symptoms that revolve around your condition. In this exam, it is common to raise one’s legs when evaluating back pain for signs of nerve tension, disc pathology, joint pain, and or muscle aches. There are countless other orthopedic test that may be used to better help understand your condition and determine what the primary issue is. At times, x-rays may be needed to evaluate the spine or joints in further detail. Usually after an examination the Chiropractor will discuss with you the nature of your condition and recommend an appropriate treatment plan.
Treatments can vary from office to office and the type of condition you may be experiencing. There’s a host of therapies that can be used, to name a few: spinal adjustments, decompression therapy, cold/hot packs, cold laser therapy, diathermy, therapeutic ultrasound, electric muscle stimulation, intersegmental traction, massage therapy, myofascial work, instrument assisted soft tissue mobilization, and stretching and strengthening exercises. Your Chiropractor will recommend a treatment that is appropriate for you and your condition. Typically a visit after the initial exam will be 20-40 minutes depending on the severity of your condition, and may include an adjustment and 1 or 2 additional therapies. Many people find these visits very beneficial, enjoyable, and like the way they feel after being adjusted, usually reporting that they “feel lighter!” With a series of treatments, usually lasting 2-3 weeks, most conditions can be resolved. Chiropractic has been a great success story for many individuals when they had no where else to turn to and will continue to be so in the future!
I hope you found this article informative, entertaining, and that I was able to clear up any of the confusion surrounding Chiropractic. If you have any questions please do not hesitate to ask, you can leave comments down below or contact our office. Also if you or anyone you know is experiencing musculoskeletal complaints, injuries, accidents, or are just looking for a new Chiropractor, please call our office for complimentary consultation!
-Dr. Colt Andrea D.C.
National Board Certified Chiropractor located in Jacksonville Fl.
Having a disc herniate, bulge, slip or rupture can be a very trying time for the person experiencing it. There is a lot of information out there about what causes disc pathology and what to do when experiencing these issues, some of it good and some bad. I have treated hundreds of people with disc herniations with great results and what I can tell you is that there is no one cookie cutter approach for everybody; it takes a careful examination, appropriate therapeutic modalities, rehabilitation, and time to ensure a successful, long-lasting path to recovery.
Why does the disc herniate in the first place? The anatomy of your disc, also known as the intervertebral disc, gives us clues to this. The disc, located between the vertebrae of the spine, acts very similar to a supporting load bearing cushion for our spine. Lots of people are familiar with the analogy of the jelly doughnut, and that when a disc ruptures it’s like the jelly of the doughnut squeezing out – which is a great, simple, and fast explanation to use in office. More correctly though the disc is comprised of many concentric ligamentous fibers known as the annulus fibrosus. These ligamentous fibers run at opposing angles to each other in multiple layers to make a very strong and resistant ligaments exterior boundary that contains the nucleus pulposus. The nucleus pulposus would be the jelly from our example earlier and the annulus fibrosus is the doughnut that encases the jelly, so to speak. The nucleus pulposus is composed of a loose network of collagen fibers and water that make it elastic and jelly-like, able to evenly distribute the forces and pressures applied to the disc from everyday life.
So where does it go wrong? The annulus fibrosus, these concentric, layered, opposing fibers, are very strong when force is applied in a manner that they were designed to handle the stress; but with any good design, improper use can and will lead to failure. This means improper lifting, repetitive flexing and twisting, overuse, dehydration, prolonged sitting or driving, a sedentary lifestyle, and of course, injury can cause failure. The annulus fibrosus begin to tear and separate between the fibers and layers. It may be something like a little back pain here, a sore ache another time or a noticeable full on episode of swelling, deep, achy, sharp, I-need-a-day-off-from-work type of pain. These microscopic tears create opening, and over time, with multiple episodes of tearing and separation of the layers and fibers, the nucleus pulposus is finally at a point where is has channeled through these multiple tears and fissures of annulus fibrosus that you are left with only one or few supporting layers left! This can take years to happen and is most common in our 30’s to 50’s. Finally, you drop your razor in the morning or sneeze during the day and that last layer of the annulus fibrosus lets loose and the contents of the disc, the nucleus pulposus, spill out of the disc under pressure and into the spinal cord canal where a cascade of biological events happen leaving you with a great deal of pain, swelling, and inflammation. This is also a common cause of sciatica due to the close proximity of the spinal nerve roots to the disc.
This is the point where it may be confusing for some: your back is fine and suddenly goes out while performing a simple, ordinary task that has not been an issue for you in the past, but hopefully, now you can understand and see how all previous events of back pain, bending at the waist, and a sedentary lifestyle have added up and accumulated to cause the perfect storm. Life may come to a screeching halt at this point as it’s very hard to do anything when your “back is out!” This is a very unhappy place to be right now, but rest assured there is a way to get your feet back under you and a light at the end of the tunnel.
Chiropractic care has been demonstrated to be a safe and effective means of treating and disc herniations. Gentle spinal adjustments can be done to help increase joint mobility, improve physical function, and relieve joint pain. Passive care such as ice, ultrasound, and electrical muscle stimulation may also be used to modulate pain, reduce swelling, and relax the surrounding muscles and tissues. After the initial phase of acute pain and swelling it may be appropriate to move from passive therapies to more active physical therapies such as active rehab focused around core development and strength with progression to encourage more favorable long term outcomes. At times adjunct therapies such as spinal decompression may be used in cases where progression has stalled or is slower than we would like, each case is different and is treated uniquely in our office. At times, it may be necessary to see a physician specializing in pain management for epidural steroid injections to help manage pain and swelling. In most cases this is not necessary, but can be very beneficial. With time, proper care, and the knowledge you will learn here at our office, your disc will heal and you will be back to the activities you like with the tools necessary to maintain a strong and healthy back!
-Dr. Colt Andrea, D.C.
Shoulder pain includes any pain that arises in or around your shoulder. Shoulder pain may originate in the joint itself, or from any of the many surrounding muscles, ligaments or tendons. Learn what may be causing you your pain and how we can manage your symptoms and restore function so that you can get back to doing what you like to do best!
Do you suffer with back pain? Learn the tools to manage your symptoms and improve your quality of life!