RSSWhat is Leg Length Inequality?
What is Leg Length Inequality?
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How is Leg Length Inequality Diagnosed?
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Joint pain
Joint pain can occur anywhere in your body and usually includes stiffness or restricted motion and inflammation. As long as there is no fracture, infection or disease process involved: restoring movement and reducing inflammation is the most direct route toward resolution. Think of two hinges. One is shiny and right off the shelf and the other is well used, rusty and creaky. So if you had the rusty, creaky hinge on your garden gate, you would spray it with WD-40 and work the hinge until it moved smoothly. It may not look like it came off the shelf, but it would function as if it did and last a long time.
We are basically biological machines with hinges (joints), that can either function smoothly like shiny hinges or stiff and creaky like the rusty one. Chiropractic adjustments or manipulation of stiff, creaky joints in the body restores the movement and joint health, just as you restored the movement and “health” to the garden gate hinge … thereby getting rid of the inflammation and pain. Whether the pain has been there a day of a year, the application of this oldest form of medicine is just as effective and available to you right now.
Arm and leg pain
Arm and leg pain if sharp in nature and following a “linear” or line-like pattern can be caused by pressure on, or damage to a nerve. Most typically it is a “radiculopathy” which is irritation or stimulation of the sheath surrounding the nerve roots as they exit the spine. This can be caused by “stenosis,” which is thickening of the bone around the opening for the nerve roots, disc herniations or even compression of the nerves in the musculature of the arm or leg. The most important thing one needs when experiencing these symptoms is a good diagnosis. Once it is clear where the pain is coming from, appropriate treatment or a referral can be provided. Chiropractic care seeks to reduce the pressure on the nerve, reduce the inflammation and pain, restore the function of the related spinal area and strengthen to prevent re-injury.
Shoulder Pain and Injuries
Shoulder Pain and Injuries
Learn more: watch the video or read the transcript below.
The Structure of the Shoulder
The shoulder is a complicated joint. It moves in many directions, and it can be very stubborn when it starts to become painful. The first thing a person wonders when they experience shoulder pain is “What’s going on with my shoulder?” Since the term rotator cuff is so common, many patients come in to my office and ask if they might have a rotator cuff tear. 
First let’s talk about the structure of the shoulder which is one of the most movable joints in the body, but not the most stable. The way the shoulder is structured, you will see that it is basically a ball-and-socket joint. The ball-and-socket joint sits beneath a bony ceiling that is made up by the clavicle and the acromion, which is a bony projection at the outer edge of the shoulder blade. When you reach and touch your shoulder, you will feel that bony ceiling. Between the bony ceiling and the top of the ball-and-socket joint is a very complex and dynamic environment. Contained in this area is a group of tendon
s, blood vessels, and other structures, which include fatty tissue and bursa.
The bones of the shoulder are held in place by tendons, muscles and ligaments. The five tendons of the rotator cuff, which hold the bones of the shoulder in place, begin as muscles that come up and insert into the ball part of the ball-and-socket joint. Those muscles and tendons provide us with all of the fine motor movements of the shoulder.
Tightness of the Shoulder
Many of my patients with shoulder pain come to see me because they are experiencing a limited range of motion, pain that occurs with everyday activities, and pain while sleeping. This can be caused by a person creating an impingement, or pinching, in their shoulder just by tensing the shoulder during activities. The repeated tensing of the shoulder can begin to shorten and tighten the musculature that houses the shoulder, and it can create a condition called Impingement Syndrome. This is when the tendons can be trapped under the acromion, and the ball-and-socket joint is pulled and starts to rub and grind away at the tendons.
Tendon Problems of the Shoulder: Descriptions and Symptoms
- Tendonitis
- This is simply inflammation of the tendon. This not only occurs in baseball pitchers who constantly use their shoulder, but can be a result of injury or simply from aging.
- Tendinopathy
- This when we start getting tearing of the tendons themselves. The tears come in four grades:
- Grade one is an inflammation or some very, very fine tearing of some of the fibers in the tendon.
- Grade two has a little bit more damage to the tendon, and it’s starting to get some depth to the tear itself. The person is probably already starting to have some problems sustaining weight with that shoulder motion.
- Grade three is when the tendon has a fairly deep tear to it, and the person is probably going to have some real difficulty taking the shoulder through ranges of motion.
- Grade four is where the tendon is torn completely in two.
- This when we start getting tearing of the tendons themselves. The tears come in four grades:
Diagnosis and Treatment
The first step in dealing with shoulder pain, as with any large joint, is getting a correct diagnosis. A determination needs to be made as to whether it is a muscular issue; a tendonitis, an inflammation of one or more of the five tendons of the shoulder; a tendinopathy with tearing or a combination of issues.
That’s where the diagnostic process comes in. In our office we perform testing to make a determination about which category a patient’s pain or injury is in.
When a patient is in the early stages of these conditions, our treatments includes rest, ice, massage therapy, physiotherapy in the office, and perhaps manipulation of the neck or the shoulder. We will usually carry out about a two-week course of care as long as we see improvement and we are convinced that we are helping. If there is no improvement, we will provide you with a timely referral. We have referred patients for physical therapy, massage-therapy, and if needed, for an MRI and then on to the orthopedic surgeon for a consultation.
If you would like further information on shoulder pain or problems, please go to our website, http://www.wakeforestchiropractic.com. To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.
Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302
November 19, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Color images are courtesy of the US Library of Medicine and the US National Institutes of Health
Barefoot Running, plantar fascitis, achilles tendonitis, foot, knee, ankle problems
A Basic Overview of Barefoot Running and its Benefits
Learn more: watch the video or read the transcript below.
Transcript of Video:
Barefoot Running
This video showcases a barefoot running clinic conducted by Dr. Phelan at Wake Forest Chiropractic. Strengthening and reconditioning the feet are part of our protocol for treating plantar fasciitis, Achilles tendonitis as well as foot, knee and ankle problems. To restore the integrity of the feet, we run on trails in as close to bare feet, as possible. The “shoe” that I have found to be as close to bare feet as possible is the Vibram fivefingers™. They are running shoes that are designed specifically for running while wearing as little material, so that your feet are protected, and yet retain the natural flexibility they would have if you were not wearing any shoes at all.
Vibram Brand fivefingers™ Barefoot Running Shoes
People have been running barefoot or in thin soled shoes such as moccasins until the introduction of modern running shoes in the 1970’s. The running shoes generally have extra padding at the heels and therefore change the way we walk and run. When shod, the heel bears the most strike force, and that is then sent up the leg to the knees and hips. In barefoot running, the balls of the feet strike the ground first. Therefore, the foot and lower leg absorb the impact and turn this energy into a forward, springing motion.
Key Points for Barefoot Running
You can stub your toes in “barefoot running shoes”. It’s not that bad, so don’t be too nervous about that. It is helpful to build up a few calluses on your feet and also to transition slowly to increase the strength of your foot and calf muscles. Take your time, and walk if you have to and when you get tired.
Lean your weight forward. You’re going to run differently than you have been in your running shoes. What will happen is your strike will be forefoot back, instead of heel striking down and forward. It’s very different. Your engine is in your lower leg and thigh. There’s not a whole lot of drive muscle in your shin, but it does exist in your calf and thigh. Conversely, on the hills, what you’ll be doing is landing forefoot first and your drive is going to be coming from the back of your leg in the gluteus muscle instead of using all of the quadriceps (thigh muscles) to push you up and forward.
Dr. Phelan's Barefoot Running Clinic
When you begin, bend your knees and keep them bent throughout the run. This should help transfer your weight to the front of your feet and decrease the possibility of landing heel first. Also, take shorter strides than you did in your running shoes – you may even find that this happens naturally.
Please keep in mind that there is an unwritten rule on trails: if you want to pass someone, always up on their left and just let them know you’re coming by.
NOTE: In the video, you may see that many of the runners are not landing forefoot first. That is because this is a clinic for beginners. Landing heel first is a hard habit to break.
Read more about how barefoot running can help symptoms of plantar fasciitis.
If you would like further information about barefoot running, or if you’re interested in speaking with us, please go to our website, http://www.wakeforestchiropractic.com. If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to hear from you. Thank you.
Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302
October 20, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Plantar Fasciitis
Plantar Fasciitis: Causes and Treatments
Learn more: Watch the video or read the transcript below
Transcript of Video:
Plantar Fasciitis
Plantar fasciitis is the inflammation of the connective tissue on the bottom of the feet. Methods of treatment include rest and ice, taping of the foot, orthotics, massage therapy and cortisone injections. We need to understand the source of the plantar fasciitis, so that we can work on healing it – perhaps even on your own.
The origins of plantar fasciitis come from wearing footwear and walking on hard, flat surfaces. Improper footwear can destroy the arch in our feet, and that can lead to inflammation of the plantar fascia.
Approximately 25% of the joints and bones in our bodies are dedicated to the structures of the feet. That being said, the foot is perfectly designed to handle our weight and gravity, to propel us and to support us without the use of footwear. That is what the foot is designed for.
In our current culture in the USA, we put our feet into many different types and styles of shoes. When we walk on hard flat surfaces, the muscles and the connective tissue in the feet begin to weaken and break down. 
What is plantar fasciitis? The plantar fascia is a connective tissue that is on the bottom of the foot, and it provides us with support. It also provides us with the information about what is happening in the feet because it is very pain-sensitive.
The plantar fascia is providing the arch support to the foot. Arches are designed to support downward forces from above. If you want to break an arch down, you press up on it from underneath. This pressure causes the arch to lose its integrity, and consequently other structures are needed to support it.
This image shows footprints of three different feet. They are the imprints that 
would be made if a person stepped on a piece of wet concrete. The one on the far left would be considered fairly normal, the one in the middle would be considered a flat foot, or a foot that is pronated. The last is a foot that has a very high and rigid arch.
When we are wearing the modern running shoes with very supportive arches, what we are doing is artificially supporting the arch, breaking down the integrity of it, and allowing the plantar fascia to take more abuse. Therefore, we have to be very careful with the type of footwear we use and the aggressiveness of the arch support we’re using in them.
Zola Budd, a professional athlete, competing in bare feet.
“Can you improve your arches once they do start to collapse? Can you get rid of the plantar fasciitis?” These are the questions that people ask when they come in to our office suffering with foot pain. Yes, you can improve the arch and, yes, you can get rid of the plantar fascia pain. Our treatment includes using a combination of methods that were mentioned earlier: rest and ice, taping to support the foot, orthotics when necessary and massage therapy. If cortisone injections are needed, we will provide you with a referral to the appropriate physician.
Recently we have begun to have people train outside on uneven surfaces such as trails. Because we don’t want them to be at a great risk for cutting their feet, we recommend that they wear a barefoot running shoe like Vibram fivefingers™. It is a slim running shoe that looks like a rubber booty with toe articulations.
At Wake Forest Chiropractic, we are taking our tri-athletes and high-level runners and moving them off of the hard services, out of the highly-supportive running shoe, and moving them onto a trail in these running shoes.
This is an image was taken from a video we shot of a running clinic we recently held on in Raleigh. We had a group of trainers and therapists who participated in a barefoot run through three miles of trails. The purpose of this clinic was to assist these professionals to become better coaches to their patients.
Barefoot running is a technique that is coming to the forefront of running itself. Many people who have begun barefoot running have been able to restore some of their problems with the arches in their feet. It provides another option for professionals to offer their patients to help to rehabilitate the feet.
The most important thing a person with foot pain needs is an accurate diagnosis. If you come to see Dr. Shawn Phelan at Wake Forest Chiropractic in Wake Forest, NC, he will provide you with a proper diagnosis, and if needed, proper treatment or a timely referral.
Read more about how barefoot running.
If you would like further information about plantar fasciitis and barefoot running, or if you’re interested in speaking with us about your foot pain, please go to our website, http://www.wakeforestchiropractic.com. If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to hear from you. Thank you.
Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302
October 20, 2009 © copyright 2009-2010 Wake Forest Chiropractic.
All rights reserved.
The images showing the anatomy of the foot are courtesy of the US Library of Medicine and the US National Institutes of Health
Knee Pain and Injury
Getting the Right Diagnosis for your Knee Pain
Learn more: watch the video or read the transcript below.
Transcript of Video:
Knee Pain and Injury
Hi, I am Dr. Shawn Phelan and I’m here to talk with you about knee injuries or knee complaints. In our office we often have people coming in thinking they have arthritis or an injury involving their knee.
The first thing we need to do is determine a correct diagnosis. So, the purpose of this video is to give you a little information and some idea of the structures involved in knee conditions and how they might be addressed.
Front view of knee
When you look at the knee itself from an anatomical standpoint it is fairly simple. The femur attaches to the tibia and the patella or knee cap sits in front. Stabilizing the patella on the outside and the inside are the medial and lateral collateral ligaments – the ligament tissue is in purple. In between the femur and the tibia is a structure called the meniscus, this is a fibro-cartilaginous type of material that acts as a cushion between the femur and the tibia.
When we look at the leg or knee from the side, what we see is the patella, or the knee cap, sitting in front of the femur and the tibia. It is connected to the musculature in the front of the leg and it is connected to the tibia via the patellar tendon.
Image courtesy of the US Library of Medicine and the US National Institutes of Health
Inside the knee what we have are the cruciate ligaments (ACL). They are called cruciate because they are in the shape of a cross. Then, in-between the femur and the tibia, again we have our meniscus. So this is the universe as far as how the knee is built and how it can be injured.
In injuries, what we will typically see is damage to the ACL or to the medial and lateral collateral ligaments. It is possible to simply strain the medial collateral ligament and not injure the meniscus but, often when you injure the medial collateral ligament, or the ligament on the inside of the knee, you will also injure the meniscus since they are attached.
If you injure the lateral collateral ligament, or the ligament on the outside of the knee, you can often do so without affecting the meniscus because they are not attached.
You will often hear the term meniscal tear, or you will hear the term cruciate ligament tear – anterior cruciate ligament tear in particular. These are the deeper injuries within the knee. Most often when a person is having knee pain and comes to our office, it is usually because they have inflammation of the musculature attaching to the knee cap or they’ve got inflammation to the patellar tendon, which are both superficial structures. That is fairly easily dealt with if we work with the inflammation in these structures.
Deep inside the knee, the cruciate ligaments can be injured during trauma. This is typically going to require an MRI and a referral to physiotherapy or possibly to a surgeon for repair of that structure.
Image courtesy of the US Library of Medicine and the US National Institutes of Health
The meniscal injuries can come in a number of different forms. They can simply come in the form of small cracks and tears due the trauma or degeneration or they can be torn straight through. You can also get what are called bucket-handle tears, where a little piece of the meniscus actually peels backwards and kind of flip-flops around. That is where the knee will lock and click and cause problems intermittently.
I have talked about many different conditions some of which require surgical interventions or physical therapy. Other conditions may just require a look at the feet, or their daily lifestyle habits.
The most important thing a person with knee problems needs is a good diagnosis. If you come to see us we will help provide you with a proper diagnosis, and if needed, proper treatment or a timely referral.
If you would like further information on knee pain or problems, please go to our website, http://www.wakeforestchiropractic.com. To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.
Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302
October 13, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
