The patients of Wake Forest Chiropractic come from all over the Triangle area, from as close as Wake Forest, Wakefield, and Raleigh to Chapel Hill, Durham and beyond.
Why do some patients travel 30+ miles to see Dr. Phelan, when there may be other chiropractors within a 5 mile radius?
One word: Results.
For 18 years, Dr. Phelan has enjoyed helping seniors, adults, teenagers, children, and infants to get an accurate diagnoses and to heal quickly.
It is said that it is easier to stay well than to get well. That is very true. If you neglect the health or maintenance of anything it begins to break down. If you do not see the dentist periodically for your teeth will decay. If you neglect preventive maintenance in your vehicle it will break down. The same applies to your spine, your neuromusculoskeletal system, vascular and digestive systems, immune and endocrine systems. You are a fascinating and complicated biological machine and in order to maintain wellness you have to invest some resources in it.
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.
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 tendons, 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.
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
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
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.
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
Learn more: watch the video or read the transcript below.
Transcript of Video:
What Makes Fish Oil and Omega-3 so Special?
There are a lot of questions about nutritional supplements such as; which ones to take, when are they appropriate and what is the correct dosage. Today, we will concentrate on fish oil because of its current popularity and its many potential benefits.
Why should we take it? Why should we not take it? How does it help us?
If we look at the length of time that we’ve been consuming food on this planet as a species, it is only the last ten thousand years that we’ve been eating agriculturally produced grains. Imagine that the entire pencil represents the length of time that modern humans have existed, and that the eraser represents the length of time that modern humans have been eating grains, which is just ten thousand years.
Prior to this period of time we were hunter/gatherers who consumed roots, tubers, berries and meat, when we could bring it down. When we developed grain, it helped us to become stationary. We could stay in one place; we didn’t have to travel with the seasons and with the food which helped us become civilized. The problem with that is our gastrointestinal tracts have not caught up to the need to process these grains.
What happens when we eat a lot of grains and pastas and baked goods? These foods are all essentially made from grains, and the grains produce something in our bodies called omega-6 fatty acids. We should have some omega-6 fatty acids in our systems, but not an excessive amount. What we should have is a ratio of omega-3 fatty acids and omega-6 fatty acids which is equivalent to about a 1:1 ratio. That’s what we are looking for and that’s what our bodies need – the omega-3 fatty acids. We are used to hearing that we should eat our fish, such as salmon, to protect our hearts with the omega-3 essential fatty acids, and that is true.
The ratio that we are looking for is 1:1 and that was the ratio that we had when we were hunter/gatherers before we started producing grains. In the USA, our diets are very heavily laden with grains. The reason that is a problem is it produces the omega-6 fatty acids in much higher ratios than our bodies need.
If we look at the American diet, what we see, instead of a 1:1 ratio of omega-6 to omega-3 fatty acids, are ratios as high as 60:1. The problem with that is the excessive omega-6 fatty acid will produce arachidonic acid (an essential fatty acid found in most animal fats). This fatty acid crosses our cell membranes and creates prostaglandins (an unsaturated fatty acid found in all mammals), which in turn creates inflammation.
Let’s look into what happens with inflammation, and the reason we need fish oil. The inflammation that we are talking about isn’t just muscle inflammation, a stiff neck, or tight muscles. This inflammation is occurring on a cellular level in our bodies and is driving certain diseases such as heart disease. There are other conditions that we may not commonly associate with this ratio imbalance such as: obesity, diabetes, hypertension, cancer, neurological disorders, and many others.
This country, although it is one of the wealthiest on the planet, is leading the world in these diseases. So how do we stop this from happening? We need to realize that we should consume less grain – safely one to two servings per day. If you are eating a bowl of cereal for breakfast, a big lunch with sandwich bread, and a bowl of bowtie pasta and garlic bread for dinner, then you are consuming an a lot of omega-6 fatty acids. As discussed above, too much omega-6 will create arachidonic acid which leads to inflammation, and imbalanced ratios. The consequence can be the production of the same diseases you have seen in your ancestors such as high blood pressure from arteriosclerosis and heart disease.
What can we do about it? One proactive step we can take is to supplement our diets with fish oil. This will allow us to continue to consume grains and protect ourselves with the fish oils’ rich omega-3 fatty acids. The EPA and DHA, two fatty acids found in fish oil, are going to protect the cell wall. Protecting the cell wall will then reduce the amount of arachidonic acid that is able to enter the cell. Less prostaglandin will be made and therefore, the amount of inflammation is reduced.
Not everyone should take fish oil. Excessive dosage of fish oil may create allergic reactions and adverse side effects on the body. Further, fish oil can be problematic in many conditions and hence, it is necessary to take fish oil supplements cautiously. You should consult a doctor or physician for the correct dosage.
To summarize, if you are going to consume grains, which most of us are, do it within limits and also take fish oil in the correct amount. Remember to check with your physician before you begin adding any kind of supplement to your diet.
If you’re interested in speaking with us about fish oil or other supplements, 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 help you. Thank you.
Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302
The Importance of Obtaining the Correct Diagnosis for Jaw Pain
Learn more: watch the video or read the transcript below
Transcript of Video:
Let’s look at TMJ or TMJ dysfunction (TMJD or TMD). Temporomandibular joint disorder is a condition that can cause popping, clicking, or pain in the jaw. Other symptoms associated with TMJD are headache, ear pain, ringing in the ears, neck pain, shoulder pain, dizziness and nausea.
There is a significant level of confusion regarding this condition, and the person suffering from jaw pain often wonders whether they have a muscle problem, joint problem, or problems with their teeth. Many TMJ patients will visit multiple healthcare providers in their search for an accurate diagnosis and the proper treatment. Unfortunately, this is very common, and the process may take years. In turn, the symptoms may become more severe, money and time are unnecessarily wasted, and the patient may become confused and frustrated.
It is crucial to find a healthcare provider who has strong diagnostic skills and an open mind to that can see issues beyond their own specialty. Once you have a correct diagnosis, your healthcare provider can recommend that you see the proper specialist such as a dentist, an orthodontist, a chiropractor or an oral surgeon.
TMJ Anatomy
This image shows the anatomy of the temporomandibular joint. The lower jaw is called the mandible. Above the joint is the part of the skull referred to as the temporal bone. The joint where the temporal bone connects to the mandible make up the T and the M of the TMJ. The J is simply the joint. Everyone really has two TMJs, one on each side in front of your ears.
What we’re really talking about here is temporomandibular joint (TMJ) dysfunction. What can become dysfunctional in the temporomandibular joint? There are several conditions that can cause TMJD and its symptoms. Let’s look at them one by one.
As shown, the jaw itself articulates with the temporal bone, and this demonstrates the location of the temporal bone. In between the mandible and the temporal bone is a small fibrocartilaginous disc called the articular disc, which is bonded to the jaw by some ligaments. Popping and clicking can occur if we have a situation where the disc itself becomes disrupted and dislodged from the condyle, or rounded part, of the jaw itself.
Now, you have a situation where the disc can become free floating. Attached to the posterior elements, or the back, of the disc is a material called retrodiscal tissue that produces the synovial fluid which lubricates the joint. This tissue will work to hold the disc in place, but what can happen over time that is the disc can migrate forward and become adhered to the anterior portion, or front, of the temporal bone.
Close-up of a Healthy Tempormandibular Joint (TMJ)
When this occurs, we have a situation where the mandible rotates and translates forward as you open and close it. As it translates forward, it has to climb up and over the disc instead of the disc riding with it. When this happens you will notice that when you initially open your jaw there is no pop but as you open wider, the pop occurs as the jaw slides up and over that disc. Now you understand the first diagnosis, which is disc disruption in the jaw.
A second diagnosis involves the capsule. In the image above, the capsule is illustrated by the thin, light blue area that begins at the back of the TMJ, goes under the condyle, and in front of the muscle. The capsule is the ligamentous envelope that wraps around the joint itself, and the capsule itself can become inflamed. The person can have perfectly normal open and closing of the jaw and they may or may not experience popping or clicking. The problem is not the disc, even if the disc is dislodged, but the capsule itself is inflamed. This tissue is the same ligamentous material that holds our ankle together. When you sprain your ankle, it swells, becomes inflamed and uncomfortable. The same thing can happen in that capsule in the jaw. So, if the person has jaw pain, they may automatically assume they have TMJ or TMJD when they really do not. What they have is ligamentous inflammation of the capsule itself.
The third possibility may involve the retrodiscal tissuewhich we mentioned previously. The retrodiscal tissue is the structure in the posterior elements of the jaw that connects to the disc. The retrodiscal tissue itself can become inflamed. That will typically happen with people that frequently clench or grind their teeth (called bruxism) while they are sleeping. This contracts the jaw, driving the mandible back up into the temporal bone and squeezing the retrodiscal tissue in between. When the retrodiscal tissue is inflamed, the result is jaw pain.
If the inflammation of the retrodiscal tissue lasts long enough, you will actually start to get adhesions that form in the jaw inside the joint itself. You may have vascularization, or the development of blood vessels, of the adhesions. The trauma that results from these adhesions and scar tissue can also become a source of pain.
The fourth issue we will discuss is problems with occlusion or with the teeth as the teeth are fitting together. When a person opens and closes their jaw, they may notice that some of the teeth are not lining up properly. What they will notice is that when they close their jaw some of the teeth will land early on one side, and the jaw will then have to settle into a normal closure.
Another problem with occlusion can be an under bite. We have heard of people who close their lower jaw and their lower teeth are actually too far forward, and they have to move their jaw backward in order to close fully. That can cause problems with the TM joint as well.
The last problem that we can see with the temporomandibular joint is really somewhat external. This involves the musculature that runs the joint and the muscles that open and close our jaw, move it from side to side, and forward and back. These are very big powerful muscles which are inserting on the jaw itself. These muscles can become short and tight, and like anywhere else in our body with short, tight contracted muscles, they are going to cause pain sooner or later whether it’s in our necks or in our backs or in our jaw.
To summarize, there are five possibilities when we have temporomandibular joint dysfunction:
Issues with the disc
Inflammation of the capsule
Inflammation of the retrodiscal tissue
Alignment of your bite, or occlusion
Tightening of the musculature of the jaw
When we see you in our office, we will typically begin an examination that allows us to arrive at an accurate diagnosis. We can treat some of these conditions in our office in Wake Forest, NC. There are some that we do not treat, and for those we will refer you to an experienced specialist for the proper treatment.
If there is a problem involving retrodiscal tissue inflammation, capsulitis or musculature that’s hypertonic, short and tight, that is probably something that we can help with here in the office. Approximately 70 percent of the people that I see with a diagnosis of TMJ dysfunction fall into this category, and we have the ability to treat them.
The other condition that would not respond as well to conservative care would be a disc problem where the disc is dislodged. Often, if you can treat the inflammation in the retrodiscal tissue and the capsule, and balance the musculature, the person can go on and live normally with a disc that’s displaced. There should be no pain, but there may be a little popping once in awhile. These people are not necessarily surgical candidates. This is a non-surgical or a “leave alone” condition unless the jaw is locking and not allowed to open or close.
Once you have an accurate diagnosis and you know exactly which one of these structures is the problem, then you are in a situation where it can be treated. A good diagnosis and directed care, either in our office or at the appropriate orthodontist, dentist or surgeon is the pathway out of chronic temporomandibular joint dysfunction.
If you would like further information on TMJD, jaw pain or jaw 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
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