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Looking Through the MIST – Minor Impact Soft Tissue Injury

As a personal injury attorney in California I, or an attorney anywhere else for that matter can tell you, low impact cases resulting in soft tissue types of injuries, including whiplash, are specifically “red flagged” by the insurance industry as cases meriting special attention. Such cases have been labeled by the code word “MIST”, short for Minor Impact Soft Tissue injury. The idea behind the “MIST” injury originated with insurance companies to allow for lower pay outs for claims resulting in little or no damage to the vehicles involved in an auto accident, and to also permit the insurance companies to pay less for injury claims that cannot be easily seen by the naked eye.

MIST cases are typically denied in their entirety by the defendant’s insurance company. If the MIST claims are not denied categorically, the defendant’s insurance company will often make an extremely low offer to settle, often not enough to even cover all the related injury expenses. This holds true even in cases where the defendant is clearly at fault in the accident. What can be even more frustrating is the fact that often, fault is admitted by the defendant in the accident. The insurance companies simply state that these “low ball” settlement offers are in keeping with what they see jury verdicts rendering in these kinds of related personal injury cases. As a result of the difficulty in litigating MIST injuries, many personal injury attorneys will no longer accept auto accident cases involving low property damage to a vehicle when the injury involved is a soft tissue injury.

The difficulty of litigating soft tissue injuries creates a quandary, leaving an auto accident victim with only two options: accepting the insurance company settlement offer or proceeding to take the defendant to court. Although one does not have to accept an insurance company settlement offer, there are a several facts to keep in mind during the decision making process. The first thing to remember is that going to court involves a substantial commitment of time for both the representing attorney and the recovering client. The second idea to consider is that bringing a case to trial and ultimately through to a verdict is often costly in terms of the expenses required to so, including but not limited to the costs of specialists, medical experts, and accident re-constructionists. Thirdly, it must also be noted that litigation can be risky and that there are absolutely no guarantees as to a successful result. It is up to the client to request their personal injury attorney to proceed through a cost-benefit analysis to determine if the case can be successfully litigated in a cost effective manner.

For victims of MIST injuries, it is important to engage in an active discussion about the possible outcomes of the options comprising soft tissue litigation. It is also important that one question their attorney about the bottom line when obtaining advice for an appropriate course of action to best resolve the soft tissue injury case.



Source by Jeffrey Frank

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Neuromuscular Physical Therapy – Megan’s Case Study

In studying Megan’s case history and symptoms, key moments and events stand out in her time line of pain and dysfunction. Nine years ago, after the birth of her second child, was the first time that Megan noticed that her left foot was slightly wider and longer than her right foot. The timing of this is relevant as during the course of her pregnancy a hormone called relaxin would have been released into her system to loosen the ligaments of her pelvis in anticipation of childbirth. However, relaxin can also loosen ligaments elsewhere in the body and a longer and wider left foot would indicate the collapse of the main arches of the foot due to ligament laxity. This is one of the turning points in Megan’s history that has had a detrimental effect on her health ever since. The relaxed ligaments may never have fully recovered their full stabilizing strength and when she developed a tired aching sensation in her left medial arch a few years later it was probably as a result of this. A fallen arch will lead to over pronation and this will in turn put the tibialis anterior and possibly tibialis posterior muscles under undue stress as they try to stabilize and counteract over pronation. Stressed or overwhelmed muscles will form trigger points (TPs) within them and for tibialis anterior this can refer pain anteromedially as it passes the retinaculum. TPs in the tibialis posterior will refer pain into the sole/arch of the foot. Over pronation will lead to shortened peroneus longus which will further inhibit the tibialis muscles which will further exacerbate the problem in a continuous vicious circle.

The whiplash injury experienced last year would also add to Megan’s problems and since then she has experienced occasional headaches and neck stiffness. The whiplash injury almost certainly would have affected her sub occipital muscles, sternocleidomastoids (SCM), scalene and other stabilizers of the neck and spine. This whiplash would lead to improper neck movement which in turn would lead to TPs in the SCM and possibly the longus colli on one side (left) possibly due to the leg length discrepancy. TPs here would leave these muscles in a shortened state resulting in rotation of the head to the right hand side. If the longus colli is involved it result in kinetic chain problems and affect the peroneals on the lateral aspect of the lower limb further exacerbating the fallen arch. With the peroneus longus muscles in such an unhealthy state it is possible that it could have an effect on the sacrotuberous ligament of the pelvis and its ability to hold the sacrum in position. Megan states that one day last year she felt a twinge in her right sacroiliac joint while assisting an obese client up from a supine position. She experienced locking/jamming and diffuse soft tissue pain in QLs, multifidis and shooting pain into her hip. The fact that she was locked into torso flexion to the right suggests that the QLs went into spasm on the right side after insult and as we find out later her sacral base is an inch high on the right and there is posterior rotation of the right ilium with resultant postural imbalance whereby 2/3rd of Megan’s weight is pressing down on her right side. This extra load and postural imbalance has led to shooting pain in the trochanteric region and referred pain on the lateral aspect of the thigh due to TPs in the weakened gluteus medius and iliotibial band issues due to the over worked tensor fasciae latae.

With all this pain getting to unbearable levels, Megan turned to prescription drugs, codeine based painkillers, antidepressants, Zoloft, anti inflammatory tablets all of which would have exacerbated her problems through time by building up toxins in her system. She was also whilst under the influence of painkillers probably injuring tissue by doing activities that she would not have done if she had her natural alarm system of pain stopping her. The elastic support belt and the taping would have made the situation worse by encouraging atrophy of supporting muscle tissue.

Megan’s right shoulder is lower than the left possibly due to shortened latissimus dorsi pulling on the humerus and inhibiting upper trapezius and hypertrophy of the pectoralis minor muscle pulling the scapula forward and down.

As we consider Megan’s problems, symptoms, and case history, we can appreciate that she is suffering abject pain and dysfunction up and down her functional kinetic chain. From the pain in the plantar fasciae, spastic peroneus longus, inhibited tibialis, medially rotated tibia, medial knee pain, lateral thigh pain, trochanteric pain, lumbo – sacral pelvic pain and dysfunction, posteriorally rotated right ilium, lower left anterior superior iliac spine, 2/3rd weight imbalance to right hand side, lower back pain with QLs and multifidis in a shortened state, latissimus dorsi, neck extensors and flexors all giving problems we have to ask the question as to which functional kinetic chain we are dealing with. In my opinion, considering all areas involved, it would be the spiral oblique chain.

Megan would have to be informed that her treatment will be extensive and prolonged because some issues have been there for a while and would involve neural retraining for the dysfunction and imbalances present.

  • Medical screening.
  • Case history.
  • Postural assessment.
  • ROM testing / neural testing.
  • All shortened and restricted muscles would have to be relaxed / lengthened with TP therapy, METs, positional release / strain- counterstrain.
  • Inhibited muscles would have to be fired and strengthened with tapotement, METs and strengthening exercises.
  • Any areas of bind would need STR, cross fiber friction etc.
  • A consideration would be referral for PCIs to address the pronating left foot initially with a plan to strengthen that area long term.
  • Megan’s nutrition was not mentioned but I would be referring her to a specialist in that field to ensure that she has no nutritional deficiencies that would hinder the healing process.



Source by Charlie J Molloy

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Cervicogenic Headaches – A Pain in the Neck (Part 2) – Treatment Options

OK, so in part 1 we looked at causes and effects of the cervicogenic headaches, now let us turn our attention to treatment options that can be utilized to help decrease their severity and frequency as well as postural and lifestyle changes to eliminate the underlying cause. Treatment options and expectations can be difficult to establish as the cervicogenic headache can be somewhat of a “chicken and the egg” process. The better we can tell what caused what the more accurate the recommendation and prognosis. For the purpose of this article we will divide recommendations into acute or recent onset that resulted from an injury or event and chronic or long term conditions without a history of injury. Certainly there can be a combination of both acute injury and chronic resultant conditions but for simplicity we will look at the former:

An acute injury or traumatic event is most commonly associated with a sports injury or auto accident. Remember, just because you may have not been the driver in an accident, the body goes through the same injury. As an example, studies indicate that a typical low to medium impact “whiplash” injury has the same impact as taking off in a fighter jet…about 5 to 7G’s of force. This force is absorbed by 22 cervical ligaments and tendons in the neck that attach key muscles allowed for movement and overall function. Common treatment options for an acute cervical injury with resultant cervicogenic headache include muscle relaxants, pain killers, manipulation / chiropractic, physical therapy and massage. Ideally, studies indicate that the best results may in fact be accomplished with all of the above used in combination. Pain killers should be considered as a last resort or at best a temporary option due to the potential side effects and addictive qualities. The muscle relaxants do just that, they serve to relax the muscles that are in spasm. These muscle spasms are the body’s natural defense mechanism, however left in spasm for too long they can cause on- going issues including but not limited to the cervicogenic headaches. So, from a relaxation and functional standpoint the anti-inflammatory, muscle relaxer and pain killer (preferably over the counter) provide the body a chance to rest which is important when injured. However, it does little to actually treat the underlying cause of the injuries, that being the sprain and or strain of the cervical spine muscles and ligaments as well as potentially the minor misalignment of the 7 cervical vertebrae or bones in the neck. The manipulation process addresses specifically the top three vertebrae to ensure proper nerve flow, think of it in terms of having a water hose with a kink in it and then releasing the hose to its normal position. Additionally, the muscles need to be addressed through physical therapy and massage in order to maintain the proper alignment. Like a tug of war, if the bones are manipulated to take pressure off of the nerve, yet the muscles remain in spasm then the muscles will simply pull the bone back where it was at the time of the accident or injury. Again a combination of the above treatment options appears to have the best results for acute injuries.

The treatment management of chronic or long term cervicogenic headaches can certainly utilize some or all of the above options as well, however generally speaking the results may be slower as the body has already adapted perhaps with cervical muscle scar tissue and / or cervical spine osteoarthritis depending on the events if any and the duration that led up to the headaches. The body will heal itself the best way it can to function and protect itself in the short term, however if the joint integrity and / or muscle tone is compromised for a prolong period of time then this healing process may not have been biomechanically correct if you will, resulting in chronic cervicogenic headaches. The most common cause for cervicogenic headaches appears to be resulting form postural imbalances. The head forward or flexed positions that we face through the day in front of computers, etc. coupled with poor overall posture sitting, standing and sleeping have lead to headache complaints in record numbers. Some studies indicate that over 2% of the population, translated to 18 million people have suffered cervicogenic headaches resulting in clinical outpatient visits every year! In addition to the above referenced treatment options it is very important to be aware of the potential detrimental result of poor posture of the neck and the relation to cervicogenic headaches. Options for treatment of the chronic cervicogenic headache should include adjusting any book, computer etc. to be at a position that does not require the neck to be in a flexed position for a prolonged period of time. Headsets for phone work are much better than having a phone to the ear (including cell phones). Additionally, daily stretching and range of motion exercises for the neck are very important and lastly, our sleep habits. It is important to sleep on your back or side (do not tuck chin) with the usage of a cervical pillow. The cervical pillow is designed to maintain the integrity of the neck in its proper alignment while we sleep, allowing the supporting and overstressed muscles a much needed chance to rest.

As mentioned earlier cervicogenic headaches are complex to evaluate and treat. Try these suggestions under the direction of your doctor as individual circumstances and results vary. You may just discover that those headaches you have learned to live with may not be around much anymore. Maintain good cervical posture and timely and appropriate health care for any neck injury…The quality of your life may depend on it. Best Wishes.



Source by Eric J Chartier

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Podiatry Treatment Addresses Many Health Challenges

While many consider podiatry to be an exclusive realm of all things below the ankle, the truth is that treatment of injuries and other problems of the feet affect the whole body. When the biomechanics of walking are misaligned by damage to the feet, it can cause overarching issues in the legs, knees, hips, and back. Chronic pain can reduce the desire to exercise, leading to lethargy and depression.

Help with toe pain

Toes are made up of multiple small bones, ligaments, and muscles. When something in these complicated constructs gets out of place, injured, or torn, the pain can be debilitating. A patient suffering from bunions or hammer toe should seek treatment sooner rather than later. Addressing toe pain earlier on can reduce the need for invasive treatments, and this may make treatment more effective in the long run.

Tendonitis and heel pain

Although tendonitis can happen in several places from the ankles to the toes, it’s most commonly diagnosed in the Achilles tendon. This inflammation can cause moderate to severe pain and make even light exercise difficult. It is most often treated with physical therapy, but other treatments can become necessary if the pain is severe. The normal causes are repetitive stress or not taking enough time to stretch before working out.

Leg, knee and back pain

Most people seek out podiatry treatment only after first consulting an orthopedic surgeon about their knee, back, or hip pain. Many patients don’t realize that the pain in their lower body may be caused by problems in their feet. Balance, movement, and articulation can be affected by injury or malformation of the feet. By treating the source of the problem, these kinds of injuries can be addressed more effectively than by treating the symptoms with painkillers or antidepressants.

Treatment possibilities

Many patients seeking out the care of a podiatry specialist expect surgery to be a part of their treatment plan. While some issues must be dealt with surgically, many can be addressed through less invasive means. X-rays can help pinpoint a diagnosis, and they are often necessary in devising a long-term treatment plan. The options for treatment may range from education about appropriate footwear, to physical therapy, to specialized orthotic inserts.

Preventing podiatry problems

Many patients don’t realize that feet change in shape and size long after puberty, unlike most parts of the body. Many podiatry problems can be avoided simply by having the feet measured when buying shoes, and wearing shoes that fit properly, especially for exercise. When there are problems with the shape of the feet, or an injury that causes problems with walking, custom-created orthopedic inserts may correct balance and other issues.

Seeking out orthopedic treatment at the first sign of pain or strain often prevents further injury. Foot injuries should be treated promptly to reduce the recovery time and help ensure the fullest possible recovery. Wearing the correct shoes for activity and exercise, and taking the time to stretch and warm up before exercise help prevent injuries.



Source by Abigail Aaronson

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Car Crashes And Back Pain

If a person is involved in an automobile crash, they may very well experience sudden pain in their neck or back. Some individual’s pain will heal naturally, on its own. Others may require treatment to bring pain relief. What may not be apparent is that those involved in a motor vehicle collision may be more likely to have spinal pain in the future. This article discusses auto crash spinal injuries, some recent research about the subject and possible treatment options.

There are various types of motor vehicle collisions. Some are where an unaware person’s vehicle is struck from behind and they suffer the classic “whiplash” injury to the neck. Others may be where the driver and occupants are aware of an impending impact, they brace themselves but spinal injuries to the neck and back still occur. Regardless of the type of accident it is possible that those involved will experience some spinal pain.

When the human body is subjected to trauma from an automobile crash several mechanisms of spinal injury occur. Let’s discuss what happens on an anatomical level. Ligaments are tough, fibrous tissues that attach from one bone to another. They allow movement of the bones but should not allow excess movement. If one imagines a guy wire stabilizing a utility pole this would be a good analogy to the human body’s ligamentous structures.

In an automobile accident, ligaments can be sprained. A sprain is simply tearing of fibers. Sprains are mild tearing, moderate tearing or severe tearing with a ligament is fully ruptured. If ligaments are damaged, they may not heal with normal tissue but, may partially heal albeit with weaker scar tissue embedded in the ligamentous structure.

Weak, damaged ligaments allow excess motion between the bones of the spine which are also called vertebrae. Excess movement between two bones is called hypermobility. Hypermobility over months and years causes wear and tear which is known as spinal degeneration.

On an x-ray, spinal degeneration shows as bone on bone narrowing of disc spaces and bone spurs. This is a classic, objective sign of degeneration of the spine.

A recent scientific journal, Accident Analysis & Prevention, May 2020 noted systematic research review discovered that individuals involved in a motor vehicle collision may be more likely to develop back pain in the future than those who have not been in a car accident.

Doctors of chiropractic, are trained to evaluate and effectively treat musculoskeletal injuries caused by motor vehicle accidents. Upon visiting a chiropractor, the patient can expect to be asked questions about their injuries, pain, and the details about the car crash itself. Next a physical examination will determine if a patient has objective signs such as muscle spasm, range of motion limitations of the neck or lower back and other neuromusculoskeletal tests. Many times, imaging such as x-rays and MRIs are obtained.

If it is determined that chiropractic care is appropriate, the chiropractor will commence with the necessary treatment to best help the patient recover from their neck and back discomfort. Chiropractic care may make the difference between successful back and neck pain relief and long-term healing of the spine, versus those developing chronic, painful, spinal pain from not receiving proper care.



Source by James Schofield

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Taking Care of Your Feet is Not Child’s Play

With winter’s cold weather passing and the sunshine beginning to peek through the clouds, it’s time for kids to escape the clutches of the television and embrace the playground. Whether it’s participating in a game of tag, playing a sport or having fun in the sandbox, plenty of children will be active on their feet this summer.

However, a day in the sun can end with a day at the doctor’s office if the proper safety measures are ignored. Before children catch a glimpse of the giant slide at the pool, the oversized toys at the park or the exciting rides at the amusement park, prepare them with the right footwear and protect them with the right care.

These tips from the American Podiatric Medical Association (APMA) could save your child’s soles this summer:

– Carefully observe your child’s walking patterns. Does your child have toes that point in or out, have knock-knees or other gait abnormalities? These problems can be corrected if they are detected early and treated by a podiatrist.

– Children’s feet change size rapidly so always have your child’s feet measured each time you purchase new shoes.

– When shopping for shoes, look for stiff material on either side of the heel, adequate cushioning and a built-in arch. The shoe should bend at the ball of the foot, not in the middle of the shoe.

– Never wear hand-me-down shoes.

– Limit the time children wear platform or heeled shoes and alternate with good quality sneakers or flat shoes. High-tops generally help prevent ankle sprains.

– Don’t buy shoes that need a “break-in” period. Good shoes should feel comfortable right away. For athletic activities, choose a shoe that is designed for the sport your child will be playing.

– Never pack brand new shoes for your children to wear on vacation.

– Walking barefoot on pavement, hotel or airplane carpeting, in hotel bathrooms or a locker room and near the pool can make your child susceptible to a host of infections. Always wear a pair of flip-flops or strappy sandals made of soft, supple leather to prevent contracting a bacteria or fungus like athlete’s foot or plantar warts.

– When applying sunscreen, don’t forget about putting some on your child’s feet. Additionally, always remember to re-apply.

– Lack of complaints by a youngster is not a reliable sign. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware.

– Be careful about applying home remedies to children’s feet. Preparations strong enough to kill certain types of fungus can harm the skin. Your best bet is to visit an APMA member podiatrist for treatment.

For more information, please visit www.FootAnkle.com.



Source by Justin Jacob

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

What the Insurance Companies Say About Whiplash

The name assigned for the neck strain received from the impact of a car crash sounds painful enough: whiplash. But the achy discomfort, disruption of regular life activities and any other complications that follow really can be excruciatingly difficult to deal with.

If you live in a state that mandates no fault auto insurance, you can file a claim for losses directly to your own carrier. In the event, you do not have that coverage option and your injury was as a result of another drivers’ fault, you will want to file an injury claim and related loss insurance claim if it pertains to you with his or her company.

Other losses related to the injury may include:

• Mileage costs to and from doctor visits

• Loss of income because of the disruption of work

Although initial symptoms immediately following the collision may be minimal, increasing pain and other progressive signs of the condition can take time to develop. While full-fledged symptoms can appear immediately after a vehicle crash, it can also take hours or even days after the accident.

If you feel any of the following symptoms – at any range or extent – be sure to seek medical attention from your physician right away.

Whiplash symptoms include:

• Painful muscle cramps

• Inability to turn head partially or fully

• Increasing achiness in the neck area

• Headaches that begin from the lowest part of the skull and move towards the forehead

Seeing your doctor immediately after feeling the first signs of a whiplash condition – no matter how minimal they may initially appear- is of utmost importance. This is in relation to full recovery prospects, as well as your chances in receiving appropriate auto insurance compensation. As soon as you get a doctor’s diagnosis verifying whiplash, waste no time in writing to the insurance company about your wish to file a claim. Of course, it is imperative to keep records of all expenses in regard to the losses and damages.

While whiplash is a painful reality that a victim must endure for some time, it should heal on its own with the help of doctor’s directive and your own pain management.

These suggestions will aid in treatment:

– Immediately after feeling a symptom, place an icy wrap on your neck. Do this for a quarter of an hour every 3-4 hours for the first two to three days. Swelling and tenderness should subside as a result.

– Ask your physician to prescribe painkilling medicine.

– Ask your doctor if he or she feels it is necessary to make use of a supportive neck brace.

– Following the period after ice treatment, apply moist heat on your neck. You can do this by taking hot showers, warm baths or by placing a warmly moistened towel on the aching spot.

For more information about how to file a vehicle accident induced whiplash insurance claim, contact an experienced independent agency that is connected with the leading companies.



Source by M Wyzanski

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Treatment of Sinus Tarsi Syndrome

Where and what is the sinus tarsi:

The word “sinus” refers to a cavity, most often in bone. The cavity known as the sinus tarsi is located on the outside of the foot in front of and below the outside anklebone. The cavity is formed at the junction between the heel bone and the bone that sits over the heel bone called the Talus. The heel bone forms the floor of the cavity and the talus creates the roof.

Within the cavity there are blood vessels, nerves and ligaments. The ligaments function to hold the two bones together.

Symptoms:

“Sinus Tarsi Syndrome” refers to a painful condition located in this cavity in the rear portion of the foot. The pain is made worse with weight bearing. The pain can become much more intense when walking, running or hiking on uneven surfaces.

Causes of Sinus Tarsi Syndrome:

The most common cause of sinus tarsi syndrome is an inversion injury to the foot. This occurs when the foot rolls inward and stretches the soft tissue in the cavity. When the foot is stressed by this inward motion a tear or strain occurs to the ligaments. The injury to these ligaments results in inflammation, swelling and thickening.

The other causes of this condition are structural as apposed to the injury noted above. One of these structural abnormalities that can occur is growths or masses of soft tissue. Over growth of nerve or fat tissues in the cavity can cause increased pressure and result in pain. The pain in this area can also be caused by deviations in the bone structure. For example, bone spurs; arthritis and bone bridges can be responsible for the development of sinus tarsi syndrome.

Diagnosing Sinus Tarsi Syndrome:

To make the diagnosis of this condition the podiatrist will listen to the history of how the symptoms began and then examine the area. Most of the time, that is all that is needed to confirm sinus tarsi syndrome. In addition to the history and physical exam an x-ray should be taken to rule out bone cyst, fractures, bone bridging and arthritis. In some cases if the condition does not resolve with conservative treatment an MRI or diagnostic ultrasound may be ordered to evaluate the soft tissues in the cavity.

Another helpful procedure to determine the exact location of the pain is to inject the sinus tarsi with a small amount of local anesthesia. If upon examination after the injection the pain is gone the diagnosis is confirmed. If however, the pain is still present following the injection the injury may be in another location in the foot.

Non-Surgical Treatment:

Research has shown that a majority of the people with sinus tarsi syndrome will respond favorably to conservative management. Rest, ice and compression are suggested to reduce the inflammation. Oral anti-inflammatory medications can be prescribed to further decrease the pain and swelling.

Another treatment option is to tape the foot to attempt to limit the motion at the subtalar joint. If the taping successfully reduces the pain long term treatment with a custom orthotic can be used to control the motion of the rear foot. In most cases foot orthotics are sufficient to treat this condition, however in some cases an ankle foot orthotic may be necessary to fully control the motion.

Finally, a steroid injection into the sinus tarsi may be effective at relieving the pain.

Surgery:

In conservative measures have not helped to relieve the pain surgery may be needed. A common surgical procedure to threat this condition is decompression or removing the abnormal tissues from the cavity. If the MRI scans shows a soft tissue mass present in the sinus tarsi surgical removal of the mass will be needed.

After the surgery, protected weight bearing in a post-operative shoe or walking boot will be required for a period of approximately 2-4 weeks.

If this surgery fails or the patient has severe arthritis the bone in the rear foot may need to be fused.



Source by Bruce Lashley

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

The 5 Most Common Causes of Serious Neck Pain and How to Fix Them!

1) Muscle Strains or Sprains
This most often occurs as a result of an injury. Something like a whiplash injury from a fall, sports injury or a car accident. It can also be from sleeping in an awkward position or being in one position too long. Even an injury to your shoulder or turning too quick can do it. There’s actually many ways someone can strain a muscle; sometimes it can literally be from stress or that combined with one of the other things I’ve mentioned.

2) Herniated or Bulged Disc
A Herniated disc occurs when the inner disc, the nucleus, protrudes or ruptures through the outer part and puts pressure on a nerve or nerves. It usually occurs as a result of a very serious injury, like one of the above but on a more serious scale. Most often someone has accumulated a certain amount of wear and tear first then something is the “final straw” causing that disc to rupture. A bulge is similar except the outer disc stays intact but bulges. The same pain and inflammation may result. Depending on exactly where the disc bulge is and its size will determine the amount of nerve pressure. Often as discs degenerate and flatten they bulge. This leads me to my next common cause…

3) Arthritis
Arthritis is another word for degeneration or wear and tear. People who beat up their bodies more over the years will have more arthritis as they age. There are actually many factors, but basically people who don’t take care of themselves usually break down faster. Just like a car, if you don’t feed it with good fuel and maintain it by changing the oil and cleaning certain things it may stop running. Our bodies are the same way and as more degeneration sets in the bones become more brittle, muscles become tighter, and pain increases. Constant repetition of certain activities or having poor posture overtime can lead to degenerative changes in the spine.

4) Muscle Spasm
Muscles are an important factor in allowing us to move, and to be active. Doing one motion incorrectly, or repetitively can cause the muscles to overstretch and be injured. Muscle spasm can cause constant pain because the muscles are irritated and pressure on nerves. Remember those muscles are attached to the spinal bones and call force misalignment which also puts pressure on the nerves. Misalignment can cause poor posture or the reverse.

5) Poor Neck Posture
What your posture looks like on the outside is often what your spine looks like on the inside. So if you have forward head posture for example, most likely you’ve lost the normal neck curvature. This is also known as loss of cervical lordosis or “military neck”. This will tension the spinal cord and nerves; it will strain the muscles in the back of the neck and predispose you for all of the conditions mentioned above.

Now, onto how to prevent and fix these common cause of Neck Pain…

The best way to prevent and correct all of the above is to keep the spine in it’s best alignment. Injuries and strains will happen but when they do, they will be less and the muscles will heal much quicker. My best recommendations to avoid and end your neck pain are to see your chiropractor when an injury occurs, avoid repetitive stress to the neck, and try to maintain good neck posture. I realize sometimes you can’t get to your chiropractor’s office soon enough, or you find it difficult sometimes to maintain good posture. In this case I would also recommend using a good neck pillow. The traction pillow will help correct and maintain alignment while you sleep. This is central to keeping pressure off of the nerves and therefore preventing muscle spasm, degeneration, and disc injury.



Source by Matthew Bellinger

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Callus Removal From Feet: Myths and Facts

Calluses under the feet are common sources of pain and frustration There is often a misconception about these can be treated, as many people assume they can simply be cut out. This article will discuss what actually can be done to provide treatment, and dispel some of the myths surrounding their treatment.

Calluses on the bottom of the foot are from a natural process that is designed to protect the foot skin from excessive pressure. This excessive pressure can come from several sources. Externally, pressure can come from simply walking or standing on the ground, whether one is in shoes or not. The shoe itself can even be a source of external pressure, although this is usually seen resulting in corns on the top of the toes (which is the same type of condition as a callus). Internally, pressure can come from the bones that lie beneath the skin. If the bones are abnormally prominent due to a foot structure abnormality (like a bunion or flat feet), or if the skin and padding below the bone is abnormally thin, then pressure will increase on the overlying skin. The skin is usually irritated by both internal and external sources of pressure at the same time, where external pressure from walking combined with internal pressure from prominent bones or thin skin create a reaction in the skin tissue. This reaction causes the skin to form a thickening of the outer layer of keratin-based cells, which squish together to form multiple layers.

Over time, a callus (also called a hyperkeratosis) develops as the skin becomes excessively thick at the spot of pressure. This callus, if thick enough, can be painful as the original normal skin layer on the bottom of the callus is harmed by the pressure of the layer that covers it. What once was a simple protective measure by the skin can turn into a source of pain and damage for the skin if growth progresses far enough. Sometimes, the callus grows inward towards the base layer of the skin, leading to the formation of a thick, hard core that tunnels inward (but does not break the skin). This is also called an intractable plantar keratosis, and is often mistaken for a wart. Finally, sweat and other skin glands can fill with keratin material, forming a small pinpoint callus called a porokeratosis. This type of callus does not need to have a prominent bone underneath it for it to form, and is usually not painful.

Callus treatment is often misunderstood, and in reality can be somewhat complicated. The most common form of treatment is simple shaving of the callus by oneself, a pedicurist, or a podiatrist. The act of thinning the hard skin will make it more comfortable to walk on, and will reduce pain. However, the cause of the callus still will exist, and the callus will eventually return in a month or two. This causes great confusion for some people, who simply associate a callus with a temporary skin growth, and not something directly tied to their foot structure and activity. The use of special shoe padding or foot supports to reduce the pressure on the bottom of the foot can help to limit the growth of a callus, when used in combination with callus shaving and properly fitting shoes. Unfortunately, these will not eliminate the callus permanently, and will only serve to help reduce the overall thickness of the callus when it regrows. Even prescription shoe inserts (orthotics) will not permanently reduce calluses, although they do de-weight the callused area better than store-bought inserts by being custom made to a mold of the foot.

It should be noted that diabetics should never attempt to manage their calluses on their own. Due to poor sensation from diabetes, diabetics trimming their own calluses or having an unskilled family member try this at home could lead to a wound and an infection from an accidental cutting into normal skin.

Some people assume a callus can be burned off, like a wart or other skin growth. The use of chemicals, lasers, cold treatment, and electricity to destroy skin growths is very common, and often effective for other types of skin disorders. Unfortunately, these techniques do not work as well on callus tissue, because the growth of the callus is continuous, and not based on the simple presence of abnormal skin cells that can be removed. Callus tissue is normal tissue, and any destructive procedure against this tissue will only temporarily be successful until skin growth begins anew, and the callus reforms. The only exception to this is a porokeratosis, which can be removed if the underlying gland and gland duct is destroyed.

Surgical treatment is the next level of callus care. This is another area where there is great confusion, and treatment myths abound. In short, calluses cannot be cut out or otherwise surgically removed, with the expectation that the callus will not return. The new skin that grows following the surgery will continue to form a callus, and when combined with a surgical scar may be even more painful than the original callus. The only exception once again is the porokeratosis, which can be successfully removed with surgery. The only way to permanently get rid of a callus is to get rid of the underlying bone prominence, and to ensure shoes fit properly and are properly padded to account for any skin and tissue thinning over these bones. There are a multitude of bones in the foot that can cause enough of a prominence to irritate the skin, and as many ways to resolve the pressure through bone surgery. Procedures can include lifting of bones that steep too far towards the bottom of the foot, removal of extra bones that naturally form during development (very common), shaving or removal of bone spurs or loose bone fragments, or even full removal of the part of the bone causing the pressure. Procedures to correct the overall deformity causing the pressure, such as a bunion, or arch abnormality, may be needed. Healing times will vary, and is dependent on whether the bone was simply shaved or extracted, or whether the bone position was moved. These procedures are generally successful in eliminating callus formation if done properly, although there is a risk for the pressure point of the foot to simply move over to the next bone. Orthotics are often used following surgery to prevent this from occurring.

As one can see, callus care is not simply about shaving or cutting out the hard tissue. In reality, this myth does not work out well, and bone surgery is necessary to keep callus care from becoming an exercise in regular skin maintenance through regular shaving and shoe inserts. This may provide complete relief for some. For others, surgery is needed to break the ongoing pain cycle.



Source by Scott Kilberg DPM

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671