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Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
July, 2010, Vol. 10, Issue 07
Research: Sport, Pelvic Pain and Associated Symptoms
By Leon Chaitow, ND, DO
There is abundant research linking pelvic pain, and associated urinary tract symptoms, with various sporting activities. The studies reported on in this brief review are offered as a caution - particularly against excessive training and sport in early life.
In contrast however, with a few notable exceptions, evidence largely supports the benefits of athletic activities, and the negative long-term effects of inactivity.
Sport and CPP in Men: Pudendal Nerve Issues
Antolak et al (2002) report that chronic pelvic pain (CPP) syndrome is a puzzle that may be explained partly by pudendal nerve entrapment (PNE), which causes neuropathic pain. In men with PNE may involve aberrant development and subsequent malpositioning of the ischial spine as a result of excess athletic activity during youth. The changes appear to occur during the period of development and ossification of the spinous process of the ischium.
Common causative activities include "flexion activities of the hip (sitting, climbing, squatting, cycling, and exercising) induce or aggravate urogenital pain, chronic pelvic pain, or prostatitis-like pain."
Specific sports incorporating these activities involving teenagers and/or young adults include: American football, weight-lifting and wrestling.
Antolak et al suggest that hypertrophy of the muscles of the pelvic floor among young athletes, causes elongation and posterior remodeling of the ischial spine, leading to the sacrospinous ligament rotating, so that the sacrotuberous and sacrospinous ligaments become superimposed over each other. During repetitive squatting activities, or during sitting and rising, stretching of the pudendal nerve occurs over the sacrospinous (SSp) ligament or the ischial spine, with shearing forces on the nerve.
The piriformis muscle may also be involved. Antolak et al note that: "The pudendal nerve exits the pelvis at the inferior aspect of this muscle. In the athlete, flexion and abduction of the thigh are common motions, and they may lead to hypertrophy of the piriformis muscle, causing compression of the pudendal nerve against the posterior edge of the SSp ligament. Pain that suggests this process includes ... that induced during sports activity such as that of a baseball catcher (squatting and then rising to throw the ball - motions that require extension of the gluteus muscles and abduction and extension of the hip)." They suggest that the same principles be investigated in women with pelvic pain, in case their symptoms are "misdiagnosed and inappropriately treated."
Cycling and Genitourinary Symptoms in Men and Women
Leibovitch and Mor (2005) have reported on bicycling related urogenital disorders. They note the following pertinent facts:
Andersen and Bovim (1997) applied a questionnaire to 260 participants in a Norwegian 540 km bicycle race.
Thirty-five of 160 responding males (22%) reported symptoms from the innervation area of the pudendal or cavernous nerves. Thirty-three had genital numbness or hypaesthesia after the race. In 10, the numbness lasted for more than one week. Impotence was reported by 21 (13%) of the males, lasting for more than one week in 11, and for more than one month in three.
Both genital numbness and impotence were correlated with weakness in the hands after the ride, a complaint that in some cases lasted up to eight months. It is suggested that changing hand and body position, restricting the training intensity, and taking ample pauses, may all be necessary to prevent damage to peripheral nerves.
LaSalle et al (1999) reported that the hardness of bicycle seats, and years of cycling, influence lower urinary tract symptoms in women. "The hardness of the bicycle seat increased the incidence of incontinence and other urinary symptoms in females....[possibly] related to the neurologic and vascular stress that hard seats produce on the perineal area."
Sports That Appear to Increase Urinary Incontinence
Thyssen et al (2002) surveyed a total of 291 women with a mean age of 22.8 years. Of these 151 women (51.9%) reported having experienced urine loss, 125 (43%) while participating in their sport and 123 (42%) during daily life. The proportion of urinary leakage in the different sports was:
The activity reported as being the most likely to provoke leakage was jumping.
Osteitis Pubis and Running
Strakowski and Jamil (2006) report on osteitis pubis, "an uncommon cause of pelvic pain in runners". This condition presents insidiously with pain in the hip adductors aggravated by running or pivoting on one leg. The adductor muscles are usually noted as hypertonic, with pain on resisted hip adduction. Tenderness over the pubic symphysis will also be evident. Plain film radiographs commonly reveal sclerosis of the pubic bones, with occasional widening of the symphysis. (Harris and Murray 1974) Treatment includes use of NSAIDS and corticosteroid injections into the symphysis, along with stretching of shortened adductors.
Click here for more information about Leon Chaitow, ND, DO.
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