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NSAID'S as Preventative Medicine.....A Bad Idea!

In a practice working with athletes of all levels—from professionals to weekend warriors—I get to hear many different strategies they have devised for their own health care.  Fortunately, a lot of them will run these ideas by me so that I can either approve or revise them.  One of the more common—and worst—is the use of non-steroidal anti-inflammatories (NSAID's) as preventative medicine.  NSAID's include aspirin, ibuprofen, and naproxen sodium which are the active ingredients in the most commonly used over the counter options for pain.  Countless patients over the years have told me of their plans to take NSAID's prior to competing/participating in an event “just in case” pain should develop during the event.  

Inflammation is the body's primary step in tissue repair following injury.  Injury can be a sprained ankle, a broken bone, or even micro-damage from overuse.  NSAID's do not target specific tissue in a specific area based upon what is hurting the individual, they inhibit all inflammation.  Taking them preventatively will limit the body's effectiveness in repairing the damage done to muscles and tissues during activity.  This will slow recovery, and could lead to chronic pain in the future.  

If you are concerned that you will not be able to perform an activity due to the pain that may arise, then perhaps it is time to use your better judgement and rest until the issue is resolved—you could be doing more harm to your body than good.  Following a workout or competition where you are sore, turn first to ice and compression.  Each is able to reduce inflammation while still allowing it to perform its task of repairing damaged tissue.  Ice and compression are both able to be applied to the specific area of complaint which allows repair and recovery of the other areas of your body. 

NSAID's have their place in the world of sports medicine, and it is always after activity when there is noticeable pain that ice and compression cannot relieve.  Should that not be enough, you should have the complaint evaluated by a physician specializing in joint and soft tissue injuries as soon as possible.  

Stay active, and stay healthy!  

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Cycling and Shoulder Pain

As cyclists, there is always advice floating around us on how to prevent against knee and leg pain—moving the saddle fore and aft, the 30 degree rule-of-thumb for knee flexion with the pedals at 6 and 12, and even articles I've posted regarding the hip/pelvis and foot/ankle. But what more infrequently gets addressed is shoulder and upper back pain/discomfort from riding for long periods.  

As I've said throughout my years in practice, you should always have the problem evaluated by a sports physician prior to beginning any self-treatment. This ensures that you are not risking further damage to the area, and are also not reinforcing bad habits. Doing exercises with compromised muscular balance and dysfunctional joints can lead to injury, and you are likely not able to perform any exercises as they are truly intended with any level of dysfunction that is great enough to cause pain. And more so, performing them in a manner in which they are not intended will reinforce the dysfunctional movement patterns and imbalances.

That being said, if the symptoms are more of discomfort or fatigue than pain, this exercise should be very effective at helping to relieve your shoulders on longer rides.

Many times the fit is the problem, and you are putting too much pressure on your hands as you lean forward on your bike (more common with road cyclists). A professional fit is crucial if you are planning on riding a bike regularly. I always recommend that your dysfunction is evaluated prior to any fit so that you are not being fit into a biking position with compromised joint function and muscle balance. Fix the body, fit the bike.

In a lot of cases the problem is a chronic weakness in the middle and lower trapezius muscles of the back. The middle and lower traps are located between your shoulder blades. They oppose the more commonly known upper traps by bringing the shoulders down away from the ears. The upper traps are the big muscles between your neck and arm that are often tight or sore with desk work or stress—or cycling!

The key is to strengthen the middle lower traps so that the upper traps do not have such an advantage in pulling the shoulders up to the ears (it's a muscular tug-of-war). A great way to do this is to consciously pull your shoulders down toward the ground and pinch your shoulder blades together. Hold them there for counts of 15 seconds 3 times once a day. Gradually add time until you are able to keep them there comfortably for a minute each of those 3 times.

For the second exercise, get onto the floor on all fours. Keep your knees under your hips, and your hands under your shoulders. Really focus on keeping your shoulders pulled down from your ears, your shoulder blades together, and both of the blades flat against your back. This is more advanced and may require some training from a sports medicine physician or Pilates instructor to make sure that you have the correct starting position. Hold this position for 30 seconds 3 times once a day. As you progress and this becomes easier to maintain, gradually shift your weight from your left to your right hand without allowing your shoulder blades to move—keep them stable.

With these exercises, you will be able to develop middle back strength that will allow you to ride longer more comfortably, and even sit at a desk/computer longer with greater comfort.

If these exercises do not help your discomfort within 2-3 weeks, please consult a sports medicine physician to have the problem evaluated and treated. I am fond of helping my patients cheat by using kinesiology tape which allows their bodies to focus subconsciously on using specific muscles based on how the tape is applied.

Ride safe and comfortably!  

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Lateral Knee Pain

Are You Experiencing Lateral Knee Pain?


A common complaint amongst active patients, especially long distance runners, cyclists and triathletes is lateral knee pain, and the most common cause of that pain is Iliotibial Band Syndrome (ITBS).  Have you ever experienced lateral knee pain during the beginning of a run, or about 30 minutes after completing a long run?  Have you ever experienced sharp lateral knee pain that gets progressively worse as you increase your mileage? 


Unfortunately ITBS gets in the way of people reaching their fitness and competitive goals, but this doesn’t have to be the case at all.  Knowing how to avoid ITBS, how to recognize it, and how to treat it can allow athletes to continue to train and make it to race day. 


The Iliotibial Band (ITB) is a tendon, which originates just above the lateral hip and inserts just below the joint line on the lateral knee.  It helps with knee stabilization while running as it constantly moves slightly forward and backward with knee flexion and extension.  A disruption of the forward and backward movement, or an increase in tension can lead to irritation and eventually inflammation anywhere along the ITB.  Things that can cause these changes in the movement and tension to the ITB include excessive adduction of the hip and increased rotation of the knee. 




During the normal gate cycle of running, when one foot is planted on the ground, the other foot is swinging forward.  If the hip on the side of the swinging foot dips down toward the ground this is a sign of weak abductor muscles causing excessive adduction on the plant foot side.  Similar biomechanics are utilized while cycling.  If the pushing leg has week abductors the hip on the pulling leg can dip down toward the ground.  This causes increased tension along the ITB and it will likely lead to ITBS.  Several things cause this abnormal movement, including running on an uneven surface, weak gluteal muscles, uneven leg length and misalignment of the pelvis. 


Excessive knee rotation will also cause increased tension on the ITB leading to ITBS.  Hyper-pronation and low/weak arches of the foot will cause medial rotation of the knee.  Wide hips and a weakness in the medial quad muscle will also cause excessive medial rotation of the knee.




With all of the causes of ITBS it’s amazing that everyone doesn’t have it.  However it can be easy to avoid.  One of the most important and easiest things to do is to be properly equipped with the right shoe and to make sure the bike being used is properly fitted for the rider.  Another simple solution is a proper warm up and stretching after activity.  Finally never increase your mileage or training intensity too quickly, giving your muscles time to strengthen as you spend more time on your feet. 


Fortunately, getting ITBS does not mean you won’t be able to continue to train.  The key to success is seeking help early.  The longer you wait, the longer it takes to heal.  Your health care provider must identify what caused the ITBS and not only treat the symptoms, but fix the root of the problem.  Painkillers and anti-inflammatory medication will not do the trick.  The fibers of the ITB need to be manipulated stretched, iced and stabilized.  At ESSM we utilize Active Release Technique™, Graston, Kinesio-taping, dry needling, acupuncture and deep tissue massage.  Often times the joints above and below the area of pain need to be adjusted to restore normal mobility, and finally rehabilitation and strengthening of the areas of weakness will keep the ITBS from reoccurring.  You can continue to train as long as the pain is continuing to decrease and you are able to move without modifying your biomechanics.  If running is not an option then a good alternative is finding another way to get your heart rate up for the same amount of time that you would be spending running. 



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