What is Sacroiliac Joint Dysfunction? Relationship between SI, Hip & Back Pain

What is Sacroiliac Joint Dysfunction? Relationship between SI, Hip & Back Pain
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Over the last few years, I have treated various individuals (male and female, young and old), for a condition that is often under and/or misdiagnosed.  Patients usually come to my office as a last resort – after trying various treatments that have not provided them with any longer term  success.  These patients usually complain of locking or discomfort in their hip joint and point to an area above their buttock.  Sometimes, they complain of lower back pain or thigh pain.  After a history and physical examination, I notice that it is neither the hip or back that is the source of pain/discomfort.  In other words, the pain/discomfort/locking maybe a consequence of a bad back or hip, but not the source of the pain.  The type of condition that I diagnose is known as Sacroiliac Joint Dysfunction (SI Joint Dysfunction).  Try saying that name five times fast. 

What is the Sacroiliac Joint?

The sacrum is the triangular bone located at the bottom of the spinal column.  Above the sacrum, you find articulation with the last lumbar vertebrae (L5) and below is the joint made with the coccyx (tailbone).  At either sides of the sacrum you have two ilium or ala.  The sacroiliac joint is the joint that is formed between the sacrum and ala.  The ilium is the bone that also forms part of the area of the hip joint (where the thigh bone, known as the femur, articulates with the ala).  The hip joint is the joint that allows us to move our thighs freely in many directions – upwards, outwards and backwards.

What is the function of the Sacroiliac Joint?

The function of the SI joints is to allow torsional or twisting movements as well as to provide shock absorption from the forces coming above and/or below the joint.  Our thighs and legs act like long levers and without the sacroiliac joints and other joints within the area, the pelvis would be at greater risk of fracture or injury.

What is Sacroiliac Joint Dysfunction?  What does dysfunction mean?

Sacroiliac Joint Dysfunction refers to the SI joint not working properly.  Sometimes the joint can be either too tight (hypomobile) or too loose (hypermobile).  Said another way, the joints can either be locked/restricted (hypo) or loose/abnormally moveable (hypermobile).  When you have a hypo or hyper SI joint, you influence the ligaments, muscles and other surrounding soft tissues in the area (gluteal muscles, piriformis muscles, etc).  As a result of the dysfunction, you change the biomechanics of the joints above and below the area – the back and the hip joints.  The question is – Is it an injury or dysfunction to the back or hips that causes the SI joint dysfunction OR is it the SI Joint dysfunction that causes the hip and/or back pain?  This is the chicken and egg scenario that we commonly get faced with as health practitioners.  I think it can go either way.

What Conservative Treatments are available for SI Joint Dysfunction?

Chiropractic adjustments work very well for SI Joint Dysfunction.  Furthermore, I find that electrotherapy, soft tissue therapy, laser therapy and taping techniques, in combination, also help.   Of course, it is important to address the other joints in the region to ensure that they are functioning properly.  Strengthening exercises are also prescribed for the lower back, core, gluts and legs.

What is a Chiropractic Adjustment?

An adjustment is a highly skilled and precise movement usually applied by hand to a joint of the body. Adjustment loosens the joint to restore proper movement and optimize function.

When a joint is adjusted, a gas bubble escapes causing the popping noise you may have heard about.

Chiropractic adjustment techniques have been researched extensively. Complications are rare and side-effects, such as temporary soreness, are usually minor. Your chiropractor is well-trained to determine if your problem will respond to chiropractic care or if you require referral to another health care provider.

-Ontario Chiropractic Association

I hope you have enjoyed this blog post.  Please feel free to write any comments or to contact me if you have any questions.

Dr. Luciano Di Loreto

Chiropractor & Acupuncture Provider

Fit for Life Wellness & Rehabilitation Centre

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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Part 1 of 2: Is it Carpal Tunnel or Is it Something Else?

Part 1 of 2: Is it Carpal Tunnel or Is it Something Else?
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I have a number of patients that mention that they have carpal tunnel syndrome. When I ask them how they know, they can’t explain.  After a history and physical assessment, I often recognize that their symptoms are in fact not related to carpal tunnel. Why the confusion? One thing that I have learned, while practicing, is that tingling in the forearm does not always equate to carpal tunnel syndrome.

In part 1 of this blog, I will provide specific information pertaining only to carpal tunnel syndrome. This will create a firm base for part 2 of the blog – when I explore and explain other nerve conditions which create symptoms similar to carpal tunnel. Let us begin…

What is Carpal Tunnel Syndrome?

Ok, so what is it?  Carpal tunnel syndrome, simply stated, is when a nerve in the forearm is squeezed at the wrist. More specifically, carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes compressed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (half of the fourth finger and not the little finger). The median nerve also provides motion to small muscles in the hand. The carpal tunnel is a narrow, tight, passageway of ligament and bones at the base of the hand. This tight box is home to the median nerve as well as tendons that attach to muscle and allow our hands to move. Sometimes, the carpal tunnel soft tissues thicken and/or swell. As a result, the tunnel narrows and causes the median nerve to be compressed. This creates pain, weakness, and/or numbness in the hand, wrist and may radiate up the arm.

Let us provide you with an analogy.  Think of when a four lane road merges to become a two lane road.  This creates a bottleneck in the road, which usually leads to heavier traffic due to the less room to manoeuvre.  The more the road reduces, the less the passageway for cars to pass.  Numerous reasons can cause the passageway to shrink (accidents like trauma/injury in a wrist, floods like swelling/inflammation in a wrist and construction like scar tissue/tissue rebuild/healing in a wrist) – the bottom line is that the same amount of cars still need to get through to the other side, but with obstacles or a bottleneck, it becomes harder and thus more issues (symptoms) can arise. This is what occurs when someone has carpal tunnel issues – that is – their passageway for the median nerve is being blocked or squeezed.

Symptoms usually start slow but gradual. Usually, it starts with frequent burning, tingling, and/or numbness in the palm of the hand and the fingers. Some sufferers say their fingers feel swollen and weak, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night. The person may wake up feeling the need to shake out the hand or wrist. As symptoms progress, patients complain that they feel tingling during the day. Continued carpal tunnel may result in decreased grip strength and muscles wasting at the base of the thumb. Furthermore, some people are unable to tell between hot and cold by touch.

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome is often the result of a combination of factors. These factors are responsible for increasing pressure on the median nerve and tendons in the carpal tunnel. Most likely the disorder is due to genetics. Some individuals are born with a smaller carpal tunnel. Moreover, trauma or injury to the wrist that causes swelling, sprains or fractures, rheumatoid arthritis, mechanical joint issues at the wrist, stress, vibrating hand tools, fluid retention during pregnancy or menopause or the development of a cyst or tumor in the canal. Sometimes no cause(s) are identified.

Who Develops Carpal Tunnel Syndrome

Women are more likely than men to develop carpal tunnel syndrome. Carpal tunnel syndrome usually occurs only in adults and not in children.

How is Carpal Tunnel Syndrome Diagnosed?

There are a variety of tests that are used to produce symptoms of carpal tunnel syndrome.  In the Tinel test, the practitioner taps on or presses the median nerve in the patient’s wrist. The test is positive when tingling in the fingers occurs. The Phalen test, or wrist-flexion, involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together (like a reverse prayer sign). The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.

Diagnosis is confirmed by electrodiagnostic tests such as nerve conduction studies. Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist.  Furthermore, ultrasound imaging can show impaired movement of the median nerve and Magnetic resonance imaging (MRI) can show the anatomy of the wrist.

How is Carpal Tunnel Syndrome Conservatively Treated?

Treatments for carpal tunnel syndrome should begin as early as possible. Underlying causes such as diabetes or arthritis should be treated first.

I treat carpal tunnel syndrome by using a variety of chiropractic techniques electrotherapy, ultrasound, laser, cyrotherapy and exercises.  Furthermore, soft tissue therapy techniques over the forearm, wrist and palm of the hand as well as acupuncture are beneficial.  Patients usually feel relief with two to three treatments over the course of 4 to 6 weeks.

Now that you know more about carpal tunnel syndrome…let me explain why people get it confused with other nerve issues located in the forearm.  In part 2 of this blog, I will explore and explain other nerve conditions which create symptoms similar to carpal tunnel.

 

Dr. Luciano Di Loreto, HBSc., DC

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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The “Glass Ankle” Patient

The “Glass Ankle” Patient
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What do you mean by glass ankle?

From time to time, I have patients who replace a common medical diagnosis with a slang term or name.   The first time I heard that my patient had “glass ankles, I remained uncertain as to what he meant.  I asked him to explain further.  He explained that a simple misstep, stumble or twist would lead to his ankles giving out.  When this occurred, he explains that it is difficult for him to walk.  Furthermore, his ankles become weak, swollen and movements are painful.

Why compare the ankle to glass, you ask? 

As with glass, you need to be very careful not to tilt, drop or misplace it…if you do it will break into many pieces.   With those with “glass ankles“, they must make sure to be delicate on their feet and avoid compromising positions.  In Medical terms, the glass ankle refers to someone with ankle instability.  Usually, this is caused by multiple ankle sprains.

Within this blog, I will go into the anatomy of the ankle, who is predisposed to ankle injuries, signs and symptoms of a twisted ankle/sprain, and treatment methods used to assist with the healing of a twisted ankle or sprained ankle.

What is a twisted ankle?

A twisted ankle, ankle twist, rolled ankle, ankle sprain/strain, or someone with a glass ankle is one of the most frequent types of injury seen by health practitioners.  The ankle joint, which connects the foot with the lower leg, is injured often when an unnatural twisting motion occurs to the foot when it is planted awkwardly.  This usually occurs when the ground is uneven or when an unusual amount of force is applied to the joint. Such injuries happen during athletic events, while running or walking or even doing something as simple as getting out of bed. There are various ligaments in the ankle which can be twisted or sprained, however the most common is the one located on the outside of the ankle. This ligament is known as the ATFL (Anterior Talofibular Ligament).

What makes up the ankle joint?

The ankle joint is composed of three bones, which include the tibia, fibula, and talus.  The tibia is a large leg bone (on the inside of the leg) that bears most of the body’s weight.  The fibula is the smaller leg bone (on the outside of the leg).  Both the tibia and fibula attach to the talus (the top bone of the foot).  The three bones together create the ankle joint. Tendons and ligaments cover these three bones.  On the outside of the ankle you find the anterior talofibular liagament (ATFL).  On the inside of the ankle is the deltoid ligament.   Most ankle sprains involve the outside ligament,  the ATFL.

What are the signs and symptoms of a twisted ankle?

Ankle sprain symptoms may vary from being very mild to severe.

Usually a sudden trauma, twisting or turning over of the ankle will happen.  The patient will experience pain on the outside of the ankle.  Swelling or bruising may be present but not always.  Ankle sprains are graded 1, 2, or 3 depending on severity.  Furthermore, the patient may pain, redness, warmth, trouble walking & stiffness in the ankle.

Grade 1 sprain:

  • Some stretching or perhaps minor tearing of the lateral ankle ligaments.
  • Little or no joint instability.
  • Mild pain.
  • There may be mild swelling around the bone on the outside of the ankle.
  • Some joint stiffness or difficulty walking or running.

Grade 2 sprain:

  • Moderate tearing of the ligament fibres.
  • Some instability of the joint.
  • Moderate to severe pain and difficulty walking.
  • Swelling and stiffness in the ankle joint.
  • Minor bruising may be evident.

Grade 3 sprain:

  • Total rupture of a ligament.
  • Gross instability of the joint.
  • Severe pain initially followed later by no pain.
  • Severe swelling.
  • Usually extensive bruising.

What treatments are available for a twisted ankle?

Despite common medical practice, treatment of ankle sprains should not be limited to rest and ice.  Modalities such as ultrasound, interferential current, TENS, Graston Therapy, Laser Therapy and soft tissue therapy can and should be used to assist in the healing  of the sprained ligaments in the ankle.  Furthermore, acute ankle injuries need to be addressed immediately, both passively (with modalities and soft tissue work) and actively (exercises and rehabilitation).  If treatment does not commence immediately, you will probably experience stiffness, tightness and instability in the ankle joint at some point in the future.  Moreover, ankle instability will most likely lead to more ankle sprains. Ultimately, more ankle sprains may dub you – the person with the glass ankles. 

I hope you found this blog informative.  If you have any questions, please feel free to comment.

Dr. Luciano Di Loreto

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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Can Acupuncture help with Menopause?

Can Acupuncture help with Menopause?
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If you are reading this post, you probably know of someone suffering with menopausal symptoms or perhaps you may be going through menopausal symptoms yourself.

Menopause does not have to be a terrible and awful time of your life.  It does not have to include constant hot flashes, night sweats, and inconsistent hormonal mood swings. 

What is Menopause? 

Menopause is a transitional period which marks the end of ovulation for women.  This change can last months to years and symptoms range from mild to severe due to decreasing estrogen. Menopausal symptoms include hot flashes, night sweats, insomnia, fatigue, mood swings, memory loss, vaginal dryness, headaches, joint pain, and weight gain.

 

Menopause

Menopause

How do I treat Menopause? 

Recently, there is much debate on the benefits of Hormone Replacement Therapy (HRT).  HRT usually starts when the first symptoms of menopause appear. While HRT may help to get rid of hot flashes and prevent bone loss (osteoporosis), they have been associated with increasing the risk of breast, ovarian and uterine cancer.   HRT isn’t the only answer to menopause.  Many women are exploring alternative options such as acupuncture.  Herbal Medicine and Traditional Chinese Medicine (such as Acupuncture) have been used for women’s health can be found in early medical literature dating back to 3AD. 

How Acupuncture work for Menopause?

The basic foundation for Acupuncture is that there is a energy flowing through the body, which is termed Qi (pronounced chee). This specific energy flows through the body on channels known as meridians that connect all of our major organs. According to Traditional Chinese Medicine, illness/disease/negative changes in the body such as menopause arises when the flow of Qi in the meridians becomes unbalanced or disturbed. 

Acupuncture may help to reduce menopausal symptoms. It may help to reduce stress, hot flashes, mood swings and irritability. 

How does Acupuncture work?

Acupuncture stimulates specific points located on or below the surface of the skin.  These specific points have the ability to alter various biomechanical and physiological conditions in order to achieve the desired effect.  During the acupuncture treatment, very thin needles (no medication in the needle) are placed in specific spots located on your arms, back, legs and feet.  The number of needles utilized, length of treatment, number of treatments and frequency of treatments will vary case to case. Typical, an acupuncture treatment lasts at least 30 minutes.  Patients are recommended to attend treatments at least 2-3 times per week. 

For additional information on acupuncture, please take a look at the following website www.fitforlifewellnessclinic.com

Dr. Luciano Di Loreto

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What is Chiropractic?

What is Chiropractic?
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This piece of literature comes directly from the Ontario Chiropractic Association website.  This is an excellent synopsis of what chiropractic is all about.

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What is Chiropractic?

One of the largest primary-contact health care professions in Ontario, chiropractic is a non-invasive, hands-on health care discipline that focuses on the neuromusculoskeletal system.  Chiropractors practice a manual approach, providing diagnosis, treatment and preventive care for disorders related to the spine, pelvis, nervous system and joints.  Chiropractors use a combination of treatments, all of which are predicated on the specific needs of the individual patient. After taking a complete history and diagnosing a patient, a chiropractor can develop and carry out a comprehensive treatment/management plan, recommend therapeutic exercise and other non-invasive therapies, and provide nutritional, dietary and lifestyle counselling.
For many conditions, such as lower back pain, chiropractic care is frequently the primary method of treatment. Where other conditions exist, chiropractic care may complement or support medical treatment by relieving the neuromusculoskeletal aspects associated with the condition. Chiropractic care may also be used to provide symptomatic relief for patients with chronic conditions. According to patient surveys, by treating the neuromusculoskeletal elements of such disorders, chiropractic treatment has been shown to improve the general well-being of the patient.

There are many reasons to seek chiropractic care:

  • Back pain
  • Neck pain
  • Headache
  • Whiplash
  • Strains and sprains
  • Repetitive strain injury (RSI)
  • Work and sports injuries
  • Arthritis
  • Limited range of motion in the back, shoulder, neck or limbs
  • General health and well-being

Chiropractic is a regulated health profession, recognized by statute in all Canadian provinces and American states. Almost 2 million patients in Ontario rely on chiropractic care every year to help them live healthy, active lives.

Dr. Luciano Di Loreto, Chiropractor & Acupuncture Provider

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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My Feet Hurt with the First Few Steps Out of Bed in the Morning! Is it Plantar Fasciitis?

My Feet Hurt with the First Few Steps Out of Bed in the Morning!  Is it Plantar Fasciitis?
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Perhaps, you have something called plantar fasciitis…..

What is Plantar Fasciitis? 

Plantar Fasciitis

Plantar Fasciitis

Commonly (but not exclusively) found in runners, plantar fasciitis (more currently referred to as plantar fasciosis, plantar fasciopathy, or heel foot pain) is a common cause of back heel pain. The most commonly known syndrome is sharp pain at the bottom of the heel with the first few steps out of bed. Pain can also occur with prolonged walking, running, or standing. The cause of this condition is a build up of tension in the tissues under the feet (the plantar fascia) which tugs on the inferior aspect of the heel bone causing pain. Sometimes this constant tug of the heel bone creates a heel spur at the back of the foot.

What symptoms may I experience?

-Symptoms include heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.

-Pain when pressing on the inside of the heel and sometimes along the arch (see plantar fasciitis diagnosis).

-Pain is usually worse first thing in the morning as the fascia tightens up overnight. After a few minutes it eases as the foot gets warmed up

-As the condition becomes more severe the pain can get worse throughout the day if activity continues.

-Stretching the plantar fascia may be painful.

-Sometimes there may also be pain along the outside border of the heel. This may occur due to the offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.

Sourced from http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/plantar-fasciitis

What treatment options are available to me? 

Several treatment options can help relieve tension in the tissues including soft tissue therapy, interferential current, cold therapy, graston, ultrasound and custom made orthotics (for shock-absorption). To learn more about how these techniques may help you, please feel free to contact us.

Dr. Luciano Di Loreto

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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Difference Between a Strain and a Sprain?

Difference Between a Strain and a Sprain?
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What is a strain?  What is a sprain?  What is the difference? 

Often times, I get asked these questions.  Many of my patients play sports such as basketball, soccer and baseball regularly experience a few strains and/or sprains.  I have many patients that do not participate in regular sport activities, however, also encounter the same health problems.  Whether low back, ankle or knee, individuals regularly experience strains and sprains.  In other words, sprains and strains are common in our population – they happen.  Within the next few paragraphs, I will spend time describing and educating about the differences between the two terms: Sprains versus Strains.

What is a Sprain?

Sprains are injuries to ligaments, those structures that attach one bone to another creating a joint.  A sprain occurs when a ligament is stretched beyond capacity.  Any joint can experience a sprain, however the most common sprains occur in the ankle (ATFL – Anterior Talofibular Ligament), knee (ACL – Anterior cruciate ligament, PCL – Posterior cruciate ligament, MCL – Medical Collateral Ligament, LCL – Lateral collateral ligament), fingers, wrists and toes.

The grading of ligament sprains is officially done on a 3 point scale.

Grade 1 is a mild stretch of the ligaments.

Grade 3 is a complete tear of the ligament

Grade 2 is everything in between.

How do I treat a ligament sprain?

Although most ligaments in the body have a good healing capability once injured, incorrect healing of these structures can leave the joints which they cover loose and susceptible to re-injury.  We provide extensive rehabilitation as well as the manual therapy necessary (including kinesio taping and massage therapy) for the treatment of these injuries. Once the grade of the ligament sprain has been diagnosed, we will provide ice massage (decrease pain/inflammation), interferential current/tens (decrease pain/inflammation), laser therapy (healing), ultrasound (healing) and extensive rehabilitation to help treat strains.

What is a Strain?

Strains are injuries that occur to our muscles.   Muscle strains often occur due to strenuous activities such as any sudden jerk, heavy lifting, twisting, sport activities and/or while performing job/work tasks.  A muscle strain is often times referred to as muscle pull.  If a muscle is severely pulled is can result in a muscle tear. This tearing can damage small blood vessels.  Damaged small blood vessels causes local bleeding (bruising) and pain.

Muscle strains can occur in any muscle of the body. Strains most often occur during the eccentric portion of a muscular contraction (when the muscle is actively lengthening). When the forces placed on the muscle exceed the muscles force-absorbing capabilities, tearing occurs in the tissue. There are three grades of muscle tears. Grade 1 indicates very minor or micro tearing of the muscle. Grade 2 indicates a more substantial tear of the muscle, however there is still a portion of the tissue that remains intact. A grade 3 tear indicates a complete rupture of the muscle. The severity of a muscle strain can be graded by assessment of the patient’s symptoms and/or by diagnostic ultrasound or MRI. Symptoms include pain with muscular contraction, bruising and swelling in the muscle belly.

How do I treat a muscle strain?

Once the grade of the muscle strain has been diagnosed, we will provide ice massage (decrease pain/inflammation), interferential current/tens (decrease pain/inflammation), laser therapy (healing), ultrasound (healing) and extensive rehabilitation to help treat strains.

I have a strain/sprain! What do I do now?  

Whether you have a strain or sprain, ensure you get it checked out immediately by a health care provider!  You do not want to leave it alone and hope things heal.   This type of thinking may make things worse or prolong proper healing.  As a result, you may make the issue a chronic one that may require much more attention and future treatments.

I hope this blog is informative.

Dr. Luciano Di Loreto

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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Ice or Heat? What do I use for my injury?

Ice or Heat? What do I use for my injury?
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Today, I thought I would touch upon a question that I get asked quite often in practice.   When should I use Ice and when should I use Heat?  What is the difference between ice or heat for treating my injury?

These are both interesting questions and something that I would like to address in this blog.

When to use ICE or Cryotherapy?

Ice or cryotherapy is usually used for pain relief and inflammation immediately post injury (acute phase of injury).  With ice usage, inflammation, edema (swelling), hemorrhage, as well as how fast your nerves conduct decreases, while pain tolerance increases.  Generally, ice should be used throughout the inflammatory process (acute phase of injury).  This process typically begins immediately post injury and lasts between 3 to 5 days.  Along with ice, individuals may use a technique called RICE. 

What is RICE?  

Rice stands for rest, ice, compression and elevation.  For instance, when one presents with an acute ankle sprain, this technique can be used. By resting, one avoids aggravating the area further, by icing and compressing, one can decrease swelling, and by elevating one focuses on draining swelling back towards the heart.  Cold/ICE should be applied during the first 4 hours post injury at intervals of 10 minutes every 30-60 minutes.

When do I use HEAT Therapy?

Heat is generally used for increasing blood flow to the area and helping muscles and tendons to relax during chronic phases of injury – in other words, an injury that has been around for long periods.  By using heat, we are better able to relax tight muscles. Heat has been thought to increase the inflammatory process and thus is usually not advised during the acute phase (immediate post injury phase).

What cold treatments are available?

We may use the following cold treatment in practice: cold packs, gel packs, ice tape, compression units, menthol compounds and even vapo-collant spray.  One of the most common and arguably the best way to cool down an area is to use a baggie filled with ice/cold water.  Some individuals may use a bag of peas from the freezer – which will work as well.

What heat treatments are available?

Heat can be administered using a variety of ways including: hot packs, hydrocullator pads (we use this quite often in our practice), paraffin baths, whirlpools, and hot towels.  No matter which way is utilized, it is important to monitor the skin for inflammation via redness.  The main concern is that the individual may burn themselves if not monitored.

Before using heat or ice, always be sure to consult with your health provider.

Although, it may seems fairly simple, there is quite a bit of confusion out there when it comes to ice and heat.  Hope this post clears up some of the questions between heat and ice!

Dr. Luciano Di Loreto

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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The Slipped Rib Syndrome

The Slipped Rib Syndrome
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The Slipped Rib Syndrome

It was great to post my first blog yesterday!  I would like to thank all those who have spent the time to read my first posting.  Today, I would like to start by discussing a very common, yet in my opinion, misdiagnosed and under diagnosed condition that I see quite frequently in practice.

Have you ever felt a sharp pain in the upper back or middle of your back? Right between the shoulder blades? Moreover, have you ever experienced a sharp localized pain in the back while taking a deep breath? Has this pain ever gone from being localized in the back to referring to the side and front aspect of the torso? These are all symptoms of what has been referred to as a ‘slipped rib’ or ‘slipped rib syndrome’.

What is a slipped rib?

I have experienced many patients who have come to me with these symptoms without knowing exactly what was going on. They explain that the pain they experience is “annoying” and “feels as if a knife is digging in their back”. Whether it be by twisting, bending , lifting, getting in and out of the car, sitting at a desk all day or constant repetitive strain, slipped ribs occur and do so at a frequent rate. Often gone misdiagnosed, slipped rib syndrome can be a very frustrating condition to deal with.  What do you do?  Before explaining what I do for patients, I will describe more about what a slipped rib is.

What is slipped rib syndrome?

Slipped rib syndrome was first described in the early 1900’s.  Cases have been reported in children as young as 12 years and much higher in females than males.  We have 2 sets of 12 ribs which create the rib cage.  The ribs attach to each thoracic vertebrae in the back.  Sometimes the ligament connection (called costovertebral/costotransverse ligaments) linking the vertebrae of the back and the rib can cause symptoms and discomfort.  If this connection is slightly lax or loose, it may cause something known as hypermobility.  Let’s break up this word – hyper – and – mobile.  Hyper meaning excessive or beyond.  Mobile meaning capable of moving or being moved. Hypermobility may result in stretching of the ligament, misplacement of the bones, and thus an irritation in the back over the attachment location.  Sometimes the nerve in the area can become irritated from this stretching and as a result sends a sharp pain around the torso from the back to the front.  Furthermore, the muscles around the area become taut and irritable as well.   Hope I did not lose you!  If I have, think of it this way…your rib and vertebrae bones are connected together by a ligament (in this case, think of the ligament as an elastic band).  If the elastic band stretches too much, it may cause the bones to shift out of there normal position.  If the bones shift, they feel out-of-place and thus cause our bodies discomfort.  Hope this explanation makes things more clearer.

How to treat a slipped rib?

Slipped ribs can be treated by various techniques.  One technique is to relax the musculature with heat, interferential current (electromodality that assists in pain reduction), and registered massage therapy.  These techniques will assist in realigning the rib(s) and vertebrae.  A second technique is to adjust the rib(s).  This will also assist in realigning the rib and vertebrae into a ‘normal’ or more comfortable position.

What is an adjustment?

The Ontario Chiropractic Association defines an adjustment as a highly skilled and precise movement usually applied by hand to a joint of the body.  Adjustment loosens the joint to restore proper movement and optimize function. When a joint is adjusted, a gas bubble escapes causing the popping noise you may have heard about. Chiropractic adjustment techniques have been researched extensively. Complications are rare and side-effects, such as temporary soreness, are usually minor.    

How is a slipped rib adjusted by a Chiropractor?

One technique is to have the patient lie on his/her stomach on a chiropractic table.  The adjustment is applied by the chiropractor to the area where the slipped rib(s) is/are irritated.  The adjustment to the area is very quick.  Following the adjustment, the patient usually knows whether or not that rib(s) is/are still irritating them.  Most of the time the pain goes away.  Sometimes, the muscles around the slipped rib remain tender to the touch.  Another techniques is to have the patient sit at the end of the chiropractic table.  The patient sits facing away from the table.  The patient is lowered onto the table and will usually feel the pop or click once he/she reaches the table.  Trained Chiropractors and other trained practitioners can perform this rib adjustment procedure in various ways.  Always consult a trained health practitioner when contemplating treatment.

From my experience, a combination of techniques, modalities (IFC, Cryotherapy, Heat Therapy), registered massage therapy and adjustment, work extremely well to help with the discomfort of a slipped rib. Furthermore, I find that adding mid back strengthening exercises (such as wall angel exercises) to the mix, helps to prevent future episodes of slipped rib syndrome.

Please note that I have not exhausted and discussed all the options for dealing with a slipped rib.  I have only touched on a few that I find work for my patient’s.  Do your  own research and if you have any questions, please send them along and I will do my best to address them.  Look forward to comments.

Hope you found this information on the slipped rib syndrome interesting. To make an appointment to see Dr. Luciano Di Loreto, please contact the office at 647.873.4490. 

 

Dr. Luciano Di Loreto, HBSc., D.C. & Associates

Chiropractor & Acupuncture Provider

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

 

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