In the Corner with the Ring Doc: The Separated Shoulder, That Bump on Your Shoulder May be Fixable

 

 

 

ac_joint3

Written by Dr. Beau B Hightower
MS, DC, CSCS, CES

Many athletes and weekend warriors have experienced pain in their shoulder after a hard fall. Pain can continue for many years and may begin to impact your day to day activities as well as your athletic performance. There are many causes for shoulder pain, the most common of which include rotator cuff pain, labral tears, fractures of the humeral head, shoulder dislocations, and shoulder separations.

Separated shoulder injuries occur when blunt trauma is applied to the side or top of the shoulder. This can happen with collision sports such as basketball, football, soccer, and mixed martial arts when an athlete runs into another athlete. These injuries also occur during hard falls which are common in cycling, skiing, and even distance running. The separation that is referred to when we discuss separated shoulders is a specific joint along the collar bone that is called the acromio-clavicular joint or more commonly, the AC Joint.

shoulder_impingement_causes01

The AC Joint is the connection between a part of the scapula or shoulder blade and the collar bone. When an impact occurs that is strong enough to damage the ligaments that hold this small joint in place, one end, typically the clavicle or collar bone, separates and is pushed either up or down. This causes immediate pain, and there is nearly always a visible elevation in the affected area of the shoulder.

AC Joint separations are classified into six types with type one, or the least severe being the most common. Types four through six are so severe that surgery is typically required to stabilize the joint and attempt to repair fractures and ligament tears. Type one and two can leave permanent deformity as arthritis and ligament thickening or hypertrophy set in. Type one and two can clinically be improved by shoulder mobilization that can actually improve the visual appearance of the “bump” even years later. By creating motion within this thickened structure, synovial fluid is allowed to re-lubricate the joint which can dramatically improve shoulder pain and appearance. If left untreated, type one and two shoulder dislocations can cause permanent deformity and can contribute to neck pain, shoulder arthritis, and even a painful shoulder restriction condition known as impingement syndrome in which the AC joint can actually damage the rotator cuff that glides underneath it.

If the shoulder trauma is recent, it is important to seek medical evaluation so that they may prescribe diagnostic imaging if needed to rule out fractures or other severe trauma. Treatment of a separated shoulder depends on the severity of the injury. When beginning treatment some of the things one should do first, is control the inflammation, rest the joint, and ice the joint. Take an anti-inflammatory such as ibuprofen or naproxen to help minimize the pain and inflammation. Rest the joint which will also help minimize painful symptoms and allow the healing to begin. When icing, it should be done every four hours for 15 minutes at a time. You may wear a sling until the pain subsides.

 However, if you have a noticeable bump on the end of your collar bone that bothers you, you owe it to yourself to seek a qualified physical medicine specialist to see if this chronic shoulder separation can be improved. If you have pain from an AC Joint separation, you may not have to “shoulder” the load of  unsightly shoulder bumps and pain anymore!

Disclaimer: This article is for educational purposes only. If you have a medical condition, it is prudent that you seek medical evaluation by a properly qualified and licensed practitioner.

hightower-beau 

Dr. Beau Hightower is a former collegiate athlete and avid fight fan. He serves as the President of Elite Ortho-Therapy and Sports Medicine LLC, the premier sports injury resolution center in New Mexico. He serves on the Executive Board of Directors for Parker University and their Alumni Association and treats many elite level UFC fighters in his home practice.

Elite-OSM.com

In the Corner with the Ring Doc: Growing Pains, Keeping Your Young Athlete In The Game

            severs-disease

Written by Dr. Beau B Hightower
MS, DC, CSCS, CES

Remember the 80’s sitcom, Growing Pains? Do you remember the family name on the show? That’s right, if you guessed Seavers, you are correct. If you have ever experienced, or known someone to experience “growing pains” during the teenage years, then you may be familiar with the terms Osgood Schlatter’s and Sever’s. These are painful afflictions that affect the knee and heel of teenagers and young children, particularly in the athletic population. Today we are going to discuss the whys, hows, and ways to prevent these painful disorders from knocking your young athlete out of the game.

Growing pains is a common term used to describe a very specific bone abnormality known as apophysitis. Apophysitis literally means inflammation of the apophysis, which is the technical term of a bony tubercle wear tendons attach to bone. For those of you not familiar with muscle and skeletal anatomy, ligaments connect bone to bone, while tendons connect muscles to bone. In order to move, the muscles must contract which pulls on bones to move our bodies into the position that we desire. Because the force is transmitted through the tendon to the bone, any over-activity can cause tendinitis in adults, or for those whose bones haven’t fully hardened yet, apophysitis. Due to repeated trauma associated with sports, mutiple avulsion fractures occur below the tubercle which results in a painful bump. The most common sites for such an injury are on the heel, below the kneecap, and where the hamstring muscles tie into the pelvis, known as the ischial tuberosity.

These can be extremely painful and cause physical and psychological trauma to a young athlete. Because their growth plates are still open, the athlete’s bones are growing longer, and if they don’t keep the muscles and tendons relaxed and elongated, these muscles will struggle to maintain the accelerated pace of the bone and begin to pull at the attachment points on the bones. One key way to prevent and relieve the symptoms associated with growing pains is by being proactive with self myofascial release. For specific tips on foam rolling, lacrosse ball use, and myofascial stick, please see my previous article on muscular hygiene.

http://knuxx.com/nm/2013/02/in-the-corner-with-the-ring-doc-muscular-hygiene-keeps-fighters-in-the-game/

The most common devices used to apply SMR are foam rollers, lacrosse balls, myofascial sticks, and myofascial “canes”. These tools can prevent and repair  injuries such as anterior and posterior shoulder pain, IT band syndrome,  lower back pain, shin splints, plantar fascitis and more.  Research has shown repeatedly that static stretching is not the definitive answer to musculoskeletal problems, and while there are few papers relating to foam rollers and others, there is plenty of clinical evidence in the athletic community. Stretching tends to put stress at the tendon-bone intersection, and the muscle-tendon intersection, while restrictions within the belly of restricted muscles remain unaffected.

Traditional treatment for apophysitis include rest, ice, compression, and the use of NSAIDS such as Ibuprofen and Naproxen. You should always consult with a medical professional, but by making consistent use of your self-myofascial tools, you can keep your young athlete healthy and in the game. If addressed properly, growing will not require the pains associated with adolescent sports.

Disclaimer: This article is for educational purposes only. If you have a medical condition, it is prudent that you seek medical evaluation by a properly qualified and licensed practitioner.

hightower-beau 

Dr. Beau Hightower is a former collegiate athlete and avid fight fan. He serves as the President of Elite Ortho-Therapy and Sports Medicine LLC, the premier sports injury resolution center in New Mexico. He serves on the Executive Board of Directors for Parker University and their Alumni Association and treats many elite level UFC fighters in his home practice.

Elite-OSM.com

IN THE CORNER WITH THE RING DOC: Gamer's Thumb, When an Arthritis Diagnosis Gets a Thumbs Down

owthumb

Written by Dr. Beau B Hightower
MS, DC, CSCS, CES

Our culture continues to move into a digital age which means  more and more use of our hands due to these digital devices which include cell phones, video games, tablets, and more. Due to this reliance on technological devices, particularly with the millenial generation, it is to no surprise that we are seeing a younger and younger patient population with debilitating thumb pain. In the past, most doctors and practitioners would brush thumb pain off as arthritis or simply a part of the aging process, but as we learn more about the pathology of soft tissue injuries, we have come to realize that a simple condition known as De Quervain Tenosynovitis is the main cause for our current epidemic of thumb pain. Symptoms of this particular disease include pain, tenderness, and swelling over the thumb side of the wrist, and difficulty gripping.

Professions such as dental hygienists, office staff, and yes even UFC fighters are at high risk to develop this type of overuse injury.

 While most of the muscles associated with the thumb lie on the palm side, (this is known as the thenar eminance) the most common tendon restrictions lie on the top side of the thumb. Two specific tendons, the abductor pollicus longus and extensor pollicus brevis  are often entrapped either within the tendon sheath (the area that wraps around tendons that protects and allows proper movement) or the retinaculum ( a band of tissue that wraps around the wrist to provide support for tendons, veins, arteries, and nerves) The following image show’s finkelstein’s test, the most accurate orthopedic test to verify gamer’s thumb.

ans7_finkelsteintest

Research shows that 90 percent of patients with gamer’s thumb will recover in one year, but most people simply cannot wait that long for resolution, as the thumb is so vital to our lives, particularly in the digital age.  Most patients can be completely healed within 1-3 treatments by using soft tissue treatment methods  such as Ortho-Therapy or instrument assisted soft tissue mobilization. Due to the frustrating nature of the injury, and the general lack of knowledge of the condition within the medical community, patients are occasionally referred for surgical consults unnecessarily. Operative procedures on the thumb can lead to debilitating bio-mechanical changes down the line. Second line therapies include efficacious treatments such as NSAIDs and Corticosteroid injections of the synovial sheath (doctors often are mistaken and attempt injections into the joint in hopes of alleviating what they perceive to be osteoarthritis)

 If you are experiencing sharp thumb pain, and you believe or have been told that you simply have arthritis, you owe it to yourself to seek out an evidence-based practitioner of physical medicine to evaluate your injury. More than likely, you will be back to texting, typing, and doing the things that you love to do in a very short period of time, simply by getting the right treatment for the right condition. You will be smiling, and will certainly give a “thumb’s up” to the healing hands of your doctor!

 

 

Disclaimer: This article is for educational purposes only. If you have a medical condition, it is prudent that you seek medical evaluation by a properly qualified and licensed practitioner.

hightower-beau 

Dr. Beau Hightower is a former collegiate athlete and avid fight fan. He serves as the President of Elite Ortho-Therapy and Sports Medicine LLC, the premier sports injury resolution center in New Mexico. He serves on the Executive Board of Directors for Parker University and their Alumni Association and treats many elite level UFC fighters in his home practice.

Elite-OSM.com

Anderson Silva Blames Injury for His Loss to Weidman!

silvaweidman

Posted by Guest MMA Blogger Art Smith

So, Anderson Silva says it isn’t an excuse, but he was only 85% healthy going into the Weidman fight due to a rib injury.  The same thing he said after the first Sonnen fight.  In a Bleacher Report article I read about the comments, the reporter asked, “Will Silva prove the first win was a fluke or will “The All-American” showcase that he truly is the best there is to offer at 185 pounds?”

Well, I guess we will see, but one thing that is for sure, if Silva loses again or has a bad showing, it will most likely be due to a rib injury!

If you ask any fighter and they are being honest, they would say it is rare to enter a fight at 100% and most of the time all fighters are dealing with some sort of nagging, ongoing injury, a harder than usual weight cut or something. However, it is very rare for a fighter to let these things keep them from competing because they need to fight in order to make a living. If the injury or issue ensures a lose or has the potential to end a career, then and only then, will a fighter pull out of a fight.

In the case of Anderson Silva, all of this is ridiculous because 85% is probably average for most, he doesn’t need the money and he didn’t lose the fight as a result of Weidman taking him to the mat and pounding him in the ribs. He lost by dancing around like a clown and getting clipped in the jaw! Injury or not, Silva lost because he thought he was invincible and couldn’t be beat.

That is what I think.  What are your thoughts?

11th Hour Picks for UFC 165!

ufc165

Posted by Art Smith

UFC 165 is TONIGHT Saturday, September 21st and will take place at the Air Canada Centre in Toronto, Ontario, Canada.  This post will be short, sweet and to the point.  Let’s get right to it…

Here’s my picks! Continue reading 11th Hour Picks for UFC 165!

Haters Gonna Hate… Jon Jones, the Man, the Myth, the Legend!

jon jones

Posted by Art Smith

Let me start off by saying that I really like Jon Jones.  Seriously, he is an amazing athlete and competitor.  Physically and athletically, Jones is second to none.  He has worked hard and nobody can deny that he has earned everything he has accomplished in MMA.

Now, with that being said, I would like to share with you some thoughts about timing, competition level, etc… Continue reading Haters Gonna Hate… Jon Jones, the Man, the Myth, the Legend!

In The Corner With The Ring Doc: The Dreaded Lizfranc Injury

                lisfranc

 Written by Dr. Beau B Hightower
MS, DC, CSCS, CES, FMS-C

The dreaded Lisfranc injury has been known to end the seasons of athletes of all ages. A noted victim of late was Jaguars’ running back Maurice Jones-Drew who was lost for the 2012 season after having his ankle and foot trapped under another player during a running play. The injury itself is a dislocation and sometimes fracture of one of the metatarsal bones as this bone is literally  separated from the tarsal bones. Essentially, the base of one of the middle toes is dislocated from the bones of the structurally more compact and stable bones of the mid-foot. What does this mean? Typically this means a lengthy stay in a boot and occasionally surgical interventions if the fracture is unstable.

The Lisfranc injury is named after the 19th century French surgeon Jacques Lisfranc de St. Martin, who first described this foot injury in 1815. This injury can occur in fighters as the foot is stepped on, torqued against the cage, or caught under the body during ankle submission attempts. Typically the second toe is dislocated laterally and this can be seen on x-ray imaging and by clinical evaluation by a licensed practitioner.

Clinical guidelines dictate that if the dislocation is less than 2 millimeters, the foot can be treated by casting or by placing in a boot for 6 weeks. The ligament can be partially or completely torn, and if it is completely torn, the dislocation must be reduced by surgical procedure. This often puts the athlete out of action for over 3 months. Some athletes never return to their pre-injury levels of sport after these injuries. Despite excellent surgical reduction and fixation, arthritis may occur from the damage to the cartilage. This may result in chronic pain and may require fusion in the future.

It is crucial to rule out other types of mid-foot injuries such as Morton’s neuroma, plantar neuroma, plantar fascitis, and impact type injuries such s acute tenosynovitis and contusions. As with all types of injuries, it is very important to consult with your local healthcare practitioner to ensure proper diagnosis and treatment. Remember, while rare, missing a lisfranc injury can not only cost you a season, but potentially a career if not treated in an appropriate manner.

Disclaimer: This article is for educational purposes only. If you have a medical condition, it is prudent that you seek medical evaluation by a properly qualified and licensed practitioner.

 

hightower-beau

 

Dr. Beau Hightower is a former collegiate athlete and avid fight fan. He serves as the President of Elite Ortho-Therapy and Sports Medicine LLC, the premier sports injury resolution center in New Mexico. He serves on the Board of Directors for Parker University and their Alumni Association.

Elite-OSM.com

KNUXX IN THE CORNER WITH THE RING DOC: IT BAND PAIN, MORE THAN JUST A RUNNING INJURY

itband

Written by Dr. Beau B Hightower
MS, DC, CSCS, CES

Knee pain and hip pain are painfully common ailments in society as a whole, but have been known to cost MMA fighters opportunities in the ring and sideline a whole myriad of athletes who rely on distance running for condition. A common, yet misunderstand cause of both hip and knee pain is pain related to the Iliotibial band.  The Iliotibial or IT Band can manifest pain and disability  in several different ways, but the most common way that this condition presents is with sharp pain on the outside of the knee that is made worse by running. Another common symptom is severe lateral knee pain when moving from seated to standing position after a long period of sitting. Prolonged IT Band dysfunction can lead to debilitating range of motion loss in the knee as well as severe hip pain and occasionally numbness in the lateral lower leg and foot. IT Band pain’s most common alias is the term runner’s knee, but this injury is far more prevalent and under-diagnosed in patients that don’t actually spend much time running.

 The IT band is an area of thick connective tissue that begins at the side of your hip and ends just past the knee on the Tibia bone. The band is made of fascia, and as such exhibits properties that are different than muscle, the main property  being that it is very difficult to stretch both histologically (on a cell level) and bio=mechanically. The band also crosses over the top of the greater trochanteric bursa on the lateral hip, and thus can cause acute hip bursitis if the IT band is overactive. Bursa, are sacs of fluid designed to cushion areas of bone from pressure and when they become inflamed, present with sharp, burning pain at the site of the bursa. Patients dealing with this type of hip pains are often x-ray imaged and told that they need a hip replacement, when a simple cortisone shot at the bursa and a foam roller home exercise program would typically suffice for injury resolution.

Fighters often experience IT Band dysfunction as a consequence of road work, which is the traditional runner’s knee presentation, and as a consequence of taking knees and kicks to the side of the thigh. How do you know if you have IT band dysfunction? There is an easy way to check, simply lay on a foam roller on the lateral part of your thigh. If you experience excruciating pain or discomfort, then there is a high probability that you are experiencing over-activity in your Iliotibial band.

Occasionally, patients will present to my office that have had their condition deteriorate to the point where they can’t bend their knee at all. These patients again are typically x-ray imaged by traditional medical providers, and told that they have arthritis, and that they are a candidate for cortisone shots, arthroscopic surgery, or the dreaded “lateral release” surgery. Because the common peroneal nerve can travel underneath the distal IT band and it’s synergist muscles of the lateral hamstring, occasionally patients will present with burning pain in their lateral calf muscle, and/or numbness in their lateral calf and foot. Doctors will often assume that these symptoms are coming from the spine, and as such will order imaging of the lower back and possibly attempt cortisone shots at the disc in the lumbar spine. If you press on the lateral side of your knee and the symptoms increase, you are likely dealing with a sensory peroneal neuropathy (specifically  lateral dorsal cutaneous nerve).

Women tend to have a higher incidence of IT band symptoms do the their increased Q-angle of the hip.  Also, if you are running for distance, you are likely to experience these symptoms due to the braking nature of distance running. Sprinters rarely suffer the same symptomotology due to the fully extension of the knee and hip joints achieved during the running motion.

Making a habit of utilizing a foam roller on your IT bands, quadriceps, and groin muscles will significantly improve your thigh and knee pain, and will make your activities much more tolerable.

 Most IT band rehabilitation programs will consist of the following:

  • Stretching of the hip flexors and abdominals
  • Strengthening of the gluteus medius (exercises like resisted side steps or monster walks)
  • Inhibition of the IT band and quadriceps muscles by using the foam roller
  • Inhibition of the calf muscles and lateral lower leg (peroneals) but use of the foam roller
  • Strengthening of the tibial muscles by using theraband resistance exercises

Use of the foam roller prior to any lower body activity is a must for those suffering from IT band pain and dysfunction.

  The following is an example of how to use the foam roller on your IT band and other thigh muscles!

 

http://www.youtube.com/watch?v=ClsjNw0iKFE

Stay in the game and keep on rolling!

Disclaimer: This article is for educational purposes only. If you have a medical condition, it is prudent that you seek medical evaluation by a properly qualified and licensed practitioner.

hightower-beau 

Dr. Beau Hightower is a former collegiate athlete and avid fight fan. He serves as the President of Elite Ortho-Therapy and Sports Medicine LLC, the premier sports injury resolution center in New Mexico. He serves on the Executive Board of Directors for Parker University and their Alumni Association and treats many elite level UFC fighters in his home practice.

Elite-OSM.com

 

Bellator Returns to Albuquerque July 31st Live on Spike TV

Newport Beach, CA. (July 9, 2013) – Bellator MMA returns to Albuquerque, New Mexico Wednesday, July 31st as the Santa Ana Star Center will play host to a Bellator Lightweight World Title fight as defending Bellator Champion Michael Chandler puts his title on the line against David “The Caveman” Rickels, while Bellator Welterweight Champion Ben Askren will defend his title against Russian phenom Andrey Koreskov live on Spike, as well in Spanish language on mun2. The night will also feature the Light Heavyweight Tournament Final as King Mo faces the electric Jacob Noe, while Heavyweights collide as Vitaly Minakov battles Ryan Martinez in the Bellator Tournament Final. The Bantamweight Summer Series Tournament will also begin, as Rafael Silva will battle Rodrigo Lima, while Anthony Leone will take on Bellator newcomer Frank Baca.

Continue reading Bellator Returns to Albuquerque July 31st Live on Spike TV

KOTC “East vs West” Photos

IMG_0304

Event photos from Saturday, June 22nd at the action packed King of the Cage: East vs West.

Continue reading KOTC “East vs West” Photos