Temporo-mandibular Joint Problems (TMJ)

The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull.

Temporomandibular disorders (TMD) occur as a result of problems with the neck, jaw, jaw joint, and surrounding facial muscles that control chewing and moving the jaw.

This joint is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to move smoothly up and down and side to side, enabling you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint controls its position and movement. When you talk and chew the jaw moves and also causes the upper neck vertebrae to move as well!

The cause of this disorder is not clear, but chiropractors and dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.
Injury to the jaw, temporomandibular joint, or joint and muscles of the head and neck such as from a heavy blow or whiplash can cause this disorder.

Other possible causes include: grinding or clenching the teeth, which puts a lot of pressure on the TMJ, dislocation of the soft cushion or disc between the ball and socket,  presence of osteoarthritis or rheumatoid arthritis in the TMJ and stress, which can cause a person to tighten facial and jaw muscles or clench the teeth.
People with Temporomandibular joint problems can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience this disorder and it is seemingly seen most commonly in people between the ages of 20 and 40.


Common Symptoms from Jaw problems:
Headaches, neck aches, dizziness, ringing in the ears, earaches and hearing issues

Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak or open your mouth wide

Limited ability to open the mouth very wide

Jaws that get “stuck” or “lock” in the open- or closed-mouth position

Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)

A tired feeling in the face, swelling on the side of the face

Difficulty chewing or a sudden uncomfortable bite as if the upper and lower teeth are not fitting together properly.

Jaw problems are complex and often require multiple treatment type to aid in resolving them!  Treatments such as: a night guard, acupuncture point stimulation, Chiropractic Manipulative Therapy, Active Release, Graston (Instrument Assisted Soft Tissue Mobilization), LLLT (cold laser), exercises and stress reduction.


Chiropractic treatment for the Jaw (TMJ)
Initial treatment for a temporomandibular joint disorder (TMD) can include applying heat or cold to the jaw area, eating mostly soft foods, taking anti-inflammatory drugs, or wearing a bite guard in the mouth at night. If these methods are unsuccessful, many patients resort to dental treatments to modify the bite or even surgery of the jaw. For those with TMJ symptoms, chiropractic is available as an alternative to those more invasive treatments.
Chiropractic care for the temporomandibular joint (TMJ) can ease pain by correcting the misalignment between the spine and nervous system. Chiropractic can be effective at reducing the pain associated with TMJ, either when used alone or as a complement to other treatments.

An adjustment to the joint(s) can also be done by hand or instrument (Activator), or using a technique that causes a tiny stretch inside the joint to release any fibrous attachments made by the body due to previous trauma. We most often give the patient home exercises to help strengthen the joint and loosen the tight muscles.
In some cases, misalignment of the jaw that results from improper posture or a back problem can cause temporomandibular joint (TMJ) disorder. An approach to treating TMJ caused by misalignment in the neck and upper back is to perform chiropractic adjustments on the spinal joint in these areas.


Do you have full movement in your jaw?
The jaw is a hinge joint connecting the mandible (jaw) to the skull and is surrounded by 68 pairs of muscles immediately in front of the ear on each side of the head. They allow you to chew, yawn, speak, and swallow and are in constant use. This joint is one of the most frequently used in the body. You can locate it by placing a finger in your ear and push forward while opening and closing your mouth. The articular disk separates the condyle head of the mandible and the skull. When this disk is misplaced it will cause Temporal Mandibular Joint Dysfunction (TMJ). Studies show about 35% of the North American population has TMJ disorders.

A common symptom could be having a limited range of motion within the joint. If you have TMJ, every time you open and close your mouth you put wear on the tissues of the joint. This can cause severe problems if not treated properly. . You can test the range of mobility in your jaw by holding your palm vertically with your thumb facing the ceiling. Flex your index finger so it is out of the way. Open your mouth as wide as you can without strain or pain and place the three remaining fingers (middle, ring, and pinky) between your upper and lower teeth.  If you cannot fit all three fingers and you experience pain, it is possible you have TMJ. Don’t be worried if only 2 or maybe 4 fingers fit. If there is no pain and it doesn’t affect how or what you eat then, the diagnosis is probably negative.

TMJ disorders have various causes. Misaligned or missing teeth can force the bone out of its proper position. Trauma from a fall or car crash can do the same thing. Whiplash is a very common cause of TMJ. Many times stress results in a grinding of the teeth or clenching of the jaw. This can over strain the muscles and cause discomfort, tension or pain. It can affect your face, neck, and head causing various symptoms and discomfort. TMJ may appear as various symptoms (headaches and earaches) that wouldn’t normally be considered in conjunction with it. Consult us for an examination if you experience these symptoms.  (770) 922-1212.

The Wonderful Nervous System and Its Control and Coordination of the Body

Last time, I touched on the methodology of our treatment protocol and how we treat the area of pain, but also addressed what is often the underlying cause of one’s malfunction. Obviously, if there is a cause-effect that renders a back, knee or shoulder less than optimal in its performance, that area needs to be the focus of attention. However, if there is a repeated injury, that over time, possibly due to surrounding weaknesses, becomes a chronically recurrent issue, there may be structures that are north or south of the symptomatic area that are preventing a resolution of the problem; thus, they must be addressed or there will be added frustration. So, a muscle, tendon or ligament may be the tissue that needs attention, or a vertebra or other bony structure may need to be adjusted for proper mechanics to prevail. But, often, because of a repetitive strain cycle or major trauma, nerves can become entrapped, thereby not allowing the normal signaling from the brain to reach the tissue that it ends in.

So, if a muscle, say the triceps, cannot fully extend the elbow to straight because the radial nerve that supplies it is being negatively influenced (pressured upon), the biceps, in the front of the arm will pull the forearm and flex the elbow and become over tightened, because it is overworking. Now, looking at the diagrams below, each organ, including the glands, has to be coordinated, like each member of a symphony, to constrict, relax, secrete, dilate or quicken to enable the overall concert of a healthy body to keep “in tune” and give life to the notes on everyone’s pages.  If you look closely, there is even an inherent or built in mechanism to inhibit digestive functions when the body is responding to an emergency situation…like running for one’s life; hence, the term “fright-flight”. Isn’t it great that our Maker gave us the ability to run for cover without our body hesitating, to first digest our quinoa and turkey salad? But what would happen if we were in that situation and had an entrapped sciatic nerve in the buttock, or, of a branch from the celiac plexus of nerves going to the stomach? You could be greatly injured because your bum leg prevented you from moving quickly from a speeding car’s path or you might develop a case of excess stomach acid because your stomach was not neurologically informed that digestion needed to take a back seat to survival!

Therefore, you can see that just treating a muscle (or gland) on its own may not be sufficient to address the direct cause of one’s ailment; that nerves play a paramount role in our bodily functions, neuromuscularly and somato-viscerally (nerve-gut).  Now, make no mistake, that if I see someone that has 200/100 blood pressure, I am not going to immediately find the cause, whether it be hereditary, endocrine, metabolic or psyco-emotional…I am going to demand emergency treatment by their primary care doctor or the local emergency room!  After any necessary crisis care is rendered, the cause can be addressed to work to prevent future episodes.

So, if you have been experiencing ailments that just do not seem to be improving, or are making you and your current doctor scratch their head in a quandary, please call our office to evaluate your situation.

Figure 1.

Figure 2.

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Source

Figure 1.  Illustrated Physiology, McNaught and Callander, Third Edition. ©1975  Pg. 268

Figure 2.  Illustrated Physiology, McNaught and Callander, Third Edition.  ©1975  Pg. 269

Why Do You Treat Areas That Are Not Where My Pain Is?

This question is one of those that gets asked quite frequently. The default answer has been along the line of “looking at a leak in your ceiling, in that it could be coming from the sink directly above, or from a leak in the roof 30 feet away”. Hopefully, this will better define our approach which was taught to me by a professor of mine, Alejandro Claraco, M.D. at McMaster University in Hamilton, Ontario.

We take a “Global” approach in the treatment of musculoskeletal complaints. At times, according to the exam findings, we will adjust, release or stimulate one or more of the following areas of influence to your pain or dysfunction:

•          Local area: where peripheral nerve trunks are “plugged in” to associated muscles, joints, etc. This area is treated to effect, regulate or normalize that particular region where the pain, weakness or hypertonicity is manifesting. For example, I saw a patient who stumbled and sprained an ankle. It was obviously beneficial to address that immediate area first, and so I did via Active Release, mobilization, as well as electrical stimulation, all with the intended goal to reduce swelling and increase range of motion and ability to bear weight on the injured limb. In this particular case, there were other issues north of the ankle that were longstanding, and mechanically hindering the normal gait with walking and running, so they needed to be addressed as well; but for some, that may have been the sole issue that after a few treatments, the case would be closed.
•          Spinal Segmental area: this area manifests or provokes symptoms via indirect stimulation of the spinal nerves through the surrounding muscles of the spine (close to the spinal midline). Most often, this area is addressed by spinal adjustment, manually, or by instrument. It is important to realize here again that symptoms are not always initiated by the immediate area. A patient complaining with arm pain may have their neck involved; sometimes, however, the upper back may be the primary issue.
•          Systemic Regulatory areas: are predominantly along the upper and lower extremities, as well as on the head and ears. These points are sometimes addressed to affect the muscles and other organs of the body (ill-functioning nerves are often overlooked as a contributing causative factor in, say, cardiovascular, endocrine or digestive malfunction).  While I am not in the habit of advertising for patients to come in for complaints involving non-musculoskeletal problems, I know too well that there are times when there is an electrical malfunction that allows these problems to develop. I first witnessed this early on in my practice when patients brought up the issues they were experiencing prior to the care they received for their spine and wondered why they could now breathe better without congestion, have better bowel movements and not have to get up to urinate so often. Nerves are extensions of the brain that control and coordinate every organ in the body, including skin, muscle and glands. Let me emphasize that there can be a number of causes to a malfunction, but simple modulation, or normalization by chiropractic as well through other soft tissue techniques may save one a lot of expense and time. If there is any doubt as to whether more diagnostic or revealing tests need to be made, I will either have them ordered directly, or work through your primary care provider to get them done in a timely manner, in some instances, even prior to beginning any treatment. In cases involving Medicare, the primary care doctor is always needed in ordering any specialized tests (government controlled).

The strategy or methodology employed on each patient will differ according to particular presentation and examination findings. Some of these procedures may be recommended to expedite a patient’s care, but, may not be covered by their insurance. Patients ultimately will have to make the informed decision of which procedures they would like to pursue. While I will emphasize what needs to be done to accomplish the quickest resolution of one’s issue(s), the individual may desire to proceed without, say, Active Release or rehabilitative exercises, understanding that it may take longer. If I sense, however, that the procedures are necessary and not opted for, I may suggest that we do not begin care, as your best interests, as well as my reputation for success, are paramount goals that I do not wish to compromise. I look forward to continue in gaining your trust for your health needs in the coming year!

Lower Cross Syndrome

Last time I addressed the posture pattern Upper Cross Syndrome (UCS). This article will focus on what happens with the lumbo-pelvic region, the lower back and hip area. Let me preface this discussion by saying while these syndromes are talked about independently, there are instances when there can, in fact, be a combination of the two, namely, Layer Syndrome (LS). This occurs with long standing muscle imbalances. But, I will for simplicity sake, stick with LCS so as to not cause confusion.

We have, in each of us, two types of postural muscles, those that are prone to tightness, or HYPER-tonicity and those that are prone to weakness, or inhibition. The following lists are not to bore you with the technical, but hopefully give you a better picture of the tissues involved. The symptom presentations are part of what may be experienced, and not complete. There can be significant overlapping of involved tissues because of fascial connections and pain may just be what you initially notice; there may be issues that one has compensated for that are easily ignored i.e. lower back range of motion decrease with a golf swing leading to eventual shoulder pain. The clinical manifestations or consequences of these muscle imbalances can lead to; painful and or restricted motions, dysfunctional, weak or absent motions, painful, abnormal or absent sensations, as well as swelling in the involved tissues.

UCS AND LCS MUSCLES PRONE TO TIGHTNESS/HYPERTONICITY:

• suboccipitalis (attaches to back of skull)…neck pain and headaches
• sternocleidomastoid (attaches from skull behind ear to the collar bone)…neck pain and stiffness
• scalenes (attach deep to side of neck)…neck and arm pain as well as tingling and numbness
• upper trapezius (attaches to side and back of neck to skull)…neck pain and headache
• levator scapulae (attaches from tip of shoulder blade to neck)…neck and shoulder blade pain
• pectoralis major and minor (chest muscles)…neck, shoulder and mid back pain
• temporalis (sides of skull around ears)…temporo-mandibular joint syndrome
• masseter (cheek muscles)… temporo-mandibular joint syndrome
• biceps (muscle in front of arms)…shoulder and arm pain
• erector spinae (deep muscles in back along spine)…back pain
• quadratus lumborum (between hip and lower rib)…back pain
• hip adductors (inner thigh muscles)…hip and back pain
• iliopsoas (attaches deep abdominally to sides of spine to top of thigh bone)…back pain
• rectus femoris (top center quadriceps muscle in front of thigh)…back pain
• tensor fascia latae (top side of thigh muscle that ties into ilio-tibial band)…hip and knee pain
• hamstrings (muscles in back of thighs)…hip, knee and back pain
• piriformis (muscle deep in buttock)…can spasm, along with surrounding muscles on sciatic nerve
• gastrocnemius and soleus (calf muscles)…knee pain and plantar fascitis

UCS AND LCS MUSCLES PRONE TO WEAKNESS/INHIBITION:

• serratus anterior (along side of ribs to shoulder blade)…shoulder and rib pain
• middle and lower trapezius (mid back from spine to shoulder blade)…mid back and neck pain
• gluteus muscles (hip and buttock area)…lower back and pelvis pain
• abdominals (belly area)…back pain
• rhomboids (between shoulder blade and spine)…mid back pain
• triceps (large muscle behind upper arm..shoulder pain
• deltoids (muscle that drapes over shoulder)…shoulder pain
• tibialis anterior (muscle along outside shin)…shin splints and ankle sprains
• peroneus muscles (muscles along outside lower leg)…ankle sprains and outer knee pain

The lists above name common symptoms associated with the named muscle and are not necessarily complete.
The most common pattern of muscle imbalance that the discoverer of these syndromes, (Vladimir Janda) in this discussion regarding LCS is the combination of tight hip flexors (rectus femoris and iliopsoas) and lower back (erectors), paired with weak abdominals and gluteal muscles. This scenario leads to an excessive lower back arch, a flabby tummy and a flat buttock area. What we do as far as treatment is to determine which muscles are tight and break down the adhesions. Also, the muscles that are weak or inhibited need to be strengthened. Inflammation may be treated by instrument assisted soft tissue mobilization or cold laser. Any spinal issues that may be contributory to pain, burning, tingling, etc. are addressed via manual or instrument adjusting. Ultimately, the goal is to help the individual achieve a better lifestyle, whether to be able to perform activities of daily living, or work, or re-engage in a sport activity.

I hope this has not proved to be too technical an article and that hopefully has, in fact, been helpful in understanding your physical ailment or weakness or sub-par performance at work or in your sport. Please call us at (770) 922-1212 if you have issues in this area.

Please visit our website: chiroserra.com

Upper Cross Syndrome

This month, I’d like to address a pain development that is seemingly epidemic in today’s society, that is, “upper cross syndrome”, or “UCS”.  While one may not yet be in pain, the insidious onset of muscle tightness or weakness, gradually leading to imbalances and poor posture, can be very much like heart disease or cancer; when the symptoms present, it grabs your attention by getting in the way of carrying out the normal activities of daily living.

So, what is UCS? You can observe it in people whose necks flex forward and their shoulders are rounded with the head straining back so they don’t fall on their faces; poor posture leads to UCS! Someone who works at a computer terminal, or who does a lot of driving, or who cuts hair or even attends patients as a surgeon or dentist, as each of these professions lend themselves to the flexor muscles in the front becoming overworked, especially in comparison to the extensors of the back muscles. This imbalance of muscle tension puts you at a higher risk for injury. Slouching posture must be constantly checked during one’s workday! As this poor posturing progresses, it may become increasingly more difficult to get a deep breath as shallow breathing becomes the norm and expanding the chest cavity becomes difficult, or even very uncomfortable.

In a previous article, I talked about Repetitive Strain Injuries and how if muscles stay in a contracted state for a prolonged time, the circulation to the muscles involved can be decreased and adhesions develop within, around and between other muscles, and even nerves. This is usually when I begin seeing individuals with UCS. They cannot recall any trauma or incident that brought their neck, back or upper extremity pain on, they just awakened one day with it, or just innocently sneezed or made a quick head movement.

A short list of the usually involved tight muscles includes the upper trapezius, SCM, levator scapulae and pectoralis major and minor. Muscles that become weak and inhibited (not firing or contracting optimally include in part, the deep neck flexors, middle and lower trapezius, serratus anterior and rhomboids. My job now is to find the tight and weak muscles, as well as those that are inhibited, locate the adhesions and then flush out the swelling and restore the normal function of the involved joints and muscles. Exercises and, yes, nagging you about your posture become necessary to then begin activities with a gradual pain threshold increase (everyone will have a tissue tolerance or redline, how high it is will be determined by genetics, amount of wear and tear as well as the degree to which flexibility and strengthening exercises are followed).

So, observe how you are sitting, standing and performing work/sports activities, possibly using a mirror, window reflection or by having someone look at you and capturing you on their phone camera; then call us at (770) 922-1212 if you think you have UCS! Next time I will address, what else?....Lower Cross Syndrome!

Please visit our website: chiroserra.com

Kinesio Taping

 Another procedure that we employ is Kinesio Taping.  Although this technique has been around for about 25 years for sports performance, pain management and swelling (edema) control, it wasn’t until the 2008 Olympics in Beijing that the media coverage expanded and interest or even curiosity increased.

Kinesio Tape is applied over injured areas or where tissue needs to be supported, relieved of edema or re-educated for a given exercise.  The tape gives support and stability to joints and muscles without restricting circulation or range of motion.  While traditional “strapping: of sports tape has long been utilized strictly for stabilization, the side effects of fluid obstruction often lead to swelling.  To ensure that muscles have near/full range of motion, the tape was developed to have 130-140 % elasticity.  In fact, Dr. Kenzo Kase manufactured the tape with the same elasticity as healthy human muscle. We often use the tape on youngsters involved with over-use syndrome, with soccer in particular, but with adults in repetitive or over-use straining from yard work, running, golf, and tennis.  This is a procedure that can be learned and done at home, although, it has been observed by me that a couple of sessions of having it applied by someone with experience, enables better quality self application later…and less wasted tape.


Call: 770-922-1212 for an appointment!

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Low Level Laser Therapy

This is a continuation of the therapeutic procedures that we employ at this office to give you an explanation that can be referred back to at your convenience.



Low level laser is an FDA approved laser for treating pain and increasing range of motion on the market.  It has been found to be extremely beneficial for enhancing and accelerating wound healing and reducing acute inflammation.

The research has been done and more is planned.  With over 200 clinical studies – many of which are double-blind, placebo-controlled – and in excess of 2000 published articles on LLLT (low level laser therapy), this innovative new technology has a well-documented research and application history.  Having grown far beyond its distant Institutional Review Board (IRB) and experimental treatment status, LLLT is now being considered a therapy of choice for difficult pain management challenges such as fibromyalgia and myofascial pain.

Its positive effects are many and well-researched.  For example, research demonstrates that the laser increases oxygen, healing and tensile strength of healed tissue.  It reduces swelling, increases blood flow, reduces inflammation, increases cellular metabolism and repair, promotes collagen formation, and much more.

But how does it work?  If you are like most people, when you first see a demonstration of the laser you might find yourself thinking, “How is this possible?  All you are doing is shining a blinking red light on patients and they are getting quick and often amazing results.”  To answer that question properly you would have to investigate the fascinating interface between biology and quantum mechanics – a huge undertaking.

Stated in its simplest form the cold laser is a biomodulator.  If the body is doing too much of something or not enough of something else, then the laser will up-regulate or down-regulate it accordingly.  It accomplishes this regulation by returning the targeted area of the body back to normal frequency.  The concept of entrainment comes from physics.

Entrainment is defined as a situation in which two rhythms that have nearly the same frequency become coupled to each other so that both have the same rhythm.  For example, a number of pendulum clocks mounted on the same wall will eventually entrain, so that all the pendulums swing in precise synchrony.  For this to happen, the pendulums must have about the same period, which is determined by their length.  What couples the pendulums are vibrations (elastic or sound waves) conducted through the structure of the wall.

The laser restores balance, harmony, and order by entraining the out-of-step frequencies back to their proper oscillations.  The laser is actually integrative in its effects.  You simply program in the appropriate frequencies, laser the affected areas, and the body is entrained back to coherence, and hence, normal functioning.

To date, there have been no adverse side effects reported in over 2000 publications.  However, individuals with the following contraindicated conditions should avoid laser therapy:  cancer, photophobia (sensitivity to light) and pregnancy.  Also, laser therapy should not be directed toward the thyroid, endocrine glands, or eye (we utilize special protective goggles), be used on individuals that take photosensitizing medications (i.e. antibiotics, Retin A) or on areas of hemorrhage.

While the FDA has approved LLLT devices for treatment of:  Carpal Tunnel Syndrome as well as neck and shoulder pain of musculoskeletal origin, insurance companies consider the treatment “experimental” and therefore may not cover or reimburse the cost.



Call: 770-922-1212 for an appointment!


Please visit our website: chiroserra.com

Graston Technique

Again, the following is a continuation of the treatment protocols at our office.  I utilize this procedure when the scar tissue found is very tough or thickened.  It has proven over and over to be a very effective tool in soft tissue re-modeling.


Instrument Assisted Soft Tissue Mobilization

How does the Graston Technique Work?
The Graston Technique is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions.  The Technique utilizes stainless steel instruments designed specifically to detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.  Treatment with the Technique is conducted in concert with a rehabilitation regimen designed to restore athletes to their pre-injury level of activity.  This is accomplished by implementing a functional progression program, which zeros in on imbalances throughout the kinetic chain.  Flexibility, strengthening, and muscle re-education is employed to provide the athlete/patient with optimal results within a minimal number of treatment sessions.

The positive clinical results achieved thus far have led to additional research that explores patient responses to the Graston Technique.  Athlete outcome data that measures pain and function – including activities of daily living – continues to be gathered.

Product Use and Procedures
The patented Graston Technique Instruments – shaped to fit the contour of the body – are used to scan the area and assist clinicians to locate and then treat the injured scar tissue that is causing pain and restricting motion.  Clinicians utilize the instruments to supply precise pressure to break up scar tissue, which relieves the discomfort and restores normal function.


Frequently Asked Questions

Q:  How does the Graston Technique Work?
A:  It is theorized that the Graston Technique is effective because it provides controlled micro trauma to the affected soft tissue structures.  It also stimulates a local inflammatory response, which leads to remodeling and repair of affected soft tissues structures.  The instruments allow therapist to specify the area that is being treated.
Q:  Who can benefit from the Graston Technique?
A:  Individuals who are experiencing pain and loss of motion and function following surgery, injury, cumulative trauma disorders and tendinitis may benefit from the Graston Technique.  Some clinical diagnoses which have responded well to the Graston Technique include:

• Carpal Tunnel Syndrome (wrist pain)
• Scars
• Plantar Fasciitis (foot and arch pain)
• Adhesions
• Cervical Strain/Sprain (neck pain)
• Restrictions
• Lumbar Sprain/Strain (low back pain)
• Muscle Spasms
• Achilles Tendinitis (ankle pain)
• Muscle Pulls
• Rotator Cuff Tendinitis (shoulder)
• Trigger Points
• Patellofemoral Disorders (knee pain)
• Tendinitis
• Later Epicondylitis (tennis elbow)
• Muscle Strains
• Medial Epicondylitis (golfers elbow)
• Shin Splints

Q.  Why is scar tissue a problem?
A.  Scar tissue limits range of motion, and in many instances causes pain, which prevents the patient from functioning as he or she did before the injury.

Q:  How is scar tissue different from other tissue?
A:  When viewed under a microscope, normal tissue can take a couple of different fashions: dense, regular elongated fibers running in the same direction, such as tendons and ligaments; or dense, irregular and loose with fibers running in multiple direction.  In either instance, when tissue is damaged it will heal in a haphazard pattern – or scarring – that results in a restricted range of motion and, very often, pain.

Q:  How are the instruments used?
A:  The Graston Technique Instruments are used to enhance the clinician’s ability to detect adhesions, scar tissue or restrictions in the affected areas.  Skilled clinicians use the stainless steel instruments to comb over and “catch” on fibrotic tissue, which immediately identifies the areas of restriction.  Once the tissue has been identified, the instruments are used to break up the scar tissue so it can be absorbed by the body.
Q:  Is the treatment painful?
A:  It is common to experience minor discomfort during the procedure and some bruising afterwards.  This is a normal response and part of the healing process.

Q:  What is the frequency of treatment?
A:  Patients usually receive two treatments per week over 4-5 weeks.  Most patients have a positive response by the 3rd to 4th treatment.


Please visit our website: chiroserra.com

Active Release Technique

The following is a continuation of a sequence of the types of treatment that are utilized at our office.  Our goal is to improve and/or correct the functional impairments that prevent one from accomplishing activities that range from the simple daily living to the more extreme demands of work or recreation.  First, the joints of the body must be able to move as freely as possible, which is why we use chiropractic manipulative therapy/spinal and limb adjustments.  Genetics, past surgeries and trauma may be, to some degree, limiting factors.  Then, the goal is to address the supporting tissues surrounding the joints.  Pain is often what brings people in for care, however, the more important benefit is to have the “structural body,” enabled, without continuous compensation for weakened areas.  Active Release is one of our most effective treatment protocols to accomplish this.


ART® Is a highly successful approach to the diagnosis and treatment of muscles, tendons, ligaments, nerves and fascia, known as soft tissue. It is effective for low back pain, neck pain, TMJ, elbow tendonosis, rotator cuff tendonosis, knee pain, shin splints, carpal tunnel syndrome, running injuries and numerous other conditions. Many professional athletes have been using ART® for years.

What's new about ART®
ART® Is a change in the basic understanding of soft tissue injury. It gives the doctor the insight necessary to identify and correct the root cause of a problem. Unlike other treatment methods, the patient is an active participant in ART®.

ART® and the doctor
Treatment with Active Release Techniques® is exclusively "hands on." There are no unwanted side effects from medication or surgical complications. ART® doctors are trained to identify areas of scar tissue by the way it feels -- like a tight area in the soft tissue with an altered texture and decreased movement.

How Injuries are identified
In cases of carpal tunnel syndrome, for example, the doctor may check for injury along the entire length of the nerve, including the forearm, arm and neck. Identification and treatment of all involved areas often results in quick, complete resolution.

The scar tissue connection
When a muscle, tendon, or ligament is injured, the body forms scar tissue (commonly called adhesions). Scar tissue is how the body connects and binds injured tissue. Unfortunately, that same scar tissue often sticks to surrounding structures like "glue." If a nerve runs through a muscle in the spot where there is scar tissue, the nerve can be pinched or pulled by that adhesion, causing it to fire pain signals. The resulting limited motion overworks healthy tissue, also leading to pain.

Other causes of scar tissue
Scar tissue can also result from overuse of muscles, tendons and ligaments. Overuse causes an increase of tension in the tissues. This decreases the blood supply, causing the body to form adhesions. What does all this mean? Poor posture, improper form during exercise, athletic pursuits and repeated incorrect or overuse of soft tissue can result in still more scar tissues.

How ART® works
ART® uses movement of the patient to increase tension on scar tissue. It's the most effective way to break up adhesions. Every ART® session is a combination of examination and treatment, which identifies the soft tissue that has been injured.

Call: 770-922-1212 for an appointment today!

Please visit our website: chiroserra.com!

Chiropractic Manipulative Therapy

In the next few articles, I will describe the treatment procedures that are employed at our office to give you a better understanding of what to expect when you are considering care:

CHIROPRACTIC MANIPULATIVE THERAPY

A lesson in joint anatomy and physiology 
All the joints of the body have many of the same characteristics. They are bound by ligaments and soft tissue, moved by muscles, and separated by cartilage. Most important are the nerves that monitor and control the position and motion of each joint.
Usually, joints move freely. Either they move voluntarily due to deliberate muscle control, or involuntarily, without our control. Under unrestricted conditions, the nerves in and around the joints sense motion and relay important information to the spinal cord and brain.

How the body protects itself 
If motion is altered or reduced, nerves can relay inaccurate or insufficient information about a joint's motion. When this happens, as is often the case in sudden injury or overuse of the spine, pain occurs. This is called joint dysfunction.

As the pain increases, the nerves create reflexes that cause the muscles in the area surrounding the joint to tighten, or spasm. This "guarding reflex" helps reduce movement in the area.

Properly performed manipulation 
Manipulation should be performed with only as little force as is required. Unlike karate moves, manipulation does not involve sudden twisting of the neck or any other joint. It is a subtle, gentle and controlled procedure that can be performed on nearly every injured joint in the body.

Motion blocks pain signals 
In order to function properly, joints must move freely. Motion produced by the joints actually serves to "block" continued pain signals.

Why manipulation works 
Chiropractic manipulation slightly opens the joint, normalizing its motion-sensitive nerves, blocking pain and reducing muscle spasm.


Frequently asked questions:

How is manipulation performed? 
First, the patient is positioned in a way that isolates the involved joint or joints from the others. Then the doctor uses his hands to apply a gentle thrust of the joint. This moves the joint surfaces and usually results in a popping sound.

Why is thrust necessary? 
Imagine a door that only opens halfway because of a stuck hinge. It still can be used, but it is more troublesome than a door that fully opens. The joints in your spine and throughout your body can be thought of in the same way. When a proper thrust is applied to a "stuck" joint, its full motion is restored, and associated muscle tension is decreased.

What is the noise heard with manipulation? 
During manipulation, joint surfaces are separated. As this happens, movement of fluid and a release of gas occur within the joint. The "cracking" noise frequently heard during manipulation is similar to gas being released from a carbonated beverage.

Is manipulation safe? 
When performed by an expert, manipulation is safe and effective. I am well trained, experienced and licensed to perform manipulation. I am able to recognize patients who should not receive manipulation, and to minimize the risk of injury to all patients on an individual basis.

What happens when I "crack" my own back or neck? 
When the doctor makes and adjustment, it increases motion in a "locked" or "stuck" joint. When most people "crack" their own back or neck, they affect joints that are already gliding or moving properly, not the joints that are "stuck."

Does "cracking" knuckles lead to arthritis? 
There have been many studies published to demonstrate that ''cracking" your own knuckles does not cause, but actually reduces the risk of arthritis!

Call: 770-922-1212 for an appointment today if you have been experiencing these symptoms!
Please visit our website: chiroserra.com

Shoulder Pain

Bursitis, tendonosis (often inaccurately referred to as tendonitis, but not enough blood supply to this tissue type to consider inflammation), frozen shoulder and rotator cuff injury can each promote a detour in one’s plans for a season.  Each of the above, aside from an obvious acute injury, usually develop over an extended period of time. The shoulder’s design allows for a maximum range of motion, but at the cost of compromised stability. A sudden increase in activity, repeated trauma and micro-trauma from repetitive action, pre-existing muscle imbalances, soft tissue restrictions and scar tissue, possibly from earlier surgical procedures can produce the “frog boiling in water” scenario, where by this time, the pain has gotten to the point where activities of daily living, work and recreation are no longer an option and a remedy is now sought.

The shoulder is made up of:
·         The clavicle, or collar bone
·         The scapula, or shoulder blade
·         The humerus, which is the long bone between the shoulder and elbow that attaches to the scapula
·         The four rotator cuff muscles
·         The tendons that attach the muscles to the bones and the ligaments that attach bone to bone
·         The shoulder bursa, which is a fluid filled sac that allows a smoother glide for the humerus’ articulation

There needs to be an ongoing “tensegrity” within and around the shoulder joint. This concept can be likened to a tent with lines attached from its four corners to ground pegs. If one of the lines is slack (inhibited or weaker), or too taut (hyper-active or stronger), the shape and design of the tent will be affected. So there is an inter-relationship between the structures of the shoulder, as well as the rest of the body, especially when compensation comes into play. Repetitive actions like raking, vacuuming or swinging a golf club may initially produce small tears that heal with a less giving adhesive tissue that can initiate inflammation along with a repetitive strain or cumulative injury cycle. So, if one muscle, say the subscapularis (on the underside of the scapula, or shoulder blade, and rotates the shoulder inward and pulls the shoulder and arm toward the body) is injured, being able to lift the arm becomes difficult, or impossible and the biomechanics are altered, including the counter-balancing muscles, which further inhibit normal motion.

If you have followed my previous articles, you are familiar with the procedures that we employ at my office.  Utilizing Chiropractic Manipulative Procedures, Active Release (ART), Graston instruments, LLLT (cold laser), as well as other procedures have brought about extremely positive resolutions, with some exception, i.e. spurs that have produced tears that may need surgical repair. On occasion, it may be necessary to have an injection first if the inflammation and restriction are so chronic that little can be accomplished conservatively in the short term. Whatever it takes, I want to see your “function” restored, pain eliminated and strengthening accomplished. My ego will not be attacked if we need the assistance of other health care professionals to help us in the desired outcome. Sometimes, this will take diligence and patience!    

Call: 770-922-1212 for an appointment today if you have been experiencing these symptoms!

Help, I need some elbow grease!

There’s golfer’s elbow, tennis elbow and even “I don’t do either” elbow. Golfers have more of a tendency to irritate the inside “bump” on the elbow, known as the medial epicondyle, mostly because of repeated tightening of the flexor muscles of the forearm. This repetitive strain injury (RSI) creates small, or micro-tears of these structures. The normal healing process then engages by the laying down of adhesive scar tissue between the muscle layers to help stabilize the area. This scar tissue then inhibits normal movement, or translation, of adjacent structures, which causes friction to occur, as well as an ongoing inflammatory cycle that must be broken up for healing and normal function to return.

The tennis elbow is similar, but involves the outside bump, or lateral epicondyle. This area is irritated by the repeated tightening of the extensor muscles along the knuckle side of the forearm. In both scenarios, the epicondyles are a major sight of tendon attachment; the tendon is the fibrous end of muscles that have a very limited blood supply.

Many wonder how they develop these sometimes debilitating pains when they do not even own a set of clubs or a racket. The sport involved is not as much of a concern as the “mechanism of injury”. You can irritate the extensor muscles by pulling weeds for an hour or the flexor muscles by making a hundred biscuits, especially if you are not accustomed to these actions.

The treatment for these injuries is similar from the standpoint that we analyze not only where the pain is, but also look to see if you are compensating due to a problem elsewhere, say, in the shoulder, or even a restricted back that is causing you to use more arm movement than normal. Usually, between 6-8 visits are necessary, involving the breaking down of the restrictive scar tissue and home therapy, including stretching and strengthening exercises (which are so important in not only the healing process, but in the prevention of future injury) as well as ice and/or moist heat therapies. However, if other areas are chronically restricted or weak, suggestions will be made for what treatment may be needed. I utilize a number of therapies that are outlined in my website. Please contact us if you have any questions. My next article will begin to address the shoulder injuries.

Call: 770-922-1212 for an appointment today if you have been experiencing these symptoms!

An Interesting Article For Those Who Buy In "Bulk"

Has your food gone rancid?

Monica Eng
Chicago Tribune
03-07-12

March 07--Does your cupboard hold a package of unfinished crackers? An old bag of whole grain flour? Some leftover nuts from holiday baking? Or perhaps a bottle of vegetable oil you've been slow to finish?
If so, you may be harboring dangerous, rancid foods.
Protecting against rancidity -- which occurs when oils oxidize -- has long been a challenge for home cooks, but a recent perfect stew of factors has made the issue more serious. Strangely enough, this situation comes courtesy of the rising popularity of "healthy" polyunsaturated fats, whole grain flours and warehouse stores -- not bad developments on their own, but taken together they've resulted in American pantries full of food that goes rancid much faster than we're used to.
Add to that Americans' growing acclimation to the taste of rancid foods, and the problem gets bigger.
So what's wrong with eating rancid oils?
"There are at least two," says lipid specialist and University of Massachusetts professor Eric Decker. "One is that they lose their vitamins, but they also can develop potentially toxic compounds" that have been linked to advanced aging, neurological disorders, heart disease and cancer.
"They're carcinogenic, pro-inflammatory and very toxic," says integrative medicine specialist Andrew Weil. "They are also widespread in the food chain."
The growing problem comes as a byproduct of Americans and food manufacturers swapping trans fats for polyunsaturates in their products over the past 10 years. This has resulted in a whopping 58 percent drop in trans fatty acid consumption in the U.S. in the past decade, according to a recent government report. But for all of their artery-blocking evil, trans fats had at least one big benefit: They were very stable, meaning they took forever to go rancid. The same is true of highly refined white flours.
But when these flours and fats were replaced with whole grain flours and polyunsaturates, such as corn and soybean oil, that shelf stability collapsed.
"Manufacturers noticed this and had to change their delivery schedules and formulations," says Kantha Shelke a food scientist and spokeswoman for the Institute of Food Technologists. "And some consumers became irrationally angry that their food was not lasting as long as it had before."
Indeed, while Americans followed orders to ditch saturated and trans fats for polyunsaturated (vegetable) and monounsaturated (olive, canola and peanut) fats, they didn't realize these healthier fats don't last nearly as long.
"People buy these huge containers of oil (at warehouse clubs) and just don't realize that there's no way they can use it before it goes rancid," Decker says. "They don't recognize it as a problem."
While monounsaturates (like olive or peanut oil) also can go rancid after about a year, they are still 10 times more stable than polyunsaturates, according to Decker.
"People need to minimize their use (of polyunsaturated oils)," Weil says. "And if you do use them, keep them in the refrigerator in the dark, and buy only small amounts that you use up quickly."
And while some consumers can sniff out (and toss out) rancid foods, many don't know the telltale stale, grassy, paintlike odor. Others may not be able to detect them through layers of other flavorings. And still others might feel compelled to consume them out of thriftiness or hopes that a strong sauce will mask the taste.
Because air, light and heat speed up oxidation, it's normally a bad idea to, for example, buy vegetable oil in a clear bottle and place it on the counter in a warm kitchen for several months.
Exotic oils (macadamia, walnut, sesame, fish, flaxseed, etc.), nuts and whole grain flours are also major candidates for fast rancidity, and should all be stored in the refrigerator or freezer. Whole intact grains and nuts in their shells, however, last much longer.
"When grains are ground, their interiors are exposed to the air," says food scientist and author Harold McGee. "The whole grains contain the germ and the bran, both of which are rich in oils, that are especially prone to oxidizing and going rancid. So you end up with off flavors very quickly in whole grain flours compared to refined flours."
Frequent shopping for small quantities of fresh and freshly processed foods has served much of the world well in avoiding rancid food. Americans, however, favor a different grocery-shopping pattern that involves less-frequent trips for larger quantities of shelf-stable foods.
Trans fats, preservatives and refined flours combined to train a couple of generations of Americans that "chips, cakes, cookies and crackers could last for months," Shelke notes, "and we became accustomed to that."
Those habits may change in time, but until they do, Weil suggests that consumers train their "noses to recognize the smell of rancidity even in parts of a dish."
Though some hope that our sense of smell and taste can help us avoid rancid foods, recent studies raise doubts. Shelke notes that new immigrants to America often think peanut butter -- now often made with polyunsaturates -- smells rancid while American natives think it just smells like peanut butter.
McGee notes that the problem extends to rancid olive oils, which, in a 2011 University of California study, were actually preferred by 44 percent of American tasters.
"We assume that rancid flavors are normal," McGee says, "because, in some cases, that's what we've gotten used to."
The smell test
A rancid food is "the smell of oil paint," says integrative medicine specialist Andrew Weil. "Linseed oil, which is the same as flax oil, is the basis of oil paint. It's highly unsaturated and so it oxidizes fast when exposed to the air."
How long is this good?
Although the FDA oversees advice on the safe storage of food at home, it has not updated its recommendations since the gradual switch from saturated fats to unsaturated fats in food production.
Experts advise paying close attention to "use by" and "sell by" dates on packages, which may have changed in recent years because of new formulations.
The Institute of Food Technologists' Kantha Shelke says she's found that similar boxes of soda crackers using refined and whole grain flours had shelf lives of 141 and 80 days respectively when left unopened.
In general, buy products that contain oils or fats in small quantities.
Store most cooking oils in a cool, dark cabinet -- not next to the stove.
Refrigerate polyunsaturated oils especially fish, nut and flax seed oils.
Store nuts and whole grain flours in the freezer.
meng@tribune.com
___
(c)2012 the Chicago Tribune
Visit the Chicago Tribune at www.chicagotribune.com
Distributed by MCT Information Services
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Articles featured in Life Extension Daily News are derived from a variety of news sources and are provided as a service by Life Extension. These articles, while of potential interest to readers of Life Extension Daily News, do not necessarily represent the opinions nor constitute the advice of Life Extension.

Spring Is In The Air, But My Golf Swing Is Not Up To Par!

The holidays have come and gone and the perennial stiffness from inactivity has become resident in many backs and shoulders. For some reason, the action of bringing one’s hand to their mouth does not seem to provide adequate exercise to prepare for that first day on the links. Two common golf related scenarios that I have observed in my practice, aside from screaming back pain from muscles that have experienced the “beyond the threshold of tissue tolerance”, from those first few driving range rehearsals, are the rotator cuff and hip, or pelvic area injuries.


Allow me to pause a moment and address a common question that I receive about stretching before swinging the club. For the majority of individuals, as there are always those exceptions, it is not wise to climb out of the car and begin twisting the torso and bending over to touch the toes. Stretching a “cold” muscle can actually promote injury. The best way to warm up a muscle is by marching or jogging in place, or doing jumping jacks for 2 minutes. Then go through your stretch routine with the adequate blood flow to the muscle. It has been shown that this pre-stretch warm-up works better than ultrasound (not that you would normally carry one along in your golf bag). Now practice or play and lightly stretch throughout the round.


Now, the lower back may need to be worked on after that first round or to break up adhesions that have slowly developed because of inactivity or repetitive strain (including sitting for extended periods!). That generally resolves in just a few visits. What can be very frustrating for injured golfers is when they start with one problem, such as back or hip pain, and then develop a pain somewhere in the shoulder. The most obvious scenario is simply when, say the lower back or hip area hurts, the mechanics of the swing changes to engage more upper body activity to avoid irritating the lower lumbo-pelvic area. Our first goal is usually to clear out the area of pain, with its restriction(s) and then address the other dysfunctional areas so that the repetitive injury cycle is broken. Considering that the golf swing follow-through engages a forced external rotation of the club holding side shoulder, this can actually initiate a shoulder pain that then forces a compensatory mechanical load increase on the lower back or hips to thrust the club through its path. Add an incomplete follow through with an abbreviated or abrupt stop, or too steep a swing angle, and the symptom presentation may amplify.


We will examine to identify what motion is restricted (say forward flexion of the lumbar spine or external rotation of the shoulder), and then treat with tissue specific protocols (i.e. the iliopsoas or infraspinatus adhesion, tightness or weakness rather than just a generalized lower back or shoulder mobilization) with appropriate spinal or other joint adjustment, Active Release Technique, Graston Instrument, LLLT (Cold Laser), Frequency Specific Microcurrent or ultrasound and then advise you on exercises.

I hope this information is helpful and that your golf season is most rewarding this year!


CALL US TODAY IF YOU ARE STRUGGLING WITH YOUR GAME! (770) 922-1212

Carpal Tunnel Syndrome

Did you know that over 260,000 surgeries are performed each year with over half requiring 31 or more days of lost work time? What can cause CTS?

*Poor ergonomics (positioning of the chair, mouse, monitor, keyboard, or even poor mechanics on an assembly line).
*Decreased strength due to poor conditioning or injury.
*Insufficient relaxation/rest time away from the mechanism of injury.
*Excessive force that is required to perform an action.
*muscle imbalances

All of these factors place unnecessary, repeated stresses upon all the soft tissues of the neck, shoulders, arms, wrists and hands!
Interestingly, what initially seems to be a restriction at the carpal tunnel, may actually be caused by a compression of the nerve in a location further up the arm.

We evaluate and treat CTS and pseudo-CTS, in which other peripheral nerves (beside the median nerve) become entrapped, simulating true CTS!

Treatment involves addressing adhesions via manual therapy at locations in the neck, shoulder arm and wrist. Exercises are provided for home use as soft tissue improves.

Call: 770-922-1212

Treatment of Adhesions

In providing care for our patients, I often get asked questions regarding the procedure Active Release Technique and the treatment of adhesions. Adhesions can restrict motion, cause swelling and manifest weakness in muscles. To that end, adhesions can grossly affect one’s ability to work or recreate optimally. Running, swinging a golf club or even simply using a keyboard can become difficult or even impossible. So, at this office, we treat adhesions so that you can go on with life, although sometimes with some modifications. I hope that the following may answer your concerns.

What are Adhesions?
Our bodies contain special protein structures called Fascia ( a connective tissue). Fascial tissue interconnects all the components in your body, and acts as a flexible skeleton. When this tissue is healthy, it is smooth and slippery, allowing the muscles, nerves, blood vessels, and organs to move freely and function properly.
Adhesions attach to muscles, decreasing their ability to work properly. You know you have an adhesion on a nerve if you get many abnormal sensations like numbness, tingling or pain.
Imagine a piece of scotch tape, the smooth side is healthy fascia, the sticky side is scar tissue or unhealthy fascia. Try rubbing both sides of the tape along your skin. The sticky side drags across your skin. The drag that you feel, the “pulling” sensation is how an adhesion affects the smooth functioning of your body.

Are all adhesions bad for me?
No… adhesions are actually a powerful tool that your body uses to prevent further injury. Adhesions are used to help start the healing process for damaged or injured tissues, and allow them to heal slowly.
Unfortunately, due to our active lifestyles and lack of rest to an injured area, these adhesions are not laid down in smooth, even layers, and do not follow the direction of the muscle action.
This is where Active Release becomes a powerful tool for restoring the free movement of your tissues!

Who can benefit from ART?
ART can help everyone, from athletes, to office workers, to home keepers.
Many professional athletes have come to regard Active Release Techniques very highly for it almost miraculous treatment of serious injuries. Professional sports teams as well as big names have benefited from ART. If you have any type of repetitive strain injury (RSI) ART should be your first choice.

Visit Chiroserra.com or call (770)922-1212 today!

Conditions That We Treat and How

We see a number of conditions caused by repetitive strain, auto and work injuries as well as sports injuries. Headaches, jaw pain (TMJ), neck pain, shoulder pain (rotator cuff), elbow pain (golf and tennis), back pain, sciatic pain, knee pain, ankle and foot pain, including plantar fascitis.

We use Chiropractic adjustment (including Activator, Diversified and Traction Techniques), Active Release Technique, Graston, Ultrasound, Frequency specific micro-current, and Acupuncture LLLT (Cold Laser). Treatment is utilized to control or resolve pain, as well as for functional rehabilitation.

Call us today at (770)922-1212