There are various symptoms of CTS (sometimes knows as Repetitive Motion Injury or RMI) including numbing and tingling in the hands,  lose of hand strength and pain in the hands and wrists.   As these symptoms progress, pain and weakness can become debilitating.    Standard treatment options include wrist guards, hand splints, medications and surgery.    Although alternative treatments are not given much credibility in the modern medical environment, Yoga is one option that the National Institutes of Health endorses as having proven results.  Changing the ergonomic set up for computers is another beneficial adjustment for those who spend a lot of time typing and doing other computer related work.   But, in the long run, the best treatment (and prevention) is simply creating the correct alignment in the palm and wrist as it relates to the central carpal area.     Let me explain.

The carpal tunnel is a narrow passageway located on the palm side of your wrist. This small tunnel houses the median nerve of your hand as well as the nine tendons that bend your fingers. In addition to the nerve and tendons, veins, arteries and bursa fluid also travel through this narrow opening at the wrist.    It is compression of the median nerve that produces the numbness, pain and hand weakness that make up carpal tunnel symptoms.

I have worked with about 200 CT cases in my career and the common factor in nearly all of them was incorrect positioning of the hand characterized by a closing in of the sides of the hand.  It is this side-to-side compression that is highly problematic for the carpal area.    Check out this short video for a visual explanation of correct and incorrect hand positioning as it relates to the wrist.

Common medical information suggests that the CTS is a nerve problem, but in my opinion it is a swelling problem, which results in compression on the nerve.  The risk for CTS increases with pregnancy, which in my opinion, makes perfect sense. Pregnant women often experience edema, or swelling and swelling in the carpal area is a prime ingredient for CTS.  Resolve the swelling and you resolve the pressure on the nerve.   As there’s very little space in the carpal area, even a little bit of swelling will aggravate the nerve.  The Mayo Clinic states that  “anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome”, yet somehow they fail to include problematic hand positioning as a possible cause of the compression.

As I wrote in the blog on thumb arthritis, the correct and incorrect alignment of the hand is not in dispute.   It is accepted anatomy across all medical and healing fields.  This is one area where the AMA and I are in complete agreement.   So I am perplexed as to why this very simple cause and effect is largely absent from the medical cannon on CTS, thumb arthritis and other structurally related medical conditions.

Although we often think of CTS as a computer or tech related problem, this is only a small slice of those affected.   Studies indicate that up to 75% of dental professionals experience carpal tunnel symptoms at some point in their careers. Jobs that require manual labor also have a high incidence of CTS , such as carpenters, electricians, plumbers and factory workers.   Musicians face this problem all the time.

On the positive side, I would rate those cases that involve Carpal Tunnel symptoms as some of the most solvable cases we get in our office.  Similar to the thumb, the hand and wrist are easy to access and reposition.    Various stretches and self-massage techniques are also available to aid in recovery.  I will demonstrate these techniques in my next blog, so stay tuned.  In the meanwhile, if you are experiencing the pain, numbness or lose of strength associated with carpal tunnel syndrome, schedule an appointment with us today.    With offices located in San Diego and the California Central Coast, BDK is here to help you feel better forever.

Claudia started working with BDK in the Summer of 2010.   Her primary concern involved a diagnosis of thoracic outlet syndrome.     According to the National Institutes of Health this is “a rare condition that involves pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip.”    It is believed to be caused by compression of the blood vessels and nerves as they pass through the narrow space between the clavicle and the upper ribs on their way to the arms.

Claudia was also tested for carpal tunnel syndrome, which was ruled out, along with a more vague diagnosis of “chronic pain syndrome”.  Physical therapy was recommended, but when her symptoms did not improve she discontinued treatment.  Chiropractic adjustments did not help either.  Pain medication was the only thing that eased the pain.  She eventually found her way to BDK, however, where we started her on the path to rehabilitation.

During my assessment of Claudia it became clear that a large part of the problem was her strenuous work schedule.   She worked 50-60 hours a week, mainly sitting at a desk working on the computer.  I was immediately struck with her problematic  thumb positioning, with the thumbs drawn in and palm closing down.  Her shoulders were also drawn up toward her neck and the muscles of the shoulders and the neck were very tight.

It was quite odd for me to learn that the pain in Claudia’s thumbs were considered by other medical practitioners to be symptoms of thoracic outlet syndrome when to me the problem and the solution were clear as day.      From my perspective, the problem with her thumbs, hands, arms, shoulders and neck were highly aggravated by her improper ergonomics, compounded by the long work hours and on-going stress over many years.    Once we addressed her ergonomics, she quickly began to heal.  The thumbs were the easiest piece to resolve.

Once I demonstrated to Claudia the correct and incorrect positions of the thumbs it was as if a light bulb went on for her.   She became vigilant in correcting her positioning as well as working daily to stretch the fingers and hands and draw then open.     I massaged the affected area and taught her to do self-massage using a wine cork.  (In our previous post I included a short video that details this self-massage method.  You can view the video here. ) Claudia is now dedicated to taking 15-minute breaks every 2-3 hours and stretching her thumbs, hands, shoulders and neck.    She believes these short self-care breaks have been instrumental in relieving her symptoms and allowing her to continue in her line of work.

Here’s my take on how chronic pain conditions develop and how they need to be addressed.   There’s often a triggering event, in which a shoulder, for example, is injured.  If left unresolved the person will naturally compensate for the pain and disability by changing their position, such as drawing their shoulder up.  The typical response to a bodily insult is to contract and constrict the musculature.   This action causes a biomechanical imbalance that can then cause a domino of effects.

Add stress and the related muscle tension into the equation and there’s a much greater chance for a chronic condition to develop.  In my opinion, Claudia’s thoracic outlet syndrome was the result of such a domino effect.  And of course the longer the imbalance exists, the harder it is to remedy.  Ergonomic adjustment alone will not fix Claudia’s chronic symptoms, but they cannot be fixed without it.

If you are experiencing chronic pain or have a health care condition that has been unresolved through conventional means, we at Brian Dorfman Kinesiology might have the answer.    Sometimes it takes an alternative perspective to see clearly what a conventional eye has missed.   Begin to feel better forever with an appointment with Brian Dorfman Kinesiology today.

This first video details specific stretches that can alleviate pain and discomfort in this area.  These are very simple exercises that anyone can do pretty much anywhere.

As with any type of stretching, start slowly.   Rushing things and pushing past your limits will only delay recovery and may make the problem worse.     Stretch only to the threshold of discomfort.  Stay here and breathe.  Try to relax the affected area.   And, if you ever have any questions about these stretches, please contact me.  I’m always available to assist anyone using my products or following my stretching programs.   In the unlikely event that you experience a worsening of your symptoms, discontinue immediately.

This second clip demonstrates two simple self-massage techniques that can be used in conjunction with stretching for optimal benefits.

In this clip I mention a product called Power Putty which I often recommend to patients with thumb and hand issue.   As I stated in the video, you can use the softest putty to start with.   The exercise it not about building strength, but rather about expanding the space between the bones in your hand.   And similar to the caution I mentioned above, go slowly and gently.  Rushing things and moving beyond your limits will impede your recovery.

In my next blog I’ll present a case study of a woman with serious problems in her hands and thumbs, which had worsened over the years despite various attempts at medical care.   At BDK we were able to  remedy the problem quickly and permanently using the common sense methods described here.

In the meanwhile, if you suffer from pain and/or immobility in your thumbs, make an appointment with us today and start to feel better forever.

Disclaimer:  These exercises are not suggested as a replacement for medical care.  Please consult your physician before beginning this or any new physical exercise.

While this was a unique case, due to the young age of the patient, the traumatic nature of the injury, and the particular joint affected, arthritis in the thumb is a very common problem.  Arthritis in the basal joint, at the base of the thumb where it meets the wrist, is considered to be second in prevalence only to arthritis in the knee. 

This joint is formed by a small carpal bone of the wrist and the first bone of the thumb, called the metacarpal. The unique saddle shaped joint allows the thumb to have a wide range of motion, including up, down, across the palm, and the ability to pinch.    This kind of motion is used to type and text, for example, as well as to hold a phone or portable gaming device and a fork, spoon or knife.

Basal Joint (also called Carpometacarpal Joint)

Not only does immobility and discomfort in the basal joint cause many problems associated with working our hands, but the predisposition to get arthritic here is also a precursor to carpal tunnel issues.  While the Mayo Clinic states on their website that the exact cause of thumb arthritis isn’t know, they posit that age, weight and repetitive motion are primary causal factors.  In my opinion, however, it is the position of the thumb that is largely responsible for creating the arthritis as well as repetitive motion carpal tunnel issues.  For me, it’s an issue of biomechanics, which is largely overlooked in the western medical model.

From a biomechanical perspective there’s nothing emotional about alignment. It’s not like saying this alignment looks good or doesn’t look good.   It simply comes down to structure.  With regard to the structure of the joint, the correct and incorrect positions are a matter of anatomy.  It’s accepted knowledge in any medical or healing arena.   It is not in dispute.  And this is true with every joint in the body.  It is a mystery to me why this very simple concept of structure and alignment is absent in the modern day consideration of  joint health, especially  thumb arthritis, which affects over 25 million people today.

Here’s how it works:  Check out how much you can move your thumb when holding down the basal joint, where the wrist and thumb meet.    Many people get into trouble as they tend to lock that joint and use the second joint as their primary source of movement for the thumb.  This is the joint above the basal joint, where the webbing of the thumb connects to that of the index finger, called the metacarpalphalangeal joint.   You can actually immobilize the basal joint and retain about 80 percent movement in the thumb.   So we think everything’s just great and don’t realize there’s a problem until the joint becomes calcified and then arthritic.  If the tension becomes great enough you also get the swelling and that’s where carpal tunnel syndrome issues come in as well.  (I will address carpal tunnel syndrome in more detail in a future post so stay tuned.)

See this short video that I put together for a visual explanation of thumb positioning.

So here’s the good news.     Experience has shown me that age and repetitive motion themselves do not necessarily lead to either arthritis or repetitive motion symptoms.   My grandmother, for example, worked full-time as a secretary for Disney.  She typed 120 words per minute for years.  She knitted and crocheted regularly throughout her senior years.   I had the opportunity to look at her hands when she was 94 and her hand and thumb alignment was perfect.   She never had any problem with her hands despite the constant use and advanced age.

More good news is that the basal joint of the thumb is one of the easiest joints for a practitioner to adjust and position correctly.  Even if the joint has been out of alignment for a long time.     If we’re talking about a shoulder or a hip, for example, the joint can be difficult to access as it is shielded by layers of muscle and connective tissue.  In the case of an elbow or a knee, there’s actual bone in the way. But the thumb is right there for the taking.   And, with the hand, unlike these other joints, the resistance is quite minimum.

At BDK we’ve had great success resolving chronic hand and thumb cases quickly and permanently because of the ease of repositioning the mechanics in the hand and the thumb.  The design of the hand allows for that, more so than any other joint in the body.  Coming shortly in a follow-up post I’ll present a case study of a woman who had attempted various treatments to address her debilitating hand problems, before finally finding permanent relief through the simple biomechanic-centered method described here.   I will also detail simple hand exercises that anyone can do to prevent or alleviate hand and thumb discomfort.    In the meanwhile, if you are seeking relief for stiff and painful  joints, come see us at either our San Diego or Central Coast location, where our mission is to help you feel better forever.

Avery 2.5 years with bent right thumb

I’m embarrassed to admit that it took a while for my wife, Nicole, and I to notice, and then we wondered if he was actually born with a crooked thumb – (photos attest to the fact that he did once have a perfect thumb).    At the time we realized there was a problem the top joint of Avery’s less-than-3-years-old right thumb was completely immobile.   He would not let me work on it at all so I let it be, for a while.  We did consult with a few experts – an orthopedic doctor, a chiropractor, and a pediatrician – who all informed us that we were looking at surgery to correct the problem.  One doc said the tendon would shorten and lose its elasticity and that we would definitely need surgery to remedy that issue as well as those in the joint itself.  In an older person, the problem would have likely been diagnosed as arthritis.   Again, we were dealing with a thumb that was completely immobile.

September 2010 - thumb still bent

Now Avery is 5 years old.   At some point a few months ago I realized it was time to act.  He was old enough to handle the pain associated with breaking up the calcification that had formed on the joint.  And if we did not mobilize the joint soon, I was concerned the bones of the joint would actually grow together, as at that age bones grow very quickly.    Still Avery would not let me manipulate the thumb as I knew I needed to.  Then my wife came up with the perfect solution – Disneyland.

Avery today with straight thumb

I was immediately reminded how important motivation is in any healing situation.  Once Avery learned he could earn a trip to Disneyland  he was an eager participant in his treatment. It took us 3 weeks of regularly massaging and manipulating, the thumb to get it mobile. Once it was able to fully straighten I also taped it to keep it in position.  Now, 6 weeks later, it is 90% fixed.   Avery is so focused on getting his thumb right that he has, on occasion, woken Nicole and me in the middle of the night to tape his thumb as we had forgotten to do so the night before.

Now, the thumb is pliable and the calcification has dissolved enough to no longer cause concern.   The next step is to get the thumb moving from the inside.  I have complete faith that by his birthday at the end of May, the thumb will be back to normal and we’ll be partying with Mickey and friends at the Magic Kingdom.

In my understanding, the term arthritis has always been used to identify an area that has some kind of inflammation.  It is interesting to me that the AMA views the swelling associated with osteoarthritis as a “symptom” rather than a “cause” of the immobility in the joint.   And often there is only one joint where a person will have swelling.  So the idea that one thing is swollen, then the person has a “disease” or a predisposition for a disease is a bit absurd.  Arthritis is almost always localized. (Rheumatoid arthritis is a different story.  It results from inflammation in all the joints.  It is a systemic disease that affects the whole body).

One of the first rules about injury rehabilitation is that when a joint is injured or compressed, there is some swelling.  This inflammation can be alleviated, but until it is it can easily, and in my opinion, erroneously be diagnosed as arthritis.   Especially chronic swelling, which can happen all the time in a joint.

And the idea that a knee (or an elbow or thumb) that is swollen, that is injured, can’t at some point not have swelling is false.  We know swelling can be resolved in a joint.   And when it’s resolved the pain is alleviated , there is more mobility.

The reason swelling can easily lead to bigger problems is that it pinches off the capillaries and decreases circulation. So now you’re having a situation where the body is not able to actively move calcium out of a joint and the nature of a joint is that if it is immobile it starts to calcify.  So a joint that is swollen and immobile will also likely have some level of calcification.   And this would qualify as arthritis.    I’ve been told many times by patients diagnosed with arthritis that their cartilage has worn away and that the joint is now bone on bone.  For what it’s worth, in my opinion, the more likely scenario is that the bone has collected more calcium, which is now compressing the cartilage.  I believe it is quite rare to truly have a “bone-on-bone” situation in a joint.  But in most cases, once the extraneous calcium is broken up and removed from the joint, the vascular system can be freed to do its job again and the joint can begin to heal.

In other words, this disease that can’t be cured, can be cured.    But, don’t take my word for it.  If you suffer from joint pain and immobility, Dorfman Kinesiology will  prove it to you directly.   Set up an appointment today and start to feel better forever.

The topic of this week’s blog is plantar fascitis, which has been called the Achilles Heal of the NBA.  Two of the most well known Lakers to have suffered this condition are Kobe Bryant and Shaquille O’Neal.  Ron Artest played thru this problem in both feet early in 2010.  Tim Duncan of the Spurs and Tyreke Evan of the Sacramento Kings are currently competing on damaged feet, for now, although who knows if and when the situation might progress to the point where they will need to sit out a game or two.  The Celtics Rajon Rando recently received the diagnosis as well.  Last season, the starting center for the Chicago Bulls, Joakin Noah, was pulled out for 18 games due to this condition.    And this is but a small sample of the past and present afflicted.   And yes, normal people are also affected by plantar fascitis (not just the golden boys and girls of professional athletics).  A November 4 article by the American Association of Orthopaedic Surgeons states that 2 million Americans seek treatment for this condition each year.  That could be you.

So what exactly is this ailment that takes down so many of our best and brightest? Let me explain about the anatomy of the foot and it will become clear.  Plantar fascitis is named for a sickness in the area of the plantar group of muscles; the largest muscles in the foot.  This broad band of fibrous tissue attaches at the heel bone, runs along the whole bottom of the foot and then attaches to the base of each toe. The plantar’s role in the movement and stability of the foot is unparalleled and its power is nearly equal to the jaw per square inch of force.

Although the most common symptom of plantar fascitis is a stabbing pain in the heel, the “sickness” of the plantar could cover anything in this broad range of the foot.  It’s a bit of a general diagnosis, sort of like saying you have a Rotator cuff injury.  The rotator cuff is such a prevalent muscle in the shoulder that any injury in that area is going to involve the rotator cuff.  So any injury to the muscles of the bottom part of the foot seems to be, in medical lingo, termed plantar fascia.  It has become a catchall diagnosis for any deep problem in this area.

For athletes the plantar area can get pretty tight as it is the body’s first line of defense from impact forces associated with the running and jumping that the pros do so much of so well .  When the muscle gets tight there can be considerable pain depending upon what it compresses.  If it compresses on a nerve that’s one thing, or if the joints compress on each other because of all that tension, that’s another.  There are 27 bones in the foot, which means there are a lot of joints in a very small area and a lot of opportunity for compression.  Whatever the specific root of the pain, however, the treatment for Plantar fascitis can be quite simple.  Once you loosen up the muscles of the bottom of the foot, magically you don’t have the pain.  You don’t have the compression on the joints, which causes the swelling that causes the pain.  You don’t have the aggravation of the tendon being pulled by the tight muscle.

One of the best forms of therapy I know for releasing this area is standing on a tennis ball. (CAUTION:  This exercise is NOT recommended if the plantar is damaged due to high impact trauma.)  I know it sounds odd, but it works.  The trick is to keep your leg straight, keep your hand on a door or a desk for support and step on the tennis ball with just enough pressure to feel a little discomfort on the bottom of the foot.  That is the key – to really get your weight on top of the ball – and to keep that degree of pressure on the whole time while you slowly roll the ball under your foot so that it comes into contact with as many parts of the bottom of the foot as possible.  If you do this exercise every day, for 5 -15 minutes you will get results.  Check out this youtube video for a simple demonstration.   As with most structural ailments, the sooner you catch and treat the problem, the quicker it can be resolved.

Good luck Lakers.  Keep your plantar on the tennis ball and feel better forever.

Let’s start with Joe (not his real name), a 58-year-old man whose presenting problem was pain in his left knee accompanied by pain and discomfort in his left calf and foot.  By the time he came to my office he had been dealing from this problem for about 2 years, had received 10 months of injections with Hyalgen for the osteoarthritis in the knee and was fitted with a knee brace (which was later suspected by various doctors as the being the cause of blood clots forming in his lungs).   An ortheopedic surgeon had stated that the knee joint was “bone-on-bone”.  It was suggested that in the near future Joe was looking at a total knee replacement to correct the problem.   I saw him one time, did massage work on his knee and calf, and now these areas are feeling almost 100% better.  I had him use a tennis ball to work out the tight muscles in his foot, which is now significantly improved as well.   And this is not an isolated case.

It is disturbing to me how quickly expensive drugs and total knee replacements are being introduced to patients as the only solution, as opposed to more comprehensive testing and treatment.    While I am very much in favor of appropriate medication and knee replacements (and hip replacements) when they are truly needed, I am concerned about the growing trend to offer these treatments as the de facto solution when alternative, less expensive, less invasive treatment is a perfectly viable option.    At Dorfman Kinesiology it’s not that we’re trying to reinvent the wheel, we’re just trying to take the wheel and remind people it still works.

Another case was a 31-year-old woman, Mary (not her real name), who started having headaches when she was 13.  Her symptoms had grown progressively more consistent and more intense.  She described her headaches to me as a “hatchet in the side of my head”.   The neurologist and other medical doctors told her “based on what our tests show, you’re fine.  We don’t see any reason why you should be experiencing headaches.”    And sure enough when she came to our office and we started addressing the head and musculature of the head in relation to the cranial bones, she had muscle tension, like a hatchet, more than I have ever seen.  Basically she had a knot over half of her head.  For me, the cause of the problem and the solution were obvious and we naturally addressed that chronic tension.   From the AMA standpoint, however, that tension can’t exist because it can’t be seen with an x-ray or CAT scan or MRI.   Yet, when the tension was addressed in my office Mary got the first lasting relief she’s had in 17 years.  Her husband started crying.  And not only because the pain had abated, but because someone had actually validated that there was a physical reason why she was having these headaches and they weren’t just in her mind.   It was a tremendous relief.

The next individual is a 50-year-old man named John (not his real name) who had injured a hamstring 3 months earlier.  The hamstring had been slightly problematic.  On the recommendation of his doctor John went to see a physical therapist (PT).  Recently PTs  have started to include more stretching, yoga and pilates into their their procedures and this is the route they took with him.   John, however, is very athletic and very tight.  In working with such individuals it is important to go very slow and easy, stretching only far enough to feel the initial tension in the stretch.  But instead of offering appropriate stretches for John’s degree of injury and flexibility, the PT leveraged on him and busted his hamstring.    While John was on his back with his injured leg in the air, the PT pushed his leg toward his head to force a deeper stretch and busted his hamstring.

This case reminds me of an article I wrote a few years ago for Triathlete magazine called Turn on the Off Season, in which I state that an athlete should never get hurt while stretching.  (To read the article, click on this link to Active.com where the piece was also published.) We shouldn’t be leaning on people.  The idea that you should jump on someone who is very inflexible to help them heal is a complete misunderstanding of the right application of stretching.

Jane (not her real name), a 50-year-old woman, is another example of the success of an alternative health care perspective.  She was in a car accident 15 years ago and although she’s had better days and worse days, there hasn’t been a time in a decade and a half when she hasn’t felt some of the effects of the trauma, mainly in her neck.   In the last 4 years Jane’s physical condition had deteriorated significantly, despite regular medical attention.   Then, she decided to get on a bumper car at an amusement park with her grandchild.  Unfortunately, Jane was very vulnerable.  She ended up with intense headaches and a complete inability to move her head, the acute symptoms that finally brought her to my clinic.    Although she had seen a range of medical practitioners over the years no one was able to help her.   They did tests and prescribed medications, but left her in an increasingly vulnerable position, because the root cause of the problem was never addressed.

The misalignment of Jane’s neck and head was obvious to me the first time I saw her.   Jane’s alignment was skewed in the impact of the car accident.   Then she likely began to compensate for the trauma to her upper body by holding her neck in a way to minimize the pain and discomfort suffered.  This troublesome alignment was never addressed in all her years of treatment.  Not once.   In two appointments at Dorfman Kinesiology, however, we were able to give her a lot of relief and start her in a direction where she won’t be at such great risk if she ever misses a step somewhere, or wants to pick up her grandchild.

The care we offer at Dorfman Kinesiology is not rocket science, but rather a common sense, individualized approach that takes into account various components of the human system to bring balance to that which is out of balance.     If you have concerns or questions about a diagnosis or treatment you have received from another health care provider, I am available to help.   And always get a second opinion, whether at Dorfman Kinesiology or with another practitioner.   Mistakes are too common in the modern medical system and your health and well-being are too precious not to take that extra step.

It’s clear that there is a big change in the type and frequency of injuries for student athletes today and I believe this difference is the byproduct of spending so much time using computers and cell phones and just sitting a lot while using the computer and the phone.  It’s not that athletes are sustaining more or worse injuries than non-athletes due to today’s extreme reliance on electronics, but rather, that athletics tends to highlight low-grade imbalances.

For example, a 16-year-old starting pitcher came to Dorfman Kinesiology because he had pain and discomfort in his elbow and it hurt him to throw a ball.  I quickly discovered that the root of the problem was tight biceps – caused by the rigid position of his arms while texting.   Instead of keeping his elbows close to his body in an ergonomically correct position, he was raising his elbows up and away from his body.   This common misalignment shortens the biceps and will cause problems for the musculature of the arm if it becomes habitual.    So although pitching didn’t cause the problem, it brought it to light very quickly, because he had to straighten his arm and extend the muscle significantly.    I was able to resolve the problem in one appointment by correcting his biomechanics, doing hands on massage, and teaching him a few relevant stretches.

Here are some numbers I just pulled off the web which are pretty astonishing and really back what I’ve been seeing in my clinic with regard to postural and repetitive motion related pain and injuries.   A 2009 study by the Pew Research Center found that on average teenage boys send and receive 30 texts a day while the average girl is up to 80 texts.    More than 30% of the subjects reported sending and receiving more than 100 texts per day!   On top of all this texting, on average, teens spend 31 hours a week on the computer, sending emails, surfing the web, visiting facebook, myspace and youtube or playing games.  31 hours of sitting on top of the sitting they are doing each week during school.     And, to finish it all off, kids aren’t walking anymore.  They are driving to and from school, to meet up with friends and for sporting events.  Even more sitting.  While texting perhaps.  Or playing video games on an iphone or hand held device.

Fortunately these young athletes respond quickly to the right treatment and it’s amazing how a sprained ankle can become a perfect ankle again.  It’s really remarkable.  For me, it’s great to be able to see a case resolve in one or two appointments.

So if you or your child or someone else you know is a student athlete with an injury of any kind, we can definitely help.   Come in and learn first hand who we are and what we can do.  You’ll be happy you did.    Email me at brian@briandorfman.com or call 619-742-9934 to set up an appointment today.

But now, on the other side of the injury spectrum is Andrew Bynum.   The Lakers center has been dogged by knee injuries for three straight seasons.  Then, in an unfortunate turn of events, Bynum  was diagnosed with a torn meniscus in his right knee following the Lakers first-round playoff series against Oklahoma City.   This injury has limited him since.     Bynum admitted that the pain is “there every step” – but he chose to continue playing and delay surgery until after the finals.    If someone had asked me, which nobody did, I would have had him  do the surgery right away.

The  tear in the meniscus (the cartilage which is the soft tissue between the bones of the knee) is very small – probably the size of a pea.
In the off season he’ll have arthroscopic surgery – they’ll come in with a couple tools about the size of a pen and, using a microscopic camera for guidance,  they’ll cut out the part that’s torn and he’ll be good to go.     He should be playing ball again in 7-10 days after the procedure.   What’s often misunderstood is that they are looking at doing something very minor and non-invasive.  If they do go in for something non-invasive and they end up finding a bigger problem, they usually pull out and have a conversation and decide what to do later.

But now, since the tear remains, Bynum’s biggest issue is dealing with the body’s compensatory response to the injury: the swelling.   Any time there’s damage or an insult to the soft tissue in a joint, like an ankle, a knee, an elbow or a shoulder, the body responds with a lot of swelling and then the swelling becomes the problem.   It’s hard to move the joint through all that swollen tissue.  In Andrew’s case, the fluid needs to be drained regularly – maybe once a week or so.   In addition, he needs to ice his knee every few hours to keep the swelling down.

I was recently asked if a torn meniscus is a common injury.   My response was yes and no.  Common, yes, for a 7 foot 2 inch 320 pound pro athlete.   I imagine if we looked up the statistics of how many athletes on professional teams – football, baseball, soccer, basketball – have had minor knee surgery for this type of problem, I think it would be staggering.   Someone like John Elway, probably had his knees done about 5 times each.

The way it works is like this -  as soon as you take something up to an elite level and you increase force, you increase injury.   The two most important factors in determining the force of an impact are an object’s size and the speed of its movement: a combination of mass and acceleration. If you’ve got one of these athletes at the top of their game you’ve got at least one of those factors at play pretty strongly.   And you’ve got a recipe for some pretty good injuries.

But no, this is not a common injury for the rest of us. I would say that if we separated impact injury from non-impact injury in the general population very few would have these tears.  But knee problems are often misdiagnosed.  Without having a car accident, or a bike accident or falling out of a tree or something of the like,  a normal person rarely has a torn meniscus.  Now of course there are many people out there with chronic knee problems.   The difference is, they’re feeling the discomfort of the swelling, but it’s not because of a tear.   It’s because of all the tightness and compression.  I think a good way to look at it is when your knee has a lot of tightness, that forces a certain level of swelling.  You get into a relationship between swelling and compression – more compression equals more swelling which makes the joint more achy.  Whether the joint is responding to an insult or to chronic tightness and misalignment, the end result is the same, which is pain.

At Dorfman Kinesiology we frequently resolve this more common type of knee problem through a combination of massage, stretching, and biomechanic adjustment.     So, if you are one of those people walking around with a bad knee or two (or ankle, elbow, shoulder or wrist) give me a call at 619-742-9934 to schedule an appointment or send an email to brian@briandorfman.com.    If you have been diagnosed with a torn meniscus and want a second opinion I can help with that too.

Meanwhile, keep it jumping Andrew.  When you’re ready for rehab give me a call.
Go Lakers!