injury and treatment of knee, shoulder, elbow, wrist, and hand problems

Wearing Flip-Flops Can Cause Problems With Your Feet

As the weather begins to warm up, you will notice that many people are starting to wear flip-flops. In fact, it is common to see anyone from a child to the elderly wearing them leisurely, or even at work. However, this fashion statement is causing problems. The Province newspaper even printed an article on this where they are quoting healthcare practitioners as saying “flip-flops have gone from the boardwalk to the sidewalk” and that “doctors are flipping out over flip-flops”. The paper also reported that “there has been a “15% rise in flip-flop related injuries”. I don’t know how accurate this statistic is since I doubt that anyone actually keeps track of how often someone experiences a flip-flop injury. However, I do agree that wearing flip-flops can cause problems with your feet. As a chiropractor, I agree with other physiotherapists and podiatrists that this is becoming a definite problem.


Most of the flip-flops that can be purchased today have only one strap across the top of the foot. These shoes have no real support for the bottom or sides of the foot. With no support on the sides, the foot can easily slide off of the edge of the sandal making an ankle sprain much more likely. This is particularly true if the flip-flop has a thick or high sole. With no support on the bottom of the foot, the arches of the feet can become stressed. This is even more so if the person has “fallen arches” to begin with. Furthermore, unsupported arches of the feet can negatively alter how the foot, ankle, and knee function. This inevitably leads to plantar fasciitis, knee pain, and possibly even lower back pain. If you must wear these trendy flip-flops, don’t wear them for too long at one time. Definitely do not walk for long distances while wearing them.


Another problem with wearing flip-flops is that there is that the single strap passes between the first and second toes before attaching to the sole. The foot is not designed to have a strap jammed between the toes while walking or standing. This constant pressure may irritate the small nerves that travel along each side of each toe. This may cause numbness of the toes directly next to where the strap inserts.


The easiest way to solve the increasing frequency of flip-flop injuries is to not wear them at all. However, try that one on your teenage daughter who thinks they are the most fashionable and comfortable summer footwear possible. To compromise, try to not wear them for too long at one time and definitely not when walking long distances. If you think you are experiencing some of these symptoms or have already sprained your ankle and you would like it examined, feel free to contact my office


Fallen arches


Did you know that there are 52 bones, 36 joints, and lots of ligaments in your feet? Why is this significant? Well, your feet are the foundation of your entire body. They must withstand pressures every day of two to three times your body weight as you move. Just like the concrete foundation of your house, it has to hold the weight of the entire house. If the foundation begins to shift or can no longer hold the weight, the house begins to show physical changes or signs of “settling” all the way up to the roof. The same scenario occurs in your feet. If the ligaments become “stretched” or the joints become “rigid or stiff”, the feet cannot tolerate the daily forces that are applied to them. Over time, this leads to the breakdown (arthritis) of the joints of the feet, microscopic tearing of the ligaments (plantar fascitis), fatigue of the foot muscles, and eventually painful feet. People who are experiencing these problems find it difficult to stand or walk for even short periods of time. But this is not the end of their problems. When the feet are settling or changing structurally (most commonly called “fallen arches”), other areas of the body can be dramatically affected. Changes in the feet, such as fallen arches, often cause pain in the knees and shins. Particularly if one foot changes more than the other, pain can also show up in the hips, pelvis, and low back. In dramatic cases, changes in the feet can lead to postural alterations in the spine that can cause problems up as high as the neck, usually showing up as neck stiffness and muscle tension headaches.

In my office I recently came across a patient that appeared to have simple mechanical low back pain. With chiropractic treatment, he demonstrated great improvement in mobility and the pain disappeared. But within three weeks, the pain in the low back began to creep back. This happen a couple times before I decided to look for other possible causes. I asked him about his feet. When he removed his shoes and socks, he had fallen arches. And, it was much more significant on the left foot. When he stood and I looked from behind, the left fallen arch made his left hip, pelvis, and lower back drop slightly. Not to my surprise, this was the same side of the low back that always became sore. It was then apparent that to correct the mechanics of his feet, he needed “custom orthotics”. To do this, I made a “foam cast” of his foot while it was in a neutral, non-weight-bearing position. In simple terms, this means that I made a foam cast of his foot while he was sitting down so that the arch and joints of the foot were in their proper position and not flattened. Plastic orthotics or shoe inserts were then made to specifically fit his feet that would give them the support they needed. As long as he wore the orthotics, the fallen arches of the feet were maintained in their proper position and the postural changes in his low back were eliminated. As I expected, the pain in his low back was also eliminated.

It is also important for people who have additional or extended health through their work to know that if they often have coverage for custom orthotics. You can talk to your employer to confirm either way.


Exercise After An Injury

In my chiropractic practice, I have noticed a substantial difference in how one patient can heal much faster than another, even if they had similar injuries. This most often occurs with soft tissue (muscles, ligaments, and tendons) and joint injuries suffered by people in motor vehicle accidents. For example, if I treat two different people that were of the same sex, similar age and size, both with similar injuries, and even in the same accident, why wouldn’t they heal in relatively the same time period? One of the primary reasons why there may be a difference is due the difference in the level of their physical activity before and after the accident. If one person continues to exercise after an injury and the other person does not, the active person will generally get better faster and to a greater degree.

If you are unlucky enough to be in a motor vehicle accident, generally you will suffer from varying degrees of a whiplash. The joints of your neck and upper back will be sprained and swollen. The muscles, tendons, and ligaments will be stretched and microscopic tears will likely occur. If the accident was serious, fractures should be ruled out by taking X-rays. Then, a good physical examination by your medical doctor or chiropractor should be completed. Once this is done, you should rest for a short period of time until the acute phase of the injuries has settled down slightly (the swelling starts to decrease, the severe muscle spasms begin to subside, and the person is mobile).

As soon as you feel good enough, you should get moving. I realize this goes against the old train of thought that if your neck or back hurts, don’t move it. Years ago, when someone suffered a whiplash, they were told to wear a cervical collar for six weeks to immobilize the neck. More recent research has shown that this may actually prolong the pain and suffering. New studies are showing if you stretch and maintain the strength and mobility of these areas in a controlled manner, the healing will occur faster and to a greater extent. In my office, I am able to improve and maintain the movement in the joints by doing gentle chiropractic manipulation or mobilization. I also use various soft tissue treatments to loosen the muscles.

Once the injured areas are relatively pain free and have a good range of motion, I will encourage the patient to increase the intensity of their exercise. We encourage all of the patients to continue maintaining this higher level of activity and to have the joints of the spine checked every couple weeks until I am confident everything is healed completely. This is because the healing process extends well beyond the time when the pain disappears. Scar tissue that formed in and around the injured areas must be dissolved by the body and replaced with normal tissue. As well, previously injured areas will remain more vulnerable to flare-ups for quite some time.

In closing, if you have a whiplash or other injury, see your medical doctor and chiropractor. Then, once your body is ready, get into an exercise program so that you can help your body heal as fast and as completely as possible.



With the Wrist, a Small Fracture Can Become a Serious Problem

The popularity of skate boarding, snow boarding, and rollerblading is increasing every year.  Unfortunately, as the participation in these sports grows, so do the number of wrist injuries.

One of the more common areas to be injured is the wrist. Our wrist is made up of eight small individual bones, called “carpal” bones.  When participating in the above-mentioned activities, falling forwards or backwards can be a common occurrence. When we fall forward, our first reaction is to put our hands out with our wrist bent backward in order to catch ourselves. When the wrist and hand hit the ground, they must absorb the entire weight of the upper body. When the force put through the wrist bones (called “carpal bones”) is excessive, one or more of them can fracture. Unfortunately, one of these carpal bones (the scaphoid) is the most common one to break. This “scaphoid” bone has a unique characteristic that the other carpal bones do not. Most bones in the body have a small artery entering them from each end. For example, the large bone in your thigh (femur) has blood supply entering it from both ends of the bone – near the hip and down by the knee. So, when you break that bone in half, each end of the bone has its own separate blood supply to keep it alive and healthy. The scaphoid bone is designed differently. Its primary blood supply enters the bone in middle instead of the ends (see diagram). Therefore, if you break off one end of the bone, the fragment may not get an adequate blood supply. This fragment of bone will then die and degenerate, causing severe arthritis in the wrist. I have had numerous patients come to the office who have broken their wrist before and have not had it treated properly. Their wrist is no longer able to bend backward or forward as it should and it is often suffers from moderate to severe arthritic pain.


scaphoid fracture xray scaphoid_fracture_diagram

To make matters even more difficult, a crack or break of this bone is very difficult to see on x-ray and can be easily missed by even the most trained medical or chiropractic doctors. With some patients, the swelling is minimal and no significant bruising is revealed. To be sure there is no fracture, the wrist should be x-rayed again 10 days later. After this period of time, a crack is easier to see as it is attempting to heal. If a fracture has occurred, the wrist must be immobilized with a cast.


If a fracture has been definitely ruled out and just a bad sprain has occurred, the wrist should still be immobilized for a short period of time. Once the pain and swelling has decreased, the wrist should receive conservative treatment. This includes mobilization of the eight bones in the wrist by a chiropractor. Stretching and strengthening exercises should also be prescribed to accelerate the recovery and prevent significant muscle wasting.


To prevent serious wrist injury, purchase wrist guards that are often sold with rollerblades. They protect the wrist from impact when falling forwards and prevent the excessive backward bending of the wrist joint. These simple and inexpensive pieces of equipment can prevent many of the wrist fractures from occurring.

Thoracic Outlet Syndrome

Are you one of those people who regularly wake up at night because your hands and lower arms have gone numb? You may find that it happens when you are sitting at a desk or even when driving long distances. This is commonly caused by compression of the nerves and blood vessels that enter the arm. The technical term is referred to as “thoracic outlet syndrome”.

Thoracic-Outlet diagram

The neck portion of the spine, called the cervical spine, has seven vertebrae. Passing inside of vertebrae is the spinal cord. Originating from the spinal cord, there are eight nerves. These nerves exit the spine between each of the vertebrae and 5 of them combine into a large bundle of nerves. The bundle of nerves then pass under the chest muscles, through the shoulder, and down the arm. The primary job for most of these nerves is to control the pain or touch sensation and the contraction of the muscles of the arm.


When you sleep with your arm under your pillow or over your head, the bundle of nerves can become mildly stretched. Whenever this happens, these nerves cannot function well and you may end up with thoracic outlet syndrome. For example, if the hand is being touched, a message from the hand is sent through the nerves to the spinal cord and then to the brain. Your brain then consciously tells you that your hand is being touched. If the nerves become stretched or compressed, they cannot communicate their message to the brain properly. This will eventually make your hand and arm fell numb and weak. This can also happen to those of you that prefer to sleep curled up into the fetal position. Your arms are likely curled up tight in front of your chest. This position causes compression of the nerves as they pass through the shoulder and into the arm. The result, numb hands and arm, will occur again for the same reason. If you spend too much time at the computer or drive for long distances, the muscles in the chest and shoulder can become very tight. This can also compress the nerves as they pass through the shoulder and give the same result of numbness. If these muscles are only mildly tight but not enough to cause numbness, the overall space that the nerves have to pass through is still less. If you combine this scenario with your arm in the previously mentioned sleeping positions, you are even more vulnerable to experience the numbness.


So how do you deal with this hand and arm numbness? First of all, avoid sleeping with your arms over your head or curled up in front of you. To alleviate the potentially tight muscles in the chest and shoulder, a simple stretch has been shown. Avoid a slouching posture, as the shoulders will roll forward and further decrease the available space for the nerves to pass through the shoulder and into the arm.


If you are experiencing numbness into the arm or hand, you should also have your neck properly examined by a chiropractor. Problems in the neck can potentially cause symptoms very similar to Thoracic Outlet Syndrome.