Sports Medicine and Rehabilitation Bradenton FL & Parrish FL - Sports Medicine physician Florida USA

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Frequently Asked Questions 2005

Frequently Ask-The-Doctor Questions Asked

Archives 2009 2008 2007  2006  2005


Q  I read your article on increasing pitching velocity. I could not find any info on Logan or the Exergenie Cord.  I would like to try the exercises but could not find any info on the web on Logan, the device or the program.  My goal is to reach 98 MPH, please let me know if you could provide some more info.
 

A In the article, the researcher's name was Logan.  Information regarding the Exergenie can be found at the following web site  www.exergenie.com.  Sport specific conditioning and training has shown to be most effective in functional outcomes. 

 


Q  My 13 year old daughter is a serious dancer (ballet, modern) who has been struggling with an ankle injury for over a year.  She has seen two orthopaedic surgeons, was diagnosed with mild osteochondritis and put in a cast for six weeks.  She has also been in physical therapy during this time.  Her pain is recurring and I am not convinced she is receiving the proper approach. 

I believe her ankle is very unstable (I watch her dance class and she is wobbly on her right leg), which may be leading to musculoskeletal strain and subsequently causing other problems.  I fear that if she is put in a cast again, her problems will only get worse as her muscles weaken even further.  Is this a patient you would consider evaluating? 

If not, do you recommend anyone?   Any advice you may give us will be greatly appreciated.  I realize this may seem like we are doctor shopping.  As a physician, I can assure you this is not the case.  We are just wondering if looking at the problem from a different angle may be more fruitful, and the information on your website sounds very promising.

A Ankles instability in young ballet dancers is very common and lead to proximal musculoskeletal mal-alignments.  I have treated three such Sarasota ballet dancers by manually repositioning their subtalar bones back into alignment.  I do not know anyone but myself that does this.  I have tried to educate others from my articles on the web.

 


Q I have chronic tightness in my right gluteal area in the bottom half, middle and where it attaches to hamstrings. It causes me discomfort when I sit for long periods of time, running, walking for more than 1/2 hour and hamstring exercises. My right side is less flexible when doing stretching.
I have been told that my right leg is 1/4 inch to 5/8 inch shorter.  I have a minor herniated disc at L5. 

I have had different diagnosis' and treatments from five physical therapists in the last 12 years since I first experienced this deep ache/pain. It has been off and on until the last 3 years it has become chronic. Nothing has helped and I am frustrated. I have been told my problem is because of L5 and then told by another physical therapist that it is not. (I have no pain or tingling down leg). I was told my right hip is weaker and then told by another that that is not. I have also been told I have bursitis in the hamstring area and then that was discounted by another.   

 

Without seeing me but by my explanation can you recommend a path to take or do you have any idea what could be the cause so I can approach my problem without wasting time?

Is rolfing or deep tissue recommended? Chiropractor?
The latest physical therapist has told me to do bending backward (extension) exercises and to stop flexion exercises including yoga, pilates, abdominal flexion and high impact exercises. I realize you cannot give me a diagnosis but some general ideas would be so appreciated!

 

A  From the information you've provided I will try to give you my best assessment.  My assumption is that at some time you may have landed on your right buttocks from a slip or fall.  Your presentation is consistent with a right sacral-iliac subluxation that creates gluteal muscle tightness as well as strains the affected hamstring muscle. 

This combination creates a problem of mal-alignment of the right knee and the patellar tendon.  This subluxation causes a "functional" but easily correctable leg length discrepancy.  The slightly complicating factor is the L5 surgery that is keeping the sacral-iliac junction in tightness and not allowing a functional release.  So what do I recommend other than visiting us and correcting it.

 

1.  See a chiropractor who will provide adjustments to the sacral-iliac region.

 

2.  Find a expert in myofascial release techniques.  The two best are Active Release Technique ART --chiropractor in Colorado developed this technique or Active Isolated Stretch - developed by Aaron Mattes from Sarasota Florida.  Rolfing is not as specific and massage too general.  Deep tissue will just aggravate the tissue unless you take steps one and two above. 

 

3.  Exercises won't change anything until you proceed with above.  In fact some exercises will aggravate the condition.

 

4.  Modalities like TENS, Ultrasound, E-Stim, Acupuncture will not change the mechanical mal-alignment of your pelvic bones and will benefit you superficially for a couple hours at best.

I was in a rear end collision 1 week ago and have since developed pain in the left side of my neck, left shoulder and distal portion of my upper left arm with tingling into my left arm radiating into my left thumb.  My x-rays reveal a narrowing at C5, is this an injury that can be treated without surgical intervention?  I am a flight nurse and am extremely concerned about the prognosis, can you give me further info?

I am 43, and was hit at approximately 60-70mph, my car was thrown 117 ft from the sight of impact.  I am concerned because I cannot wear my flight helmet without severe pain in my shoulder and tingling in my left arm and hand.  It has actually spread from the thumb to the entire hand when lifting patients, bags etc. C5 and 6 reveal old arthritic changes and a severe narrowing on the left.  I am awaiting my MRI.

A The symptoms are common.  As you know muscles can mimic nerve root like paresthesias.  X-rays are limiting as they do not show disc or nerve entrapments.  The distribution of symptoms can be C6 involvement.  The speed of impact and your chronological age can be factors to predicting the potential of a herniated disc. 

Early radicular symptoms are a poor sign of quick recovery.  I suggest finding a good osteopathic physician or chiropractor to initiate manual treatments and modalities.  A MRI of the cervical spine would be beneficial to assess disc abnormalities.  Your primary physician can order medications for symptomatic relief.


If someone has a tight psoas will their pelvis be tucked or flat?

A  I work with elite athletes who have "six pack" abdominal muscles, but have tight psoas major and minor muscles.  As well, very deconditioned individuals have very tight psoas muscles.  Therefore, I cannot categorically correlate "tucked or flat".  One observation is that tighter psoas muscle may in a side view show a slightly forward quadriceps muscle (anterior). 

Older individuals with a condition of spinal stenosis lean forward across their waist line and develop compensatory psoas tightness, but clinically they are leaning forward to relieve the pressure upon the spinal canal in the lumbar region. 


I would like to ask you the recommended exercises that I can do for golf at home.  I am a beginner at Golf and after 2 months training I have broken a rib (6th & 7th), right side under the right axila.  I did it just playing, or better:  training!  My doctor recommended to relax for 6 weeks - no Golf.  I am worried about returning to Golf (and I will).  How can I prevent a new accident (another broken rib) with exercises?

This is a rare situation that you present, but occurs enough to be written about in golf injuries.  Referring to the biomechanics of the right sided 6th rib, this correlates with a muscle group deep under the pectoralis muscle called the serratus muscle.  More specifically the serratus anterior.  

Usually more than one muscle is involved and you may have very tight pectoralis and latissmus dorsi muscles.  I apologize in advance for the technical terms of the muscles, but this will give you a better reference when you search the internet for rehab of these muscle groups. 

The rib heals on its own in 6 weeks.  The muscles between the ribs are more susceptible to spasm and strain.  You need to find a resource on how to stretch and release these muscles to functional flexibility in order to reduce the tension-torque that could lead to re-fracture.  Myofascial release techniques for these deeper muscles may have to be done by a trained therapist as you may not be able to get full flexibility on your own. 

Try looking up Active Isolated Stretching, Active Release Technique. PNF, and should you not find a qualified therapist, find a good experienced massage therapist to work on these muscles.  Additionally, prior to your golf game, you need to warm up with stretching exercises to prepare these muscles before strenuous activity.  Possibly a rib cage binder (wrap) may help stabilize the rib cage in the early stages of healing.  I hope this helps you understand the mechanism of injury.


Is it true that babies should not get their shots when they are born. That kinesiology will take care of them.

Well, as I understand the question, does kinesiology substitute for shots?  Kinesiology is the study of movement--biomechanical function.  Shots for babies are for the purpose of injecting a vaccine or medication to help the baby with a illness, disorder or prevent diseases.  The trauma of the needle may leave a scar, that as a child grows is not noticeable, not interfere with function. 

There are incidences where an injection can be made near or at a major nerve and cause damage to this nerve.  This damage is just bad luck or carelessness.  The question may be from a natural physician--are immunizations necessary for babies and newborns, but this is quite a debated topic that I don't feel I am an expert to provide an authoritative decision. 


Q I am a college baseball pitcher interested in gaining throwing velocity.  I have already gotten two training baseballs, one 4 oz and one 6 oz, 20% above and below the standard 5 oz weight of a regular baseball.  I am very interested however in the "Exergine" wall pulley workout spoken of in this article, claiming an 8.1 gain in mph.  I'm familiar with surgical tubing workouts and the like but not with this.  Any information you could give me on where I could acquire something like this or where they have them etc. would be great.

A Thank you for your question.  Sounds like you have been diligent in your conditioning.  You can get more information at www.Exergenie.com


Q I recently underwent a posterior lumbar spinal fusion, L4/5, 12 weeks ago. 6 pedicle screws were inserted, awoke with no power in left knee and loss of sensation down left shin. It took a week for my surgeon to return me to theatre as he had miss-aligned one of the screws and it was compressing a nerve, resulting in my symptoms  (I had no problems with my left leg prior to surgery). 

I now walk on two crutches since my left knee is essentially a dead wait, and surgeon has told me only time will tell if it will heal or I'm in this state for the rest of my life. Compression over that length of time and due to nature of trauma to the nerve do you think it will heal?

A The answer is a difficult one.  It sounds like you had the L4 nerve root injured by the appliance--screw.  This is a rare event.  Nerves do regenerate, but at a very slow rate.  You may need further studies, a nerve conduction test and possibly EMG to diagnose the degree of injury and site of injury.  An MRI may be helpful to diagnose where the screw traumatized the nerve.  I would also get a second opinion to substantiate the findings.


Q We (Virtually Perfect Golf Inc.) have produced a Virtually Perfect Golf Learning System that incorporates a level of virtual reality feedback into tradition video analysis lessons.  We are trying to find research that: 1) supports our notion that virtual reality feedback is the most effective way to of learning a motor skill or that it achieves the highest level of motion retention, and 2) if there are statistics that show what level of motion retention different teaching methods achieve (i.e. visual, audio, full motion, demonstration, etc.).

Please see our website for more information: www.virtuallyperfectgolf.com

Your comments would be very much appreciated

 

A Your method may prove to be superior in concept to fragmented golf instruction.  I have worked with biomechanics analysis with Univ. Calgary, Univ. South Florida, and Univ. Tennessee in analysis of learning styles in sports as well as specific body mechanics that differ for men and women in athletics, most importantly in golf.  Recently,

I was invited by TaylorMade to meet with their research team.  TaylorMade has a goal of trying to develop biomechanically/ergonomic club design, with a special interest in women's golf.  I have over 5 years of unpublished data that has been based on 80 years of research information that has been applicable to golf.  My web site is just the basic knowledge that is acceptable to the industry and does not hold any of our research developments. 

 
I have reviewed your web site and find it intellectually stimulating.  As I had my residency training in functional anatomy and physical medicine at McMaster in Hamilton, I recognize your sites.  I studied three years with Dr. Basmajian at McMaster, who is the father of anatomical muscle function.
 

I am a new personal trainer.  I have a client who strained her quad from doing stationary reverse lunges. She was holding 20# dumbbells. Seems like she was going basically nothing for this to happen. She’s very fit, hikes a lot, so not  sure what happened. Anyway, my concern now is what to do with  her and how long it will take to heal. We laid off for 4 days and then only did some straight leg raises, no weight body squats and stretches. Any advice for this newbie is greatly appreciated.

In the reverse lunge the quad muscle may strain at two different attachment sites. If the pain is near the Anterior Superior Iliac Spine, then it is the proximal attachment.  If the pain is suprapatellar, then the problem is distal quad.  If the person had a previous injury mid quad, either site is vulnerable.  If the person has had knee problems such as patellar tendonitis, ligament sprains, or meniscal tears/sprains, the lower quad attachment is tight. 

To assess, place the person on a table and had them lay on their non affected side (the knee that doesn't hurt.  In a perpendicular line have the person bend-flex the knee towards the buttock.  Measure the distance from heal to buttock.  Then have the person roll on the affected knee side and repeat this measurement.  Look for dys-symmetry in heal to buttock range. 

Find a technique you prefer and stretch the quad to complement the best range.  This will accelerate healing and functional strength.  Please review the article on sports assessment.  For Active Isolated Stretching technique, you can visit the site of www.stretchingusa.com

 

Can you point me to illustrations of the exercises to which you allude to in your article?

The Active Isolated Stretching exercises--I would refer to to Aaron Mattes' website www.stretchingusa.com


Q I have had two sessions with AIS for chronic knee, hamstring and quadricep discomfort.  The quadricep discomfort is the most concerning in my running as the quad just "turns off" and my leg feels "dead".  Prior to AIS I had done the traditional route with EMG and artieriogram secondary to a positive drop in pressure during an ABI test. 

Claudication symptoms without evidence of sclerosis or thrombosis.  So back to the muscular route.  Negative MRI for disk disease and other back ailments.  This all started after a hamstring injury 3 years ago with a Medial Menisci Tear resulting in surgery 2 years ago this May. 

The quadricep pain goes on- but is improved with work on the semimembranosa/tendinosa and sartorius.  However, I still have numbness symptoms in my right glute/piriformis with leg weakness and occasional foot numbness.  The tightness around my knee has not totally resolved, but my good days are more frequent than my bad days.  What would you suggest at this point?  Where else should I be looking for problems? 

Should I be doing more AIS treatments than every 2 weeks- like home therapy?  Any and all input would be greatly appreciated as I seem to becoming an enigma here and my elite running career is at a standstill due to inability to tolerate training.

 

A Interesting situation.  In my experience, I think you had a subluxation of the sacral-iliac bone that predisposes individuals to gluteal, piriformis and hamstring strains as the shift in this bone causes slight shortening of these muscle structures.  The chronic hamstring situation progressed to involve the posterior thigh muscles as you described. 

The referred pain into the foot is the irritation of the sciatic nerve as it passes near or even through the pirirformis muscle.  The compensatory quad strain may have resulted from the sacral-iliac malalignment which shifts anteriorly and superiorly giving rise to the proximal attachment of the quadraceps and sartorius muscles.  The meniscal tear occurs as this sacral-iliac malalignment can slightly externally rotate the femur and the patellar bone.

 
What I propose is that you find and experienced chiropractor or osteopathic physician who performs manual adjustments to correct this sacral-iliac subluxation.  Then after the re-alignment would your sessions with AIS be effective.  Without the structural re-alignment, your AIS sessions are limited without long term correction.

 Q I am a 40 year old male.  I incurred an injury while playing squash 5 years ago.  My right pelvic area is not right.

I cannot walk without having my right leg feel as if it is dragging.  I feel no pain while standing still or lying down.

If I go from sitting to standing my lower right ab area from pubic bone to iliac drest is tight and sore.

It bothers me in the hip area to sleep on my right side.  My right upper thigh and pelvic crease area is tender, you can see swelling.

My right leg is noticeably weak when raising it up while laying down

If I am very active the soreness will encompass not only my lower pelvic and ab area, but also up into the lower ribs and lumbar plexus area.

When I wake in the morning with a full bladder from time to time my lower right ab area feels stiff.

A standing x-ray shows that my right crest is approx. 22mm higher than my left and I am tilted forward a bit

I am now undergoing prolotherapy treatments to the iliolumbar and sacroilic ligaments, etc.

If my psoas minor or major is the problem ( how do you tell which?) how can it be fixed?  How can I bring my pelvis back in line?

 

A Thanks for being so descriptive of your symptoms as this does help.  First of all you have a subluxed sacral bone on the right that has caused an anterior superior shift.  As a result the sacroiliac ligaments are strained.  Additionally, the psoas major muscle is sprained. 

By your description of the referral of pain into the pubic bone suggests to me that you may have a psoas minor muscle strain.  The iliopsoas attaches in the proximal medial femur and may account for the minor swelling.  If the swelling is near the Anterior Superior Iliac Spine, then the sartorius muscle may also be involved.  If the sartorius is involved, you may find difficulty crossing the affected leg into a figure four position while sitting.

 
I would suggest the following:
1.  Consult with a Chiropractor or Osteopathic physician who does manual manipulation to correct the sacral subluxation.

 

2.  Find a myofascial therapist that can isolate the iliopsoas muscle group.  This may be a highly qualified Massage therapist with a background of Active Release Technique (ART) or Active Isolated Stretch (AIS) or even Reiki Technique.

 

3.  I would not continue with Prolotherapy, as the purpose of Prolotherapy is to "glue" and strengthen the ligaments and muscle tendons.  This causes increase scarring to a malaligned muscle ligament bone position.  Prolotherapy is popular and has its purpose, but I don't feel that this approach is warranted as I would like to have a therapist/chiropractor re-align your pelvic structures.

Q I have a muscle strain of my left forearm. The muscle strained is my Brachioradialis muscle. I strained it back in March 2005. I had an MRI done in July. I have not been exercising since the MRI. What are the best options for recovery?
 

A Brachioradialis strain. Usually related to either a repetitive movement against resistance--such a using a screwdriver or hammer, of a resistive pull of a weighted object with associated lateral elbow pain.  Avoidance of these activities helps the healing process.  Additionally, the traditional-- rest, ice, compression then specific exercises (RICE) protocol should have helped. 

Local analgesic creams help moderate the pain.  Anti-inflammatory can help reduce the inflammation.  Having undergone an MRI indicates that the pain was severe and prolonged.  I would venture to guess that the lateral collateral ligament was also sprained in the injury. 

Please refer to an anatomy book to identify this ligament, then push on this ligament to see if it reproduces the pain you experience.  Elbow ligamentous sprains take longer to heal and for the pain to resolve. 

.....Q MRI results show the extensor carpi radialis muscle is torn on my left arm. I am right handed. I have had these symptoms since May of 2005.  At the time when it happened I did not rest it and kept on exercising, not  knowing what I had done to my arm. I tore the muscle doing wrist dumbell curls on a swiss ball. Since my MRI on July 14, I have rested the arm as much as possible. I do not know if I have an irreversible injury or not, I have never had this before. I would say the injury is most likely a grade 2 muscle tear.

A A partial muscle tear will functionally fuse itself together, but loss of flexibility and functional strength will diminish.  Before you start loading the muscle, ensure that you receive appropriate stretching in Active Release Technique, or Active Isolated Stretching. 

Then after proper stretching, start at low weights and work on increasing repetition rather than high resistance loading in your work out routines.  If the tear was worse, you could have considered a surgical reattachment.
 


Q I am a 41 year old woman who has been in right sided pain for 3 years.  In 2003 I found a bulge under my right rib cage almost sitting on the iliac crest. (I am small and thin framed).  Turns out it was my kidney...renal ptosis or floating kidney.  After many consults with urologists (at least 12) I was told my condition was not the cause of my pain...I also have extreme bowel pain...seems to me to be the colon and I continually have to lay down to let the gas travel to the left side.  My hip, knee and ankle all snap and feels like the ligaments are "grinding".  My pain is only when I have been standing for prolonged periods, if I side sleep and after I eat if I cannot lie down. 

Despite compete GI work-ups...(colonoscopy, small bowel series and endoscope), IVP's, spine MRI's and CT scans...(all supine I might add) I am coming up negative.

I have spent a great amount of time learning about the abdominal wall musculature and have compared normal anatomy to my scans.  I have extreme asymmetrical differences in both CT scans and "standing MRI films.  Most appear at the right iliac crest. The iliacus muscle seems to have a huge bulge and is not smooth in cross sections as is the left. 

The transverse abdominus has thinned out so much, it does not even look like it is attached to the iliac crest.  My internal oblique, in cross sections has shortened to half its length and does not reach to the quadratus...which is also "short and squared off". 

In my supine images it looks as though I have bulge of fat protruding into the quadratus, yet in the standing MRI this disappears and my right side seems to appear larger then the left when measured from the center navel around to the spine. The psoas minor has seemed to completely vanish as it is about 1/4 the size round compared to the left on the femur.

Although I point these asymmetrical differences to the doctors I visit...they all tell me we are not symmetrical.  Could I have some type of sportsman hernia or groin hernia? No one can explain the extreme bowel pain I have on the right side...its as if my whole digestive track just stops until I can get supine. 

I had a nephropexy in Oct. 04 where an endourologist "tacked" my kidney to the psoas and a ligament of the liver...(my liver is also extremely low).  However, the procedure did not work and my kidney still falls to the iliac crest and front abdominal wall.  

Right now my only alternative is to "mesh" the kidney to the inside of my rib cage.  I don't think I am convinced this is the best option because I have so much abdominal wall pain, groin pain and ribcage pain which I am assured is not associated with a kidney that will not stay in place.

Can you think of anything that can be causing my right side to fall apart?  I was in physical therapy for pelvic strengthening...it did little help.  I also should add all the pain started after I had my son who was 8.5lbs...I am a size 2.  Could giving birth have stretched my pelvis so far that my right side just did not go back?  Could I have ripped muscle or tendons that did not heal right and now I have a "snowball" effect of pain, ptosis, and muscle atrophy over 3 years.

A This is a most unusual case.  The abdominal pain may be caused by the psoas or ligaments, but I honestly don't know.  The psoas minor appears in only 40 % of individuals and inserts into the pubic rami not the femur.  Why the dis-symmetry?  I would ask for a referral to Mayo Clinic, Duke, Cleveland Clinic, John Hopkins or equivalent to provide a more accurate diagnosis to your problem.


Q After reading the article about mobilizing the wrist I'm interested in finding any information or help that I can about my own condition.
8 weeks ago I had a colles fracture to my right wrist and now I'm undergoing physio therapy to help with the movement of my wrist ,unfortunately its not helping as much as I hoped. 

Being a plaster by trade and a fanatic golfer I'm starting to become concerned about my ability to work and play again.

 

The 2 main problems are the ability to turn my wrist to the full palm up position  and also the ability to raise my wrist above the horizontal position which in my profession is a must.  I would be grateful for any advice that you could give me or any alternative medicines that you might be able to recommend .

A The Colles fracture is either stabilized within a cast or in the event of displacement, surgery may be indicated.  However, as I noted in the article that the eight small wrist bones may shift with the injury that resulted in the forearm fracture.  This wrist bone malalignment caused limitation in wrist range of motion and pain. 

This is a structural-biomechanical problem that alternative medications nor physician prescribed medications can't help.  Acupuncture may ease the discomfort, but unless you have someone re-align these small wrist bones, optimal results will not be obtained.


I'm a 41 year-old female.  I had surgery last year (360 arthrodesis) and lately I have been having terrible neck pain on the right side of my neck.  The pain shoots up into my head and down to my shoulder.  I recently visited a chiropractor who told me that my neck pain could be caused by my optical righting reflex.  Could you elaborate on this subject for me? 

A  Thank you for taking the time to write in your question.  Neck pain and headaches are really complex as many different structures can mimic similar presentations.  Surgery  just adds to this confusion.  First of all I am not an expert of the optical righting reflex.  Reflexes usually don't create painful symptoms.  Additionally, treatments for reflexes are not specific and are in low yield to response.

However, you did have a neck problem that required surgery.  Surgery 360 degrees is very extensive.  There are a grouping of muscles--(anterior, middle, posterior scalenes, levator scapulae, upper trapezius) that can all present with occipital to shoulder neck pain.  These are the first  structures that come to mind.  If you have additional symptoms of dizziness, nausea (usually without vomiting), difficulty with prolonged neck positions, slight loss of balance-posture with swelling of muscles around the side of the neck, then the culprit could be the sternocleidomastoid muscle.  This muscle is occasionally cut through inadvertently during surgery of the neck.

A good source of information can be gotten from a medical text called Myofascial Pain Syndromes by Janet Travell and Dr. Simon.  I am recalling this title and authors by memory and may be slightly off in the exactness of the title and name, but I wanted to return your email quickly.

Please feel free to share this information with your Chiropractor.

 


I am an airline pilot and am interested in your Muscle Memory Article.

I am really becoming more and more interested in this subject as I try to make these changes. This has to be one of the subjects that Tiger Woods and his staff must have studied a lot.  But Tiger has no idea what it is like to try to make the large swing changes that I have had to go through. He has always had a solid swing and his muscle memory changes were small.

Let me give you an example:

My initial take away of the club has been flawed for 20 years. When I start the club away from the ball my muscles in my hands and arms tense a little, the club hesitates a little and goes back on a slightly incorrect path.

I think a lot of this has to do when I was 15, I started working out with weights a lot and trained > these muscles to do something else.  I also believe that it is partially mental and that when I start the back swing this is all my mind and muscles know to do.  At this age my game started going down hill and I lost confidence and starting the club back became hard.

I can stand in front of a mirror or take a practice swing and make the correct take away and movement easily. This is what makes this interesting, I can make a perfect take away, just not on an actual shot.

When I look at trying to make a change to this muscle memory, I wonder how long and how many repetitions would it take me to correct the muscle memory. It sounds also that how I think and feel will affect the progress.

There have been some swing corrections that I have successfully changed and now are fairly ingrained in my muscle memory. I did not log how long it took me to change this which I wish I did.

The particular take away move I talked about before I would like to log and record details to see how long it would take to successfully change. Any ideas on how to go about this?

A book to help you with muscle memory Psycho Cybernetics by Dr. Maxwell Maltz.  Apparently is addresses habit changes by retraining the subconscious.  In regards to forming any opinion in swing biomechanics, I can't do this effectively without examining you.


If you were involved in a rear ended motor vehicle accident (I was hit from behind at a stop light) how soon should I have had an MRI of the cervical spine done?  I mean, when is the best time frame to achieve true objective results of a disc herniation?  And if my results were negative 3 weeks after the injury, but they are positive now - (1 year after the injury)  how is it that in the first 3 weeks nothing showed up on the film?

A  It is a great question.  An MRI is done following trauma doesn't show any disc lesion, but later a positive herniation.  Multiple things can explain this phenomenon.  The first to come in mind is the activities the person partakes in.  Workers who lift, carry, twist, are at a greater risk of disc protrusion-herniation following deep muscle-ligamentous trauma than if no trauma occurred.  Secondly, the treatment--chiropractic, osteopathic, deep manual therapy, working with weights, can induce an extension of the disc lesion. 

A cough, sneeze, forceful bowel movement can induce a disc lesion.  These are the most common.  Finally, a radiologist's interpretation can make a small protrusion into a herniation if he feels that he's trying to help a litigated case to explain radicular or referred pain sensations from the neck or back into the extremities (arms or legs). 

 
A second trauma could have occurred from a much lesser force, but once you have a spinal injury, from a second trauma, the disc lesions are more common (protrusions, herniations).

We had a great season at Carmel. We went 31-4-1, won our league and also the Central Coast Section D III Championships. We were also ranked 3rd in the state for schools our size. Actually >> worked with the players in the dugout before the semi final and championship games at San Jose Giants Muni field. It's not the majors but was just as fun.

I started depending on the players about 14 games in the season so we had some great before and after numbers. The coach got me the stats and I wrote a case study based upon those findings and the actual work with the kids. I am sending you via snail mail a copy of the study. The results were almost unbelievable and probably wouldn't be had it not been for the actual stats and the letter from the coach detailing the season. I'd love your feedback and any ideas about getting it published.

Great work.  I would be glad to review your study.  Additionally, you are most welcome to visit and spend time with us so that we can show you our work.  Collaboration yields to exponential successes.
 


If you were involved in a rear ended motor vehicle accident (I was hit from behind at a stop light) how soon should I have had an MRI of the cervical spine done?  I mean, when is the best time frame to achieve true objective results of a disc herniation?  And if my results were negative 3 weeks after the injury, but they are positive now - (1 year after the injury)  how is it that in the first 3 weeks nothing showed up on the film?

 

It is a great question.  An MRI is done following trauma doesn't show any disc lesion, but later a positive herniation.  Multiple things can explain this phenomenon.  The first to come in mind is the activities the person partakes in.  Workers who lift, carry, twist, are at a greater risk of disc protrusion-herniation following deep muscle-ligamentous trauma than if no trauma occurred. 

Secondly, the treatment--chiropractic, osteopathic, deep manual therapy, working with weights, can induce an extension of the disc lesion.  A cough, sneeze, forceful bowel movement can induce a disc lesion.  These are the most common.  Finally, a radiologist's interpretation can make a small protrusion into a herniation if he feels that he's trying to help a litigated case to explain radicular or referred pain sensations from the neck or back into the extremities (arms or legs). 

 
A second trauma could have occurred from a much lesser force, but once you have a spinal injury, from a second trauma, the disc lesions are more common (protrusions, herniations).
 

.....Q  I did not undergo any chiropractic treatment and I have a pretty sedentary job--I sit at a desk for 8 hours a day.  The only exercise I do is 30 minutes on an inclined treadmill.

 
Is there any literature that would explain a time frame of the formation of a disc herniation following the low impact rear ended accident?  I mean, I was very surprised to learn that a herniation had developed.  I was always under the impression that if it was a very forceful trauma, then a disc herniation would show up immediately on the MRI, but all that was noted was a loss of signal three weeks after the accident. 
 
So I guess what I also want to know is given the lifestyle I described to you, this herniation appears to have been very progressive in nature - correct?
 
So while I have back pain I am still able to function close to normal. Was there any way that I could have prevented this herniation from developing?

 

You apparently have two MRI's one following the accident and then one a few months later as I understand from your email.  Trauma will create a herniation and should be visible on MRI.  First thought is to take both MRI to one center for a comparison reading as variations occur by radiologist's interpretation.  You may discover that it was present in a milder form on the initial reading and possibly the second MRI was "over-read".  This does happen on rare occasions. 
 
As I explained earlier, a cough, sneeze, lift against resistance is enough force to create a disc lesion.  Golf can create herniations.  Occasionally, individuals who can't recall any trauma are discovered to harbor a disc herniation.  All in all it is easier to explain a herniation associated with force.
 
I don't recall if your herniation was in the neck or low back.  Each one has it's own specific reason for herniation.
 
Sorry I can't be more helpful as I have not found any literature on the progression of a herniation.

Your article about golfers and muscle memory was really unconvincing.  You would use the same muscle groups in the same order to chop down a tree, but how many lumberjacks do you know that have made the transition from tree felling to professional golf?
 

If you want to use your scientific expertise to explain the perfect golf swing, you would be better advised to look at the finger and palm print configurations of great golfers.

 

Right handed people that play a lot of golf, quickly develop a callous on the second flange of the ring finger of the left hand. over time the callous develops its own 'finger print' pattern over an area covering a diameter of about a quarter of an inch. Non-golfers do not have this area of super-developed finger print.

 

I have no doubt  that a comprehensive study of the palm and finger prints of great golfers would reveal a particular pattern of super developed areas that would shout 'golfer'.  These are the areas that tell the brain how to use particular muscle groups, in a particular order, with a particular force, to produce a golf shot.

A Thank you for your question.  I agree with your assessment of specific callous formation in high level golfers.  The ability to develop such callous' deems good muscle memory.  As in the waggle, the sensory input sets off a chain of neurological signals to prepare the muscles into sequential movements--a form of muscle memory. 

Callous' are sensory epidermal stimuli that initiate a similar phenomenon.  I don't recall any specific research done to map the callous formation in golfers, but it would be interesting to identify differences in amateur and professional players.  I hope I helped with your astute observations.

Response: Thank you for your prompt and very informative reply to my unsolicited and bothersome e-mail, it was most kind. I had not properly thought of a callous as providing sensory epidermal stimuli. It would seem by its nature to be a natural precursor to the more sophisticated finger print formations.

Thank you again.


I found your muscle memory article interesting and on target for book research I am doing.  Could you recommend some sources for good information along the line of muscle memory and sports.
 

Thank you for reviewing my web site.  Muscle memory is a relatively new concept and has many applications.  Sports and athletic ability is fascinating for my work.  The resources are recent and not well peer reviewed.  Most research is anectodal and not double blinded.  This is a learning concept which is hard to provide scientific procedures to validate. Please write back, providing me with more specific needs for your book, i.e. what sports, what age groups, what conceptual applications, ect.

.....Q  I am part time professional golfer that is rebuilding my swing with top instructors. When I say part time, I have a full time career. I am learning just how hard it is to change muscle memory.

I am writing a book on how I am changing my swing for the better. It covers a lot of what I have experienced over the last couple of years. Muscle memory is turning out to be a huge challenge and factor in these changes. It also appears it is going to be one of my strengths when I obtain the correct swing.  I have achieved great changes in my swing but it is amazing how the old muscle memory will still show up when I play, etc.

There really is not much information on muscle memory and any rules on how many repetitions it takes to learn a new move. This subject will be at least a chapter or two in my book.  Any information or help would be of great help.
 

A So much has been studied in golf, but little integration with the studies of biomechanics.  The present golf studies of biomechanics have only confirmed what the researcher was trying to validate.

I on the other hand have no golf experience and have an open mind to biomechanics.  I work with professional instructors and high speed cameras to observe motion and muscle function.  The golf swing is complex in that three different swing mechanics are identified based on your biomechanical  make-up. 

Some are born natural swingers, some are born natural hitters and most fall into the middle group.  We have tested the muscles that make each swing unique and are in the process of building and educational foundation for golf instructors.  Next month we have been invited by the
 Japanese LPGA to do a special seminar to bring this information forward.  Our goal is to write a book on biomechanics that is functional and understandable.

Next, muscle memory.  If you have instructors who tinker with your basic swing and not analyze your natural movements--you have the phenomenon of trying to provide wheel alignment to a car with a bent frame--the bent frame being the historical experience of instruction.  Not much will change, as you need over 20,000 specific movements to encode into muscle memory.

Unfortunately, golf is not the best suited sport to isolate new and repeatable movement.  Additionally, emotional input plays a major role in muscle memory--your situational state of learning must mimic playing conditions to be effective in creating memory.

This is just a short overview of the complexity of golf.  Equipment is extremely important.  You need proper swing weight, frequency. moment of inertia balancing, loft, lie, and grip to provide you with the proper tool to execute consistent and successful play.  If you lack confidence in your  equipment, how good can your muscle memory be established?  We have spent four years analyzing vibrational engineering for club making with some golf pros.

Unfortunately, I have held back the new information and the research that we have "discovered".  It is probably an ego thing, but if I released it earlier in my work, I would have made some mistaken analysis.  Science proves what athletic training shows to be successful.

If your in the Southwest Florida area, please let me know and I will try to spend time with you to give you our input to your re-established career goal.


One year ago I was in Bosnia as a civilian contractor and I suffered a severe fall while carrying about 75-80 pounds. The Army doctors said I had a widening of the Mortis space in my ankle. They put me in a walking cast and had me on crutches completely for about 8 weeks. Here it is now a year later and I am back in the states but I still have a lot of pain when I try to do any kind of jogging or even sometimes when I am sitting at a desk. Any idea why this should still be giving me so many problems?

The ankle is a complex compilation of small and medium sized bones arranged in a precise matrix supported by many thick ligaments that allow for a sophisticated muscle pulley mechanism for function.  Additionally greater than 500 pounds per square inch of pressure could be applied through the ankle. 

Widening of the Mortis space indicates that you have to some degree torn the supportive ligamentous attachments that caused a disruption to this complex structure.  As a result, there is a high degree of probability that the small and medium sized bones may have shifted ever so slightly out of their functional position, leading to slight loss of range of motion and resultant pain.  Occasionally, minor swelling can be associated with this problem. 

Unfortunately, I don't know anyone who repositions the bones as I have been fortunate to learn on my own.  The ankle repositioning learning was an extension of my work on the wrist for my son's fractured wrist.  If you haven't read this article, I would encourage you to read it as the wrist has many similarities to the ankle joint. 

I live in Bradenton/Sarasota area on the Southwest coast of Florida just south of Tampa.  Should your travels take you here, I would be glad to assist you in reassessing and hopefully providing some solutions to your problem.  Unfortunately, I have not yet written an article on how to correct ankle malalignments of more specifically what we call in healthcare as "subluxations".


Q I am a female age 43 who injured my left wrist in June2005 in a fall.  I had fractures on the distal radius and ulna styloid process.  The doctor inserted fixation pins to stabilize the fractures and my hand was in a half cast. ( In the x-ray, it would look like a x-cross of two pins. )  After 4 weeks the fixation pins were removed and my hand was put in a cast.  After 3 weeks this cast was removed.  In total, my hand was in cast for 7 weeks. 

Upon removed the cast, x-ray showed that the distal radius had collapsed by about 1cm and also there was subluxation of the radial Ulnar joint.  My problems were weak grip, flexing the wrist and turning my palm upwards.  The doctor also noted that I developed Reflex Sympathetic Syndrome.  I have been going for physiotherapy sessions for almost 4 months already.  The grip and flexing has improved but I can only turn my palm slightly.  Upon doing stretching exercises, I can turn more but once rested, my palm cannot turn much.  I also feel restriction at the Ulnar bone when I turn or flex my wrist.  The Ulnar bone (distal) also feels bigger than my normal right.  There's some slight similarity in the 'dinner fork' deformity.

What is causing me so much problem and recovery progress in turning my palm ?  What does this subluxation of the radial Ulnar joint meant?  What options are available for me to recover ?  Will I have future difficulties or possible to develop other complications ?  I would like to know more so as to be more informed.  I appreciate your professional advice.

You have a serious injury that required surgical stabilization.  Unfortunately, the wrist somewhat collapsed on the radial side.  My real concern was the development of Reflex Sympathetic Dystrophy.  That in itself is quite disabling.
 
Your options may be limited.  I am not an expert on surgery, thus I don't have any opinion for further surgery.  Surgery can be beneficial, but comes with substantial risks and no guarantees.  After surgery, the biomechanical function of muscles and ligaments gets distorted from secondary scarring.  The nerves can become irritated and thus lead to RSD.  You may want to find a good manual therapist or massage therapist that will work with you on trying to release the tightness and improve range of motion.
 
My intuition suggests that because of your age and loss of function, you may need to attempt a second surgery.  However, do you homework and find a physician at a University teaching hospital, Mayo Clinic in Rochester Minnesota, Duke University Hospital to see if there is a specialist in this corrective hand wrist surgeries.
 
I tried to answer your question, which has been difficult for me to provide a more definitive answer. 

Q I read with great interest you article "Assessment and Treatment of Motor Vehicle Accidents", as it has shed some light on some of my long-standing problems. Here is my story:

On October 1994 I was involved in a rear end impact MVA. I was stopped in traffic; I checked my rear view mirror and saw a car coming at a high rate of speed. I had braced myself both arms "locked" (for lack of a better word) and hands gripped on steering wheel and both legs braced right leg "locked" on brake and left leg "locked" on the floorboard. Head slightly tilted right and up (looking in the rear view mirror). I was driving a 1980 Monte Carlo.

I should mention that, at the time of my accident I was 33 years old. I am shorter in stature- measuring 5 feet and 3.5 inches in height and weighed about 120 lbs. I was undergoing treatment for TMJ and approximately 9 months prior to the car accident I had undergone treatment for whiplash and concussion (injuries were not as a result of MVA).   I should mention that, unfortunately, I wore the soft collar for months on end (not knowing any better) and developed muscle atrophy.

After the MVA, I was treated for whiplash and soft tissue injuries for my upper chest, upper back, right shoulder and hip soreness. I participated in conditioning program with little improvement.  Approximately 1 1/2 months after the accident I started to experience sharp pains running down my neck along my spine when I turned to look over my right shoulder.

Finally in August 1998, after worsening of symptoms, right arm weakness, tingling and pain I had a MRI. The MRI indicated I had 2 herniated discs, with nerve root impingement at the C4/C5 level and C5/C6 level.

July 1999 I underwent an Anterior Cervical fusion. Approximately 8 months after surgery I started to develop "cold burning spots", first on my right forearm (about the size of a silver dollar) then on my right calf. These "spots" have grown in size and spread to my left arm and leg. At times I have a 3 degree temperature change from my right hand to left (right being 3 degrees cooler), which had been documented by a physician. I also burned my right hand on an oven element. I was putting the lid on a roasting pan and I did not feel the hot element. These symptoms, cold spots/burning/ sensitivity to hold cold, are intermittent and appear to be activity dependent. I also experience occasional burning sensation on my feet.

My right hip/groin and low back area is very painful at times. My right hip, at times, feels "out of line" and when doing certain leg exercises my hip snaps. When my right leg is pulled straight back I feel my hip is back in alignment.

I also experience headaches, migraines, chronic pain, fatigue as I rarely sleep through the night without waking up 2 or more times per night.

The above is just a snapshot of what has been happening with me over the past 11 years since my MVA.

Despite attending 4 Neurologists, 2 Neurosurgeons and 2 Orthopedic Surgeons, (I might add all referral to these Specialist were done by my family GP or by the Specialists themselves) I have no clear diagnosis. I have had one Specialist indicate "Failed neck Surgery Syndrome".

I am extremely frustrated and frankly feed up! I am tired of being thought as and treated as a malinger, I have been a hard worker all my life and continue to work very hard… I should mention that during the 11 years since my MVA, I completed my University Honors Degree, with Honors, and have worked steadily since 1998 (with the exception of 3 months when I had surgery). And have done this, despite of the pain and fatigue I experience on a daily basis!

I am really hoping you can help me and shed some more light on my symptoms….

 

Thank you for your information and reading the article.  Let me add more clarity to your situation.
 
The first mistake you made was to brace for impact.  The energy of the impact was then transferred into your musculoskeletal system.  With the arms in a locked extended position, you may experience subluxation of the wrists, elbow tendonitis, but more importantly shoulder joint trauma especially in the acromial-clavicular AC joint that is interconnected with the clavicle bone that attaches at the sternum or top front of the rib cage.
 
In the lower extremity one would mimic similar pattern of biomechanical forces.  Distally, the ankle can malalign, the outer aspect of the lower and upper leg can absorb the force into the small muscle called the tensor fascia lata, as well as the sacral-iliac joint can become subluxed (malaligned).
 
Additionally the forward and back movement of the spine can result to deeper disc lesion in the forms of a bulge, a larger bulge called a protrusion and finally a disruption of the disc into a disc herniation.
 
When the skull moves forward and back rapidly, the gelatinous brain swells as if jello was thrown about in a metal container leading to concussions or if forceful enough to loss of consciousness.
 
When one experiences pain while asleep, the pain awakens the person to change positions.
 
You have done with diagnostic tests such as the MRI to identify the major traumatized areas and their causes.  My recommendations is to find an osteopathic physician who performs manipulations or a chiropractor in your area to realign the minor joint Subluxations (malalignments).  Massage can be added to follow each manipulation.  If you have access to an AIS trained massage therapist  AIS Active Isolated Stretching or the Mattes Method, this technique is quite good.  If you live in the St. Louis area I know of an excellent therapist with various manual techniques. Mark Frank is his name and I can forward his contact number if you need it.
 
I hope this helps you understand your immediate needs.

 

Q.. Thank you so much for writing back and shedding light on my symptoms. It has been a 11 years since my car accident and no one has ever explained things to me as you have in one email.  I realize now that bracing for the impact was not a very good idea....
 
I live in Canada, so finding professionals who are aware and can treat my symptoms are rare if found at all.
 
I have tried attending a Chiropractor for adjustments and Massage Therapist, but I do not believe he specialized in AIS. Besides my Insurance company has advised me they will no longer reimburse me for either treatments. I can not afford the $60 per week to attend both treatments.  
 
The massage did help with my pain control and at times the Chiropractic adjustments helped with the alignment, but adjustments on my neck, near the fusion, became to painful and I became fearful.  I try to keep active and exercise on a regular basis, albeit at a much slower and less intense pace than before the MVA.
 
No one has ever addressed my shoulder soreness or why I am unable to work with my arms above shoulder height. One theory is thoracic outlet syndrome. I do have a dimished pulse when tested according to my Doctor.
 
I have also under went needling (deep muscle), botox treatments, cortisone shots, embrol shots, deep tissue massage and manipulation. At best, these treatments have been of limited benefit and provide temporary relief. I typically attend my doctor on a weekly basis for treatments.
 
I did forget to mention that the Insurance experts estimated the force of impact to be 15-18 kilometers per hour (9 -10.8 miles per hour) forward velocity.

 


  I think I have an upper ankle sprain on my right leg. I have been icing it and it is still very painful. Is it worth it to see a doctor or should I just keep icing it and take it easy until it feels better? What is the exact location of an upper ankle strain? About a third of the way down from the knee on the outside part of the leg downwards? I am just curious because I am leaving for a ski trip in a few weeks and want to be able to ski in comfort if possible.

A The upper ankle sprain is located above the proper ankle joint.  This implies muscular strain.  Muscles that move the ankle, foot and toes have their upper most attachment in the area.  The location of the attachment helps identify the muscle that a person overstretched and a biomechanical mechanism of injury can be explained.  These upper ankle strains respond as any other tendonitis, initial ice to reduce the area of swelling, then rest--which implies not to overuse this muscle, applying a tension wrap to give a slight support to the muscle, then after a few days or up to a week later, start to increase its use and possible address attention of strengthening that muscle group.  The activity of skiing won't be as affected for upper ankle sprains as the boot provides an excellent "brace" for the lower third of the leg.  You may experience discomfort from keeping the muscle contracted within the boot, but it is unlikely that you would worsen the tendonitis.  After skiing, you may want to incorporate some isolated stretching exercises for that specific muscle group.  Over the counter anti-inflammatories may also be beneficial or even aspirin if you can tolerate aspirin and have no medical conditions that contradict its use.


 Q Can you tell me if the breaking of an airbag in an auto crash can cause labored breathing and pain in the chest. I can't seem to be able to get out of bed without extreme pain. If I cough oh my god forget it. The pain seems to be like a straight line right across my chest and after two weeks it has not gotten any better.

A Chest wall pain, even difficulty in breathing are common occurrences following a motor vehicle accident.  The ribs are joints that "articulate" or connect in the spine called the thoracic spine.  All twelve ribs insert into small joints.  At impact, the force call shift these ribs slightly out of position or a term we call in medicine as "subluxation".  As a result of this shift, the muscles that attach to these ribs change their length and strain or spasm causing chest wall tightness.  If the trauma was more forceful, ribs may break or fracture, but not displace.  X-rays can miss these non-displaced rib fractures and a MRI of bone scan are more sensitive.  Frequently associated with chest wall/rib injuries are the collar bones on each side called "clavicles" that can also displace from their insertion into the sternum and cause upper chest wall tightness and some shoulder pain--notably in the acromion-clavicular joint (AC Joint).  I agree with your plan of an MRI.  For readjustment of the ribs, a chiropractor or a DO (Doctor of Osteopathic Medicine) be best trained to provide proper manual adjustment and corrections in the malalignment.


 Q I have a few questions as I have been struggling with pain in my wrists, hands, and fingers for 7 months now.  I have also experienced tingling in my fingertips and painful clicking and popping in my fingers and wrists.  I have had numerous tests and several possible medical problems have been discussed, but none decided upon.  I was hoping to get some general information or at least be pointed in the right direction to have my questions answered. 

 I am very curious about the volar anatomy of the wrist.  I notice that I have bumps (bilateral) on the volar side of my wrist, just below my thumbs.  These are the areas of my wrists that I have pain in and the bump is there when my hand is in radial deviation and then almost appears to shift distally when I move my wrist into ulnar deviation.  The left wrist has a slightly larger bump and they are just above the most distal wrist crease.  I have done a lot of research, looked at numerous pictures on e-hand.com, and also used friends and relatives for comparison. 

There are similarities in some cases, but the other bumps I have detected are much smaller in size than mine.  I am not sure if this is normal or if it is some sort of abnormality.  My best guess, if this is a bone, is that it is the scaphoid or lunate.  However, I cannot find a diagram or photo that indicates that there is a volar protrusion, other than the scaphoid tubercle, of either bone.  I have also seen pictures of ganglion cysts in similar areas, but I am not sure how likely bilateral and nearly symmetrical ganglion cysts are. 

I am a 24 year old male and any problems without a previous history of trauma or an underlying condition would be out of the ordinary anyway. Can you give me more details on the volar wrist surface anatomy or tell me how to find more information?  I appreciate your time, effort, and consideration.  I am going to see a hand surgeon next Thursday and I want to be as prepared as possible.  I have a fairly extensive background in medical research, but finding the details that I am looking for has proven to be difficult.
 

A It appears that you have a good foundation in human anatomy which helps me explain at a higher level of understanding.

Your approach to the problem was very logical.  Symmetry of bone protrusions is unusual in trauma or disease state for your condition.  Familial tendency is more common.  I have seen protrusion of the distal ulna and radius that look like a deformity, but yet most of these variations were non-painful and functional.

The problem lies in the pain you experience and the numbness of the fingers. I seriously doubt that the scaphoid is shifted out of its position.  The area at the junction of the wrist and thumb, the
metacarpalphalangeal joint is the most common first area of inflammation for an individual prone to osteoarthritis, especially if they use their fingers and wrists against repetitive resistance.  You may even have a slight subluxation of this joint, malalignment, that allows the MCP bone to shift out of the joint proper.

Another problem lies in the tracking of the tendons that glide over these bony structures.  In the radial aspect, three tendons glide to give movement and strength to the thumb.  If they are inflamed, a condition of  DeQuervain's syndrome develops. 

This is the consequence of the tendons causing friction and resulting tendonitis.  I usually try to shift the carpal bones back into alignment and ensure that the MCP joint is not subluxed, then myofascial stretching allows the functional elongation of these muscles and tendons to return back to their proper position and function.

The numbness of the fingers.  Compression of the sensory nerves in the wrist may lead to two patterns of numbness.  If the large median nerve is irritated by compression, then the thumb, index and middle fingers become numb.  This is known as carpal tunnel syndrome. 

If the ring and little finger are numb, then the ulnar nerve may be irritated.  If only the finger tips are numb, I don't know, but I know a significant number of my patients describe this, usually after some neck trauma, but I don't know how it neurophysiologically is explained, or worse, how to correct or fix it for them.

If you are a golfer, and you carpal (wrist) bones have slightly shifted out of position, you will experience pain with movement and hitting the club. At age 24, it is doubtful that you have degeneration occurring. Sounds like your doctors have eliminated or ruled out inflammatory  diseases of the small and medium joints.

Many doctors will give you an opinion, even if they don't know the answer.  Few state the honest--I Don't Know.  Therefore, before you agree to anything invasive, such as surgery, make sure that is the definitive answer.  Before surgery, get at least one other surgical opinion from a doctor the initial surgeon may not know.  Hand surgery is great for those who need it, but terrible for those they are "exploring" to find answers.

 .....Q Thank you so much for your response.  I know that your time is incredibly valuable.  It answered a couple of my questions, but also prompted another one.  Can the Scaphoid and/or Lunate bone be felt on the volar surface of the wrist?  I have attached a few pictures of my wrists.  I am not sure if you can comment on them or not since we do not have much of a relationship and you have not conducted an exam.  The pictures of my left wrist have the "mass" circled and there is a deep crease between it and the thenar muscle nearby.  My right wrist looks very similar, but the mass is not quite as big.

A Regarding your question.  The lunate bone is the only carpal bone that moves dorsally, whereas the others are usually palmar shifters.  Yes, you can palpate all the carpal bones if you understand and have experience in anatomical assessment. 

Divers are the most prone to lunate dislocations.  They usually use taping as a measure to prevent this carpal bone from subluxing.  Another test is range of motion.  Do you have full range of motion of the wrist in all planes?  Is it symmetrical to both wrists, assuming that you did not traumatize, fracture, or had surgery on one wrist?

 .....Q I do not want to bother you, but I came up with a few more questions.  I hope you don't mind, but no hard feelings if this is asking too much.  Where is the approximate location of the scaphoid bone
on the volar side of the wrist?

Is the carpal tunnel just to the ulnar side of the scaphoid?  In a normal wrist, is there a visible protrusion of the scaphoid bone?

I followed up with my hand surgeon and he told me that he does not believe that I have carpal tunnel syndrome based on the negative emg/ncv study from May of 2005.  I have had the same tingling in my fingers for nearly a year now.  I have no idea what else it could be.  I was a little upset this week because a co-worker of mine has been having arthritis like pain in her left wrist for about a week and her PCP ordered an MRI no questions asked.  In 8+ months, I have only been able to get 1 set of x-rays and some blood tests during a number of very brief office exams with 4 different physicians.  Am I doing something wrong during my appointments?  Would an MRI even be helpful?

A Yes an MRI is indicated.  It could be the scaphoid bone, or it could be a ganglion cyst.  Symmetrical
on both palms usually a congenital condition rather  than a disease.  I did get the pictures finally, but I can't give you a definitive answer.

.....Q Thank you for the information.  I have an appointment with my hand surgeon next Wednesday.  I pleaded my case on the phone, but they would not order the test until I go back into the office.  What do I have to say in order to make sure that they don't just say to continue with NSAID's (which have not helped at all in 10 months) and splints rather than ordering an MRI?

They also mentioned injections, but I am not willing to settle for temporary relief and then have to deal with the same issue again in 6 months.  I think injections are overused and the doctors do not
consider the possible complications.  The injection site cannot be seen and I know that an undiagnosed infection can lead to sepsis after an injection.  Also, what if a persons anatomy is different for some reason and the landmarks traditionally used leads to a nerve or tendon injury?

As always, I really appreciate your help.  I want to be prepared for my visit so that I get the treatment that I think I need.  I think that patients need to be their own advocate, but I do not want to be threatening or hostile either.  After all, this doctor may take a knife to my hands at some point.

A Your concerns are valid.  The most important aspect of medicine is the most precise diagnosis.  The MRI provides invaluable information that we as clinicians use to help us make that diagnosis.  To arbitrarily inject a substance into a very complex area of ligaments, nerves, and tendons just to experiment is flawed medicine.  Additionally, you are paying for insurance for situations like these.  Why shouldn't the doctor utilize the diagnostics for his benefit, it doesn't cost him anything?  In your visit, provide as concise of a history and also politely request that other physicians have recommended and MRI.  Possibly summarize our ongoing email discussions.  The successful outcome of your doctor's visit is establishing a diagnosis.

 


  I have recently noticed and felt that my wrist is hurting. I don't remember falling on it or anything. I don't know if it is just a sprain or something else. Their is a protrusion of some bone in that middle of my wrist when i bend it down at a 90 degree angle. I was wondering what this protrusion was and how to treat it. The Protrusion is more towards the thumb side of my right wrist but really almost centered.
 

A Your question is a good example of a wrist bone malalignment.  Out of the eight small wrist (carpal) bones only one of them dislocates dorsally or to the top of the wrist.  This bone is the lunate bone, often seen in divers (not scuba, but swim divers).  As the divers hit the water, the wrist bone shifts out of position and causes pain and discomfort.  Typically, these divers must use a taping technique to help stabilize this bone from shifting.

If you were in my office I would position your wrist in a neutral position an place my thumb at the top crease of your wrist.  Separating the small bones from the large forearm bones, as I pull (or apply traction) on the hand away from the forearm and body, my thumb would focus on pushing the
> small lunate bone downward into its anatomical position.  You can't perform this technique on yourself as you tighten up the muscle and the bones can't shift.  You need someone to apply appropriate amount of traction.  If you experience pain at the force of traction--too much traction is provided.

 


 Q Can you list the muscles involved in the kinetic chain of events for a baseball pitcher?

A Thank you for your question.  It is a great question.  Since the mechanics of pitchers differ and differ for the type of pitch, I shall defer to a better specialist to address your question.  He is the former Cy Young pitcher Dr. Mike Marshall.  He is a PhD in kinesiology and has a great website that explores many aspects of biomechanical explanation.  Dr. Marshall and I have worked alongside at Univ. of South Florida in the High Speed Camera Analysis of various pitching motions, but he has a greater expertise than me.  His web site to address your question is www.drmikemarshall.com 


 Q I'm a middle-distance runner.  Or rather I was.  I have chronic ITB tightness/pain, with weakness on the lateral aspect of my knee that has prevented me from running for 18months, despite much physiotherapy.  I eventually found some straps that allowed me to play basketball without much pain (but still couldn't run long distances).  (I don't know if this is normal?). 
In playing this I have now developed what appears to be an equally debilitating injury.  It 'came on' following a new exercise in the gym - a lunge and a particularly heavy playing week. 

I initially thought it was a quad strain, with the middle quad (vastus intermedius, I think) being the most painful.  Then, following the games, the 'point of pelvis' (anterior rim of wing of the ilium? - my partner's a vet, trying her best with the human animal anatomy!  Anyway, it's the bony point at the front) was also painful.  In 6 weeks the pain in the pubic area and quad has not gone away, stretching makes it worse, and swimming/walking don't improve it, situps and pushups exacerbates the pain.  Worryingly, the quad area has also been numb, even during exercise, for the six weeks.  The numbness is focused in the middle quad, but extends down to the lateral side of the knee joint, and sometimes includes the whole quad muscle and ITB.  
 

I have seen an osteopath, who diagnosed and treated uneven leg length and malaligned spine.  This has improved the ITB problem, but not the pain, weakness and numbness of the quad.
Any suggestions you can offer would be wonderful.

A Lunges are questionable, as they can create more problems than benefit.  The attachments in the area where you describe is either the bony landmark of insertion of the quadriceps or the sartorius muscle.  Both flex the hip, but the sartorius attaches below the knee.  The numbness most likely-may be an entrapment of a superficial sensory nerve and not of significant clinical concern.
 
To obtain diagnostic certainty to your problem, start with a plain X-ray looking for an "avulsion fracture" of the anterior iliac spine.  This is the bony landmark that these muscles insert into.  Soccer players are most often affected with this as they kick against resistance.  The plain x-ray may not be conclusive, then a bone scan may help.  CT is usually better for bone problems over an MRI.
 
Recommend that you find out what the problem is and not aggravate it.  Should avoid lunges and other plyometric work until you have a diagnosis.

Q I had a spinal fusion  L5-S1 from an injury. I do stretching exercises and go to physical therapy 3x week. I work part time. I am very healthy. My problem is : The muscles in my buttocks are like knots and are very painful. PT helps temporarily, but the muscles tighten up a day later. I am considering Botox injections to help. If this is possible, how many injections will it take?

A I don't know the history of your problem.  Botox will paralyze these muscles, but doesn't solve the problem.  It could be that you may have a sacral-iliac malalignment and a chiropractor may be of help.  If you would write a bit more on how old you are, what transpired, what was the basis of the surgery and diagnostics X-rays, I could be more specific to your needs.

.....Q I fell down on 2/1/03 and sustained an injury. I had spondylolithesis. Spondylolysis with the slippage. I was in severe pain. I had the surgery June 21, 2004. I returned to work July 2005. I have been in and out of work since then (depression, pain, adjustments etc.) I still have pain from the affected muscles. Since the pain isn't as severe as it was before the surgery, I have been told that I should be grateful.

I have finally adjusted to this and I am back to work and happy and healthy. I can not accept that nothing further can be done. It is a muscle problem. The massage helps. The muscles are knotted and I was hoping to unknot them with the Botox.

I am a 38 year old female. I am active. Today I walked 1.5 miles. I eat healthy. I am approximately 20lbs overweight.

The pain stops me from exercising and leading the life I want to lead.

A I think you should try a consultation with an Osteopathic Doctor or Chiropractor which can provide adjustments for malalignments followed by massage therapy and stretching.


Q  I'm having a big problem hooking my irons.  What is the problem?

I apologize in my delay for replying to your question, as I tried to contact some golf pro instructors to help me.  As I assumed, they need much more information about your swing mechanics and club specs.  I will direct you to Frankie Costa who I feel can help you with your question.  He can be reached at fcfsu@aol.com


Q I am finally going to get the MRI that I have been wanting.  I saw my PCP today and explained my symptoms again along with my experience with the hand surgeon he referred me to.  He actually applauded me for learning as much as I have about medical conditions in the last few months.  I told him I felt like I caught the hand surgeon off guard with my questions, but I was able to confront him when his answers did not make sense to me.  Anyway, after reviewing everything he
recommended an MRI.  I have to schedule the appointment, but I will keep you updated.  I only have 1 questions at this point - I bet you are pleased about that.  It is - will the MRI show the problem no matter what it is e.g. Carpal Tunnel Syndrome, Tendinitis, Tenosynovitis, nerve lesion, circulation problem etc?

A I am pleased with your persistence.  MRI show tendonitis is prominent, not nerve lesions nor circulation problems.  CTS is a clinical manifestation of increased pressure in the canal where the median nerve and tendons lie.
 


Q My son who pitches has just been diagnosed by an orthopedic doctor as having posterior capsular tightness. He will be going to physical therapist in next couple of days for stretching exercises. For the moment, the doctor has told him to stop pitching.

What’s the prognosis for a condition like this? Is it likely that he will be able to pitch later this year? Will be able to bounce back and pitch well again?

A The question remains--why a tightness of the posterior capsule?  Is there a posterior capsule micro tear and the muscles are tightened to protect it?  Are the supporting ligaments been sprained and secondary protective tightness?  Are any of the individual four rotator cuff muscles strained, thus shortened, causing a tightness?  Are any of the top thoracic vertebrae out of alignment leading to strain of the supraspinatus of upper trapezial muscles?  Are there any strains in the neck that lead to a protective tightness?  Are any of the internal or external rotators of the shoulder girdle affected?  Does the shoulder joint show swelling indicating a problem with internal derangement?  Any acromial joint problems such as a partial AC separation?  Does the shoulder capsule tighten with repetitive overuse or is it always present?  Any bone spurs in the shoulder and AC joint complex?  Any over strengthening of the pectorals or latissimus muscle that will restrict range of motion?  Any diagnostic tests, i.e. plain X-rays, MRI's?  Once an exact diagnosis is made and confirmed clinically, then a solution is most often found.  If you are in the Southwest Florida area, I would be glad to see your son and offer you an opinion.  Hope this helps.  If you have further questions, please responds with them and I will do my best to address them as best as I can.


Q I'm a truck driver who has had sciatica running down my left buttock and leg.  Recently I have had a burning condition in my right side as well as my left and mid abdominal wall.  I have had a CT scan, bloodwork, urinalysis, and even a MRI of my lower back. I have not been able to work in the last 5 weeks because of the burning pain in my right side, as well as the sciatica in now both legs.  My doctor is at a loss and seeking the neurologist for help.  My chiropractor thinks it could be the psoas muscle causing all the nerve pain. I really need your help and Dr's opinion.

A Having read your symptoms and your diagnostic work-up, the good news is that there is no need for surgery or other invasive procedures.  However, sciatica does not always have to be a problem of the spinal nerves.  Based on your information and symptoms, I would have your chiropractor evaluate you for a piriformis syndrome.  The piriformis muscle allows the sciatic nerve to pass through it.  If this muscle is strained, it places pressure on the sciatic nerve causing symptoms of referred pain down the leg.  Piriformis muscle problems occur when one falls on directly on their buttocks.  Another condition that can lead to a piriformis syndrome is a malalignment of the sacral-iliac area causing strain of the gluteal muscles with the piriformis muscle. 

If the sacral-iliac bones are malaligned, one experiences pain with sitting, and most intense pain in the sacral notch.  The sacral notch is located on the medial superior aspect of where your back pocket of your pants would be located.  Again your chiropractor would be best to correct this problem.  Bring this summary to your chiropractor and let him evaluate you for this possible piriformis syndrome. The other condition is the iliopsoas, and you can read about it in my clinical article.  The release technique is unique and we have developed an effective one in our clinic.  Should you be in the Southwest Florida area, I would be glad to see you and provide you with this release of this deep muscle.  I hope this helps you.


Q How many repetions are necessary for a particular movement to be considered part of your muscle memory?  

A Muscle memory is conceptually modeled to explain reproducibility of movement.  I believe there is no one number for it, although some claim that 20,000 is the standard.  Let me explain, a child learning a task may master is it with significantly less attempts with precise muscle memory, a golfer may practice twice as much and never fine tune it.  The learning environment plays a factor, emotional and physical preparation.  Avoidance of chemical stimulants and reduction of external distractions also play a role.  In short, one number for muscle memory can't be established without evaluating all the other circumstances. 


Q I have a 14 year old boy who is a lefty pitcher.  He complained of hurting elbow and we had a bone scan and all was normal.  They told us hot and cold and pills to take and cream.  It never swells and when he pitches it gets to a pain point and goes no further.  He rested it for a week but still is bothered with it.  Is this something he has to work thru and keep on pitching or what.  So many stories I am at a lost what to do. 

Thank you for your inquiry.  Elbow pain in adolescent years have historically been ignored.  We now recognize that tiny stress fractures can and do occur.  Bone scan is a sensitive tool, but may miss very subtle stress fractures.  At 14 years old, boys start their growth spurt and the triceps muscles are elongating to the growth of bone.  Secondary triceps tendonitis occurs with a causes extension pain.  Furthermore certain pitches such as a curve ball may create increase torque or forces across the elbow leading to strains and stress fractures.  I follow Dr. Mike Marshall's work on biomechanics and his theories are sound and he can provide more detail for you.  He welcomes questions at his web site, www.drmikemarshall.com  I hope this helps, but biomechanically or over repetitions may be the problem.  If you have further questions, please get back with me.


Q On December 14, 2004 my daughter, who is now 16, dislocated her right shoulder as a result of diving for a volleyball during a high school tournament. She was taken to a local hospital were it was "popped" back into place. The arm was isolated for three weeks and then she began some minor rehab.  On May 13, 2005 while playing in a varsity fastpitch softball game she attempted to fake a throw and her shoulder popped out again. She had shoulder surgery on June 16, 2005.

The "anchored" the shoulder during orthoscopic procedure. The arm was isolated for six weeks and then she went through two months of rehab. I am happy to say that she is doing great.  My question is this. How do we get her throwing velocity back to at least where it was prior to the injury? She is very fit and has no pain, discomfort or lack of flexibility in the shoulder. She is 5'4" and weighs 122 lbs. She currently can do 50 men's push-ups in strict form and can do 3 reps of 100lbs in lat pull downs.  Any help or advice you can give is greatly appreciated.
 

A Fortunately, the surgeons were successful in stabilizing your daughter's shoulder.  With this surgical correction, tightening of the shoulder complex occurs and range of motion and/or strength may be jeopardized.  You first need to have a good physical therapist assess all the ranges of the shoulder, i.e. flexion abduction, adduction, extension, internal and external rotation.  Then the therapist may assess functional strength by manual testing or by specialized machines. We need more information, but it is dependent on mechanical performance of flexibility, range of motion and strength.  This may be a good start.
 


Q When we are conditioning our arm, we usually do long toss followed by about 5 sets of surgical tubing resistance (we call it green tube).

Is it better for our arms if we throw first & then green tube or should we green tube first & then do our long toss?

Any advisement is appreciated.

A Warm up is most important.  How you partake in warm-up could be the long toss of the tube resistance.  Either way as you prepare the arm to more extreme forces of throwing.  The warm-up increases blood flow and range of motion flexibility in your throwing motion.  Try both ways and look at the outcomes as well as how your arm feels and your performance.  Whatever works best, then continue.


Q I have been experiencing constant leg pain, both legs, not a numbness but an ache that actually hurts at times. It occurs at all times of the day but usually in the afternoon and evening.
 
I am not sure how to alleviate this pain...sitting and laying down do not help.
 
Any advice you can give would be greatly appreciated. (I am 35 years old, not overweight)

A Honestly, I would need more information about your clinical history.  First are you taking any cholesterol lowering medications that can cause muscle pain?  Secondly, have you had an injury to your low back?  Any history of circulation problems from childhood, occasionally we have constrictions in the blood vessels that cause lack of blood flow or ischemia to our extremities?  Any other symptoms, such as double vision, numbness in any part of the body, dizziness or vertigo which may suggest multiple sclerosis?  I'll try to guide you with an approach to helping identify the possible causes as I understand more about your situation. 

.....Q As for my history, thankfully there really is none. No childhood problems or high cholesterol.  No injuries to my back either.
The pain is concentrated in my legs and once in a while it is mainly in my lower leg below the knee. The pain is a throbbing pain to that part of my leg.  I do occasionally experience low back pain and once in a while it radiates into my left leg.
 
I also (less frequently) experience dizziness and was tested (an ear test if I remember correctly) for vertigo. That was about 5 years ago. I sometimes get dizzy spells but they are not frequent, I would say maybe once every other month or so.
 
Again I appreciate any guidance you can give me...I assume I will need to get a physical exam from my physician soon.

A Well you have eliminated the more obvious problems.  Questions:  Do you have pain in your sacral notch, especially when you sit?  Are your hamstrings tight and prone to strain?  The pain behind the knee, is it below the knee and to both sides of midline?  Do you have pain in crossing your leg into a figure four?  If this is similar, then you have a shifted sacro-iliac pelvic positioning that would best be suited for a physician of osteopathy or a chiropractor to re-align and manually adjust.  If not, provide me with more information.


Q I am looking for a profession opinion regarding my lower back problem.
 
In the past, while suffering from lower back pain as a result from a fall, on occasion, I experienced sharp pain to the lower left side of my stomach.
 
The pain was extremely intense when I sat up or lift something.
 
My question is, could their be a connection with my lower back pain and these sudden lower stomach muscle pains?

A Your history of a fall seems to have created this problem.  Two clinical opinions come to mind.  The first is referred pain from the spine, notably lumbar 1 and 2 vertebrae.  You may have had a stress fracture, compression fracture of protrusion of a disc that impinges a nerve that refers pain into the abdominal region.  The second opinion is that with the fall, you may have strained the upper abdominal muscle groups, the obliques or externals that cause muscle referred pain symptoms.  If your pain is reproduced by pushing on the abdominal wall muscles, then a muscular strain is suggestive of your problem.  Otherwise a plain X-ray may find a compression fracture, or a MRI is needed to visualize the disc and nerve structures.  I hope this is a start to you discovering the source of your problem.


Q I am looking for a profession opinion regarding my lower back problem.
 
In the past, while suffering from lower back pain as a result from a fall, on occasion, I experienced sharp pain to the lower left side of my stomach.
 
The pain was extremely intense when I sat up or lift something.
 
My question is, could there be a connection with my lower back pain and these sudden lower stomach muscle pains?
 
Any assistance you provide will be greatly appreciated. 
 
I am a self proclaimed disabled Veteran working with the US Army overseas, and am trying to justify a compensation for disability claim for lower back pain and headaches and want to get a professional opinion on how my abdomen muscles pain could be related to the constant back pain that is a result of my fall.
 
Is it ok to use your opinion to submit as evidence to justify my claim. The federal activity the was the custodian of my medical records that showed treatment of my back says that they cannot locate them (fighting to get the records for the last ten years).
 
The stomach and back muscles have caused me problems since the injury occurred in the early eighties. Can't do sit ups, can't stand up to quick after setting down ( for years).
 
However, its been an uphill battle with snow trying to convince the VA that the injury is service connected. The only medical records that I have for treatment that is service connected is for the strained muscle treatment. I was directed by the treatment doctor to not lifting anything over 10 lbs and limited sitting for approximately 2 weeks.
 
I just received the records that shows the strained muscles this week and am trying to get the appropriate language to convince them that the abdomen pain was in fact, caused as a result of the constant pain that is from the back injury.

One establish how you fell as specifically as possible and where the level of the injury occurred.  Any bruise or bleeding.  Any ER visit and X-ray taken?  Then you need an MRI to view the upper lumbar spine levels.  A nerve conduction study and electromyopathic study of the nerves and muscles can be done to see any neurologic injury from the spine or corresponding nerve.  Thermography is a vague test but may show area of injury.  This should prepare you to make a clinical diagnosis.  You need a good neurologist to summarize the findings.  Hope this helps you.


Q I suffered an injury to my posterior cruciate ligament which I believe is a sprain, after a week of no exercise my walking got much better but the problem is that I cant squat more than 3/4 of the way before I feel pain. I tried running on it again and it felt fine. my question is , should I keep resting it longer or would I cause any damage by running on it even though there is no pain while I run ? the pain only occurs while I bend my knee completely or when I squat on it.

Clinically, you have difficulty squatting past 3/4 range in your knee.  Running doesn't cause you discomfort.  You feel that you strained your posterior cruciate ligament, which may be the situation, but possibly you may have torn the posterior lateral horn of your meniscus (cartilage).  To determine the extent of this type of presentation, an MRI is needed for diagnostic certainty.  An orthopedic surgeon specializing in sports injuries can assess the type of injury and extent of the problem.  The MRI will show him diagnostically what physical damage you have and treatment options can be offered.  In the short term avoid aggravating factors, consider a non-restrictive soft knee support, and use ice for swelling and over the counter anti-inflammatories for comfort.  If you would provide more information on how old you are, what activity caused the injury and symptoms that were immediate and now, this would help me.  Also, how did you determine that it was a posterior cruciate ligament that was your specific problem.


Q My son is a right handed pitcher he says he gets sore or has pain on his right  elbow not quite on the inner part but like the middle of the elbow is there a tendon there and what can we do to get him better he is 17 years old.

A The pitching elbow of a competitive baseball player is very vulnerable to injury, especially in adolescence.  The medial and lateral elbow attachments are for the wrist and forearm flexors and extensors.  The more middle aspect of the elbow attaches the pronator and supinator muscles.  These muscles rotate the elbow allowing the forearm to turn in and out.  The middle muscle that extends from the elbow to the wrist and hand is the plantaris muscle.  Any one of these can strain and lead to chronic inflammation and pain.  To find the specific muscle, either use google.com of in the bookstore there is a good simple anatomy book by Yancey that provides a description of the anatomy and stretching/strengthening program for the specific muscle.  In the meantime, pace his number of pitches, look at his biomechanics by digital filming and slow motion viewing.  For pain and discomfort use over the counter anti-inflammatories, ice, a compression sleeve and rest if needed.  Hope this helps.  If you would be more specific to the muscle involved, I may be able to provide more guidance. 


Q Would having been an avid guitarist from age 10-30 have an effect on range of motion in my wrists?  I became a devoted golfer and student of the swing at age 34.  
  I would like to be able to create and hold more of an angle between my arms and the clubshaft but my wrists simply will not allow it.  It seems to me that the thousands of hours spent playing guitar placed the wrists in the opposite position of what I would like to achieve in a golf swing.

A A physical examination would be optimal to make an informed opinion, but I'll try my best.  If you have either medial or lateral epicondylitis ( tennis or golf elbow) then your problem is at the wrist with a shift in the small bones of the wrist.  The alignments of the tendons across these bones affects tension and impedes range of motion.  If don't have this problem then you should see swelling in the wrist area that limits range of motion by inflammation or edema.  This edema or inflammation occurs from repetitive motions and overuse.  These are the two most common causes other than the obvious fracture in the wrist or around the wrist.  Hope this helps you get started in determining the cause of your problem. 

 
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