CPOYA | Dr. Tim Maggs

Dr. Tim Maggs        sports biomechanics        INJURY PREVENTION        SPORTS REHABILITATION        SPORTS MEDICINE        CHIROPRACTIC CARE

Figure 16
Figure 17
Figure 18
Figure 19

The significance here is great, in that the gravity line is falling through the back of the joints and discs, putting significantly more weight on them than they can sufficiently tolerate. This increased weight-bearing contributes greatly to the ultimate disc bulges. Ultimately, to fix a disc injury, you must improve the centers of gravity and reduce the abnormal weight-bearing on the joints.

After taking the digital foot scan and the low back x-rays, we knew that custom orthotics would play a major part in balancing the pelvis and lumbar spine of this patient, which would be needed for maximum healing of the discs and function of the low back. In the front to back low back x-ray (Figure 18), we see the initial imbalances. In the front to back x-ray that was taken after the custom orthotics were put in the patient’s shoes (see Figure 19), we can see a 50 percent improvement before treatment even begins.

As of February 1, 2013, this young patient has been under corrective care for almost 2 years and has made substantial improvements. She has received many chiropractic adjustments, LLLT, and applications of Kinesio-tape. She continues with weekly chiropractic treatments, cold laser therapy and decompression treatments.  She applies ice treatments at home and made the use of custom orthotics as part of her life.

She spent a good amount of time getting back into shape with a personal trainer on specific core and conditioning exercises. For the most part, she is pain free and is now choosing a different sport to begin participating in.

We have reminded this patient that she’ll need to continue her exercises, maintain some frequency of treatment, and use custom orthotics for the rest of her life to maintain the improved alignment and joint mobility that has helped her reach this new level of physical improvement.

Figure 15

During this physical exam, we also performed a digital foot scan (see Figure 15) that shows which arches of the patient’s  feet have fallen, what percentage of body pressure is going through each side of the body and how the patient’s feet compare with optimal arch support.

It’s evident in this patient’s feet that there is a structural imbalance based on the percentage of body pressure, left vs. right in this scan (54.5 percent left and 45.5 percent right). This abnormal weight distribution can certainly cause joint, tendon and muscle breakdowns over time.

In addition, the outer arches of the feet have fallen unevenly, necessitating custom orthotics. The custom orthotics will support the fallen arches and balance the right and left feet, making the body’s foundation balanced and supported, which will begin the reduction of abnormal weight bearing above the feet.

The low back x-rays this 15-year-old patient brought in were not useful, as they were taken in the lying down position that removes the effect of gravity and weight-bearing, which are necessary for proper interpretation of biomechanical information on a patient, especially one with disc injuries at such a young age.

On July 22, 2011, we took new low back x-rays in the standing position. When x-rays are taken in the standing position, alignment and balance issues become obvious, as weight-bearing and gravity now come into play. As seen in Figure 16, the long vertical line represents the center of gravity, and should be aligned with the short vertical line at the bottom of the x-ray.

The two horizontal lines represent the different heights of the pelvis, demonstrating the severe imbalance in the neutral standing position. Looking at Figure 17, we can see the long vertical line, again, is the center of gravity from the side. It’s supposed to go through the short vertical line that lies ahead of it.

On July 22, 2011, this patient came into my office with the history and test results given above. We immediately performed a physical exam, and found highly restricted motion in her low back. There was also increased trigger point activity in all of the supportive muscles of her low back and gluteal region. Her leg lengths were even by measurement.

Figure 14

From a purely medical perspective, these x-rays gave little usable information. They could have even been called “normal.” The orthopedist merely recommended six weeks of physical therapy to help reduce the pain. The patient was also instructed to avoid all exercise and activity, including rowing, during these six weeks.

In the spring of 2011, when she went back to rowing, her low back pain immediately returned. On April 11, 2011, she returned to her orthopedist for further evaluation. An MRI was performed on April 13, 2011, with the following results;

  • L4-L5: Minimal broad-based disc bulge (think of a bubble in a tire) in the second lowest disc in her low back.
  • L5-S1: A broad based disc bulge and mild bilateral facet arthopathy (arthritis) in the lowest disc.

The orthopedist recommended that she stop all exercise and rowing.

Figure 13
Let us consider this 15-year-old female rower who had developed significant low back pain at the age of 13. On September 10, 2010, she went to a nationals rowing competition. On November 24, she saw an orthopedist for serious low back pain. X-rays were taken of her low back in the lying down position. The first x-ray (Figure 13) is front to back; the second (Figure 14) is from the side.

cAse History:  15 Year Old Female Rower