The Diaphragm - Not just for Breathing

In a previous article I discussed the proper mechanics of the diaphragm during normal respiration. This article is to build upon those principles and to inform you of current research just released that shows the importance of proper diaphragm function as it relates to neck and low back pain.

Karel Lewit, MD, practicing in Prague, Czech Republic, is considered by many to be “The Father of Manual Medicine” and I am one that agrees 100%. His knowledge and clinical expertise has been and continues to be an inspiration to me. Dr. Lewit has said for year that “if breathing is not normalized—no other movement pattern can be”. This statement made years ago is finally being brought to the forefront through research performed by his protégé Pavel Kolar, PaedDr., PhD.

In the December 2011 Journal of Orthopaedic and Sports Physical Therapy, Dr. Kolar published a study that showed that individuals with Low Back Pain had altered diaphragm activity when compared to individuals that did not have low back pain. Specifically the diaphragm did not move as much and also had a higher resting position in those with Low Back Pain when compared to those that did not. What this study shows is that how the diaphragm moves during normal inhalation and exhalation has an effect on how much “core stability” we truly have. Before we can move our arms or legs we have to have a stable core and proper diaphragm activation is the first step.

So now hopefully you are thinking “what is proper breathing because I’m obviously alive and thus I must breathing ok….right”?? Well…not necessarily. If you place one hand on your chest and one hand on your belly and take a normal breath in you should see your belly hand rise as we breathe IN. If your diaphragm is working correctly your belly should expand during inhalation due to the diaphragm lowering and increasing the pressure inside your abdomen. The increased pressure in our abdomen helps support our core which is the best way to prevent low back injuries. If we do NOT breathe with our diaphragm, then what are we breathing with? In most cases we are using our neck and chest muscles to help “lift” our chest more than we are “dropping” our diaphragm and causing excessive neck tension and poor core stability --- Thus the neck and low back pain.

Normal breathing will decrease neck tension and increase core stability in individuals that do not breathe as described above…..just as Dr. Lewit’s quoted, “If breathing isn’t normalized – no other movement patterns can be “. If you want to watch someone with normal breathing watch a toddler! As I watch my baby boy breathe, his breathing pattern is correct and it gives me a good reference for what I want to see in my patients.

If you have tried traditional care, including chiropractic, physical therapy, or medication and still have pain or just are looking for a highly effective option without severe side effects, give us a call at 615-302-4747 or visit As always, Get In Motion Spring Hill.

Jumper’s Knee - Put that Spring back in your Step

Jumper’s Knee is a term used to describe Patellar Tendonitis. Patients with Jumper’s knee usually present with knee pain near the patella and along the front of the knee. This pain usually increases with jumping and running activities and decreases with rest.

The patellar tendon is what joins the quadriceps muscle to shin bone. It attaches at the patella (knee cap) and at the shin bone. When the quadriceps muscle contracts it pulls on the patellar tendon which straightens the knee. Jumper’s Knee occurs when there is inflammation and irritation of this tendon due to excessive stress, too much or poor training as well as overuse of the quadriceps muscle.

Jumper's knee occurs in many types of athletes but is most common in sports such as basketball, volleyball, or soccer, which require explosive jumping movements. Eccentric loading, which is contraction of the muscle while it is lengthening, occurs when landing from a jump or decelerating. In fact, knee loads up to 7 times body weight occur in a soccer player during kicking and between 9 and 11 times body weight occur in volleyball players during landing. These eccentric loads are thought to be the primary cause of overload in jumper's knee.

Conservative treatment of this condition includes hamstring strengthening and flexibility, VMO (vastus medialis obliquus) activation, hip flexibility and strengthening, myofascial (muscle) release of tight/ overactive muscles as well as foot exercises. Laser therapy is also very effective at decreasing inflammation and accelerating the healing process. Jumping, landing, running and quick changes in direction involve using muscles of the entire lower extremity so training and evaluation should include everything from the core down to the foot.

For questions about Jumper’s Knee or other topics feel free to browse our website for more articles and information at In Motion Spine and Joint Center will gladly answer any questions you may have at 615-302-4747.

Fascia - What Is It? Why Are You Treating It...or More Importantly, Why Is My Doctor Not Treating It?

Fascia is an extensive system of connective tissue. It not only separates muscles and tissues from one another, it also connects them to one another. Our fascia is comprised of collagen and elastin whose purpose is to support, lubricate and transport tissue fluids to every muscle, nerve, bone, organ and blood vessel in our body. Imagine a web of continuous thin tissue that goes from the top of our head to the tips of our fingers and toes and everywhere in between. For many years it was believed that fascia was merely a “binding material” for linking different tissues together. However, in recent years studies by Luigi Stecco and many others have proven that the fascia actually transports fluids and conducts tension between different tissues.

Excessive mechanical, chemical or traumatic irritation causes the fascia to become injured resulting in fascia that is less elastic and less slippery. This causes a decrease in its ability to coordinate muscles efficiently resulting in functional changes and pain usually follows. This also explains why prior injuries or problems in one area of our body can cause pain and altered function in another area of our body. In our office we will often treat an area of dysfunction that may or may not be the site of pain. Fascial restrictions are one of the more common dysfunctions that can cause pain or altered function to occur in other areas of the body. Treatment to the fascia is important to help minimize the risk of a repeat injury in those cases.

Fascia can be treated with various methods or a technique which includes, but not limited to Active Release Technique, Graston, FAKTR, cross-friction, massage therapy, trigger point therapy and dry needling to mention a few. The name of the treatment being performed is not what is important here, what is important is that treatment to the fascia is being performed.

Hopefully this helps explain the complexity of the fascial system and understand there is still much more to learn. We strive to stay abreast of new information and studies so we confidently say we are an evidence-based chiropractic manual therapy rehab facility….whew, that’s a lot! With the holiday season soon to be upon us, be safe and Happy Holidays!

For questions or more information please visit and watch our Video or call us at 615-302-4747.

Why Not "Pop" Your Own Joints?

If you or your child is “popping” their neck or back on a consistent basis, please read this article. Manual chiropractic adjustment or manipulation is used at In Motion Spine & Joint Center. Adjustment involves bending or rotating a “stuck” joint to the end of its range of motion and applying a very quick but short force beyond that range. The result is increased range or quality of motion.

So why do joints get stuck?

1. Gravity and Posture: Gravity encourages slouching and slouching habits make joints stiff or stuck in that poor posture.

2. Injury: Injuries cause muscle spasms, muscle spasms, after only days cause joints to get stuck and stay that way.

3. Body Type / Genetics: Some people are just stiff.

When joints get stuck in one area, we feel tight and restricted, and some people will try to “pop” their own neck or back, a wildly common trend among students these days. Patients may say that they have learned how to fix themselves but for some reason cannot fix it this time. Self-adjusting may cure your tight or restricted feeling temporarily, but very likely the pop is coming from the weaker joints in the area and with repetition WILL make your pain worse and the area unstable. Research is inconclusive at best on the subject of whether “cracking” your neck, back or fingers causes arthritis. With great consistency I can pick out those patients that are habitual self crackers by palpating the area and finding segmental instability. Instability is one of the most difficult conditions to fix. Joint popping feels good at the time because it stimulates the sensory portion of the nervous system in such a way that our brains love, but it’s only helpful if used in the right spots.

At In Motion Spine & Joint Center, knowledge and research about how joints should move is applied both to analysis and treatment. Study under the Motion Palpation Institute, of which both doctors are certified, is applied specifically to the joints that are stuck and NEVER to the ones that are not. After the joints are adjusted Dr. Hawkins goes one step further to find out why they got stuck. Tight muscles are stretched with Active Release Technique and proper movement patterns are trained through specific rehab exercises. My personal opinion is that “cracking” your knuckles is not damaging, however “self cracking” the neck and lower back greatly increases your risk for instability and injury. If you are interested in replacing your or your child’s bad habit with the correct stretches or rehab exercises, please call 302-4747 or visit

Preventable Osteoarthritis??

So, a lot of us, if we ever think about it, think that arthritis (osteo- not rheumatoid or other inflammatory arthritides) is just something everyone gets as they age or that it is some kind of inheritable disease. Research is finding out more and more that arthritis is highly affected by how our joints are loaded. That’s right, studies suggest that maintaining how well your joints move, much like “an apple a day”, “keeps the hip, knee or shoulder replacement surgeon away.”

Herzog, Clark and Longino found in 2004 that if they surgically cut one of the ligaments in a cat’s knee then the muscular control and joint stability of that knee would be negatively changed. Follow up study of that knee showed highly accelerated formation of osteoarthritis. Other studies have been done on cartilage samples to test their response to loads and have found that too much load and too little load on joints causes accelerated cell death.

We can learn from these studies that weight bearing joints of our body need a few conditions for long term health. They need PROPER muscular control, ligament integrity, movement and cyclical loading.

When I first see a patient with low back pain, they always get a thorough hip examination. If I find significant tightness in one or both hips, those hips may be greatly contributing to the back pain. They are also developing arthritis and aging at an accelerated rate. My job is to help the back, but also educate that patient about the consequences of having stiff hips. This goes for the spine, shoulders, knees, wrists, and ankles as well.

Some easy strategies to maintain the health of your joints include supplementing with glucosamine/chondroitin and omega-3 fatty acids, maintaining an active lifestyle, having injuries checked AFTER they heal to ensure no dysfunction resides, and having a functional examination performed by a specialist.

For much more information please visit or call In Motion Spine & Joint Center at 615-302-4747. As always, Get In Motion Spring Hill!

Carpal Tunnel Syndrome

There are many issues that can cause tingling in the arm and hand.  In this edition of Get In Motion I would like to offer information that will keep patients from considering unnecessary carpal tunnel surgery.

If you have nerve type symptoms in your arm (i.e. burning, tingling, numbness), your answers to the following questions will reveal if you have carpal tunnel syndrome (CTS):

Do the symptoms follow the median nerve’s pattern?  It carries sensation for the palm side of the thumb and first 2.5 fingers.  If your symptoms are in other places, then you do not have CTS.

Did the symptoms start above the wrist?  If so, it is likely that a nerve is being compressed at another site, higher up its path.  It could be the Median, another nerve, the bundle of nerves at the shoulder, etc.  It is unlikely that carpal tunnel surgery would be productive in this case.  “Double Crush” is a term that describes compression of a nerve at two different places.  This is common because assembly line workers, for example, often have repetitive injuries and poor posture, causing injury at the carpal tunnel and at the shoulder.

Conservative care for nerve injuries must include multiple approaches.  Soft tissue work such as Active Release® is needed to release the muscle, tendon or ligament compressing the nerve.  Flossing and tensioning exercises should be prescribed to get the nerve moving again and healed, as described by David Butler.  Then the patient must be advised how to change the causative posture or movement.

Carpal Tunnel Release Surgery is a needed treatment option.  But it should only be considered on those patients with confirmed median nerve pathology at the carpal tunnel and after failing four weeks of conservative care.

If you should have any questions or need help with your situation, please check or call 615-302-4747.

Functional Exercises Versus The Old Standards

When most are planning their weight lifting routine there are common exercises that come to mind: bench press, dumbbell curls, tricep extensions, lat pull downs, leg curls, knee extensions, situps, etc. This covers most every muscle group and is “what everybody does.” In this article I would like to take look at goals that should be considered when planning out your regimen.

If your goal is cosmetically focused only then these exercises with a bit of guidance will be just fine to meet it. Isolating muscles and repeating repetitions until failure will hypertrophy muscles.

If your goal is strength and, more importantly, power you must consider some major revisions to the workout “everybody else does.” Useful power is a combination of strength, the ability to steer it, and generating it from the ground up. The bench press, no matter how popular, is not a useful power building exercise. Using a bar drastically decreases the need to steer your strength, and being on your back keeps you from generating power through your body from the ground. Let's try to relate this to real life or sports; if you are on your back pushing something off of you in football you're tackled, beaten. But the NFL combine still uses this exercise to gauge the strength of next year's pro athletes. This principle can be applied to any exercise in the gym. If you can see yourself using the motion in life then the power that exercise produces is useful and can relate directly to performance enhancement. These are called functional exercises.

Logical programs should include every muscle group, but train them how God meant for them to work, as a unit. Some great exercises in this category include: standing cable chest presses, push-ups, pull-ups (not generating power from ground up, but still useful), one leg stance bent over rows, wood chops, Combination squats with shoulder press or bicep curls, and dips.

Another good thing about this type of workout is that natural motions are less taxing on your joints than isolating motions. So, when it comes time to change up your workout, consider these things: Is the power you're gaining useful? And, is the exercise safe (the benefits outweigh the risks)? I would rather be big, safe, and powerful than only big, any day. For any questions regarding this article, sports performance enhancement, or joint health, please contact In Motion Spine and Joint Center at (615) 302-4747.

Class IV Laser Therapy

The term Class IV laser may seem a bit futuristic to you but the clinical results and backing by research are clear. It is providing pain relief, decreasing inflammation, and stimulating healing faster than any therapy modality to ever hit the manual therapy world. The premise behind this cold laser is applying photons of light at sufficient power and in a specific wavelength in order to get the energy deep into the body’s tissues where pain generators hide out. When the laser light gets to a damaged area of tissue the cells are stimulated to start producing energy again in the form of ATP. This “restart” of the cell is where the real results come in because cells with sufficient energy have the great power to repair.

Laser therapy has been utilized in Europe by physical therapists, nurses, and doctors since the 1970’s. Laser therapy has been used extensively in the US since FDA clearance in 2002. At In Motion Spine & Joint Center, we have been using LiteCure’s model of Class IV laser since December of 2011. When combined with chiropractic manipulation, Active Release Technique®, Graston Technique®, and corrective rehabilitation exercises we have seen results on difficult cases in a shorter amount of time than ever before.

If you have tried traditional care, including chiropractic, physical therapy, or medication and still have pain or just are looking for a highly effective option without severe side effects, give us a call at 615-302-4747 or visit or As always, Get In Motion Spring Hill.

The Shoulder: Quite the Common Denominator

In this edition of Get In Motion I would like to explain the importance of proper shoulder and shoulder blade function. If our shoulder complex does not function properly, we are set up for a multitude of injuries and avoidance could be simpler than you think.

The quickest and easiest test you could perform on yourself is a simple shoulder abduction test. To set you up for success, stand up and use good posture before starting. Side-raise one arm at a time and check to see if you can get your elbow by your ear with smooth movement and without pain or great restriction. Failure of this test sets you up for multiple injuries not limited to the common ones described below.

The first and most obvious injury would be rotator cuff impingement. This injury happens when the shoulder’s ball and socket joint repeatedly pinches tendons of the rotator cuff, tearing or inflaming the tendons and surrounding area. Left untreated this could lead to debilitating pain.

Neck pain is another common injury consequential of a failed shoulder abduction test. When the motion cannot happen at the shoulder, the neck muscles compensate by elevating the entire shoulder blade in order to get daily activities requiring raising the arm accomplished. This lifting happens with every raise of the arm and overworks the neck musculature and leads to neck sprain, strain, or even headaches that throb at the base of the skull.

So, what is the cause of a failed shoulder abduction test? Most likely the culprit is longstanding poor head and shoulder posture. Slouching the head and shoulders forces the compensation pattern at the shoulder blade that trains your brain to cause injury instead of functioning properly. Prior trauma to the area may have changed the function as well.

Try the simple shoulder abduction test on yourself now. If you fail, make a wise decision for your body’s health and talk to one of the doctors here at In Motion Spine & Joint Center about help. To learn more about fixing your shoulder or injury prevention feel free to call us or visit As always, Get In Motion Spring Hill!

Chiropractic At In Motion

The profession of chiropractic is a resource that means something different to almost everyone.  Rightfully so, because there are so many differences among each office you visit or doctor you see.  In this week’s article, I would like to describe what chiropractic means at In Motion Spine & Joint Center.

All doctors of chiropractic are trained very extensively in the diagnosis of disease, just as medical doctors, almost 300 total credit hours of classes.  Beyond general diagnosis training, the differences begin. 

One difference among chiropractors is their orthopedic training.  The doctors at In Motion are well trained to diagnose injuries from meniscus tears in the knee, bursitis at the hip, disc injuries in the spine, or labral tears of the shoulder.  Some offices choose to narrow their focus to the spine only.

Many chiropractors use electric stimulation or heat to relax tight muscles.  Dr. Hawkins feel that long term benefit is achieved through releasing specific muscles that are loading joints of the spine or extremities without modalities.  They are certified in the latest soft tissue techniques such as Active Release® or Graston®.   

Dr. Hawkins utilizes Motion Palpation Technique to analyze the movement of joints and manipulate them by hand.  Others may use instruments to vibrate the joint or drop tables to do the adjusting.  These are useful tools, and drop pieces are sometimes used for the right situations at In Motion.              

Another difference is in the rehab exercises extensively studied and prescribed at In Motion.  These exercises help us empower our patients to get the quickest and longest lasting results possible, allow us to treat unstable joints, and to help everyone from the elderly to elite athletes.  

This treatment takes time in the office.  The doctors spend personal, face-to-face time with their patients at each visit both doing the manual therapy and going over reviews and updates on rehab. 

So, at In Motion Spine and Joint Center, chiropractic means the diagnosis and hands-on conservative treatment for any musculoskeletal condition.  Please visit our website at to find out if chiropractic would be a helpful resource to help your condition.

Movement Patterns - Learn From The Pros

Do you ever wonder if there is a secret to alleviating most pain and maximizing your overall health, especially the health of your muscles and joints? Well, the secret is: do what babies do; yes, babies! The fact is, if you or I had never lost the 'movement patterns' that babies have, we would not 'wear out' our knees, shoulders, low back, etc. in a lifetime.

Babies with normally developing brains have predictable movement patterns that ensure the safety of their joints and muscles before every move they make. Watch a baby pick up something off of the floor. They do a perfect squat using their hips, not knees or back. Watch a baby get off of the floor. They do this task the same spine sparing way every time. Watch a baby cry loudly. They project their ear piercing cry with the diaphragm in perfect spine position like a well trained singer. Even though they may scream for quite some time in a day they don't strain their voice because they do it properly.

Let's take a patient with a disk injury in the low back. During my exam, I see chest breathing, feel stiff hips, and watch them bend at the low back when rising from sit to stand. This patient has movement patterns that injure their back all day long. My job is to change this patient's muscles and joints so that they can keep their back safe while the body heals the disk injury. Then I have to 're-teach' this patient the proper movement patterns.

During the holidays, many of you will see grandchildren, nieces/nephews, or cousins in the 1 - 3 years of age range. Watch them play and you'll learn how you can keep your joints and muscles healthy and safe. If stiffness or weakness is keeping you from 'doing as they do', the doctors at In Motion would be glad to help.

For much more information please visit WWW.INMOTIONSJC.COM or call In Motion Spine & Joint Center at 615-302-4747. As always, Get In Motion Spring Hill!

Jogger's Foot - Another Cause of Heel and Foot Pain Common in Distance Runners

Jogger’s Foot, also known as Medial Plantar Neuropraxia, is an uncommon cause of foot and heel pain for the average person but does happen more frequently in long distance runners. Specifically, this condition is a nerve entrapment of the Medial Plantar Nerve along the inside portion of the arch of the foot. The most common entrapment site for this nerve occurs where the flexor digitorum longus and flexor hallicus longus muscles cross called the “Knot of Henry”.

Often times pain along the arch of the foot is simply diagnosed as Plantar Fasciitis but with Jogger’s Foot the pain will be accompanied with occasional weakness of the foot or toes and increased burning along the inside portion of the heel. A specific nerve stretch can also help determine if the pain is due to an entrapment of the medial plantar nerve.

The two most common causes of Jogger’s Foot are flat feet and a poorly fit orthotic. If long distance runner’s with flat feet are not in correct shoes the repetitive stretching of this nerve can be the cause of the pain. Also if the orthotic is slightly off, it may compress the nerve and may need to be replace or altered to avoid irritation of the nerve.

Treatment can consist of many things including but not limited to; rest, manual therapy (ART nerve release), rehab exercises, orthotics, nerve flossing exercises, cortisone injections or for severe cases surgical release of the nerve entrapment.

Foot pain is commonly treated in our office due to our training in nerve entrapments, soft tissue release and gait analysis. Please feel free to call or email with questions to 615-302-4747 or With the marathon and running season being in full swing, good luck and take care of your feet – hopefully they will carry you to the finish line First!

Whiplash: The Effects of Car Accidents

Many of us have had our fair share of car wrecks, from small fender benders to high speed crashes. Regardless of the accident, when a vehicle changes speed or direction instantly, jarring your neck, injury is sustained. And vehicle damage is not usually proportionate to the extent of injury. Other than body parts striking the vehicle, acceleration-deceleration injuries are the most common and will be discussed here.

Injury occurs in two ways. The first happens when the person is not ready for the collision and the joints, ligaments, and muscles are stretched beyond their limits. The second is when the accident is anticipated, the person tries to fight the whiplash and force wins, usually damaging the supporting muscles of the spine. After injury, healing follows four fairly predictable and usually overlapping stages.

During stage 1 (from 12 to 72 hours) significant swelling and pain limits motion and causes pain; support, rest, and ice are the go-to therapies here. Stage 2 (between days 2 and 4) swelling decreases, but ice is still important as well as the start of modest range of motion exercises. Stage 3 (around day 5 up to 6 months) indicates the need for more aggressive range of motion, treatment and prevention of internal scar tissue, as well as starting stability work. Stability work includes light resistance exercises specifically designed for each person’s needs. Internal scar tissue formation, sort of like a scab on a cut externally, should be treated in these injuries by manual therapies. While this internal micro-scarring is necessary, when left untreated it sometimes causes lingering joint, muscle, and neurological symptoms. Stage 4 (6 weeks up to 1 year) is also called the remodeling stage. In this stage the tissues sort of “sure up” or tighten up after being over-stretched and clean up of some of the scar tissue. Active movement training is mandatory. At this time, muscle imbalances and abnormal sensations, such as tingling or numbness due to scarring should be diagnosed and treated.

At In Motion Spine & Joint Center we treat scar tissue with Active Release Technique® and Graston Technique® and rehabilitate proper movement patterns and muscular weakness with state-of-the-art rehab techniques. Whether you’ve had an accident or not, I hope this entry of Get In Motion has helped everyone understand the effects of acceleration-deceleration traumas. If you should have any further questions about injuries please contact us at 615-302-4747 or and feel free to visit WWW.IMSJC.COM.

The Hip Bone's Connected to the Back Bone

Our readers likely have no idea how true the line is from the old song “Dem Bones” that says, “The hip bone’s connected to the back bone.” At least half of the patients that come into my office with low back pain have it because their hips have been bullying their low back. I will tell you some strategies in this article that could help your back problem or prevent one in the future.

Simply put, if your hips are too stiff, your back will be pushed into vulnerable positions. Consider bending over to tie your shoes. If your buttock muscles are too tight for the motion to happen at your hips then your back gets flexed every time to accomplish the task. Forced flexion with rotation is precisely how scientists herniate spinal discs in laboratories. While walking, if the front of your hip and thigh is too tight, your back will be forced to extend with each step in order to maintain a full stride. If I were walking a mile for my health, that’s a lot of injury to the low back. When we ask our backs to perform task which it is not designed to do, it WILL fail, sooner or later.

When we decide that the health of our back is important and want to use preventative stretches, we must use safe and effective stretches to loosen the hips. A good hip stretch stretches the hips and not the back! Research and clinical experience have taught me that stretches should be performed twice per day and that you should count deep breaths instead of seconds during the stretch. Believe it or not, a deep breath in tenses our muscles and a big breath out relaxes our muscles.

Somehow, dentists and our Moms have convinced us that we should brush our teeth at least twice per day to fight cavities. I would like to submit to the Get In Motion readers that our spines are AS important as our teeth. I encourage each of you to find out what may be tight about your hips and stretch everyday twice a day when you brush your teeth only for a few moments. If this story of hip stiffness and back injury applies to you, give us a call at In Motion Spine & Joint Center or at least visit our website at WWW.IMSJC.COM. And, Get In Motion Spring Hill.

Fisherman's Elbow

Spring is here and if you’re like me, fishing is taking up all of your spare time. One of the most common injuries that plague fishermen is elbow pain from casting and retrieving. Fisherman’s elbow is more commonly known as “tennis elbow” or lateral epicondylitis.

Tennis elbow is an irritation or degeneration of the tendons of the forearm that cock back the wrist or extend the fingers. Usually the pain is just beyond the outside part of the elbow at the origin of the extensor tendons. Pain gets worse when lifting objects with your palm facing the ground, turning a screwdriver, using an open-faced/spinning reel on the holding arm, or turning the handle on a close-face/bait casting reel.

This problem is caused by repetitive overuse of the muscles, past injury that limits blood flow or changes the natural balance of the elbow, or a degenerative process in the tendons at their attachment. Other conditions that must be ruled out in these cases are arthritis, radial tunnel syndrome, and a muscle or ligament tear.

To treat this condition, the irritating activity must be avoided. For spring fishermen, NOT fishing is NOT and option, so modifications must be considered. Changing rod or wrist angles or limiting the use of certain equipment are some of the strategies I use for patients with these problems.

Anti-inflammatory approaches may help. Options here are ice, over-the-counter anti-inflammatory medication, or a cortisone shot. Be aware that risks are involved with cortisone injections and should be considered if “all else fails.”

Most importantly, an expert on this condition needs to examine the function of the shoulder, elbow, and wrist and treat with effective techniques. If joint or muscle restriction is hindering proper movement patterns or overloading the tendons, the injury will never completely resolve.

At In Motion we provide great relief for lateral epicondylitis utilizing Active Release Technique® and Graston Technique® to break up scar tissue formed from these overuse injuries and unload tension across the elbow joint. If pain in your elbow is getting worse this season or just won’t go away, treatment is available and it can be resolved and avoided in the future. For any questions or treatment please contact In Motion Spine & Joint Center at 615-302-4747 or visit WWW.IMSJC.COM.

Baseball Injuries: Prevention Programs

As you may have read in last issue’s “Get In Motion” Dr. Hawkins and I traveled to Tampa, Fl for the 29th annual American Sports Medicine Institute, Injuries In Baseball course. Surgeons, physical therapists, and Major League Baseball athletic training coaches from literally across the world presented the latest research and techniques on preventing and treating injuries in the pitcher’s elbow and shoulder. I would like to give readers some of the latest insight on preventing these injuries. There were three functional highlights that must be addressed about a pitcher to lessen the likelihood of injury: Shoulder blade, rotator cuff, and core stability, total shoulder rotational range of motion, and regulation of pitch count.

The rotator cuff’s job is to rotate the shoulder but even more importantly these muscles should put a stabilizing force on the arm as it rotates. Core stability and shoulder blade stability are commonly overlooked components of a pitcher’s training program. Skipping this training is like building a house on a soft foundation. Pitchers generate enough force from their feet to their fingers to throw baseballs in upwards of 90 MPH. If the core and shoulder blade do not have the ability to stiffen properly during arm acceleration there will be an energy leak. Force will be imparted to the shoulder, not the entire body and loss of speed and/or injury will occur.

Total shoulder rotational range of motion (TRM) is calculated by measuring the total degrees of internal and external rotation at the shoulder joint. The shoulder blade must be stabilized during this measurement. According to Wilk, Macrina, Fleisig: AJSM ’10, pitchers with a lack of TRM greater than 5 degrees especially when the loss is internal rotation were 3.5x more likely to end up on the Disabled List during the season.

When a young pitcher’s talent is discovered please remember the importance of preventing injuries. Don’t over utilize them because of their talent. Pitch counts in games AND practices should be regulated according to Little League Baseball’s program. And if the talent is there, have a functional examination performed by a qualified physician. To learn more about injury prevention feel free to call In Motion Spine & Joint Center or visit WWW.IMSJC.COM.

Baseball Injuries: Just the Facts

I recently attended the 29th Annual Baseball Injuries Seminar hosted by the American Sports Medicine Institute. Here the focus was not only performance enhancement but also injury prevention. Injury prevention amongst youth baseball players has become a focus of several organizations including Little League Baseball® and USA Baseball®. On the flight back from the conference I started compiling some of the information that pertained to injury prevention so I could inform the public about how to prevent some of these baseball injuries. Prevention is the BEST Treatment.

Important Facts

The fastest measured joint motion in a human occurs when the pitcher’s arm is accelerating towards the plate. (if the arm maintained that peak speed for 1 sec, it would make 20 full revolutions!)

The number of MLB pitchers that threw more than 120 pitches in a given appearance in the 2000 baseball season: 528……in 2010: 158.

If we look at just these two facts we can say that pitching is stressful to the throwing arm and that the MLB understands this more today than they did 10 years ago due to the fact that pitchers are not throwing as many pitches per outing.

If a pitcher throws more than 100 innings in a season, their risk of having a serious arm injury goes up by 3.5x’s.

If a pitcher throws fatigued, their risk of having a serious arm injury skyrockets to a 36x’s higher risk.

Pitchers with full range of motion (ROM), which is 180°, have shown to perform better than those with less than full ROM.

A pre-participation evaluation that is specific to baseball (this includes assessing shoulder ROM, shoulder blade strength and function, core strength, etc) helps to identify those players at risk and should be performed yearly.


Performance enhancement in pitchers can only occur when they are healthy so injury prevention is the first step. I feel those of us that coach and treat baseball players should know all that we can so our youth can enjoy baseball for many, many years. For questions or the references to this article please contact In Motion Spine and Joint Center at 615-302-4747 or visit us at WWW.IMSJC.COM.

I'm Alive So I Must Be Breathing Right...Right??

The act of breathing is controlled by our brain, and more specifically the pons and medulla. This area of our brainstem is responsible for automatically stimulating us to take a breath (luckily for us men because I have heard we are less than perfect at multi-tasking). Considering the average person takes between 15,000-25,000 breaths per day, depending on our physical and/or emotional demand, it is important that we have a correct breathing pattern. A poor breathing pattern can cause certain neck and chest muscles to be overused while weakening and causing instability in our low back. But how is this possible??? In order to understand how this can occur we must first understand proper breathing patterns.

Let's start by discussing the importance of our diaphragm. The diaphragm is a circular done-shaped muscle that is rather thin and has attachments to the vertebrae of the low back, the lower six ribs and our sternum. This muscle serves as the primary muscle in breathing as well as the separation between the thorax and the abdominal cavity. During proper, non-stressful inhalation the diaphragm will contract causing it to flatten and increasing the pressure in the abdominal cavity while lowering the pressure in the thorax. When this occurs the abdomen will swell activating the abdominal, pelvic floor and low back muscles which creates a cylinder of stability for the low back. If normal breathing patterns exist a person should be able to lie on their back with one hand on their chest and one hand on their abdomen and while inhaling feel the hand on their abdomen move the most.

With a basic understanding of proper breathing patterns, lets discuss faulty breathing patterns. If the diaphragm is inhibited or poor utilized then the chest and neck muscles dominate the breathing process. This faulty breathing pattern is called Paradoxical Respiration. Paradoxical respiration commonly causes neck and/or low back pain due to the lack of diaphragm and core muscle activation as well as over activity of certain neck and chest muscles. In a recent study they found that nearly 75% of those people with neck or back pain had faulty breathing patterns (JBMT (2004) 8, 297-306).

For years, health care providers have known of faulty breathing patterns and how it relates to chronic neck and back pain. Now, hopefully after reading this, you do too. For more information please contact In Motion Spine and Joint Center at 615.302.4747 or WWW.IMSJC.COM.

Core Stability: What Is It, Really?

Core stability is a word that is misused enough that I felt motivated to discuss it in today’s article. Our “core” is the center of our body; everything from ribs to pelvis. It houses the lumbar spine and is surrounded by vertical muscles in the front and back and hoop muscles around the sides. “Stability” is the ability to resist movement and to support when demand is applied. A bridge is stable when it supports cars from the top and resists wind from the sides.

Think of our core as a coke can. Try pressing straight down (as gravity and our upper bodies do) on the can and it is surprisingly strong. Next, try denting that can on one side and then press down again. The can is much weaker. My point is that our core is very stable and supportive IF we keep our posture in neutral and allow its natural cylinder shape to support us. This is why we are always told to sit up straight.

The “abs are sheet-like (flat and short) muscles, designed “from the factory” for stability. On the other hand, the hamstrings are long and thick muscles, meant for movement; to bend the knee and extend the hip. So, when you think of exercises geared toward the core train stability not movement. Your back will thank you for it. Stay away from sit-ups, crunches, and the trunk flexion/extension or rotation machine in the gym. Lift with your hips and knees while keeping your back stiff and straight. I promise you that increasing your activity and a healthy diet will do way more for your “six pack abs” than hundreds of crunches.

In Summary:
-Sit with slightly better posture, nothing drastic.
-Keep your back straight when you bend or lift, even the lightest objects.
-Stay away from exercises that move your back; Stability not Mobility.

If you should have any questions about back safety, core stability, or safe exercises to train your core, please visit WWW.IMSJC.COM or call 615-302-4747 and as always, Get In Motion Spring Hill.

Quality Supplements - Hype or Necessity

This year a large Multiple Sclerosis research group made some very interesting findings of common over-the-counter (OTC) vitamin D supplements. They found that many patients aren’t getting what they pay for or worse yet, what they need.

They took 10 OTC brands of vitamin D and compared what the bottles said to what was actually found in each pill or capsule. They found that the average brand only contained 33% of what was claimed, ONE THIRD! One of the worst brands contained around 1% of the labeled claim and the best was 82%.

The great concern with this inconsistency is that patients with Multiple Sclerosis need certain levels of Vitamin D to regulate their immune system and fight against osteoporosis, which is very common among MS patients. Physicians recommend levels of Vitamin D depending on the patient’s individual needs, however 4000 IU daily is common. If a patient received only 33% that’s 1320 IU; not close to the needed value.

The problem is that supplements aren’t regulated by the Food and Drug Administration, or any outside agency. Therefore, some companies, without worry of repercussion, cut corners on the expense of providing the full quantity of vitamin or mineral or compromise on quality products or processing.

My readers should draw their own conclusions about what other supplements besides Vit. D actually provide….or don’t provide. As a physician, my office cannot worry with the inconsistencies mentioned here. We offer products by one of the only brands that make supplements AND pharmaceuticals. This mandates strict regulation of their entire product line by the FDA. We receive periodic “third party assays” (outside source quality testing) stating exactly what was found in each product. For more information contact us at In Motion Spine & Joint Center, consult your primary care physician, or ask your local vitamin store about third party assay results. Don’t throw away your money on poor quality or quantity products and as always Get In Motion Spring Hill.

For more information or health tips please visit WWW.IMSJC.COM or call 615-302-4747.