Langford Chiropractic Clinic Newsletter, June 2000

Kids and Sports Injuries

by Dr. Anne Langford

Sports are great fun. They encourage social skills, build self-esteem and create a habit of exercise that can last a lifetime. However...

Sporting injuries are frequently encountered in a chiropractic practice. When sporting injuries occur in childhood or adolescence particular care needs to be taken to ensure that subtle injuries are not overlooked. For example, pain in the ankle may actually be due to knee problems.

Each sport has its most common injury patterns and each of these is discussed in this column.

The Limping Child
Any child presenting with a limping gait should be checked for hip pain as a primary concern. Disorders of the hip which may present with a painful lump can include Legg-Calve-Perthes disease, joint infection, infections of bone, reactive arthritis, and juvenile rheumatiod arthritis. Careful evaluation of the hip and knee should be carried out to rule out the above conditions before labeling the injury as a sprain or strain.

Football
In the US, football is the most common sport for "collision injuries" in children. About half of all sporting injuries to high school and college students are the result of tackling in football. The most common injuries occurring from football involve the head and neck. Cervical spine injuries are the greatest cause of long term disability and therefore represent the most serious type of injury suffered. Injuries to the neck are usually the result of poor tackling procedures. The problem with head tackling as an allowable feature of the game is that inexperienced players, before a head tackle, will tend to flex the neck just prior to impact, producing the potential for spinal fractures. One survey of collision injuries in football revealed that of 40 spinal injuries suffered, 39 were in players under the age of 20. Thirty-five of these players were quadraplegic upon admission to the E.R. and only 6 recovered function.

Lateral flexion injuries to the neck involving traction injury to the nerves in the low neck, called the brachial plexus, are less serious but are more common football injuries. This type of injury, known as a "burner," involves a sudden shooting or burning pain down the arm. but this quickly resolves leaving just a dull aching sensation in the extremity. Players with such injuries should not be allowed to continue to play in that game, and a detailed examination should be undertaken.

Water Sports and Diving
A common sports related injury to the cervical spine is that associated with diving. Diving into shallow water and hitting the head on the bottom or on a submerged object is the most common cause of neck injuries caused by diving. Most injuries involve neck fracture and/or spinal cord damage. Studies have shown that the velocity of the body at entry to the water is not significantly dissipated until the diver reaches a depth of 10-12 feet. Diving technique has been shown to have a significant impact on the incidence of injury. Experienced springboard divers use their hands to precede their body's entry into the water. This technique significantly protects the head upon entry. Inexperienced divers, with no particular technique, tend to leave their head unprotected thus leading to a higher incidence of neck and spinal injury. Studies of low back injuries have demonstrated a significant incidence of this type of injury in inexperienced divers, due to poor diving technique. In particular, hyperextension of divers' extended legs at the point of entry into the water can cause the lumbar spine to hyperextend and result in compression fracture of the vertebrae.

Gymnastics and Trampoline Injuries
Gymnastics, and especially trampoline injuries, have come under considerable criticism in the literature for the high incidence of cervical spine injuries encountered. The incidence of such injuries was of great concern prior to the publication of a policy statement in 1977 by the American Academy of Pediatrics. Subsequently, banning of trampoline programs took place in most schools and the incidence of cervical spine injuries diminished. The recommendations for the use of trampolines in gymnastics programs state in part "highly trained personnel who have been instructed in all aspects of trampoline safety must be present when the apparatus is used" and "maneuvers, especially somersaults, should be attempted only by those qualified to become skilled performers."

Skiing
Spinal injuries related to skiing are primarily associated with injuries to the cervical spine.

Weight Lifting Injuries
Spinal injury due to weight lifting is a common occurrence, especially in adolescents. Hyperextension facet syndromes are the most common injuries associated with weight lifting in this age group. Low back pain can be aggravated by weight lifting during the adolescent period. It is thought that lumbar hyperextension, associated with squats, is the mechanism of injury, particularly during the adolescent growth spurt when the spinal structure is at its weakest. The rule is to discourage squats and power lifting in young adolescents.

Summary
Many of these injuries can be prevented through simple measures. Chiropractic care can be helpful both before and after an injury occurs. Of course, being treated before an injury occurs, as a preventative measure, is better -- so make an appointment for your child for pre-season care.

If you have any questions or concerns about this topic please contact Dr. Langford and Dr. Karls at their office.

News From Dr. Karls

As most of you know I am going to be having a baby and am due at the end of June. My plans are to continue to do the work I love until the baby arrives. I will be going on maternity leave for July and most of August. During this time I would like to assure you that you will continue to receive excellent quality, friendly treatment. Fortunately, a good friend of mine, Dr. Danielle Brink, will be helping me during this time, as will Lori Pottebaum, my chiropractic intern. Also, Dr. Langford will continue to work Monday, Wednesday, and Friday if those days are more convenient for you. If you have any questions and concerns, please let me know.

Knowing Your Insurance Benefits

by Barb La Motte

What is Managed Care (MC)? Your insurance company, in an attempt to control the cost and quality of care, coordinates medical and other health related services through a MC organization. The MC organization, by way of a Case Manager, then decides for your insurance company if the treatment you are given is within the insurance company's limitations. A Case Manager is a health professional (i.e., nurse, doctor, chiropractor) affiliated with the MC. If the Case Manager believes that the treatment is not a benefit, they can deny your claim. Most insurance companies may not know that you are being denied because your claim never gets to them. Now you may be asking yourself what can I do if this ever happens to me? You have a few options. Understanding the benefits of chiropractic care, you could pay out of your pocket. Or, you could find another provider. For most patients this is not an option. Why would you want to start all over with a new provider when the care you are receiving is working? Maybe you have been with the same provider for years and just don't want to change. Some MCs are willing to continue payment if you receive treatment from another provider. Your next choice, which is what I would do if this situation happened to me, would be to fight the MC.

Most insurance companies say that they do not limit the number of visits you can have. If this were actually true, they would not need to hire a MC. You and your doctor should be the only ones to tell when a treatment is working and when it is not. Also, a MC is deciding that you can not have more treatment when they have never seen you. Most MCs and Case Managers rely only on information submitted to them by your doctor. Even with the information submitted, most Case Managers usually reduce the number of visits requested if they are higher than that typically requested by other providers for similar cases. My question is, why would you care about other providers with similar cases and why should their cases be grouped with yours? Because, this is the game that insurance companies are now playing -- your treatment compared to others.

Tip of the Month:
Always fight for what you deserve. If you need help or have questions, let me know.

Vitamins and Other Supplements

by Dr. Heather Karls

This article was suggested by a patient of mine, Kim D. She and I were discussing what is helpful an what is hype when it comes to vitamins. I think that with so much to choose from, there is a lack of information on why you should (or shouldn't) take a particular supplement.

Now for the disclaimer: Everyone is unique and needs different forms of help. Dr. Langford and myself recommend vitamins based on your particular need. Ask us if we do not recommend a supplement you feel would be helpful to you.

Here are a few good supplements:
1) Everyone should take a good quality multivitamin. By good quality, I mean that it is absorbed and used by your body. Most multivitamins that Target and Walmart sell are full of "fillers" and are not completely absorbed. Most of us do not have a perfect diet, and those that do still need a good multivitamin. Along with a healthy breakfast a multivitamin is the best way to start your day. My recommendation is Metagenics Multigenics with iron for women with heavy menstrual flow, or Multigenics without iron for men and others who are not prone to anemia. Recommended dose: 1-2 vitamins per day.

2) Glucosamine Sulfate -- as many of you know, I am an advocate of Glucosamine Sulfate and Chondroitin Sulfate. Why? What they do is help maintain the body's cartilage -- the "bumper cushion" between bones. Almost every joint has some sort of cartilage protection, and as we get older our joints suffer from wear and tear. This is called degeneration or DJD (degenerative joint disease). Often times it is what people think of as arthritis. Osteoarthritis is helped by Glucosamine Sulfate and Chondroitin Sulfate. The American Arthritis Association recently did a clinical trial on the positive results of Glucosamine Sulfate also. Recommended dose: Varies, but generally 1000-1500 mg per day for one month, then the amount may be reduced.

3) Calcium -- Good for bones and muscles. Look for calcium hydroxyapetite or calcium citrate. Recommended dose: 1200 mg per day.

4) Vitamin E -- Very good for your heart and a great antioxidant. Recommended dose: 400 iu per day.

This is a good start. Depending on your condition other supplements can be extremely helpful. For example -- if there is a history of colon cancer in your family, you should take folic acid and selenium. B vitamins are helpful for stress and can be very beneficial for the symptoms of PMS. Vitamin C is another good antioxidant that also helps your immune system. Flax seed oil (freshly ground) has omega 3 fatty acids which are a helpful cancer preventative when taken in a 1:1 ratio of omega 3 to omega 6 fatty acids (found in olive and fish oils). Want more information? Call us! We'd be happy to let you know what is helpful for your situation.

Intern's Corner

by Lori Pottebaum

Hello everyone. My name is Lori Pottebaum and I will be interning with Dr. Karls through the fall. I look forward to meeting and visiting with all of you.

To tell you a little bit about myself, I am originally from Sioux City, Iowa. I received my B.S. degree in exercise and sports sciences from the University of Arizona. After graduation, I became a personal trainer in a women's health club in Tucson, Arizona. I then moved to Pheonix and worked as a chiropractic assistant for one year before relocating to Minneapolis to pursue a career in chiropractic. I am currently in my last year of schooling at Northwestern College of Chiropractic in Bloomington.

When I'm not being a chiropractic student or intern, I work at Nordstrom's in the Mall of America selling women's shoes. I enjoy many sports including sand volleyball, cardiac kick boxing, and roller around the lakes.