5 Warning Signs Of Stroke

The American Stroke Association suggests that if you see these signs on a love one, you call 911 immediately.  It is a medical emergency!

1. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
2. Sudden confusion, trouble speaking or understanding
3. Sudden trouble seeing in one or both eyes
4. Sudden trouble walking, dizziness, loss of balance or coordination
5. Sudden, severe headache with no known cause

Be prepared:

  • Keep a list of emergency rescue service numbers next to the telephone and in your pocket, wallet or purse.
  • Find out which area hospitals are primary stroke centers that have 24-hour emergency stroke care.
  • Know (in advance) which hospital or medical facility is nearest your home or office.

Take action in an emergency.

  • Not all the warning signs occur in every stroke. Don’t ignore signs of stroke, even if they go away!
  • Check the time. When did the first warning sign or symptom start? You’ll be asked this important question later.
  • If you have one or more stroke symptoms that last more than a few minutes, don’t delay! Immediately call 9-1-1 or the emergency medical service (EMS) number so an ambulance (ideally with advanced life support) can quickly be sent for you.
  • If you’re with someone who may be having stroke symptoms, immediately call 9-1-1 or the EMS. Expect the person to protest — denial is common. Don’t take “no” for an answer. Insist on taking prompt action.

For stroke information, call the American Stroke Association at 1-888-4-STROKE or contact the ASA


What Is Nursemaid’s Elbow? 5 Ways kids can have elbow pain

Nursemaid’s elbow, also known as “pulled elbow” usually happens in kids from ages 1 to 3 years old, but Infants and older kids can experience it, too.

So, what is Nursemaid’s Elbow?

Your elbow joint consists of three bones. The Humerus (upper arm bone which rounds at the shoulder), Radius and Ulna (lower arm bones in the forearm). Ligaments surround these bones and keep them tight and stable.  If there is force on the joint, a ligament may slip over the bone. This is normally the radius but can be other ligaments as well.   This pulls the bone out of place.  Pain will occur and your child may start grabbing his/her elbow, hold their arm in a abnormal position or experience pain when moving their arm. This can happen a lot easier than you think with minimal force so it is not recommended to grab kids by the arm and yank them up for any reason.

Here are some common reasons why Nursemaid’s elbow may occur:

1. Jerking a child’s arm.

    • Pulling a toddler along while walking or quickly grabbing his or her hand can jerk the arm, causing the radial head to slip. Remember to be gentle when taking a child by the hand.

2. Pulling a child up by the hands. Pulling on hands or forearms can put stress on the elbows. Never pick up a toddler or infant by the hands or wrists. Lifting under the armpits is the safest way to lift a child.

3. Swinging a toddler by the arms. Any type of swinging by holding the hands or wrists can put stress on the elbow joint and should be avoided.

4. Breaking a fall with the arm. The natural response to falling is outstretching an arm for protection. The elbow can overextend during this action, resulting in a slip of the radial head.

5. Rolling over in an awkward way. Sometimes rolling over in a crib, bed, or on the floor can cause nursemaid’s elbow in infants and very young children.

The injury happens in younger kids because their ligaments (the elastic-like bands that hold bones together) are loose and bones are not yet fully formed. This makes it easier for some of the bones to slip in and out of place. As kids get older, however, their ligaments tighten, bones enlarge and harden, and the risk of nursemaid’s elbow decreases.

While a child with nursemaid’s elbow has some initial pain in the arm, the injury does not cause any long-term damage. We can gently put the bone back into place, causing symptoms to go away quickly.

If your child is experiencing elbow pain, give our Redwood City office a call.  We can help.


Adolescent (Teen) Sports Injuries

Athletic injuries occur in two different ways.

  1. Macrotrauma: an injury from a major force. Falls, collisions, sudden twisting. Examples are fractures, sprains and strains, bruises or cuts.
  2. Microtrauma is normally due to repetitive actions over a long period of time causing injury. Examples stress fractures, little league elbow, golfer’s elbow and shoulder impingement syndrome.

In high school, football accounts for the most injuries in boys, while soccer accounts for most injuries in girls.

Sprains of ligaments, muscle strains and bruises account for most of the acute injuries. However, repetitive and overuse during sports are more common in adolescents than acute injuries. Research studies have shown that up to 48 percent of high school athletes sustained one injury during their playing season.

Why are adolescents at risk for injury?

While they are still growing, the skeleton takes on the increased weight and load put forth during an athletic activity. They are not fully formed and as a result, there is increased risk for a severe injury in teens. During growth and development, agility, power, speed and motor coordination improve.

During their growth spurt, lengthening of the bones occurs before growth in the connective tissues. As a result, there may be a relative decrease in flexibility during this period. Girls tend to be more flexible than boys and peak in their flexibility around age fifteen years compared to boys who develop increased flexibility later in adolescence. Decreased flexibility may cause an increased risk for overuse injuries in both boys and girls.

There are other factors that may contribute to a teenager sustaining an athletic injury. These include the following:

  • Hazardous playing fields
  • Poor conditioning
  • Competing while injured or fatigued
  • Poor nutrition
  • Poor physical fitness
  • Inadequate supervision
  • Stress
  • Weather conditions
  • Inadequate, poorly fitted, improper safety equipment
  • Teams set by age rather than size

How are athletic injuries treated?

For acute injuries, always remember the mnemonic PRICE. Sprains and strain may be treated with Protection, Rest, Ice, Compression and Elevation.  Fractures may require casting.  Allowing the body to heal and alleviating the swelling can allow rehabilitation process to start. After the swelling is eliminated, appropriate adjustments can be administered, scar tissue can be properly addressed and exercises can be given.

How can we prevent these athletic injuries?

The following are some of the strategies that may help teens prevent athletic injuries:

  • Get a sports physical examination before allowing participation
  • Before each training or sports event, warm up and then cool down afterward
  • Do flexibility exercises
  • Play within safe ranges for one’s age and size
  • Use proper and well fitted equipment
  • Stay physically fit
  • Begin training one to two months before the season of the sport to prevent trauma to the body
  • Gradually increase training time but not more than ten percent each week

Parents should recall the following strategies to help prevent athletic injuries in adolescents:

  • Encourage teens to participate in several different sports
  • Be sure that coaches adhere to appropriate training principles
  • Modify rules for adult games so they are appropriate for adolescents
  • Ensure contests are supervised carefully and rules strictly enforced
  • Safety is more important than winning

-MassGeneral Hospital for children

3 Examples To Prevent injuries while doing Yoga

When done correctly, yoga provides you with a stronger, flexible body.   It relaxes you, increases your athletic performance, sharpens your concentration and promotes better breathing.   This is all wonderful but if yoga is done incorrectly, it can result in injuries including pulled muscles, joint pain, hernias or chronic problems leading to chronic problems and permanent disability.

Knowing what is good for you and not good for you will keep you healthy and prevent chronic injuries.  Partial poses keeping a strong core and proper body alignment is recommended rather than perform poses that puts added stress into the body. Yoga can be very physically challenging and hard on your joints so knowing your limits will allow you to prevent injuries.

How do Yoga Injuries Occur?

Injuries usually occur when:

  1. Trying hard poses when your body is not flexible or strong enough
  2. Not posing correctly
  3. If you have a physical problem already and you push yourself too hard, you may worsen it by pushing beyond their capabilities

What are some common yoga injuries?

  • knee popping or clicking
  • Chronic adhesions and scar tissue injuries happening over time because of long-term repetition of poor technique.

Neck: Poses like “plow,” “shoulder stand” and “headstand” if done improperly can put undue pressure on the neck and cause pain or discomfort. Beginners should try these poses only under the close supervision of an experienced teacher.

Wrists: Do you have carpal tunnel syndrome or weak wrists? Then do not perform poses that put excess weight on your wrists.

Knees: Don’t force your knees into Lotus or other vulnerable positions. Without adequate hip-joint flexibility you could tear a meniscus (cartilage) or you could stretch or tear one of the knee ligaments.

Lower Back: Forward and backward bends and twists, if done incorrectly, can result in back damage. Do not over-twist or push your back through a painful bend.  Your body is telling you that it is too much!

Inversion Poses: Inversion poses like shoulder stand and headstand put the head lower than the heart and raise blood pressure. If you have cardiovascular problems, hypertension, diabetes or glaucoma please don’t do these poses.

A great rule of thumb…make sure you are supervised if you are beginning so you prevent injuries.  If you have been doing yoga for a long-time, periodically have someone look at your posture and poses to make sure you are still doing them correctly.

Is Swimming Good For Back Pain?

In many cases, swimming can be a very helpful exercise for back pain sufferers.  Athletes commonly become injured and swimming is a great way to keep active without putting excess strain on a swimmers back.  However, that is not to say that swimming can’t cause back pain or injuries as well.

Sometimes lower back pain can be caused from swimming when the muscles in the lower back become hyper extended, or over stretched, during the breaststroke or other forward stokes. In addition to hyper extension of the lower back, the cervical spine, or upper spine and neck, can also become injured while swimming. Repetitive jerking motions of the head during frontward stokes could also seriously injure the area.

The neck and cervical spine are particularly prone to injury while swimming. The anatomy of this area of the spine is very complex and is composed of seven vertebrae surrounding the spinal cord, which extends downward from the brain. Stretching outward from the spinal cord are nerves which travel to muscles and other tissue throughout the body.

To prevent back pain while swimming, it’s crucial that you use proper form and techniques. Unnatural or awkward movements while swimming can easily damage tissue through the back, so it’s important to maintain the correct stokes and movements. In addition, swimming with sidestrokes or backstrokes can also minimize stress on the back when compared with frontward strokes. When doing the front crawl or other forward strokes, make sure to roll your body when taking a breath and avoid jerking the head backwards so that you can reduce strain on the neck. Using a snorkel can also help reduce the awkward movement of the neck by reducing the need to adjust the head when taking breaths. Wearing a mask or goggles can also reduce unintentionally jerky head movements while trying to get water out of the eyes. Boards, life vests, or other types of floatation devices can also help maintain proper form while swimming.

If you are actively involved with swimming and are experiencing neck or back pain, seek the advice of a coach or more experienced swimmer. If they spot you while swimming, they may be able to determine if something is wrong with your stroke and can advise you on proper technique.

Specific swimming strokes can cause their own unique back injury problems. Here are some items to be aware of when doing certain strokes:

  • For the freestyle, make sure you do not rotate your head too much when taking breaths. In addition, do not let your head move up too much or deviate from the axis along the length of the body. Deviating from this axis, or over rotating the head, can easily lead to neck and back injury while swimming. Also, when you’re not going up for breathes make sure you keep your head looking downwards. As already mentioned, rolling too much can easily lead to damage.
  • With the backstroke, muscles along the front of the neck tend to become fatigued if you have not done that stoke in a long time. Make sure to ease into this stoke and avoid over doing it.
  • When doing any flipturns, tuck your head in and don’t have it extended outward from your body.
  • For the breaststroke, keep your head and neck still, while gently raising the head and back to take breathes.

When back pain becomes a problem there are several methods to help relieve discomfort:

  • Stretching, icing, and using over the counter medications such as ibuprofen are also very conservative ways to help reduce discomfort with mild cases of back pain.
  • However, with more serious pain, more serious forms of treatment may be required and seeking the help of a chiropractor or physical therapist may be more beneficial. With chiropractic manipulations, pain can often be relieved in many instances, but not necessarily for everyone.
  • Physical therapy is a common treatment for back pain ailments. Physical therapists design specific exercises and routines that are intended to both strengthen the tissue in the back while increasing flexibility, helping to minimize back pain.
  • Back braces are also a common way to treat back pain since they help to limit awkward movements and aid in the treatment of injured tissue.

If swimming continues to be painful it’s important to stop and seek the advice of a physician in order to stop back pain. By continuing to swim despite continual or worsening pain, the condition affecting the back may become worse and more serious forms of treatment may be required to reverse discomfort. Only in rare cases is surgery required to reverse ailments that affect the back. However, there are still instances where surgery may not be enough to completely reverse back pain conditions.

In many cases, swimming can actually help back pain. Swimming is an activity that is good for you, and it also does not usually strain or add significant weight to the back. This makes it a great alternative for those looking for an exercise that won’t aggravate their neck or back, as well as any other conditions that may be affecting their bodies. However, repetitive or awkward movements in the pool can lead to injury, so it’s important to learn the proper safety methods and techniques to avoid injury to the back

Kneecap (Patella) Pain And Instability, What Can Be Done?

Proper movement of the hip and leg are essential for walking, jumping, running. During any leg movement, your kneecap (patella) moves up and down because of contraction and relaxation of the quadriceps muscles. Bending your leg pulls the kneecap down and straightening your leg brings it up.

There is an indention or groove in the front of your leg that allows the kneecap to glide smoothly up and down and not rub directly onto the bone. Sometimes the indention is not deep enough, muscles are not working properly or your bone is out of place.  This can cause your kneecap to move improperly and slide outside of the groove. In time, this promotes arthritis, pain and long term bad body mechanics. This can lead to painful surgery and long periods of rehabilitation.

Here are some symptoms of kneecap instability and incorrect body mechanics:

    • 1. Knee buckles and can no longer support your weight

2. Kneecap slips off to the side

3. Knee catches during movement

4. Pain in the front of the knee that increases with activity (especially while running)

5. Pain when sitting, standing or bending

6. Stiffness

7. Cracking sounds during movement

8. Swelling and pain


If the kneecap has been completely dislocated out of the indention or groove, it must be put back. This is not as painful as it sounds. Sometimes it can happen when you are bending or moving. The kneecap just pops back into place. Other times, it is gently placed back in the groove with an adjustment.
During an examination, I can normally figure out if one of your quadriceps muscles is either too strong or too weak. This can lead an improper pull of the kneecap during movement. Stretches or exercises can even out the force in the area and keep your kneecap moving properly.

Allowing the kneecap to move properly in the groove will keep the risk of arthritis, tendonitis and knee replacement at low risk.  It will also allow you to keep the active life style that you need to stay fit and healthy.

Mallet (Not Mullet) Finger, A Common Baseball Injury

What is it?

Mallet finger or “baseball finger” occurs when the tendon which extends or straightens your finger is shortened and damaged.  Sometimes a ball may hit the top of your finger and cause tears making the finger to shorten up and not straighten out.  A fracture can happen in some instances depending on the force of the ball.

How do I know if I have it?
There are several symptoms of mallet finger.   Pain, swelling and bruising are common indicators.  Drooping of the tip of your finger may be noticeable.  Bruising underneath the fingernail may occur and in some cases, you may loose your fingernail.

Most mallet finger injuries can be treated without surgery.  It takes time to slowly train the tendon to move correctly and scar tissue has to be cleared away to make sure proper mobility can be obtained.  If the injury is new, elevate the wrist to above heart level and apply ice.   should be applied. and the normal rules of P.R.I.C.E (protection, rest, ice, should be applied.  elevated above the level of the heart.   If you have blood beneath the nail or your nail has fallen off,  make sure to get an x-ray to see if there is a fracture.

Splints are often used to keep the finger straight but make sure to periodically take it off and loosen up the tissues surrounding the finger.  This will allow blood flow and mobility to increase.

In my experience stretches of the finger along with soft tissue work get great results and keep chronic flare-ups at a minimum.