Friday, 16 June 2017

Treatment for Adductor Muscle Strain in Malaysia


Physiotherapy and chiropractic treatment can be commenced as soon as possible when an acute adductor strain in the hip is present. Patients normally present with inner thigh pain or groin pain near the inferior pubic bone. The strained adductor muscle can be very tender upon palpation and stretching of the adductor muscle can reproduce the pain. The initial treatment approach is to reduce swelling and bleeding at the injured site. Therapeutic modalities that help to promote soft tissue healing can be used.

Active pain-free exercises and gradual strengthening exercises for the adductor muscle can be commenced with care after the first 48 hours of injury. Functional strengthening that involves more aggressive movements such as stationary bike, pool running, jogging or swimming can be part of the treatment in the later stage. Once the full passive and active range of motion of the injured hip returns to normal and with full strength, the athlete can return to progressive sport-specific training that involves sudden and rapid change of direction.

Exercises such as running in a straight line or figure of eight and kicking should be avoided in the early stages of rehabilitation. Early return to these exercises without sufficient rehabilitation may predispose the athlete to recurrent adductor muscle strain. The treatment for adductor muscle strain should include management of the associated low back pain or pelvic imbalance at the same time in order to prevent chronic recurrent pelvic and hip injuries. 

Sunday, 11 June 2017

Adductor Muscle Strain in Malaysian Athletes


Adductor muscle strains are very common among athletes whose running involved sudden changes of direction. The location of the pain is usually very easy to identify as the pain usually present at the belly of the adductor longus at the inner thigh or near the origin on the inferior ramus. The pain normally will start immediately after the injury. Physiotherapy and chiropractic care can help to increase the healing rate and reduce the time required to get back to sports. Stretching of the adductor muscle with passive hip abduction can cause the pain. Resisted adduction will cause active contraction of the muscle can cause pain at the injured site too.


PRICE regimen for acute injury should be initiated within 48 hours after the injury to reduce the swelling and bleeding at the injured site. PRICE regimen includes protection, relative rest, ice, compression and elevation. Early stretching of the adductor muscle is not recommended for treating acute muscle strain as this may cause chronic tendinopathy of the adductors in the future. Progressive strengthening exercises such as pain-free range of motion (adduction and abduction) can be commenced after the first 48 hours if there is no other re-injury of the adductor muscle. Resisted adduction/flexion of the hip with a resistance tube or light weight can be included if active abduction and adduction are not causing any pain. Stabilising exercises such as pulleys with other leg and one leg squat is recommended to strengthen the core muscles and the adductor muscles at the same time. 

Tuesday, 6 June 2017

Hip and Groin Pain in Athletes


Sudden onset of hip pain is quite common in athletes who are involved in sports that require a lot of twisting, turning and kicking. Athletes who are actively involved in soccer and Australian football are at a higher risk of sudden hip and groin pain due to musculoskeletal injuries. The presenting symptoms may vary according to the structures that are damaged. Adductor muscle strain is a very common cause of inner thigh pain. Injury to the hip joint, such as labral or chondral tear, can lead to severe hip and groin pain. Injury of the muscles and bursae associated with the hip joint can co-exist with a hip joint injury.

The location of the pain is the most useful sign to localise the area abnormality. Differential diagnosis can be made based on the location of the pain. The adductor muscle, iliopsoas and rectus femoris are the more commonly strained muscles. A strain of the above-mentioned muscles can cause pain at the inner thigh or groin region.


There are some more severe causes of hip and groin pain that should not be missed by the health care practitioners. Intra-abdominal abnormality such as appendicitis or urinary tract abnormality can sometimes refer pain to the inner thigh and hip region. Rheumatological disorders such as ankylosing spondylitis can cause hip and groin pain as there are extensive tightness in the hip flexors. 

Thursday, 1 June 2017

Posterior Thigh Pain and Hamsting Muscle Strains in Malaysia


Hamstring is a group of muscles located in the lower part of the buttock and it extends all the way down into the back of the knee. It plays a main role in extending the hip, bending the knee and rotating the leg. These actions are involved in several activities of daily living such as running, walking and jumping. Therefore, hamstring muscle strain is a very common injury among sprinters, hurdlers, long jumpers, footballers, Australian football and field hockey players. These activities normally involve a lot of high speed running and forceful kicking. Hamstring strain can have severe impact on the performance of the athlete and absence days of training can be quite high too. Recurrent injury of the same muscle or associated muscles can happen as a result of inadequate post-injury physiotherapy and rehabilitation.


Biceps femoris of the hamstring muscle group is the most commonly injured muscle. The musculotendinous part of the biceps femoris is at a higher risk of injury especially during sprinting. This injury normally present as a non-contact injury. The hamstrings are likely to reach its point of failure during the terminal swing phase just prior to foot strike as this is the point of maximum eccentric contraction. During the terminal swing phase, the hamstrings are undergoing eccentric contraction to decelerate the swinging tibia while extending the knee to prepare for heel strike. During the initial stance phase, the hamstrings are now working concentrically to extend the hip joint. 

Saturday, 27 May 2017

Prolonged Sitting is Killing the Lower Back in Malaysia

Sitting over a prolonged period of time is one of the most important factors that aggravate the lower back condition. Most of the Malaysians are adopting the sedentary lifestyle which involves a lot of sitting. Most people spend about 75% of the time in a day in a seated position. Malaysians are trained to sit since our younger age. We spend at least 15 years sitting in the classroom for studies if not more. The lectures may last from 30 minutes to 2 hours for each subject and school kids spend 6 to 8 hours in the school almost every day.

The working environment for adults is actually creating more issues that are affecting the health of our spine. Long hours of desk work or computer work, prolonged sitting for meetings and prolonged driving are causing continuous damage to the spine. Repeated damage to the spinal disc over a prolonged period of time can cause severe spinal problems and severe pain in the lower back or lower limbs.


The weight of our body transmitted to the spinal disc in the lower back will increase tremendously in a seated position when compared to standing or lying down. This is causing a lot of stress and continuous damage on the lowest segments in the lumbar spine. If this repeated damage occurs every day over the years, the spinal discs are unable to recover properly. This can lead to serious spinal disc problems that can present as lower back pain and pain and/or paraesthesia that radiates into the lower limbs.

Monday, 22 May 2017

Jaw Exercises for TMJ Pain in Malaysia

Place one to two fingers on both sides of your jaw. Apply a gentle pressure against the jaw while try to open the mouth slowly without letting it clicks. Repeat the exercise again if the jaw clicks in the middle of the procedure. Repeat this exercise without clicking of the jaw for 10 times. This exercise allows a better control of your jaw movements and the gentle pressure applied helps to correct the jaw misalignment.

Another exercise that can increase the mobility of the jaw while allowing better rotation of the jaw. Place the tongue against the roof of your mouth and slowly open your mouth as wide as you can. Hold for 2 seconds while breathing in slowly. However, the tongue should remain in contact with the roof of your mouth throughout the whole exercise. Repeat the exercise for 10 times.

Strengthening exercises for the jaw muscles are needed to make sure the temporomandibular joint has the stability and mobility to perform all the movements required. Isometric strengthening exercises can strengthen the jaw muscles while relaxing the muscles on the opposite side. Make a fist and place it under your chin. Open your mouth slowly while the fist is applying a gentle upwards force under the chin. This upwards force should resist the opening of the mouth. Hold the pressure for 10 seconds. Repeat this exercise for 10 times.


The next exercise is similar to the one described above. Place the left hand on the left side of your face. Move your jaw to the left side against the left hand while applying a gentle force to the right with your left hand. Hold for 10 seconds and repeat the procedure on the right side. 

Wednesday, 17 May 2017

Exercises for Jaw Pain or Temporomandibular Joint (TMJ) Pain in Malaysia

If you are suffering from severe jaw pain and have difficulty chewing or talking, health care practitioner such as physiotherapist or chiropractor can help you to relieve the pain. Jaw pain in Malaysia commonly consists of a restricted range of motion in TMJ, muscle tightness and pain around the jaw, upper neck pain, and headache. There are a few exercises that can improve the jaw pain while getting more mobility in the jaw.

You can apply heat packs on both sides of the jaw for 10 minutes before you start the exercises. This helps to increase the blood circulation to the jaw muscles and can further relax a tight muscle. Then you can try to massage the jaw on both sides of your face gently with two fingers in a circular motion. Try to be as gentle as possible within your comfortable level as this may cause you more pain if you overdo it.


Gently and slowly open your mouth and place one finger in between your front teeth. Hold for 5 seconds and repeat the exercise for 5 times. Next, try to place a knuckle in between your front teeth. Hold for 5 seconds and repeat the exercise for 5 times. Then repeat the same procedure with 2 fingers, 2 knuckles or 3 fingers gradually. This can help to stretch the jaw and improve the range of motion of the jaw. A jaw with a normal range of motion can easily accommodate 3 fingers in between the front teeth with no pain and discomfort. 

Friday, 12 May 2017

Rehabilitation Program for Musculoskeletal Injuries with Spinercise in Malaysia


The conservative management of a musculoskeletal injury should include a multi-modal treatment program that may include chiropractic care and physiotherapy to address different aspects of the injury. The initial treatment approach involves pain management and preventing further damage to the injured structures and tissues. This part of the treatment program may give the patient a pain-free period while able to return to activities of daily living. However, the rehabilitation exercises in the later part of the treatment program are needed so that the patient is able to return more aggressive sports injury and to prevent reoccurrence of the same condition.

Rehabilitation is necessary after musculoskeletal injuries and post-surgery. Rehabilitation allows a patient or athlete to return to aggressive activities of daily living or sports with full function in the shortest possible time. If rehabilitation after a musculoskeletal injury is not done properly, the damaged site may be re-injured again easily. Other than that, the joints or soft tissues adjacent to the damaged site are at a higher risk of injury as the patient may compensate with other parts of the body to perform the activities. An athlete may not be performing at his or her best state or even may not be able to perform at his or hers pre-injury standard.


Spinercise is a device designed specifically for musculoskeletal rehabilitation, especially for lower back and knee injuries. Spinercise helps to strengthen the specific muscles required to provide stability to the joints. 

Sunday, 7 May 2017

Less Common Causes of Cervical Myelopathy in Malaysia

Compression of the spinal cord in the cervical spine that results in motor and sensory dysfunction affecting the upper extremities is known as cervical myelopathy. Sometimes a severe compression of the spinal cord at the cervical region can also cause motor and sensory deficient in the lower extremities and disrupt the bowel and bladder function. Degenerative changes in the cervical spine can cause severe cervical myelopathy. There are a few causes that lead to compression of the spinal cord in the cervical region. Narrowing of the spinal canal where the spinal cord is located due to degenerative processes or congenital causes can cause cervical myelopathy. Ossification of the posterior longitudinal ligament or calcification of the ligamentum flavum can result in spinal cord compression. Posterior bony osteophytes arising from the vertebral bodies and uncinated processes can cause narrowing of the spinal canal. Disc herniation or slip disc in the neck is another common cause for cervical myelopathy.


Degenerative changes of the lower cervical spine are more common and can cause more significant signs and symptoms in the affected region. C5/C6 and C4/C5 are the two most common levels affected by degenerative processes in the cervical spine. Spondylosis of the facet joint or hypertrophy of the facet joints can be a cause of spinal canal stenosis and cervical myelopathy. However, the presence of spondylosis or hypertrophy of the facet joints only rarely causes spinal cord compression. There may be other factors that are causing spinal cord compression at the same time. 

Tuesday, 2 May 2017

Knee Pain after Sports Activity in Malaysia


Acute knee pain is very common during sports, especially football, basketball, netball and alpine skiing. These activities involve a lot of twisting around the knee joint and sudden changes of direction. These movements will put additional stress on the knee joint if there is insufficient muscle strength to support the knee. Acute knee injuries can be disastrous for athletes as they can lead to disability, time off sport and recurrent injuries.

The knee actually involves two different joints that are located very closely to each other. The tibiofemoral joint consists of the thigh bone (femur) and the leg bone (tibia).  This tibiofemoral joint is commonly referred as the knee joint. Medial and lateral collateral ligaments, anterior and posterior cruciate ligaments and the meniscus that is associated with the tibiofemoral joint are the major stabiliser of this joint. The patellofemoral joint consists of the knee cap (patellar) and the thigh bone (femur). The stability of the joint comes from the medial reticulum and the patellar tendon/ligament.


Each and every ligament associated with the knee and the meniscus play different role to provide stability to the joint. Therefore understanding the mechanism of injury during history taking can provide crucial information to find out the most likely injured structures in the knee. However, there will be damage to multiple associated structures when there is ligamentous damage in the knee. A holistic treatment
approach for knee pain that involves ligamentous damage should also address the other associated structures.

Thursday, 27 April 2017

Elbow Pain Treatment in Malaysia

There are different causes and various types of injury that can lead to elbow pain. A health care practitioner should first identify the major causes of pain so that the treatment can be targeted at reducing or correcting the anomalies. Chiropractic care and physiotherapy in Malaysia are proven to be able to reduce the symptoms of most elbow injuries with a musculoskeletal cause. However, there is no one single treatment has proven to be highly effective in treating a musculoskeletal condition of the elbow joint. A multi-modal treatment approach has been proven to be effective in resolution of the symptoms of most musculoskeletal based elbow injuries.


The treatment approach to address the musculoskeletal problems that leads elbow pain is similar to other treatments for soft tissue injuries. Initially the main goal of the treatment is to control the pain and promote the healing process. Restoration of flexibility and strength of the muscles and connective tissues can be achieved by active and passive stretching and strengthening exercises. Manual therapy, chiropractic adjustment and therapeutic modalities can be effective to treat associated factors such as increased neural tension and referred pain. Gradual return to sports activity can be achieved with functional strengthening exercises. Correction of the predisposing factors, especially poor techniques during sports activities, is very crucial in preventing re-occurrence of the same injury. 

Saturday, 22 April 2017

Chiropractic Care for Elbow Pain in Malaysia

There are two main types of injuries in patients with pain on the inner side of the elbow. One of the injuries involve repetitive stress to the tendinous insertion of the wrist flexors at the inner elbow. The tendons of pronator teres and the wrist flexors group are being irritated due to excessive activity of the wrist and hand. This condition is commonly known as the Golfer’s elbow, or flexor/pronator tendinopathy.

The other cause of inner elbow pain is due to excessive throwing activities. The throwing action can cause additional stress on the medial collateral ligament due to increased valgus stress on the elbow. The anterior part of the medial collateral ligament and the joint contour of the radiocapitellar joint are the major contributors to the stability of joint under valgus stress. Poor throwing techniques and repetitive throwing can lead to over-stretching of the medial collateral ligament. This can result in an instability of the joint due to increased laxity of the ligament.

Prolonged injury to the medial collateral ligament may lead to additional scar tissue deposition. This can result in fixed flexion deformity of the elbow joint. If this fixed flexion deformity continues, synovitis or loose body formation may develop in the elbow joint as the medial tip of the olecranon can impinge on the olecranon fossa. There may be an increase compressive force which can damage the radiocapitellar joint when additional valgus stress is exerted on the unstable elbow joint.
Chiropractic care in Malaysia can help with the elbow pain by correcting the misalignment of the elbow joint and muscle imbalances. We can also give you some advice on how to perform the exercises that you like without hurting yourself.







Monday, 17 April 2017

Neck Pain due to Slip Disc

Slip disc in the neck can cause neck pain, upper back pain, headache, and pain or paresthesia that radiates down the arm, forearm, hand and fingers. Physical exertion or trauma can lead to symptomatic cervical disc herniation. Slip disc in the spine does not happen overnight. Normally degenerative changes in the spine that change the structure of the spinal disc happened over a period of time before the disc herniates and become symptomatic. There are studies that showed weight lifting, especially lifting free weights, and bowling may increase the risk of disc herniation in the cervical and lumbar spine.

Patients who have done prior spinal surgery may be at risk of developing slip disc in the spine due to degenerative disc disease. Spinal segments adjacent to the surgical level are more prone to degenerative disc disease as there will be additional stress being placed on the segment above and below the affected level. People with increasing age are more likely to develop degenerative disc disease due to the natural history of aging and wear and tear over the years. Cigarette use and nicotine intake may correlate with radiological findings of degenerative disc disease as these may disrupt the bone metabolism of the spinal vertebrae.

Typically symptomatic slip disc in the neck that does not involve any trauma may recover within the first 4-6 months after the onset of symptoms with some form of treatment. However, the damaged disc may take up to 2 years for complete recovery due to the slow healing rate of the spinal disc. 

Wednesday, 12 April 2017

Chiropractic Care for Neck Pain


Slip disc in the neck can lead to diverse patterns of symptoms including neck pain, radicular pain into the upper limb, numbness, tingling or burning sensation of the upper limb, and progressive weakness in the upper limb. People who develop slip disc in the neck without a trauma usually reports that they wake up with sudden onset of symptoms. The health care practitioner should have a list of differential diagnosis in mind as the presenting symptoms may overlap with these diseases and syndromes. Space-occupying lesions and tumour should be considered in the correct population, especially those with genetic predisposition.


Further imaging of the cervical spine is needed to rule out other serious causes of cervical radiculopathy. People with unusual presentation or those who do not respond well to initial conservative treatment will need imaging of the cervical spine for further investigation. Spondylosis is the most common differential diagnosis; however, spondylosis can sometimes co-exist with slip disc injury. There are a few differential diagnoses with similar presenting symptoms such as peripheral compressive neuropathy, spinal trauma, spondylolisthesis, root avulsion, radiation injury, infiltrative, infectious, para-infections, and metabolic conditions, muscular pathology, brachial plexus pathology, rotator cuff disease, arthritis, or complex regional pain syndromes.  The list should not be limited to the above-mentioned differential diagnosis as each patient should be evaluated to find the most suitable working diagnosis that explains the patient’s symptoms. 

Friday, 7 April 2017

Neck Pain and Slip disc in Malaysia


Chronic neck and back pain is becoming an epidemic in Malaysia and is affecting a lot of people at different stages of their life. One of the reasons for the development of chronic neck and back pain is the sedentary lifestyle that we are adopting due to the advances of technologies. Occupations or habits that require repeated heavy lifting, prolonged sitting, prolonged desk work or activities that involve repeated axial loading can cause damage to the spinal disc in the neck and back. People with a genetic predisposition to early degeneration of the spinal disc or inflammatory disease are at a higher risk of developing slip disc in the neck and back.

The C6/C7 disc is the most commonly affected spinal segment in the cervical spine. Slip disc at this level will cause irritation and compression of the C7 nerve root. Common symptoms of slip disc at this level include neck pain, posterior arm pain, triceps weakness, wrist drop, and numbness, tingling or burning sensation of the middle finger. Slip disc at C5/C6 and C7/T1 levels are the second most commonly affected spinal segments in the neck.


Slip disc injuries at different levels that are symptomatic can cause pain and sensory changes in a specific pattern according to the dermatomal distribution and weakness in specific muscles. The symptoms in each slip disc cases may be different but normally involve neck pain, radicular pain, paresthesias, and progressive weakness. 

Sunday, 2 April 2017

Slip Disc (Slipped Disc) in the Neck

The cervical spine in the neck consists of 7 bony vertebrae, from C1 to C7. The cervical spinal cord is protected by these bony vertebrae as it travels down from the brain. The cervical spinal cord is considered as the most important part of the spinal cord when compared with the thoracic, lumbar and sacral levels. The cervical spinal segments of the spinal cord contribute to the major musculature of respiration and are involved in the autonomic nervous system of our body. Therefore, an injury to the cervical spinal cord can lead to major dysfunction of the body system and sometimes this can be fatal. Herniated nucleus pulposus, or slip disc (slipped disc), and degenerativedisc disease are the two most common disorders affecting the spinal disc in the cervical spine.


There are a few causes that can lead to slip disc injury or nucleus pulposus herniation in the cervical spine. A trauma or accident can cause spinal disc injury with a sudden onset. However, most of the slip disc injuries in the neck are caused by prolonged irritation from chemical and mechanical degenerative changes in the cervical spine. Occupation based injuries are one of the main contributors to slip disc in the neck, especially prolonged desk work with poor work place ergonomics. Slip disc in the neck can cause not only neck pain but also pain and/or numbness and tingling sensation in the upper back, arm, forearm, hand and fingers.

Tuesday, 28 March 2017

Frozen Shoulder Treatment in Malaysia

Frozen shoulder normally presents as a sudden onset of shoulder pain followed by marked stiffness in the shoulder and significant limited range of motion in the affected shoulder. Both passive and active range of motion of the shoulder is significantly reduced. The condition rarely attacks the same shoulder unless the shoulder joint is repeatedly injured due to physical activities, trauma or disease processes. The proposed aetiology for the development of frozen shoulder, also known as adhesive capsulitis, is the contracture of the glenohumeral capsule. The involvement of the coracohumeral ligament that lies adjacent to the glenohumeral capsule and rotator cuffs is noted in most of the arthroscopic and histologic studies. This condition is usually self-limiting; however, the signs and symptoms may last from 6 months up to 2 years without treatment. It has been reported that there may be up to 41% of patients have mild to moderate residual symptoms 7 years after the initial onset and less than 10% of patients present with continuous severe symptoms with pain and functional loss. 


The most effective treatment for frozen shoulder in Malaysia involves non-surgical interventions that address the symptoms at different stages. Health care practitioners should be able to recognise the different presentations of frozen shoulder and should understand that this condition is a continuum rather than having well-defined stages. Physiotherapy that includes different modalities and manual therapy can help to alleviate the symptoms and improve the mobility of the shoulder joint. Chiropractic care can provide some relief to the symptoms and mobilise the shoulder and the adjacent joints. Home exercise plays a major role in restoring the range of motion of the shoulder joint. 

Thursday, 23 March 2017

Shoulder Pain Treatment and Frozen Shoulder Treatment in Malaysia

Frozen shoulder, or adhesive capsulitis, is more common in Malaysians age 40 to 70 years. People with frozen shoulder normally present with sudden onset of shoulder and arm pain without a history of injury or trauma. Patients normally complain of shoulder pain that can extend into the arm region. The local shoulder pain can present over the front and inner part of the shoulder and radiates into the biceps region or over the outer part of the shoulder and radiates into the lateral deltoid region. There is a marked loss of both active and passive range of motion of the shoulder, with at least 50% loss of external rotation.

Frozen shoulder is classically divided into 3 different stages:
  • Freezing (sudden onset of diffuse shoulder pain with progressive loss of shoulder range of motion)
  • Frozen (the pain subsides gradually, however the stiffness in the shoulder remains, restricted motion in both active and passive movements)
  • Thawing (gradual resolution of symptoms and improvement of the marked stiffness in the shoulder)


There is no external cause or preceding shoulder condition to a “true” primary frozen shoulder. There is no systemic diagnosis, precipitating shoulder injury or diagnostic imaging to explain this sudden painful shoulder with significant restriction of the range of movement. However, there may be positive results with arthroscopic and histologic studies of the shoulder. These studies may show evidence of glenohumeral capsular contraction, especially the coracohumeral ligament within the rotator interval. This condition is thought to be self-limiting, however, physiotherapy and chiropractic treatment can help to alleviate the shoulder pain and restore shoulder range of movement. Treatment for frozen shoulder in Malaysia can help to prevent residual symptoms and pain with loss of function of the shoulder joint in the future. 

Saturday, 18 March 2017

Non-Surgical Treatments for Cervicogenic Dizziness in Malaysia


Aquatic recreational sports activity can sometimes lead to dizziness, and this is most commonly associated with diving-related injuries to the ear, for example, alternobaric vertigo, perilymphatic fistula, and inner ear decompression vertigo. However, when pathologic, diving and ontologic related causes of dizziness during or after aquatic sports activity are ruled out, cervicogenic dizziness can be the possible differential diagnosis. Cervicogenic dizziness is often associated with stiff neck, pain in the neck or upper back, restricted movement of the neck, forward head carriage posture, and dizziness upon palpation of the tender neck musculature or upon certain movement of the neck.

Disorder of the cervical spine is the leading cause of dizziness. Our clinical teams of Physiotherapists and Chiropractors use advanced breakthrough technology coupled with specific methods of chiropractic and physiotherapy treatments. Learn more about our neck pain treatment in Malaysia.

Dysfunction of the cervical spine is one of the possible factors that leads to the development of cervicogenic dizziness. Altered proprioceptive receptors in the cervical spine and abnormal sensory input from the neck can cause dizziness. Inability to realign the head in a neutral position with the eyes closed is a sign of poor cervical perceptive awareness, and this is very common in patients with cervicogenic dizziness. Diagnostic imaging of the spine such as MRI can be prescribed to rule out slipped disc or disc herniation in the cervical spine as this can often complicate the condition.

Treatment of cervicogenic dizziness includes manual physiotherapy and chiropractic treatment. Upper cervical joint mobilization, trigger point release techniques, manual traction, suboccipital release, soft tissue mobilization, stretching of the tight muscles such as suboccipital, levator scapulae, upper trapezius, pectoralis, and rotator cuff muscles can alleviate the symptoms. Rehabilitation exercises such as cervical spine mobilization and stabilization exercises are often helpful for cervicogenic dizziness.

For more information or inquiries about our centers and services for cervicogenic dizziness, neck pain or headaches, please contact our main center at 03-2093 1000.  


Monday, 13 March 2017

Chiropractic Care in Malaysia for Cervicogenic Dizziness


Cervicogenic dizziness can lead to a sensation of room-spinning vertigo, nonspecific feelings of disequilibrium, unsteadiness or light-headedness. This is a result of abnormal afferent nervous input of the neck. The diagnosis of cervicogenic dizziness can only be made by ruling out other differential diagnoses for dizziness. Patients with cervicogenic dizziness usually present with a stiff neck, restricted range of motion in the neck, neck pain, headache, ringing in the ears, jaw pain and upper back pain. Chiropractic care in Malaysia can help to alleviate these signs and symptoms

Repetitive neck movement and posture can lead to the dysfunction of the cervical spine. This can cause an asymmetrical neck rotation and impaired proprioception input. Athletes who are involved in asymmetrical sports activity are more susceptible to cervicogenic dizziness. For example, competitive freestyle swimmers who always turn their head and neck towards the preferred side of breathing during the stroke are at a higher risk of developing neck problems.

The signs and symptoms of cervicogenic dizziness can be reproduced by neck movement and neck pain during physical examination of the cervical spine. Deep palpation of the neck muscles, especially the suboccipital muscles may cause neck pain that radiates into the temporal-parietal region in the head. The suboccipital region, transverse processes of C1 and C2, spinous processes of C2 and C3, levator scapulae, upper trapezius, splenius, rectus, and semi-spinalis muscles may be tender upon palpation and may reproduce the dizziness.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers in Malaysia. 


Wednesday, 8 March 2017

Chiropractic Care for Golfers with Low Back Pain in Malaysia


Low back pain that does not resolve after 2-4 weeks of relative rest may require an evaluation as a more serious type of injury can be the possible source of pain. There is one study which showed that about 80% of athletes with low back pain result from disc herniation were able to return to sports gradually with conservative management. This study showed that most of them took about 5 months to return to their sports. Conservative management of low back pain includes relative rest, physiotherapy, chiropractic treatment, rehabilitation exercises, and oral corticosteroids. Relative rest involves avoiding activities that can cause pain. Chiropractic care coupled with physiotherapy has shown to yeild better results when it comes to treating lower back injuries. 

Once the low back pain has subsided, intensive trunk stabilisation and gradual painless return to sport should be introduced. Every golfer should perform the swing with a stable spine to reduce the chance of injury. Transverse abdominus and multifidus muscles can be strengthened with dynamic stabilisation exercises. These core muscles are vital in reducing the activation of paraspinal muscles throughout the swing and this can reduce the intensity of pain. Proper warm up and stretching for at least 10 minutes prior to the game can reduce the risk of injury. Aerobic endurance of the golfers must be improved as muscle fatigue can be one of the main cause that leads to injury. Shortening the back swing is shown to reduce low back injuries without compensating club head velocity or swing accuracy.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers in Malaysia. 








Friday, 3 March 2017

Chiropractic Care for Low Back Pain in Golfer


Disc herniation (slipped disc), spondylosis, facet joint dysfunction, sacroiliac joint dysfunction, and muscle strain are the relatively common causes of low back pain in golfers and athletes who involved in other sports activities. However, there are other less common causes of back pain such as vertebral body compression fractures. This is especially common in senior golfers who are diagnosed with postmenopausal osteoporosis. Stress fracture of the ribs is another rare source of back pain but must be considered in senior golfers. Ribs 4-6 are the most commonly affected region as a result of weak serratus anterior.

Myofascial pain syndrome is a common cause of chronic low back pain in golfers. Tender, palpable trigger points which can refer pain locally or at a site distant from the point of contact are commonly found in the paraspinal and gluteal muscles. This syndrome commonly co-exists with other sources of back pain.

An accurate diagnosis is required before the health care practitioner can come up with a specific treatment plan to address the specific back injury. Pain management will be the first phase of treatment followed by sport-specific rehabilitation and alteration of the swing mechanics if needed. The recovery duration may vary depends on the severity of the back injury. Biomechanical back pain may resolve within 4-8 weeks, whereas disc herniation and other more serious injuries may need 3-6 months to recover.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers in Malaysia.







Sunday, 26 February 2017

Causes of Low Back Pain in Golf


Spondylolysis is a defect in the pars interarticularis in the spinal vertebra. This is quite common in young athletes, especially those that participate in sports activity that involves repeated hyperextension of the lumbar spine. This can be a cause of low back pain in young athletes and these young adults are more susceptible to low back pain when they grow older. The back pain can be reproduced by hyperextending and rotating the lumbar spine with the back in a hyperlordotic position. Palpatory tenderness is most commonly found next to the midline of the spine. If both the pars interarticularis are defective, the associated spinal segment may slip forward or backward resulting in anterolisthesis or retrolisthesis. This can lead to pain, numbness and tingling sensation that radiates into the leg. The signs and symptoms will be very similar to discogenic pain.

Lower back pain can result from facet joint dysfunction and irritation. Facet joint syndrome can be very similar to spondylosis as the low back pain often aggravated by hyperextension and rotation. Axial compression of the facet joints can result in pain in the lower back too. Inflammation and irritation of the synovial facet joints can cause pain in young athletes. While degenerative changes in an osteoarthritic facet joints is a very common cause of low back pain in older patients.
The modern golf swing that involves axial compression and rotation of the lumbar spine and forceful hyperextension during the follow-through can lead to irritation and inflammation of the facet joints in the lumbar spine.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers in Kuala Lumpur. 








Tuesday, 21 February 2017

Slip Disc (Slipped Disc) and Low Back Pain in Golf


Disc herniation or slip disc is a very common cause of lower back pain in golfers and non-golfers. The patient normally present with acute onset of low back pain following a snap or a clicking sound in the low back. Slip disc is very common in people at the age of 20-40. There may be a radiating pain shooting down the leg in the next 24 to 48 hours following the back injury. The pain, numbness or tingling sensation will most likely radiate down the leg in a specific pattern according to the dermatome. The lowest most disc in the lumbar spine, the L5/S1 disc, is the most commonly affected disc, and the S1 nerve root can be impinged at this site.

Prolonged sitting, aggressive coughing and Valsalva maneuver can increase the pain in the back. The radicular pain in the leg can sometimes be more pronounced than the back pain. Straight leg raise test that involves stretching of the sciatic nerve and spinal nerve roots can aggravate the pain during physical examination of the patient. Neurological examination needs to be performed to look for sensation changes, muscle weakness and reflex changes.

MRI of the lumbar spine may be needed in certain cases to aid in the diagnosis of the slip disc in the lower back. Slip disc can present in the adolescent as well due to the fact that they often participate in aggressive and intensity sports activities.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers.








Thursday, 16 February 2017

Mechanical Low Back Pain in Golf


Mechanical lower back pain is a very common reason for a golfer to seek help from health care practitioners. In younger golfers, sudden growth spurs can be a cause of lower back pain as this may cause a relative tightness of the thoracolumbar fascia and hamstrings. This relatively reduced flexibility can increase the stress on the spine. Whereas in older golfers, degenerative changes at the hip may be a contributing factor for the mechanical lower back pain. Osteoarthritis of the hip can lead to decreased internal rotation of the lead hip during the swing and the additional force will be transferred to the lumbar spine. Therefore, the structures in the lumbar spine exerted by this additional stress.  

Sacroiliac joint dysfunction is a very common cause of lower back pain in young and active populations. Research has shown that up to 40% of lower back injuries are associated with sacroiliac joint dysfunction. The presentation of sacroiliac joint dysfunction can mimic a low back strain or the pain can radiate into the buttock or posterior thigh. The joint is normally quite tender upon palpation and the pelvic landmarks can be asymmetry when compared from side to side. Leg length difference from side to side can cause asymmetry force transmission through the sacroiliac joint and the spine during weight bearing activity. A club that is not suitable for the golfer can result in poor swing mechanics and this can lead to mechanical low back pain. 

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers. 







Saturday, 11 February 2017

Types of Low Back Injury in Golf


The lumbar spine has relatively low tolerance to rotation in comparison to other spinal segments. Therefore, a lower back injury is commonly associated with twisting or torsion of the lumbar spine. A lot of low back pain injuries occur during the backswing axial rotation that exceeded the golfer’s pain-free maximal rotation in the neutral position. Facet joints of the lumbar spine can be injured easily with only 2-3 degree of intersegmental rotation in the spine. The most commonly known mechanism of injury for a disc herniation in the lumbar spine involves axial compression, rotation and side bending of the lumbar spine.

There are a few types of injury for lower back that present in golfers. Mechanical factors such as muscle strain or spasm, discogenic problems, spondylogenic pain or facet-related injuries can cause pain in the lower back. Some other less common factors of low back pain such as infectious, autoimmune, oncologic, abdominal, pelvic visceral causes and psychogenic factors should not be missed and overlooked. However, mechanical factors are the more common reason for lower back pain in golfers.

Mechanical lower back pain usually present as a localised back pain with associated muscle spasm or tightness and restricted movements in the facet joints. The pain can be relieved by relative rest and can be aggravated by movement, such as swinging a club. The pain can have a sudden onset or it can happen gradually. The biomechanics of the swing and overuse are the main reasons for mechanical lower back injury.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers. 








Monday, 6 February 2017

Low Back Pain in Golf


The golf swing is a complicated and asymmetrical movement that involves the coordination of the trunk and the limbs. Significant axial twisting, axial compression, anterior-posterior shearing and lateral bending is being exerted on the spine during the golf swing. The most common cause of low back pain in amateur golfers are poor swing mechanics and poor physical condition. However, the most common cause of low back pain in professional golfers is an overuse injury. The axial compression force exposed to the spine during the swing may reach up to eight times of the body weight in golfers. The force needed to prolapse an intervertebral disc in cadavers is reported to be lower than this axial compression force.

The more upright classic golf swing involves more simultaneous rotation of the hips and shoulders. This result in less rotational stress on the lumbar spine and less sideways bending of the spine at impact. The modern golf swing involves limited hip and pelvic rotation at the top of the backswing, and the hips are used to initiate the downswing while the shoulders and the trunk are still loading in the backswing. The reverse C position, or the hyperextension of the lumbar spine is found in modern golf swing during follow-through. All of the above-mentioned factors can be the reason for lower back pain in modern golfers.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers.








Wednesday, 1 February 2017

Chiropractic View on Low Back Pain in Golf


Golf is a popular sporting activity that provides a social setting for players to spend time with friends. The frequency of play for this sport differs from other sports, as it increases with age. This is a sport without any physical contact and requires relatively low levels of activity but over a prolonged period of time. In male professional golfers, lower back injuries are the most common form of injuries reported, followed by elbow pain and forearm injuries. Whereas in female professional golfers, the most frequently reported injuries are lower back injuries, followed by left wrist injuries. Chronic overuse is the most common cause of injury, especially during the swing at impact and during the follow-through phase.

Research showed that people who involved in golf only are more likely to have low back pain when compared to people who are active in other sports at the same time. This suggests that inactivity and lack of physical fitness prior to taking up golf may be a risk factor for low back pain in golf. One study actually reported a lower risk of lumbar disc herniation in active golfers who played two or more times per week.

The main function of trunk muscles during the golf swing is to stabilise the spine. The erector spinae muscle is found to be more active in pain-free golfers. Golfers with low back pain tend to fire these muscle groups before starting the backswing. This can lead to an increased stiffness of the spine and increased pressure in the lumbar disc. However, these muscles are not activated before the backswing phase in pain-free golfers.

For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers.

Thursday, 26 January 2017

Chiropractic View on Leg Movements in Low Back Pain


Chronic low back pain can affect the movement coordination of the trunk, pelvis and lower limbs during movements in daily living. Changes of level are normally required during walking. For example, when crossing a road, stepping on the sidewalk, mounting doorsteps, climbing stairs and etc. Adaptations in muscle recruitment are necessary and these are more challenging than level walking. Chronic low back pain can have a significant impact on these muscle recruitment pattern and causes a change in the normal walking pattern.

When healthy people without low back pain is requested to stiffen the trunk by contracting their abdominal muscles, or wearing a lumbar support belt that limits trunk movements, this results in similar  outcomes in thorax-pelvis coordination as observed in low back pain patients. However, the pelvis-leg coordination showed slightly different results, with the pelvis movements stayed out of phase with the legs.

During a slow walk, the hamstring activity of healthy people with no low back pain decreases as the walking speed decreases at the end of the swing phase, right before the heel touching down. The knees are more extended at touchdown. People with lower back pain tend to walk slower compared to normal healthy people. Therefore, this suggests that people with lower back pain will have more significantly extended knees and reduced hamstring activity at touchdown. There is an increased in the vertical forces and minor shock absorption when the knee is more extended at touch down.

If you have any back pain associated with prolonged walking, do not hesitate to contact Chiropractic Specialty Center for a check up. For more information or inquiries, please contact us at 03-2093 1000 or visit one of our centers.

Saturday, 21 January 2017

Chiropractic View on Gait Pattern Alterations with Low Back Pain


The gait pattern of a person with lower back pain is usually different from that of a normal person without lower back pain. The most common finding is that people with lower back pain tend to walk slower than the normal healthy individual. The presence of pain and/or the avoidance behaviour associated with pain can explain this slower walking pattern.

In normal healthy subjects without lower back pain, horizontal thorax and pelvis rotation are more in phase when they walk at lower speeds. This means that the thorax and the pelvis rotate in the same direction about the same time. However, when they walk at higher speeds, the phase difference between horizontal thorax and pelvis rotation increases and tends toward anti-phase.

People with chronic lower back pain have difficulty adjusting pelvis-thorax coordination and the horizontal thorax and pelvis rotation are more in phase even when they walk at higher speeds. This remains the same when they are running and they have less transverse plane coordination.

This reduced movement coordination variability can be explained by increased stiffness of the trunk in people with lower back pain. There is an increased activity of the superficial lower back muscles in people with chronic lower back pain in order to protect the spine for unexpected movements of the thorax and pelvis during walking. The muscle activity of the erector spinae and rectus abdominis is increased and this leads to an increased stiffness of the spine.

We are here to help if you are suffering from back pain with prolonged walking. For more information or inquiries about back pain treatment, please contact Chiropractic Specialty Center at 03-2093 1000. 


Monday, 16 January 2017

Treatment for Thoracic Outlet Syndrome with Arm Pain, Numbness and Tingling

Roo’s test has a better sensitivity for provoking symptoms of thoracic outlet syndrome. This test requires the patient to adapt the “surrender position”, which involves hyperabduction and external rotation of the arm. The patient is instructed to open and close the hands for 1-3 minutes with the elbow bent and arms abducted to 90 degrees and externally rotated to compress the neurovascular structures and provoke the symptoms. The shoulder blades need to be evaluated to check for abnormal movement and position of the scapular.

The site of compression of the thoracic outlet syndrome changes the main focus of the treatment. 
However, there are a few treatments that are suitable for most of the cases of TOS. The health practitioner should correct the drooping shoulders, poor posture and poor body mechanics of the patient by teaching them proper positioning while sitting, standing and lying down. 

Manual therapy such as stretching, trigger point therapy, soft tissue mobilization, scapular mobilization and scapula-thoracic mobilization can be used to address tight muscles and restricted tissues. Restoration of the accessory motion at the sternoclavicular and acromioclavicular joints can be achieved by mobilization of the first rib. Side-bending and chin-tuck exercises help to stretch the soft tissues of the neck and strengthen the deep neck muscles. These exercises can correct anterior head carriage. Thoracic extension and brachial plexus stretching exercises can be given to reduce the tension in the muscles and neural structures.

Chiropractic Specialty Center offers chiropractic treatment and physiotherapy for thoracic outlet syndrome with pain, numbness and tingling sensation in the arm, forearm or hand. For more information or inquiries, please contact us at 03-2093 1000.  


Wednesday, 11 January 2017

The Diagnosis of Thoracic Outlet Syndrome


People with thoracic outlet syndrome (TOS) often present with signs and symptoms that result from the compression of the neurovascular structures that travels from the neck to the axilla. They can present with pure arterial, venous or neurogenic picture, however, most health practitioners encounter TOS with a mixed presentation. Signs and symptoms of TOS include, but not limited to, neck pain, shoulder pain, numbness and tingling in the upper limb, weakness in the upper limb, and coldness in the upper limb.

People with a chronic abnormal movement of the shoulder blade are more susceptible to thoracic outlet syndrome. The tightness of the pectoralis minor, scalene and upper trapezius muscle combined with weakness in serratus anterior and lower trapezius can cause excessive anterior tilting and protraction of the shoulder blade. This can cause further compression of the neurovascular structures in the thoracic outlet.

Adson’s test is used to assist the diagnosis of arterial compression in thoracic outlet syndrome. The patient is asked to rotate the head and neck towards the affected side and extend the neck. The practitioner can check for a diminished radial pulse while the practitioner passively abducts, externally rotates and extends the arm of the patient. The patient can take a deep breath and hold it in to further increase the arterial compression at the thoracic outlet. Reproduction of the symptoms with diminished radial pulse indicates positive sign for Adson’s test.

For more information or inquiries, please contact us at 03-2093 1000 or visit Chiropractic Specialty Center


Friday, 6 January 2017

Common Causes of Thoracic Outlet Syndrome in Malaysia


Thoracic outlet syndrome is a group of conditions that involves pain, numbness or tingling sensation in the neck and/or upper limb as a result of compression of the neurovascular structures. This condition is very common in athletes that are actively involved in overhead sports. People with poor posture such as drooping shoulders are more susceptible to thoracic outlet syndrome as the diameter of the cervicoaxillary canal is reduced. Congenital abnormalities of the structures in the neck can compress the neurovascular structures in the thoracic outlet and result in signs and symptoms in the neck and the upper limb. Complete cervical rib, incomplete cervical rib with fibrous band, fibrous band from the transverse process of the lower cervical segments and clavicular abnormalities are a few of the congenital abnormalities that can cause neurovascular compression at the thoracic outlet.

Learn more about thoracic outlet syndrome. 

Cervical ribs can present just on one side but are more commonly found on both sides when present. However, not everyone with cervical ribs have signs and symptoms of thoracic outlet syndrome. In fact, only about 10% of patients with cervical ribs have signs and symptoms of thoracic outlet syndrome. Shortening and tightening of the scalene muscles due to active trigger point can result in thoracic outlet syndrome. Patients with fractured first rib or clavicle, psudoarthrosis of the clavicle, malunion of clavicular fractures, callus formation or crush injury to the upper thorax are at a higher risk of developing thoracic outlet syndrome.

For more information or inquiries, please contact Chiropractic Specialty Center at 03-2093 1000.


Sunday, 1 January 2017

Thoracic Outlet Syndrome with Chiropractic Care and Physiotherapy


Patients with thoracic outlet syndrome (TOS) often present with neck or shoulder pain, numbness or tingling that affects the entire or part of the upper limb, and weakness in the arm. Sometimes patients may complain of coolness or venous engorgement of the affected arm. Patient with TOS often complained of signs and symptoms that result from irritation of the artery, venous, neural structures or a combination of the structures above.

Thoracic outlet syndrome is a group of conditions due to compression of the neurovascular structures that run from the neck to the axilla through the thoracic outlet. The brachial plexus and subclavian vessels are most commonly being compressed as these structures are located very close to each other in the thoracic outlet. These neurovascular structures are most commonly being compressed at the costoclavicular space which is located between the clavicle and the first rib. This is commonly known as the costoclavicular syndrome.

Another common site of compression is the space between the anterior scalene muscle, the middle scalene muscle and the upper border of the first rib. This is usually known as the anterior scalene syndrome. Hyperabduction syndrome or pectoralis minor syndrome involves the compression of the neurovascular structures at the space between the coracoid process and the pectoralis minor insertion.

Chiropractic care coupled with physiotherapy in Chiropractic Specialty Center can help to alleviate the signs and symptoms of thoracic outlet syndrome. For more information or inquiries, please contact us at 03-2093 1000.