Repetitive motions can cause many conditions in adults, but can also cause overuse syndromes in children, too. Common symptoms of pediatric overuse are shoulder pain, hip, pain, knee pain, and ankle pain. Because of the everyday use of technology, a condition called “Tech Neck” has emerged.  This is caused by looking down at our phones and tablets for prolonged periods of time while unaware of our posture presentation. This condition can cause dramatic health effects to your body.

When we look down, we flex the neck anteriorly, causing the amount of pressure on the cervical (neck) spine to multiply. The neck supports the head while protecting the integrity of the spinal cord. With optimal posture presentation, the cervical spine maintains an anterior lordotic curve to support the weight of the head, which on average weighs about 10 pounds. As the neck flexes forward, the cervical spine is diminished and the weight of the head dramatically increases. This cause tight muscles and conditions such as headaches, neck pain, and even shoulder pain.

Tech neck can be prevented with proper posture and alignment of spine. Chiropractic is very safe and effective in children with this condition. Have your child checked at Orthopedic Surgery San Diego.

By Dr. Jason Kart D.C.


Hip Pain can be caused numerous types of conditions such as: hip bursitis, dislocation, fracture, osteoarthritis, rheumatoid arthritis, hamstring/groin strains, and more. It is very important to see a qualified orthopedic doctor to get a correct diagnosis for hip pain, and occasionally a patient might find that acupuncture treatment can be part of the solution. Frequent acupuncture treatments can reduce the inflammation of the hip, ease pain ,and help improve healing.

In Traditional Chinese Medicine (TCM), the lower back and hip area are dominated by the Kidney meridian. The Kidney is the organ known to improve bone, tendons, and joint health. The Kidney is the source of red and white blood cells in the body, and controls the development and growth of our bones.

TCM uses 12 primary meridians, each of which corresponds to an organ, that run throughout the body. For example, when treating Greater Trochanteric Bursitis (a cause of hip pain), an acupuncturist treats local pain by surrounding the area of the stomach meridian with needles, using a method called “surround the Dragon.” He might also supplement the Kidney meridian to enhance the result. This is due to the holistic view of Traditional Chinese Medicine, which is important in acupuncture treatments.


The School Year Can Be a Pain!

images (20)

With the new school year in full force, it is important to know possible injuries that can occur to children who play sports such as baseball, cross country, and track. During this time of growth spurts, our muscles and bones often grow at different rates. This can cause hip pain, ankle pain, shoulder and knee pain, along with swelling and tenderness.

Little League Shoulder

Children have growth plates that grow new tissue at the end of the bones in our arms and legs. Bones eventually stop growing and harden when we reach skeletal maturity around ages 13-15 in girls, and 15-17 in boys. Before this happens, growth plate fractures can cause severe shoulder pain, and sometimes damage. Children who play baseball and throw too long without rest, or pitch improperly are at risk for swelling near the shoulder growth plate, which can cause it to widen not allow it to close as it should. Treated quickly, however, it can usually heal completely with rehabilitation.

Osgood Schlatter’s Disease

During growth spurts, children can develop pain in the area below the knee where the shinbone meets the kneecap. While this can happen to any child, active youth who are involved in running and jumping type sports are more at risk. Knee pain and muscle tightness along the front and back of the thigh are telling signs. If pain persists, a doctor will check for pain in the area, and watch the child walk, jump, or kneel to see if the pain is consistent. Sometimes an x-ray is ordered, but usually, rest, NSAIDS and gentle exercises are enough to help the pain and issue subside.

Sindig Larson Johanson Disease

Another knee issue for active youth ages 10-15 is Sindig Larson Johansson Disease (or Syndrome). Teenagers, still in the midst of a growth spurt and are involved in sports can commonly experience this issue. Symptoms are pain at the bottom of the kneecap, swelling and tenderness, increased pain with activity, and severe pain while kneeling. Occasionally, a lump will appear at the bottom of the kneecap. As with Osgood Schlatter’s Disease, a doctor will assess the area, and may order an x-ray or MRI to diagnose the issue. RICE (rest, ice, compression, and elevation) along with NSAIDs and stretching can help ease pain.

Sever’s Disease

Along with shoulders and knees, foot and ankle pain can also be common in children. Sever’s Disease affects the heel of those during a growth spurt, as the heel bone often grows more rapidly than the muscles and bones in the leg. This can stretch the heel, causing pain, swelling, and tenderness. A flat, or too high arch in the foot, along with obesity, adds pressure to this area. Activities that cause pain should be stopped until the pain is gone.
Warm ups and stretches are an important part of avoiding many injuries. Those in pain in the San Diego can find care at San Diego Orthopedic Surgery from our caring staff.

Dr. Robert Afra M.D.


Hip Pain and Possible Causes

Hip pain can afflict many people through wear and tear, although it can happen regardless of age. There are many reasons that our hips can fail us, may it be overuse or underuse, an injury, sitting too long with poor posture, arthritis, and more.

How the Hip Works

The hip joint is known as a ball and socket joint. The ball, called the femoral head, is located at the top of the femur, the bone in the upper part of the leg. This fits into a socket, or hollow area in the pelvis, called the acetabulum. Within the acetabulum is cartilage, called the labrum that helps keep the ball in the socket. These two parts are covered in a sleeve called the capsule that holds the joint in place. This capsule contains fluid that provides a lubrication to keep the joint moving as, well, a well-oiled machine.

What Could Go Wrong?

Although this strong system is amazing in its simplistic complexity, it can still be injured, torn, or broken. A common cause of hip pain in younger adults, 20-40 years old, are hip labral tears, usually caused by an injury to the area. When the labrum that keeps the ball inside the socket becomes damaged, it can decrease stability in the joint causing pain and lowered range of motion.

Hip Impingement Can Happen to Anyone

Aside from labral tears, another cause of hip pain is hip impingement. One can have this issue for many years and not be aware as it initially is not a painful condition. Hip impingement can be caused when the ball, or femoral head, is deformed, or irregularly shaped and rather than gliding effortlessly within the socket, jams into it painfully. This type of hip impingement is called femoroacetabular impingement (FAI), and can occur with many types of activity, from bike riding or yoga or squats. Impingement can also be caused by a deformity of the socket, or in some cases, both the ball and socket.

Greater Trochanteric Bursitis

While this condition sounds like something from the prehistoric era, bursitis is common in joints, such as the hip, elbow, knee, and shoulder. The bursa are sacs of fluid that lie between bone, muscles, and tendons. They enable the joint area to move smoothly. When they become irritated or inflamed, it can cause pain in the area. This condition makes it difficult to get out of a chair, walk up stairs, or do normal functions without pain in the hip area. It can also cause low back pain, and pain in the thigh or even buttock.

How to Make It Better

Depending on the severity of symptoms, NSAIDs, rest, alternating between heating pads and ice packs are the first course of action. However, if the pain impedes on day to day activities, and none of the above methods seem to ease the pain, it may be time to seek an expert in sports medicine. Those in the area can contact San Diego Orthopedic Surgery.


Dr. Robert Afra, M.D



Femoral acetabular impingement, or FAI, occurs when the ball shaped femoral head does not permit a normal range of motion in the acetabular socket, known as the hip socket. This causes abnormal compression of the femoral head on the acetabulum. Damage, such as labral tears, can occur to the articular (or labral) cartilage. Symptoms include pain or a pinching sensation in the groin as you bring your knee towards your chest. The pain is often worse when you try to bring your knee towards the opposite shoulder.  


There are various contributing factors to femoral acetabular impingement.  Three possible contributing factors include a CAM lesion, a Picher hip lesion, or a combination of the two. A CAM lesion is when the femoral head (ball) is larger than normal, or has a bump on it that jams on the rim of the acetabulum (hip socket).  A pincer lesion is due to an over-deep acetabulum (socket), which restricts the movement of the femoral head. Studies have suggested that ‘CAM’ deformities are more common in males, while ‘Pincer’ deformities are more common in females.  Mixed lesions occur when both a CAM and Pincer lesion is present.

FAI has been speculated as a cause of premature hip osteoarthritis due to the abnormal motion leading to early wear and tear of the joint.

Physical therapy may optimize alignment and mobility of the joint, thereby decreasing excessive forces on irritable or weakened tissues. It may also identify specific movement patterns that may be causing injury.



Your hips serve innumerable functions for our body. They keep us upright, allow us to bear weight, walk smoothly, run, jump, kick, and play. Since the hips are engaged in nearly every way we move, pain in this area can have debilitating consequences for patients. Although hip pain is frequently the result of osteoarthritis or injury, it can also be a sign of other health conditions. A doctor of chiropractic can help you identify the source of your hip pain and develop a tailored treatment plan for your symptoms.

Among older adults, osteoarthritis and hip labral tears, are the most common causes of hip pain. It involves a cycle of progressive cartilage loss and joint degeneration. Although this degenerative disease has no real “cure”, there are ways to slow its progression and prevent symptoms from worsening.  Other inflammatory diseases, aside from hip arthritis, can also cause hip pain like rheumatoid arthritis, inflammatory bowel disease, or inflammation of the spine (ankylosing spondylitis).

The Hip or Not the Hip?

Often what patients describe as “hip pain” may actually derive from a different part of the body. Some patients that experience pain in the lower back and hips may actually be suffering from dysfunction of the sacroiliac joints, or the joints that connect the sacrum to the iliac bones. Pain in the groin and hip can also be a result of a hernia, when the abdominal wall is torn or weakened. One of the more common types of referred pain is sciatica, or inflammation or irritation of the sciatic nerve. This can result from conditions like disc herniation, spinal degeneration, narrowing of the spine due to osteoarthritis, or Piriformis syndrome. Irritation of the nerve root can cause pain the in low back, buttocks, hips, as well as radiating leg pain.

Attitude Adjustments for the Hips

Some patients with hip arthritis (HOA) have also benefited from chiropractic care. In one study, 83% of the patients improved within nine visits to a chiropractor. Treatment included axial manipulation of the hip, stretching, and full kinetic chain treatment (manipulative therapy to the spine, knee, ankle, or foot when appropriate).1


After performing a careful physical examination and evaluating your familial and personal history, a doctor of chiropractic medicine can work to determine the source of your hip pain. The team at San Diego Orthopedic Surgey, will create a personalized treatment plan that could include chiropractic adjustments, exercise therapy, posture advice, stretching, massage, coordination with other health practitioners, and more. Treatments will aim to reduce inflammation, relax any existing muscle spasms, strengthen weakened muscles, and improve the mobility of the joint. Depending on the cause of your hip pain, chiropractic adjustments could help.





  • Brantingham JW, Globe GA, Cassa TK, et al. A single-group pretest posttest design using full kinetic chain manipulative therapy with rehabilitation in the treatment of 18 patients with hip osteoarthritis. Journal of Manipulative and Physiological Therapy 2012; 33(6): 445-57.






In Chinese Medicine there is a term called “Wu Shi Jian” which refers to shoulder pain that starts at around age 50. These categories of shoulder pain could be anything from Rotator Cuff Tendonitis, Impingement, Bursitis or Adhesive Capsulitis.  Acupuncture is very effective in treating these shoulder patterns.
Acupuncture is performed by insertion of thin needles into points called “Acupoints”. There are thousands of Acupoints along what Chinese Medicine calls Meridians pathways. Meridians carry energy called “Qi”. When there is blockage of Qi, there is pain. Needles unblock Qi and ease pain. Needles also blocks pain impulses from reaching spinal cord and brain and stimulate body to produce more pain reducing substances such as endorphin. Acupuncture promote blood circulation to improve healing, relaxes muscles, reduce inflammation and ultimately eliminate pain.
Acupuncture is usually painless and performed 1-2 times per week. Each session usually last between 30-45 minutes. While the average number of treatments for shoulder pain is 3-5, but depending on the cause and duration of the shoulder pain, more Acupuncture treatments maybe required.

If you have shoulder pain and have tried different treatments without much relief, you may want to give Acupuncture a try.

Dr. Mohammad Javaherian L.Ac  /  DAOM



shoulder pain dr jason

Many people think of Chiropractic care for neck and back issues. As a Chiropractor, I also work on extremities such as the shoulder joint by using manipulative therapy. Sometimes the best results occur when you treat a health problem from several different aspects, as we do in this clinic. Today I will share the results of a study published recently in the Annals of Internal Medicine that found “manual therapy” in conjunction with “usual medical care” to be much more effective for shoulder dysfunction and pain than usual medical care alone.

Researchers in The Netherlands noted significant improvements in recovery, severity of complaint, shoulder pain and shoulder disability with the addition of a 12-week course of manual therapy. Usual medical care (control group) included “information, advice, and therapy.” During the first two weeks of care, patients in the control group “were given information about the nature and course of shoulder symptoms, along with advice on daily use of the affected shoulder” with prescriptions for “oral analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) if necessary.” Control group patients who did improve could receive another two weeks of analgesics or NSAIDs; if this approach was ineffective, they could be given “up to 3 corticosteroid injections.” If improvement remained insufficient two weeks after injections were administered, the injections could be repeated, or patients could be referred for physiotherapy consisting of shoulder exercises, massage, and physical applications.

Patients in the intervention group received usual care and manipulative therapy that included specific manipulations (low-amplitude, high-velocity thrust techniques) and specific mobilizations (high-amplitude, low-velocity thrust techniques) “to improve overall joint function and decrease any restrictions in movement at single or multiple segmental levels in the cervical spine and upper thoracic spine and adjacent ribs.” (emphasis added)This is an important point, as this study provides evidence that by utilizing spinal manipulation to address shoulder pain and dysfunction, problems in the shoulder (and other extremities) can be addressed through manipulation of the spine.

Almost all of the control patients (92%) “were treated with a wait-and-see policy, 28% were treated with corticosteroid injections, and 27% were referred to a physical therapist for a maximum of 9 treatment sessions.” Patients in the manipulative therapy group received similar care, but in addition, they received an average of 3.8 “treatment sessions from a manual therapist.”

The differences in results showed substantial improvement for those patients receiving manipulative therapy. 

The authors made several important comments regarding their study: 

“We demonstrated that manipulative therapy for the shoulder girdle in addition to usual medical care by a general practitioner accelerated recovery of shoulder symptoms and reduced their severity. These effects were sustained at 52 weeks of follow-up.”

“We believe that general practitioners should include a short physical examination of the shoulder girdle in their structured medical examinations. For patients with shoulder symptoms in whom dysfunction of the cervicothoracic spine and adjacent ribs is found, referral to a manual
therapist (Chiropractor) should be considered.”

Bergman GJD, Winters JC, Groenier KH, et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain. Ann Intern Med2004;141:4320439.

Dr. Jason Kart D.C.


alexis picture

The ability to lift your arm overhead is accomplished by 2 major actions, the upward rotation of the scapula or shoulder blade and humerus or arm bone.  In normal pain-free shoulder motion the shoulder blade will rotate upward 1 degree for every 2 degrees of humerus flexion or at a ratio of about 1:2.  This interaction is known as scapulohumeral rhythm.  

If the normal position of your shoulder blade is alerted at rest or with active motion due to pain, muscle weakness (Carisoprodol), tightness, or in coordination this is called as scapular dyskinesis.   Faulty scapular positioning or movement can result in tipping and downward rotation of your scapula, which causes the tip of the scapula also known as the acromion to pinch down on sub acromial structures such as your bursa and rotator cuff tendons.   This contributes to rotator cuff impingement, bursitis, and rotator cuff tears.

Once it is identified that scapular dyskinesis is present the next step is to assess the potential contributing factors, this requires a thorough assessment by your physical therapist. The assessment may include testing of passive scapular mobility, rotator cuff and scapular muscle strength and function, muscle length and flexibility, and glenohumeral joint capsule restrictions.

Dr. Alexis Adiarte , D.P.T.


 Not Rotator Cuff TearsShoulder pain is a problem that is quite common and it has a number of different causes. Often, it is an indication of another problem. Shoulder pain may occur due to the following reasons:
• Bad posture
• Frozen shoulder – which is a painful condition that lessens normal movement in the shoulder joint (this can at times hinder movement in the shoulder completely)
• Rotator cuff conditions – the rotator cuff is a bunch of muscles and tendons surrounding the shoulder joint, whose function is to keep it stable
• Shoulder instability – in this case, the shoulder may be unstable and also have an abnormally large range of movement referred to as hypermobility
• Acromioclavicular joint disorders – ailments such as osteoarthritis which affect the joint located at the top of the shoulder (the acromioclavicular joint)
• Osteoarthritis in the shoulder joints
• A broken (cracked) bone, for instance a broken collarbone or a fracture of the upper arm bone (humerus)
In some cases, shoulder pain may not occur due to a problem in the shoulder joint but rather in a different area, like the neck, which can be felt not only in the shoulder but also in the upper back.
Rotator cuff
The rotator cuff comprises of a cluster of four tendons and muscles. These converge around the shoulder joint located at the top of the upper arm bone just above the elbow, known as the humerus.Rotator Cuff Tear They combine to form a “cuff”, which holds the arm in proper position and enables it to move in different directions.
The shoulder happens to be one of the most mobile joints; however, it is somehow weak. Subjecting it to too many fastballs for instance, can cause not only partial tears but inflammation in the rotator cuff’s tendons. Sudden stress can even cause one of the tendons to be jerked from the bone or to tear right in the middle of the tendon.
Rotator cuff tears and diagnosis
Rotator cuff tears are common in swimmers, tennis players, pitchers and several other athletes and a rotator tear could as well end a player’s career if it is serious.
A proper diagnosis of the shoulder pain will ensure that right treatment is done. Symptoms, physical examination, and various types of X-rays as well as related investigations can provide a lot of information regarding the nature of the problem. However, shoulder arthroscopy is often used to determine the exact cause of the problem.
To diagnose a rotator tear, a thorough physical exam is conducted to allow the doctor to rule out other disorders and confirm that the patient has a rotator cuff tear.
The types of syndromes which can be diagnosed using arthroscopy include tears, inflammation, detachments, abnormal formations, loose fragments/bodies, and arthritis. Arthroscopy can’t diagnose all the disorders and so proper examination is required before determining if arthroscopy is appropriate for the patient.
Surgical Animation
key-hole surgeryArthroscopy is generally referred to as “key-hole surgery”. Normally, only two or three puncture wounds measuring 5mm are required. This tends to avoid large wounds and scars. Presently, most shoulder surgeries can be done by arthroscopy instead of open surgery.
The treatment of rotator cuff tears with shoulder arthroscopy is contentious. While some orthopaedic surgeons use arthroscopy to treat every rotator cuff tear, some choose specific tears, and others treat all tears open. As such, there is no agreement on which procedure is better.

Contact our sports medicine specialists at Orthopedic Surgery San Diego for an evaluation to provide you with the best care suited to your needs.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow