Caring Medical & Rehabilitation Services, S.C. (CMRS) is a medical clinic located in Oak Park, Illinois, a nearby suburb of Chicago. Established in 1991 by Ross Hauser, M.D., and Marion Hauser, M.S.,R.D. Caring Medical has been fortunate to have been able to help patients from the Chicagoland area, from all over the United States, and the world.

Why Come To Caring Medical? Because of Our Doctors!
Patients come because our doctors are very skilled in treating chronic pain problems without reliance on pharmaceuticals or invasive techniques. Most of the patients they see at the first visit have a long history of chronic pain and medical problems. In many cases, our doctors, are the 6th or 7th or 8th (sometimes more) physician our patients have seen in seeking answers to their medical problems.

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Baseball Injuries
Elbow Pitching Injuries
The most serious problems in the younger pitchers are those of the radiohumeral joints. Although less common than the medial injuries, these changes tend to be predictive of permanent deformity or disability to the elbow in the future. Medical reports have shown that disability occurs more commonly in association with a certain style of pitching, specifically related to the sidearm throw, the horizontal position of the extremity, and the whipping or snapping motion used to increase velocity. These seem to increase the compressive and tensile forces on the elbow.

Rotator Cuff Tendonitis
Rotator cuff tendonitis may occur  when the muscles of the rotator cuff, which include the supraspinatus, infraspinatus, teres minor, and subscapularis, are overworked causing the tendon to become inflamed and painful. The more common scenario of RCT occurs when a chronically unstable shoulder forces the muscles of the shoulder, especially the rotator cuff muscles and tendon, to work beyond their capabilities to stabilize the shoulder as it moves through its complex motions.

Shoulder/Rotator Cuff Injuries
Shoulder pain is a common problem amongst both serious and recreational athletes. Chronic instability, rotator cuff tendinitis, impingement syndrome, AC joint separations can each be effectively treated by Prolotherapy. Prolotherapy has many advantages over surgery, including less rehabilitation time, cost, and the fact that it gets at the root cause of the athlete's problem, which is tendon or ligament weakness. 

The Annular Ligament
Any kind of throwing motion, whether in javelin, baseball (especially the curve ball), bowling, or even lesser-known sports like hurling, puts tremendous force on this ligament. The team physician or athletic trainer rarely examines this ligament, so its injury is never diagnosed. The annular ligament is responsible for the majority of lateral elbow pain that continues for more than a couple of months. In our experience, nearly every patient that comes to our office with this condition has been told they have tennis elbow.

Shoulder Dislocation
Shoulder dislocation occurs when an athlete falls on an outstretched hand or when an anterior force to the shoulder occurs when the shoulder is abducted and externally rotated. This is the position of the shoulder when, for example, a person is waving to someone. Very few people dislocate their shoulder for the first time without having a significant force or injury.

 Running
Feet Pain and Prolotherapy
Patient A was an avid runner. He ran 30-40 miles per week. He had several marathons under his belt. He didn't look too good when he came in. "Doc, my right foot kills me by mile six. I have to be extremely careful. I have worn these orthotics but they don't seem to do much. I have even rested my feet but the pain just continues to recur."

Patient B had an important race coming up in two months and he was also distraught. "My arches are killing me. Both of them. The doctor says I should get a bone scan to see if I have a stress fracture. I have tried different shoes, physical therapy for plantar fasciitis...it helps for a little while but the pain comes right back. I really want to do this race."

Arches of the Feet
To understand why other injuries occur in the feet it is important to consider the three arches of the foot. The figure below shows the medial longitudinal, lateral longitudinal, and transverse arches of the foot. The talus, cuboid, and intermediate cuneiform bones function as keystones to these arches. These bones have joint surfaces that form a wedge to provide support. Interlocking joint surfaces also provide support.

plantar fasciitis
An athlete presenting to the physician with plantar fasciitis characteristically complains of a pinpoint, knife-like pain in the plantar aspect of the heel pad at the base of the fascial insertion to the calcaneous. Pain is generally worse when the athlete first arises in the morning, as the plantar fascia is cold, contracted, or stiff. Pain is due to the stretching of the damaged tissues. For the same reasons, the athlete is generally symptomatic during the initial stages of exercise, with improvement as exercise continues, presumably because the warm-up increases the pliability of the fascia. The onset of plantar fasciitis is generally gradual and often flares only with exercise. As the problem continues interference with walking becomes a common problem.

Nutritional Tips for Runners
Nutrition is an important, but often misunderstood, part of the running equation. By making small dietary changes, staying away from fad diets, and understanding what our bodies need, we can successfully build our own eating styles that provide each of us personally with what we need to reach our goals.

Running In Bad Weather
For athletes in cold climates who run regularly, the onset of winter temperatures and icy, slippery surfaces means choosing one of two options: take their running indoors for the winter, or find ways to make running in sub-zero temperatures safe and relatively comfortable.

Back Pain
Loose Ligaments
When back pain is due to loose ligaments, a very characteristic behavior of pain is observed. An athlete with loose ligaments of the lumbar spine or pelvis will experience recurring dysfunctions at the intervertebral joint (degenerative disc and possible nerve compression), at the facet joints (locking in flexion or extension), and at the sacroiliac joints. In other words, the low back pain can be due to an unstable disc problem, facet joint locking, or sacroiliac dysfunction.

Iliolumbar Ligament Injury
The iliolumbar ligaments are very important and very strong ligaments connecting the lower lumbar vertebrae to the crest of the iliac bone. They run, posteriorly and laterally, from the transverse processes of the fourth and fifth lumbar vertebrae to the ilium.

The iliolumbar ligaments contribute, with the interspinous and supraspinous ligaments, to stabilize the lower lumbar spine on the base of the sacrum. The iliolumbar ligaments counterbalance the shearing forces of the fifth lumbar vertebra on the base of the sacrum and prevent the forward shifting of this vertebra as well as that of the fourth lumbar vertebra onto the fifth vertebra. If the vertebrae shift, the condition is called spondylolisthesis.

LOW BACK PAIN
Recently in our practice, we have been seeing a lot of athletes including Olympians and Olympic-hopefuls with low back pain. They come from a variety of sports including pole vaulting, skiing, running, volleyball, baseball, wrestling, and many others. 

Back and Pelvic Pain
Injuries to the lower back are quite common, especially in athletes. By midlife more than 50 percent of the population has had significant episodes of low back pain. Some people suffer from chronic daily pain in their backs and pelvis and have often even required lower back surgery. Unfortunately, back surgery usually causes the muscles and ligaments to become even weaker. A surgery that was supposed to strengthen the area actually ends up weakening it to the point that the non-surgerized back is stronger than the back that was surgically repaired.

Back Pain and Hormones
The net effect of all of this is that the joints of females, even females who have no pain whatsoever, are not normal. They cannot possibly be normal because of all the negative effects of estrogen as the prime instigator and relaxin as a lessor instigator. The turnover time (or half-life) of ligaments and cartilage is about one to two years. This means that about half of the cartilage or ligaments is regenerated about every 300 to 700 days. This is a very, very slow rate. Fibroblastic cells, which make collagen, and chondrocytes that make cartilage tissue, are stable cells in the fact that they do not proliferate easily. They need to be stimulated to proliferate.

Knee Pain
Surgical Alternatives to Ligament Surgery
The complications of orthopedic surgery on knee ligaments are significant and frequent. The ligament grafts used in surgical procedures are profoundly weakened about eight weeks after surgery.

Anterior Cruciate Ligament Injuries
Some of the most horrible words a competitive athlete could hear are, "You have an anterior cruciate ligament tear." In the best case scenario, athletes are told that a tendon can replace the ligament and the rehabilitation of this new structure takes a full year.

Knee Pain: Meniscal Injury
By knowing the function of the meniscus, it is possible to predict what will happen when meniscal tissue is shaved or removed. Since it provides some of the nutrition to the articular cartilage, its removal will aid in the demise of the cartilage. If the cartilage is damaged, then the pressures on the bone will be too great and arthritis will soon follow.

Meniscus Surgery
Meniscus injuries occur in most sports, but most commonly occur in contact sports. They often occur in combination with ligament injuries, particularly when the medial meniscus is involved. This is partly because the medial meniscus is attached to the medial collateral ligament and partly because tackles are often directed towards the lateral side of the knee, causing external rotation of the tibia.

Shoulder Pain
Shoulder Dislocation
Shoulder dislocation occurs when an athlete falls on an outstretched hand or when an anterior force to the shoulder occurs when the shoulder is abducted and externally rotated. This is the position of the shoulder when, for example, a person is waving to someone. Very few people dislocate their shoulder for the first time without having a significant force or injury.

Acromioclavicular Joint Pain in Wrestlers
The acromioclavicular (AC) joint is one of the unsung heroes of the body. It is a diarthrodial joint formed by the distal clavicle and medial facet of the acromion. (The end of the collar bone and that portion of the shoulder blade that meets to form the point of the shoulder).

Shoulder Injuries
The rotator cuff tendons are the most common structures affected in shoulder sports injuries. Particularly common are injuries to the supraspinatus tendon. Onset of its symptoms is usually quite gradual. Pain and weakness occur during shoulder motion, particularly when the arm is moved from the body to the side, between 80 and 120 degrees. Treatment of supraspinatus rotator cuff injuries involves avoidance of repetitive over arm motion and the use of a conditioning program to stretch and strengthen the rotator cuff muscles.

Pitching Injuries - Rotator Cuff Tendonitis
Rotator cuff tendonitis may occur  when the muscles of the rotator cuff, which include the supraspinatus, infraspinatus, teres minor, and subscapularis, are overworked causing the tendon to become inflamed and painful. The more common scenario of RCT occurs when a chronically unstable shoulder forces the muscles of the shoulder, especially the rotator cuff muscles and tendon, to work beyond their capabilities to stabilize the shoulder as it moves through its complex motions. These small rotator cuff muscles were not designed to stabilize the shoulder or perform the major work in shoulder motion, but instead should function to perform shoulder rotation.

Shoulder/Rotator Cuff Injuries
Shoulder pain is a common problem amongst both serious and recreational athletes. Chronic instability, rotator cuff tendinitis, impingement syndrome, AC joint separations can each be effectively treated by Prolotherapy.  Prolotherapy has many advantages over surgery, including less rehabilitation time, cost, and the fact that it gets at the root cause of the athlete's problem, which is tendon or ligament weakness. 

Hip and Groin Pain
Sacroiliac and Pubic Symphysis
Seldom is the cause of an athlete's hip and/or groin pain just in the hip joint. The sacroiliac and pubic symphysis areas are often overlooked because some doctors do not know the ligament referral patterns from the lower back and pubic symphysis.

Post Hip Dislocation
Because the hip joint is a ball-and-socket joint with massive ligaments, it is a very stable joint. It is therefore injured less frequently. However, athletes are getting bigger and stronger as the years go by, therefore the amount of forces on the athletes are tremendously high and increasing every year. The most common hip dislocations occur posteriorly because of the greater strength of the anterior capsule of the joint. They are also more common because in sports such as football, rugby, hurling, and soccer, the individual is hit in the front of the thigh, forcing the thigh/hip complex backward, resulting in hip dislocations. This tears the ligamentum teres and the posterior capsule.

PUBIC SYMPHYSIS PAIN
In my opinion, Prolotherapy works great for pubic symphysis injuries. The athlete is seen every two to three weeks for three to six sessions of Prolotherapy. If it is a real bad case (like the case I myself had) I’ll treat someone every week.

Groin Pain Blog

Elbow Pain
Annular Ligament Injury
The mighty annular ligament wraps around the radial head and attaches to the ulna, which stabilizes the radius bone when an athlete does any twisting or rotating movement of the elbow.

Golfer's/Tennis Elbow
The anatomical structures involved in tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) are structures located very close to the skin-in some people only two or three millimeters-that traditional treatments such as physical therapy, heat, ultrasound, and massage should very quickly resolve. These treatments greatly increase the metabolic rate in the muscle attachments at these sites, so recovery should be quick and easy. Because these conditions do not recover quickly, this tells us that the muscles are not the problem, but the underlying ligaments.

Elbow Braces
To think that putting a band around the elbow could do anything to help a physical condition is ludicrous. Wearing a brace actually has the potential to harm the injured area due to the compression exerted by the brace and by changing the biomechanics of motion from the compressive force.

Elbow Pain and Carpal Tunnel Syndrome
Eighty percent of chronic elbow pain is due to a sprain of the annular ligament, a ligament rarely examined by a family physician or an orthopedic surgeon. Nearly all of our patients with chronic elbow pain tell us their doctors told them they have tennis elbow (lateral epicondylitis) and not a sprain of the annular ligament. The latest treatment for tennis elbow is the dreaded cortisone shots! Cortisone weakens tissue, whereas Prolotherapy strengthens tissue. 

Elbow Pitching Injuries
In the acceleration phase of a pitcher’s motion, extreme valgus stress is placed on the elbow. Tensile forces that result from this stress may cause injury to the flexor musculature (wrist flexors), medial collateral ligaments, avulsion fractures of the medial epicondyles, and traction spurs of the ulnar coronoid.

The Ulnar Collateral Ligament (Elbow Pain)
The ulnar collateral ligament does not get much press but it is the reason for most chronic medial elbow pains. This ligament supports the inside of the elbow. It is responsible for holding the ulnar bone to the distal end of the humerus. This enables the arm to flex, pivoting at the elbow. An athlete's complaint of pain on the inside of the elbow will cause the orthopedist to examine the lateral epicondyle's "sister," the medial epicondyle. The orthopedist will quickly diagnose medial epicondylitis and recommend NSAIDs, or something even worse in our opinion, the cortisone injection.

Foot Pain
Plantar Fasciitis
An athlete presenting to the physician with plantar fasciitis characteristically complains of a pinpoint, knife-like pain in the plantar aspect of the heel pad at the base of the fascial insertion to the calcaneous. Pain is generally worse when the athlete first arises in the morning, as the plantar fascia is cold, contracted, or stiff. Pain is due to the stretching of the damaged tissues. For the same reasons, the athlete is generally symptomatic during the initial stages of exercise, with improvement as exercise continues, presumably because the warm-up increases the pliability of the fascia. The onset of plantar fasciitis is generally gradual and often flares only with exercise. As the problem continues interference with walking becomes a common problem. This entity accounts for about 10 percent of all running injuries.

Arches of the Feet
To understand why other injuries occur in the feet it is important to consider the three arches of the foot. The figure below shows the medial longitudinal, lateral longitudinal, and transverse arches of the foot. The talus, cuboid, and intermediate cuneiform bones function as keystones to these arches. These bones have joint surfaces that form a wedge to provide support. Interlocking joint surfaces also provide support.

The Achilles Tendon and Heel Spurs
As we age, flat feet become more common. This means that the foot has too much pronation (rotation). As the foot pronates excessively, a plantar fasciitis or even a heel spur can occur. To prevent these injuries from occurring, proper footwear is essential to support the arch through correct orthotics. Once plantar fasciitis occurs, Prolotherapy of the plantar fascia (strong attachments at the bottom of the foot) can be quite helpful in eliminating this pain.

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