I had a patient come in a few days ago who got up that morning, bent over to pick up an exercise mat, and was unable to come back up due to excruciating pain in her lower back. I hear this kind of story frequently.

People come in, bewildered, wondering how doing something that they’ve done hundreds of times before, on that particular day, could literally drop them to their knees in pain. How is it that picking up something as light as a fold-up exercise mat could make your back “seize up”?

Clearly, it wasn’t the mat that did it.

The Most Important Muscle in Your Back

To understand what the real culprit is, we need to go over some basic anatomy. Specifically, we need to get intimately acquainted with the psoas muscle (pronounced SO-UHS).

The psoas is a large muscle, deep in the core of your body. It originates from all of the vertebrae and discs (in between the vertebrae) in your lower back. It inserts deep in your groin area, on the inside of your femur, or thigh bone.

It’s a thick muscle. Well developed, it’s about as big around as your lower forearm.

Keep in mind that a muscle’s strength is directly proportional to it’s cross-sectional area. Roughly translated, that means the larger the muscle, the greater it’s ability to generate force.

A muscle with a diameter equal to the size of your forearm is pretty respectable. Most people’s bicep muscle in the upper arm isn’t near that size. This means the psoas has power. Power to move, and power to do damage.

If you take a look at the illustration (click on the thumbnail to get a larger view), the psoas is the muscle that originates in strands from all of the vertebrae in the lower back, then travels deep through the pelvic opening, inserting on the inside of the femur below the hip joint.

If you’ve ever seen a sailboat mast you’ve probably noticed that the mast doesn’t just stick up out of the boat with no other support. There are usually wires, called “stays”, that run from the mast to the front, back, and sides of the boat to provide stability.

Your spine needs similar help. Your back would not be stable if your spine simply stuck straight up from your pelvis with no assistance from other structures. Your psoas muscles provide a great deal of this support.

Without healthy, strong psoas function, your back just isn’t happy.

In addition, the psoas is one of your primary hip flexors. This means one of it’s main jobs is to bring your knees closer to your chest. Anytime you’re bent over, sitting, doing sit-ups, or performing your best cannonball into the pool, the psoas is potentially in a contracted, or shortened, position.

So What Happened?

This is significant for our exercise-mat-retrieving victim above. The psoas, just like any other muscle, can cramp or spasm.

If you’ve ever had a cramp in your calf or the back of your thigh, you might have noticed that these muscles tend to cramp when the muscle is shortened, not when it’s stretched out. You also probably intuitively stood up to stretch out the muscle to relieve the cramp.

Take a look at the illustration of the psoas again. The psoas runs down the front of your spine. It’s main job is to bend you forward or bring your knees closer to your chest. This means that the only way to really stretch it out well is to bend over backwards.

Most of us don’t do this very well.

So if you happen to be bending over to pick up a pencil, and your psoas decides to go into full blown spasm, you don’t have an easy remedy! It’s exactly like having a cramp in your calf but not having any way to relieve it.

If you can imagine this, you now know why a psoas spasm can be so debilitating.

In Practice

In my practice, for anyone with back pain this means the psoas gets a lot of attention. Muscles tend to “shut off” when our bodies are under stress, just like an overloaded circuit in your house (see http://collinsdc.com/blog/2007/06/26/why-you-have-an-athletic-injury for more on this concept).

I thoroughly test these muscles to make sure my patient is getting the support they need around their core and lower back. On most people, psoas muscles that aren’t working well are usually (painfully) obvious.

For someone who’s had a psoas spasm, the muscle will usually test very weak after a sustained contraction. I then use techniques that help to lengthen and relax the muscle without forcing them into yoga-like moves to bend over backwards.

Adjustments of the lower back and addressing pelvic torque are also key to reducing the propensity for this muscle to seize up again.

As with any muscle cramp, dehydration can be a key factor inducing the psoas to spasm. Many of the stories I hear of people who’s back suddenly “grabbed” on them start out with a description of a long day spent gardening, out in the sun, or working out.

So put yourself in that same scenario, but this time with a new approach. You bend down to pick something up. All of a sudden, a sharp pain hits you in your lower back.

Don’t ask yourself what was different about the way you reached down this time. Ask yourself what is different in you that caused you to not have the muscular support to do something you’ve done hundreds of times.

Is it dehydration? Have you had other lower back “twinges” or discomfort that might have been your body’s way of telling you that everything wasn’t quite perfect? Do you feel “twisted”, with one hip or shoulder higher than the other?

If you can’t clearly answer questions like those and address the problem, get some help to do just that. Your body will thank you, and seemingly innocuous exercise mats will no longer be your nemesis!

I want to talk to you today about a really insidious little substance that may be significantly affecting your health. Here are some hints: It’s not just in Chinese food, it causes more than just headaches, and there’s a really good chance that you had some today.

Yep, I’m talking about MSG, also known as monosodium glutamate. What’s the big deal? Well, glutamate is an excitatory neurotransmitter that can have effects in areas much more far reaching than just your taste buds.

Excitatory neuro-whatever, you say? I know it sounds like mumbo jumbo, but allow me to explain…

A Little Physiology

A neurotransmitter is a substance that your nervous system uses to transmit a signal from one nerve, or neuron, to another. Your brain, and the rest of your nervous system, is made up of literally billions of neurons, and they each use various kinds of neurotransmitters to convey different signals to each other.

Glutamate is excitatory in that it stimulates any nerve that it acts upon, causing it to have a higher propensity to stimulate other neurons to perform functions that are as widely varying as your nervous system itself. This could be anything from causing a muscle to contract to getting your heart to beat a little faster.

Conversely, an inhibitory neurotransmitter is one that would cause the neuron it acts upon to be less likely to fire. It’s this balance of excitatory and inhibitory signals that determines what nerves fire, what signals are received, and the balance of your brain chemistry.

The actual molecule glutamate is an amino acid. Amino acids are the building blocks of protein. Put a bunch of them together and you have a strand of protein, which might be a muscle fiber or a pigment that makes your eyes a certain color. Individually, however, amino acids have varying roles and functions in the body.

The sodium part of monosodium glutamate is added to make the entire MSG molecule more stable, so that the effects of glutamate are more long lasting.

So What’s the Problem?

MSG stimulates the nerve endings in your taste buds, making the food you eat seem to have a more intense flavor. If you were part of a food study, being asked to rate the taste of a food on a scale of 1 to 10, you’d say the MSG-laced food might rate a 7 or 8, while the one without it would be down around 3 or 4.

The problem is that the effects are not confined to your taste buds. After you swallow it, MSG can go on to stimulate neurons all over your body, causing anything from headaches and heart palpitations, to numbness and shortness of breath.

Being a basic amino acid, glutamate obviously exists in nature, so you might think it’d be a relatively harmless substance. The form of glutamate we get with MSG is not the same as what you find in nature, however.

The processed MSG you consume actually ends up having a high percentage of molecules that have a geometric shape that is a mirror image of that found in nature. This is problematic for the body in much the same way that left-handed people have trouble from time to time working in a world that is dominated by right-handers.

Even though our two hands are identical in design and function, trying to use your left hand on a device designed for the other can be an exercise in frustration.

This simple difference in the MSG created in the food lab can make a big difference in how our bodies react to and process the substance. Additionally, there are many contaminants that come along in the typical MSG creation process that are known carcinogens.

The Labeling Game

On your average food label, you don’t see the phrase “monosodium glutamate” on too many things. This is because that particular phrase is reserved by the FDA for use by a product that has at least 99% processed freeglutamic acid (PFGA). PFGA is a term used to describe the processed, synthetic variety of glutamate mentioned above.

This means that a product can be 98% PFGA, with essentially all of the problems and side effects of MSG, without ever being listed as such on a food label. Instead, what you get are label names like “yeast extract”, “yeast nutrient”, “textured protein”, “hydrolyzed protein”, “gelatin”, and dozens of others. Additionally, labels like “flavor”, “flavoring”, and “natural flavors” may also contain high amounts of processed glutamate.

Regardless of the reason for its use, these products most likely carry all the inherent problems and sensitivity issues of run-of-the-mill MSG. (There is a much more comprehensive list of all the names under which processed glutamate might be hidden at http://www.truthinlabeling.org/hiddensources.html.)

Furthermore, any item on a food label that you know has ingredients, but does not list them, should be suspect. A classic example is a from a popular brand of canned tuna. The ingredients listed are “tuna, water, vegetable broth, salt”.

We know “vegetable broth” has ingredients. In this case, the “vegetable broth” is simply “hydrolyzed vegetable protein” (see our list above) and water. In other words, the only reason “vegetable broth” is added is to get MSG (orPFGA) into the product.

The intent of most of these products is the same: to enhance flavor based upon the properties of the excitatory neurotransmitter glutamate. There is also a percentage of products that add in PFGA or MSG for their preservative and stabilizing properties, making foods or chemicals less susceptible to the effects of things like heat, light, or acidity.

The common flu vaccine FluMist, according to the CDC, includes MSG as a stabilizer. I don’t know about you, but I’d rather not shoot something into my nostrils, to be absorbed by blood vessels just inches from my brain, that includes anything like MSG in it.

The Effects

By far the most common symptom I see in the office from MSG is headaches, particularly migraines. If I mention the possibility of MSG, the usual response I get is, “But I haven’t had any Chinese food recently!” Education about just how many places you can find MSG then begins.

Rashes, redness, stomach discomfort, or “brain fog” are examples of just a few, varied symptoms patients notice that they stop having once they make a concerted effort to eliminate their MSG intake. Once you know MSG is the problem, anytime your particular symptom crops up again, the question to ask isn’t so much “why am I having this headache?”, but rather “what new thing did I eat recently?”

Taking this approach allows you to get better and better at keeping MSG out of your system, keeping you where you want to be: pain free.

Regardless of whether you experience clear symptoms from MSG exposure, my recommendation is to stay away from the stuff. The health of your brain and nervous system isn’t worth a food company’s experiment to try and make their snacks tastier!

If we ignore the current trend in professional sports to seek external, pharmacological help, there really aren’t any magic fixes for athletic performance enhancement. If our training techniques are optimal — and that’s a big “if” — then the methods available to try and take yourself to the next level are limited.

As usual, the trick is to get more fitness while preserving your health. Check out some earlier articles in this space to understand how the drive to improve our fitness can potentially negatively impact our health (see http://collinsdc.com/blog/2007/07/23/french-fries-count-too/).

So, within these constraints, how do you get an edge? There are several techniques that have been used by both Olympic teams and weekend-warriors. Some are more available to the amateur athlete than others.

We’ll explore a few, break down the basic concept behind them all, and then finish off with a technique that can be used by anyone in day-to-day training.

More Air Please

Not too long ago the US Olympic Speedskating team was rumoured to have used supplemental oxygen to train its athletes. Team members put on masks that supplied oxygen at levels above normal atmospheric concentrations while they performed their usual workouts.

The idea was to provide “extra” oxygen to the athletes’ muscles, allowing them to engage a higher percentage of muscle fibers than they would otherwise. In so doing, the thinking went, they would be able to more effectively train a larger percentage of their muscle fibers than they would without supplemental oxygen.

Given the phenomenal success US Speedskaters had at the 2002 games in Salt Lake, many believe the technique is effective. It was an idea born out of the now popular “live high, train low” approach of having an athlete perform workouts at a lower elevation, enabling him to work out harder, while living at a higher elevation, reaping the benefits of the increased ability of his blood to carry oxygen after acclimatization.

Cool Down First

Everyone knows that you tend to get warmer when you exercise. In particular, the harder you workout the hotter you seem to get. It should come as no surprise then, to learn that world records in endurance sports are routinely set in cooler conditions.

Well, what would happen if you had a way to keep your body temperature cool, or even pre-cool it prior to exercise? This is exactly what the Australians did prior to the 1996 Olympics, with the development of a special ice jacket for their athletes.

The jacket was supposed to keep an athlete’s body temperature down in hot and humid conditions. With the body working under artificially cooler climes, it might be able to produce performances akin to the world record results seen when the mercury drops well below a normally comfortable 72 degrees.

Suspend Your Activity

When the media covered the amazing story of the thoroughbred Barbaro’s win at the Kentucky Derby and subsequent on-the-track injury, we were bombarded by video and photos of the horse suspended by a special pulley system to facilitate his movement and recovery (see http://sportsillustrated.cnn.com/multimedia/photo_gallery/0605/gallery.barbaro/content.1.html).

Similar contraptions exist for humans, too, when recovering from injuries that render us unable to support our full weight when we walk.

These devices support the pelvis, effectively reducing the weight that our legs have to bear while we walk on a treadmill. We can thereby retrain muscles that have lost strength due to trauma.

Instead of being used after an accident, what if we used such a device in training for competition? By removing a mere 10 lbs. of the load our legs have to bear under normal circumstances (and if you don’t think that’s a lot, try heading out for a 30 minute run carrying a 10 lb. weight next time), we’d be able to perform workouts at a much higher intensity, engaging, and thus training, a higher percentage of our muscle fibers.

And the Connection Is?

What do all these things have in common? Reduced stress. The technique applied reduces the stress from gravity, heat, or lack of oxygen.

In all cases an attempt is made to free the body of what is a common stressor, one that under normal circumstances would be considered unavoidable. In so doing, physiological resources become available to be applied to a not-so-common variable: the stress of training.

Unfortunately, all of these require specialized equipment and training to employ. So how can you and I get in on the action?

Go Downhill

Dr. Phil Maffetone, coach of six-time Ironman World Championship winner Mark Allen, recommends using a normal training tool: hills. Only this time, you’re not concentrating on going up the hill for its physiological benefit, but down the hill. The very thing that makes going downhill easy — lack of gravity stress — is what will allow you to push your muscles that little bit extra for an added training effect.

Whether doing this on the bike or on two feet, choose a long, gradual downhill section that will allow you to do some moderate intervals for at least 3-4 minutes. The longer the better.

Your pace should be right at the edge of your aerobic threshold (see http://collinsdc.com/blog/2007/12/07/slow-weigh-down/ to find out how to determine this). If you’re coming up on racing season and you’ve spent a few months steadily building your aerobic base, doing anaerobic threshold intervals downhill are appropriate too.

Play it safe, though. You can pick up a lot of steam headed downhill on the bike, so stay aware and keep your hands close to the brakes.

Improper form running downhill is also a great way to pick up a case of plantar fasciitis. The repetitive pounding on your calcaneus, or heal bone, is a common way to knock that bone out of position and inflame the connective tissue on the sole of your foot, the plantar fascia. Shorten your stride and stay off your heals, which is a good plan no matter what your running terrain.

Remember, it’s the downhill portion of the interval that’s important, so take it easy headed back to the top, spinning in a light gear on the bike, and jogging lightly, or even walking, when on foot.

This isn’t all to say that working the uphill portion of your terrain is useless. The strength-building benefits of uphill intervals are well known. Using the other side of the rise is a great way to change up your training and add a little extra to your routine, with little added stress.

Finding ways to effectively lower your total stress and still achieve good training adaptation will keep you healthy long enough to get optimally fit! Have fun!

How to exercise for maximum weight loss — and health preservation — over the holidays

So here you are, caught in the weight loss abyss somewhere between the the culinary onslaught that was Thanksgiving, and the approaching diet-destroying duo of the Christmas and New Year’s celebrations.

Time for exercise is in short supply. You figure that your best bet is to workout even harder than ever for the little time you have in order to maximize your calorie-burning hours.

Losing weight is all about burning more calories than you take in, right?

Well, no. It’s not quite that simple.

That idea leaves a lot unsaid about the overall effects of exercise on our bodies. There are lots of technical details involving fats, carbohydrates, and number crunching to illustrate why this doesn’t completely add up.

For now, though, I’ll spare you the mumbo-jumbo so we can get right down to understanding how different exercise intensities can impact our ability to get rid of those unwanted pounds. We can also use this knowledge to exercise in a way that helps you become more fit and stay healthy in the process.

Got energy?

We exercise because it takes more energy than just sitting on the couch. The energy comes from calories we burn, and the calories themselves are burned off from stores of fat and sugar in our bodies. (We burn protein, too, but since consuming protein for energy typically happens far less than the amount of fat and sugar we burn, we’re going to leave it out for the purposes of simplifying this explanation.)

Generally speaking, our bodies have two ways of producing energy — one with oxygen, and one without. Given that we’re oxygen breathing mammals you can probably guess which one is more common, and which one our bodies prefer.

Physiologists refer to energy production in the presence of oxygen as aerobic energy, and energy production without oxygen as anaerobic energy. Anaerobic energy is the kind we rely on when we’re running hard and gasping for air. That need to breathe hard is our body’s not-so-subtle way of catching us up on the oxygen “debt” we put ourselves into by pushing ourselves harder than we’re able to go for a long period of time.

At lower levels of exertion we rely primarily on aerobic energy, and at higher levels we rely more and more on anaerobic energy.

The aerobic system is a fat burning machine. With plenty of oxygen and stored fat, you can exert yourself for hours at a time.

Without enough oxygen for higher intensity efforts, the body’s chemistry changes to burning more stored sugars. The available energy in the form of sugar is far, far less than what’s available in our fat stores, so the amount of time you can exercise at a higher, anaerobic intensity level is typically measured in minutes.

As you might guess, our bodies like oxygen, so anaerobic energy production is significantly more stressful than aerobic energy production.

Like all other forms of stress, this means that we have to treat anaerobic energy production — and the level of exertion that it requires — with some reverence. Guyton’s Textbook of Medical Physiology — the bible of the physiological field if ever there were one — refers to exercise as the biggest stressor of our bodies, bar none.

This means that when we choose to exercise, and in particular, when we choose to exercise anaerobically, we should do so carefully, with planning, and a healthy amount of respect.

Burn The Right Stuff

From a weight loss perspective, exercising at high intensities burns proportionally more sugar than it does fat. So to burn fat, you have to slow down and work at a more moderate intensity.

Yes, you will burn more total calories with that advanced “aerobics” class (you now know why they should really be called anaerobics classes!), but you’ll pay the price in many ways.

Bodies get better at tasks with repetition, and energy production is no exception. This means that the more time you spend with sugar-burning high intensity exercise, the more efficient you’ll become at it, and the more likely your body will be to rely on this source for future energy needs.

Conversely, if you spend your time in a fat-burning zone of intensity, you’ll be more likely to engage that particular energy system for other tasks as well.

Now which would you rather have, a body that leaves all that extra weight you’ve packed on untouched while you’re kicking back after the Christmas feast, or one that gets to work right away on burning off the excess fuel? Consistently exercising at a lower intensity, aerobic effort will prime your body to use fats instead of sugars as its energy source.

Additionally, with anaerobic work being more stressful, the chances of you surviving constant high intensity work without getting sick or injured are far, far less. All that excess stress induces our bodies to produce high amounts of the stress hormone cortisol, too. Cortisol is the prime culprit when it comes to feelings of being burnt out and fatigued.

If you’re a high-intensity exercise addict, ask yourself how many times you’ve been sick or injured over the last year. If your answer is more than two or three, you’re probably exercising too hard, too much, or some combination thereof.

This is why most New Year’s Resolution exercise plans don’t last much beyond February or March. Most people work out too hard, too much, too soon. After 6 or 8 weeks they’re typically sick, injured, burnt out, or all of the above.

The Remedy

The fix is to take it down a notch. Run slower. Cycle slower. Swim slower. Don’t push quite as much in the weight room.

Exercise at that oft-heard “conversational pace”. Even better, wear a heart rate monitor. Get a knowledgeable coach or doctor to prescribe an exercise test so you can figure out your personal exercise intensity that keeps your workouts in that aerobic range.

I do this frequently with patients and it does wonders to help people get more from their workouts. More weight loss. More fitness. More health and exercise longevity.

If you can’t get someone to help you figure out your personal exercise zone, take an educated guess. The best kind is the 180-formula advocated by Phil Maffetone.

Here’s how it works. Subtract your age from 180. Next, choose one of the following categories:
-If you’re on regular medication or are recovering from a serious illness, subtract 10.
-If you’re new to exercise, you’ve been injured, or you’re frequently sick, subtract 5.
-If you’ve been exercising without problems for 2 years and you don’t get sick more than a couple of time a year, make no adjustments.
-If you’ve been exercising without problems for 2 years and are making regular progress, add 5.

So, if you’re 40 years old and you get a cold a few times a year, your number is 135. This is your maximum aerobic heart rate. That is, any efforts at a heart rate above this number are considered anaerobic, and are above the intensity at which you should be exercising.

Using this formula obviously requires a heart rate monitor, but it is a minor investment when it comes to being able to workout in a way that not only helps you lose weight, but also keeps you healthy in the process.

In short, feel free not to have to work so hard all the time. It’ll help you lose weight, feel better, and enjoy the holiday season that much more!

Referred Pain Can Be A Pain In The Neck

How many times have you awakened some morning in the not-too-distant past to find that you have a new ache or pain? Trouble turning your neck. Pain around your shoulder blade. An uncomfortable lower back.

Where does this pain come from? Did you “sleep wrong”? Was the bed too hard? Too soft? Why, of all mornings, is it bothering you on this one?

The sensations we have in our bodies are not random. The perhaps unimaginable complexity of the human system can make what we experience seem random. But just because the pattern is too difficult for us to figure out doesn’t mean that there isn’t one.

So when we wake up with pain in a muscle, a common assumption is that the problem is right there with that muscle. This may seem self-evident, but it’s not quite so easy. Let me explain.

If your phone keeps ringing over and over from an annoying prank caller, the “symptom” you experience is your discomfort from the phone constantly ringing, disturbing your peace. The problem doesn’t start with the phone, though. It started with the prank caller on the other end of the line.

Bodies have a similar mechanism, where a problem in one area can send a signal that shows up elsewhere.

Take heart attacks, for example. You might have heard that a common symptom experienced during a heart attack is pain in your chest that can spread into your left arm and shoulder.

What does your arm and shoulder have to do with your heart? Not much, except that they share part of their nerve supply from similar levels in your spinal cord.

A common explanation for the shoulder and arm pain experienced by heart attack sufferers is that your brain misinterprets the flood of information it receives from an organ in trouble.

Instead of having us perceive this influx of information as a problem with the organ itself, our brains interpret the signals as pain and discomfort in a part of our bodies that are much more accustomed to those sensations. This kind of discomfort is called referred pain, since the pain is originating one place, but showing up in another.

What makes things interesting is that just about every organ we have seems to have a referred pain pattern.

You might have gotten up one morning, for example, with a “crick in your neck”. Pain into one side of the neck — typically, but not always, the right side — that might radiate down around your shoulder blade.

Patients come in from time to time with this kind of pain. The usual explanation goes something like, “Well, I must have slept wrong or something.” In many cases they’re surprised to find out that the source of their pain has little to do with how they slept, and a lot to do with their gall bladder!

The gall bladder has a referred pain area that usually covers the right side of the neck and shoulder, down around the shoulder blade. As such we have to rule out gall bladder trouble as a source of their pain anytime a patient presents with this kind of pattern.

It’s likely that the crick in your neck is more highly correlated with what you ate the night before than the position in which you happened to fall asleep. Fatty foods, spicy foods, or foods to which you may be allergic can frequently irritate the gall bladder.

After a good physical exam, if gall bladder irritation turns out to be the source of the problem, I have to advise the patient to avoid re-irritating the area with the foods mentioned above. Bile salts and pancreatic enzymes can also be helpful to reduce the load on the gall bladder while it recovers from the episode.

In short, if pain around the shoulder and neck turns out to be referred from the gall bladder, no amount of soft-tissue work will resolve the problem alone.

Since most organs appear to have a referred pain pattern, the gall bladder example used above is just one scenario where a visceral, or organ-related, source must be considered for what might appear to be a structural problem.

Seemingly structural problems can have visceral components. Likewise, a structural problem can have a very direct impact on our organ function.

The job of a truly holistic practitioner is to evaluate all facets of your well-being to help you improve your complete health.

Your Body is Not Trying to Heal

Why we honor the drive to survive before trying to heal ourselves

Stress is used as an explanation to cover everything from an outbreak of cold sores to a full blown heart attack. But how do we get from a nebulous concept like stress to a symptom that’s not at all subtle, like a headache in the middle of the night?

Last time we explored the varied forms of stress and we got a broad view of how it leads to illness. In this article, I’ll go over how our bodies actually respond to the varied stresses it is placed under. Understanding this will leave you much more prepared to handle health decisions and challenges you’re faced with every day.

I’ll start with an example that I use with a lot of my patients.

Let’s say a person — we’ll call her Jane — has recently twisted her ankle. As a result, she’s walking more towards the inside of her foot to avoid the pain she experiences when she gets too much weight on the outside.

Jane does this for a week or so, and the pain in her ankle seems to resolve.

A couple of weeks go by with her ankle feeling pretty good, though perhaps just a bit stiff from time to time. However, now the inside of her knee is hurting.

She doesn’t know why this started, but she’s found that, without really even thinking about it, if she just shifts her weight a little bit to the outside of her hips her knee stops hurting.

Jane continues to hold herself this way and six or eight weeks go by without her knee or her ankle hurting. The problem she has now is that her hip has started to bother her.

No change in position or amount of time resting make the discomfort go away.

This is the state she is in when she walks into my office, complaining of hip pain. So put yourself in the doctor’s shoes for a moment, and tell me: where is Jane’s problem?

From experience, I can tell you that if we just address the spot where she’s having discomfort — around her hip — we won’t get very far. She’ll either have no relief at all, or the pain will be back in short order.

Our fictitious patient has essentially layered herself into a problem that won’t go away until we remove the layers in the order that they came about. That is, we have to address the hip, knee, and foot — and typically in that order — to provide our patient with complete relief and optimal healing.

We tend to layer problems on top of each other, and it’s only when we’ve layered so much that our bodies have nowhere to go that we then have pain, discomfort, or some other symptom that won’t go away. Addressing these issues in order is a process that doctors for over one hundred years have referred to as “peeling the layers of the onion”.

The question you might ask at this point is: why wouldn’t the body just heal the original problem and be done with it?

The big concept to get here is that, contrary to popular belief, the body’s main priority when it is hurt is not to heal. The body first and foremost is trying to survive.

Let’s use an analogy.

Imagine you’re sitting in a house somewhere and all of a sudden you feel a huge earthquake begin. You look up and see the ceiling cracking. It seems like the whole house could come down on top of you at any minute, so you start to run to the door to get outside.

Before you make it to the door, though, you find a big bookcase that you had in the hallway has fallen over. It and the dozens of books that were placed upon it are now strewn on the floor in front of you, blocking your path out of the house and away from imminent danger.

Given this scenario, would you take the time to carefully stand the bookcase back upright, and then proceed to neatly place all the books back on their proper shelves in the appropriate order?

I would guess not.

Chances are, you’d use whatever strength you had to quickly push the bookcase out of the way, and throw the pile of books in whatever direction was most convenient so you could get out the door fast.

You’re not worried about what the mess looks like right now, as you have survival as your first priority. You know there will be plenty of time later to come back and pick up the mess.

You hope so anyway. But what happens if you come back, and instead of having time to clean up, you now have to deal with a tornado, or a fire, or a family crisis?

The books might just get pushed to the side somewhere, maybe even preventing you from getting easily to the kitchen, bathroom, or bedroom.

Our bodies work very much along the same sorts of principles. Systemically we deal with problems in order of priority, stacking things on top of each other without necessarily having fixed the last thing.

Basically, we adapt to the problem at hand in order to remain functional and survive against the onslaught of stresses that each of us encounters every day. True healing is something else entirely.

Healing, like an orderly cleaning of our traumatized house above, requires time and energy. If that time or energy is concentrated on something else, problems will pile up, and it will require additional, focused energy to neatly clear out the adaptational mess that has developed.

My time as a doctor is spent helping people find their way out of the maze, frequently addressing issues that people might have thought they had completely dealt with ages ago.

What they didn’t realize is that they simply adapted to whatever problem they had, without really healing from it.

Jane never really healed from her twisted ankle. The pain stopped, yes. But she never addressed the altered gait or lack of muscular support that she had from the original trauma.

Each adaptation we layer on top of a problem requires energy. Having to walk over or around the pile of books that used to be on the bookcase takes more energy than simply walking the straight path that used to exist before things fell over.

Every additional adaptation that gets added on requires more energy, until it becomes all we can do just to navigate our little mess of a house.

The effort it takes to clean up the mess (or “heal” from the problem) will take an additional, one-time expenditure of energy. But over the long haul the energy saved in having a clear path will be far greater.

Knowing this along the way can save lots of time, energy, and discomfort. Just like addressing small messes along the way is a lot easier than a complete house cleaning, getting aches, pains, or injuries you might experience evaluated before they become unmanageable will keep your physical, mental, and emotional house in order.

French Fries Count, Too

The Many Faces of Stress and Its Not-So-Subtle Effects

Stress comes in many forms. Most of us understand this intuitively. For example, we know that we feel “stressed” when we have a hard day at work or when we’re carrying a heavy load.

We use the word to describe an intense emotional event, and to convey what is happening to a wooden board bent to the point of breaking.

While the concept seems very natural to all of us, the actual term “stress” hasn’t been around very long. It wasn’t coined until a researcher by the name of Hans Selye came along in the 1950s.

On the other hand, the idea that people and things could be subjected to environmental irritants has been around for a long time. D.D. Palmer, the founder of chiropractic, made this observation back in the late 1800s.

Palmer divided these irritants, or forms of stress, into mechanical, chemical, and psychological forms – or what he called “traumatism”, “poison”, and “auto-suggestion”, respectively.

A mechanical stress could be in the form of an uncomfortable pair of shoes worn all day long.

Chemical stress could come from a food allergy or a toxin from unfriendly bacteria.

Psychological stress is perhaps the most well known, and might arise via a fight with your spouse or dealing with an unreasonable boss.

An important thing to understand about all forms of stress is that they’re cumulative. That is, you can’t separate the different varieties of stress and somehow recover from them independently.

If you spend the weekend playing touch football (mechanical stress) and then have a big deadline looming at work early in the week (psychological stress), and as a result of your time crunch at work you scarf down some fast food filled with lots of sugar and hydrogenated fats (chemical stress), then it won’t be any wonder when you’re worn down and sick by Friday!

Selye actually determined this half a century ago, when he would stress lab rats in various ways and then see how their bodies responded. No matter what form the stress, the eventual breakdown always followed the same pattern.

Humans also follow this pattern, and if we don’t make an effort to relieve the various forms of stress placed upon us, we end up sick, injured, or both.

So if various forms of stress can make us sick, then what exactly is health? It is pretty easy for us all to understand that we feel good until mechanical, chemical, and psychological stressors (or “MCP” for short) add up and we break down.

But then what about that point in between, when we have a fair amount of MCP, but we’re not yet sick or injured in any noticeable way (i.e. we don’t have any symptoms)?

That space in between the level of stress we’re currently under, and the level we have where we start experiencing symptoms is called “resistance”.

These ideas are best demonstrated with a stress chart, devised by Dr. John Bandy of Austin, Texas. Take a look:

The chart is read like a thermometer, with our total exposure to environmental stress (or MCP), reflected by the “Now” point on the chart. Various stresses can contribute to our total stress, as already discussed. Anything from marital strife to fatty foods to, yes, exercise, can add to the total level of stress we experience.

The point “D” on the chart is the Disease point. That is the point at which we begin to exhibit symptoms. “R” then, is a graphical representation of resistance. If the next big stress we are subjected to happens to exceed our current supply of resistance (“R”), then we experience symptoms of illness or disease.

At any given point in time we have varying amounts of resistance. It varies within and between individuals based upon how good our diet is, what our job is like, how much exercise we do, whether a loved one recently passed away, and whether we’ve just been exposed to a “bug”, to name a few.

That is, it varies based upon how much MCP we’re experiencing.

So health, then, is that state where we still have some resistance, keeping the level of environmental irritants that we are experiencing from producing symptoms. We are “unhealthy” (or experiencing “disease”), when MCP exceeds our resistance.

From this it follows that any stressor reduces the amount of resistance you have, bringing you closer to a state of disease. These concepts are well described in Dr. W.D. Harper’s book, Anything Can Cause Anything. The title gets to the crux of the idea: just like any expense — be it business or pleasure — will deplete your bank account, so too will any stressor deplete your overall reserve of health.

Next time, we’ll explore these ideas more to understand how we survive and adapt to all the stress that is around us!

It might seem as though I’m being loose with my article titles, but I assure you I’m serious. If we really stop and look at the kind of injury that befalls your average athlete, we’ll find that this kind of impairment afflicts most of us at one time or another.

To start though, we have to know what we’re dealing with. The easy, broad way to define athletic injuries would simply be as an injury an athlete gets.

More specifically, it would be something that impairs the ability of that athlete to perform. The movements athletes perform — running, jumping, throwing, swimming, etc. — are the same ones the non-athletes utilize, only less often and less vigorously.

Some confusion arises over how injuries are diagnosed and classified. For example, the cause of your average case of tendinitis — inflammation of a tendon — is frequently chalked up to “overuse”. What does this mean?

It could certainly be said that an athlete might tend to work a body part a little more than the average Joe. A pro tennis player will exercise and put much more stress on her elbow as part of hundreds of serves in practice and match play.

But this doesn’t explain why she got tendinitis and her teammate, performing the exact same regime, did not.

Two players are as different as their genetics, environment, and training, but beyond this there must be some mechanism by which the tendon of Player “A” became inflamed and that of Player “B” did not.

I suspect the “overuse” classification of athletic injuries is frequently the descriptor added to an inflammatory condition for which the causal factor is unknown.

Evaluate Function, Not Pain

The impairment of the athlete is no different than any ache or pain you might have from time to time.

A wrist that hurts when opening a jar.

A shoulder that stings when you reach for something in the back seat.

A knee that “talks to you” when you climb a flight of stairs.

The ankle that still hurts from time to time after you twisted it years ago.

All of these ailments have a cause that goes beyond the stand-by “getting old” or “the same thing my Dad used to have” explanations.

More information can be garnered — and a more distinct cause perhaps identified — if time is taken to evaluate a person’s function, and not just their pattern of pain. By this I mean looking beyond where it hurts to try and ascertain, for starters, what movements are restricted, how posture has shifted, and what muscles are not working as they should.

The more specifically movements and muscle function can be evaluated, the better we’ll be at isolating the things that need to be addressed to improve function. If function is improved, the pain almost always takes care of itself.

How can I assume that you have an “athletic injury”? From the above it follows that athletic injuries result from impaired function. I haven’t seen a patient walk in the office yet who didn’t have an area that, once thoroughly evaluated, didn’t have some impairment of function.

We never walk around in a perfect state of function. Rather, we’re always in some state of adaptation to the stresses that befall us, both past and present.

The Fix

Whether we experience pain is determined in large part by how well we are able to adapt to a potentially injury-causing stress. Twisting your ankle may or may not hurt depending upon how well you alter the way you walk and carry your body weight differently over knees and hips.

A body will fix a problem by itself — healing a torn muscle, for example — if it has the resources to do so. It will otherwise adapt its function so that that particular muscle is utilized minimally.

Fixing the problem thus depends on isolating the part that isn’t performing normally. That is, find out how function is impaired, and then address the condition that is preventing its restoration.

This is very much like the circuit breaker in your house tripping when you try to flip the switch to turn on the lights in the bedroom. The circuit for the bedroom lights could have blown due to a number of reasons. Faulty wiring, electrical overload, or a short in a particular appliance, to name a few.

Getting the lights back on then requires two things. First, address the problem. Remove the appliance that’s causing a short, for example. Second, reset the circuit. Only by performing both actions will you get the lights back on.

Bodies work similarly, but the circuits are a lot more complex. When seeing patients, the “circuits” I fix every day can require the restoration of alignment with an adjustment to the joint, fascial work around an impaired muscle, or the aid of supplemental nutritional enzymes to help clear out debris and damaged tissue.

As we are indeed holistic individuals, the restoration of function can require that we address the entire spectrum of chemical, structural, and psychological stresses that each of us encounters every day.

For lasting change, however, we must both address the cause of the problem and do whatever is necessary to “reset the circuit”. Anything less is a disservice to you as an athlete in the game of life!

It wasn’t my habit years ago to walk into your average office and cringe at the sight of workers sitting at their desks. I have to confess that that sort of reaction is exactly what takes hold of me nowadays.

After seeing many patients that need treatment for everything from numbness and tingling in their fingers to debilitating lower back pain, it quickly became obvious that the desk posture of the average American office worker really isn’t working out. Home computer users needed plenty of help, too.

This article is dedicated to those of us who’ve made the jump to the information age. If you use a computer, read up. You need this information.

We’re going to walk step by step through setting up your computer workspace. You’ll be rewarded with a much less stressful setup that will treat you better long term.

A Good Foundation

We start with your chair. The more adjustable, the better. The base, or seat, of the chair should not only raise and lower, but ideally it should be able to tilt forward and back.

That is, the edge of the base that is closest to your knees should be able to lower relative to the edge that is closest to the back support.

You need the base of the chair higher than you think. You want to be able to raise the base so that your hips are significantly higher than your knees. Say, at least 4-5 inches.

Stand up. Place one hand at the small of your back and the other on your tail bone. Keeping your hands where they are, slowly sit down onto a low chair that has your hips even with your knees. Feel how your lower back rounds out substantially?

Now start over in the standing position. This time, sit down onto a taller chair, stool, or even a tabletop so that your hips are well above your knees.

You should notice that your lower back doesn’t round out as much, keeping your spine in a more neutral position and the weight of your torso centered through your pelvis. When you’re in the right position, even your feet will feel more grounded on the floor.

Here’s where the base tilt comes into play. With your hips higher than your knees, on some chairs the front edge of the base will dig into the backs of your thighs.

Tilting the front edge of the base downward eliminates this pressure, and also has the beneficial side-effect of slightly rocking your pelvis forward into an even better position.

If your chair doesn’t have this feature, you can accomplish the same thing with a small pillow or wedge, with the thick part toward the back.

Now that the base is at the optimal height and tilt, you should be able to sit comfortably, balanced, without the need for any particular back support. This is the reason most people sit with better posture on an inflatable exercise ball.

Sitting on an exercise ball, your hips are typically higher than your knees, and the natural curvature of the ball tends to rock the pelvis slightly forward so that you are balanced over what yoga practitioners call your “sit bones”.

Anatomically these are known as the ischiums, and they make up the part of your pelvis that is closest to the ground. You can feel them simply by putting your hands under your buttocks when you’re sitting.

Balance is key. If our spine is centered over our pelvis, it takes very little energy to maintain good, low stress posture. It’s only when we slouch, lean too far forward, or too far back that we have to engage extra, non-postural muscles to hold our position.

As far as exercise balls go, there’s nothing wrong with using one as your regular “chair” of choice. Most people will prefer the aesthetics and extra adjustability of a well-made office chair, however, so read on.

Gentle Reminders

Now that the base of your seat is at the right height and tilt, you can adjust the back support of the chair. Once you’re sitting in a balanced, tall position, with hips higher than knees, simply adjust the back of the chair until it gently contacts your lumbar area.

The seat back should essentially function as a reminder when you begin to slouch. When you do, your spine will press more firmly into the back of the chair. This additional pressure will serve as your cue to get yourself back into a good position.

The next reminder comes from the armrests. Sitting tall, your shoulders should be relaxed, hanging loosely from your torso. Your elbows should be bent at 90 degrees or more, so that your forearms are angled slightly down from elbow to wrist.

Assuming this position, bring the armrests up so that they gently touch the undersides of your forearms. Once there, if you start to slouch your forearms will rest more firmly on the armrests, and your shoulders will start to sneak up closer to your ears. That’s your wake-up call to get back where you need to be.

The Desk is Next

The base is at the right height. You’re sitting balanced over your pelvis. Your forearms are angled slightly downward. Your wrists are not bent, but are flat and relaxed so that you don’t engage any more of your forearm musculature than is absolutely necessary.

Now, look at your hands. Right where they’re placed is the level that your desk should be. More accurately, this is where your keyboard should be, so your desk should actually be placed an inch or two below that.

Notice that we did not determine what level your desk should be until we got your chair setup exactly as we wanted it. We’re obviously assuming that you have a desk that is capable of having its height adjusted. If not, you have options.

First, you have some room to play with the height of the chair. As long as you keep your hips higher than your knees, and you can tilt the base so that your legs are comfortable, you can raise the chair until your hands rest comfortably at the level of your keyboard.

If your desk is set too high, you may run into a couple of problems. You might not be able to tilt the base of your seat enough to get comfortable. Or, in order to get your hands at the right height you might have to raise the chair so high your feet come off the floor.

In these cases a footstool can be a lifesaver. You can find them at most office supply stores and they’re made for this very reason. Using a footstool your legs will be able to rest comfortably using a chair that is set high enough to get the rest of your body into a good position.

If your chair won’t raise you high enough to get you into the correct position relative to your desk, sometimes a keyboard and mouse tray that slide out from underneath the desk will solve the problem. Consult your local office supply store for options here. If that’s not possible, it’s time to invest in a new chair, desk, or both.

Look Up to Work

The last thing we adjust is the position of your monitor. Don’t skimp on this one. Neck problems that end up causing shoulder, arm, or hand pain are frequently caused by chronically poor head position.

Where do you put it? Right where your eyes go. Place the center of the screen at eye level. You can pick up a monitor riser or even a cantilevered stand to set it at just the right spot. Again, consult your local office supply store. In a pinch, a couple of phone books will also do the trick.

Many “ergonomic guides” that come with computers and monitors recommend placing the top of the screen at eye level. This is too low. Your head will follow your eyes. If your monitor is set on your desk before long you’ll find your neck craning forward so that you can look into the screen.

Finally, make sure the screen is at least a couple of feet from your eyes. Any closer and the constant glare of the screen so close to your face will cause eye strain. Any further and you’ll find yourself bending over your desk to get close enough to the screen to be able to read what is on it.

If you have to use reading glasses or bifocals to see the screen clearly, do yourself a favor and invest in a pair of computer glasses. These are glasses that are designed for computer use.

The entire lens, as opposed to just the bottom half, is devoted to the distance at which you would read from the monitor. This way you’re not constantly tilting your head back and looking down your nose to take care of your daily work.

The Bottom Line

With any setup for a repetitive activity, use your body as a guide. The error often made is in attempting to mold your body to a new task or piece of equipment. This is approaching it backwards.

Always try and position yourself in the most neutral, stress free position and then attempt to adapt your task around it. For this reason it pays to invest in desks and chairs that are as adjustable as possible. This gives you the most freedom to play with different positions and find the one that keeps you at ease.

Investment is an appropriate term here. Anything you’re going to spend hours a day on — for weeks or years at a time — is worth a little extra financially. The return you get in reduced stress, tension, and injury will be well worth it.

Last time we talked about sleep, and how a lot of people out there have a strange idea of what it is to be “normal”.

From waking frequently in the middle of the night, to only sleeping 4-5 hours at a time, to not being able to get to sleep at all, they think somehow that dealing with these issues on a regular basis just makes it part of the ordinary human physiological landscape.

In this issue we’re going to talk about shoulder, arm, and hand pain, which is another group of common complaints I see with patients. Any sort of nagging pain in the upper extremity is also frequently accepted as something that is just “part of getting old” or from some previous injury that can’t be helped. Neither is true.

Often, part of the problem is misdiagnosis. Take Carpal Tunnel Syndrome, for example. Carpal Tunnel Syndrome, or “carpal tunnel” as it’s known for short, is a condition that affects the hand and is caused by compression of the median nerve, which runs through a passageway in the wrist — a tunnel, that is — formed by bones, ligaments, and fascia.

The median nerve sends signals from the thumb, index, and one-half of the middle finger so that you can feel sensations in those digits. It also supplies stimulation to small muscles that control some motions in these same fingers. Sensation and movement on the pinky side of your hand is controlled by the ulnar nerve, which does not pass through the carpal tunnel.

That last point is key. The median nerve runs through the carpal tunnel. The ulnar nerve does not. This means if you experience pain, tingling, or numbness in your entire hand, the problem can’t be originating solely in the carpal tunnel!

It is much more likely that the problem is coming from an area that is affecting both of these nerves simultaneously. Yet, we frequently see patients in the office with pain or numbness in their entire hand who have been diagnosed with Carpal Tunnel Syndrome.

Even worse, surgery is often recommended and performed on these patients with the inevitable and unfortunate outcome that they receive no relief in symptoms. Simply understanding how the nerves are anatomically positioned — the “wiring diagram” of the body, if you will — avoids a lot of problems with misdiagnosis and inappropriate treatment.

Knowing these relationships is important for complaints other than hand pain. Nerves that supply our extremities originate from the spinal cord in large bundles. As they travel farther away from the cord they branch into smaller and smaller segments, splitting up to cover areas of skin, muscle, and other tissue. The closer to the cord a nerve gets caught, compressed, or otherwise irritated, the larger the area of tissue that is potentially affected.

Other places outside the normal area of sensation supplied by the nerve can also be affected as muscles that are supplied by the nerve are limited, or inhibited, in their function. When that happens the biomechanical relationships that are supported by those muscles are altered. Joints and supporting tissues can become inflamed and sore.

Many people are familiar with the radiating pain down the leg commonly called “sciatica”. This radiating pattern doesn’t just affect the legs and the lower back. I frequently see patients with problems originating from their neck that show up as shoulder, arm, or hand pain. The pattern is the same as what happens in the lower extremity: something affects the nerve root that supplies skin and muscle in the upper extremity.

Pain, tingling, or numbness is thus experienced at a place distant from the source of the problem. Biomechanical relationships in the arm are also altered which can add further irritation to any joint or muscle in the area.

Again, understanding the anatomy is crucial. Just like in the lower back, in between each vertebrae in the neck are discs with a fibrous outer ring and gel-like material in the center. Nerves come out of the spinal cord between the vertebrae, right where the discs are. This means anything that might cause the disc to bulge or herniate has the potential to affect the nerve root.

The nerves in the neck supply the muscles of the arms, among other things, and provide sensation on the skin in predictable patterns called dermatomes. See http://www.collinsdc.com/images/dermatomes.jpg for an illustration. Doctors can use this knowledge to aid in determination of what nerve root might be affected with someone experiencing, say, hand pain in their thumb and index finger.

Look at the dermatome picture again. Pain in this area, in addition to simply being a problem locally in the thumb, could also originate around the 6th cervical vertebra. Your doctor should be able to distinguish between the two.

Aside from the more obvious causes of shoulder or arm pain — falls, sprains, etc. — the most common cause of upper extremity pain I see in the office is habitual. That is, something we do every day as part of our normal routine or posture can bring about aches, pains, tingling, or numbness that would seem to have no particular cause. This is prime material for the “I’m just getting old” or “I must be out of shape” explanations that float around the water cooler.

In particular, poor neck posture seems to be a big culprit. Anything that routinely brings the chin closer to the chest seems to lead to the type of pain described. Back to the anatomy, bringing the chin closer to the chest flexes the vertebrae in the neck forward. This position creates wedging of the vertebrae, with the front edges closer together and back edges farther apart.

Remember the discs between each of the vertebrae? When this wedging happens, the discs have to go somewhere. Being more fluid in nature, with the vertebrae wedged together in the front, the discs tend to push out toward the back. If this happens over a long period of time, eventually the discs can bulge or even herniate.

When any of this disc material — or any other anatomical tissue, for that matter — starts to abnormally push on a nerve, you’ve got problems. The nerves at this level supply everything you can think of in the upper extremity. Shoulder pain, elbow pain, tingling down the arm, or pain in the wrist and hand are all fair game, to name a few.

So what qualifies in the realm of bad habits? Reading in bed or watching TV with your head propped up. Routinely using a laptop or even a desktop computer with the monitor too low. Long periods of studying or writing with the material on the desk under your chin. Handwork, such as knitting, done with your hands close in to your chest. Sleeping on your back with your head on a pillow that is too high, or on your side, curled up tightly in the fetal position.

There are many others. The bottom line is: if you keep your chin down close to your chest for long periods of time doing anything, you have the potential for this sort of problem.

The good news is that fixing this problem is generally not complicated as long as you find someone who can properly diagnose what’s happening. Once you’ve done that, treatment is relatively straightforward.

Chiropractic adjustments help tremendously. The adjustment has to be done in a position and direction where the nerve root is not impinged in any way. When done properly, this seems to clear the nerve root of any impingement and minimize any radiating symptoms experienced.

The adjustment isn’t the whole fix, however. Lifestyle habits must be changed. In other words, keep your chin up! This is crucial to keep the vertebrae aligned and free of any wedging so that things have time to heal. This is analogous to having your skin cut with a knife. The wound will heal cleanly with minimal scarring if it is dressed properly and the edges are held closely together with stitches or a butterfly bandage.

On the other hand, if every day you go in and spread the wound apart with your fingers, you’ll be left with a nasty scar or, worse, the wound won’t heal at all.

Once the adjustment is made and lifestyle habits are addressed, residual issues can be tackled. Long periods of time with poor or diminished function and improper biomechanical support to tissue in the shoulder or arm can leave joints inflamed and muscles gnarly. Get in with a good Applied Kinesiologist, Rolfer, or massage therapist to work out the kinks.

Don’t let anyone tell you that the types of pains I’ve described here are a “normal” part of life. Keep your detective cap on and take an inventory of your usual activities that could be contributing to your condition. With a little persistence you’ll pass up that “normal” life for an optimal one!