Ice baths or Nah?

As sports begin to pick back up again I have been asked a bit about ice baths. I have never heard of anyone actually enjoying a nice cold ice bath after a rigorous practice or long days of games. Sure enough there is even limited research supporting positive effects of using an ice bath as a recovery tool! Sweet, no more awful recovery baths, but if they are not a positive way of recovery, then what is?

The attached article suggests based on athlete perception that contrast therapy may be a better option, participating athletes perceive to be more relaxing and find it easier to rest and sleep post-game or training.

What are your favorite recovery tools?

https://journals.lww.com/nsca-jscr/Fulltext/2011/04000/A_Random_Control_Trial_of_Contrast_Baths_and_Ice.23.aspx

Chiropractic beyond pain: chiropractic lesions, dysafferentiation and the altered body map

I have recently downloaded and splurged on some new chiropractic basic science research podcasts that I listen to during my commute, a real nerd heaven. The author of the study, Dr. Kent, has been ahead of his time in our profession. His research has been focused on the basic neurology of chiropractic and how it affects health, body function, well beyond pain.

The article is heavy on basic science. It explores the ways in which mechanical lesions and malfunction in spinal joints disrupts feedback loops between the brain and the body. At any given time, your body is in a constant state of “homeodynamics”, constantly getting feedback from your external environment ( for ex how hot it is ), and your internal environment ( for ex how much food just landed on your stomach ) , and responding correctly ( increase sweating if your body temp is too hot or start to secrete stomach acid to digest your burger ).

One of the first manifestations of a disrupted feedback loop is a phenomenon referred to as dysafferentiation, a big word that describes an distorted sensory input from your body to your brain. Truly dysafferentiation can be caused by several things, but this article explored the role of the spine mechanical lesions because of their prevalence. If you want a simpler image : your brain needs to have an accurate “map” of what is happening in your body in order to produce the right response. Dysafferentiation is basically a faulty, distorted map. ( excuse my nerdy old love of classic literature, but I could not resist the analogy to the Dorian Gray story ).

The connection between chiropractic care and dysafferentiation is that reducing the mechanical lesion at the spine can prevent the distortion of sensory input reaching the brain, and thus an incorrect response. This phenomenon can happen regardless of the presence or absence of pain, and regardless of what part of the body map is distorted. Think about what happens if your body decides not to sweat in 90’ weather or if your body refuses to produce digestive juices to break down that big fat burger…

https://www.researchgate.net/publication/320306138_Heart_Rate_Variability_to_Assess_the_Changes_in_Autonomic_Nervous_System_Function_Associated_With_Vertebral_Subluxation

My IT Band is tight. Not likely.

I tend to hear over and over again, “my IT band is too tight, I foam roll it all the time, but it just doesn’t seem to get better”. Well, chances are it’s not your IT band that is tight, but instead the tensor fasciae latae (TFL) muscle or the gluteus maximus muscle that is inserting into the IT band and even the TFL or Glut Max might not be “tight” but functioning inappropriately. So you can spend all your time targeting the wrong area and never really make much progress, but it hurts when you do it so it must be right, right? No. Victims vs Villains. What is the villain or causing the problem and what is just a symptom, casualty or victim of the problem? 

The IT band is actually layers and layers of fascial tissue, fascial tissue differs from muscular tissue by the fibers that make them up and their vascularity. 

So next time you go to foam roll your “tight IT band” try rolling the TFL or Gluteus Maximus muscles, or stop in and we can assess the villains.

The Not-So-Strange Exercise of Walking Backwards

https://www.youtube.com/watch?v=cslOAA3o5L8

One of the biggest challenges with the postural distortions of modern humans is that all of our activities are in front of us and below eye level. Over time this will cause a strong tendency for the body to lose its proper relationship to gravity and for the whole body to lean forward: the pelvis anterior to the heels, the shoulders anterior to the pelvis, and the head anterior to the shoulders. Holding all of these body areas at a leverage angle to the supporting structure below causes chronic painful muscle overload and difformity of the supporting ligaments and mechanical overload of several key structures like the front of the knees, and the spinal discs.

Preventing and reversing forward postural shift can take many forms. Limiting poor ergonomics such as elevating our reading material to eye level is one strategy, but modern life also requires us to actively practice activities that reset our brain’s response to gravity and makes us actively reset our whole body over our heels, 2 or 3 inches back from where we typically stand.

There are a variety of such practices: yoga, tai chi for example and an often forgotten and easy activity is also walking backwards.

Walking backwards fires up the same cerebellar brain pathways that make you better sense that you are leaning forward as well as fires up the muscle groups that pull you back up from your forward posture. It can be done pretty much anywhere with no equipment, and you don’t have to do it very long or very far to get the neurological benefits, however there are a couple of important caveats for safety and efficiency-

• SAFETY: Always check behind you to make sure that you have a clear path for the distance you are going to walk back. That seems like a no-brainer but from what I have seen at the office, not always the case… If you walk with a buddy for exercise you can have your partner be a spotter while you do this for a couple of minutes.

• EFFICIENCY: Start by making sure you are standing tall and relaxed. Also YOU ALWAYS NEED TO SWING YOUR ARMS while walking backwards to get the neurological benefits. You will be surprised that it will take you a little bit of intention to find the correct arm to opposite leg coordination at first. This is why I do not recommend walking backwards while holding on to a wall, since you will be preventing normal arm swing. I also advise patients to only walk backwards on the treadmill if they can do it without holding on the the handrails.

Breathing Through a Mask and Neck Straining

It has been another interesting week at the office. The ever evolving COVID situation has many folks wearing facial coverings including all of us at the Office. But for many folks getting used to wearing a mask has had some rough patches, especially if you have to be somewhat physically active or talk a lot. Breathing with a facial covering is different than breathing without, regardless of what you try to do intentionally. Our brain is hardwired with some very strong primitive reflexes to decrease the depth and vigor of your inhalation if there is a physical barrier to your airways, to conserve energy and oxygen use during decreased availability. Hence this sensation of being breathless even when the actual venting of your masks lets enough oxygen pass through.

The above fact is instinctively understood by most, but a patient posed me a great question that is understood by fewer: Is there a correlation between use of a facial covering and a sensation of unusual neck straining? The answer is yes, there definitely can be. Several of the anterior and lateral muscles of the cervical spine are “accessory muscles of inspiration”: they are recruited to enhance the efficiency of breathing in, normally born largely by the diaphragm muscle below the lungs. So wearing a mask for a long time, especially when you have to talk or get your heart rate up, will build up over recruitment of the accessory muscles. The sensation of straining will often be felt deep within the neck radiating to the collarbone and into the top of the shoulder blades, and can trigger headaches to the front of the head.

Masks are not going to go away soon or completely, so we better develop some coping strategies.

• Several times a day when NOT wearing a mask, practice some breathing exercises to fully empty out the lungs, such as puffed exhalations, slowly breathing out as far and as long as you can, or blowing up a balloon slowly as big as you can in one breath. This will stop the shallow breathing cycle and retrain your brain to take a full breath. I personally do that during my morning and evening commute to reset my normal breathing.

• Learn to stretch the accessory muscle: dangling one arm and letting your relax to the other side and slightly in extension, or lay on your back with your head hanging very slightly over the edge of the bed.

Post Pregnancy Abdominal Diastasis and Core Strength: Is There an Absolute Contraindication ?

As always daily patient flow is good fodder for blog topics, especially when a question comes up more than once in a week. This week’s theme was diastasis and abdominal exercises. We have had a fair crop of new moms this spring. Diastasis is a fairly common problem. The stretching of the abdominal wall can result in excessive soft tissue separation/stretching between the right and left abdominal muscle group, usually extending a few inches up and down from the umbilicus. It is sometimes accompanied by pain when contracting the abdomen but mostly it is non painful, however the new mom will notice the gaping area and sometimes an outward bulging.

The standard recommendation is to avoid any form of abdominal strength exercises. And while I think that is a very appropriate recommendation for 6-12 weeks after delivery, I take issue with it as an absolute recommendation for all women long term. There is a strong potential negative impact on the spine from limiting core strength building, and not all women have a manifestation of diastasis that will get worse with some form of abdominal strengthening exercises.

My approach is to assess each woman individually in the following way: first, palpate the resting width of the diastasis with the patient laying on their back with their knees slightly bent. Next, keeping my fingers in each side of the gap, have the patient engage their abdominal muscles in a variety of ways: table top leg lift, crunch, and plank. In each position, I will compare the starting width of the diastatis with the exercise width. If the distance increases, the exercise is making it worse. If the distance stays the same and the patient has no pain, the exercise is value neutral for the diastasis but not unsafe, and can be done beneficially for the lumbar spine. In many instances, the distance will actually decrease, suggesting that the exercise is actually beneficial in reducing the diastasis gap over time. In the past 10 years since I started assessing patients in this way, I would estimate that more than half of the patients actually see a benefit from finding the right kind of abdominal exercise. So remember that blanket recommendations in that regard are worth revisiting for your individual case.

The Relationship Between Cervical Spine Disc Degeneration and Dizziness

https://cdn.journals.lww.com/spinejournal/Abstract/2017/04150/Mechanoreceptors_in_Diseased_Cervical.4.aspx

I have had a couple of cases of dizziness in the past two weeks. In both cases, they were glad to find out that we were actually open. Both patients have had prior occurrences of the same symptoms that have responded well to chiropractic care, and if you have ever been in the same boat, you can understand why the idea of waiting until May 4th is wholly unappealing.

Dizziness is a broad lay term that actually encompasses a range of symptoms from a sensation that the room is completely spinning (true dizziness/vertigo), to a sensation of being lightheaded, off balance, and/or on shifting ground. The former is unlikely to be fully caused by a cervical spine disorder but the latter may well be.

The cause of dizziness can be difficult to pinpoint. I have several colleagues, much smarter than I am, who say the day is off to a rough start when a patient presents with a primary complaint of dizziness or fatigue. Behind the joke is the reality that some symptoms can really be caused by anything and you have to be a very persistent detective to sift through the options.

The part of the brain that integrates you sense of position in space receives input from a variety of little sensors throughout the body. The biggest contributors are the inner ear, the visual system, the joints of the lower extremity, and the joints of your neck. If one of the sensors does not give off correct information, the brain center that processes all the information will get very confused by the conflicting sensory data and the end result can be this sensation of being “off”: lightheaded, dizzy, nauseated, or off balance.

The research paper in question was quite interesting in that it pointed out that the mechanism by which the neck can be a cause of dizziness, in particular in cervical spines with degeneration from trauma, age, or a combination of both. The degeneration can lead to an increase of position sensors in the neck (a protective mechanism of the body to give you early signal of a problem in a previously injured area so you stop injuring it further), and this can create a sensory storm to your brain centers if you add even the slightest bit of misalignment and mal-position of the cervical spine to top it off. Chiropractors have discovered that phenomenon by trial and error many decades ago, long before this research paper, when patients reported a decrease in their dizziness after a cervical spine adjustment. Since dizziness diagnosis is usually a diagnosis of exclusion, a chiropractic evaluation when other causes have been ruled out seems a logical choice.

COVID Creative Home Ergonomics

I have started to notice a trend last week that will probably only get worse during the rest of April, and possibly beyond. Many folks have transitioned to working from home and the transition in some cases was hasty. Office workers especially have gone from a great desk, set up with a correctly aligned screen, keyboard and mouse, chair and armrest, and in some cases, sit stand workstations, to a makeshift work corner in their house where their laptop was haphazardly enthroned. Some patients are coming in with unusual complaints of neck and shoulder tenderness, headaches as the day progresses, and wrist pain. When we dig deeper in the mechanism of onset, it clearly emerges that their home station is causing some physical strain.

Remember that you may be working in this situation for several weeks, possibly months, so you owe it to yourself to spend a little time setting things up correctly.

First: You do not need any fancy set up to get started. You can dust off your bookcases and find a use for a lot of books or boxes that can be used as props to bring screens to the right height.

Second: Laptops and tablets are as always the reason for most of the problem unless you use the tablet and laptop as a screen and retrofit a wireless keyboard that can be maintained at the right level, close to elbow height. Wireless and bluetooth keyboards can be found online with 2 day delivery and cost less than $20 in most cases.

Third: Your mouse also needs to be positioned correctly, if you forget about it you will be feeling shoulder pain very shortly.

Fourth: Continue to alternate sitting with standing whenever possible. For that you will need to set up a second work station to float to and from with your laptop and keyboard. Kitchen counters often are the closest height for that.

Attached are a couple of photos of the makeshift stations at the Demel house. I normally do most of my computer work at the office but with shortening the patient days and facing some increased administrative demands due to COVID19, I find myself putting in several hours at a time with my Surface tablet.