SWITCHING "RICE" TO "POLICE"

Switching RICE to POLICE

I have recently been working on completing some online courses in the efforts to obtain my Certified Chiropractic Sports Physician (CCSP) certificate and in these efforts I came across some research and material regarding the traditional Rest Ice Compress and Elevate (RICE) for injury. It really isn’t that recent research has been pointing away from this, but it still seems to be what the general population recalls and has been sticking to. So instead of  Rest Ice Compress and Elevate (RICE) we should be doing Protect Optimal Load Ice Compression Elevation (POLICE). 

I really want to talk about the “Optimal Load” portion.

Optimal Load- “Optimal loading means replacing rest with a balanced and incremental rehabilitation programme where early activity encourages early recovery” (CM Bleakley, P Glasgow, DC MacAuley).

EARLY ACTIVITY ENCOURAGES EARLY RECOVERY- YES! We want the injured area moving again and moving well. With the optimal load we are able to return quicker and more efficient. Optimal load can look like body weight, resistance bands, a book and/or weights, etc. The tricky part can be getting the load that it optimal based on the injury.

Don’t continue being a victim of the RICE mentality. Move often, move well.

IASTM_ANKLE.jpg

NEW YEAR RESOLUTIONS AND "DETOX": WHAT DOES THAT REALLY MEAN ?

As many folks head into the new year with the desire to reboot their health, there is a renewed interest in the concept and practice of “detoxification”.

The idea of periodic “cleansing”, “purging” to improve health is not a new one, however I would say there is a a lot of confusion about what it really means in sound biological terms, leaving a lot of folks reaching out for the wrong ineffective method at best , doing themselves some harm at worst.

The body’s mechanisms of detoxification are quite complex and varied, but for the sake of this blog entry, I am going to simplify them to try to give the average person a basic “one-size-fits-most” template. For some patients, however, a detoxification program will be individualized for emphasis on what toxic burden they are facing and what additional personal deficits they are trying to balance.

The toxic burden that our body has to keep up with on a daily basis includes both internal toxins (getting rid of old hormones for example) and external toxins (medication, environmental pollutants). Our body’s toxic burden is the balance between our toxic exposure and our toxic excretion.

For starters: If you want to “detoxify”, you need to include lessening your toxic load, otherwise trying to improve your toxic excretion is like scooping water out of the proverbial leaking boat. This include simple steps: cut out processed foods, alcohol, go organic when you can on your food items, body care products and household products.

The biochemistry of detoxification is complex, but here is the 10,000 foot view:

  • The first phase involves uploading toxins from the blood into the cytochrome enzymes, which are mostly found in the liver.

  • The second phase involves binding those toxins with another chemical group that allows it to be packaged into a form that can be excreted. (methylation, sulfonation etc.)

  • The third phase involves excretion of the packaged toxin through the bile salts into the stools, into the urine, and in smaller amounts through the skin and mucous membranes.

There are key nutrients that are necessary for the normal detoxification pathways to work:

  • The cytochrome enzymes are regulated by a lot of plant nutrients and some minerals. Hence many ingredients found in commercial “detox” supplementations (super greens, milk thistle, beet root etc).

  • The second phase requires a robust amount of high quality protein, including some sulfur amino acids.

  • The excretion in the intestines via bile salts requires clean fats (for bile salt production), a lot of fiber to capture bile salts and prevent reabsorption of toxins.

  • A healthy and diverse gut microbial flora is essential to capture toxins that enter our body through our mouth, as well as help discard of old bile salts.

  • Adequate hydration to ensure a normal filtration volume of urinary toxins.

  • Adequate levels of oxygen circulating in the blood. Much of our enzyme system is oxygen dependent.

  • While not technically a nutrient, adequate restful sleep. Many of the cytochrome enzymes are depressed with inadequate sleep no matter which supplements you take.

  • While not technically a nutrient either, there is lots of emerging evidence that exposure to natural light activates pathways in our subcutaneous tissues that may be really important for health, including detoxification (nitric oxide pathways).

  • The frequency of eating is also misunderstood. There is no benefit to grazing every two hours. Actually your GI does a better job at emptying out if you have 4-5 hours between meals, or if you practice various forms of intermittent fasting.

So if you are serious about “Detoxification” in 2021, you need to understand that your action plan needs to include more than just gulping down an expensive powder smoothie once a day. Look at all the elements above and include as many as possible in your action plan.

  • Clean eating 95% of the time. Eliminate toxins in your environment over which you have control.

  • A base of high quality plants with every meal. OK to supplement, but not replace with the appropriate nutritional support.

  • High quality diverse protein intake with most meals. This would include both animal and vegetarian sources. Try to stay with whole food sources whenever possible.

  • Enough food based fiber in your diet. Aim for 25 gr/day, no more than 10 in supplement form.

  • If you are at risk of probiotic deficit in your GI (medication side effect for example), consider adding probiotic foods, or supplements. Otherwise nourish your own gut bacteria with enough fiber every day.

  • Consider having three main meals and not plan on snacking unless you are hungry in between meals.

  • Stay hydrated with good filtered water, enough to keep your urine a pale yellow.

    Make sure you get enough sleep, oxygen, and sunshine.

Detoxification.jpg

Knee Proprioception Fatigue and Injury Risk

A few years ago as a student at an ACA Sports Council Annual Symposium, I presented on some original research regarding knee proprioception fatigue and injury risk. So basically we wanted to know if when an athlete gets tired, does their body positioning awareness in space change to a point that may put them at risk of injury. Unfortunately, our population size was too small to obtain any statistical significance making this a pilot study and statistically not seeing a correlation. However, what was really interesting is we did notice some of the participants did have difficulty recreating the test once the subject self reported fatigue. To view the poster- click on the button below.

runner_holding_knee.jpg

New Year, Weight Management and Road Blocks

Lots of folks have made New Year resolutions that include aiming for a healthier weight, and a few have made it past the first weeks sticking to it… I was listening to an older episode from Chris Masterjohn’s podcast series where he recounts his weight loss journey in 2017-2018. One of the most interesting parts of the talk is the disclaimer in the first 5 minutes of his talk, when he talks about WHEN NOT to tackle weight loss. This is not to say that you should defer healthy weight management indefinitely, but that there are a couple of crucial non-dietary factors that will be a roadblock to not only effective, but SAFE weight reduction. The two main ones are:

  • uncontrolled stress

  • inadequate sleep quantity and quality

Chronic or acute unmitigated stress will lead to dysregulation of cortisol and lower your body’s ability to adapt to any new environmental demands. Weight reduction often requires increased energy expenditure in the form of increased physical activity, or decreased food intake, both of which are a mild form of stress which could overwhelm your body’s ability to cope if already in a high state of stress. If under high stress, at minimum you need to incorporate some stress reduction practices ALONG with weight reduction protocols to avoid a crash and burn situation.

Inadequate sleep is often the proverbial elephant in the room as well. The metabolic domino effect includes many biochemical and physiological disruptions that will also make weight reductions difficult if not harmful to the body: lowered insulin resistance, increased free radical state, decreased leptin sensitivity, decreased anabolic hormones, just to name a few. As a crude benchmark, you need to aim for at least 7 hours of actual sleep (which means closer to 7 1/2 to 8 hours of time in bed). Sleep quality is harder to quantify but for those of you with fitness apps, your sleep efficiency should remain above 90 most nights.

Bottom line: If you want to be safe and successful with a healthy BMI in 2021, pay close attention to the non-dietary factors that may otherwise sabotage the journey.

https://chrismasterjohnphd.com/podcast/2016/08/09/how-i-lost-30-pounds-in-four-months-and-how-i-knew-it-was-time

waist-measuring.jpg

SIDE SLEEPING AND SHOULDER PAIN

We have had a string of real bad shoulders roll into the office in December (most often accompanied by their owners). Rotator cuff problems are extremely common and everyone can expect at least one bad episode in a lifetime. For some, the problem will be more chronic.

In previous posts, we have talked about shoulder treatment, but today I wanted to give you a tip for a very common quality of life issue for chronic should pain sufferers: Sleep. If you have any sort of narrowing in the area of the lateral shoulder (shoulder impingement syndrome), any pressure over the area, or anything that even slightly pushed the shoulder upward will make sleep very elusive, with a domino effect on the rest of your life that is pretty ugly.

The obvious long term solution is to correct the problem (neck/blade alignment, shoulder alignment and muscular balance). But even so, some shoulder soft tissue damage can be semi-permanent and so will the limitations associated with how much pressure it can tolerate. The questions about sleeping position, pillow, and mattress remain. The generic recommendation is to have a thick enough pillow to support the full distance between your head and shoulder, as well as 2-3 inches of soft top layer on the mattress to cradle the shoulder tip. In most extreme cases, there is a sleep system that will allow you to sleep on your side in an elevated position while completely taking off the pressure from the shoulder by distributing on a wedge supporting your trunk and head and letting your shoulder dangle through an opening. With a price tag over $200 it is certainly an investment that should be reserved for the people who have serious long-term sleeping disruption from an unresolvable shoulder issue, but in that case it could make a difference in quality of life.

DSC00817_grande.jpg

Persistent Post-Epidural Pain: Lumbar Meningeal/Fascial Tethering

Just over 8 months ago now, we brought our little boy Lee into the world and as special as that is, it was definitely a tough situation. Long story short I ended up getting an epidural and with a difficult placement was poked about 7 times. I also ended up receiving the dreaded spinal headache which is one of the risk factors of an epidural that happens when the Dural sheath is punctured. When the Dural sheath is punctured CSF or cerebral spinal fluid, leaks out of the hole creating a deficit in volume which decreases the pressure. Imagine your brain in a cup floating in liquid and then put a hole in the side of the cup allowing fluid to leak and now your brain begins to sink.  To fix that we had to go back into the ER where they had to place another epidural to put in a blood patch (a band aid for the hole to stop the leaking), this took them another 4 attempts, another 4 stabs to my spine. This was by far the worst pain I have ever experienced. No joke, I walked into the ER looking about as rough as it gets with no care because I was seriously in that much pain. After feeling better and actually being able to function, I experienced this tight rubber band from the base of my skull to my legs, creating a sensation of collapse with too much forward flexion, too much was as little as looking down. For anyone that has breastfed or held a baby, imagine holding that baby without being able to look down at them because it caused too much pain. Dr. Demel and I ultimately realized there were some residuals of tethering from the fascial system and the meninges that were damaged with the multiple pokes.

epidurals-during-pregnancy.jpg


There is a point to this story, I promise. Here it is:

With the multiple punctures to the fascial system, it had gotten bound and tugged and didn't really heal well unsupported and on it’s own. With continued chiropractic care including both adjustments and soft tissue care including cupping, I was finally able to feel normal again. Here is how each of those pieces were able to help. Adjustments: to clear any segmental dysfunction occurring and help improve the function of the soft tissue that was already incredibly damaged. Soft tissue care/ cupping: to help release adhesions that had occurred with the binding of the fascial system in the lumbar area around all of the poke sites.

For more information on cupping and fascia please refer to my previous blog: Soft Tissue Care- Part II

Unfortunately, it took me experiencing this first hand to realize how many of my patients have experienced or are experiencing something similar and have been overlooked. Think MS or cancer patients or anyone that gets multiple spinal pokes for assessments or procedures. As awful as this pain was, it has brought a greater understanding and thought to treating patients that may be experiencing something similar. 

So, if this sounds like something you can relate to we can and would love to help you!

AnatomyTrains-The-Spiral-Line-Thomas-Myers.png

Aerobic Exercise Idea for a Long COVID Winter-

After our Silver Sneakers orientation Facebook Live presentation earlier this week (videos to be found on the office Facebook page), I received several questions from folks wondering how they can replace some of the cardio workouts they have been getting from outdoor walking, especially since the fieldhouse at the Cannon Falls school has been closed. We have been lucky with a mild winter so far, but soon the temps will drop and the roads and trails will have a treacherous layer of ice.

One simple solution that we have implemented at my house is to find a new life for one of of our outdoor bikes. My husband and I , and a few members of our pandemic bubble, have made the best of the COVID summer by avidly exploring new bike trails in the neighborhood over the past 6 months. This came to an end with one last hurray on Thanksgiving morning. Not ready to invest in a high quality stationary bike, a friend suggesting converting one of our summer bikes into an exercise bike by mounting it on a trainer. Bingo, I found a good used magnetic trainer on Craigslist and baited a handy friend to pin the back wheel. at least twice a week or more, I hop on it in the morning for a robust 30-40 pedaling session.

So think about that option is you have a decent bike that spends half the year in the garage. A good used magnetic trainer will cost you between 100-200$. You can mount it indoors for the winter and revert it to a regular outdoor bike for the sunny months.

There are also a trove of free online bike exercise workouts that will prevent the boredom of just mindlessly pedaling. I have been using the free videos from the Global Cycling Network on Youtube. Pretty fun and some British accent to boost.