Men, Running is Never Enough

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Men, Running is Never Enough

In a society where appetites, waistlines, and meal portions are ever-increasing, it's easy to think that the best thing we can do is to get out and go for a run or long bike ride.  But as a man, if that's all you're doing, you're putting at your body at risk for a number of health concerns including:  decreased muscle mass, premature loss of hair, decreased bone density (especially with cyclists who do not experience the impact that stimulates bone growth), decreased sexual drive, inhibited reproductive function, anddecreased levels of red blood cells.  The reason?  Low testosterone.  Studies reveal that testosterone levels in men who have engaged in endurance training for longer than one year are 60-85% lower than untrained, otherwise comparable men.  

So what do we do, stop running and cycling?!  Not at all, but it is important to vary the workouts.  Studies have also shown that short, intense efforts as well as strength training can boost your testosterone levels.  There are two easy ways to accomplish this:  

  • Add a few 15 second to 2 minute bursts of high-intensity riding/running followed by slightly longer periods of recovery 2-3 times a week.  
  • Instill a resistance training component to your workout regimen.  Focus on low reps and higher weights which will create a higher intensity workout.  Do not rest more than 1 minute between sets.  

The internet is a great tool for finding workout regimens that incorporate weight training and intervals.    

As with any new exercise, be sure to ease your way into either or both of these new pieces to the workout puzzle.  If you are an experienced and conditioned rider/runner, the intervals will not be too difficult to adapt to, but you must make time for recovery.  With the weight training, be sure to start with lighter weights before moving up into the recommended low rep/higher weight program.  You must ensure that your muscles and neuromuscular system adapt to the new demands placed upon it, and that takes time.  

If you testosterone levels are a concern, please consult your physician.  Levels can be evaluated with a simple blood test, and there are many natural methods to boost levels, as well as ways to keep from prematurely lowering them.  

References:  

Hackney, A.C. Testosterone and reproductive dysfunction in endurance-trained men. In: Encyclopedia of Sports Medicine and Science, T.D. Fahey (Editor). Internet Society for Sport Science: http://sportsci.org. 20 Sept 1998. 

http://fitness.mercola.com/sites/fitness/archive/2012/07/27/increase-testosterone-levels.aspx

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Athletic Injuries & The Non-Athlete

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Athletic Injuries & The Non-Athlete

As a Certified Chiropractic Sports Physician since 2006, and having been both the owner and associate of a “Sports Chiropractic” or “Sports Medicine” office, I am often asked if I treat non-athletes.  While I understand how the office name or my credentials can lead people to thinking I may only focus on athletes—which is my specialty--what everyone needs to realize is that you don't have to be an athlete to have athletic injuries.  

Most commonly, athletic injuries are overuse injuries, sprains, or strains.  A sprain is damage to a ligament (connects bone to bone).  A strain is damage to a muscle or tendon (connects muscle to bone).  Overuse injuries are the accumulation of mini-tears in the muscle or tendon fibers that accumulate with repetition of a motion over time.  The only difference between an athletic injury and what I like to call an “athletic-type” injury is when, where, and how the injury occurred.  

You can sprain your ankle stepping off of the curb awkwardly in front of the grocery store, or you can do it while playing soccer, or trail running.  Of the hundreds of cases of “tennis elbow” (aka, lateral epicondylitis) I've treated over the years, perhaps 15% max actually played tennis.   Turning a wrench, typing/using a mouse at a computer, painting, and even drumming are all causes of overuse injuries that I have treated as “tennis elbow”.  

The benefit of having a Sports Chiropractor evaluate your painful condition/injury is that we're trained to recognize the tissues affected, diagnose the condition, direct the treatment, and provide you with preventative exercises/stretches to avoid future aggravation of the symptoms.  We address both the joint component and the soft tissue component of the injury which provides for a more complete and speedy recovery.  

If you have an injury you believe needs evaluation by a trained specialist—whether it occurred crashing on the ski slopes, or slipping on ice in the parking lot on your way back to the car—do not hesitate to contact us at Evergreen Spine & Sports Medicine where we treat professional athletes, weekend warriors, and non-athletes the same!  

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Slowing Down Runner's Knee

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Slowing Down Runner's Knee

As a Chiropractor and Sports Medicine doc, I want to be as specific as possible in my diagnosis so that I can target and treat the offending problem to quickly return patients to their healthy lives.  It is for this reason that I hate the term “Runner's Knee”.  It is a catch-all term for pain.....that runners get.....in the knee.  Brilliant.  There can be many causes of knee pain in the running population, and in other areas of society as well.  To lump them all together under one umbrella complicates the matter and confuses the patient.  

“Why do I have Runner's Knee?  I don't even run!”

“I did XYZ for my Runner's Knee based on an article in a running magazine, and it didn't help.  What am I doing wrong?!”

“My Runner's Knee hurts on top of the kneecap, and my wife's Runner's Knee is on the bottom.  How is this possible?!”

In this post I'm going to talk a little about different types of knee pain that can arise from running, and what you can do to alleviate it.  There are not going to be any vague terms, and I will provide specific recipes to provide relief to each.  

First it is important to understand the origin of your knee pain.  Was there a twist, a direct hit, or is there a history of arthritis or prior injury/surgery?  If not, your knee pain is likely not being caused by the knee at all, but rather the foot/ankle or the hip/pelvis.  In my post regarding knee pain among cyclists, I stressed the importance of a bike fit.  This does not apply directly to non-cyclists, but there is equipment to consider--shoes.  Regardless of activity or activity level, make sure that you have footwear that fits, and that is properly suited to what you will be doing.  I always suggest to any runner that walks into my office with pain, that they visit a running specialty store for an evaluation and fitting.  Get this out of the way before pain starts.  In other words, a) before you start running b) before you significantly increase mileage c) after you have worn your shoes for approximately 350 miles of foot travel

The following will address knee pain by relating its location to the kneecap:

Above & Below:  Typically pain above the kneecap is due to tight or overactive quadriceps muscles.  Tight muscles can be massaged, foam rolled, and stretched to reduce the stress on the tendon attaching the quad to the kneecap, and therefore alleviating pain.  Overactive quads are typically due to weak hamstrings.  The balance of pull between quad (front of thigh) and hamstrings (back of thigh) is most effective when the strength is distributed 60-40 respectively.  If this is off, and the hamstrings are weaker, then the quad will be too strong and put too much pull onto the quad tendon that attaches to the kneecap.  The difference between tight and overactive is often difficult to discern on your own, so I would start with the roll, stretch method [5 min/leg, 3 sets of 30 seconds respectively], and if that doesn't create relief, then visit a sports medicine professional.  

Inside & Outside:  Pain in these areas is often due to a pulling of the kneecap laterally (outside) by the connective tissue attached to the end of the illiotibial band, or IT band.  You cannot stretch the IT band, so do not try.  It is an extremely strong, dense band of connective tissue that runs from the gluteus medius and tensor fasciae latae (TFL) muscles on the pelvis and runs along the outside of the thigh to just below the knee.  If the glute med and TFL muscles are tight, they will pull on the IT band which then pulls the kneecap laterally.  This pulling can create pain on both the outside and the inside of the kneecap.  

The muscles of the outside hip can be rolled and stretched just as the quads in our previous example.  The lateral quad can also be rolled along the IT band to break up any adhesions that may have formed between the muscles of the lateral thigh and the IT band.  The hip muscles become are tight if they are overused, or if there is not adequate movement at the sacroilliac (SI) joints.  For this scenario, a chiropractor can determine the movement of the joints, and address any problems.  Too much pronation or inward rolling of the foot can also cause tightness in these muscles.  This should hopefully be addressed by the shoes that you got fitted to your feet and gait.  Kinesio tape is also helpful for keeping the kneecap where it belongs so that it may travel in its preferred tract on the knee.

Behind:  Pain behind the knee is usually due to a degenerative disease known as chondromalacia patella.  This is a condition where the cartilage that covers the backside of the kneecap becomes warn and tattered.  There is often grinding and some discomfort.  Stretch and roll the quads in the same manner as you would for Above & Below kneecap pain, and it will take some of the stress off of the kneecap, not pulling it into the knee joint so hard.     

The stress on the knees from running can be reduced by shortening your stride.  Refer to my earlier post on changing (or not changing) running stride to learn more about this. 

Needless to say, there are many other knee injuries and ailments that can occur with runners and with all populations.  These are simply the most common overuse injuries seen in runners, and athletes of all sports and of all levels.  If you are experiencing knee pain, and these above methods have not worked for you, please contact an experienced sports medicine professional.  Also, if you are experiencing pain that is more severe than you would assume for an overuse injury, please consult a professional.  

If you have any questions regarding the material covered in this post, or on your specific knee pain, please do not hesitate to contact Dr. Stoughton via email at info@evergreenchiro.com or by phone at Evergreen Spine & Sports Medicine 303-670-8902

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Fascinating New Study Shows Chiropractic Can Potentially Improve Muscle Strength

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Fascinating New Study Shows Chiropractic Can Potentially Improve Muscle Strength

A new study published in the journal Experiment Brain Research has shown that a full-spine chiropractic adjustment can increase the test subjects' ability to increase electrical activity in their contracting leg muscles by almost 60%.  In the study, this translated to a 16% in absolute force generated.  Also shown was a 45% increase in the ability of the brain to activate the particular muscle being tested.  

A collaboration between the New Zealand College of Chiropractic's Centre for Chiropractic Research and neurophysiologist Professor Kemal Turker, “this study is the first to indicate that chiropractic adjustments of the spine can actually induce significant changes in the net excitability for the low-threshold motor units.  The results of the study also indicate that spinal adjustments can prevent fatigue”, according to Dr. Haavik, Director of Research at the NZCC.  

So what does this mean for us?  This study has initially shown fascinating results that could have huge ramifications to various populations in society.  

Who needs their muscles firing more efficiently and powerfully?  Athletes, for starters.  The ability to gain a 16% increase in absolute force from a muscle cannot be achieved with most training regimens in less than several weeks, at best.  At the higher end of the athletic spectrum, marginal gains are frequently sought after to give any edge over their competitors.  A marginal gain is typically considered 1%.  Imagine 16 times that in one chiropractic session!!

Another population to consider are those individuals who are either injured and forced to rehabilitate, or suffer from a muscle degrading dysfunction, such as a stroke.  By increasing the ability of the brain to activate targeted muscles, you increase the efficiency of the rehabilitative efforts.  This study has shown a 45% increase in that area, so that should translate to decreased time at the physical therapists' office, and more time living an active lifestyle.  

Cautions

While this research study is very exciting, it must be mentioned that it is newly completed, and has not had time to be subjected to follow-up studies.  However, where there is smoke, there is typically fire.  Even if some of the numbers do not hold up to repeat studies over time, there is certainly compelling evidence that chiropractic adjustments can benefit muscle function.  It goes with the idea I've used as the basis of my practice for over ten years:  The body works better when it is working the way it is supposed to.  

I will keep my attention focused on future studies of this subject, and am excited for the possibilities of what they might reveal.  

In the meantime, there are other performance and healing benefits that are associated with chiropractic care.  Do not hesitate to contact ESSM to learn more about the benefits, and to take advantage for yourself!!

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“Belay on....but hurry up!”  How Climbers Can Self-Treat Belay Neck

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“Belay on....but hurry up!” How Climbers Can Self-Treat Belay Neck

At the crag or on a multi-pitch route, there's pretty much no way out of having to belay.  And unless you're using the mirrored belay glasses, or your partner is climbing very, very low angle slab, you're going to be looking up for extended periods of time.  Personally, I consider about 2 minutes to be “extended periods of time”.  

Your partner starts out, and by the time they have either placed the first piece of gear, or clipped the second bolt, your neck is already screaming and you're dying to look down.  This is part of climbing.  You cannot take your eyes off of your ever-ascending partner, and you can't take your hands off of the rope to tend to the aching muscles on the back of your neck.  What I'm telling you is what you already knew:  deal with it.  

After you hear the “off belay” you've been dying to hear, you can look down and tend to the sore, cramped muscles on the back of your neck.  Here's a few tips on how to relieve the discomfort in your neck after you have belayed, either on-site, or at home:  

Look down:  As you look up, the muscles in the back of your neck and mostly at the base of your skull will become cramped from extended contraction.  To alleviate this, stretch them by looking down and tucking your chin to your chest.  I also like what I call the “smell your armpit” stretch.  Put your nose into your armpit, and using your hand on that armpit side, pull your head down with only the weight of your arm.  This will address tightness in the armpit-opposite upper trap muscle.  

Self-massage:  This can most easily be accomplished by rubbing out the sore muscles with your hands.  It helps at the crag or on-route, but what more can you do at home?  I like to take two tennis balls and put them into a sock tying a knot at the top so that the balls cannot be separated in the sock.  Lie on your back and place the two balls at the muscles near the base of your skull and top of your neck.  Just let the weight of your head rest on the balls.  This will create a pressure that relieves any muscle knots as you lay on it.  It helps to lie on the floor, and you may need to add some folded towels under the balls to raise them higher to create the desired pressure. 

Chiropractic:  For more serious and/or persistent neck pain, you might have more than just muscle tightness.  A visit to your chiropractic physician can check for dysfunction in the joints of the neck.  This dysfunction can often be relieved with chiropractic manipulative therapy.  

Belay glasses:  There are now several brands of these available for purchase.  They use mirrors so that you can keep your head straight, but your gaze up on your partner.  Practice wearing them and getting used to the view through them before having your friend jump on their project—it takes a little getting used to.  

Boulder:  Don't want to look up and belay?  Start bouldering.  You will have a 30 second spot, max.  All you need is some crash pads, crazy strength, and a beanie!

If you have pain or discomfort in your neck from climbing or other sports/activities, please do not hesitate to contact Dr. Stoughton at Evergreen Spine & Sports Medicine by phone at 303-670-8902 or email at info@evergreenchiro.com.  

 

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“Watch that first step...” Plantar Fasciitis Self-Treatment

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“Watch that first step...” Plantar Fasciitis Self-Treatment

Many athletes and active individuals are familiar with plantar fasciitis as pain in the arch and heel of the foot.  Less familiar is what causes the condition, and how to treat it for relief and recovery.  

Plantar fasciitis is an inflammation of the plantar fascia.  The plantar fascia is a web of thick connective tissue that runs from the heel to the toes.  It provides stability to the arches of the feet.  With every step, the tissue will help maintain the integrity of the foot's arch along with muscles along the bottom of the foot.  Like any soft tissue, it is susceptible to overuse and injury.  A Too-Much-Too-Soon approach to athletics, standing long periods on hard surfaces, and engaging in athletics on hard surfaces (volleyball, tennis, etc.) can all cause micro injury to the tissue, as well as subsequent development of painful, restrictive adhesions in the arch.   

Characterized by pain in the heel and arch—especially the first few, excruciating steps in the morning—plantar fasciitis affects a large population of athletes and non-athletes.  So once this painful and often severely-limiting condition sets in, what are the options for treatment and recovery?  Here are 3daily keys to treating plantar fasciitis at home:  

  1. Roll the tissue:  Using either a tennis or golf ball (depending on what your condition can tolerate), roll your bare foot over the ball as it lies on the ground.  This is a form of self-myofascial release, and will help break up the scar tissue and adhesions that are responsible for much of the pain in your foot.  5 minutes/foot
  2. Bonus Tip:  use a water bottle with frozen water in place of a ball.  It will provide you with the myofascial release, as well as cold-therapy
  3. Don't forget the calves!:  The calf muscles pull directly on the heel via the Achilles tendon. Pulling in opposition to this are the muscles of the arch as well as the plantar fascia.  It becomes a virtual tug o' war for your heel.  Use a foam roller to address the calves in the same manner as the balls/bottle are addressing the arch.  Roll from ankle to knee, and hold the position over any knots or sore spots.  5 minutes/leg
  4. Stretch:  After rolling the calves and arches, make sure to stretch the tissues.  The stress applied from stretching will guide the remodeling of tissues after breaking down the adhesions.  To hit all areas, I have patients start by facing the wall in a lunch position with the affected leg as the back leg.  Lean into the wall with the back leg straight to stretch the gastrocnemius (upper calf). Still leaning, bend the knee of the back leg and move your hips backwards from the wall to a position more over the back foot—this addresses the soleus or lower calf.  Finally, with the leg bent, raise up the heel of your back leg to stretch the arch.  3 sets of 30 seconds for each stretch, each leg

If after a few weeks of this procedure and avoidance of any activities that cause/create pain you do not have any relief, contact your local sports medicine specialist.  More aggressive tissue work may be necessary, along with supportive taping techniques.  Beyond that, cortisone shots are occasionally used, and surgery is necessary in a reported 5% of cases—I have never personally known of anyone to have had that in more than a decade of practice.  

If you have any questions regarding the tips above, or your own case of plantar fasciitis, please contact Dr. Stoughton via email at info@evergreenchiro.com, or at Evergreen Spine & Sports Medicine 303-670-8902

 

 

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Thawing Frozen Shoulder

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Thawing Frozen Shoulder

Frozen shoulder or adhesive capsulitis is a thickening of the capsule around the shoulder joint that results in a loss of range of motion.  The thickening can be a result of an injury to the shoulder, or immobilization such as holding the arm in a sling for a long period of time.  Many times, the shoulder will “freeze” without any prior significant injury or immobility.  The “freezing” process and onset of the condition itself is not well understood by medical professionals and sports medicine physicians.  

What is known, is that to undo the “freezing” the patient is in for an uncomfortable period of forced mobilization by a trained practitioner.  In extreme cases, with the patient under anesthetic, a medical professional will force the arm's range of motion to tear the thick adhesions of the shoulder capsule.  There are many reported instances of the adhesions being so strong that the humerus bone will actually break from the forced movement before the adhesions release.  Again, this is in extreme cases.  In eleven-plus years of practice, and having seen countless cases of frozen shoulder, I have only known one patient to have had such a break, and that was one of only two that even required anesthetic.  

More commonly the shoulder will be evaluated to determine where the range of motion is lacking, and therefore what portion of the capsule is frozen.  At this point, during treatments that can last several weeks, gradual increases will be made by forcing the shoulder into the areas of decreased range.  A skilled practitioner will be mindful of the keeping the shoulder in the correct positional orientation so that further complications do not arise as a result of just yanking on the arm.  

In addition, the patient will be given exercises to perform at home to continue to gain range of motion, as well as to not lose what has been gained at each visit.  These are often done in front of a mirror to self-monitor how the shoulder is moving, and to ensure that compensatory muscles are not doing too much in the role of moving the arm.  For example, it is very common that when raising an arm on the side of an injured shoulder that the upper trapezius muscle will do more than its fair share of work in lifting the shoulder up closer to the ear to account for the motion that is not occurring at the shoulder joint.  This does nothing for improving shoulder mobility, and can create aberrant neuromuscular patterns which will create problems that will last after the shoulder has healed.  

If you have frozen shoulder, or have noticed that your range of motion is not what it should be, please contact your local joint specialist and/or sports medicine provider.  While the treatment is rarely comfortable, it is far preferable to not having full use of one of your arms.  

If you have further questions about this post, or about frozen shoulder in general, please do not hesitate to contact Dr. Stoughton via email at info@evergreenchiro.com or through Evergreen Spine & Sport Medicine at 303-670-8902

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Chiropractic in the Golden Years

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Chiropractic in the Golden Years

As a Sports Chiropractor, I often get asked if my practice accepts non-athletes.  Commonly the question comes from existing patients seeking care for their parents.  The answer is—and always will be—yes.  Having training that extends past the already rigorous curriculum of chiropractic school only makes me more adept at examining, diagnosing, and treating conditions in any patient population.  As for patients' parents—and all individuals 65 years and older—I believe that they need it as much as their children and grandchildren, regardless of activity levels.  

 

Chiropractic can play a vital role in ensuring the proper functioning of joints and balance of muscles as patients deal with chronic conditions that are associated with aging.  It is every bit as important that they receive the same, competent care as the younger generations—only with modifications.  

 

Treating the 65 and older population requires an ability to sometimes sift through a stack of medical records, work around existing medical conditions, and to know when less is more when it comes to treatment.  

 

Accounting for a previous surgery, pre-existing health condition, or perhaps an artificial joint is very important when it comes to treating any patient, but the painful truth is that we are all acquiring a greater collection of these as we move through life.  Will suggested supplements can have negative reactions with existing medications?  Will certain positions for joint manipulation put artificial joints at risk?  Can the patient comfortably hold positions for exercise or treatment?  

 

It is important to know the full history prior to beginning treatment.  Some patients whose health has suffered, have extensive collections of medical records that they present in the office on their first visit.  Some are vitally important, and others are not relevant.  It is up to the physician to determine which is which, and to apply the information derived from the records appropriately.  

 

As we age past thirty years and beyond, our bodies do not heal and recover at the same rate as they once did when we were taking our youth for granted.  Recovery is not limited to healing up from an injury.  Many forms of physical medicine use a breakdown of dysfunctional tissue to allow the body to replace it with more healthy, functional tissues.  This is an important step in recovery from injury, but one must remember that a 70 year old will not recover from this treatment as quickly as a 20 year old.  Swelling may be more pronounced, the body will not clean up the damaged tissue as quickly, and the new tissue will take longer to be formed.  For myofascial work, one should typically incorporate more time in between treatments, as well as taking into account how aggressive that treatment is in the first place.  

 

Each patient is different in their health, condition, activity levels, genetics, and health history.  For this reason, it is of paramount importance to treat each patient as if they are not a condition, but rather an individual.  A competent, trained healthcare provider will recognize this, and tailor their programs to each patient—there is no place for cook book-care in chiropractic or medicine.  

 

If you have questions about your health, if chiropractic is for you, or anything you read in this post, please do not hesitate to contact Dr. Stoughton at Evergreen Spine & Sports Medicine by phone at 303-670-8902, or email at info@evergreenchiro.com.

 

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Adolescent One-Sport, Year-Round Athletes:  Preparing for college, or the operating table?

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Adolescent One-Sport, Year-Round Athletes: Preparing for college, or the operating table?

The adolescent athletic landscape has changed dramatically in the last 2 decades.  Mostly gone are the 3 sport high school athletes, as club teams have risen to prominence and demanded that athletes play one sport year-round.  Not to say that clubs are prohibiting young athletes from participating in other sports, but to remain competitive on high school teams, kids are finding themselves almost needing to play for private club teams whose seasons alternate with the high school season.  This specialization in one sport is creating more polished players by the time they get to college—and may even earn them a scholarship--but at what cost?  

The playing of one sport for 10+ months a year overuses specific muscles and joints.  This creates imbalances in developing musculature, painful overuse syndromes,  and allows the young athlete little time to recover.  

A 10-year study of teenaged pitchers who throw more than 100 innings/year has shown that kids who play baseball year-round are 3 times more likely to end up having elbow or shoulder surgery by the time they are 20 years old, than those that do not play year-round.

I personally recall a young patient who was a great, young volleyball player playing year-round between her club and high school seasons.  After winning the Illinois State Championship in volleyball, she had secured a full-ride scholarship to a Big Ten Conference school.  However, due to the wear and tear on her body, she required shoulder surgery and also a repair of a ruptured Achilles tendon prior to beginning her college career.  And sadly, she never would begin that collegiate career.  The injuries sustained while developing into an adult had followed her to early adulthood and kept her from playing in college at all.  

But professional athletes play and train year-round, right?  Yeah, because they're professional athletes: genetic outliers not in the midst of their bodies' development.  

I cannot argue with the logic that if you want your child to succeed in a sport, that they have to have similar access as their competition—even if that means playing a single sport 10+ months out of the year.  But there has to be an understanding by the coaches, parents, and young athletes that this will create imbalances in the musculature and potentially lead to injury.  To account for this, there must be programs in place to work oppositional muscles to those that are being used regularly in the sport; cross-training can create a more balanced and stronger overall athlete than just focusing on one sport.  Adequate rest and recovery periods must be worked in as well, and there has to be healthy communication between high school and club coaches so that there is not a conflict in training schedules/recovery time.  

Playing one sport year-round isn't a one-way ticket to the operating room, but you do have to be careful and monitor how your young athlete is feeling at all times.  With anything, moderation is key!  

If you have questions or concerns regarding sports injuries for youths or adults, email Dr. Stoughton of Evergreen Spine & Sports Medicine at info@evergreenchiro.com

 

 

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Runners' Debate Cleared Up:  Heel-Strike vs Forefoot-Strike

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Runners' Debate Cleared Up: Heel-Strike vs Forefoot-Strike

In the last 5 to ten years, a movement has been made toward changing the gait of runners to have them land not on their heel, but rather on the fore- or mid-foot.  This trend has gained a lot of followers,  lining up behind minimalist shoe company marketing, spouting off about how our ancestors ran, and even buying those creepy-looking foot gloves; but is it actually easier on the body, and more efficient?  

Studies comparing heel- to forefoot-strikers running at a pace slower than 6:25 minute/mile pace have shown that heel-strikers are more efficient.  Faster than that pace, and the efficiency becomes equal between the two groups.  

As for the forces absorbed by the body, additional studies have shown that they are equal between the groups, but that the forces are absorbed by different joints.  Heel-strikers absorb the forces in the knees, and forefoot-strikers absorb them in the arches of the foot and Achilles tendons.  Pick your poison!  

The simplest way to reduce the forces your body is absorbing is to reduce your stride length.  By doing this, and increasing your stride cadence (steps per minute) you can maintain the same speed while limiting the forces applied to your body through each step.  You may even avoid stress fractures while running in your bare feet or glove-shoes.  I personally do not recommend any one foot-striking pattern beyond, “do what feels best for you.”  Well, that and “ride a bike!”

Like many arguments about what diet/form/shoe/gear/etc. is “best”, it all comes down not to what is popular or which celebrity spokesperson has had success with which method, but rather what works for you.  Everyone is an individual with different preferences, genetics, goals, and injury histories.  In my practice I treat everyone as such, and try to steer people away from adhering too vehemently to any one trend or practice.  Together we work to find the right regimen that creates a balance between the goals of the patient, and their health.  

For more information on running gait, injuries, please email  Dr. Stoughton of Evergreen Spine & Sports Medicine at:  info@evergreenchiro.com

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Two Steps to Self-Treat Knee Pain

I've often said that barring direct injury, arthritis, or an old injury/surgery, that knee pain doesn't come from the knee. It is often from either problems with the foot/ankle, or the hip/pelvis. Problems or dysfunction in those areas can create an altered gait, tight/over-active muscles, weak muscles, and trigger points responsible for referring pain to the knee directly.

The muscles originating from the pelvis include the hamstrings, quads, adductors (inside of the thigh/groin), and the muscles joining at the illiotibial band (or IT band) on the outside of the thigh. Together these muscles work to both move the knee, and stabilize it as guide wires on a circus tent pole. Any dysfunction of movement at the hip or pelvis will alter the balance of these muscles, and therefore the function/stability of the knee itself. This can create pain and needless wear and tear on the knee.

As for the foot/ankle, it is literally the base for what the rest of our body stands on. Whatever dysfunction is present there will be translated through the kinetic chain up the leg and into the rest of our bodies.

So what can you do at home to relieve knee pain? There are two things that you can do on your own: roll and stretch.

Foam rollers have gained popularity in recent years and for good reason, they are extremely effective at breaking up muscle knots, trigger point, and other dysfunctional tissue. They are easy to use, and you can target any area of the body on your own. Typically, you sit on the roller perpendicularly and with your hands on the ground as support, roll across the ground so that the roller massages the tissues.

Following a workout, or later in the day (you want to allow the muscles to warm up prior to rolling) roll out the quads, hamstrings, glutes, calves, muscles of the shins, and every other area you can roll over that feels tight or sore. This is not a comfortable process. In fact, when you find a spot that especially hurts, hover over that area for 15-30 seconds. This helps break up those sore spots and they will begin to resolve.

Following the rolling, make sure that you stretch each area rolled for 15-30 seconds. The rolling process breaks up tissue in the areas targeted, and to ensure proper remodeling of new tissue, the stretching is critically important. Otherwise, the problems may persist.

If after 3-7 days of repeating this process every other day, the problems still persist, it is time to visit a sports medicine physician. We can diagnose the problem to target the proper tissues and joints, and enact a plan to resolve the problem.

For cyclists and runners, you may be tempted to get a professional bike fit or shoe fit. I would strongly recommend against this prior to having the problem evaluated and addressed by a sports physician. Fits are necessary, but if you do not correct the body's dysfunction, then you are fitting to a body that is not functioning ideally. You do not want a bike or shoe that encourages your dysfunction!

Try these at-home steps first as long as the pain is not severe. Hopefully we will not have to see you in the office, but if we do, knee pain is something that we successfully treat regularly at Evergreen Spine & Sports Medicine.   

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What is the popping sound that occurs with an adjustment?

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What is the popping sound that occurs with an adjustment?

We get this question all the time in our office.  The fear is that the sound is actually coming from the bone or the cartilage in the joint.  We always answer by letting people know that it is actually tiny gas bubbles forming in the joint.  We know that the adjustment helps to restore normal mobility in the joint, increase blood flow to the area which delivers oxygen, and causes your body to release endorphins (our natural feel good brain chemical).  Some really cool things happen when we adjust you and now you can actually see it on MRI.   Scientists at the University of Alberta wrote an article and released a video MRI of the bubble forming in the joint capsule which causes the "pop."  Check out it out HERE. 

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Rest and Recovery - How To Optimize Performance and Reduce Injury

You are working so hard to accomplish your goal of running your first half marathon, participating in your first triathlon, or getting your first pull up since grade school.  You get on a role and you finally feel like you are getting somewhere.  Your long run on the weekend is getting easier, riding your bike up that big hill isn’t quite as hard anymore, and you are down to using the smallest band to assist your pull up.  Then things start to hurt.  Your right knee hurts every time you run up hill, your left shoulder is hurting in between rides, and your neck hurts any time you reach or lift over your head.   

There are plenty of factors that play into injury, but one of the easiest things to correct is proper rest and recovery.  For many of us it can be something that is hard to incorporate when we feel like we are making such great training progress.  

Rest?  I don’t want to lose any of my strength that I’ve worked so hard for! 

Study after study has shown that incorporating rest into our training actually allows for more gain and helps reduce injury.  The actual amount of rest can depend on the athletes training status (trained vs. untrained) and individual’s ability to deal with physical, emotional, and psychological stressors.

Rest allows the body to recover between workouts.  Recovery occurs when your body returns to its normal metabolic state.  Your body must remove metabolic waste from your muscles (lactate and hydrogen ions) re-establish intramuscular blood flow for oxygen delivery, and regain muscle membrane potential (the ability to contract). 

The greater the stress of the workout, the greater the overall muscle recruitment, and the greater the potential for muscle damage and soreness, therefore the need for longer recovery time.  When a muscle group becomes sore, damaged, and fatigued it is unable to work at it’s full potential.  This leads to muscles imbalances and changes in form, which puts an athlete at risk for overuse injuries. 

Every athlete is different and incorporating rest into a training schedule can look different depending on several factors.  Your ability to recover efficiently will be influenced by your amount of muscle soreness and weakness, your efficiency as an athlete, your appetite, your immune system, your sleep habits, and your digestion.  Working on improving all of these factors will help you recover faster, decrease your required rest time, and maximize your gains during training. 

The specific plan of rest and recovery may vary.  Listen to your coaches and trainers, and follow the schedule that has been laid out for you.  Most plans will incorporate 1-2 days of rest after several days of lighter training, and 1-2 days of rest after heavy training session.   

Injuries may still occur even if you are extremely diligent with your training habits.  That is where the team at ESSM comes in.  It is important to get treatment early.  At ESSM we use advanced soft tissue work like Active Release Techniques™, Graston and dry needling.  We also incorporate chiropractic adjustments, kinesio-taping, rehabilitation exercise programs and massage therapy.  Our goal is to get our patients back to full function as quickly as possible and teach the tools they need to stay better and accomplish their training goals. 

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New Study Shows Chiropractic Can Potentially Improve Muscle Strength

A new study published in the journal Experiment Brain Research has shown that a full­spine chiropractic adjustment can increase the test subjects' ability to increase electrical activity in their contracting leg muscles by almost 60%. In the study, this translated to a 16% in absolute force generated. Also shown was a 45% increase in the ability of the brain to activate the particular muscle being tested.

A collaboration between the New Zealand College of Chiropractic's Centre for Chiropractic Research and neurophysiologist Professor Kemal Turker, “this study is the first to indicate that chiropractic adjustments of the spine can actually induce significant changes in the net excitability for the low­threshold motor units. The results of the study also indicate that spinal adjustments can prevent fatigue”, according to Dr. Haavik, Director of Research at the NZCC.

So what does this mean for us? This study has initially shown fascinating results that could have huge ramifications to various populations in society. Who needs their muscles firing more efficiently and powerfully? Athletes, for starters. The ability to gain a 16% increase in absolute force from a muscle cannot be achieved with most training regimens in less than several weeks, at best. At the higher end of the athletic spectrum, marginal gains are frequently sought after to give any edge over their competitors. A marginal gain is typically considered 1%. Imagine 16 times that in one chiropractic session!!

Another population to consider are those individuals who are either injured and forced to rehabilitate, or suffer from a muscle degrading dysfunction, such as a stroke. By increasing the ability of the brain to activate targeted muscles, you increase the efficiency of the rehabilitative
efforts. This study has shown a 45% increase in that area, so that should translate to decreased time at the physical therapists' office, and more time living an active lifestyle.

Cautions: While this research study is very exciting, it must be mentioned that it is newly completed, and has not had time to be subjected to follow­up studies. However, where there is smoke, there is typically fire. Even if some of the numbers do not hold up to repeat studies over time, there is certainly compelling evidence that chiropractic adjustments can benefit muscle function. It goes with the idea I've used as the basis of my practice for over ten years: The body works better when it is working the way it is supposed to.

I will keep my attention focused on future studies of this subject, and am excited for the possibilities of what they might reveal. In the meantime, there are other performance and healing benefits that are associated with chiropractic care. Do not hesitate to contact ESSM to learn more about the benefits, and to take advantage for yourself!!

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Is Movement Missing From Your Golf Game?

Like most athletes, golfers are constantly searching for that extra edge in their game. The goal being to consistently shoot as low as possible, there are many options on the market to help achieve this. Ball and club technologies, as well as swing analyses and lessons are prevalent in the golfing community to help hit the ball into orbit, but there is a commonly overlooked aspect of the swing equation—the elimination of joint dysfunction.

Joint dysfunction is improper movement—or lack of movement—between two bones of the body. Joint dysfunction can affect the body by decreasing range of motion, creating muscle imbalances, and affecting neurology and the reproduceability of movement patterns. This may exist without any signs or symptoms of pain.

Range of motion is paramount to a successful golf swing. The back-swing and follow-through are what creates distance on your ball. If your movement is limited by fixated or stuck joints in your spine, then you will not be able to create the distance that you would were everything working properly.

Muscle imbalances are created when muscles that are designed to perform a certain job moving bones meet the resistance of a fixated joint. Now they contract and pull, but the resistance causes them to spasm and become painful. To achieve the desired movement, other muscles must join in. Now the body has muscles doing work that they were not designed to do. This creates pain in areas, imbalances, and a lack of normal, smooth movement. Each of these can negatively affect the swing mechanics.

Finally, when a joint does not function properly, and the muscles around the joint are not in their natural, balanced state, then the neurology of that area becomes dysfunctional as well. There are nerve receptors in the joint and in the tissues in/around muscle that detect movement and body position, and if they are compromised, then the messages that they relay to the brain are inaccurate. This leads to the brain having a slightly “off” picture of how the body is truly positioned. Without really knowing where the body is in relation to itself, the club, and the ball, no amount of lessons, and not even a $5000 club will help you get the most out of your swing.

To address this problem, and to get the most out of your body you need to have the joint dysfunction addressed and corrected. The sports chiropractors at Evergreen Spine & Sports Medicine are ideally suited to this task as they not only address the dysfunctional joint, but also the surrounding tissue problems that have arisen as a result of the problematic joint. This will improve the range of motion, the muscular imbalances, the neurological function, and ultimately your swing—and with far less effort on your part than hitting a few buckets at the range!  

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NSAID'S as Preventative Medicine.....A Bad Idea!

In a practice working with athletes of all levels—from professionals to weekend warriors—I get to hear many different strategies they have devised for their own health care.  Fortunately, a lot of them will run these ideas by me so that I can either approve or revise them.  One of the more common—and worst—is the use of non-steroidal anti-inflammatories (NSAID's) as preventative medicine.  NSAID's include aspirin, ibuprofen, and naproxen sodium which are the active ingredients in the most commonly used over the counter options for pain.  Countless patients over the years have told me of their plans to take NSAID's prior to competing/participating in an event “just in case” pain should develop during the event.  

Inflammation is the body's primary step in tissue repair following injury.  Injury can be a sprained ankle, a broken bone, or even micro-damage from overuse.  NSAID's do not target specific tissue in a specific area based upon what is hurting the individual, they inhibit all inflammation.  Taking them preventatively will limit the body's effectiveness in repairing the damage done to muscles and tissues during activity.  This will slow recovery, and could lead to chronic pain in the future.  

If you are concerned that you will not be able to perform an activity due to the pain that may arise, then perhaps it is time to use your better judgement and rest until the issue is resolved—you could be doing more harm to your body than good.  Following a workout or competition where you are sore, turn first to ice and compression.  Each is able to reduce inflammation while still allowing it to perform its task of repairing damaged tissue.  Ice and compression are both able to be applied to the specific area of complaint which allows repair and recovery of the other areas of your body. 

NSAID's have their place in the world of sports medicine, and it is always after activity when there is noticeable pain that ice and compression cannot relieve.  Should that not be enough, you should have the complaint evaluated by a physician specializing in joint and soft tissue injuries as soon as possible.  

Stay active, and stay healthy!  

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Cycling and Shoulder Pain

As cyclists, there is always advice floating around us on how to prevent against knee and leg pain—moving the saddle fore and aft, the 30 degree rule-of-thumb for knee flexion with the pedals at 6 and 12, and even articles I've posted regarding the hip/pelvis and foot/ankle. But what more infrequently gets addressed is shoulder and upper back pain/discomfort from riding for long periods.  

As I've said throughout my years in practice, you should always have the problem evaluated by a sports physician prior to beginning any self-treatment. This ensures that you are not risking further damage to the area, and are also not reinforcing bad habits. Doing exercises with compromised muscular balance and dysfunctional joints can lead to injury, and you are likely not able to perform any exercises as they are truly intended with any level of dysfunction that is great enough to cause pain. And more so, performing them in a manner in which they are not intended will reinforce the dysfunctional movement patterns and imbalances.

That being said, if the symptoms are more of discomfort or fatigue than pain, this exercise should be very effective at helping to relieve your shoulders on longer rides.

Many times the fit is the problem, and you are putting too much pressure on your hands as you lean forward on your bike (more common with road cyclists). A professional fit is crucial if you are planning on riding a bike regularly. I always recommend that your dysfunction is evaluated prior to any fit so that you are not being fit into a biking position with compromised joint function and muscle balance. Fix the body, fit the bike.

In a lot of cases the problem is a chronic weakness in the middle and lower trapezius muscles of the back. The middle and lower traps are located between your shoulder blades. They oppose the more commonly known upper traps by bringing the shoulders down away from the ears. The upper traps are the big muscles between your neck and arm that are often tight or sore with desk work or stress—or cycling!

The key is to strengthen the middle lower traps so that the upper traps do not have such an advantage in pulling the shoulders up to the ears (it's a muscular tug-of-war). A great way to do this is to consciously pull your shoulders down toward the ground and pinch your shoulder blades together. Hold them there for counts of 15 seconds 3 times once a day. Gradually add time until you are able to keep them there comfortably for a minute each of those 3 times.

For the second exercise, get onto the floor on all fours. Keep your knees under your hips, and your hands under your shoulders. Really focus on keeping your shoulders pulled down from your ears, your shoulder blades together, and both of the blades flat against your back. This is more advanced and may require some training from a sports medicine physician or Pilates instructor to make sure that you have the correct starting position. Hold this position for 30 seconds 3 times once a day. As you progress and this becomes easier to maintain, gradually shift your weight from your left to your right hand without allowing your shoulder blades to move—keep them stable.

With these exercises, you will be able to develop middle back strength that will allow you to ride longer more comfortably, and even sit at a desk/computer longer with greater comfort.

If these exercises do not help your discomfort within 2-3 weeks, please consult a sports medicine physician to have the problem evaluated and treated. I am fond of helping my patients cheat by using kinesiology tape which allows their bodies to focus subconsciously on using specific muscles based on how the tape is applied.

Ride safe and comfortably!  

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Lateral Knee Pain

Are You Experiencing Lateral Knee Pain?


A common complaint amongst active patients, especially long distance runners, cyclists and triathletes is lateral knee pain, and the most common cause of that pain is Iliotibial Band Syndrome (ITBS).  Have you ever experienced lateral knee pain during the beginning of a run, or about 30 minutes after completing a long run?  Have you ever experienced sharp lateral knee pain that gets progressively worse as you increase your mileage? 


Unfortunately ITBS gets in the way of people reaching their fitness and competitive goals, but this doesn’t have to be the case at all.  Knowing how to avoid ITBS, how to recognize it, and how to treat it can allow athletes to continue to train and make it to race day. 


The Iliotibial Band (ITB) is a tendon, which originates just above the lateral hip and inserts just below the joint line on the lateral knee.  It helps with knee stabilization while running as it constantly moves slightly forward and backward with knee flexion and extension.  A disruption of the forward and backward movement, or an increase in tension can lead to irritation and eventually inflammation anywhere along the ITB.  Things that can cause these changes in the movement and tension to the ITB include excessive adduction of the hip and increased rotation of the knee. 




During the normal gate cycle of running, when one foot is planted on the ground, the other foot is swinging forward.  If the hip on the side of the swinging foot dips down toward the ground this is a sign of weak abductor muscles causing excessive adduction on the plant foot side.  Similar biomechanics are utilized while cycling.  If the pushing leg has week abductors the hip on the pulling leg can dip down toward the ground.  This causes increased tension along the ITB and it will likely lead to ITBS.  Several things cause this abnormal movement, including running on an uneven surface, weak gluteal muscles, uneven leg length and misalignment of the pelvis. 


Excessive knee rotation will also cause increased tension on the ITB leading to ITBS.  Hyper-pronation and low/weak arches of the foot will cause medial rotation of the knee.  Wide hips and a weakness in the medial quad muscle will also cause excessive medial rotation of the knee.




With all of the causes of ITBS it’s amazing that everyone doesn’t have it.  However it can be easy to avoid.  One of the most important and easiest things to do is to be properly equipped with the right shoe and to make sure the bike being used is properly fitted for the rider.  Another simple solution is a proper warm up and stretching after activity.  Finally never increase your mileage or training intensity too quickly, giving your muscles time to strengthen as you spend more time on your feet. 


Fortunately, getting ITBS does not mean you won’t be able to continue to train.  The key to success is seeking help early.  The longer you wait, the longer it takes to heal.  Your health care provider must identify what caused the ITBS and not only treat the symptoms, but fix the root of the problem.  Painkillers and anti-inflammatory medication will not do the trick.  The fibers of the ITB need to be manipulated stretched, iced and stabilized.  At ESSM we utilize Active Release Technique™, Graston, Kinesio-taping, dry needling, acupuncture and deep tissue massage.  Often times the joints above and below the area of pain need to be adjusted to restore normal mobility, and finally rehabilitation and strengthening of the areas of weakness will keep the ITBS from reoccurring.  You can continue to train as long as the pain is continuing to decrease and you are able to move without modifying your biomechanics.  If running is not an option then a good alternative is finding another way to get your heart rate up for the same amount of time that you would be spending running. 



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