High Ankle Sprains

Last night I had the pleasure of sitting in the 2nd row at the Celtics game.  Which, for anyone who's never been that close to a professional athlete, is quite impressive.  The size and speed of these athletes is incredible.  They bounce off the floor with breathtaking speed and agility.  They effortlessly jump higher than most of us could ever think of jumping and seem to not even be trying.  Kicking and twirling all over the place.  And yes, if you hadn't figured it out already, I am talking about the Celtics Cheerleaders! Now this post isn't about me, and most the other guys in the stadium(you know who you are) watching the cheerleaders, well I don't think it is... we'll have to see where this blog ends up :)

But in all seriousness, I was really impressed by what these very small, but very strong, women could do.  Now on the other end of the spectrum are the gigantic basketball players.  These guys also showed some incredible speed, agility, and jumping power.  The human body is remarkable and to see professional athletes perform certainly puts the human body on display.  Now to be clear, this is not about me just going gaga for professional athletes, because I think what professional athletes do should be appreciated, not idolized or deified.  Lets all remember what Charles Barkley had to say about professional athletes (his famous commercial "I am not a role model" for those of you who've forgotten).  

Now I know when I started this blog I had a point... now what was it?  We've really gotten off track here.  Professional athletes, cheerleaders, Charles Barkley... Oh yeah... Ankles!

As I watched the game I noticed the extensive wrapping on many players ankles, clearly to provide more support.  One guy seemed like he was actually playing with pants on because he was so heavily taped.  It seemed nobody had bare ankles.  But why would everyone tape an area of the body that is already so strong and stable?  What happens to the ankle that is so bad?  It turns out that the ankle joint isn't quite as stable as we'd like, especially when pushed to extremes, and some very painful injuries occur when things go wrong.  So the next few posts will be all about the foot and ankle!  Who's excited?  We'll discuss ankle sprains, plantar fasciitis, turf toe, fractures, cuboid syndrome and who knows what else?!!  But today we'll start with what is called a High Ankle Sprain.

Now if you're a football fan then you're probably a fan of America's team the Dallas Cowboys... but if you're not that lucky then you may be a Patriots fan.  And every Patriots fan knows the damage a high ankle sprain can cause.  Both of their tight ends, Gronkowski and Hernandez, have had this injury over the past 2 years.  But why is it so bad?  Isn't it just like any other ankle sprain?  Just higher?  Well not quite.  I'm sure many of you have scoffed at the tv when you saw them unable to run and jump like normal after weeks of not being able to play.  You may even have thought you could recover quicker than these guys... well not so fast.

Every athlete in the world knows what it feels like to sprain an ankle.  You jump up, land wrong and boom, the ankle rolls to the outside and you're out for a few days.  It hurts, it may bruise, but it heals.  The picture below demonstrates this rolling action of what is called an Inversion Ankle sprain.  You get some muscle tissue tearing, maybe some slight ligament tearing, a good deal of swelling, pain and bruising.

This type of sprain is so common because of how the ankle joint is designed.  Right now you could roll your ankle to the outside as you're sitting at your desk with no big problem.  If it went too far, as in a sprain, it would hurt, but normally it's an action the ankle can handle.  But try to roll your ankle to the other side and it's a different story.  Try it.  Roll your ankle from the outside to the inside and it's not as easy.  

An ankle that rolls to the inside is what is called an Eversion Ankle Sprain... which most often causes what is called a High Ankle Sprain.  The image below shows the contrast between inversion and eversion sprains.

As you can see the Eversion sprain causes pain, bruising, tearing, and swelling on the inside of the ankle as opposed to the outside of the ankle.  Seems easy enough right?  Well the issue here is that the inside of the ankle is protected by a huge ligament, called the deltoid ligament, which prevents these types of sprains.  This is why most athletes have never had an Eversion sprain, or a high ankle sprain.  It's as if the body has it's own ankle taping mechanism for the inside of the ankle.  So to get an eversion sprain you have to tear through that taping mechanism which means the amount of force needed is much greater.  So you don't see these in basketball players usually, or dancers for that matter.  You see these injuries in Football players.  Because what you need for these injuries is basically for someone to fall on your leg and twist it outwardly.  The image below shows this injury... now if you're a patriots fan you may want to look away.

As you can see here Gronkowki's ankle is being forced outward, which is normally a very stable area because of that strong deltoid ligament.  As the defenders body weight becomes heavier the deltoid ligament can't prevent the ankle from rolling even further outward.  What happens next is the issue.  That ligament starts to tear and not only that but since there is so much force involved other ligaments start to tear... ligaments that are higher up on the leg called syndesmotic ligaments.  These are ligaments that connect the two bones in the lower leg to one another.  They hold the tibia and fibula together.  The picture below demonstrates this.  

Now not only has the athlete torn a few ligaments in the lower ankle but now they've torn some very important ligaments in the lower leg as well.  These ligaments keep the bones connected so if they're torn the ankle becomes very unstable.  Also, many times the force is so great that part of the lower leg bone(the fibula) actually breaks.  Now for some people the tear, or the break, isn't severe enough to require surgery so they eventually heal.  For others surgery is required, and for many football players surgery is the only option.  These injuries require a 6-week minimum recovery time and in surgical cases it could be months before the player returns.  Which is why Gronkowski had such a hard time moving in last years super bowl, and the fact that he even played is actually very impressive.  The picture below demonstrates all the types of ankle sprains we just discussed.

High ankle sprains are clearly much different than the ankle sprains most of us have experienced, not only are they higher but the mechanism is completely different.  The whole foot rotates outward, not inward, and very important ligaments are torn and bones may be broken.  So the next time you hear that a football player on your favorite team has a high ankle sprain remember that they're probably not weak or just milking the injury.  These injuries are a totally different animal.  

Doctors Note:

1.  There are essentially two types of ankle sprains.  Inversion, where the foot rotates inward.  And Eversion, where the foot rotates outward.  Inversion sprains are common, eversion are not common and usually require someone falling on the ankle to occur.

2.  Inversion ankle sprains can heal usually in 1-4 weeks.

3. Eversion ankles sprains involve much more ligament tearing and damage which requires more time to heal.

4. Eversion sprains usually cause what is called a high ankle sprain where not only are the inside ligaments torn but also the syndesmotic ligaments holding the tibia to the fibula are also torn.  A broken bone may also occur during a high ankle sprain.    

5. Eversion sprains may require surgery and almost always require a recovery time of well over a month.

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IT Band Syndrome

Fall is officially here and the holidays are approaching... what's this mean?  Well it means that we can all stop working out, grow beards, wear flannel shirts, watch football and drink beer all day... fantastic! Just kidding.  Or am I?  No I really am, we can have a football flannel shirt blog some other time.  What it really means is that everyone and their mother is trying to get the most out of the last few weeks of bearable weather by running more. Boston is filled with road races this fall, every weekend, and every holiday until it gets too cold outside to feel feelings anymore!  And like clockwork, every year, our office fills up with runners complaining of IT band pain and/or IT band Syndrome.  Now you may be saying... "what's an IT band?"  Lets find out.

If you look at the pictures above you'll see a long white "band" of fascia (which is kind of like a tougher skin that's underneath the skin... not a muscle and not a tendon).  The IT Band is a tight band that runs from the gluteal muscles up near the hips all the way down to the outside of the knee. The purpose of this band is hip and knee stability, especially during running or standing on one leg. If this area gets too tight or irritated it starts to pull on where it attaches to the knee and can cause pain, in most cases the pain is rather severe.   It's described as a stabbing pain that prevents runners from continuing their run.  But it's not only seen in runners, it can be seen in people who aren't very athletic at all... but we'll talk about runners because it's more prevalent in this demographic.

There are a few causes of IT band syndrome and IT band pain.  The first is simply a tight IT band which happens when we sit too much, don't stretch our gluteal muscles, don't exercise enough, etc.  These cases usually get better by stretching, rest and rolling.  Everyone has seen these people at the gym rolling up and down on a foam roller trying to loosen up their IT band.  It would be great if healing this problem was as simples as rolling up and down on a foam roller.

The second cause is the angle created from the hip, the knee, and the ankle. The picture below explains what we mean.  The example on the left is the problem, where the knees come close to connecting.

 

This natural posture causes abnormal stress on the hips and eventually the IT band.  And since women more often have this type of anatomy we see IT band problems popping up more frequently in woman.    People with this problem have a harder time healing and getting back to running because it's not as easy as rolling on a foam roller.  This problem has to be looked at from many angles. First we look at the feet, to see if flat feet or fallen arches are causing the knees to bend inwards.  If they are, sometimes inserts can help.  Or on the opposite end of the spectrum, bare foot running or minimal shoes may help.  Try the new balance minimus shoes or the vibram 5 finger shoes. These shoes seem to help a lot of people regain their arch stability, so you can also try those for a few months. And if you don't want to look ridiculous all the time I would go with the new balance ones :) Next we look at the hips for tight or spastic TFL muscles or gluteus medius muscles which may be tugging on the femur bone and increasing the angle at the knee.  If inserts, stretching, and/or deep tissue gluteal work doesn't fix the problem then we look at the 3rd cause of IT band syndrome which, believe it or not, is the spine.  

Now at this point you may be saying "oh here we go, of course the chiropractor thinks IT band syndrome is caused by the back... just like every other problem."  And you may even be saying this to yourself in a mocking tone!  Don't worry, I won't take offense :) Just try to stay with me on this one!  The reason some IT band issues are caused by the low back has to do with physics and how the body absorbs shock.  

Every runner understands shock and the transfer of force.  We've all had that run, when we're tired and achy and it feels like every step is painful.  Or you've literally heard someone running by you as their feet slam against the ground in what looks like a very painful running motion.  In an ideal world the force of hitting the pavement would be absorbed by your body.  Try to picture a runner.  Now think of the runner in black and white.  As the foot hits the ground think of an electric shock being formed down near the foot.  Now watch that shock wave travel up the foot, through the ankle, through the knee, through the hip, through the BACK, up the spine, into the head and then back down the body.  This is how force is absorbed by the body.  Anyone who's gotten a headache during running knows what it feels like if force is not properly absorbed.  

If the spine isn't moving correctly this force doesn't travel through it correctly, it basically gets blocked by an immobile spine.  What I mean by this is that the human spine should move like a slinky(I hope everyone remembers what a slinky is).  Each part of the spine should move independent of every other part, just like a slinky moves and glides.  If, due to injury, tightness or prolonged sitting, the spine becomes compressed, it's like the slinky gets a a few kinks in it.  Now instead of having a nice fluid spine where the force can easily be absorbed we've got a spine that is very rigid and unable to absorb force.

Now back to that image of the electricity running up from the foot into the body.  Visualize again that the force has made it up to the low back but now instead of being absorbed by the upper body it's deflected back to the leg.  This causes all the force to be absorbed in the lower body.  This in turn will stress out the muscles of the leg, the IT Band in particular, and eventually cause pain.  These cases of IT band syndrome don't respond well to simple stretches or ultrasound therapy.  

Many IT band issues can be avoided or cured rather quickly once the low back is adjusted and allowed to move like it's supposed to move.  If you're someone who is frustrated with the lack of improvement in your IT band issues you may just need a difference approach.  There's always a cause to the pain, and in turn, there's typically a cure.  Happy running.

Doctors Note:

1. IT Band Syndrome is caused by either tight muscles, fallen arches, poor leg mechanics or low back problems.

2. Most cases don't need months of treatment.  Make sure whoever is taking care of your pain looks at the low back as well.  Every part of the body effects the other, so don't just focus on one part.  Look at the body as a whole.

3. Rolling on a foam roller, ice and rest will help mild cases.  But many other cases need to add in low back work as well.

4. Try the new balance minumus shoes or the vibram 5 finger shoes for 3 months and see if it helps.

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How Often To See Your Chiropractor

Recently I was able to spend some time out in Lake Tahoe.  It's the second deepest lake in the US (at 1,645ft), has enough water to cover the entire state of california with one foot of water, and the water is basically turquoise due to it's incredible clarity (you can see 65-75 feet down).  Feel free to use this newfound knowledge at dinner parties or talking amongst your coworkers :)  And since it's up in the mountains, everywhere you look are athletes and outdoor enthusiasts.  So just walking around the town you see bikers, runners, hikers, swimmers, skiers, etc, etc... it's almost exhausting!

Since Tahoe is 3 hours behind Boston I was up at about 4:30am everyday, and inevitably made it to the local coffee shop each morning.  This particular weekend Tahoe happened to be host to a tough mudder competition.  If you're not familiar with tough mudder, it's basically an extreme endurance event of 12ish miles that takes you through obstacle courses and intense physical tests.  The whole thing is very "extreme" and fits right in with the tahoe lifestyle.  So during one of my 5am coffee breaks I sat down next to four guys who were preparing for the days tough mudder race.  Normally I don't pay attention to who's sitting next to me, but when one of them stated "I saw my chiropractor yesterday" my ears of course perked up.

Following the first statement, I heard the next 2 out of the 3 guys say the same thing.  75% of the table had seen their chiropractor the day before.  But one guy hadn't, and he asked each one of them if they were injured.  Their responses were better than anything I normally come up with.  Each one stated that they go to their chiropractor a few times a year because it makes them perform better.  They didn't know how, and they didn't know why, but they didn't care.  All they knew was that their personal performance went up when they saw their chiropractor.  Just like getting my car tuned up, I have no clue what they do under there, but I know it helps :)

And I know what you may be thinking... oh that's just cause it's california and they are just different from us on the east coast.  Well maybe, but maybe not.  I got to thinking about how many athletes I see in the office and also professional athletes who see a chiropractor on a regular basis.  Tom Brady of the New England Patriots uses a chiropractor throughout the season.  Usain Bolt, the worlds fastest man, was seen being adjusted during the 2012 summer olympics.  Tiger Woods, arguably the best golfer of all time, has been seeing a chiropractor for "as long as I can remember".  Lance Armstrong's chiropractor traveled with him during every stage of all 7 tour de France victories.  Arnold Schwarzenegger, 7 time Mr. Olympia, went regularly to prevent injury.  And Aaron Rogers, the current MVP of the NFL, has been going to a chiropractor since he was a kid... cause his father is a chiropractor.  Yet even though almost all professional athletes (who care and know more about their bodies than almost anybody else) use chiropractors on a weekly basis, most people have never even seen a chiropractor.

If you've come into our office here in Boston, Copley Square Chiropractic, you know that we don't preach about chiropractic.  We don't tell you to come back every week to get adjusted.  Sure, when we see someone for the first time we end up seeing them a bunch of times to get them better, that's how any therapy works, but after they are feeling better most people hear me say this... "use me when you need me."  But you know what?  My recent trip to california has made me think about this recommendation.  If "extreme" athletes and weekend warriors out there are using a chiropractor to improve performance on a regular basis maybe more people should as well.  After all, I get adjusted every 2 weeks, like clock work.  I don't do it because I'm in pain, I just do it because it makes me feel good and seems to keep me from getting injured.  And yet my normal recommendation is "use me when you need me."

But even with my weak recommendation I still end up seeing many people a few times a year, I see many other people once a month, and I see many athletes every couple weeks, because they see a value without me saying it.  I see professional athletes and very powerful people being adjusted on a regular basis because it improves how the body works.  I heard from one of my best friends yesterday, who lives down in DC, after his first adjustment ever and he said "am I supposed to feel this good afterwards?"  And this is not uncommon, it's what I hear all the time, and it's how I feel after I get adjusted every couple weeks.

Now this brings up another "issue" that I deal with pretty regularly, and that is the feeling that "once I go to a chiropractor I have to go for the rest of my life."  Believe me, I hear this all the time, and some people in a lot of pain won't even go see a chiropractor because they don't want to go forever (which is a shame).  Many people are very up front about not wanting to go for the rest of their lives... and you know what?  That's fine.  And I can relate, I mean I sometimes say no to people's recommendations just for spite, I don't even know why (but that's probably a whole other issue we don't want to delve into!) But some people come in a couple times, feel better, and I never see them again, and that's okay.  But the feeling of having to come in forever is one that you hear with a lot of different things, not just with chiropractors.  You hear it with dentists, who's only gone once?  You hear it with healthy eating, you kinda have to stick with healthy eating forever for it to help right?  You hear it with going to the gym, cause who gets anything out of going just once?  Basically, anything that we may benefit from is something that we have to incorporated into our life.  I saw it out in california a lot because people seem to be very active, very interested in nutrition, and very interested in improving their bodies (by using their chiropractor).

I think many chiropractors give themselves a bad wrap because they just say, "Good to hear you're feeling better, but we've got to see you every month for the rest of your life."  And I honestly believe most of them are giving that recommendation because they think it will help that particular person.  It may be an idealistic view, but once again, it's not only seen in chiropractors.  When a nutritionist says to continue eating healthy for a long and rewarding life they really mean it. But my profession sometimes has a tough time explaining what we mean with our recommendations.  We should be explaining that, just like exercise, eating healthy, or saving for retirement, the true benefits can only be seen when these activities are done regularly.  Chiropractors make sure the joints, nerves and muscles of the body are working as best they can.  Other professions would also get a bad wrap but they seem to explain it better.  A nutritionist says you've got to eat healthy for the rest of your life, and nobody freaks out.  A trainer says you've got to work out for the rest of your life, and most people nod in agreement.  An accountant says you need to save every month for retirement and we all seem to work that in.  But if your chiropractor says you should come in every couple months for an adjustment it's blasphemy.  I've always thought that was interesting.  But you know what?  People go off and on with exercise, with eating healthy, and with saving money, so it's okay if people go off and on with chiropractic care as well.

Now let's get back to Tahoe.  Seeing those athletes talk about going to their chiropractor has certainly altered how I feel about people getting adjusted on a regular basis.  Will it change my recommendation of "use me whenever you need me?"  Well I don't know.  I do think people should be adjusted every few months, and at a minimum quarterly(4 times a year), and actually some people do need it monthly.  But if they don't, I won't be upset, and I'll adjust them whenever they feel like they need it.  I believe in people having choices, I'll give my general recommendations and people can decide for themselves.  I mean if someone doesn't want to eat healthy and exercise that's totally up to them.  However, if we look at people who know a lot about their bodies, such as professional athletes, we can see a value in going to a chiropractor.  It may not be obvious, and it may not be easy to explain to other people why we get adjusted every few months, but clearly there's a value past just pain control.  Is it valuable to everyone?  Well that's up to each individual to decide.  Americans are all about choices... and the freedom to choose what's best for them.  Lets all just be thankful for that :)

Doctors Note:

1. Use your chiropractor whenever you feel like you need him/her

2. For overall health and improved function see your chiropractor at least quarterly (4 times a year)

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Elbow Pain - Tennis Elbow

Most of us had random jobs growing up, and for me it was building tennis courts for my uncle's company out in the Berkshires (if you only vacation on the Cape, the Berkshires is that green part of the map 2 hours west of boston and a beautiful part of our state).  Piretti Tennis was a great place to work and, for the few of you who have never actually built a tennis court, it's actually pretty difficult.  And it's amazing how many people can afford their own private tennis court!  It didn't matter if we were in Lenox or up in Dalton, people just loved to have their own courts... it always amazed me... But that's not really relevant here now is it...so lets try to stay focused :)

Building these courts was not only grueling work that caused me to go home with random aches and pains, but it was also a good place to learn about something called tennis elbow.  Since I was around tennis players from time to time (and since my uncle was a coach) I learned a lot about elbow injuries.  So let's talk a little bit about what tennis elbow is, and how to prevent this nagging injury.

If you turn your hand over, palm facing the ceiling, and look down at your elbow you'll see a bump on the inside that sticks out a bit.  That bump is called the medial epicondeyle of the elbow and on the opposite side of that bump is another smaller bump called the lateral epicondyle.  Both spots are attachment points of the forearm muscles.  The medial epicondyle is where the flexor muscles attach (the ones that flex your wrist in a "come here" motion) and the lateral epicondyle is the attachment point for the extensor muscles of the wrist (which would pull your wrist back if you suddenly touched a hot stove).  Both areas can cause pain, but Tennis elbow is referring to the Lateral Epicondyle of the elbow.

Photo Credit: http://prpstopspain.com/tennis-a-golfers-elbow-a-painful-elbow-tendonitis/

It's referred to as tennis elbow because of a one-handed backhand.  Now I'm not an expert when it comes to tennis but when you hit a one-handed backhand you're using the extensors of your wrist.  Not only that, but when you  hit a forearm you have to use your extensors to pull the racket back before you hit the forehand.  Overuse of these muscles, as seen in tennis, can cause inflammation at the point where these muscles attach to the bone... the lateral epicondyle.  But it's not just seen in tennis.  It can be seen after typing too much, using a mouse too much, using a hammer, twisting a screw driver, basically anything that is a repetative motion can cause "tennis elbow."

The question is why does it effect one person and not another?  You can take two carpenters and one may have tennis elbow and one may not.  The primary reason is that one person probably has a tightness in the extensor muscles which pulls the muscles too tight, and then they pull at the point where they attach to the bone.  Another reason is simply overusing the muscle and not resting.  If you bang a hammer day in and day out, and your extensor muscles are too tight, you'll probably develop some elbow pain.  A third reason is just doing too much too fast, as seen with a "weekend warrior" tennis player who wakes up, after a day playing tennis, with elbow pain.  But the main issue is usually a tightness of the extensor muscles that predisposes people to this problem.

To prevent tennis elbow you have to make sure the extensor muscles are nice and loose, through self massage, stretching, or actually getting a massage.  Second, make sure the muscles are strong by using some form of weight training.  Third, don't do too much too soon, take it slow and give the muscles time to build strength and hopefully stay loose at the same time.

If you already experience tennis elbow you've got a bunch of options for treatment.  First is rest, ice and anti-inflammatories.  This is the first line treatment because tennis elbow is an inflammatory condition, just like any tendonitis.  So anything that gets rid of the inflammation will get rid of the pain.  If that doesn't work some people get a cortisone injection, this is like crumpling up a bunch of advil and shooting it directly into the elbow (not the most accurate analogy but it's close enough).  These typically help, but don't come without risks.  Cortisone, since it's a type of steroid, can decrease bone density and may decrease tendon strength... so they aren't the best option although they do usually work.

The best treatment option is to first have someone evaluate the extensor muscles of the forearm for tightness and weakness.  If you figure out why the elbow is actually hurting then you can fix the problem and prevent the elbow from hurting in the future.  A good massage therapist or physical therapist will be able to evaluate the forearm and work out any tight or spastic muscles, thus decreasing the pressure on the elbow and decreasing pain.  Then they will give exercises and stretches to do at home so that it doesn't come back.

So if you've got elbow pain there are a few options, but there's really only one good option, and that's to have it truly fixed.  You can pop advil and ice it but the pain will probably come back and become a chronic issue.  It's not something that anyone should have to live with, and if you find someone who knows how to treat this problem it may be a quick fix.

Doctors Note:

1. Tennis elbow can be seen in any form of repetitive work, not just tennis, and is caused by tight or weak muscles in the forearm that pull on where they attach to the elbow, which causes inflammation.

2. Anti-inflammatories and cortisone injections, although effective, won't cure the underlying problem and the pain may return later in life

3.  A good Chiropractor, massage therapist or physical therapist should be able to loosen the tight muscles, and strengthen the weakened muscles, which will decrease the elbow pain and provide permanent relief.

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Can Changing Your Brain Change Your Pain?

I'm always getting asked about "other things" people can do to decrease their pain, when they can't make it into the office.  Luckily, in my former life I was a personal trainer so I've always got certain exercises or stretches that can help some of the time.  A few people need weight loss, some people need muscle strength, and others need a different way of thinking.  This blog is dedicated to one of those patients, who opened my own eyes to a different way of thinking.

Recently I finished a book called Finding Flow: the psychology of engagement with everyday life by Mihaly Csikszentmihalyi.  It wasn't the easiest read, I wish I could recommend the cliffs notes, but it was fascinating.  I picked up this book a few weeks ago because of a patient I see every month who has a horrible back.  A back that I wouldn't wish upon anyone, but amazingly this guy is always up beat, and happy.  He lives in pain, and we try to give him some relief, which he is always grateful for.  But last time I saw him I was particulary stressed, about who knows what, and I had to ask him how he stayed so positive, so relaxed... so happy.  And he referred me to this book he read years ago called Finding Flow, and what follows is my own journey to find flow.

Flow is often times referred to as "the zone" and athletes around the world can relate to this feeling.  But it doesn't just relate to athletes, it can be seen anywhere.  Basically it's those times in life when all of the sudden you wake up and say "wow, I was just (doing something) for the past hour and it felt like 5 minutes."  It can be seen when new couples are out to dinner and they notice nothing about their surroundings, not the time, not what they ate, not anything but each other.  Or when a mother holds her newborn baby for 8 hours straight and realizes she hasn't even eaten breakfast.  Or when you workout intensely and forget about all the stress in your life.  It's a time where intense focus for the present event completely drowns out your surroundings.  Whether it's during intense exercise, intense work, or intense connection with another person, flow is when our brains are the most happy.

The author believes that the happiest people on the planet live most of their lives in flow.  No matter what they do, whether they're athletes, teachers, or carpenters, they all find a way to live in flow.  He thinks that when the brain blocks out all other stimuli it can function at a high level and what comes from this is happiness.  The book delves into many examples and he makes some great points about how focusing intensely on whatever we're doing will eventually train our brains to enjoy that activity.  It's a very interesting premise.

Now for me, and maybe you as well, finding flow is not as easy as it sounds.  I once had flow... playing sports years ago.  That cingular focus, where nothing else enters your brain other than what you have to do at the moment.  It's the exact opposite of multitasking.   As a business owner and just as a person in general, finding flow is much more difficult.  You can probably relate.  What bills do I have to pay?  What new supplies do I need? Have I payed my quarterly taxes? Does this tie match? What am I eating for dinner, etc. etc. etc.  When I allow my brain to think about everything I must do during a single day I am scattered and nowhere near my flow.  I'm sure you can find times in your life when you're looking at a task in front of you, and ten minutes into the task you realize that you're searching the web, checking your phone, checking the weather, planning the weekend, or texting a joke to a friend.  Even when we walk down the street enjoying the weather our brains lose focus.  We start thinking about our jobs, our appearance, the appearance of someone walking by us, what we have to do this weekend. We all do it, but is it the best way to live?

Back to the patient we talked about earlier.  He explained to me that he never allows his brain to multi-task.  He writes out what he has to do for that day, and he focuses on each act separately, as intensely as possible.  It enables his brain to stay focused, allows him to finish every task he starts, and his days just fly by.  He says that he used to allow his brain to focus on what was wrong with his back or what was wrong with his life, but once he trained his brain to start focusing on the right things a lot of his pain went away.  Now he goes from activity to activity with focus and passion, no matter if it's closing a deal or washing the dishes, he uses focus to keep him on point.  When he gets home and talks to his wife, he actually talks to her, he doesn't stress about anything that happened at work, cause he knows he needs to focus on what he's doing at that very moment.  He said after a few weeks of practice it became second nature and now he's happier than ever before.

After reading "Finding Flow" I started to take a look at how much of my day was spent out of flow.  How many times do I listen to someone talk but not hear what they're saying?  How often do I check my phone, facebook, twitter, email, etc for no apparent reason other than to pass time?  How many days have I gone to the gym and been bored by doing the same routine over and over again?  When was the last time I felt that feeling of complete focus without letting other thoughts creep into my head?  Let me tell you, this exercise was not easy.  It made me realize that most of my day is spent multitasking but not really getting much done.  I realized that most of my productivity can be boiled down to just a few hours of intense focus, and the rest is just fluff.

So I started to think about how I could get some flow back in my life.  I asked my patient how he found his own flow, and he told me he started with exercise, in his case it was yoga but he said it could be anything.  This I liked.  Like many others, I am drawn to exercise and it's the one area where I used to feel that flow feeling, as many people probably do.  I can remember when I used to play basketball and got into the "flow" of the game and how it was impossible to think about anything else.  As time has gone by my workouts have been filled with thoughts about what's for dinner, how the work day went, do I have to pick up my dry cleaning?  These are all flow stoppers.  So in an instant, I stopped all that, and joined a boxing gym.

If you follow us on facebook, which apparently is a big flow stopper :), you know that a few weeks ago I started doing fighter training classes over at Peter Welch's gym in southie.  It's a 50 minute workout that is constantly moving... and intense.  You're doing different movements throughout the class, all of which are pretty difficult.  If you go full throttle the entire time you'd probably pass out, unless you're in great shape.  The first time I went I had to stop because I was going to throw up, but I  got through the class.  And you know what I realized?  It was the first time in a long time that I'd gone an hour without thinking about... well anything.  Not once did I want to search the internet, or check my phone, or worry about any ache or pain I normally feel... not once did I think about anything other than the task in front of me.  I was focused, for one hour, on just getting through the class.  And you know what?  That feeling of focus lasted the whole day.  Even when I got to work, I wasn't worrying about every little detail, I wasn't wondering what was going to happen tomorrow, or what happened yesterday.  For that day, I was relaxed, and focused... I was in flow.

And that's how it happens, according to my new Yoda (or Miyagi if you prefer a karate kid reference).  Once your brain feels that flow experience the results last for hours.  Day after day, as flow enters your life again, you supposedly go longer and longer feeling like you're in flow.  This is how my patient trained himself to go throughout each and every day.  He started with something intense that could keep his focus, and he built from there.  Now he focuses on the present moment and doesn't allow his brain to stress out about his pain.  His foundation was Yoga, mine apparently is boxing.  And after a few weeks I am a convert, I believe in finding flow.   Have you found yours?

Doctors Note:
1. Read Finding Flow: the psychology of engagement with everyday life by Mihaly Csikszentmihalyi
2. Take an inventory of your own life.  How often do you lose focus, check email, etc when it's not really necessary.
3.  Find something that enables you to intensely focus, whether it's athletics or art or building something.  Just find it.  And start doing it for an hour each day.  That focus will eventually spill over into everything you do.
4.  Do what Timothy Ferris (the author of The Four Hour Work Week) does.  He checks his email twice a day(if that), and looks at his phone twice as well.  How many times have you checked your phone today???  He says constantly looking at these things causes you to lose focus, and I think I agree.
5.  If you're in chronic pain this may help you focus your brain on something other than the pain.  It may allow your nervous system to reset itself and enable you to live your life in less pain.  It's worth a shot.
6.  Just try it... I'm in no way an expert on flow, I just started paying attention to it.  But I think everyone could use a little more flow in their lives... because honestly, do we really care what that person we met, that one time, and are now friends with on Facebook, had for dinner last night?  Are we really that bored? :)

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Disc Injuries

A long-time friend of mine is a great personal trainer down in Miami.  He travels from Miami to the Bahamas on occasion to work with private clients on their private island... sounds nice right? But from time to time he'll call me with a medical questions that he's a bit unsure of.  Most of the time it's an injury that isn't responding to exercise.  Since his background is in exercise he usually thinks that if you exercise more the pain will go away.  He (as most of us do) sometimes falls prey to that old saying... if you were a hammer everything would look like a nail... meaning since he's a personal trainer everyone should respond well to exercise.  But to his credit, when things aren't responding he looks for answers elsewhere, which every health provider should do.  This post is dedicated to one of his questions... and of course the names and locations have all been changed to protect the innocent :)

Question:
"I'm working with this woman who is complaining of tingling and pain down the back of her gluteal muscle that sometimes goes into the front of her thigh, but not all the time.  We've been doing core exercises and back stabilizing exercises to strengthen the low back.  But after 1 month of exercise she's not getting any better.  And she heats the area every night, takes Advil, even takes some stronger stuff too.  But nothing is changing. Oh and it started when she bent down to pick up her baby one day, who is obviously tiny, but she could hardly stand after it happened.  What do you think?"

Let's delve into this case.  First off, whenever I hear tingling, pain, or numbness going down the back of someones leg or into the thigh I put that into a more sever category.  It's in a category called "disc or pinched nerve."  Which means that this could very possibly be a disc problem or a pinched nerve problem.  Then we think about how the original injury happened... bending forward to pick up her child... this puts her in another category... "hurt bending forward."  Which means that it's more likely to be a disc or nerve impingement problem as opposed to a muscle or joint problem.  Of course, these are just generalizations, but it's how most health providers go through the thought process.

I follow up with a few more questions:

1. Does the pain get worse with sitting?
2. Does the pain get worse with sneezing?
3. Does heat seem to help for a few minutes, but does the pain then come back soon after?


The answer to all 3 questions was "yes."  Before we go over why the "yes" answer is important we have to discuss the basics of a disc in the back.

In between each vertebrae of the spine are shock absorbers called discs.  They are like large pads of cartilage that prevent each bone from rubbing against each other.  Similar to how a knee has cartilage to keep it moving, the spine has discs to keep it moving.  I like to think of a disc as a jelly doughnut because each disc has an outer layer which is stronger, and an inner layer that is more fluid.  Similar to a jelly doughnut.  When someone bends forward the jelly in the middle of the disc will naturally be pushed towards the back of the doughnut, and when someone bends backward the jelly will move a bit forward, it's normal physics.  Similar to  how when you pinch one side of a jelly doughnut the jelly will move away from your hands.

A problem arises when the outer part of the jelly doughnut (disc) becomes weak from inactivity, obesity, trauma, sitting too much, old age, etc.  When the outer part becomes weak the jelly can push out towards the edge, like when you push down on one side of a jelly doughnut and the other side bulges outward.  This is what's called a bulging disc.  This causes inflammation, pain, and sometimes causes a pinched nerve since the nerves are very close to the disc itself.  If the outer part of the doughnut becomes weak enough the jelly may leak out of the doughnut (disc) which is a big problem.  The jelly then irritates and pinches off nerves near the spine causing extreme pain and dysfunction. Luckily most problems are simply bulging or irritated discs, and not the kind where the jelly actually breaks through the disc wall.

So lets go over the questions.

1. does sitting make it worse?  Yes... this is important because when we sit the pressure on the disc increases by 50% because now the legs don't take any of the force.  Also, when in a sitting position our  bodies are actually flexed forward... and thus the jelly in the disc will naturally flow toward the back or our bodies.  For someone with a disc problem this will cause an increase in pain.

2.  Does the pain get worse with sneezing?  Another important disc irritation question.  When we sneeze the internal pressure increases dramatically.  For someone with a disc problem this can cause more pain.  As the pressure inside increases it will push on any areas of weakness.  With a disc problem this means that the weaker outer crust of the disc will be pushed upon buy the jelly inside and thus make the disc bulge a bit worse, and the pain worse as well.

3.  Does heat seem to help for a few minutes, and then come back soon after?  This question is not really specific to a disc problem, but I see this problem so often that I thought I'd throw it in here.  Heat is the #1 most deceiving healing modality on the planet.  On a daily, literally daily, basis I have a new patient walk into the office with a disc problem or a nerve problem and they say this... "My doctor said use heat and it helps me for a little while but then I wake up in pain again."  Here's the issue with heat, and the reason why many doctors and therapists use it so much.  Heat increases blood flow and decreases muscle tension so that people feel better right away.  If you have a party to go to and your back hurts, heating it will help for a little while.  Similar to how you can get in a bath and your pain will most of the time get better.  This is also why many people say "oh just heat it" and they sound like they know what they're talking about... if it gets immediate results most people think it helps.  So by the time I see someone they are pretty well convinced that using heat is the way to go.

Any injury, any injury at all, causes swelling.  It's just how the body works.  If an area is damaged the body sends out more blood flow with healing blood cells to start in the healing process.  The redness we see around a simple scratch is a form of swelling.  It's a vital part of healing, but when the swelling gets too great it irritates nerves and causes pain.  We've all sprained an ankle, seen the swelling and felt the pain.  The same thing happens in the back, but unfortunately it doesn't swell up like an ankle, so most of us can't see the swelling.  The back normally swells deeper than an ankle would, and since there are larger nerves in the back that deep swelling causes a lot of pain.

When you heat the back it improves blood flow and decreases muscle tension, but it also increases swelling.  This causes a feeling of improvement for an hour, maybe a couple hours, and then the symptoms come right back.  Many therapists and doctors use heat in an office setting because it makes the patient relax and feel better while they're in the office, and makes them "feel" like coming to the office is helping... but usually it's not helping the problem.  It sets up a vicious cycle of heating, feeling better, going to bed, waking up with pain again.  So unless the problem is arthritis or truly just a muscle tightness issue, do not heat an injury... ICE IT!!!!  But I digress...


Since I didn't have a chance to examine my friends client there was nothing else we could use to come up with a diagnosis.  Most of the time I can use reflex tests, orthopedic tests, spinal palpation and even an MRI to make a proper diagnosis.  But many cases can be solved just by hearing the history of the problem.  In this case, we came to the conclusion that a disc in her lower back had probably become irritated, perhaps bulged, when she bent down to pick up her baby.  The exercise wasn't helping because it was increasing swelling, and the problem wasn't that she had a weak back, the problem was that she had an irritated nerve.  She was also keeping herself injured by heating every day and sitting too much.  After my friend listened to my thoughts on disc injuries he decided to have the woman rest and ice the back for the next 2 weeks and within a week she was not experiencing the neurological symptoms any more.  Within a  month she was back working out with her trainer.  Sometimes it just takes an understanding of spinal anatomy and a couple small lifestyle changes to see a dramatic effect.

Doctors Note:

1. Do not heat an injury!  It may help your pain momentarily but it's deceiving!  Ice should be used!
2. Do not try to exercise through a back or neck injury... although injuries may occur because of a weakness in the back, they very rarely get better by exercising more.  Most people need to get the inflammation down, perhaps seek some treatment, and then after the pain has decreased start to exercise again.
3. Avoid anything that flexes your body.  Examples: sitting, bending forward, biking, stair climbing, etc.  These all push the jelly of the disc back towards the nerves that cause pain.
4. Disc issues are hardly ever surgical cases, unless the "jelly" has really gotten out of the "doughnut." Most cases respond to small adjustments in the spine to get some pressure off the discs and allow the inflammation to go down.

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Shoulder Pain During A Workout

A few days ago I was working out at Equinox here in the Back Bay with a friend of mine who's a trainer and we got to talking about his shoulder.  He said "when I work my chest or shoulders I get pain in the front of my shoulder, so I just avoid doing shoulder work."  And since this is something that I see a lot of in the office I thought we could discuss it here in this post.  After a few weeks of treatment to his shoulder he was back doing military press after avoiding it for months.  But shoulder pain can be complex, so lets run through a few of the common causes.

First we have to look at the major muscles of the shoulder area itself.  The main ones, that you can find on yourself, are the trapezius and the deltoid.  Basically the trapezius is the large muscle going from the shoulder up to the neck, and the deltoid is the actual shoulder muscle itself.  These are the primary movers of the shoulder.  When performing military press, lateral raises, or shoulder shrugs these are the muscles doing the most work.  These will cause pain when they are either too tight, too weak, or torn.  But even though these are the main movers of the shoulder they are rarely the cause of shoulder pain.

Another cause is an actual torn tendon, muscle or cartilage in the shoulder, which can happen but most often occurs after a trauma like being tackled, or launching a football when you haven't thrown one for years.  There could also be arthritis in the shoulder joint itself which can cause significant pain.  Irritation to a nerve in your neck can also cause pain into the shoulder.  But these are all more rare and more severe than what most people experience in the front of the shoulder.

One of the main reasons that shoulder pain comes about a problem with the rotator cuff, which is composed of four muscles; Supraspinatus muscle, Infraspinatus muscle, Teres Minor muscle, and the Subscapularis muscle.  Try to picture your scapula, or your wing bone on your back, this is where your rotator cuff is located.  These muscles all turn into tendons, the way any muscle does, and these tendons travel through the shoulder area and attach near the outside and front of the shoulder.

Picture Source: http://www.nlm.nih.gov/medlineplus/ency/imagepages/19622.htm

This attachment is why most people who have rotator cuff problems will feel the pain in the front of their shoulder.  When a rotator cuff muscle becomes too tight, too weak, enflamed, or torn the body feels the pain in the front, and not normally in the back.  The primary goal of the 4 rotator cuff muscles is to keep the scapula close to the rib cage, and to provide stability to the shoulder.  Most people think of a baseball pitching injury when they hear rotator cuff, but these muscles can become dysfunctional just by sitting too often.  The more we sit, the tighter the rotator cuff becomes, and the more it will pull on the front of the shoulder.

So what can we do about this anterior shoulder pain?  First you should try to loosen up that area.  Get a tennis ball and lie on the ground with the tennis ball touching the muscles near you shoulder blade.  If you're doing this correctly you'll start to feel pain in the front of your shoulder, where the tendons attach.  Now just lay there for a few minutes until the pain subsides.  Repeat this a few times a day for a few weeks and see how the shoulder pain decreases.  If that doesn't help you'll have to see your chiropractor, physical therapist, or massage therapist to get these muscles evaluated for you.  If you find someone who knows what they're doing they'll be able to figure out what muscles are tight, which are weak, and which may be actually injured.  Then a plan of strength and stretching can be created to help ease the pain.

Doctors Note:  If you suffer from pain in the front of your shoulder it may be an easy fix.  More often than not the problem is in the rotator cuff.  Try lying on a tennis ball directly on the muscles of your rotator cuff for 5 minutes each day to see if this decreases the pain.  If it doesn't then have someone evaluate the shoulder.   And avoid the urge to just lift weights through the pain... you'll probably just end up tearing something... which can put you out for months.

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Hip Pain While Running in Boston

As the summer flies by here in Boston we're seeing more and more people come into our Copley Square Chiropractic office with a common running injury which can only be described as hip pain.  The hip is a hard area to define for most of us because it combines many different parts of our anatomy.  Most of us think of the outside part of our hip or butt area when we think of the hip, but others think of the internal structure, where our leg connects with our pelvis.  It all depends upon who you talk to.  The main point of this post is how to deal with pain felt more externally, on the outside of the hip area, or the "jamming" internal feeling that is primarily caused by a tight and tender Tensor Fasciae Latae muscle.

Picture Source: http://www.bcnlp.ac.th/Anatomy/page/apichat/muscular/page/Tensor-fascia-latae.html

Your TFL runs essentially from the top of your hip bone (iliac crest) to the outside of your femur.  It's not very long, only a few inches in most people, but is essential for proper walking and running.  Along with your gluteus medius muscle it helps to stabilize the leg and hip area during one legged movements, such as the push off phase of running, or standing on one leg.  It's an area that tightens with sitting, but to this point we don't have a great stretch to ease the tightness.  Eventually the TFL "turns into" your iliotibial tract (or IT Band) which connects to the outside of the knee, as seen in the picture above, and may cause knee pain.

Common symptoms of TFL issues are low back pain, outer hip pain, pain going from sitting to standing, outer knee pain, a "jamming" feeling inside the hip joint, and pain during or after running.  Tightness in the TFL often leaves the athlete feeling as if the hips are "twisted" or that they need someone just to pull their leg away from their hip.  It's an annoying problem that can last for months and in some cases years.

Luckily for runners of all ages there is a way to treat this problem.  The first step is to work on the TFL muscle yourself.  This can only be done with self trigger point work, which means you get some sort of a ball (tennis ball, golf ball, softball) and lie directly on your TFL.  It will look as if you're on your side, with the ball jamming into your TFL.  It's always recommended that you find exactly where the TFL is located before performing this movement, because if you end up lying on your hip bone or femur you're going to be in more pain than when you started.  Once you find the TFL you can lie on the ball for 2-5 minutes.  This should decrease some of the pain, and after a week should take the pain away completely.

If you're an avid runner or athlete who has tried this approach and aren't getting the results you're looking for it probably means you need some outside help.  Here in the office we see many people, and not necessarily runners, who just can't seem to get relief on their own, so they need our  help.  What we do is deep muscle work on the TFL itself and also we can adjust the femur so that it's not so tight in the hip joint.  This takes away the "jamming" feeling and enables the TFL to relax.

Doctors Note:  Hip or outer glut pain is often caused by a tight TFL.  TFL tightness is caused by sitting or squatting too much.  Stretching hardly ever helps... and this is NOT something that just goes away on its own.  Try self trigger point therapy for a few days to see if you get relief.  If not, call either your chiropractor, physical therapist, or massage therapist (whoever knows how to do deep tissue work) to have them work the muscles on a deeper level.

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Numb Hands and Tingling Fingers

Many people have experienced the symptoms of numbness in the hands and fingers. The typical symptoms are described as pins and needles and most people describe it as if their fingers or hands have gone to sleep. This usually occurs during sleeping, after sitting for prolonged periods, or when someone holds their hand above their head during activities such as changing a light bulb. Most people will self diagnose themselves with either carpal tunnel syndrome or with something much more dire. But for most people, neither assumption is true.

If you look at the anatomy of our hands you will notice that all the nerves and blood vessels come from further up. They don't start at your hand and end at your hand. They actually start at your neck and end up in the tips of your fingers. They must travel through your shoulder, below your pectoral muscles, through your elbow, underneath your forearm muscles, through the 8 bones in your wrist and then into each one of your fingers. That's a long way to travel. It also presents numerous opportunities for an obstruction to occur.

Think of the nerves and blood supply in your arms as if it were a river. And think of your neck as being the reservoir. Now, normally the river runs from the reservoir out to the surrounding areas(your fingers). However, sometimes a tree falls across the river and prevents most of the water from running down the river. So the areas at the end of the river(your fingers) don't get much water(nerve and blood supply). At this point most people notice that they have numb or tingly fingers and decide that they have a hand or wrist problem. But most of the time the problem lies with the tree that fell over the river, not with the areas downstream.

There are numerous places that the nerves and blood supply that go to your fingers can become restricted. These places are your neck, shoulder, pectoral muscles, elbow, forearm, 8 bones of the wrist, or the muscles of your hand. Therefore, be careful in assuming that your problem is in your hand just because you feel symptoms in your hand. To get the best diagnosis for your tingly hands you must find someone who will inspect all the areas between your neck and fingers.

One of the most common places for a restriction is in your neck and pectoral muscles. This is because most people sit at a desk for a living. This causes us to roll our shoulders forward and stick our heads out, usually to see a computer. When our shoulders roll forward our pectoral muscles shorten and eventually become extremely tight. This then presses on the nerves and blood supply that run directly underneath your pectoral muscles. If these muscles get tight enough we start to feel numb or tingly hands. Stretching of the pectoral muscles can usually prevent this problem. 

Even though one of the most common sites for a restriction is your pectoral muscles there are many other places where you may have issues. I would urge your to have a qualified practitioner look at your entire arm for restrictions. Since your wrist has 8 different bones you should have a chiropractor make sure that each one is moving properly. If there is a bone that isn't moving correctly it can put pressure on a nerve and give you carpal tunnel syndrome. They will also make sure that the muscles and bones of your arm are moving properly and allowing the nerves and blood vessels to flow freely.

Doctors Note:  Numb hands can mean many things, but the simplest reason is usually the right one.  Most the time it's just muscles of the chest pinching something off.  Try this first:  Find a doorway, pin both your arms on either side of the doorway and take a small step through the doorway so you feel a stretch in you chest muscles.  Then hold this stretch for 3 minutes.  Repeat this twice daily for 2 weeks.  If this doesn't improve your symptoms then go have someone take a closer look.

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What's TMJ? And what you can do about it.

People come into the office on a daily basis and say "I'm here to see the chiropractor because I have TMJ" so this post is for those of you who have experienced the jaw pain, neck pain, headaches, or inability to chew that is associate with "TMJ."

The first thing to look at is the acronym "TMJ"... what does it stand for? The medical name is Temperomandibular Joint. If we break this down further into its separate parts we have three separate terms. The first word is Tempero, which truly means Temporal. The temporal bone is part of your skull. The second word is Mandibular, which means mandible...which means Jaw. The third word is Joint which simply means the area where bones come together. So if we look at them all together we get the Joint where your Jaw meets your Skull.

When someone walks into the office and says "I have TMJ" its the same thing as saying "I have elbow" which is kind of funny when you think about it.  But what these people actually mean is that they have TMJ pain, and it can be quite debilitating. The symptoms range from pain during eating or chewing, to massive headaches, to neck or ear pain.

Many people start to develop TMJ pain randomly, without any injury or trauma. Others develop this pain after dental work, such as surgery, which forces their jaw to be open for a prolonged period of time. There's numerous other reasons people will develop TMJ pain such as problems in the neck, imbalances in the muscles of the face, and chewing gum. But regardless of what the cause may be there is always a solution.

Causes of TMJ Pain:
The true causes of pain in the jaw are muscle or joint related. It's very rare to get TMJ pain because of your teeth, or because of how you bite down. Many people will experience TMJ pain after dental work and will logically head back to their oral surgeon for help, who then fits them for a mouth guard. Unfortunately the TMJ pain isn't caused by a lack of a mouth guard, you didn't have the pain before the work was done so something must have happened to the actual jaw. So these people may get a little relief by using a mouth guard as a crutch but it's usually not permanent or dramatic.

When you are forced to hold your jaw open for a prolonged period of time the muscles in your jaw get very tired, and they will normally get very tight or go into a small spasm. This is because they aren't used to being worked in such a manor. When these muscles become overly tight it becomes painful to open or close the mouth, chew food, yawn, or talk. Jaw and facial muscles need to be evaluated by someone who specializes in muscles and joints to see where there may be tight and spastic muscles.

Other causes of TMJ pain are related to tight muscles in your neck or joint tightness in your neck and jaw. Some people who slump at their desk all day or who have forward head posture will develop jaw pain. As we sit for long periods of time the muscles in the back of our necks gets fatigued and the muscles in the front of our neck become short and tight. Specifically the Sternocleidomastoid(SCM) muscles in the front of the neck can be problematic. Sometimes people will get jaw pain because the back of their necks get fatigued and the neck itself become very stiff and rigid. This doesn't allow for normal motion in the neck and this can irritate the nerves coming from the neck and going to the jaw. Chiropractic care can help these issues. Also, people who have been in car accidents and experienced whiplash will be more prone to TMJ problems due to the stress on the neck. This presentation is almost always a case for your chiropractor because they deal with car accidents and whiplash on a daily basis.

Some strategies to try:

1. Sleep on your back with a cervical pillow. A cervical pillow is one with a dip in the center. It enables your neck to get back into alignment while sleeping and may take pressure off the neck and jaw.

2. Test your SCM muscles by squeezing them. Some parts of these muscles may refer pain into the jaw or ear during squeezing. Apply pressure for 2 minutes to relieve these trigger points.

3. Visit your chiropractor to have them check your SCM muscles, your posture, and the back of your neck for areas that may be too tight and may be causing irritation.

4. Don't chew gum.

Doctors Note:  Remember, the next time you go into your doctors office and say "I have TMJ" it's just like saying "I have elbow."  :)

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Why Does My Head Hurt?

"Why does my head hurt again? I didn’t do anything, I didn’t drink too much, I didn’t hurt myself, but my head is still killing me… why?"

This is an extremely common complaint that I hear in my office. People dealing with constant headaches and not understanding why they won’t go away. Fortunately, there is always a cause of headaches and it’s not because “it’s just how I am” as many people think. There are skeletal, muscular, hormonal, nutritional and neurological causes to headaches and once we find out where the headache is coming from we can take steps to fix them.

The most common type of headache is the tension headache which is caused by muscle tightness, skeletal joint tightness or nerve irritation. These headaches are normally seen in people who are stressed out, have a demanding job or personal life, and in people who sit in an office all day. They are caused by the body being under constant stress. If the body is always under stress, physical or emotional, it usually responds by causing muscle spasms or tight spinal joints in the neck. Luckily for people who suffer from tension headaches we can quickly find the cause and fix the problem. Here’s a quick test for you to perform to find out if you suffer from tension headaches:

With your thumbs, find the base of your skull. You should feel 2 bumps on either side, now push on those bumps and then move an inch lower and push on those spots as well. If either spots are tender or give you a headache you probably suffer from tension headaches. Another way to test is by pushing on your shoulder areas, if they are very tight, painful, or cause you to get a headache then you may be suffering from tension headaches.

Another very prominent type of headache is a migraine headache. These are normally caused by lack of oxygen getting to the brain. Here’s how it works: When your brain doesn’t get enough oxygen the blood vessels expand to allow more blood flow into the brain and thus more oxygen. This is how your body reacts to a decrease in oxygen, it tries to open things up and get more oxygen to the area, it’s a normal and highly effective process. However, wrapped around those expanding blood vessels are nerves which don’t appreciate being pushed on and they react with pain. This is how you get a migraine, the blood vessels are doing their job and expanding but they’re expanding into nerves that give you a migraine. So what’s a person to do? Well the easy answer is to get more oxygen throughout the day… but how?

In the office we deal with migraines by enhancing the amount of oxygen each person takes in. This is normally done by adjustments to the thoracic spine and rib cage. These adjustments allow the lungs to expand more than they normally would, thus increasing the amount of oxygen in the system. After a few adjustment the body can start to take in more oxygen with each breath and the frequency of migraines will decrease.

Other causes of headaches and migraines are hormonal or nutritional. Both can be dealt with in a similar fashion. For some people it’s just finding out what food triggers the migraine. For hormonal migraines, such as those felt during certain times in a woman’s menstrual cycle a more advanced treatment is usually needed. These women normally need to balance out the hormones in their bodies (many menstrual migraine sufferers also suffer from fibrocystic breast disease, fibroids, endometriosis or acne, all signs of a hormonal imbalance). Luckily there is emerging evidence that diet can help to balance hormones. When we put these people on a diet filled with micronutrients, vitamins, and minerals they experience amazing results.

Doctors Note: You don’t have to live with headaches. Drugs don’t cure your headaches, they just make them manageable. But they can be fixed when we find out where they’re coming from. Everyone should be able to live pain free and if you suffer from chronic headaches there is hope.

HBO Special Says Nutrition Is Key To Obesity

If you tuned into the HBO special last night, The Weight Of A Nation: Confronting America's Obesity Epidemic, you probably noticed 2 major themes. The first, and most crucial, is that obesity is killing more people and ruining America's Healthcare system faster than any other health issue... and it's not even close. The money it takes to take care of obesity related diseases such as diabetes and heart disease is disturbing to say the least. No other health related issue has the ability to drain our healthcare system to the extent that obesity does. And as the special clearly laid out, if we don't do anything to curb the appetites of America's youth our healthcare system will be all but useless in the near future. But this is information we've all known for the past ten or so years... it's not pretty but most health experts have known for quite some time that obesity is more harmful to america than any other health issue.

The second major theme that came out of the special was the fact that most health authorities haven't known what to do about the obesity epidemic.  And as the show stated repeatedly, exercise is not the answer. Let's repeat that one. Exercise is NOT the answer to the obesity question.  As a former personal trainer it took me years to understand this so I can only imagine how difficult it will be for most Americans.  And do we all know what is the answer? Wait for it... wait for it... it's nutrition! The answer to obesity is proper nutrition! Shocking I know!

Another interesting part of the special was when they explained about the amount of calories burned during exercise, and how we have an inflated notion of how many we're actually burning.  For example, they said that running 1 mile burns about 100 calories. It's something I knew back when I was a personal trainer but hadn't given much thought to for quite some time. Let's see what else contains 100 calories. 1 light beer, 1 soda, 1/2 bag of M&M's, 1/2 a bagel, 1 very large banana, 1 small handful of peanuts, and many many more. 100 calories is almost nothing! So the point here is that exercising 45 minutes a day may only burn 300 calories, but a change in your diet may make a difference of up to 1,000 calories! So the quickest, and most effective, way of losing weight is with your fork... not your running shoes.

Think about it this way. If you never worked out but you ate properly what would happen to your weight? You'd stay nice and skinny right? I mean how couldn't you? Now what would happen if you ate like crap but worked out a lot? Which is what most people do. Well you'd be skinny, for a while at least. And this is why you see people start to pack on the pounds as they age. The body isn't able to process all those extra calories, plus the fact that people get more sedentary as they age, and the weight just piles up. The easiest, healthiest, and most efficient way to lose weight and stay thin is by eating real food.

That's the last point the documentary made, which has been echoed in just about any nutrition best seller you can think of within the past 10 years. Eat Real Food. If you can't find it growing out in a field then don't eat it. That means no bagels, pasta, bread, crackers, soda, candy, etc, etc, etc. It seems strange to have to tell our nation to eat "real food" but that's how crazy our view of food has become. People look at macaroni and cheese as if it were real food. But if we all just followed that one rule, to eat real food, nobody would be overweight. It's not about your metabolism or your grandmother or the pull of the moon... it's all about eating real food.

Doctors Note: The point here is this; we all have to stop relying on exercise for weight loss. We've got to start eating real food again.  Try eating only real food for one month and you'll be amazed at how much weight you lose and how much better you actually feel... and you may just help solve our health care crisis... so don't just do it for yourself... do it for America! :)