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A Common Source of Knee Pain: The Coronary Ligaments

2011-04-14T12:12:00.007-05:00

Much pain in the knee comes from chronic injury to one or more of its many ligaments. Fortuantely many knee ligaments are close to the surface, and therefore are very treatable by manual medicine methods without surgery or medications.

The knee is an astonishing joint: It is able to support the entire weight of the body, even while it is flexed, can hinge innumerable times without friction or pain, and also can control the positioning of the leg and foot. Of course it is the entire system of bone, cartilage, ligament and muscle that performs these miracles. But I'm going to argue that it is the ligaments of the knee that makes the whole thing hang together.

There are the major ligaments, like the Cruciates and the Collaterals which literally keep the thigh attached to the lower leg. If you tear these in half, you have a big problem.

Then there are other ligaments whose function is more mysterious. Many of these surround the knee and resist various stresses, especially torsion. They also create a capsule that keeps the workings of the knee bathed in joint fluid. Because they surround the knee, they are not very deep and as I mentioned before, they are easy to treat by manual medicine methods.

Finally, there are some ligaments which are a bit odd. I'm thinking of the Menisco-Tibial ligaments, which as their name implies, arise from a meniscus (the main cartilage of the knee, and which disappears in advanced arthritis) and then attach to the tibia, the main bone of the lower leg. These are also known as the Coronary ligaments because they wrap circumferentially a bit of the way around the knee, like a crown goes around a head.

Technically these are not ligaments, because ligaments run from one bone to another, not from cartilage adhering to a bone, to another place on the same bone. Orthopedists call them capsular ligaments because they are part of the joint fluid retaining capsule. After that, the agreement ends. It is assumed that these ligaments stabilize the meniscus and help it resist wear and tear. (See other articles in this Blog for the importance of preventing cartilage damage.)

I have found that the Coronary Ligaments are a common source of knee pain. Since these ligaments are oriented circumferentially, I believe they are very important in resisting rotation. The knee really does not like rotation. When you're moving in one direction, and plant your foot and change direction suddenly (as when playing basketball or racquetball,) you are putting rotational force through your knee, and sometimes this damages the Coronary Ligament, causing lasting pain, even years later.

I treat the coronary ligaments with Graston Technique, an instrument-assisted soft-tissue manipulation method which stimulates the body's own healing mechanism in well-understood ways. Usually three or four treatments make a huge difference in knee pain caused by these ligaments.

If you have a question about the coronary ligaments and knee pain, or whether Graston Technique might help you, please call me.

Can alcohol help the brain remember? Repeated ethanol exposure enhances synaptic plasticity in key brain area, study finds

2011-04-13T15:39:00.001-05:00

Can alcohol help the brain remember? Repeated ethanol exposure enhances synaptic plasticity in key brain area, study finds (Study linked from Science Daily)

Got a craving for fast food? Skip the coffee, study says

2011-04-08T17:39:00.001-05:00

Got a craving for fast food? Skip the coffee, study says (Study linked from Futurepundit)

Rotator Cuff: Tears and Treatment

2011-04-06T11:35:00.008-05:00

I have seen many patients who suffered for years with shoulder pain from rotator cuff injuries. Some went through shoulder rehab or PT with little improvement. Now they think their only option is surgery. But for many of these patients that's just not true. The good news is that the rotator cuff muscles can heal just like any other muscles: they're close to the surface and easily accessible to treatment by manual medicine methods. Even if the rotator cuff has been sore for over a year, the non-invasive treatments offered at The Motion Doctor can help them heal quickly.

First, a little explanation to help you understand this cause of shoulder pain.

The rotator cuff is a group of muscles that live on the shoulder blade. Of these muscles, several have tendons that run under the armpit and attach to a bump on the side of the arm closest to the body. Other tendons run around the outside of the shoulder and attach to a bump on the side of the arm that's away from the body. When the body-side muscles are contracted, the front of the arm is rotated towards the body, and when the away-side muscles are contracted the front of the arm is rotated away from the body. Because of their function, these muscles are referred to as "rotators." Because the attachment bumps are almost at the top of the arm, and the tendons wrap to each side, the resulting mass of tendons looks like a cuff (at least to anatomists who apparently don't get out much.)

The bone that the rotator cuff acts on is the humerus. People usually feel the most rotator cuff pain when making larger movements that take the upper arm away from its normal position by the side of the body and at the same time reach for something beside or behind them. However, since the lower arm is attached to the upper, the forearm and hand are also positioned by this group of muscles, so people sometimes feel rotator cuff pain when making smaller movements.

Reaching overhead also commonly causes pain. This is because the supraspinatus muscle, despite being called a rotator, actually initiates raising the arm. Pain is also due to (i) reaching overhead generally involves rotation of the arm, and (ii) quirky design of the supraspinatus, which is also the most commonly injured rotator cuff muscle. This muscle originates on the top half of the back of the shoulder blade (above the "spine" of the scapula, hence "supraspinatus,") and runs over the top of the shoulder to its attachment on the "away" side of the arm. It's protected by a bony arch that you will feel if you lay your hand on the top of your shoulder.

The down side of this protective arch is that it becomes a pinch point if there's any inflammation in the tendon. To make matters worse, limited space under the arch means reduced blood supply to this portion of the tendon, increasing the chance of an "-osis" degenerative tendon condition (see explanation elsewhere in my blog,) while at the same time impeding healing. Blood trying to make its way through this pinch point is the cause of the throbbing shoulder pain many people feel, especially at night.

As with all muscles, rotator cuff muscles generally actively heal themselves. This is true to a greater or lesser degree depending on the severity of the injury, the general health and conditioning of the muscles, and the amount of reinjury during healing. As with all muscles, excessive scar tissue can accompany healing, and this is often the cause of chronic pain and decrease in function, which themselves perpetuate pain and dysfunction, in the injured muscle as well as elsewhere.

The vast majority of rotator cuff injuries are easily treatable by deep-tissue therapies that promote healing, such as Graston Technique and NMR. My best successes generally come through NMR protocols which treat every muscle in the involved area, from origin to insertion, while the patient is directed to perform the action of each muscle, from contraction to relaxation. Using these methods, I have often resolved patients' longstanding pain of several years in just a handful of visits. If you have a question about the rotator cuff and shoulder pain, or whether Graston Technique or NMR might help you, please call me.

Fountain of Youth in Your Muscles? Researchers Uncover Muscle-Stem Cell Mechanism in Aging

2010-12-08T18:01:00.002-06:00

This one is so good that I'm just going to post the link to Science Daily:
http://www.sciencedaily.com/releases/2010/12/101201105336.htm

Oh yes, and this too:
“Performance losses in middle age are mainly due to a sedentary lifestyle, rather than biological aging. "
http://www.itwire.com/science-news/health/43721-will-you-age-slower-if-you-exercise-eat-well?start=1

Neck Pain May Begin In Your Upper Back

2010-12-03T18:09:00.003-06:00

In the past months several people have consulted me about aching pain in their shoulders and upper traps. As I looked at their postures, I found that all of them bent their necks forward, and some of them jutted their chins. When a person's head is forward, obviously the muscles in the back of the neck have to work harder to keep their head up; ergo, pain in the back of the neck and upper traps.

The first order of business is to give people some relief with Graston Technique or some other deep-tissue therapy and traditional chiropractic therapy if appropriate. After a treatment or two, most people are feeling much better. The next step is to figure out a way to balance the muscles (strengthen some and stretch others.) For many years, I would develop a rehab plan focussing on the muscles in the neck. This generally works very well.

However, what I am so grateful to these particular patients for, is that they showed me a key to this therapy. Each of them had a particular stiffness in their spines: The 4th thoracic vertebra (counting down from the big vertebra you feel at the bottom of your neck, i.e. "T4") was unusually flexed forward on the next one down, and its ability to straighten out was restricted for one reason or another.

Think about this situation for a second. If your back is bent forward and you can't straighten it out, your eyes will be looking at the floor unless you extend your neck and maybe jut your chin. The kink in one part of the chain means that its motion must be made up somewhere else. These particular people solved the problem by shifting their heads a bit forward, but unfortunately this solution caused their neck muscles to work overtime and eventually start to ache.

The real solution for them was to concentrate the first portion of rehab on their backs, not their necks. The vast majority of people do not have changes in their bones that prevent them from straightening up. Usually it's a simple matter to get things moving properly again.

Now comes the strengthening/stretching stuff. Everyone's mom told them to sit up straight, and mom was right about the importance of posture. The problem is that you can sit up straight as long as you're thinking about it, but as soon as your attention wanders, you'll slump into whatever position your muscles pull you to. The trick is to tighten or stretch the various muscles so that your posture is properly maintained without even thinking about it. I rely heavily on Egoscue's method because his exercises are very understandable (and people seem to like doing them.)

Moral of story: The place that hurts might not be the place that's causing the hurt, and the thing that's causing the pain might not be painful.

Drivers Should (And Can!) Reduce Their Back Pain Risk

2009-11-30T13:47:00.006-06:00

Do you drive a truck? Do you have low back pain? If so, you’re not alone. There’s definitely a relationship between driving and back pain, although the science is still developing about how much. One likely cause under investigation is known as “Whole Body Vibration.” (I’ll call it “WBV”) Two new studies (1 and 2 below) find that there is an exposure-response relationship for WBV and back pain in professional drivers. This means that the more whole body vibration you receive, the more likely you are to get back pain. But, short of quitting your job, how can you cut your exposure to WBV?

According to other new studies (3 and 4 below) you can significantly reduce your exposure to WBV by using a moveable back support and by changing your seating position. Here’s how:

Soften the load on your “butt-bones” by buying a squishy pad, like memory foam;
buy a low-back (lumbar) support that is not squishy but also is not rigid. This should be big enough so that it keeps about the same arch in your low back that you have when you’re standing up (the arch otherwise flattens as you sit); and
adjust the angle of your seat-back so that your thighs and low back make about a 110° angle (about 20° laid back from sitting straight up.)

Also, the ligaments that hold your spine together stretch while you’re sitting. So after getting out of your truck, try to be standing for at least 10 minutes before you start bending, twisting or lifting activities.

1. Low back pain in drivers exposed to whole body vibration: analysis of a dose-response pattern. Tiemessen IJ, Hulshof CT, Frings-Dresen MH., Occup Environ Med. 2008 Oct;65(10):667-75. Epub 2008 Jan 23. 2. Metrics of whole-body vibration and exposure-response relationship for low back pain in professional drivers: a prospective cohort study. Bovenzi M., Int Arch Occup Environ Health. 2009 Jul;82(7):893-917. Epub 2008 Oct 25. 3. Car driving with and without a movable back support: Effect on transmission of vibration through the trunk and on its consequences for muscle activation and spinal shrinkage. Kingma I, van Dieën JH., Ergonomics. 2009 Jul;52(7):830-9. 4. Biomechanical effects of sitting with adjustable ischial and lumbar support on occupational low back pain: evaluation of sitting load and back muscle activity.Makhsous M, Lin F, Bankard J, Hendrix RW, Hepler M, Press J. BMC Musculoskelet Disord. 2009 Feb 5;10:17.

Graston Technique

2009-11-20T17:29:00.002-06:00

Graston Technique is a deep-tissue therapy that is extremely effective in healing chronic soft-tissue injury. It is especially helpful for many of the "-itis" conditions, such as tendonitis, fasciitis and bursitis. Often, painful conditions that have persisted for months or years improve noticeably in one or two treatments and completely resolve in as few as six.

Most deep-tissue therapies are performed by the clinician, using only his or her knowledge of anatomy and their hands for pressure. Graston is distinguished from these others by the use of small, rigid steel instruments that allow the deep pressure to be more precisely directed to the body structure that needs therapy, sparing other areas from bruising. The rigid instruments also amplify changes in sensation as they move from normal to damaged tissue, further allowing the clinician to precisely locate the problem area. The change in sensation is also very noticeable to the patient.

There are several reasons that the deep-tissue therapies are so effective. I am convinced that the most important is that these therapies break a few capillaries, which liberates the blood-borne growth factors involved in healing, thereby initiating the so-called "healing cascade." Among these are epidermal growth factor, transforming growth factor, vascular endothelial growth factor, platelet derived growth factor, fibroblast growth factors 1 and 2, transforming growth factor and keratinocyte growth factor.

Although I indicated that many of the conditions for which these therapies are appropriate are "-itises," in fact, many of them are degenerative conditions rather than inflammatory conditions, (just the opposite,) and properly should be called "-osis" conditions. Inflammation is inseparable from healing, and many times these conditions really need a bit more inflammation to jump-start the healing process. Graston and the other deep-tissue therapies provide the needed boost. The more knowledgeable the clinician, the more the inflammation-boost will be directed to the proper spot, promoting healing where needed, while avoiding damage to healthy tissue.

The deep-tissue therapies are not appropriate for nerve pain (sciatica,) open wounds, new injuries already in the inflammatory stage of healing, or systemic diseases such as cancer, connective tissue disease and others. Some, but not all people have bruising that might linger for as much as a week or so. Because the pressure has to go deep, through the superficial tissue, this might be sore from Graston therapy. But the underlying muscle, tendon, ligament, bursa or fascia that was the reason the patient came for therapy in the first place, often feels dramatically better, even after the first treatment.

Yoga, Pilates and PT Compared for Chronic Low Back Pain

2009-11-19T11:43:00.004-06:00

Chronic low back pain is a confounding problem. Every time we think we've got it figured out, something comes along that trips us up again. Three recent studies indicate that scientific exercise programs like physical therapy ("PT") are not all that good at controlling chronic low back pain, and that Yoga and Pilates might be better.

The new issue of Physical Therapy, (Nov.2009) found that twelve sessions of physical therapy, including core-strengthening exercise, produced benefits in people's perception of their recovery and their activity, but did not reduce pain. At least these benefits seemed to last at least a year.

On the other hand, an older study in Annals of Internal Medicine (2005) found that Yoga was more effective against low back pain than either PT or a self-help book. The superiority started at twelve weeks, PT caught up over the next twelve, but after that, Yoga pulled out in front again. And Pilates turns out to be even better than Yoga. The Journal of Orthopedics and Sports Physical Medicine, (2006) found that a four-week program of Pilates (on their specialized training equipment) significantly helped people with chronic low back pain. Better yet, the improvement was maintained over a twelve-month follow-up period.

So what does all this tell us? First of all, do things that are known to prevent low back pain in the first place. An important thing to remember is that the ligaments that hold your spine together actually stretch while you're sitting, and they take 10-20 minutes of activity to regain their former tautness. During this period, your spine is less stable and more prone to injury. Therefore, if you sit a lot, or especially if you drive a lot, do NOT just stand up and start deep stretches! Instead, start off with walk-around breaks before you stretch.

Keep yourself in shape with regular strenuous exercise (if it's safe for you,) while avoiding jarring or one-sided motions. I don't think you'll be surprised if I suggest Yoga or Pilates.

If you already have low back pain, there are many necessary and important therapies that Chiropractors or PT's can offer. There are many causes of low back pain that are well-understood, and respond remarkably well to manual medicine. But in addition, a Yoga or Pilates program is likely to be a real benefit to you.

Everyone Seems Surprised at New Finding About Obesity

2009-11-11T12:02:00.005-06:00

A new study from Johns Hopkins is being trumpeted everywhere today: Today's teens are much more likely to be overweight or obese than earlier generations. Everyone thought this was because kids sit all day playing video games and chatting on MySpace. But it turns out that kids today are just about as active as their elders were. So what explains the weight increase? The researchers in this study seemed a bit confused themselves. Might it be the teens' diet?

Several posts on this blog talk about the fact that our bodies are biochemical factories, and that they will make products according to the materials they are given. The materials we are advised to eat (12 servings of grains per day/increased intake of "heart-healthy" polyunsaturated fat) push our bodies to inflammation and energy storage. The materials we are advised to avoid (saturated fats) are much more stable, and therefore less likely to cause oxidative stress than the (supposedly more benign) fats and carbs that we generally replace them with.

Have you ever tried to lose weight by increasing activity, but without also modifying your diet? If you have, you know it does not work. Yes, you'll lose fat, gain muscle and feel a lot better, but unless you work like a draft mule ten hours a day, you will not lose much weight. Once you alter your diet, change will come pretty quickly. Everyone professionally involved in fitness will tell you that's how it works.

If there's one thing people know today with absolute, complete and unending certainty, it's that animal fat will clog your arteries and kill you. They therefore go to great lengths to replace sat-fats with poly-unsat-fats and carbs. The problem is that what they "know" is just plain wrong. Your liver makes most of the cholesterol in your body, and the fat you eat has little to do with your serum cholesterol. And serum cholesterol does not clog your arteries. The cholesterol in atherosclerotic plaques was originally contained in immune cells, that congregated between layers of your arteries because they were attracted by inflammation occurring there! Lots of that inflammation is caused by the "heart-healthy" carbs and polyunsaturated oils you loaded up on to protect your heart.

This is not new stuff. I've linked several times to Dr. David Seaman's writings on this subject. (He's got a new good website: deflame.com.) On a culture-wide basis, who hasn't heard of the "Zone Diet" championed by Dr. Barry Sears? His numerous books meticulously explain the hormonal disaster spawned by a high-carb diet, and his newest one spells out why you need to balance (not curtail) your intake of various fats.

None of this is to say that more physical activity isn't important. Activity and motion are indispensable to good health. I'm not going to bore you with all the diet and exercise nagging you've heard forever. But I will say this: Exercise and diet are different aspects of health. You shouldn't concentrate on one, thinking that you can then ignore the other.

Pilates Found to Help Prevent/Reduce Neck Pain

2009-11-10T14:42:00.010-06:00

Proper posture is crucial in preventing joint and muscle pain. If your body is unbalanced, muscles are going to constantly have to work against gravity and never get a chance to rest. Also, joints that have to adapt to poor posture end up working in arcs that they were not designed to work in. The pain resulting from these two things is called "Mechanical Pain," and it accounts for about 90% of the pain people feel.

Many popular workout regimens do not pay much attention to posture. Pilates is quite different. A good amount of attention is directed to the alignment of joints and the precise action of each exercise. A new study from McGill University in the October, 2009 issue of Clinical Biomechanics finds that this is good, and that Pilates training does help reduce and ward off neck and shoulder pain. It does this by increasing body core strength, as well as the strength of postural muscles.

The study also measured the amount of muscle activity in the neck and upper traps. If you're sitting, and there's still lots of activity in your upper traps, it is a good indication that your posture is less than perfect, and that your poor muscles are likely to be in pain from constant overuse. The researchers found that a Pilates program did reduce this activity, indicating that posture was improved and pain was decreased.

Just about any reasonable exercise program is going to give benefit to the average person. But if you're troubled with constant neck and shoulder aches, Pilates would be a good program for you to consider. I'd recommend including massage to make sure the muscles can move freely. But beware of exercises that cause pain in the neck and shoulders, as these might aggravate a lurking rotator cuff injury.

Mortimer Adler, ED Hirsch, Juan Enriquez and What kids Should Learn

2009-11-08T21:32:00.006-06:00

Northwestern University has a wonderful lecture series called Science and Society. Last Thursday the lecturer was Juan Enriquez, a genomics entrepreneur, author, diplomat and philosopher. The premise of his talk was that all wealth derives from code, whether that code is a cave painting, moveable type, computer software or DNA. Among the astonishing ideas he brought to life that evening was that we are on the verge of manipulating genes with the same competence that we now manipulate computer code.

To Enriquez, the production of ethanol from corn kernels is a terrible way to produce gasoline, but a wonderful proof of concept. What a waste, he said, to grow the corn just to feed it to bacteria, when the process could be abbreviated by simply rewriting the bacteria's genome to instruct it to produce the sugar it needs to produce its own ethanol. Then it could simply be fed sludge and sunlight, and forgo the whole farming process.

Enriquez had wondered where scientific hypotheses came from, so he carefully traced the thoughts of lead researchers, who they spoke to, what articles they read and heard of through others. He then made a chart of all the hundreds of sources of such an hypothesis. If you've ever seen a model of a protein, you'll have an idea of what the chart looked like. But the most remarkable part to Enriquez (and to this father of English majors,) was that scientific insight always occurs in the presence of cultural insight. That is, there is no science without the humanities.

In large part, the humanities require (or foster) a large amount of knowledge about culture, the issues we deal with in society, and the discussions, pro and con that have been made regarding those issues throughout history. Philosopher Mortimer Adler, created a framework for acquiring that kind of knowledge, and presented it in what he called the Paideia Program schools, where a particular set of readings and discussions was directed for each successive grade. (I highly recommend an article by Adler collaborator, Jacques Barzun, about how to present history to children. The Paideia Program, Adler et al., 1984.)

Which brings me to the new book by educator E.D. Hirsch, Jr. and his most recent book, The Making of Americans: Democracy and Our Schools. While the educational standard today favors a so-called "child-centered" (learn how to learn) curriculum, Hirsch argues that these methods are not the way children actually learn. He says that the best way to prepare children to pass tests, become professionals and to participate in self-governance, is to give them a "content-based" or "subject-based" curriculum, which Hirsch calls "cultural literacy."

Drawing Adler's and Hirsch's thoughts into Enriquez' argument, I wonder whether not only is there no science without the humanities, but maybe there is also no science without cultural literacy.

The Therapies I Rely on Most

2009-11-05T09:34:00.000-06:00

COLLATERAL MERIDIAN THERAPY, the most remarkable, fast-acting and effective pain-control method I have ever seen.

GRASTON TECHNIQUE and NMR (Neuro-Muscular Reeducation) are deep tissue therapies that naturally promote rapid healing of muscle and fascia, often curing Tennis Elbow or Plantar Fasciitis in 2 or 3 treatments.

EGOSCUE METHOD is a coherent system for correcting posture, and thereby relieving wear and tear on joints that are improperly used.

My chiropractic method is called DIVERSIFIED.

Being Overweight Adds To Chronic Inflammation in Your Arteries

2009-11-04T16:25:00.000-06:00

Here's something you need to know about. It is now well accepted that low-level, chronic inflammation in your body is a significant cause of chronic illness, especially diabetes and heart disease. Other diseases caused or increased by inflammation include Alzheimer's, cancer, arthritis and vascular diseases like stroke. And if that isn't enough, an article in the Journal of Clinical Endocrinological Metabolism indicates that simply being obese is enough to set off the inflammatory cascades that lead to illness.

You can't control all inflammation, but you can significantly improve your situation by taking positive action with your diet. Most of us have an infatuation with simple carbs: sweets, sodas and starchy snacks (me too!) Because these things affect our biochemistry, our indulgence in these goodies sets off a chain reaction that ends in lots of inflammatory chemicals being produced in our bodies.It is also well-known that obese people have higher rates of the diseases I mentioned above, as well as many others.

While everyone can reduce their systemic inflammation by diet and exercise, people who carry a lot of fat have an additional source of inflammation that takes more effort to deal with.

As always, just about everyone can improve their health by being more active. If you're overweight, all the more reason to begin an exercise and weight reduction program. Cut way back on bread. Enjoy your hamburgers, but eat them without the bun. Leave four fries on your plate and toss the rest. Just forget that sugary soda even exists. Grab a beef jerky or a tomato instead of a bag of chips. Try this snack invented by my friend Rosin: soak carrot slices in lime juice and salt overnight. It's really satisfying and easy to eat.

Cartilage is Hard To Heal: Protect Yours Now.

2009-10-28T16:26:00.000-05:00

Cartilage healing has been the subject of quite a bit of study, for obvious reasons. Unfortunately, the findings are not very encouraging. At this point it seems that cartilage does not heal itself very well, except, perhaps for small defects. Best advice: protect your joints before they are injured. I’ll tell you the easiest way.

Strangely, among the best treatments known today is “Continuous Passive Motion,” where a limb is strapped to a machine that constantly flexes and extends a joint, without the patient using their own muscles. Two things about this seem interesting to me: First, Not only does the constant motion NOT contribute to “wear and tear,” it actually seems to stimulate healing. Second, the machine-guided motion is done in the pattern the joint is supposed to use.

Joints are astonishingly well-designed. For instance, the ball and socket of the hip joint do NOT match when there is no weight on them. However, the stress imposed by weight-bearing changes the shape of the contact areas, so that there is a precise fit at the moment it is most necessary. Orthopedists call this “Joint Congruity.” It is well-known that injury to the joint will alter this precise fit, and it becomes very likely that degenerative arthritis will result in later years.

Injury is not the only way to alter joint congruity. Joints, of course, are the places where bones meet, and the muscles moving the bones will affect the alignment of that meeting-place. Joints and ligaments play a role, but to a large extent, bones do what the muscles tell them to do. If you have tight muscles that rotate your hips to the outside, then your hip joints will spend most of their time rotated to the outside. If your stomach muscles are too weak (or even excessively strong,) then your pelvis will be tipped backwards or forwards, and the alignment of your hip joints will be thrown off. Joint congruity suffers.

When the top joint changes its alignment, the next one down also changes. In my practice I often see people whose pelvis is tipped forward, and their femurs are rotated out (their kneecaps point to 10 and 2 o’clock.) These same patients often tell me they have knee pain as well as hip pain. The alignment of the spine has affected the alignment of the hips, which in turn, has affected the knees. Even the feet are affected as the postural changes affect gait and result in plantar fasciitis and bunions.

The good news is that alignment is very easy to change. It does take commitment, because only you can train the muscles that tell the bones what to do. You can't just "sit up straight" like your mother told you to do, because your voluntary pose will change as soon as you stop thinking about it. You have to figure out which muscles are too loose, which ones are too tight, which ones are doing the heavy lifting for movements they're not not supposed to control, and which ones have to be coaxed into doing their proper work. It's a kind of detective work, and it's best done by a chiropractor or PT who knows how to analyze posture and specializes in this type of rehab.

You can't do very much about the big injuries that break joints. But you very easily can improve joint alignment, and thereby reduce a lot of wear and tear.

And Now, A Little Medical Heresy:

2009-10-22T18:13:00.000-05:00

OK boys and girls, time to dust off those old biochemistry charts! The topic for today is that even though it is well known HOW statin drugs work to reduce cholesterol, it is unknown WHY they reduce mortality from heart disease.

I'm going to back up a bit, and tell you something shocking: Until statins came along, there was no credible evidence that reducing serum cholesterol, whether by diet or meds, had any beneficial effect on mortality. In fact, most of the literature tended to prove the very opposite, namely that reducing serum cholesterol actually increased mortality. This was especially true for studies where cholesterol was reduced by restricting dietary fat. (I'll get to this topic on another day.)

But when statin drugs came along, for the very first time, studies started to show a reliable statistical correlation between statin use and reduced mortality from all sources. Now we've all been told, ad infinitum that the reason is because of the reducing effect statins have on cholesterol. But I'm going to assert that because statins work by interfering with crucial biochemical pathways, nobody really knows what point (or points) in any of those pathways is (are) responsible for the beneficial effects observed from statin therapy.

From Wikipedia, here's how cholesterol is made:

Cholesterol is primarily synthesized from acetyl CoA through the
HMG-CoA reductase pathway in many cells/tissues. About 20-25% of total
daily production (~1 g/day) occurs in the liver, other sites of higher
synthesis rates include the intestines, adrenal glands and
reproductive organs."
"Cholesterol - Wikipedia, the free encyclopedia"

And here's the chart:

http://en.wikipedia.org/wiki/HMG-CoA_reductase

You can't just follow the chart from top to bottom, because the entire process is a regulating step for that little cycle at the upper left, namely, the synthesis of Acetyl Co-A. That affects other products of this same pathway, most notably, Co-Q10 (otherwise known as ubiquinone or "UQ.") The reduction in Co-Q10 when taking statins is the cause of those muscle aches they warn you about in the commercials. The muscle aches happen because Co-Q10 is absolutely essential to life, and without it, muscles simply begin to die.

Again from Wikipedia, here's the Electron Transport Chain, showing the utter necessity of Co-Q10 (i.e. "UQ"):

http://en.wikipedia.org/wiki/Coenzyme_Q10

The Electron Transport Chain is part of the cellular nuts and bolts of respiration. Yes, I said respiration. Over in the lower right-hand corner of the picture, you'll notice an enzyme called "ATP Synthase." As you remember from any biology course you ever took, ATP is the body's bottom line source of energy. No ATP means "Entropic Doom." (Remember that great biology expression?)

ATP Synthase is not the main source of ATP in humans. That status belongs to the Citric Acid Cycle, which I'm sure you also remember. Again, I'm going to show you a chart from Wikipedia, because I want you to see that Acetyl-CoA is a sine qua non of this process (Upper left corner):

http://en.wikipedia.org/wiki/File:Citric_acid_cycle_with_aconitate_2.svg

Remember that statins interfere with the main pathway for regulating Acetyl CoA.

Bottom line: Statins disrupt/modify various crucial biochemical pathways that are utterly basic to life. In each of these pathways there are many steps, and each of the successive steps is regulated/limited by the presence or absence of reactants in the previous steps.

So now you tell me: How does anyone know which step is the one that results in a health benefit? As you can see, there's no definite cause and effect. For various reasons many researchers desperately wanted to see the benefit arising from the reduction in serum cholesterol. But without further reliable proof, that's just wishful thinking. I don't know whether it's the lowered cholesterol that's helping (I doubt it.) And neither does anyone else.

Some Good and Interesting Links

2009-10-21T16:01:00.000-05:00

Links To Sites of excellent Physicians,
and Sites That Explain The Therapies I use:
Dr. Warren Hammer
Dr. Hammer on Graston Technique
Graston Technique
Research on Graston Technique
Neuromuscular Reeducation
The Ingber Lab
National University of Health Sciences

Some Links to Good Articles

2009-10-21T15:58:00.001-05:00

Dr. Seaman's Article on Posture

Dr. Seaman's Articles on Nutrition and Chronic Inflammation

Dr. Hammer's Article on Deep-Tissue Therapies

Dr. Hammer's Article on "Good Inflammation"

USDA Food Pyramid: Recipe for Health or Chronic Disease?

2009-10-20T14:57:00.002-05:00

Everyone knows that there's an epidemic of obesity and diabetes going on these days. And everyone knows these conditions have grave health consequences but nevertheless are largely preventable. The catch is that you must take charge of your own health in order to prevent them. That takes self-control, effort and determination. Hard enough to do, even if no one is undermining you.

Despite their fine intentions, I think it can be said that the USDA is one of the parties undermining your attempt to stay healthy. The reason: their "food pyramid," which advises that everyone eat six to eleven daily servings of bread, cereal, rice and pasta. People could be forgiven for thinking that the USDA thinks you should eat a lot of carbs.

Dr. David Seaman, D.C. is an estimable physician and health scholar. He has written a series of articles that indicate that all those carbs push your body towards very bad health in a number of ways. The thrust of his thinking is that all those carbs turn your body into a biochemical factory for the production of the chemicals that cause inflammation. And that low-level but chronic increase in inflammation is perhaps the main factor in most chronic diseases including atherosclerosis, diabetes, and even Alzheimer's.

In addition, Dr. Seaman says that all those "heart-healthy" polyunsaturated oils you now use to replace the sat-fats, also push your body's biochemical factory towards creating inflammation chemicals. Not that the oils are bad per se, but that they should be eaten in a one-to-one ratio with omega-3 oils. The typical American diet is weighted closer to 20-1 towards the omega-6's (such as corn oil.) According to Dr. Seaman, this is a recipe for chronic disease caused by chronic low-level inflammation.

His articles are very readable and fascinating. Here's a link to them; I heartily suggest that you read them all.

www.chiroweb.com/mpacms/dc/article.php?id=15409

UPDATE: Here's a New York Times Magazine article that reviews the evidence and comes up with the same conclusion. It's from 2002, a long time ago. But from the number of ads for statins, you'd never think there was any doubt about the so-called "Fat-Cholesterol Hypothesis."

ANOTHER UPDATE: Gary Taubes, the author of the above article, has written another excellent article, for the NYT, this time about sugar, but really, it's about the same thing.

Tensegrity, Biotensegrity and You

2009-10-08T17:40:00.000-05:00

Tensegrity is a type of architecture, and here is how it was described by its inventor, R. Buckminster Fuller:

The word "tensegrity" is an invention: a contraction of "tensional integrity." Tensegrity describes a structural-relationship principle in which structural shape is guaranteed by the infinitely closed, comprehensively continuous, tensional behaviors of the system and not by the discontinuous and exclusively local compressional member behaviors. Tensegrity provides the ability to yield increasingly without ultimately breaking or coming asunder.

Huh? Fuller was saying that a tensegrity structure consists of things (like bones, for example) that can resist compression, and things (like muscles, for example) that can resist tension. (I'll keep using the Bones/Muscles examples as I explain.) Even though there are many bones piled up which keep your head over your feet, there is no single bone that goes from foot to head. If you always stood perfectly straight, your pile of bones wouldn't need anything else to keep it from falling over. But once you bend anywhere, it starts to get very difficult to trace exactly how the force of gravity travels from your head to your feet. I mean that all of the muscles and ligaments that you use for balance spread the forces out in complicated ways.

For example, when you bend your forearm, some of the force that allows your arm to bend is transferred to the upper arm. But this simple action has changed the way that the upper arm pulls on the shoulder, and the shoulder on the muscles that support it, etc, etc. Figuring it all out exactly is much more complicated than you might think.
Here's what is going on: The bones are very good at withstanding compression. After all, they were designed to support the body against the compression of gravity. They also resist the compression generated by muscles. Unfortunately, unless they're all piled up straight on top of one another, they do not form a continuous structure (that is, they are "discontinuous" from each other.) Muscles, on the other hand, aren't very good at handling compression (they'd just buckle and fold.) What muscles are good at is pulling on things. That is, they're good at handling tension.

Remember that many parts of the body have to adjust whenever a single simple movement is made. This happened because the muscles act as a continuous system where on muscle pulls on one bone, which pulls on another muscle, which pulls on another bone, and so on. Without the muscles to keep everything in its proper shape, everything would tumble down like a bunch of sticks. Looked at from this perspective, it's the things that provide the compressive forces that give the body its shape.

You Use Tensegrity!
A bicycle wheel is a familiar structure that happens to be a tensegrity. The wire spokes are "tension-loaded" while the hub and rim are "compression-loaded." That is, the hub "hangs" from the spokes. This explains why the few flimsy spokes don't just crumple when you hit a bump: The spokes can't retain their shape with much force pushing on them, but can easily withstand lots of force pulling on them.

Now let's throw something else into the mix: Your high school teacher described the musculoskeletal system to you as a bunch of levers and pulleys. However, if you want to think about the musculoskeletal system as just levers and pulleys, you are going to have some 'splainin' to do. This is because there are a number of places (particularly in the spine,) where calculating the forces generated by movement just in terms of levers and pulleys and fulcrums, results in such extreme amounts of force that the muscles should just tear off the bones, and the bones should shear into pieces! But since they don't, there must be something else going on too.

Your Fascia=Your Shape.
In the case of the whole body, that something else is the "fascia," which is the support and wrapping material for the soft-tissue in the body. All of the body structures are covered with layers of fascia, and it is a very fascinating fact that these layers are continuous throughout the body. That is, the same fascia that covers muscles in the leg is directly connected to fascia that covers muscles in the neck! (In fact, not to get too graphic or anything, but there is actually a direct connection of fascia between the cranial bones and the testes! )

The point of all this is that it's not just the muscles that hold the bones together. It's the whole system of fascia. It stretches, slides and supports the body in all of its movements. It gives the body its complete shape. At least it's supposed to.

However, through bruising, tearing and scarring, parts of the fascia can become bound to other layers. These are known as "fascial adhesions," or just "adhesions." Remember how I mentioned that it is difficult to accurately measure how changes in posture cause forces to be distributed throughout the body? These adhesions cause changes in the distribution of forces, and that can change the way the body moves. And that can result, for instance, in a case of whiplash resulting in a sore knee!

Tensegrity at the Cellular Level.
O.K., that's on a macro level. Now let's look at the micro level. Donald Ingber, M.D.,Ph.D. is a professor and reseacher at the Harvard Medical School. He is very interested in tensegrity because it helps to explain the cellular research that he does. Here's how he explains why: Cellular Tensegrity Theory. Cells and tissues are organized as discrete network structures, and they use tensegrity architecture to mechanically stabilize themselves. In the cellular tensegrity theory, complex mechanical behaviors in cells and tissues emerge through establishment of a mechanical force balance between different molecular elements in the cytoskeleton and ECM that maintains the cell in a state of isometric tension.
The things Ingber studies range from the development of blood vessels to the ways in which "cells respond to signals and coordinate their behaviors to produce tissues with specialized form and function."

As you read Ingber's following explanation of why he thinks this is important, think about the following question: Why does exercise makes your muscles bigger?

We introduced the concept that living cells stabilize their internal cytoskeleton, and control their shape and mechanics, using an architectural system first described by Buckminster Fuller, known as "tensegrity". To approach questions relating to how mechanical distortion of the cell and cytoskeleton influence intracellular biochemistry and pattern formation, we have combined the use of techniques from various fields, including molecular cell biology, mechanical engineering, physics, chemistry, and computer science. This work has led to the identification of mechanical forces and the cytoskeleton as critical cell and developmental regulators, and the discovery that transmembrane integrin receptors which anchor cells to extracellular matrix also mediate mechanotransduction - the process by mechanical signals are converted into an intracellular biochemical response.

Doctors have known for a long time that the body builds itself up according to the way it is used. That's why we prescribe rehab and "pain-free range of motion" exercises for injuries. We knew that injuries heal with less scar tissue if the healing part is (gently) used in its normal range and function. We just didn't know why. Now people like Dr. Ingber are showing why: It's because you are a tensegrity.

Thoughts for Chiropractors About how We Might Start Thinking About Subluxations

2009-10-08T16:35:00.000-05:00

Lessons From The Common Law Regarding

The E.Pluribus Unum Theory of Subluxations

Laurence Kahn, J.D., D.C.

Great minds think alike. Great professions are alike too. I can't tell you about great minds, but as a Lawyer/Chiropractor, I do have a nifty vantage point for looking at two great professions. So I can vouch for the fact that all great professions get growing pains.

Our own profession has grown to a point where a certain philosophical adjustment is becoming necessary. Fortunately this is due to a veritable embarrassment of riches in the form of new discoveries by researchers in myriad fields. As scientific investigations uncover more and more information of undeniable relevance to Chiropractic, more and more theories appear as to the nature of the subluxation. From time to time these theories are compiled into surveys such as Leach's THE CHIROPRACTIC THEORIES, or Kent's JSVR article (1996) on MODELS OF VERTEBRAL SUBLUXATION. The profession has happily recognized this by re‑titling the subluxation as the "vertebral subluxation complex." The word "complex" implies that there are several things going on. It also implies that the precise nature of the subluxation is not known but that it is likely to consist of more than one thing.

But notice that there is another implication which is glossed over: That there is a thing called a subluxation, there are many possible explanations for what it is, and as soon as we find and explore every possibility, we'll let you know. From the many, there shall be one; the E Pluribus Unum theory of Chiropractic.

As a practical matter, this has resulted in a problem which is philosophical in nature and which is illustrated by the following challenge: "Doctor, could you please tell me what a subluxation is?" Sure, got a month? That is, there's just too much to tell. But it is more important than patient education because we are failing to distinguish where one theory leaves off and another begins, even when we speak to each other. This is bad because it becomes even more unclear what a speaker means when he or she refers to a subluxation.

The law had to deal with exactly the same philosophical problem in the not‑too‑distant past. You might find it interesting because it suggests that we

chiropractors are doing some jumbled thinking. (Don't feel bad, the Lawyers were just as guilty on a point which is just as important to them as ours is to us.) So with that problem in mind, please bear with me while I bring you up to speed on the "Hearsay Evidence Rule," a mainstay evidence law.

You have likely heard that "hearsay' is not admissible into evidence. Hearsay evidence is 'the evidence of those who relate, not what they know themselves, but what they have heard from others." For instance, I'll bet you've been irritated when your patients practice hearsay medicine, expecting you to give them the same therapy that their Uncle Joe says his neighbor got. Joe heard his neighbor say it. So it must be true.

Even though Uncle Joe is well-intentioned, his medical advice is probably unreliable. You might want to ask Joe whether he is licensed to practice medicine, whether his neighbor was injured in the same way, or had the same medical history or had the same signs and symptoms. Uncle Joe might not know the full story, or might even be confusing his neighbor's illness with someone else's. In other words, you'd like to cross‑examine Uncle Joe.

Cross‑examination is one of the law's great tools for determining the value of a piece of evidence. Law is an adversarial system which, within a strict framework, relies on greedy self-interest to motivate competitors to expose the defects in each other's arguments. That's why people try to get their story straight before they're cross-examined: If they're unprepared, they know their opponent will be delighted to make a fool of them. If they're lying, they know they'd better lie the best they can or they'll be found out. Therefore, if the person who made a relevant statement can be brought before the Court and subjected to crossexamination, then their statement is likely to be admissible into evidence. There are exceptions, of course, but the basic rule is, "No cross-examination, no admission." Hearsay evidence runs afoul of this because the witness in court isn't the person who made the statement. The witness can be cross‑examined but the "declarant" can't.

I mentioned that there were some exceptions. These are situations where people just don't lie, so the simple fact that a statement was made in such a situation is fair proof of it's truth. For instance, they might believe they're about to die (they don't want to die with a lie on their soul); something overwhelming may have just happened to them (they're so excited that they don't have the guile to lie); they might be in an emergency room answering their doctor's questions (they want their doctors have good information so they can make good decisions.) In a different type of exception, hearsay statement might be offered for some reason other than it's own truth: "Your Honor, I'm not offering the Defendant's statement that he robbed the bank as proof that he robbed the bank, I'm offering it to prove that he speaks English."

Notice the distinction between admission of a statement, from the weight of importance it carries. Admission just means that the court may consider the testimony. It means nothing in regard to how persuasive it is. Once a statement is admitted, it's weight is going to be looked at, very closely, on cross‑examination. Something that seemed very important at first may seem trivial on closer inspection.

These days, the Hearsay Evidence Rule is a matter of statute. It wasn't too long ago, however, that hearsay evidence was a creature of common law, (that is, created by judges as they decided actual disputes, and later applied by other judges if the logic was compelling in a later case.) Courts aimed at allowing reliable testimony, while at the same time trying to exclude prejudicial statements and just plain lies. Traditionally the exceptions were explained by this or that, often making resort to a hoary concept known as the "Legal Fiction." (You may think that redundant.) Many legal fictions were created as follows: "This is the law because I, Lord So & So, want it to be and I have thought up a reason for it." (When your name is Lord So & So this sort of argument carries weight.)

The supreme legal fiction regarding the hearsay rule was that of the "Res Gestae" ("the thing done,") It can be thought of as the events and actions which make up a legal case. Statements which were made during the actual occurrence of those events were considered to be "part of the res gestae" and would therefore be admissible into evidence. Statements which were not made during those events would not be admissible. For centuries this analysis seemed to work pretty well, and courts were able to go about their business effectively.

But there was a fly in the ointment. When you try to use one word to describe several different things, eventually someone's going to write a comic farce about it. Legal scholars wearied of some of the bizarre and obviously wrong legal fictions related to hearsay. Not the least of these was the patent unreliability of many statements which are indeed "part of the res gestae," implying that being part of the res gestae doesn't by itself impart any particular reliability to a statement. Whether or not the statements were part of the res gestae often had little to do with the real reasons that the law decided to consider such statements more reliable and therefore worthy of admission into evidence.

As things eventually turned out, many exceptions to the rule were based on different types of statements a speaker may have made, or different situations they may have been in when making the statements now being testified about. In some cases, the exceptions weren't exceptions at all; instead, the actual statements they supposedly "excepted" weren't even hearsay!

Rather than continuing to appeal to an all-inclusive, shorthand justification for admitting hearsay, it became the consensus among scholars, and eventually the Courts, that the real reasons were easy enough to understand and say, so litigants ought to speak accurately. By the time I graduated from law school, it was clear that the res gestae was an antiquated concept. It would be more likely to hear doctors diagnose the “consumption” than to hear lawyers refer to a res gestae. You will therefore have sympathy for my astonishment when (older) lawyers often analyzed whether things were or weren't part of the res gestae. (To be fair, the term survives with a much more limited meaning, now somewhat synonymous with the excited utterance exception, especially in criminal cases: "Stick 'em up!" is a common example.) But there is no more common law of Hearsay Evidence, only statutory definition. You won't find "Res Gestae" in any American Statutes. But you will find an "Excited Utterances Exception" spelled out in black and white.

"But" you ask, "if the shorthand term worked alright, why go through the trouble of changing it?" If you stop and think about it for a minute, you'll see that the explanation "Because!" is on a par with your question. If you don't care about the meaning of the term, why on Earth should you care about the meaning of the answer? ("Stop being snotty," you say, "Give me a real reason!" And I say, "Q.E.D.")

Okay, so why should we care about what is really going on, when we have some jargon that seems to cover all bases? The problem is as ancient as the Greek philosopher Xeno, who suggested that an arrow could never reach it's target: He thought that if you looked at only an instant of the arrow’s flight, the arrow, in that instant would not be moving. Therefore, he argued, the arrow never really moved. This, in a word, is kookoo.

At least since Plato, people have known that such paradoxes were just tricks with words. Socrates dismissed them as "sophistry and illusion," using the same words without parsing out their different shades of meaning. But writers endlessly make mistakes with logic and language. Unfortunately for them, logic is an immortal bully that hangs around to give people wedgies. You and I might accuse them of sloppy thinking. Philosophers call it "quantifier switch." It's the logical fallacy of confusing one thing with many things (or the other way around.) It's a fancy name for ambiguity, and in law and in science, ambiguity breeds contempt.

By now I'll bet you've guessed why I'm telling you all this: Maybe the subluxation is at the same place that the law was fifty years ago. (Considering how law has since developed, that may not be a good thing.) On the other hand, in our profession which says it cares about philosophy, wouldn't philosophical clarity be a desired and noble goal? As much current chiropractic and allopathic research is making clear, chiropractors affect many different things. Some of these will be more likely or less likely to respond to CMT.

Nevertheless, chiropractors persist in calling all the things we affect the same thing, even if they know better. The alibi might be economic (as in the case of Medicare) or legal (as in states where DC's are licensed only to correct

subluxations.) Undeniably, it is going to be hard to tell one sort of subluxation from another by motion palpation. Philosophically speaking, however, clinical difficulty in distinguishing one from the other is no excuse for claiming that there is no difference.

Selfishly speaking (as a profession,) it is hideously counterproductive to give the same name to many different things. It is a sure sign of incomplete understanding when a sign is treated as a diagnosis. At least allopathic medicine generally has the courtesy to add "idiopathic" to alert you that it isn't sure what it's dealing with. Chiropractic makes great fanfare about "treating the cause instead of the symptoms, and chiropractors feel good that so much research supports the existence of "the subluxation" and the many different phenomena that subluxation could be.

But it seems a whole lot more likely that what's been proven is the existence of many different lesions, or many different subluxations. What's been disproven is the existence of one particular lesion.

All of diagnosis is a kind of prejudice: For example, it was recently very common to lump all tendon lesions together and call them “tendonitis.” Of course this led to giving the wrong treatment for tendonosis. You have little way of knowing whether your patient has tendonosis or tendonitis, but knowing that there are the two possibilities gives you the choice to treat the most likely one first.

By the same token, clinging to the subluxation as a shorthand description for many different lesions, is likely to lead to ineffective or wrong therapies. Other than semantic preservation of a superceded word, this strategy, for the profession, has little philosophical or practical benefit.

Please understand that this is not an argument about so-called Straights and Mixers. I'm not saying that anyone is right or wrong. This is a philosophical point which in itself has nothing to do about Chiropractic. The point is this: As we come to really understand what we're talking about, we need to speak clearly so that everyone else can understand us too. I believe that Chiropractic ought to give up the E. Pluribus Unum theory of subluxations and grow to a new understanding where from the one term, we arrive at many, each referring to its own underlying cause.

Inflammation and Tissue Healing:

2009-10-08T10:52:00.001-05:00

New studies are finding more and more connections between chronic inflammation and chronic disease. For example, arteriosclerosis is now believed to be closely correlated to the presence of inflammatory chemicals in the blood. Some researchers believe that preventing heart attacks will be achieved more by controlling arterial inflammation than by controlling LDL cholesterol. Diabetes and Altheimer's disease have also been linked to chronic inflammation. The devastating effects of autoimmune diseases are caused by inflammation.

The result of these findings has been to cause a (wholly appropriate) frenzy of measures aimed at controlling inflammation. The low-carb craze is all about controlling insulin levels and the inflammation that hyperinsulinemia causes. Fish-oil supplements are aimed at providing our bodies with the biochemical building-blocks to short-circuit the production of inflammatory hormones. Medical doctors are prescribing aspirin and statin drugs that provide anti-inflammatory effects as well as cholesterol-lowering effects. I completely agree that controlling systemic inflammation is a key to controlling many degenerative diseases associated with aging.

All that being said, it is very important to recognize the purpose for which inflammation exists. Inflammation is healing. Conversely, there is no healing without inflammation. The inflammatory response to injury or infection is inextricably intertwined with the process of tissue repair. For instance, the swelling that follows an injury is not some sort of additional insult that it would be best to completely eradicate. Rather, it is the result of blood vessels becoming permeable, so that all of the healing elements which are found in blood can make their way to the injured tissue to begin the process of healing.

This fact is now used to promote post-surgical wound healing. Before the surgery, the patient¹s blood is drawn and the red blood cells are centrifuged out. The plasma that remains contains kinins, immunoglobulins, the immune complement system, the chemicals and proteins involved in the coagulation/fibrinolysis system, fibroblasts, growth factors, and lots of other stuff that is essential for repair and remodeling. After surgery, this fluid is painted on the wound, resulting in dramatically shortened healing time and increased strength of the healing tissue. This process uses the body¹s healing system to its best effect.

Unfortunately, the standard medical treatment for chronic strain and sprain injuries is completely different. Typically a doctor will treat a tendon or ligament problem with corticosteroid injections. Steroids work by reducing inflammation. But since there is no healing without inflammation, this treatment also prevents healing. The injury (which is the cause of the inflammation,) therefore, is not eliminated. As long as the body has the ability to create inflammation, and as long as there is a stimulus for inflammation, the body will continue to create inflammation. The lucky fact is that many such injuries do heal despite the treatment.

The goal of many of the therapies that I do, is to promote healing by stimulating the proliferation of fibroblasts and other healing elements from the blood and the "matrix" surrounding the cells. This is done by carefully INCREASING inflammation where the body needs it, through the use of various "Deep-Tissue" therapies such as Graston Technique and others.

Manual Medicine:

2009-10-08T10:46:00.001-05:00

Everyone's heard about "Internal Medicine," which is generally thought of as "regular medicine." Manual Medicine is quite ancient, but not very well known. You might think of manual medicine as "External Medicine, " in that manual medicine doctors do things on the outside of the body that affect the inside. Manual medicine is not intended to be a panacea for all the ills of humankind. But that doesn't mean that manual medicine should be thought of in isolation from "regular" medicine.

There's a slight difference in focus between "regular" medicine and manual medicine. Regular doctors are certainly interested in disease processes, but they tend to focus on things like blood or UA test results, tissue pathology or imaging techniques. Manual medicine, on the other hand, tends to be more focused on function, especially of the musculoskeletal system, which composes more than 60% of the body. When you visit a manual medicine physician, most testing will examine your range of motion, assymetry of related parts of your body, and abnormalities in the textures of the tissues, such as swelling or spasm.

Many manual medicine physicians look for changes in the body's structure that may have their origins in abnormalities of the body's organ systems. Other practitioners focus on pain relief. Still others are more intereested in releasing or normalizing restricted areas of the musculoskeletal system. In general, Chiropractors, myself included, fall into this last group.

When used appropriately, manual medicine has been found to be very effective in reducing musculoskeletal pain and increasing a patient's function and wellness.

Here's How I Think:

2009-10-08T10:11:00.000-05:00

I practice Chiropractic Medicine using a blend of Western and Eastern methods. My overarching goal is to improve my patients' physical well-being, helping them improve their balance, flexibility, endurance and strength.

First, the issue of pain must be addressed. To do this, I often use Two-Point Acupressure, an Oriental Medicine technique developed over the last thirty years by Dr. San-Chi Ko, M.D. Other pain-control techniques may be appropriate, so for such patients I might also use the Egoscue Method, and traditional Chiropractic Medicine.

Most people's pain arises from the way they use their body, which very often has been altered from the normal way because of an injury. Over time, the body's structure has changed itself to adapt to that use. So after pain has been relieved to a point that the patient can benefit, I begin to offer conservative methods that address the body's structure and function. These include deep-tissue methods as Graston Technique and others.

Finally, there can be no lasting improvement without a person's own commitment to their own physical health. I will help them by creating a plan for their rehab and maintenance, and I will guide them until they are comfortable with it. Guiding principles in this phase of recovery are derived from the Egoscue Method and traditional rehab.