What does it mean if I have one leg longer than the other?

A recent visit to my local seamstress got me thinking about leg length difference. She seemed (no pun intended) surprised when I objected to her measuring each leg individually, and cutting the pant lengths according to those measurements. I think there is a large misunderstanding about leg length difference. What does it really mean?

"Oh, and I have one leg longer than the other." is something I have been told many times by new patients. They are all eager to relay to me what previous chiropractors have told them, and most of this information IS helpful. Yet I sense that many of them don't really grasp what it means, because they appear surprised when I explain it.

"Unequal leg length is usually an indicator that the pelvis is tilted or twisted, and an adjustment is needed to make them equal" is my usual explanation. I have seen some chiropractors and physical therapists try to account for the leg length discrepancy by giving the patient a heel lift. This is usually a bad idea, as it is only perpetuating the misalignment.

However, there is occasionally a patient who actually has one leg longer than the other. I have seen this only twice in my 20 year career. Both times the person had a fracture of one of the long bones in the leg. One patient had fractured the femur during childhood, effectively halting the growth in that leg. The other one had shattered both the tibia and the fibula (lower leg bones) in an auto accident, and the surgeon was unsuccessful in recreating the pre-accident leg length.

There are conflicting opinions on how to measure leg length. Some involve a tape measure. Some involve a full lower body x-ray. My method is a bit more simple. If I can't get the legs to even out by spinal, pelvic, and limb adjustment, then there is a good chance they are just different lengths. But like I said, I have seen this only twice in twenty years.

Before adjustment:

After adjustment:

Misalignment of the pelvis truly is common, and is often due to:
-Sleeping on your stomach (This torques the torso considerably, because you need to do so in order to breathe.)
-Sitting with one foot tucked under your pelvis (see photo)

-Always crossing one leg over the other when sitting.
-A previous injury to a leg or foot. This will often result in the person hiking up the pelvis on the side of pain, so as to not to put weight on that limb.

So the next time you are getting fitted for pants, and the seamstress says that they want to sew one pant leg longer, because they measured one leg longer than the other, tell the seamstress to split the difference. You are going to see your chiropractor.

Foot Pain AND Low Back Pain? Try this simple stretch.

Many of my patients are surprised to find out that Chiropractic care can help those with foot and ankle pain. Common problems such as plantar fasciitis, sprained ankles, and achilles tendonitis, often improve with foot adjustments and home exercises. Sometimes orthotics or inserts can help as well. Yes many chiropractors are taught adjustments for just about any joint in your body, so if you are unsure, please ask.

Whats even more surprising for some people is how their foot pain is related to their low back pain. To be clear, I am not talking about a pinched nerve in the low back creating pain in the foot. That is possible. But even more common is when systems of muscles develop a weak link.

One common example is when muscles behind the knee become short and tight. This is not the same as a tight hamstring. There is a system of muscles that starts at the bottom of the feet, then goes to the calf muscles, then to the hamstring muscles, then to the gluteal muscles, then to the low back, then upper back, then neck. Keep in mind that muscles NEVER work in isolation. They have to work in systems. So to isolate them for therapeutic purposes is counterproductive. There is often no pain behind the knee when this happens, so you likely don't know that you have it. This tight and short area of muscles and fascia are responsible for some people's achilles tendonitis, or plantar fasciitis, or gluteal pain, or low back pain. The weak link behind the knee is making the other painful areas work harder.

But stretching this area effectively is the key.

You are probably thinking "Why am I not touching my toes?" It's because we are trying to stretch the muscles behind the knee, not the hamstrings! Yes the hamstrings are part of the problem, but so are the gastrocnemius, plantaris and popliteus muscles. Think of WHY this area is tight to begin with. It is because we sit too much. We live in a culture where it is often necessary to sit too much, and that is NOT going to change. The sitting position puts the knees in a bent position. This is why the muscles in this area shorten and become tight. The muscles at the top of the leg, where the hamstrings start, are NOT shortened in this sitting position. Once again, to be clear, you probably don't have pain behind the knee. But trying to stretch that area is often painful, and that is exactly why we DON'T like to do it.

Don't get too aggressive with the height of the foot while stretching this area. Stay with a low chair, ottoman, or the bottom stair of a staircase. Use the railing of the staircase, or another chair for stability. DON'T bend the supporting knee. DON'T twist out the foot of the supporting leg. DO stand tall and stick your chest out and your butt out slightly. And most importantly, let it relax and BREATHE.

This one stretch alone is a good start to resolving the problem, but often it is not enough. Adjustments and more corrective exercises are usually needed for long term success.

The Most Common Postural Problem ( that you've probably never heard of )

Many of my patients have alternating symptoms of neck pain, shoulder pain and low back pain. They come to my office for the symptom that is currently the worst, and tend to downplay the symptoms that are currently minimal. They don't realize that all of the symptoms are related to the same dysfunction. Their spine is too straight.

When you look at a spine from the front, you want it to be straight (see pic below). But if you do see curvatures here, it is called scoliosis.

When you look at a spine from the side, there are normal curvatures. In the picture below the person is facing right. The forward curve to the neck and low back are called lordosis. The backward curve of the upper back is called a kyphosis. The pelvis tilts forward slightly as well. These are all natural and necessary for normal pain free function. These curvatures, along with the intervertebral discs, help to provide normal movement as well as shock absorption.

Many of us have lost touch with our bodies to the point where WHAT WE THINK is straight and upright really IS NOT. This is most common in those that have a job which requires them to sit. Sitting usually tilts the pelvis back, slouches the low back, and gives our upper body a slight forward lean. With good intentions, many of us try to correct this posture. But instead of tilting the pelvis to initiate the change, we straighten our upper backs. This eliminates the natural and necessary kyphotic curvature.

This dysfunction results in elongated low back and neck muscles that can't do their job. Muscles get weaker as they get longer. They tend to fatigue more quickly. This position also puts more pressure on the intervertebral discs of the neck and low back. So not only can your muscles hurt, but your joints as well. The muscles around the shoulder blades (scapulae) also become painful because the joint surfaces don't match up. The scapulae have a concave underside to them, which glides along the ribcage. The backside of the ribcage should be convex to match the surface, as in the picture below. But with a flat back, it is not. As the scapulae are pulled away from the ribcage, the muscles are elongated. Again, an elongated muscle is weaker, and fatigues more quickly.

Flat back posture also makes it difficult to take in a full breath, as the ribcage cannot fully spread out like it should. Altered breathing patterns result in fatigue of the muscles of the neck and low back, as these are relied upon more often. This spinal flattening plus a slight pitch forward is the most common postural problem I see in the office today. I know what you are thinking - "What can I do about it?" Stay tuned. You get your answer in my next blog.

Washboard Abs vs.Strong Core

I must admit I don't have "washboard abs". I have what you would call a "two-pack" instead of a "six-pack". But is having washboard abs really the same thing as having a strong core?

To answer that question, one must first define what "core" means. I don't always agree with Wikipedia, but here is what they have to say on the matter: "Major muscles included are the pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) especially the longissimus thoracis, and the diaphragm. The lumbar muscles, quadratus Lumborum (deep portion), deep rotators, as well as cervical muscles, rectus capitus anterior and lateralis, longus coli may also be considered members of the core group. Minor core muscles include the latissimus dorsi, gluteus maximus, and trapezius."

So there is well over a dozen muscles listed there, even if you don't include the latissimus dorsi, gluteus maximus, and trapezius, which I do. There also a few more I would add to the list such as serratus anterior. I understand the temptation to look at what you can most readily see and identify it as the "core". But we all need to get over this idea that sit-ups, crunches, or planks are the go-to core exercises for someone trying to decrease their pain levels through core muscle development. It is my humble opinion that the world of fitness, exercise science, and physical therapy have been overly influenced by the bodybuilding. The idea that we need to "isolate" one muscle at a time is quite ridiculous. In real-life scenarios, muscles don't work in isolation. Therefore training and developing them in this way is likely to end up in pain and dysfunction. Certainly the muscles look good on bodybuilders, but these folks are not as athletic as they look. Just ask one of them to run and you will see what I mean.

Here is a link to my Youtube channel. In it you will find the three core exercises I give the most : Up Dog, Side Bridge, and Bird Dog. I explain them in the videos, and in previous blogs as well, and there is no need for redundancy. Notice that none of these three main core exercises directly targets the abdominus rectus muscle. This is because the abdominus rectus muscle is one of a dozen core muscles, and is not THE important muscle. But, of course, it is still wise to train this muscle. The best way to train them is to do "Frog Abs". This exercise, like most of my core exercises, puts you into a position and hold it for three audible breaths. The breaths are very important, and it is necessary to keep them audible for two reasons. Not doing so will lead to holding your breath, guaranteed. The second reason is because it helps to stimulate the core muscles, many of which are involved with forcible inhaling and exhaling. Passive breathing (what you are likely doing right now), does not stimulate these muscles.

Click here to see Frog Abs video.


The video posted above also shows a hip position that minimizes low back pain. The turn out of the hips fires up the gluteal muscles, so that they work in conjunction with the abdominus rectus. Otherwise it is possible that the low back muscles fire up instead of the glutes, creating low back tension. Also, the lack of movement minimizes any risk of jerking your head forward, and injuring your neck.

Doing planks can be a good core exercise as well. Yet there is one inherent problem with it. The person doing it can't see their own back. I think if they did see it they would be surprised. Most people have such a gap between the shoulder blades (scapula) and their ribcage, that you could stick your fingers in there and pick them up like a suitcase. This is a sign of weak serratus anterior. Scapular winging has other possible causes, but weak core is the most common.

I guess I can't expect too much from people. They have been taught the same core exercises for decades, and now Dr. Schafer wants to start from scratch. I get it. I don't have the washboard abs, so what do I know about core muscles, right? Well, for starters, I don't have back pain.

Top 5 Running Mistakes

In the fall of 2010, I started training for the Grand Rapids Marathon in 2011. I had never run for exercise before. Gradually and slowly increasing my distance allowed me to complete the goal. However, it took me 12 months to get there, and more importantly, to do it without injury. Here I am in the final stretch, when my daughter decided to join me. When we crossed the finish line, she was quite upset that she did not get a medal. I tried giving her mine, but to her credit, she would not take it.

I try to inspire people to exercise in whatever capacity they can. I want to help my patients help themselves. When they do, I know that their long term success in fitness and health will translate into less pain overall. Yet there are always road blocks on the journey. Knowledge is key. If you want to run for exercise but are afraid, don't be. But be smart about how you train. And don't expect to go from running 0 miles to 26.2 overnight. So here are the most common mistakes made by beginners, and by those who just haven't done it for awhile.


1. Too much too soon.
This is easily the most common problem. Everybody has physical limitations. Testing your limits occasionally is good, but don't do it every time you run. Follow the 10% rule- don't increase your total weekly mileage or pace by more than 10% per week. That means you can't jump from running 1 mile to running 2 miles. Nor should you run 2 miles twice in one week, and then three times the next. It is the same principles for increasing your pace. Expect injury if you go from 14 minute mile (4.3 mph) to a 10 minute mile (6 mph).

2. Stretching but not strengthening calves.
It is just as often that I find weak calve muscles as I do short and tight calve muscles. It is also possible to have both. To test yourself, see if you are able to stand on one foot, then lift the heel. A surprising number of people can't do this. Compare right foot to left foot for how high the heel goes up. Usually you will feel one foot is not as strong, and your balance is worse. For this problem, do one leg calf raises at the bottom on the stairs, and hang on to one railing for balance if you need to. You can do the same on a curb with a signpost nearby. Go through a full range of motion up and down and pause briefly at each end. Think of it as an exercise that something between stretching and strengthening. Not only can weak calves lead to plantar fasciitis and achilles tendonitis, but it can also create overuse injuries at the hip or knee.

3. Stretching hamstrings with knees bent
Going down to touch your toes is probably the most common stretch done by runners. But in trying to push the limits of how far down they go, they will often unknowingly bend the knees. If you cannot fully straighten your knee, then you cannot correctly push off every time you stride. Your push-off will become a twist-off as the hip muscles try to make up for lack of knee motion. This can lead to hip or knee pain. Instead, try putting one leg on a chair or bench. Make absolutely sure your knee is straight. Then bring your toes toward you. If you still don't feel much stretch then stick your butt and chest out. When done correctly, even a contortionist will feel the stretch.

4. Foot Midline Crossover.
If you frequent a shoe store where they have a video treadmill setup, try using it the next time you are there. You don't need to be a specialist to see how one foot will be in the middle of the treadmill and the other will be out near the edge. If you can, ask the salesperson to drop a line down the center of the treadmill running surface, and count how many times each foot touches the "midline". I have seen many injuries on both the midline foot and the lateral foot. The midline foot supports more weight, but the lateral foot has to push harder to complete the same movement. Once again, the overuse scenario can produce pain at the foot, knee, or hip. One way to help overcome this is by "straddling the line". Find a high school track to run on. When you do, see if you can keep your right foot on the right side of the line, and the left foot on the left side of the line. This is surprisingly difficult for most people.

5. Doing the same run every time you run.
You will help stave off injuries if you can vary the terrain, distance, and pace of your run. If you do not, you are setting yourself up for a repetitive stress injury . Try running on a trail. You will notice your foot lands in a slightly different position every time. Many roads have a slant or a pitch to them to help water run off. Running on the same side of the road every time can create problems as your body tries to adjust for that slant. Try alternating types of running shoes, with different heel heights and arch supports. This will again vary the positions of your foot for every stride. Varying the pace and distance also can help. There are plenty of free couch to 5k running logs you can find online. Use those as a general guide, but listen to your body.

You are different. Your body is unique. Not everyone can or should do marathons, but most people can and should run. Especially if they like to.

Runner's knee may not be a knee problem

The recent warm weather has certainly inspired people to start running more. The increase of knee pain complaints at the office is a sure sign that summer is almost here. Knee pain is by far the most common running injury, yet it has many possible sources. Conventional wisdom suggests that since the knee is a joint, then any knee pain must be a joint problem. Patients often claim that their pain is due to a partially torn ACL or meniscus from an accident which occurred years ago. Recent research, however, indicates that muscular strain or weakness is a common cause of knee pain. Even muscles that don't directly attach to the knee can be a problem. In fact, numerous studies have shown that hip strengthening exercises greatly reduces pain on the outside of the knee (iliotibial band syndrome).

Healthimage [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]

A quick look at the anatomy shows how some of the hip muscles are connected to the knee. The iliotibial band does exactly this. It is a thick band of fascia. Fascia is very strong connective tissue which does not contract. In fact, fascia also runs through your entire body. It is better thought of as a super strong spiderweb (or matrix) that permeates the entire musculoskeletal system. That's a fancy way of saying it goes through and connects muscles, tendons, ligaments, and even bone.

So, if fascia permeates and interconnects all muscles, tendons, bones, and joints, AND the source of anyone's knee pain can be far from the actual knee, one could theorize multiple other muscular scenarios where the problem is muscles other than the hip ones described above. A thorough check of strength and flexibility of all possible offending muscles is best done by a skilled specialist. However, one could make attempts to stretch or strengthen these areas with no real repercussions if they were wrong. The worst that would happen is that their muscles would get more flexible, or maybe stronger.

If your pain is on the outside of the knee, it is likely due to weak hip muscles. A side laying leg raise is a good exercise to start with, just like the ones Jane Fonda would do. (Wow, I am dating myself with that reference.)

If your knee pain is on the inside part of the leg (medial), there is a good chance one of your groin muscles (hip adductors) is tight and short. Stretch'em.

If your knee pain is just underneath the kneecap (patella) in the front, there is a good chance that your front shin muscle (anterior tibialis) is either overused (usually from steel toe shoes), or it might be short and tight. Keep in mind that pain in this area could also be due to TMTS (Too Much Too Soon). Back off on the distance of your training by 2/3 and progress your mileage no more than 10% per week.

If your knee pain is under the kneecap (patella), but more to the inside of the leg (medial) it could be the posterior tibialis. This muscle is largely responsible for maintaining the arch of the foot. Have you been told you "pronate" too much? Strengthen this muscle by doing heel lifts while standing on one leg. Hold on to a chair or wall until you develop enough balance.

If your knee pain is in the back of the knee, it could be one of the hamstring muscles (biceps femoris) or tight calf muscle (gastrocnemius). Check to see if you are able to fully straighten your knee. Many people CAN'T do this, and usually blame previous knee injury. Yet they have never tried stretching the muscles BEHIND the knee. Try this stretch: stand with both feet pointing straight at a chair. Put one heel on the seat of the chair. That's all. Just keep in mind that your body will try to cheat the movement by twisting out out the supporting foot, or twisting the pelvis to the side of the supporting foot. Look at your foot on the floor to make sure that it is still pointing forward. Also look at your belt buckle to make sure that it is still pointed forward. If you can do this with a straight knee and no difficulty, then bring your toes toward you, and push your chest up. DO NOT TOUCH YOUR TOES!

Seeing a specialist for your knee pain is also a good idea. Finding one with experience in running is extremely helpful. Finding one who also runs themselves is better yet. Unfortunately, there are many "orthopedic specialists" who will focus solely on the knee. This is unfortunate because, as stated previously, often times the problem is starting somewhere OTHER THAN THE KNEE. It is true that many people with kne pain do have meniscus tears or other damage. Keep in mind that an MRI, X-ray, or CT scan can show where damage is. But it is no guarantee that the pain is coming from that damage. If the focus is only the knee, and no other changes are made to surrounding structures, it is just a matter of time before the pain returns.

If you have any questions about this blog, or any questions regarding running injuries, you may come to our class "Running Injuries and How to Avoid them". It will be held on Tuesday, May 21 at 6pm. There is no fee, but if you think you may be coming, let us know. Give us a call at (616) 301-3000. Or personal message us on our Facebook page here.

DON'T Make This Mistake During Core Exercises (Know Your ABC's)

As a personal trainer in the early 1990's, it was pretty standard operating procedure to give people sit-ups or ab crunches as part of their routine. I don't use these exercises much anymore, but honestly if done right they do have some benefit. I would always emphasize the breathing as I showed them the exercise. Nonetheless, EVERY SINGLE PERSON would hold their breath at some point. Then I would remind them. "OK Mr. Smith. Your form looks good, but just don't forget to breathe." Of course they would start breathing again. And of course, about 3 or 4 repetitions later, they would start to hold their breath again. EVERY SINGLE PERSON!

Fast forward to today. I am still giving people "core" exercises. By my standards "the core" means any part of the torso that connects one limb to another, or a limb to the head. That covers a lot of ground. Needless to say it's not just the "abs" anymore. Nowadays I give patients exercises which they are going to do at home without me. I can't be there to say "Breathe!". So how can I ensure that they are breathing? They need to know their ABC's

Active Breathing Core (ABC) is system of exercises that I developed in which the person holds a position, and counts breaths. They do not count repetitions. But they have to be big audible breaths. Not so big that they are hyperventilating, but big enough to challenge the respirator muscles beyond the "rest phase". It's really not as complicated as it sounds. It is similar to yoga, but you just have to count your breaths.

At rest, our breath is controlled at a subsconcious level. It involves the diaphragm, the elastic recoil of the lungs, and some parts of the intercostal muscles (the muscles between the ribs). This process happens even though we are not consciously aware of it. Therefore I call it a passive breath pattern.

Active breathing occurs when our heart rate goes up and our demand for oxygen increases. Most anything beyond sitting and resting can do this. Light activities like walking, washing dishes, or cutting the grass are good examples. Our bodies need to increase the volume of air that is taken in, and begin to use different muscles to do just that. This includes muscles of the neck and shoulders (SCM, scalenes, pec minor) for the inhale, and abdominal and low back muscles for the exhale. These "active" exhaling muscles are rectus abdominis, external oblique, internal oblique and transversus abdominis, iliocostalis and longissimus, the serratus posterior inferior and quadratus lumborum. All of those muscles are "core". Those muscles, which are activated in elevated breath patterns, are also necessary to help stabilize and support the torso during the activity. Therefore, these muscles need to be taught to be able to COORDINATE their function of breathing with their function of stabilizing!

Try this test. Stand up. Then squat down as if you are about to pick up a pencil. Then stand back up. Go ahead and do it now.
Done? Chances are you just held your breath to complete this movement. Your body should not need to shut down the breathing process in order to do such simple tasks. Now think about running. Do you think you need some core muscles during this movement? Do you think you also need to breath? Bingo!

So for simplification, I now give these positional exercises and have the person count three big audible breaths. Then come out of the position and relax for a breath or two. This is repeated at least 5 times. Coming out of position is often necessary. The longer someone holds a position, the less likely they are to hold GOOD position. So the small break helps them "reset".

Don't worry, though. You won't have to go back to school to learn your ABC's. You can see them here on Youtube.

How to tell if your headache is really from sinus pressure

Many of my patients already know that they have allergies. For some it is new territory. The idea that allergies can increase or decrease through the course of one's life is still surprising to many. ("I've never had allergies before!") In addition, many people with allergies don't really know what they are allergic to. This makes them all more difficult to diagnose. Yet allergies can definitely combine with other factors and contribute to existing headaches. It may be often enough that people may become confused about where there usual headache ends and the sinus headache begins. Then add to the mix possible sinus infections? Even more confusing.! So here are a few distinguishing characteristics.

Most people will describe their headache as "pressure" when it is sinus related. Otherwise headaches are usually felt as dull aches or bands of tension. If the pain is around the eyes and cheeks and central forehead, it is likely sinus related. Pain or pressure in the teeth is also sinus related. When it is more around the temples, or a band around the head, it's a tension headache. Near or above one eye is usually a migraine. If this does not help, try this quick test. Bend forward or tilt your head forward. A sinus related pain will usually create more pressure and more pain. Most other headache variations do not worsen when you move this way. Lastly, migraines are the only headache to also cause nausea and/or vomiting. If you experience this, then it is usually a migraine.

Attributing the allergy to the allergen is helpful in figuring out the patterns. Seasonal allergies often play a large role. Depending on what season it is can help you determine what you are reacting to. Late winter/early spring is usually from snow mould. (This is actually a fungus). Mid to late spring is more often tree pollen. Late spring to mid summer is usually grass pollen. Mid to late summer is usually weed pollen. Late summer to fall is most often leaf mold. Some sources say winter is high in mold as well. This may be true, but keep in mind indoor allergies such as dust mites. Most people don't spend much time outdoors through the coldest months. In fact, using an air purifier in your bedroom can help cut down on all allergens, especially the indoor ones. You can also use weather apps or allergy specific apps to help track the allergens according to your specific climate.

To make things even more confusing, chronic allergies can weaken your immune system to make you more susceptible to getting a sinus infection. There are some general guidelines that can help regardless. Current research suggests that people suffering from chronic sinusitis often have poor gut flora. This is where the immune system starts. Probiotic supplementation therefore can go a long way to help one's immune system under these circumstances. Herbal remedies can also be helpful. I have seen the best success in allergies with feverfew, stinging nettles, and Vitamin C. Chronic infection seems to be better treated with oregano oil. Of course, if you have a fever or other symptoms in addition to sinus pressure headache, please consult your primary care physician.

Chronic knee pain: is it really arthritis?

There are few injuries that will slow you down as much as knee pain. In circumstances where there is trauma and /or accident, the diagnosis and treatment are fairly obvious. Think of someone being tackled from the side and their knee buckles in. This is likely a tear of one or more ligaments of the knee. Treatment depends upon the degree of damage, and surgical reconstruction may not be a bad idea. But more often the pain is more mysterious. It arises with no obvious cause. It comes and goes at seemingly random times. Many people conclude it must be arthritis.

If you follow this blog or my Facebook page you likely have likely read about how there is POOR CORRELATION of pain to joint damage and arthritis. Scientists have always assumed that x-rays, CT scans and MRI imaging were the "gold standard" for diagnosing musculoskeletal pain. What they are looking for is evidence of joint damage and/or arthritis. But recent studies have shown that MRIs of "normal" or "healthy" populations WITHOUT pain also show significant levels of damage and arthritis. So the question is- how can you be certain that it is the cause of YOUR pain, when there are so many other people with the same damage and NO PAIN?
So here is some perspective. The old way of thinking goes something like this:

In the old way of thinking, ALL damage was due to overuse and overactivity. The problem with this is that everything is considered "too much". Is it really "too much" when someone squats down to pick up a small child? What about going up or down stairs? Should an otherwise healthy 25 year old woman need to stop running 5k races because it is "too much" for her knee arthritis? I think not.

The new way of thinking looks something like this. It is a double feedback loop.

You can see how even if you surgically "fix" damage and arthritis, the pain is likely to continue. It's not that damage and arthritis are always completely unrelated to pain, it's just that it's not a direct one to one relationship as previously thought.

Too often in the past, we have been told to be "careful", and "don't overdo it". Unfortunately this has led to many of us being overly cautious and fearful of daily activities. We start to see our bodies and weak, and need to avoid pain at all costs. Opioid prescriptions are a good example. They don't heal you. Your body does the healing. We just need to optimize the heeling environment. How do we do this? MOTION! Gradually increasing the activity level is crucial. Muscular resistance exercise is necessary. Studies have shown that even in the presence of arthritis, training the surrounding muscle structures helps to improve function and decrease pain. So the first question is- does such training decrease the level of arthritis? No. Arthritis can't be undone. Then there is the second question. Is the pain really from arthritis?

MIGRAINE!

The term "migraine" is often tossed around in a sense to convey a particularly severe headache. But not all severe headaches are migraines. One can also certainly have a "mild migraine". So what's the difference?

Usually the diagnosis is made from the associated symptoms and location of pain. The location of "head" pain is usually just above one eye. But the pain pattern can also reside around the temples or forehead, which would resemble a tension or sinus headache. Most migraine sufferers will also have pain in the neck. In fact, it's the single most commonly reported symptom for those who have been diagnosed with a "migraine". (Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2009.01608.x )

Nausea, dizziness, and light sensitivity are the next three on the "most common symptom" list. Sometimes the person gets a visual disturbance prior to the headache, called an "aura".  Or sometimes they just become very sensitive to light, and will tend to sit in a dark room by themselves.  Vomiting due to nausea is not uncommon.  This odd list of symptoms becomes less confusing when you start to look at one anatomical area...the BRAINSTEM.

The brainstem is divided into three major parts: the midbrain, the pons, and medulla oblongata. The last one, the "medulla", is the portion that sits lowest in the skull. Wikipedia states:
"The medulla oblongata (often just referred to as the medulla) is the lower half of the brainstem continuous with the spinal cord. Its upper part is continuous with the pons. [2] The medulla contains the cardiac, dorsal and ventral respiratory groups, and vasomotor centres, dealing with heart rate, breathing and blood pressure. Another important medullary structure is the area postrema whose functions include the control of vomiting." This is noteworthy since one of the most common symptoms of a migraine is nausea.

Why then would it then affect dizziness? Cranial Nerve VIII nucleus originates in the medulla as well the pons (source: Terminologia Anatomica). This nerve is partly responsible for balance and hearing.

How then could it affect vision? One theory as to why people will sometimes get visual disturbances (aura) is that it is from a lack of blood flow to the retina. Whereas the medulla is the control center for blood pressure, it could potentially lower the blood pressure enough to cause such symptoms. 

What about light sensitivity? This symptom may be related to the medulla's regulation of the sleep/wake cycle.   It is very common for migraine sufferers to go lay down in a dark room.  They typically do not fall asleep, yet they won't be watching TV or reading a book either.  To me, this sounds like the body is in an "in between state". It is as if it is not quite fully awake, and not quite fully asleep. Imagine if you are falling asleep, and someone shines a flashlight at you, you would certainly be "light sensitive".

From a chiropractor's viewpoint, it is also helpful to note how the medulla projects into the spinal canal of the top 2 vertebrae, C1 and C2. Therefore, any misalignments in these vertebrae can compromise or affect pressure on the medulla, and result in symptoms associated with a migraine! Things that can cause misalignments include poor posture, weak core muscles, and improper sitting and sleeping positions. Admittedly some of these mechanisms are not yet fully understood.  But considering that the medical system has yet to provide it's own explanation, I will stick with mine. 



Brainstem graphics provided by:
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016
https://cnx.org/contents/FPtK1zmh@8.25:fEI3C8Ot@10/Preface
https://creativecommons.org/licenses/by/4.0/deed.en

Rotator Cuff Injury Without Accident or Trauma

It certainly seems a bit strange, how so many people get rotator cuff injuries with no real trauma or accident. Its not like they are challenging their shoulders by throwing fastballs or javelins. Most people do remember "tweaking" their shoulder during something like painting, or perhaps some other overhead work. Often times the pain can appear for no apparent reason at all. Doing an internet search on rotator cuff injury will often get you nowhere. "Tear" or "degeneration" is what you are told. So without any real trauma one is left to believe the degeneration theory, aka "wear and tear". But you CAN'T UNDO degeneration! So what CAN you do? Prepare for surgery? Not so fast.

Once again I will try to limit the use of medical jargon, as I feel it often used to confuse the patient instead of communicate the real problem. The rotator "cuff" is the band of four muscles around the top of the arm bone, which is the humerus. All 4 rotator cuff muscles are there to keep the arm from sliding out of the "socket". Three of the four muscles are also for moving the arm by turning it outwards, away from your belly button (external rotation). The remaining one muscle helps turn the humerus inwards, towards the belly button (internal rotation). This one muscle works in conjunction with some quite large muscles by comparison, the pectoralis major and the latissmus dorsi.

When we are in the upright position, we mostly use our deltoid and trapezius muscles to do the heavy lifting. These muscles are also a bit bigger than the rotator cuff set.

The problem occurs if we are not fully upright. Then the movement starts to resemble external rotation (arm twisting away from belly button). Even a slight bend forward can make your body shift to using the smaller, weaker rotator cuff muscles to a greater degree instead of the larger and bigger deltoid and trapezius. Gravity does not change just because out body position does.

The slight bend forward in the above picture is NOT UNLIKE a slouch. You may be thinking that perhaps this exercise is not a good idea. I would generally agree. If you have worked your rotator cuff muscles to the point of chronic pain, and occasional strain, I don't see the sense in working those muscles further. Yet this and other external rotation exercises is what most doctors and therapists would give you (including many chiropractors). It can sometimes help short term, but it is a poor choice for a long term solution.

What DOES make sense is correcting posture so this strain on the rotator cuff muscles LESSENS. But posture is more than "standing up straight". Because we cannot see ourselves, it very difficult for us to monitor our own body positions. Most people have a poor body awareness to begin with. A good postural analysis is therefor essential. This includes the whole body, not just the area of pain. What I mean is that if your knees are so stiff or damaged to the point that they don't fully straighten, this could be creating a forward bent posture. If you are doing this, you are likely straining your rotator cuff muscles. This is only one example, but there are many possible postural alterations that can contribute to rotator cuff stress. Any surgical solution is temporary at best unless you correct what has created the stress to begin with. And for the record, surgical repair is not as successful as you might think. A 2010 study in the Annals of Internal Medicine concuded:
"Evidence on the comparative effectiveness and harms of various operative and nonoperative treatments for rotator cuff tears is limited and inconclusive."

Of course most people with postural faults don't realize they are doing it. This is why an integrated approach is often the best solution. If you have not had a head to toe evaluation in regards to your chronic rotator cuff pain, give us a call. We can also work on that knee problem.

"Do I Have Sciatica?"

This question is heard at least once per day here at Schafer Chiropractic. Which tells me it is a good topic for a blog. I will try to limit the use of fancy medical terminology. I often find that big words are used by people who don't fully understand the subject anyway. Sciatica is merely an irritation of the sciatic nerve that creates pain down the path of the sciatic nerve. This nerve runs down the back side of your leg. Not the front side of the leg. Not the outside of the leg. The BACK of the leg. Sometimes the pain goes to the back of the knee. Sometimes it goes to the back of the calf and the foot. See picture below.

The L4, L5 and sacral nerve roots are often compromised before they combine to make the very large sciatic nerve. Then the nerve exits the gluteal region from underneath the piriformis muscle. You may have heard of something called piriformis syndrome. This would be a swelling of the piriformis muscle to the point where it compresses the sciatic nerve. This is an unlikely cause. I say that because I have encountered very few cases in my 20 years of experience. In a very small percentage of people, the sciatic nerve actually runs THROUGH the piriformis muscle. In this small percentage of patients, it is much more likely to irritate the nerve.

Sciatica may be associated with pain in the low back. Usually this pain is unilateral (one-sided). Pain going down the back of both legs is usually due to other problems. Nerve pain can feel like a general ache, sharp jolt, burning, or tingling. How far the pain goes down the leg also can vary. More severe cases involve pain going into the foot. It is my humble opinion that most cases of real sciatica are due to a swelling or bulging of an intervertebral disc. This irritation occurs well before the piriformis muscle. Damage to the discs may be from direct trauma (fall onto your butt), or from poor posture and improper lifting techniques. Excessive sitting usually plays a significant role as well. This swelling or bulging can sometimes put pressure on, compress, tug, or pinch one of the nerves where it exits the spine. In this type of sciatica, the pain will usually be worse if you sit for too long, and when you first awake in the morning. If this sounds like you, we can help. DO NOT ASSUME that you need to be prepped for surgery.

Another possible cause for sciatica is spinal stenosis. "Stenosis" means closing. So spinal stenosis is a closing of the spinal canal. The canal is where the entire spinal cord runs through. This is often due to advanced arthritis, so if you are young, this is a very unlikely cause.

As stated above, sciatica is pain down the back of the leg. I have encountered many patients with pain down the SIDE of their leg, which they call "sciatica". Obviously this cannot be, as per the very definition of the word. Yet some of these people have been diagnosed by other medical doctors, chiropractors, and/or physical therapists. It is sloppy diagnosing. This pain often starts in the low back like sciatica, but quickly passes to the outside of the hips and stays lateral down the leg. This scenario is VERY COMMON.

This is called iliotibial band syndrome, or IT band for short. The low back muscles combine with the gluteal muscles and feeds into the iliotibial band (IT band). This band runs down the outside of the leg and connects to the outside of the knee. I often find that the patient has had knee problems of the painful side for many years prior to the "pseudo sciatica". The outside muscle of the lower leg can also be affected. These are called the peroneal muscles. It is well understood that muscles work together in systems. This is one of those systems. No muscle works in isolation. It is therefore unwise to point to one muscle and say "There's your problem!". In IT band syndrome, the IT band is not the real problem. The problem is usually weak gluteal muscles, combined with an unlevel pelvis. The pelvis may be unlevel due to poor posture, previous foot, ankle or knee injuries, or awkward sleeping positions. Successful treatment of the condition must include careful examination of all of these possibilities. If this sounds like you, we can help.

In all of the above scenarios, the condition is complex. The causes are many. A thorough history and exam are needed to properly diagnose the problem. MRI's can be helpful, but should not be the first course of action. Most insurance companies won't even cover them unless you have tried some sort of therapy first. As much as I would like to, I can't say that one adjustment, one stretch, or one massage will resolve the pain. Pain is a signal from your body. It is a cry for help. Most people just don't speak the language. We do.

Just try it: cross country skiing

It is my mission in life is to encourage everybody to exercise. This is because I know people will hurt less when they move more. Yet I hear all kinds of excuses. They say it is too costly, too high impact, too inconvenient, etc. Regardless, I believe there is an exercise out there for everybody. That's where this new blog series comes in. I will be attempting as many different exercises as possible. Taking you from trendy to old-school, from beginners to advanced, and from the common to the unconventional. I will try them all, and report back to you. I hope you enjoy.

Cross Country Skiing

If you are looking for something to keep you outside in the winter yet less dangerous than downhill skiing, try cross country skiing. The health benefits are truly impressive. And it's low-impact!

“New Records in Aerobic Power Among Octogenarian Lifelong Endurance Athletes,” a Ball State research project conducted in collaboration with several Swedish researchers, found that the long-time athletes in the study are enjoying vibrant and healthy lives. The study was published in the Journal of Applied Physiology. “In this case, 80 is the new 40,” said the study’s lead author Scott Trappe, director of Ball State’s Human Performance Laboratory. “These athletes are not who we think of when we consider 80-year-olds because they are in fantastic shape. They are simply incredible, happy people who enjoy life and are living it to the fullest. They are still actively engaged in competitive events.”

“To our knowledge, the VO2 max of the lifelong endurance athletes was the highest recorded in humans in this age group, and comparable to nonendurance-trained men 40 years younger,” Trappe said. “We also analyzed the aerobic capacity of their muscles by examining biopsies taken from thigh muscles, and found it was about double that of typical men. In fact, the oldest gentleman was 91 years old, but his aerobic capacity resembles that of a man 50 years younger. It was absolutely astounding.”

The benefits are no doubt related to the usage of the arms for propulsion via the ski poles. This differs from running and bicycling, which are primarily leg driven. Swimming has great benefits to, but cross country skiing is also a "weight bearing exercise" so it helps retain bone mass as we age. Swimming does not. Classic cross country skiing (see pic to the left) would also be a smart addition to any tri-athletes workout, as it reinforces the cross-crawl mechanism. This mechanism connects the upper body muscles on one side of the body, with the lower body muscles of the opposite side. Stimulating these connections can help prevent injuries, and improve performance in running and swimming, which also rely heavily on this pattern of muscle synchronization. The "skating" technique (not pictured) uses both arms simultaneously, and thus gives an even more impressive cardiovascular challenge. This requires a much wider and flatter snow surface, which may be harder to find.

On the right, you can see a photo of my first time out. Some coordination is required, but falling to the snow on a flat trail is certainly less painful than wiping out on the slopes. On my first time out, I fell twice, with only my pride being injured. The cost of equipment is minimal, and there are plenty of free trails around west Michigan. Some urban parks also show evidence of other cross country skiing enthusiasts. I skied Manhattan Park here is East Grand Rapids, because it is close to my house, and because I saw some trails when I took my daughter sledding there. Equipment includes skis, boots, and poles. A new set starts at about $250. If you want to try it first , rental may be the way to go. Second hand stores like Play It Again Sports will often have older models for purchase under $100. (I bought a set from a guy on Facebook Marketplace for $65.) Good or bad, this sport is weather dependent. t's a strictly limited-time option. Considering how much snow we get here in the Grand Rapids area, there is usually ample opportunity, so ski while you can.

Top 5 Signs that You Should See a Chiropractor

Our bodies may try to communicate with us by sending us signals, but we don't always speak the same language. Here are my top 5 signs that our bodies are trying to say "go see your chiropractor".

1. Your body used to hurt and be sore for very specific reasons. Now it seems to hurt for absolutely no reason. People rarely see me for pain and soreness from a home project or overdoing it at the gym. This is because they can connect cause and effect. When the pain is more random, or without any significant change in activity level, it is a cry for help.

2. You are pretty certain that your hip pain and foot pain are related, but your MD says that it's just from arthritis. The same could happen with neck and arm pain. The body is likely trying to tell you that there is an underlying biomechanical dysfunction related to both of them. In truth, many people have arthritis without any pain, so why are you different? Looking beyond the point of pain is necessary to find the point of dysfunction.

3. Sitting for long periods gives you low back pain. "Sitting is the new smoking" is a popular phrase nowadays. However, it is unlikely that our cultural norms will be changing anytime soon. Many of us will still be expected to sit at a computer for our jobs, sit and drive, sit and eat, etc. So, let's train for it. Why not train yourself, much like athletes do, to better prepare you for the physical demands of daily life? Core exercises are a must for anyone who sits for their occupation. They will get you into a better posture, and prevent further pain.

4. Your neck pain has now become headaches or migraines. Chronic misalignments of the top 2 vertebrae are often the cause of headaches, including migraines. In such cases, posture is usually to blame, and core exercises are again necessary.

5. You've tried everything else. This is where a good history and assessment of biomechanics (how you move) is essential. To treat pain without properly assessing why it is hurting ultimately fails. Too many doctors want to only examine the point of pain. But as I have said previously, the point of dysfunction may be different from the point of pain. Sitting, sleeping, and workstation postures need to be investigated for habits that contribute to your pain.