Not every hurt equals harm

If I were to go the gym and perform 300 repetitions of a 25 lb. bicep curl, my arms would hurt the next few days. Lifting my coffee cup the next day would likely be painful. Probably very painful. Yet doing so does not create further damage.

This is a good example of "not every hurt equals harm". Many chronic pain sufferers get confused with this, and I can understand why. The medical system has in the past taught us that we are fragile. The "overuse " theory makes us believe that we should not exert ourselves. The problem is that exertion is what is needed to become stronger, and thus avoid the problem next time. Einstein once said "A clever person solves a problem. A wise person avoids it".

Most assurances that rest, along with other passive treatments like medications, ice packs, or hot packs will take of the problem fail to recognize why it happened to begin with.

That is why most new patients come to our clinic. They don't understand why they hurt. New patients typically don't come to see me because they are sore from obvious strenuous activities such as home projects, yard work, or a vigorous workout. They realize some soreness is to be expected. Yet when there is no obvious trauma, accident or overuse that they can point to, it stands to reason that there is a deficiency in the person's physical ability to perform daily activities. Working through some pain is usually required.

Having someone experienced helping you through these painful exercises is essential. Ignoring pain is tricky, but there is one general rule. That is if you are exercising and it hurts, continue the exercise. If the pain goes away the more you do the exercise, then the answer is obvious. If the pain worsens it is best to stop. Unchanging pain is a judgement call. If the pain is mild and you can tolerate it, continue. Again, it is best done with an experienced professional's guidance.

Third Try for a First Tri

Well, it's official. I have just registered for the Allendale Countryside Triathlon. I have been training Since January, so I have given myself enough time to develop my lungs and my swimming skills. This is the third year in a row training for a Tri, but I have not yet completed one. The first year, I did not give myself enough time to train. Three months was nowhere near enough for a guy like me. (At 205 lbs and 5'9", I am technically in the Clydesdale Division) I did not even register. The second year I trained for 6 months, yet my asthma proved to be the limiting factor on a unusually cold morning for a "summer" Tri. So, yes it's my third try for a "Tri" (Sorry-I couldn't help myself).

Much like my story last year the swimming is by far the hardest for me. While the training has been difficult, the experience has been priceless. It has been my intention to become better at identifying conditions related to this type of training. It also helps to know something about training schedules and equipment, as it relates to common problems.

One of the most common problems I see is running is TMTS or too much too soon. There should be no increase in mileage or pace by more than 10% per week. if you break this rule, expect to hurt. The pain can be anywhere, but most often seen is knees, feet and hips.

The second most common problem I see is neck pain from swimming. Any swim coach will tell you to breath every three strokes. This ensures that you alternate sides on which to turn your head to get above water. If you breath every two strokes, you will repeatedly rotate your head above the water on just one side. This will lead to overuse of the muscles on that one side, and the imbalance will create pain.

Bicycling has its own set of problems. The most common of which is the excessively rounded low back. The lumbar spine naturally curves a bit, and this is called lordosis. When this curvature is completely reversed, more pressure is created in the intervertebral discs. Some telltale signs are stiffness when you get off the bike, and stiffness and/or pain when you wake up the next morning. Considering that the discs are already loaded from being in the seated position, any additional load can prove to be very detrimental.

My other reason for completing a Tri is to help motivate my patients. Sharing with them my failures and successes helps them to realize it is not always the destination, but the journey that is important. Just get up and "Tri" ! (Last one, I promise.)

Core Coordination?

While there is no shortage of "core" exercises, there is a shortage of common sense. I still find many patients doing outdated exercises and still injuring themselves in the process. This effectively sabotoges their health and exercise ambitions, and sends them back to the drawing board. Frustration builds until they just give up, and quit exercising altogether. They hurt because they are out of shape and don't exercise, but if they do exercise they hurt even more.

So, for the record, I am suggesting that the "sit-up" or "crunch" are not a good exercises for most people. One big problem is that the body's "core" is designed to RESIST motion, not CREATE motion. This goes back to my previous post about firing a canon from a canoe. It just doesn't work. The canoe moves just as much as the cannonball. Strengthening your core muscles to resist motion effectively locks down your cannon to dry ground.

But there is another problem with the typical person doing a "core exercise". That problem is core coordination. Not only are the core muscles meant to stabilize the spine and resist motion, they are also inherently involved with breathing. The external and internal oblique muscles, the abdominus rectus, and the quadratus lumborum muscle are all involved with forced expiration. That is considered exhaling when you are NOT "at rest".

If you watch the average person doing the crunch or sit-up or any core exercise for that matter, you will likely see this person holding their breath. You also may have noticed this pattern in yourself when you bend down to tie your shoes. This is because your body senses that it should be firing up the core muscles, but these muscles are weak, so you just hold your breath to achieve the same effect of stiffening the spine. This is called the "Valsalva maneuver", and is often used by powerlifters to lift maximum weight. Whereas it may be useful in stiffening the spine during a maximum lift, it should be avoided in other situations. It is known to cause an unhealthy spike in the blood pressure. I feel that it is cheating (except in heavy lifts) as it allows you to avoid full activation of the core muscles when completing simple movements of daily life.

So to teach the body to coordinate the activation of the core muscles with active breathing is the goal. The more you can coordinate these the more you can exercise. Obviously if you are continuously holding your breath (Valsalva maneuver), then you will not able to accomplish much. You will be too out of breath. An example of this is holding a "plank". Count your breaths instead of seconds. This is the only way some of us will actually breathe. Yoga is another good way to go, but then again I have seen many people nearly pass out in class because they were not breathing properly. Make breathing the primary consideration when choosing ANY core exercise. As much as I would like to think we would just naturally breathe through them, I am not holding my breath.

Weak Core + Running = Low Back Pain

The diagram above represents the trigger points that arise from the superficial longissimus thoracis muscle. If these areas look similar to any pain you experience I would not I be surprised. The pain pattern was identified recently in a research study published in the Journal of Biomechanics as the most likely injured due to a weakness in the deep core muscles. Multifidus, quadratus lumborum, psoas, and deep fascicles of the erector spinae are considered part of the deep core for this study. Note that the "abs" were not included! Because the superficial LT was most often the muscle overcompensating for weak deep core muscles, it may be “most at risk for fatigue or injury” if deep core muscles are not functioning properly.

If you are a runner, and experience low back pain, you are in good company. Up to 14% of American runners experience it each year. "Muscular compensations may increase risk of muscular fatigue or injury and increased spinal loading over numerous gait cycles may result in damage to spinal structures. Therefore, insufficient strength of the deep core musculature may increase a runner's risk of developing LBP."

How do you know if your deep core muscles are weak? If you have a job that requires you to sit, it is very likely. The best you can do is seek the advice of a health care professional with experience in recreational runners. Call us at (616) 301-3000 and set up an appointment for a free consultation to find out for yourself.

STOP STRETCHING!

Just kidding, sort of.
There is alot of hoopla these days about how stretching is supposedly a waste of time.

It's funny how fads come and go. And often come back again. Is high intensity cardio or low intensity cardio better? What about barefoot running? Wasn't that the hottest trend 8 years ago? Why are there so few "barefoot shoes" in the stores now? So-called experts will often become insistent that the newest research study is the final word or any given topic. But when you've been around awhile you start to see the patterns. A new study is much more likely to get published if it contradicts existing beliefs.
If you have been around the fitness industry you may have noticed that the trend has been very anti-stretching lately. In reality, there have been a few recent studies to suggest that stretching is pointless or even detrimental to athletic performance. But these studies need to be looked at in context to be understood.
A few studies suggest that stretching BEFORE exercise decreases strength. These studies mostly focus on peak effort. If you are a legitimate competition athlete then perhaps this applies to you. And it even makes sense. A powerlifter is a good example. If I were a powerlifter, I would not try to completely stretch out my pectoralis major muscles BEFORE a single rep maximum weight bench press. Or perhaps a long jumper in track and field. If I were a longjumper, I would not stretch out my hamstrings fully before a long jump competition. Warming up with a lower weight bench press would make much more sense for a powerlifter, as would light running or jumping rope for a long jumper. In reality this applies to a small percentage of people, as most of us do not earn a living by bench pressing or long jumping. The net detrimental affect that was observed was so small, it would not be noticed much by the average person exercising.
Separately, there are more studies which looked at larger populations of non-professional athletes, and the relationship between stretching habits and injury rates. They could not find any direct connection to decreased injuries with those who stretched regularly. This surprised a lot of people. But consider that there was no instruction given to these people on how to stretch correctly. There are dozens of different ways to stretch, and hundreds of different muscles to stretch. So it is possible that a correlation may have been found if specific instructions had been given?
It important to keep in mind that these studies are in contrast to decades of research suggesting that stretching is beneficial, and that it could help prevent injuries. So where does that leave us?
In truth these new studies really matter little to me. My business is pain relief. These studies don't look at specific stretching techniques on specific muscles to decrease pain. Pain levels can most certainly be affected if the ultimate problem is due to a shortened muscle.
Notice I said shortened and not tight. "Tight" can also mean "taught", or "high-tension". "Shortened" means it needs to be longer. NOT ALL PAINFUL MUSCLES ARE SHORT! Pain in a muscle can result from being overused, being under-used, being too short, or being too long. That means that if stretching does not help the pain you are experiencing, stop stretching. There is a good chance the muscle that is hurting is not truly "short", and therefore stretching it will do nothing. AGAIN, NOT EVERY PAINFUL MUSCLE IS SHORT!
The take-away message here is:
1. Don't stop stretching if you feel like it is helping you.
2. Don't assume every painful muscle is short, and therefore needs to be stretched.
3. If you are stretching a muscle and yet it keeps hurting, consult a professional. A Chiropractor or a physical therapist with good knowledge of sports injury is a good start.

Running Resolution

If your New Year's resolution is to start running, you will likely need help. Runners are particularly at risk for injury. Recent studies indicate that half of ALL runners are injured each year. And if you are training for your first marathon, you actually have a 90% chance of sustaining an injury. We can provide you with a treadmill gait analysis to help reduce the chances of injury.

You may be asking yourself why you should see a chiropractor for a running gait analysis. It all boils down to experience. I started seeing an uptick in running related low back and hip pain about 10 years ago, just as the popularity of running surged. All of these patients also had one or more of the following: knee pain, IT band pain, ankle or foot pain. These were also directly related to their back pain. The only way I could resolve a runner's low back pain is to assess and correct all of these dysfunctions. The best way to asses is with gait analysis.

All too often people have been seeing a podiatrist for their foot pain, a knee specialist for their knee pain, and a physical therapist or chiropractor for their low back or hip pain. This rarely works because there is no integration. A knee does not work in isolation, so why treat it as such? The same goes for the foot and ankle. Only when you can assess, align, and integrate the whole body will you be back on your feet and running again.

Or if you are smart, you can correct the problems before they give you pain.

When pain is the road block to your fitness resolution

As a chiropractor, I frequently hear from my patients how they hurt because they don't exercise, but when they exercise they hurt even more. Often times they will have already been to a personal trainer and/or a physical therapist and/or another chiropractor. The problem is that many personal trainers don't understand common dysfunctional movement patterns, and many physical therapists (and other chiropractors) will only look at the site of pain, and not consider how a painless dysfunction in one area (usually core muscles) will result in pain in another area.

As an example, let's look at the shoulder. Many patients have told me that they have a rotator cuff syndrome and therefore CAN'T and SHOULDN'T raise their arms over their heads. In reality they will NEVER get better UNLESS they raise their arms overhead (with good form, of course). Teaching them how to use their deltoid and trapezius muscles to perform this motion will spare their rotator cuff muscles. Just training the rotator cuff muscles is not the answer.

Your body is efficient, sometimes too efficient. It will often try to conserve energy by taking shortcuts. For example, watch someone pick up a pencil off the floor. We all know it is best to bend the knees and squat the butt as low as possible. But is this what we do in reality? Usually not. Most people, when unaware of anyone watching, will contort their bodies in all sorts of strange ways to forego using the core muscles and the big muscle: gluteus maximus. Previously I would have considered this a form of laziness. Now I consider it the body's attempt at efficiency. Using the gluteus maximus and core muscles takes more energy. But if the body continues to avoid using the big/core muscles, it will eventually shut them down and only use the smaller ones. This reminds me of a saying in my family - in order to find the most efficient way to do something, get the laziest person to do it. The only problem is they always complain about it. Your smaller muscles and joints will also complain. Unfortunately, not everybody understands the language.

Any shortcuts that your body takes will eventually result in painful road blocks. Road blocks such as pain in the neck, the low back, the hip, the shoulder, the knee, the foot, and the elbow. Many have been previously diagnosed as spinal disc bulges, sciatica, radiculitis, patellofemoral tracking disorder, plantar fasciitis, IT band syndrome, rotator cuff syndrome, or tennis elbow to name a few. But these are only names. Just naming something does not answer the question "why?". And why is it that most patients with tennis elbow don't play tennis? These shortcuts are the "why?". We can show you how to get to your fitness destination by taking the main roads and using the big muscles/ core muscles. So if someone has told you that you CAN'T or SHOULDN'T squat, lift, run, walk, bicycle, swim, or do any exercise that you want to do, get a second opinion before you give up on exercise.