Dr. J’s Health Columns

Why Every Athlete Should Use Chiropractic Care, Even If They Are Not Injured

There are some chiropractic skeptics and uninformed people who will say “once you start seeing a chiropractor, they never let you stop”. People make their own decisions on whether any health care intervention is of value them. Just like in many other aspects of life, there are those who want the quick fix, those that invest in a more robust solution and those that, when the crisis is over will invest in a preventative and proactive strategy to minimize the chances of another crisis. This can apply to your car, your home, your relationships and most definitely your health. The key to a good health practitioner is understanding the mindset of their patient and helping them achieve their health goals, regardless of where they may be in their concept of health.

An elite athlete’s level of performance and health awareness are often much higher than the average person. For them every millisecond, every bit of strength and flexibility can mean the difference between winning or losing. That is why when injury occurs, many look towards chiropractic care to help. Taking medications always comes with side effects, may make them drowsy and can become addictive. While surgery can mean months of sitting on the sidelines. On the other hand, chiropractic care can often help reduce pain while keeping the body balanced and flexible. Most common sports injuries either directly or indirectly cause misalignments in the spine causing stress to the joints, muscles, nerves, discs, and ligaments. This can interfere with the functions of other systems and parts of the body. Study after study have shown that chiropractic care outperforms other medical interventions in restoring normal function faster and safer.

Chiropractors can help athletes with a wide range of sports injuries including tennis elbow, hip, knee, ankle, shoulder, head, neck, and back injuries. But helping with injuries is only one reason most elite athletes use chiropractic care. Approximately, 90% of world-class athletes routinely use chiropractic care to prevent injuries and boost their performance. All NFL teams, 72% of PGA golfers and most NBA, MLB and NHL teams all have chiropractors on staff. Other than pain relief and just feeling better these elite athletes use chiropractic care for improving their performance, more effective training, reducing the frequency of injuries and reducing recovery time if they do get an injury.
However, one does not need to be an elite athlete to also receive these benefits from chiropractic care. People of all ages who engage in sporting activities young and old alike also see positive results. The body of a young athlete must not only deal with the demands of the sport but also the ongoing growth and development of their bones, joints, and muscles. This makes them particularly prone to the effects of overtraining. Older athletes often have issues with decreased flexibility and agility. Chiropractors have the knowledge and skill sets to help all athletes overcome these challenges.

What is your Self-Perception of Aging (SPA)?

Many people have a pre-determined idea of their health status once they get to their senior years. Based solely on their family history and experiences, some may even be inclined to accept their limited longevity as well. Henry Ford, the founder of the Ford automobile and line assembly, once said “If you think you can or you think you can’t, you are right”. There has been over twenty years of research by psychologists into this whole topic as it is related to health, longevity and mortality. These researches wanted to know if a person’s positive or negative attitudes about aging along with their attitudes about their personal health actually could predict their future health and longevity. Results were impressive. Older adults (70 years old) who had the poorest self-perception of aging (SPA) lived ten years less than those with the highest SPA. This association continued even when taking into account factors like age, physical health, cognitive function and well-being. Another study looked at young adulthood (18-49) and found that a negative SPA was predictive of increased angina attacks, congestive heart failures, myocardial infarctions, strokes and transient ischemic attacks. The general conclusion then is that your SPA becomes a self-filling prophecy. If you think you are going to be in poor health or consider yourself “over the hill” at whatever arbitrary age you have decided upon, then there is a high likely hood that it will happen. However, if you alternatively believe that you will be fit, healthy and live to a long a ripe old age then your chances are considerably better that that will happen. Of course, this only goes along with your natural desire to do all the right things to get you there. Sometimes, some of my patients will make comments such as “well, my father/mother/uncle had heart disease at 60″ or that “this or that disease runs in the family”. If you remember from one of my previous columns I mentioned how lifestyle and environment have a much bigger influence on your health (80-95%) than does your genetic make-up (5-20%). In fact, it is the environmental stimuli that will work their way right down to the cellular level, and once inside your cells, those stimuli can actually open and close cellular doors to change your genetic code! Some of you may be aware of the Blue Zone project. The origins of this project came from research and a book called The Blue Zone, 2004. The book focuses on five regions of the world where people live the longest and the healthiest and then categorizes nine lifestyle, dietary and cultural factors which have allowed these populations to live much longer lives than the average person living in modern society. Key factors included things like daily low impact activity and exercise (walking, gardening), decreasing calorie intake, minimal to modest consumption of meat with heavy consumption of vegetable, fruits, legumes and nuts. Cultural factors included daily social networking and laughter, regular interactions with youth, strong family, community and spiritual connections, and regular rest periods throughout the day and week. Very obviously missing from all of these factors is any reference to, prescription or over the counter drugs or high tech medical examinations and procedures. The Blue Zone project then attempted to use this information to create longevity in some American cities and work places. In Alpert Lea Minnesota (population 19 000) within just one year, the Blue Zone project was able to decrease health care expenses for city employees by 49% and also increase the average estimated longevity by 2.9 years. They were able to achieve this because the entire community was on board and believed in the project (city council, schools, work places, grocery stores, and the general public). Together they created a living environment that mimicked many of the characteristics found in Blue Zone regions of the world. Perhaps Henry Ford’s saying could be paraphrased to read: If you believe you will live a long and health life or you do not believe you will live a long and health life, you are correct.

3 Minutes, 3 Hours, 3 Days

Health is about movement. it is movement of the body, of the joints, of the blood and all the biological chemicals, neurotransmitters, electrical and mental impulses. Without movement, physically and physiologically, the tissues and cells will quickly breakdown, degenerate and die. Have you ever seen a video of live cells? There is always something going on. Biochemical doors are being opened and closed; the cells’ organelles are taking in energy or excreting byproducts. Your lungs will move continuously and your heart will beat non-stop from the moment of development in the womb until the day you die. This idea of movement is also essential for the neuro-musculoskeletal system to function well. The nervous system is the master control system in the body. No other system can work without the nervous system functioning properly. Chiropractors have long stated that pressure on the nerves, particularly spinal nerves can and do create a cascade of health issues. Several years ago a study was done to test out this theory. The sciatic nerve of a dog was exposed and connected to a monitor to assess conduction of nerve impulses. All mammals have sciatic nerves. They are big nerves running down the back of your legs, originating in the low back. Al slight amount of pressure, about the weight of a quarter, was applied against the nerve. Within three minutes of continuous light pressure the nerve impulse reduced by sixty percent. That is sixty percent less information, neurotransmitters, and electrical stimulation being properly conducted through the nerve. Within three hours of sustained pressure the nerve began to degenerate and breakdown. This is why the question “how do you feel” is a very poor question to assess how healthy you are, especially in terms of spinal health. You could take any number of painkilling drugs to make you “feel better” but your body is not functioning any better and the nerve conduction is still poor. Short of an accident, people who experience some type of spinal pain have lived with it for weeks, months or even years before your body finally signals that it can no longer accommodate the dysfunction. The gas tank of health is empty. But, it has been running on less than half a tank for a long while. A proper functioning nervous system is necessary for muscles to contract which then moves the joints. Without continuous joint movement degenerative changes occur quickly. Whether that be spinal joints, hips, knees, ankles, shoulders, elbows or wrist joints, movement is a must to minimize degenerative changes. In fact, joint degeneration will occur within three days of a joint being immobile, especially weight bearing joints. This is why quite often just hours after hip and knee surgeries, patients’ legs are strapped up to an apparatus to get slow movement in that joint. So, three minutes, three hours, three days, without movement it does not take long for your body and your health to start to degenerate and eventually die.

Short Legs and Where to Find Them

Quite often, during the initial consult in our office, patients will tell me that another health practitioner has told them they have a short leg. What does that mean? Is there anything you can do about it? Should you do anything about it? Having a short leg or more accurately a leg length inequality (LLI) can be either an anatomical issue or a functional one. Anatomically our legs should be the same length. This means all the leg bones and joints should be more or less symmetrical. An anatomically short leg may be a result of fractures, unequal hip or knee angles (which could be caused during birth or during early development), hip or knee surgeries, congenital malformations, or trauma. Various measuring techniques can be employed some more accurate than others. My clinical estimation is that only about one in ten leg length differences are of anatomical origin. The vast majority of LLI is due to functional changes, the most common reason being torsion or maladaptive motion of the pelvis and lower back. A fallen foot arch or inverted ankle could also cause one leg to appear shorter than the other while standing. Functional LLI are best assessed first with the patient prone (lying face down) and then on standing postural observation. The scientific literature states that up to a 4 mm difference is acceptable while other references suggest as high as 10 mm to be a normal variant. My professional opinion is that even at a 4 mm LLI, some form or compensation will show up along the kinetic chain. That is, everything is connected and you can’t change the other parts. So is there anything you can do about LLI? Absolutely. But first you must be properly assessed by a health professional who has expertise in spinal and body mechanics. What is the primary cause and what are the secondary compensations? Depending on the diagnosis you may need some form of therapy on the spine, pelvis, hips, knees, ankles, feet or all of the above. Therapies could include spinal manipulation (adjustments), exercises, ergonomic education, soft tissue therapy, or custom made foot orthotics (insoles). Once you are assessed and it is obvious that there is a LLI, the question then becomes what are the goals of any therapy. Is it to reduce the LLI? Is it to increase the function of the involved structures? How well has the body adapted to the LLI? Heel lifts or foot insoles with an attached heel lift on the short leg side are quite popular. However, one should be extremely cautious about adding any type of heel lift that was not prescribed by a health practitioner who assess the entire body mechanics and not just the foot. Adding a heel lift to a functional short leg is one sure way of encouraging and keeping those pelvic and lumbar torsions and misalignments fixed permanently. That is not what you want. A more thoughtful approach would be to strengthen and promote whole body function and movement. Custom made foot orthotics can be an effective complement to the other therapies. But, only as a last resort should a small heel lift be added on the short side, if necessary, once the body has reached its maximum LLI improvement. Are short legs real? Yes. The key is to know where to find them and what to do about them.

Sleepy Sleep Sleep

We spend approximately one third of our lives sleeping. With that much practice, especially for a normal biological process, you would think we would all be experts at it. Yet increasingly more and more people look for medical intervention to do something that is a natural part of being human. Why? There are many answers…..actually there is only one answer but how it affects us manifests in multiple ways depending on the person. Modern day society creates an environment of over stimulation either physically, mentally, emotionally or all of the above. What we are left with then is many people who get too little sleep (less than 8 hours for adults and less than 10 plus hours for children and youth) or disturbed sleep (frequent arousal without reaching deep (REM) sleep). On the risk of oversimplifying, this is what is happening. Our bodies have an autonomic (subconscious) nervous system that is divided into two systems, a sympathetic system (fight or flight, increased heart rate, muscle contraction, increase respiration rate) and a parasympathetic system (rest and digest, decreased heart rate). We are supposed to spend 90% of our time in parasympathetic mode but instead many of us now spend most of our time in sympathetic mode. This means we are always on high alert, always gearing up for a stressful situation. Physiologically this creates increased blood pressure, increased heart rate, shallow quick breathing, tense muscles. None of these states are conducive to getting a good night sleep. To get out of this sympathetic mode we need to prepare for sleep. Preparing for sleep is more than just getting on comfy pajamas and brushing your teeth, although these things are a good first step. We must prepare our mind, body and soul: Power down: Just like a computer, we need to shut down all our programs. But this must be done in a timely and orderly way. Scanning your smart phone just before bed only helps to stimulate the brain. No screen time for at least 30-60 minutes pre sleep. Is your mind racing with things you plan on doing tomorrow? Take 5 minutes and make a point form list so that you can shut down the “make sure not to forget” part of your brain. Do you have some unresolved emotions? Start journaling for 10-15 minutes before bed to help sort through them so that your thoughts don’t run like a continuous loop in your brain. Also, no caffeine after lunch. Release the tension: stretching for 5-10 minutes pre sleep is helpful in reducing back and leg pain during sleep. Pelvic tilts, shoulder shrugs, hamstring and gluteus stretches are just a few great ways to reduce the tension and calm your nervous system. Too much light: Ideal sleeping conditions require a cool dark setting. This means blinds on all windows to block 100% of the light. Those little lights from televisions and electronic devices must also be blocked. Even night lights have been shown to be detrimental to children’s development. Blue lights are the worst as long term exposure can actually increase the risk of some cancers. Not enough oxygen: Oxygen deficiency is due to external and internal factors. Externally, is there a good air flow where you sleep? Internally is more complicated. Shallow breathing, due to being in the sympathetic state, does not allow for sufficient oxygen. This causes repetitive waking and poor sleep. This is when CPAP machines can be effective. When do most heart attacks occur? In the early morning while you are still sleeping because your oxygen intake is not balanced to your myocardial muscle oxygen requirements. Clear the Heart: Meditate or pray. These are not just religious constructs. Give thanks and rid your mind of negativism. Several studies show that negative expression and thought take significantly more energy than positive ones. Now you are ready for a restful sleepy sleep sleep.

Lumbar Spinal Stenosis – A Primer

Arthritis and degeneration of the low back is a fairly common condition in humans. Over time repetitive stresses of daily life can cause wear and tear on the joints, discs and bones of the spine. This type of arthritis is called osteoarthritis. However, not everyone who has arthritic changes in their spine experiences back or leg pain or lack of function. Studies using MRI’s (magnetic resonance imaging) show that there are just as many people with osteoarthritis of the spine who do not experience any pain or dysfunction as those that do. What does this mean? It means that for health professionals who assess and treat spinal conditions the clinical exam is often much more informative and valuable than x-rays or MRI’s. If we look at this condition anatomically we would say that: extensive arthritic changes leads to thinning discs, thickening of the spinal joints and ligaments, and boney build up of the vertebral bodies which can all cause narrowing of the spinal canals. This can compromise the spinal nerves and spinal cord. If the spinal nerves are affected we call it lateral spinal stenosis. If the spinal cord is affected we call it central spinal stenosis. Often both can be compromised. Looking at this condition clinically we would call it neurological claudication. Most commonly a person with this condition is greater than 65 years old, has buttock or leg pain and weakness with walking which improves with forward bending or flexion and gets relief with sitting. This condition is dynamic meaning that it changes with posture. So what is actually happening? The decreased space surrounding the nerves creates a back up of venous flow. This in turn blocks spinal fluid which then blocks capillaries (mini blood vessels) which does not allow for oxygen and nutrients to get to the nerves and tissues which then causes numbness and pain in the buttocks and legs. So it is actually not an inflammatory condition. This is why anti-inflammatory drugs often are not effective for those with spinal stenosis. To complicate things even further, having spinal stenosis is one or more levels of your spinal column does not exclude having other conditions like disc herniations at other levels or hip disease or vascular claudication all of which can have opposing signs and symptoms. This is why it is not a good idea to listen to your friend or neighbour’s advice on what to do. Often certain exercises or movements that work great for one type of back condition are completely ineffective or even harmful for other conditions. Within 15 years 25% of the Canadian population will be suffering with some form of spinal stenosis. It will be a leading cause of pain, disability and loss of dependence in the elderly. Those with spinal stenosis become more sedentary which further causes a decline in their overall health.

Spinal Stenosis – What Can Be Done?

Arthritis and degeneration of the low back is a common condition in humans. Over time repetitive stresses of daily life can cause wear and tear on the joints, discs, and bones of the spine. This type of arthritis is called osteoarthritis. In anatomical terms we would say that: extensive arthritic changes lead to thinning discs, thickening of the spinal joints and ligaments, and boney buildup of the vertebral bodies which can all cause narrowing of the spinal canals. This can compromise the spinal nerves and spinal cord. If the spinal nerves are affected, we call it lateral spinal stenosis. If the spinal cord is affected, we call it central spinal stenosis. Often both can be compromised.

Within 15 years 25% of the Canadian population will be suffering with some form of spinal stenosis. It will be a leading cause of pain, disability, and loss of dependence in the elderly. Those with spinal stenosis become more sedentary which further causes a decline in their overall health.

Spinal stenosis is dynamic meaning that the symptoms change with posture. The most common signs and symptoms include older age, buttock or leg pain and weakness with walking which improves with forward bending or flexion, and relief with sitting. So, what is happening? The decreased space surrounding the nerves creates a backup of venous flow. This in turn blocks spinal fluid which then blocks the capillaries (mini blood vessels) which does not allow for oxygen and nutrients to get to the nerves and tissues which then causes numbness and pain in the buttocks and legs. So, it is not an inflammatory condition. That is why anti-inflammatory drugs often are not effective for those with spinal stenosis.

To complicate things even further, having spinal stenosis in one or more levels of your spinal column does not exclude having other conditions like disc herniations at other levels or hip disease or vascular claudication. This is why it is not a good idea to listen to your friend or neighbor’s advice on what to do. Often certain exercises or movements that work great for one type of back condition are completely ineffective or even harmful for other conditions.

No matter what health issues you have a logical and thoughtful approach would be to start with the most conservative therapies first, as they are generally the safest and have the least potential for side effects. Conservative therapies start with home care, lifestyle modifications, certain exercises, and postural improvements. Next would be therapies such as chiropractic care or physiotherapy or acupuncture. Attempting more aggressive therapies should be assessed for risk benefit ratios before proceeding. However, too often people and health practitioners jump to more aggressive therapies first.

Before starting any therapy, you should reflect on your goals. Is it solely to get out of pain? Is it to have better function? If so, what function are you trying to achieve: daily house chores, walking, sporting activities, social activities. When discussing spinal stenosis, one needs to understand that although pain reduction is a desirable goal, most people with this condition will always have a certain amount of pain. A more realistic goal would be to improve and maintain a higher level of function. Functional goals will go a lot further in also reducing other health risks like cardiovascular disease and diabetes than will pain goals.

Multiple scientific literature reviews described the effectiveness of various therapies:

NSAIDS (anti-inflammatories), Gabapentin and prostaglandins – not effective because spinal stenosis is not an inflammatory condition.
Pain killers like acetaminophen and opioids showed poor results.
Epidural injection – no evidence of positive outcomes. Despite this, 25% of all epidurals done are for spinal stenosis.
Chiropractic care or physical therapy – some positive effectiveness, especially to reduce leg pain but results diminish over time.
Surgery – moderate effectiveness to reduce leg pain but no effect on low back pain. Results last 2-5 years and then secondary surgery is often done. No difference in walking, pain or disability scores when compared to conservative therapies.

One therapy which has impressive results in terms of significant improvement in function, is the Boot Camp Program for Lumbar Spinal Stenosis developed by Dr Carlo Ammendolia DC. This program includes a combination of chiropractic techniques to increase spinal joint function along with specific low-tech exercises that the patient learns to do in office and then continues to do at home indefinitely. It has received several accolades amongst the spinal research community for its effective functional results, its patient centered approach and its low-tech, low-cost application. There are several local chiropractors who use the Boot Camp Program for Lumbar Spinal Stenosis. If you suffer from low back pain and/or leg pain, your best option would be to first visit a health professional that has the expertise to diagnose spine related problems and then can provide conservative treatment options.