Dr. Kyle: What You Need to Know About Stretching

When recommending a stretching routine for a patient you must first consider their lifestyle and fitness/performance goals. If someone is a dancer or gymnast, they will require more flexibility and therefore need a more intensive stretching routine. If someone is a powerlifter or explosive athlete, they might require more stiffness and elastic recoil in their soft tissue. This type of athlete would need less static stretching. There isn’t necessarily a right or wrong answer when it comes to stretching, it all depends on the person.

Here is a short list of how stretching can influence your function:

Range of Motion
• Static stretching will increase range of motion.
• Stretch after your workout.
• 30 second holds.
• 2-3 x per week (increase or decrease depending on mobility demands in sport/lifestyle).

Injury
• Static stretching has not been shown to prevent sport related injury.
• Dynamic warm-up before exertion.

Recovery
• Not shown to improve recovery
• Active recovery to promote blood flow
• Proper sleep, nutrition, and hydration

Performance
• Decrease force production and speed.
• Increase range of motion / mobility.

Muscle
• Active and passive stretching increase hypertrophy.

As mentioned, stretching routines can only be recommended after considering the individuals lifestyle and mobility requirements. There is no right or wrong answer, it’s how you use it!
Contact me @drkylearam for any questions.

Rick Shares: The Importance of Hydrating Before and After a Massage

If you’ve ever gotten a massage, chances are that your massage therapist recommended drinking plenty of water to keep your body hydrated. But have you ever wondered how massage and hydration are connected and how much water you should drink before and after your treatment?

The Science Behind Hydration

When your muscle tissues are healthy, they are spongy and supple; however, unhealthy muscle tissues are tough and tight. This tightness often builds up from stress, tension, overuse, and injury. This is an important basic concept to understand because soft tissue allows blood to flow and lymph nodes to drain properly.

These biological processes relate to massage because massage therapists are trained to untighten and de-stress unhealthy muscle tissue. Massage increases blood flow in tired muscles and uses up water stored in the body. This process can lead to dehydration if you aren’t consuming enough water throughout the day.

Hydrating Before a Massage

Many people don’t realize that drinking water before your massage is just as important as staying hydrated after your treatment is over. Drinking water before massage is a good idea because it makes your muscles softer and more pliable, which leads to a more relaxing and comfortable massage.

Being hydrated before a massage can also prevent you from feeling achy after getting a massage. Both drinking water and getting a massage eliminate toxins from the body, so when practiced together, the effects of your massage become even more beneficial.

Hydrating After a Massage

Drinking water after massage is very important because the kneading and working of your muscles are naturally dehydrating. Massage helps pump fluids from your soft tissues into your circulatory system and your kidneys, so you need to replenish that lost water by drinking more than you normally would.

How Much Water Should You Drink?

The standard recommended eight glasses of water per day works well for most people on most days, but consider adding another glass or two to your routine on massage days. Another recommended calculation is to divide your body weight in pounds by half and drink that number of ounces of water. This calculation suggests that a 150-pound person should drink about 75 ounces of water per day.

Symptoms of Dehydration

In general, most people don’t drink enough water throughout the day, and your body’s water needs increase on days you get a massage. Dehydration can be easily avoided if you know the symptoms to look for and make a conscious effort to drink more water on massage days.

These are some of the most common symptoms of dehydration.

  • Fatigue
  • Achiness
  • Lack of mental focus
  • Extreme thirst
  • Dark yellow urine

Dr. Phil Shares: 6 Must-Dos After Every Walking Workout

6 Must-Dos After Every Walking Workout

While walking is an excellent low to moderately intense workout that’s easy on the joints, you’ll still need to recover properly to improve fitness and avoid injuries. Here, seven steps to include in your post-walk recovery routine:

1

COOL DOWN

Whether you’ve gone for a long endurance walk or thrown in some intervals, it’s important to take time to let your body cool down before you head back inside. This allows you to slowly lower your heart rate and get rid of any lactic acid that could potentially cause soreness and a heavy feeling in your legs. A 10-minute walking cool down or completing a few yoga poses are great options post-workout.

2

REHYDRATE

One of the most important but often overlooked aspects of recovery is hydration. Even during low-to-moderate intensity workouts, the body loses fluid through sweat that needs to be replaced. If you don’t, recovery takes longer and your performance for your next workout will be negatively affected. In the hour that follows your walking workout, drink plenty of water. If you’re doing long distance training for a walking marathon or have completed a particularly intense workout in hot weather, an electrolyte replacement drink might also be needed. If you’re unsure exactly how much fluid you’ve lost during exercise, weighing yourself before and after workouts is one way you can gauge how much fluid you need to drink to rehydrate properly. You can also track your hydration with an app like MyFitnessPal.

3

REPLENISH YOUR ENERGY STORES

Consuming healthy, nutrient-rich food after a walk is a must to allow your muscle tissue to repair and get stronger. Skip processed, sugary foods and load up on leafy greens, lean protein like chicken, fish or even a post-workout protein shake.

4

STRETCH

Stretching as soon as your workout is finished and while your muscles are still warm can help reduce muscle soreness and improve your flexibility — both of which can help you improve your overall fitness and decrease your chances of injury. If you don’t have a ton of time to go through a series of stretches, concentrate on your weak spots. For example, if hamstring tightness is normally an issue, put most of your attention there. When you have the time, try this seated routine that targets many of the common sore spots for walkers.

5

REDUCE MUSCLE SORENESS

While nutrition and stretching are big pieces to this puzzle, there are other things you can do to help prevent soreness so you can feel better and work out more frequently:

  • Massage: This helps improve circulation and relax aching muscles.
  • Recovery tools: If you don’t have money or time for a professional massage, try recovery tools like foam rollers, lacrosse balls or a Theragun to loosen up sore spots.
  • IceTry taking an ice bath or simply icing any sore spots like your knees, lower back or shoulders post-walk.

6

TRACK YOUR PROGRESS

Setting goals and tracking your progress is an important part of the big picture. Instead of waiting and possibly forgetting about it all together, upload your workout info to your favorite fitness app shortly after you’ve finished your walk. This allows you to see the work you’ve put in and can provide a mental boost when you realize how much you’re progressing.

by Marc Lindsay

Shared By Dr. Phil McAllister @ Forward Health Guelph

Dr. Kyle: Posture Perfect

You can prevent slips and falls. You can reduce your risk of a motor vehicle accident. You can limit contact sports. One thing that you cannot avoid however, is gravity. If your body and spine are not aligned, the force of gravity will start to wreak havoc on your musculoskeletal system. Making sure we maintain proper posture throughout our work day is critical for longevity in our career. So how do we protect ourselves?

The secret to good posture is maintaining the spines natural curves. When standing, your head, shoulders, hips and ankles should all line up. When sitting, your ears, shoulders and hips should be in line and your buttocks should be at the back of the chair. Sit tall with your chest and head up.

Some tips for creating an ideal posture include:

• Stand tall with shoulders back
• Tuck your chin
• Brace the abdomen
• Squeeze your glutes
• Keep your knees slightly bent

Due to modern day technology, one of the most common signs of poor posture is anterior head carriage. This mean that the head is resting too far forward away from the body. We are not always cognisant of our head posture as we check our smart phones and work on our laptops. The farther our head protrudes forward, the greater the force on our neck. This can lead to chronic neck and upper back pain and lasting postural alterations.

One exercise I recommend to patients to reduce anterior head carriage are chin tucks. These can be done up against a wall or lying flat on your back. You simply bring your chin directly in towards the spine and hold. You can press gently into the wall or pillow to enhance the muscle contraction of your deep neck extensors. Now your spine will naturally carry the weight of your head and allow your neck and upper back muscles to relax. So keep your chin up and your pain levels down!

For more tips and tricks to enhance your posture, visit my Instagram page @drkylearam of email me at drkyle@forwardhealth.ca.

Dr. Kyle: Torn ligament? Maybe not.

Knee pain can come in a variety of presentations. Whether from a sports injury, slip and fall, or out of the blue, no two knee injuries are completely alike. The extent to which tissues are damaged is specific to the patient’s genetics, lifestyle, trauma, and fitness level. A well-trained athlete may be quite high functioning even with a serious tear, while a mild injury may keep a very sedentary person out of commission for several months.

Often times I will hear “hey doc, I think I might have heard a pop and the inside of my knee really hurts!”. My first reaction is to suspect a ligament tear. Once examining the patient further however, orthopedic testing shows stable knee ligament testing, no swelling or redness, and no severe joint line tenderness. So what’s the deal?

Like most soft tissue injuries, ligaments can be damaged to varying degrees. In the clinical world, there are 3 grades of ligament tears. Grade 1 is mild ligament damage, grade 2 is moderate, and grade 3 is severe/ruptured ligament tear. Common symptoms of a complete tear include sudden onset of pain and severe swelling, joint instability, and impaired function. The truth is, disruption of tendon fibers can happen to varying degrees. Think of muscle strains and ligament sprains on a spectrum of structural damage from 0 to 100%. The higher percentage of damage, the longer time it will take to establish preinjury performance levels.

Fortunately, if ligament stability is determined to be adequate by a healthcare professional, a conservative trial of care will often resolve symptoms. Ligaments in the body have the natural ability to heal on their own. Healing consists of 3 distinct phases including the inflammatory phase, the reparative phase, and the remodelling phase. Simply put, fibrotic scaffolding will be laid down so newly formed collagen can connect the severed ends of the tear. It is important to seek proper medical attention so that rehabilitation can begin as soon as possible.

For injuries of this nature, treatment will often begin with controlled range of motion exercises. Other modalities such a laser and acupuncture are helpful for enhancing healing at this stage. As tensile strength of the ligament improves, the joint will be able to tolerate more load. Eventually strengthening exercises will be included into the plan of management and progressed with increasing difficulty.

So if you or someone you know is worried that their knee pain may need surgical intervention, make sure you get it assessed by a medical professional who specializes in musculoskeletal injuries. It may be quite reassuring to know that with the right tools and knowledge the body will be able to heal and adapt on its own.

For more information, please contact drkyle@forwardhealth.ca or visit my professional Instagram page @drkylearam.

References:
Woo SL, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. Journal of biomechanics. 2006 Jan 1;39(1):1-20.

Dr. Kyle: Building Stronger Bones

When discussing bone health, we often talk about proper nutrition. Adequate vitamin D and calcium intake are usually recommended to enhance bone mineral density (BMD). What is not discussed as often is the role of exercise and weight training for increasing bone strength. A holistic approach looking at what we put IN our body as well as what we DO with our body is the key for building stronger bones.

As we age our body experiences several physiological changes. Our hormone levels change, muscle mass declines, and bones become less dense. Low bone density, otherwise known as osteopenia, increases our risk of fracture. Although we can bounce back from a slip or fall in our early years, a hip fracture in older individuals can have detrimental effects on quality of life. The good news is, there are important steps you can take to prevent or slow down the decline of BMD.

Research has demonstrated that healthy individuals and patients with osteoporosis can improve BMD with high-moderate impact activities and resistance training. A few examples of high impact exercises include step classes, jogging, and jumping jacks. Resistance or weight training on the other hand can include elastic band, pully, and free-weight based exercises. To put it simply, the more force you transmit through the bone, the more the bone will remodel and grow! Clinical judgment is needed to determine the intensity of force that each patient can tolerate.

Recent studies have found that high-intensity resistance training and impact training improves BMD and physical function in postmenopausal women. Low-intensity and light-resistance exercise programs are not enough to stimulate bone remodelling and improve BMD. Heavy multi-joint compound exercises such as squats and deadlifts induce extensive muscle recruitment and transmit greater force through the bones. In particular, these exercises will apply force through the lumbar spine and femoral neck, making them stronger and more resilient to fracture. Proper form and supervision are crucial when performing any high intensity or heavy loading activities.

Talk to a primary health care provider about your BMD and if an exercise program for developing BMD is right for you. Not only will exercise strengthen your bones, but it will have profound impacts on many other systems of the body as well. As always, if you have any question do not hesitate to contact me at drkyle@forwardhealth.ca or visit my Instagram page @drkylearam!

Reference:

Sinaki M. Exercise for patients with established osteoporosis. InNon-Pharmacological Management of Osteoporosis 2017 (pp. 75-96). Springer, Cham.

Mounsey A, Jones A, Tybout C. Does a formal exercise program in postmenopausal women decrease osteoporosis and fracture risk?. Evidence-Based Practice. 2019 Apr 1;22(4):29-31.

Dr. Kyle: Manipulation and Mobilization for Neck Pain

An estimated 66% of the population will suffer from neck pain in their lifetime (1). Neck pain is one of the most common musculoskeletal conditions treated by healthcare professionals. Often patients will report pain due to sleeping awkwardly, turning their head too fast, or reaching for something overhead. Whatever the mechanism, neck pain accounts for a significant proportion of sick leave, healthcare costs and lost productivity. Chiropractors have been at the forefront of treating neck pain for decades, and the results speak for themselves.

What does the evidence suggest?

Previous systematic reviews on chronic mechanical neck pain have provided substantial evidence for the effectiveness of chiropractic care. Both spinal manipulation and mobilization have been shown to be a viable option of care as compared to other standard treatment methods (2).

A recent systematic review by Coulter et. al. compared spinal manipulation and mobilization to other active modalities such as acupuncture, massage, and exercise to name a few (3). The study looked at patient outcomes such as pain, disability and health related quality of life (HRQol). They found that many previous reviews regarding non-specific neck pain reported evidence in favor of manipulation and mobilization. Other reviews concluded that manual therapies in conjunction with exercise provided superior results as compared to manual therapy alone (4).

As with many musculoskeletal conditions, it appears that a multi-modal approach is best. At this point in time, there is moderate evidence to support manipulation and mobilization for the treatment of chronic nonspecific neck pain in terms of pain and function. It appears that some movement and active rehabilitation is better for patient recovery then complete rest. More studies are still required to look at the benefits of chiropractic manual therapies long term.

To some, these conclusions may not be overwhelming, but research like this is what continues to carry the chiropractic profession in a positive direction. It is exciting to know that chiropractors and researchers alike are looking into the efficacy and safety of chiropractic care so we can better treat our patients and our community.

If you or someone you love is suffering with lingering neck pain, it may be time to schedule a comprehensive chiropractic exam to get to the root of the problem. As always, if you have any questions please do not hesitate to contact me at drkyle@forwardhealth.ca or visit my professional Instagram page @drkylearam.

References:

1. Cote P, Cassidy JD, Carroll L; The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998; 23:1689-1698

2. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: A systematic review and best evidence synthesis. Spine J 2004; 4:335-356.

3. Herman, P. M. (2019). Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician, 22, E55-E70.

4. Brison RJ, Hartling L, Dostaler S, LegerA, Rowe BH, Stiell I, Pickett W. A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions. Spine 2005; 30:1799-1807.

Rick Shares: Fibromyalgia is not all in your head, new research confirms

Researchers discover a rational source of pain in the skin of patients with fibromyalgia

INTEGRATED TISSUE DYNAMICS (INTIDYN)SHARE PRINT E-MAIL

IMAGE
IMAGE: THIS SCHEMATIC ILLUSTRATES THE ORGANIZATION OF BLOOD VESSELS AND THE REGULATION OF BLOOD FLOW (ARROWS) IN THE PALM OF THE HANDS. ARTERIOLE-VENULE SHUNTS ARE SMALL MUSCULAR VALVES THAT CONNECT…view more CREDIT: FRANK L. RICE, PHD, INTEGRATED TISSUE DYNAMICS LLC
[June 17, 2013, Rensselaer, NY] – Fibromyalgia, a painful condition affecting approximately 10 million people in the U.S., is not imaginary after all, as some doctors have believed. A discovery, published this month in PAIN MEDICINE (the journal of the American Academy of Pain Medicine), clearly now demonstrates that fibromyalgia may have a rational biological basis located in the skin.

Fibromyalgia is a severely debilitating affliction characterized by widespread deep tissue pain, tenderness in the hands and feet, fatigue, sleep disorders, and cognitive decline. However, routine testing has been largely unable to detect a biological basis for fibromyalgia, and standard diagnosis is based upon subjective patient pain ratings, further raising questions about the true nature of the disease. For many years, the disorder was believed to be psychosomatic (“in the head”) and often attributed to patients’ imagination or even faking illness. Currently approved therapeutics that provide at least partial relief to some fibromyalgia patients are thought to act solely within the brain where imaging techniques have detected hyperactivity of unknown origin referred to as “central sensitization.” However, an underlying cause has not been determined, leaving many physicians still in doubt about the true origins or even the existence of the disorder.

Now, a breakthrough discovery by scientists at Integrated Tissue Dynamics LLC (Intidyn), as part of a fibromyalgia study based at Albany Medical College, has provided a biological rationale for this enigmatic disease. The small biotechnology research company, founded by neuroscientists Dr. Frank L. Rice and Dr. Phillip J. Albrecht, reports on a unique peripheral neurovascular pathology consistently present in the skin of female fibromyalgia patients which may be a driving source of the reported symptoms.

“Instead of being in the brain, the pathology consists of excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands,” said Dr. Rice, President of Intidyn and the senior researcher on the study.

“This discovery provides concrete evidence of a fibromyalgia-specific pathology which can now be used for diagnosing the disease, and as a novel starting point for developing more effective therapeutics.”

Nerve Endings Come In Many Forms

Three years ago, Intidyn scientists published the discovery of an unknown nervous system function among the blood vessels in the skin in the journal PAIN.

As Dr. Rice explained, “we analyzed the skin of a particularly interesting patient who lacked all the numerous varieties of sensory nerve endings in the skin that supposedly accounted for our highly sensitive and richly nuanced sense of touch. Interestingly however, this patient had surprisingly normal function in day to day tasks. But, the only sensory endings we detected in his skin were those around the blood vessels”. Dr. Rice continued, “We previously thought that these nerve endings were only involved in regulating blood flow at a subconscious level, yet here we had evidencs that the blood vessel endings could also contribute to our conscious sense of touch… and also pain.”

Now, in collaboration with renowned Albany Medical Center neurologist and pain specialist Dr. Charles E. Argoff, the study primary investigator, and his collaborators Dr. James Wymer also at Albany Medical College and Dr. James Storey of Upstate Clinical Research Associates in Albany, NY, clinical research proposals were funded by Forest Laboratories and Eli Lilly. Both pharmaceutical companies have developed FDA-approved medications with similar functions (Serotonin/Norepinephrine Reuptake Inhibitors, SNRI) that provide at least some degree of relief for many fibromyalgia patients.

“Knowing how these drugs were supposed to work on molecules in the brain,” Dr. Albrecht added, “we had evidence that similar molecules were involved in the function of nerve endings on the blood vessels. Therefore, we hypothesized that fibromyalgia might involve a pathology in that location”. As the results demonstrate, they were correct.

To analyze the nerve endings, Drs. Rice, Albrecht, and postdoctoral researcher Dr. Quanzhi Hou, used their unique microscopic technology to study small skin biopsies (less than half the size of a pencil eraser) collected from the palms of fibromyalgia patients, who were being diagnosed and treated by Drs. Argoff, Wymer, and Storey. The study was limited to women, who have over twice the occurrence of fibromyalgia than men. What the team uncovered was an enormous increase in sensory nerve fibers at specific sites within the blood vessels of the skin. These critical sites are tiny muscular valves, called arteriole-venule (AV) shunts, which form a direct connection between arterioles and venules (see diagram).

As Dr. Rice describes their function, “We are all taught that oxygenated blood flows from arterioles to capillaries, which then convey the deoxygenated blood to the venules. The AV shunts in the hand are unique in that they create a bypass of the capillary bed for the major purpose of regulating body temperature.”

A Thermostat for the Skin

In humans, these types of shunts are unique to the palms of our hands and soles of our feet which work like the radiator in a car. Under warm conditions, the shunts close down to force blood into the capillaries at the surface of the skin in order to radiate heat from the body, and our hands get sweaty. Under cold conditions, the shunts open wide allowing blood to bypass the capillaries in order to conserve heat, and our hands get cold and put on gloves.

According to Dr. Albrecht, “the excess sensory innervation may itself explain why fibromyalgia patients typically have especially tender and painful hands. But, in addition, since the sensory fibers are responsible for opening the shunts, they would become particularly active under cold conditions, which are generally very bothersome to fibromyalgia patients.”

A role in regulating blood flow throughout the body.

Although they are mostly limited to the hands and feet, the shunts likely have another important function which could account for the widespread deep pain, achiness, and fatigue that occurs in fibromyalgia patients. “In addition to involvement in temperature regulation, an enormous proportion of our blood flow normally goes to our hands and feet. Far more than is needed for their metabolism” noted Dr. Rice. “As such, the hands and the feet act as a reservoir from which blood flow can be diverted to other tissues of the body, such as muscles when we begin to exercise. Therefore, the pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the source of muscular pain and achiness, and the sense of fatigue which are thought to be due to a build-up of lactic acid and low levels of inflammation fibromyalgia patients. This, in turn, could contribute to the hyperactvity in the brain.”

Dr. Albrecht also points out that alterations of normal blood flow may underlie other fibromyalgia symptoms, such as non-restful sleep or cognitive dysfunctions. “The data do appear to fit with other published evidence demonstrating blood flow alterations to higher brain centers and the cerebral cortex of fibromyalgia patients” he stated. Senior Research Chair of the Alan Edwards Center for Pain Research at McGill University, Dr. Gary Bennett, commented after seeing the results that “It is exciting that something has finally been found. We can hope that this new finding will lead to new treatments for fibromyalgia patients who now receive little or no relief from any medicine.”

This discovery of a distinct tissue pathology demonstrates that fibromyalgia is not “all in your head”, which should provide an enormous relief to fibromyalgia patients, while changing the clinical opinion of the disease and guiding future approaches for successful treatments.###

About Integrated Tissue Dynamics LLC (Intidyn)

Integrated Tissue Dynamics LLC, located in Rensselaer, NY amid the Capital region’s Technology Valley, provides flexible and scalable pre-clinical and clinical research and consulting capabilities on skin and nerve related chronic pain afflictions in collaboration with the pharmaceutical industry, government agencies, academia, and a network of pain specialists throughout the United States. The Intidyn ChemoMorphometric Analysis (CMA) platform can be used to detect chemical and structural changes in the skin and other tissues related to chronic pain, numbness, and itch associated with a wide variety of afflictions, including diabetes, shingles, complex regional pain syndrome, carpal tunnel syndrome, sciatica, fibromyalgia, psoriasis, chemotherapy, unintended side effects of pharmaceuticals, and others.

How to Support Further Research on Fibromyalgia and Other Types of Chronic Pain

Tax deductable donations to support the research of a nationwide network of pain specialists, which includes Drs. Argoff and Wymer at Albany Medical College, can be made to the Clinical Pain Research Program at the University of California San Diego, an American Pain Society Center of Excellence, by contacting the UC San Diego Office of Development (giving.ucsd.edu; 858-534-1610; specify area of research) or UC San Diego Center for Pain Medicine (anes-cppm.ucsd.edu; 858-657-7072). This network, referred to informally as the Neuropathic Pain Research Consortium, includes top neurologists, anesthesiologists, and research scientists at leading universities and pain treatment centers in California, Illinois, Maryland, Massachusetts, Minnesota, New York, Utah, Washington, and Wisconsin.

Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL (2013). Excessive Peptidergic Sensory Innervation of Cutaneous Arteriole-Venule Shunts (AVS) in the Palmar Glabrous Skin of Fibromyalgia Patients: Implications for Widespread Deep Tissue Pain and Fatigue.

Pain Medicine, May 20. doi: 10.1111/pme.12139 [Epub ahead of print].

Posted at the National Library of Medicine (PubMed): http://www.ncbi.nlm.nih.gov/pubmed/23691965

A description of this study for the general public can be found at: http://www.intidyn.com/Newsroom/article-0008.html

For further information, contact:

Dr. Frank L. Rice, PhD 
frankrice@intidyn.com 
866-610-7581, ext. 102 
©2013 Integrated Tissue Dynamics (INTIDYN)

Dr. Kyle: Cracking Down on Low Back Pain

 

2 people with low back pain attempt 10 minutes of moderate exercise on an elliptical machine. One reports that the pain is better. The other reports that the pain is worse.

What’s the deal?

It turns out that one of the main predictors of stubborn low back pain is hip mobility. You may have heard of the term “hip hinge” before, and this refers to bending at the hips while keeping a neutral spine. Elliptical machines in particular work the gluteal muscles group and keep the spine relatively straight.

When restrictions in the hip develop, the body is unable to “hinge” properly and the low back folds forward to compensate. Over time this repetitive flexion of the lumbar spine causes accumulative stress that is linked to pain!

Could it be serious?

If the pain intensity does not change with alterations in posture, loads and movement, it may not be mechanical in nature. Some “red flags” that may indicate something more serious include:

• Bowel or bladder incontinence
• Numbness in the groin region
• Unexplained weight loss
• Low back pain with fever
• Progressive and constant low back pain

Once these red flags have been ruled out and your back pain has been deemed mechanical in nature, it’s time to develop a plan of management.

What to Do

The first step is to remove aggravating factors. If your back pain is worse bending forward, stop bending forward. If your back pain is worse bending back, stop bending back. To a point. The trick is to find that pain free range of motion and to work within it.

Train the hip hinge! A major part of the process is cueing patients to bend at the hips and not with the low back. This will keep the back straight and reduce shearing forces through the spine.

Next, we train the exercises or movements that take the pain away. For many this involves abdominal bracing to stabilize the spine. A few key exercises include:
• Modified curl up
• Bird dog
• Side plank

Fine Tuning

The final step is to develop strength and endurance. Try to include exercises that challenge one side of the body at a time. This includes lunges, suitcase carries, and one arm rows.

As always, consult the expertise of a registered healthcare professional before starting a strength and conditioning program. Check out my Instagram page @drkylearam for more videos of exercises to prevent low back pain. It’s time to get you out of pain and back on the elliptical!

Rick shares: Research on Massage for Carpal Tunnel Syndrome


Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a condition characterized by tingling, numbness and pain in the hand and fingers (particularly the thumb, index, middle and ring fingers). These symptoms are often the result of median nerve irritation in the wrist or forearm.

BLAUSEN.COM (2014). “MEDICAL GALLERY OF BLAUSEN MEDICAL 2014”. WIKIJOURNAL OF MEDICINE 1 (2). – CC BY 3.0.

Why Give Massage Therapy A Try?

Massage therapy as a therapeutic intervention is being embraced by the medical community, it is simple to carry out, economical, and has very few side effects. One area that is being explored is the use of massage therapy for patients who suffer from carpal tunnel syndrome.

Randomized clinical trials have demonstrated that for some patients who suffer from carpal tunnel syndrome there is no significant differences in pain and functional outcomes at six and twelve months when surgical and conservative care are tested (Fernández-de-Las Peñas et al. 2017).

Why Does Massage Therapy Work?

The responses to massage therapy are complex and multifactorial – physiological and psychological factors interplay in a complex manner. Research has looked at both peripheral and central responses elicited by massage therapy treatments.

Pain Management
Massage has a modulatory affect on peripheral and central processes via input from large sensory neurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease discomfort in patients who suffer from carpal tunnel syndrome.

Peripheral Response
The median nerve passes through many structures and it may be exposed to mechanical irritation at many different points (Filius et al. 2017). Prolonged irritation may result in a reduction of intraneural blood flow. In turn, local hypoxia of a peripheral nerve leads to a drop in tissue pH that triggers the release of inflammatory mediators, known as “inflammatory soup”, this noxious substance can disrupt the normal function of nerves. Massage therapy may diminish intraneural edema and/or pressure by mobilizing the median nerve as well as associated vascular structures (Boudier-Revéret et al. 2017).

Carpal tunnel specific work may also involve specific soft tissue treatment to optimize the ability of mechanical interfaces to glide relative relative to the median nerve. Ongoing tissue hypoxia or inflammatory responses lead to molecular signaling that promote the development of fibrosis, this may contribute to further peripheral nerve dysfunction (Fisher et al. 2015). The application of appropriate shear force and pressure impart a mechanical stimulus that may attenuate tissue levels of fibrosis and TGF-β1 (Bove et al. 2016).

Infraspinatus Test in Carpal Tunnel Syndrome

 The infraspinatus provocation test ( Meder et al. 2017 ).

THE INFRASPINATUS PROVOCATION TEST (MEDER ET AL. 2017).

The etiology of myofascial triggerpoints are still not well understood, but that does not deny the existence of the clinical phenomenon.

A contemporary view of ‘myofascial trigger-points’ is presented by Shah, this categorizes ‘myofascial trigger-points’ by the a number of measurable characteristics: local and remote inflammation, local acidic milieu, local sensitization, local regions of hypoxia, local muscle stiffness (Shah et al. 2015).

Studies have demonstrated that assessing and treating the infraspinatus muscle may be an effective treatment option for a sub-group of patients with suffer from symptoms that present similarly to carpal tunnel syndrome (Meder et al. 2017).

Structures To Be Aware Of When Treating Carpal Tunnel Syndrome

Systematic reviews have also shown that manual therapy combined with multimodal care can improve symptoms, decrease disability and improve function for patients who suffer from carpal tunnel syndrome (Huisstede et al. 2017). Additionally, a recent randomized controlled trial in the journal Brain found that acupuncture improved the outcomes for carpal tunnel syndrome by remapping the brain (Maeda et al. 2017).

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from plantar heel pain may include neurovascular structures and investing fascia of:
• scalene muscles
• costo-clavicle space
• pectoralis minor
• biceps brachii muscle
• bicipital aponeurosis
• pronator teres
• transverse carpal ligament
• anterior interosseous membrane
• palmar aponeurosis
• infraspinatus
• lumbricals