Friday, April 22, 2016

Clinical Neurodynamics: Lumbar Foramen Mechanics and Implications for Nerve Root Health

If you read my last blog post you know that I recently attended the Clinical Neurodynamics course with Michael Shacklock.  One of the most interesting bits of discussion was his research and findings with lumbar foramen biomechanics and it's relationship to the lumbar nerve root.  I've asked permission from him to write this blog post as this is part of the course and he has graciously permitted this.

For the longest time we assumed the foramen in the lumbar spine was doing what the disc did.  This is no longer the case.  The therapy approach Mckenzie has a large component of extension to drive the disc forward.  This has been shown in MRI to be true.  But for the disc to be driven forward, the posterior annulus must essentially spread or get larger to help drive the nucleus forward.  So as this spreads, the foramen actually gets smaller.

So, going forward also does the exact opposite.  As the spine bends into flexion the discs nucleus is pushed back.  The annulus gets smaller.  The foramen increases in size.  A larger foramen is created.  With the larger foramen comes 5 positive and tested outcomes.

1.  The foramen area increases between 15-40%
2.  Pressure on the nerve decreases 30-40%
3.  Size of the nerve root increases.  (from the reduction of the pressure)
4.  Electrophysiology of the nerve improves.  Strength of the contraction is better.
5.  Pain has decreased.    

Essentially the lumbar nerve roots and lumbar discs have opposite biomechanics.  This doesn't mean the Mckenzie approach is wrong.  It just means different techniques for different times  It shows how some approaches such as PRI with their flexion based activities in my opinion give relief to some peoples back pain.

It reinforces to me some very important concepts like Functional Range Conditionings approach to having segmental control of the lumbar spine.  How can you ultimately take pressure of a nerve root if you can't flex the lumbar spine segmentally?

They are showing that the same spine in a standing MRI with disc bulges go away essentially to the point you can't tell the disc has a bulge when the individual goes into flexion.  This doesn't mean flex a disc patient that is in pain.  What it does mean is perhaps the person that has fear based apprehensions to flexion because of a prognosis of disc bulge can be reeducated.

Again, there are some really important points to take away on how to use different movements at different times.  Assess what you want to happen and use movement to help facilitate the right healing environment the body needs at the time.

Thanks again to Michael Shacklock for letting me share this.  I can't recommend Clinical Neurodynamics enough for health practitioners out there.

Tuesday, April 5, 2016

Clinical Neurodynamics Course Review

The last 4-5 years I've pretty much realized what I want from a seminar.  I want to learn something.  I want to be able to go back to my clinic and use the information right away.  I want it to spark some type of further learning.  I'm pretty happy when I get 2 out of 3.

I recently took Clinical Neurodynamics Upper and Lower with Michael Shacklock.  This course fulfilled 3 out of 3 in my wants.  I had read the book years ago and found it to be quite interesting and had tried to incorporate some of the info into my evaluation process when I deemed it necessary.  This is a very well taught course.  He has a great teaching style and I became much better at evaluating normal vs abnormal neural tension.  There is no substitute with having the author himself give you hands on on how to do a test.  There are very subtle nuances to really do the neural tests optimally.  This is something that is hard to get from a book.  The learning of how to regress/progress each neural test for treatment is invaluable in my opinion.    

I've found that great courses are able to be incorporated with whatever technique or approach you use in practice.  In fact, as I was sitting their listening I was able to see how several techniques I have an interest in are actually saying or doing some similar thought process without knowing it.  So in a way, it helped my philosophy on my approach to practice.  

It's interesting how martial arts and stuff like Scott Sonnens IntuFLow or Pavels Mobility looks very similar to some neurodynamic upper body techniques.  

This was the first I've heard of how disc and nerve root have opposite mechanics.  This was fascinating to me.  Extension of the spine opens up disc, but closes on the nerve root and vice versa.  Perhaps this is why some Flexion based PRI exercises have helped many back pain patients.  I will be devoting a separate blog post on the lumbar foramen biomechanics, so stay tuned!

Realizing that lumbar nerve roots can have 7mm of movement when both legs are involved in a straight leg raise makes you see how an L5 ELDOA technique can be so useful.  

It had me realizing my lack of blood flow physiology knowledge.  Understanding all that takes place with venous and nerve interplay and how that affects swelling and performance.  There is a dose response to blood flow on a healthy nerve.  The research is there.  Getting edema off a nerve and increased oxygen will result in less fibroblast activity.  Better tissue quality.  

I was surprised I was the only Chiropractor there.  It seems this is just up a chiropractors wheel house.  This guy lives and works in Australia so you don't get a ton of shots learning from him in the states.  That is a shame.  

I would highly recommend this seminar to anyone that was thinking about it.  

Sunday, March 20, 2016

A Week With The Elite

Whenever I go on a trip or to a seminar I always look back at my notes/thoughts and write up my take aways.  Some of the stuff I publish on this blog, some I never do anything with.  A few weeks ago I spent 10 days down in Scottsdale, AZ with the professional track and field organization called ALTIS.

ALTIS is where professional track and field athletes (mostly sprinters/jumpers/throwers) come to live, train, get high level coaching and high level therapy year round.  They make a living as an athlete.  They travel the world competing on the track.  Most will be competing for their country at the Olympics (hopefully).  ALTIS isn't just for Americans.  Any country or athlete that qualifies can come train.  While I was there athletes from China, South Africa, Canada, Korea, Germany, Scotland, England, Australia, Ivory Coast and I'm sure a few others were there living and training.

First, some impressions.  There isn't magic formulas and secret workouts.  It's often assumed because someone is elite, that they do special "stuff."  In fact, if you were to write it down on paper it would be somewhat boring  "Really, this is it?"

When you step back you can see the beauty in the basics.  Mastery.  They master the basics.  They master drills, they master posture, they master the boring.  They sleep well.  Hydrate well.  Eat well.  Bring enthusiasm and joy to the workplace (track) They listen well....and do it day after day.

There aren't secrets.  Successful people and organizations don't have secrets.  In fact, ALTIS offers clinics all the time that allow coaches and therapist come and watch and learn exactly what they do.  Day in and day out.   The programming and coaching is simply smart.

I think often times athletes get injured when they or there coach over reach (over complicate) their progressions/workouts.  Probably the notion that mental toughness can be achieved by physical beat downs still exist in the college track scene.  Running to get tired.  If being tired meant you got better, I'd be world class athlete from my chasing my 2 kids around.  Smart training, done consistently.

2nd, some questions I have received.

Can someone if they work hard enough become that fast?  Quite simply, no!  To have the ability to run 9.9 in the 100m is a God given genetic talent.  Does that mean they don't have to work that hard to do it?  Absolutely not.  Just because you have the ability doesn't mean it will happen.  Years and years of training and hard work on top of unique talent is what it takes.

Is it a lot different working with elite athletes vs the average joe?  Honestly, no.  Anatomy is anatomy.  Histology is histology.  Joints move and muscles contract.  Fascia transmits.  Humans respond to load and fatigue.  The nervous system is the same.  What is different is sometimes the quality of muscle tissue.  They have taken better care of themselves.  This lends to faster recovery.  But, the same attention to detail goes into treating an average joe as goes into treating the elite sprinter.

If you had to do it all over again, would you do the same educational path?  A lot of the work I do isn't traditional chiropractic in the truest sense.  There are PT's that adjust.  I consider myself a strength coach that adjusts joints and treats connective tissue and makes everything play nice.  I doubt if I would need a Chiropractic license to do the exact stuff I do today, but I also don't think I would have been afforded the opportunities that I was presented with without it.  Catch 22.  (PS..I'm glad I went to school)

Take aways.  Start today on getting better at the basics.  Being around Olympians and Elite athletes you can't help but feel the urge to get better.  Today is the first day of Spring.  Pick something in every area of your life to improve on and commit to doing it every day.  Walk 10 minutes.  Do 50 push ups.  Read (study) for 20 min on a topic in your field.  Write a paragraph.  Eat 3 more vegetables.  Save 10 dollars.  Get 8 more minutes of sleep tonight.  Drink 2 more glasses of water.  Start becoming a master of the basics.  That is the path to an Elite life.

Monday, March 7, 2016

Don't Let Your Hobby Become A Chore

More and more I stop and ask myself why I do what I do in training and fitness.  More and more I stop and ask my patients why they are doing what they do in training and fitness.  I've decided there are good answers and there are answered that we won't call bad, but they need to be explored more.

I'm going to go back and use my 8 year old self as the filter to this question.  My 8 year old self, loved Star Wars, playing in the woods, playing with my dog Chelsea, playing baseball, building forts, reading books, climbing trees and riding bikes.  (Not to much has changed)  lol

My 8 year old self hated weeding, raking leaves, shoveling snow, hanging laundry, doing dishes, mowing the lawn.  Life Chores.  (Nothing has changed here!)

I can remember running as fast as I can for as long as I can.  Not because I was trying to prove something to someone or to myself (important point to remember) but because I liked that feeling of being utterly spent and exploring what my body could do.  If you had asked me why after I had done something like that I'm pretty I would have just said, "It was fun."

Why are you training that particular way?

I like riding my bike.  A few years ago I was talked into doing a longish ride/race/event.  Every weekend I'd go and add a chunk of time on my ride, till I was up to about 6-7 hours.  I hated it.  I really don't like riding my bike longer then 2 hours.  This wasn't fun.  It had taken a fitness activity that I had really liked and made it a life chore!

How often do we let our hobbies become life chores?  Something that becomes another check mark on our daily to do list.  No longer something that we look forward to, that pumps are body with feel good "stuff."

Why is this an important distinction?

Runner comes in banged up and injured.  "I started running to lose weight and found that I really enjoyed it."  I loved the feeling of just getting out there and forgetting the stress of my day for awhile.  I started training for a 1/2 marathon a few months ago and now my last long run I got really sore, but the plan called for me to run again and now my hip has been hurting ever since.  But, "I HAVE TO GET MY MILES IN."

This isn't a rant on smart training or listening to your body.  It's about defining your relationship to fitness and training.  If it's about proving something to you or someone,  I'm not sure you can get that from exercise or an event.  It might seem frivolous to do only stuff that is fun, but research shows exercise that is a stress, doesn't really do a whole lot for us.  In fact, I personally think it opens us up for injury and sickness.

This is a rant about protecting the stuff you love doing.  The stuff that brings genuine joy in the activity.   Guard your joy.  This is what will bring health and happiness in your fitness and training.  If your workouts have become a chore, analyze when and how it did.  Rethink your goals.  Don't get caught in the elusive trap of comparing yourself to another.  Don't get caught in the trap of letting a hobby become a chore.  Chores suck.

Sunday, February 28, 2016

Everything I Need To Know About Health I Learned from My Dog

It's been a little more then a month since I had to make the decision to put my dog Rocco to sleep.  A tumor had ruptured by his spleen and in a matter of days he went from a vibrant dog full of energy, to unable to raise up on his legs.  To say it sucked, would be an understatement.  It was a strange combination of easy/hard and to say goodbye.  You never want something you love to be in pain, so it was easy.  You don't want to lose something you love, so that was hard.  That is pretty much life.  

After a few weeks of missing him I started to think about how amazing dogs are.  There are a lot of health benefits to having a dog.  Here are a few.

Reduction in stress.  People with dogs in their lives were able to deal with stressful situations with less anger.  Lower blood pressure.  Just the act of petting a dog will lower ones blood pressure.  Increase in the feel good neurotransmitters were also measured with those that owned dogs.  Kids tend to have less asthma and allergies when they grow up with dogs.  People tend to exercise more,  dogs keep you moving.  This is less obesity and less arthritic pain episodes.  There is also a tendency to be more social when you own a dog.  This can have several trickle down effects of health as staying social is related to lots of positive health scores.  

I always enjoyed the book, "Everything I Need to Know, I Learned In Kindergarten," by Robert Fulghum.  So in honor of my late friend, I've thought about that and here is my take.

Everything I Need to Know About Health I Learned From My Dog.

1.  Wake up and Pandiculate.  Pandiculation isn't stretching, it's a way of contracting your muscles and then releasing them.  It is a way of keeping your spine healthy and we naturally do it when we yawn.  Do this every day, multiple times of day. 

2.  Drink water.  Drink lots of water.  Hydrating is important. 

3.  Go poop everyday.  You would be surprised how important this is for your health.  You literally need to get the "crap" out of your body.  Don't hold on to your waste.

4.  Play.  We don't stop playing because we grow old, we grow old because we stop playing.  There is so much truth in this.  Play games, don't just exercise, find a hobby you love doing, play at it.  

5.  Exercise.  Dogs love to walk, run, wrestle, tug of war and play fetch.  In fact, this is just what humans need.  Walking (slow endurance) wrestle and tug of war (some resistance exercise) Fetch, some faster interval workouts with small amounts of rest.

6.  Hang out with those you love.  Most of the time dogs just want to be with you.  Laying in the same room as you do whatever.  Hang out with those you find important.  

7.  Greet everyone with a wag of the tail.  Greet everyone as a potential friend.  The world would be a better place if we all did this.  

8.  Eat Good Food, but not all of it.  Rocco would eat until he was full, but wouldn't eat all the food in his bowl if he wasn't hungry.  Learn to stop eating when you are not hungry.  Just because it's on your plate, doesn't mean you need to finish it.

9.  Sleep.  Healthy dogs sleep like 12-16 hours a day.  Humans tend to not sleep enough.  Take naps, get your rest.  Sleeping is so undervalued.  Every day we realize more and more how lack of sleep is detrimental to our overall health.

10.  Lay in the sun.  When you find some sun, lay in it.  Get your Vitamin D.  Relax and Enjoy.

We rescued him around 7 years ago.  They thought he was about 3 when we did.  He had been walking the streets of Oklahoma City when he was picked up, they thought he was a Katrina Dog.  I wish he had lived longer, but am thankful he got to be a great friend to my oldest daughter Piper and got to spend a year and half with my youngest Skyler.  He will be missed, but I'm grateful for all the days of friendship and health that he taught me.  

Sunday, January 31, 2016

Mushrooms as Medicine with Paul Stamets

I could listen to Paul Stamets (One of the leading Mycology experts in the world) all day.  Super cool info.

Tuesday, January 26, 2016

Things I Don't Understand

Ever now and then I think to myself, this really doesn't make a lot of sense, I usually just move on, but I figured I would keep a list of them lately.


Ordering a Starbucks drink with room for cream, they put the lid on.  I then carry my covered drink 3 steps to the cream, take the lid off, pour in the cream and put the lid back on.  Why not just give me the drink with the lid off?  (maybe it's policy)

When a patient comes in as a new patient for you to look at something, (quite chronic) and they proceed to tell you they have a surgery scheduled for one week, but wanted to see if you could do anything.  This has happened so often, I quit keeping track.  A good rule of thumb, if you really want to avoid surgery, give yourself the same amount of time to see what can be done as the amount of time you will be in rehab.  So if you are having a shoulder surgery that requires 4 months of rehab, give yourself 4 months to see if indeed a surgery can be avoided.

People that do an exercise that they know hurts them even though they are doing it to feel better.   Every time I do the yoga twist my back is sore for days?  Why do you keep doing it?  I want my back to feel better.  Talk about an oxymoron!  This goes for every exercise.  I've had people tell me everything at some point.  Ask for an alternative, or figure out the why that exercise hurts.  But, don't keep banging your head against the wall hoping it solves your "headache."

People that tell me coffee is unhealthy.

The gap between what we know in physical education and actual school education.  There is researched well known facts, that are repeated over and over that shows direct relationship between physical activity, (gym, play, recess) and doing better in school.  Yet, it's getting systematically cut from the schools.  Ironically, these same schools are cutting it to chase better test scores.

You brush your teeth most likely 2x a day.  Your teeth can be replaced.  Dentures.  Do you want to do  But, it can be lived with.  How come no one does a musculoskeletal "cleaning" 2x a day.  Something as simple as a minute of cat/camel in the morning and evening.  You don't have the option of replacing your spine.  Your just old before your time.

People that tell me they don't like to read.  This statement is for foreign to me.  I grew up loving books and still do.  As a kid, you could travel to amazing adventures.  As an adult you can travel to amazing adventures, that you can actually plan on doing yourself!  Some books are also like the boiled down version of everything a person knows.  A person may have worked in a field for 30 years and then taken that 30 years of lessons/experience and boiled it down to 300 pages.  In a matter of hours you can download that 30 years for yourself.  Whenever I get a new book, I get a little excited and think about that scene in the Matrix where Neo downloads a new program..."I know Kung Fu."

People that expect to be good at something they have never done.  Being good at golf, doesn't make you good at swimming.  Lance Armstrong was downright mediocre as a runner, he was the best biker in the world.

Equating security for freedom.  This job has good health insurance so I'm staying at the job I hate.  That is self imprisonment.

Why my 16 month old can't sleep through the night.  Kid, give us some uninterrupted sleep.  We'd all be better off including you.

People are still smoking that are under 50 years old.  I give you an age break, because lets face it, addiction is a real thing.  I'm not going to judge that.  In the 50's and 60's they still had advertisements that it was healthy.  Presently, there is no room for misunderstanding.  It is horrible for your health.  No one thinks you look cool.  There is no possible reason to even try smoking.  Yet I still see younger people huddled in the freezing cold, puffing away their health and money.

Spending primo money on things you put on your body, clothes, lotions, shoes and looking to spend the least amount possible on the things you put in your body.

Young athletes that are looking for the keys to the kingdom, but ignore sound advice, like get 8 hours of sleep, drink lots of water and eat protein with every meal.  The next visit they are asking about some new supplement that is like 70 dollars.  You getting good sleep yet?  No, but I'm working on it. Have you ever heard of XYZ MAX PRO?  It's supposed to put on lean muscle really quick.  LOL.

I'm sure at some point I'll think of some more.