Most of us have experienced some sort of pain.

There is a tendency for patients and their healthcare providers to focus on the site of pain.

Approaching pain from this perspective can often be frustrating for both the patient and practitioner.

Hence the title of this week’s blog:                                   Pain- Is it the Puppet or the String?

The site of  chronic pain  can often be an  inflammatory puppet

In general,  the site of pain is where there is some sort of irritation that creates local tissue damage. In turn, the body attempts to “wall off” and heal the damaged tissue with the production of biochemicals.

This chemical cascade leads to several phases of healing, with the optimal end result being tissue remodeling and complete repair.

The problem

In many circumstances, the body’s healing process is disrupted by inadequate nutrition, poor biomechanics, lack of corrective rehabilitation and overuse of anti-inflammatory medications.

In addition, more often than not, the area being treated (especially if it is chronic)  is the “puppet”, while the underlying cause is orchestrated somewhere above, below and even possibly on the opposite side of the pain.

A good example is a typical case of tendinitis.  Most people focus on where the tendon inserts into the bone, which is usually where the pain is felt. However, as is illustrated below, it is the shortened muscle pulling on the tendon where it inserts into the bone that causes the pain.

If you have some sort of joint pain, feel the muscles leading up to and around the joint.

More than likely there will be “hot spots” or tender points (the shortened muscle as seen above).

These spots are often the “strings” that are the source of pain.

Bonus Recipe-  I have modified my Gluten Free Chocolate Chip Cookies and they are good!

Dr. Geoff’s Gluten Free Chocolate Chip Cookies

Ingredients

• 1 1/2  cups ground raw almonds (in Vitamix). Trader Joe’s almond meal also works.
• ¼ cup dried, unsweetened, shredded coconut
• ½ tsp salt
• ½ tsp baking soda
• 1/2 cup extra virgin coconut oil (I like Barleans)
• 1/4 – 1/2 cup local honey
• 1 tbsp vanilla extract
• 1/2 cup dark chocolate chips (70% cacao)

Directions

• Preheat oven to 350F.
• Mix dry ingredients
• Melt coconut oil in a small skillet over low heat.
• Turn off flame and add honey to the oil.
• Add vanilla extract to the honey/oil mixture and pour into dry ingredients.
• Allow mixture to cool
• Add chocolate chips and mix well
• Form small balls of the mixture and place on a cookie sheet lined with parchment paper
• Cook at 350 degrees for 7-9 minutes (check at 7 minutes)
• Let sit for 20 minutes to allow for hardening

Let me know what you think.

I will be teaching a Trigger Point Performance class in Seattle this June:

Myofascial Compression Techniques (8 hr) – Seattle

Saturday, June 08, 2013 9:00 AM – 5:00 PM (Pacific Time)

Elite Performance Center

413 Fairview Ave.

Seattle, Washington

United States

For registration: Trigger Point main office: (512) 300-2804

 Did you know you can now schedule online?                                                                               

http://wwws.practicefusion.com/98936a7b-2bbd-456d-a45f-b565eafbf156

Unfortunately, while this approach may seem to make sense, in many cases, it is counterproductive and can possible adversely affect recovery and/or predispose one to chronic problems.

Another approach involves manual stimulation to mechanically load the injured tissue.

The effect of mechanical load on soft tissue is receiving a lot of attention in the rehab community, especially among those involved with fascial research.

Research shows that soft-tissue mechanical loading, including exercise, manual muscle treatments such as fascial release, stretching techniques, acupuncture and instrument-assisted soft-tissue mobilization methods, all affect the cells called fibroblasts.

Fibroblasts are considered the most important cells in the extra-cellular matrix (ECM). The ECM is the extra-cellular part of  tissue that provides structural support to the cells, in addition to performing various other important functions.

It is the defining feature of connective tissue. The repair, regeneration and maintenance of soft tissue take place in the ECM.

Fibroblasts synthesize essential substances such as collagen, elastin and proteoglycans.  They have the ability to act as mechanotranducers, meaning they are able to detect biophysical strain such as compression, torque, shear and fluid flow, and in response, create a mechanochemical response.

Manual fascial techniques (e.g. cross friction massage and gua sha) can stimulate fibroblasts, resulting in an anti-inflammatory response and positive clinical outcomes.

Injuries strain fibroblasts and fascia in negative ways, while controlled manual muscle treatments strain fibroblasts in curative ways.

Light fascial-release technique can have an anti-inflammatory effect on acute conditions, while a deeper manual loading may be more beneficial for chronic tissue injuries.

Inflammation is often regarded as a bad thing, hence the common practice of prescribing anti-inflammatory medications (NSAIDs) and using ice.

NSAIDs can block the healing of an injury by disrupting the inflammatory process and inhibiting fibroblastic activity and collagen formation.  They also have numerous side effects.

Inflammation  is how the body heals. If you stop this process, injuries either heel poorly or not at all.

Mechanically loading a tissue through soft-tissue mobilization leads to an increase in fibroblasts and the re-creation of an inflammatory process.

This healing cascade enhances the supply of blood and  nutrients  to the region, aiding in healthy collagen deposition and soft tissue repair.

Increasing fibroblasts is an essential way of producing clinical results -  it facilitates healing.

Does your pain keep recurring?

Do you feel like your health care providers are chasing your pain?

Has your treatment been directed towards your symptoms vs the cause?

Pain usually begins with some sort of injury affecting the Human Movement System (HMS): Soft Tissues, joints and the nervous system.

Over time, this results in a pain-injury cycle

Are you on your Pain-Injury Cycle?

In the pain-injury cycle, tissue trauma causes inflammation, muscle spasm,  the formation of adhesions,  altered neuromuscular control, muscle imbalances (over active muscles and under active muscles) and joint dysfunction,

Over time, dysfunctional movement patterns become learned by the brain and nervous system, affecting Motor Behaviors.  

The Brain, Motor Behavior and Pain Patterns:

Motor Behavior is influenced by:

1. Motor Control- Where posture and movements are used by the nervous system to assimilate and integrate information from previous experiences
2. Motor Learning- Practice and experience leading to a relatively permanent changes in ones capacity to produce movements
3. Motor Development-The change in motor behavior throughout one’s life

So how does one undo undesirable motor behavior that perpetuates pain and injuries?

After an injury, the motor control center in the brain adapts with compensatory patterns of imbalance as described above.

It holds these in its memory indefinitely-  unless reprogrammed to change.

Reprogramming involves some intervention that inhibits over-active muscles, activates under-active muscles and re-establishes functional movements through corrective exercise.

How can you reprogram your brain to eliminate your pain?

1. Identify the problem through an Integrative assessment
2. Solve the problem through a  step by step process (Inhibit*Lengthen*Activate*Integrate)
3. Implement a corrective solution through exercise

An Integrative Assessment consists of a movement screen that identifies faulty movements. These dysfunctional movements can then be further assessed with range of motion and muscle testing.

The assessment identifies which muscles are tight, which are weak and the joints they are affecting.

The step by step solution includes deep massage and/or dry needling to the tight muscles, followed by stretching. Positional isometric exercises to the weak muscles, joint mobilization and functional exercise e.g. squat, lunge, row.

A note on Acute vs Chronic pain/injuries

Acute pain/injury is characterized by tissue damage. These injuries usually require minimal care and respond quickly because the brain has not had time to learn a new pattern. If you have an acute injury, take the appropriate measures to make sure that it will heal properly. Restricting movement is not always productive and in many cases will lead to chronic pain. There are numerous treatment options to normalize movement in an acute injury and reduce the pain cause by biochemicals that are involved in the healing response.

Chronic pain/injuries is characterized by fibrosis, muscles imbalances and joint dysfunction. In this case, movement restrictions are perpetuated by the nervous system and brain. It takes longer to undo these restrictions. Palliative therapies such as electric stim and ultrasound are generally ineffective. This type of pain requires deep manual therapies to break up the adhesions and corrective measure as described above.

Lately I’ve been receiving a number of referrals from other practitioners (MD’s, PT’s and other Chiropractors) for a technique I learned about 20 years ago called Dry Needling.

Dry needling is a procedure in which a filiform needle is inserted into the skin and muscle directly at  myofascial trigger points.

Myofascial trigger points consist of contraction knots, which are related to the production and maintenance of the pain cycle (see prior posts).

Dry needling was introduced by a Czech physician Karel Lewit in 1979.

Lewit noticed that the success of injections into trigger points for relieving pain was unconnected to the analgesic used and could be achieved using a dry needle.

Chan Gunn, who introduced me to this procedure, developed a type of dry needling called intramuscular stimulation (IMS) in the 1980s.

Gunn believed that the peripheral muscle spasm was not the origin of pain, but instead, tight paraspinal muscles were causing spinal nerve compression (radiculopathy), and nerve damage running peripherally.

This spinal nerve damage eventually reached the associated muscle, causing shortening and trigger points.

Gunn recommended a needle be placed in the paraspinal muscles in addition to the distally affected muscle.

Later, Peter Baldry developed a version called superficial dry needling in 2005, in which the needle is inserted about 5–10 mm into the tissue above the trigger point.

Baldry practiced deep dry needling until he had a patient in the early 1980s with a trigger point in his anterior scalene muscle. Baldry decided to only penetrate the skin for fear of puncturing a lung.

Baldry has such success with this technique that he applied it throughout the body by simply puncturing the skin superficially over a trigger point without actually reaching it.

How does Acupuncture differ from Dry Needling?

The answer to this question depends upon who you ask.

An acupuncturist would say that dry needling is the same as treating “Ashi” or tender point acupuncture.

Someone trained in dry needling would argue that while the tool (i.e. the needle) is the same, the decision as to where to place the needle is different.

Having been trained in both traditional acupuncture and by Dr. Gunn in IMS style dry needling, my answer falls in line with the dry needle interpretation.

In tender point acupuncture, there is a TCM (Traditional Chinese Medical) Assessment that evaluates meridians and energy by looking at the tongue and feeling pulses. Points are chosen in order to balance energy in the dysfunctional meridians.

While some of the points chosen by a TCM trained acupuncturist may be similar to those used in dry needling, to be effective, there is a more to it than just treating symptomatic tender points.

In dry needling (at least the way I practice), the assessment includes:

1. A movement screen
2. Range of motion evaluation
3. Strength testing
4. Palpation

The needling is usually only part of the treatment which also includes:

1. Manual therapy
2. Stretching
3. Corrective exercise
4. Nutritional support

Is one form of therapy better than the other?

In my opinion, the dry needling approach is more effective for musculo-skeletal conditions, injuries and performance enhancement, whereas TCM acupuncture excels at internal medical conditions.

The following is a typical example of how acupuncture or dry needling would approach a problem:

A patient complains of pain.

The acupuncture approach includes a tongue and pulse diagnosis along with a series of questions.

The patient is then categorized as being in excess or deficient.

This leads to a TCM or constitutional diagnosis.

The patient would be treated with local points and constitutional points to balance meridians and Qi. They are also generally prescribed herbal formulas.

The dry needling approach would involve a medical history and an examination to include:
1. A movement screen

2. Range of motion evaluation

3. Strength testing

4. Palpation

Needles would then be used mechanically to deactivate trigger points in both the over active (tight) and underactive (weak) muscles as well as the involved paraspinal muscles.

These muscles would then be stretched or activated accordingly, to either lengthen of strengthen the involved muscles.

Lastly, home corrective exercises would be prescribed to reinforce the treatment.

The examination and treatment might include the joints above and below depending upon what shows up in the movement assessment.

Whereas acupuncture points are generally stationary, the points used in dry needling are specific to the individual’s dysfunction and can vary accordingly.

Physical therapist, chiropractors and naturopathic physicians are all starting to embrace dry needling, but are limited to practicing it in certain states (not currently in  Washington).

To my knowledge there are few if any other practitioners trained in both TCM style acupuncture and dry needling, which would be the only legal way to receive this procedure in Washington state other than from medical or Osteopathic doctors who has been trained.

For more articles on this style of needling, please visit my website:

www.drgeofflecovin.com

We spend billions of dollars each year on the health consequences of metabolic diseases such as obesity, diabetes, cardiovascular disease and cancer.

We know that these diseases are related to nutrition and are largely preventable, but what is the optimal diet and why are the current recommendations perpetuating the problem?

Americans are eating what we’ve been told to eat – less fat, more grains and starches – yet we’ve been getting fatter and fatter.

Is the problem simply an energy imbalance as conventional wisdom would have us believe, whereby obesity is caused by the consumption of more calories than are expended?

I think not.

An alternative hypothesis (the one I buy into) is that obesity is due to an imbalance in macronutrients (carbohydrates, proteins and fats) and deficiency in nutrient-rich foods, leading to people being over-fat and under-nourished.  To put it simply, eating processed foods (and that includes gluten-free and other so-called “healthy” food products) triggers adverse metabolic effects of hormones and enzymes.

How can you successfully take a metabolic approach to fat loss and health?

1. Metabolic diet
2. Metabolic exercise

Diet

Metabolically speaking, a diet that is optimum for fat loss and healthiest for the long-run is one that provides a balanced proportion of macronutrients along with vitamins, minerals and phytonutrients in abundance. Some of the key hormone players include:

1. Insulin
2. Cortisol
3. Leptin
4. Ghrelin

In general, a “paleo” type diet that emphasizes local, seasonal, organic meats, seafood, eggs and vegetables, with some fruits and nuts is a recipe for success.

Food sensitivities unique to an individual can also hamper fat loss.  I have guided people in eliminating  foods to which they are sensitive. Some have lost a significant amount of weight in a short period of time.

For those who do better with specific meal plans, rather than concepts, I refer you to my wife, Stephanie, who has been in practice as an RD for eight years, going to clients’ homes for nutritional counseling and kitchen makeovers: www.nutritionhousecalls.com .

Stephanie uses our kitchen as a “nutrition lab”, developing new recipes and ways to prepare foods that taste great and our optimum for metabolism.

Exercise

Cut out the steady-state cardio, here’s why:

1. Numerous studies make a compelling case that too much cardio can impair the production of the thyroid hormone T3 and its effectiveness on regulating metabolism, particularly when accompanied by caloric restriction, a common practice.
2. Too much steady-state cardio (i.e. running or exercising on a machine at a steady state) results in less fat burning as your body becomes more efficient at using fat as fuel.
3. Too much steady-state cardio also triggers the loss of muscle due to heightened and sustained cortisol levels, which up-regulate myostatin, a potent destroyer of muscle tissue.
4. As muscle mass declines from too much cardio, so does bone density.
5. There is a tendency for people who focus on this form of exercise to over-eat and/or have a reward mentality for the “hard work” they have done.

Intensity, Intensity, Intensity:

1. Interval training involving  short bursts of high intensity exercises results in sustained fat burning and muscle growth (look at a sprinter or boxer vs  a marathoner)
2. Weight lifting  (if done properly – i.e. following the OPT format) can lead to increased lean body mass, stronger bones, better balance  and enhanced fat burning capacity.

As with nutrition, if you need more one-on-one training, I can recommend a personal trainer to get you going.

For more information on individual program design, please contact our office at (425) 999-4484

We now have online scheduling:

http://wwws.practicefusion.com/98936a7b-2bbd-456d-a45f-b565eafbf156

So you’re feeling a little “toxic” and want to do a “cleanse”. Your friend told you about a juice fast she did. Should you do it?

Juice fasting is a multi-million dollar trend purporting that one can detoxify the body through a nutrition plan that consists of juices made from fruits and vegetables and sometimes herbs with diuretic and laxative properties.

These programs can cost a few hundred dollars, depending on the company you go through and how many days you perform the “cleanse”.

Some juice fasting claims include:

1. Weight loss
2. Detoxification
3. Increased energy and alertness
4. Mood enhancement
5. Colon cleansing
6. Alkalizing the body
7. Immune system enhancement

Are juice fasts a safe and easy way to lose weight?  

Juice fasting typically lasts 3-7 days, which is about how much time it takes for the body to lose the water weight stored within muscles and subcutaneous fat.

Water is stored within muscle alongside glycogen, which is the body’s storage mechanism for carbohydrates.

As you use up the glycogen stores, your body drops the water weight.

The glycogen is used up over 3-4 days, and all the water weight is dropped over the next 2-3 days. The end result? You lose weight…sometimes up to 10 pounds.  Unfortunately the weight you lose is mostly water weight and probably some muscle, since you’re eating next to no protein.

Once you go back to eating normally again, you will gain much (if not all) of that weight back, since your body will replenish its glycogen (and consequently its water) stores.

Does juice fasting detox the body by removing poisons and toxins?

Detoxification is the process of clearing toxins and excess mucus and congestion from the body. Many of these toxins come from our diet, drugs, and environmental exposure.

Poor digestion, reduced liver function, and poor elimination through the kidneys, bowels, respiratory tract, skin and lymphatic system all add to increased toxicity.

Detoxification involves dietary and lifestyle changes that reduce intake of toxins and improve elimination through the aforementioned organs and pathways. Avoidance of chemicals from refined food, sugar, caffeine, alcohol, tobacco, and drugs helps minimize the toxic load. Drinking extra water and increasing fiber by including more fruits and vegetables in the diet aids in the detoxification process.

While organic vegetable and fruit juices supply some nutrients that are helpful in the detoxification process, the fact is that our bodies are detoxing all the time. If we eat a whole foods diet, exercise, avoid alcohol, get adequate sleep and reduce our exposure to environmental toxins, we will facilitate the detox process in a way that is sustainable and long-lasting, thereby leading to long-term health benefits rather than short-term water loss.

Does juice fasting make you feel more energetic?

Energy comes from carbohydrates, proteins and fats, with carbs being the preferred energy source for the brain. Juice is composed of simple sugars (carbs), which provide immediate (but not sustained) energy. The energy that people report may be due to temporary surges in blood sugar.

Do juice fasts or any other form of detoxing improve digestion and cleanse the colon?

The small intestines and colon are designed to clean themselves. If your bowels become sluggish as a result of your diet, lifestyle, medications, or other factors, then addressing those issues is the way to improve digestion. Ironically, one of the best nutrients to “cleanse” the colon is fiber – which is eliminated in juice cleanses, since all the pulp of the vegetables and fruits is discarded.

Other considerations to improve digestion include increasing hydration, eating pre- and probiotics (or taking a probiotic supplement), identifying food sensitivities and intolerances, and possibly supplementing with magnesium if you are constipated.

What about the alkalizing theory?

Can your food significantly affect your body’s pH?

Your kidneys and lungs are constantly working to maintain a narrow pH range. Your body has mechanisms in place to bring your pH to equilibrium in the event that something happens to raise or lower the pH. This is critical to our survival.  The idea that we should attempt to override this survival system by drinking some vegetable juice is counter to basic physiology.

Can a juice fast boost the immune system?

Fruit and vegetable juices are certainly packed with phytonutrients, vitamins and minerals. These nutrients are helpful in keeping our immune systems strong.

A balanced diet that includes healthy fats and whole foods can also be loaded with these same nutrients, but with added fiber, protein and healthy fats, all of which are also essential for a robust immune system.

On another note, there are some benefits of intermittent, short-term water fasts, but I’ll save that for a future blog.

For more information on anti-inflammatory eating, exercise and naturopathic approaches for optimum health, please don’t hesitate to e-mail me or contact our office for a consultation.

How many times have you asked yourself (or your significant other), “Do I look fat in these jeans?”

A better question to ponder would be, “Do I look fat because of my genes, and if so, can I change them?”

In the March issue of Cell Metabolism, researchers found that when healthy but inactive men and women exercise, within minutes there are immediate changes to their DNA.

The underlying genetic code in human muscle isn’t changed with exercise, but the DNA molecules within those muscles can be chemically and structurally altered, resulting in structural and metabolic benefits.

These DNA changes are known as “epigenetic modifications” and involve the gain or loss of chemical marks on DNA.

The DNA within skeletal muscle taken from people after a burst of exercise is stretched in a way that “turns on” genes important for muscles to adapt to exercise.

After exercise, more genes are turned on in DNA. The more intense the exercise, the greater the production of enzymes and nutrients that the muscles need to get energy and burn calories.

Interestingly enough, exposure of an isolated muscle to caffeine has the same effect of mimicking muscle contraction (albeit in amounts that would be considered toxic to consume).

Obviously this doesn’t mean that drinking coffee can replace exercise; however, there may be a synergistic effect of combining the two.

What is the definition of intense exercise?

There are a few of factors that affect the intensity of an exercise session resulting in DNA modification and optimal adaptations:

1. Load - How much weight you lift
2. Volume - How many repetitions and sets you perform
3. Time – The timeframe in which you complete your exercise session and how much time you allow for recovery between exercises and exercise sessions
4. Frequency - How often you exercise

Based on research, intensity is the key.  Slow aerobic activity is not ideal and can be counter-productive for optimal genetic changes. In fact, some research has shown that people compensate after aerobic sessions by over eating. In addition, this type of exercise can break down muscle, adversely affecting metabolism and health.

Resistance training work-outs involving moderate weights and super-sets (back-to-back exercises) are short (usually 20-40 minutes) and intense, but yield optimum results.

These should be tailored to an individual’s level of fitness and abilities. A person can have an intense workout performing stabilization exercises if based on an assessment that is what they should be doing.

High intensity interval workouts (e.g. sprints, hills and jumping rope) are also effective exercise strategies.

The combination of personal and clinical experience has enabled me to design exercise programs leading to optimal adaptations for those desiring weight loss and/or muscle gain. If you feel like your genes are preventing you from getting into that favorite pair of jeans,  let’s talk.

Much of what I do involves treating myofascial trigger points for pain, sports injuries and performance enhancement.

Almost all of my patients are given home instructions on how to perform self-myofascial release, an extremely effective rehabilitation technique.  Those who perform these exercises generally rave about their effectiveness.

What are Myofascial Trigger Points?

A myofascial trigger point (TP) is an area of hyperirritability located in a tight band of muscle, resembling a rope-like nodular area within the muscle that is painful upon palpation and can refer pain and tenderness to a remote area.

TPs have been found to cause musculoskeletal pain throughout the body. They cannot be diagnosed by imaging or blood work; rather, they are revealed through functional examinations involving range of motion, strength, length and palpation assessments.

This type of pain in often chronic and may be relieved by chiropractic, physical therapy or massage.

Other effective therapeutic techniques that are commonly advocated for decreasing TP pain include dry needling, injections, fascial release and active release.

In my opinion, patients should be actively involved in their treatment, acting as their own primary pain managers with the guidance of a healthcare provider knowledgeable in identifying and treating this type of pain.

With the right instruction, many chronic musculoskeletal conditions can be managed at home by performing myofascial compression techniques. These techniques can also be used as a warm-up and warm-down for an exercise session or sporting event and have been shown to be effective for performance enhancement.

In a study published in Physical Therapy (Volume 80, No. 10, October 2000), results indicated that clinicians can manage pain associated with TPs through prescribing and monitoring a home program of ischemic pressure and stretching.

Myofascial Compression Technique

Compression is done using specifically designed tools (my preference being those designed by Trigger Point Performance – www.tptherapy.com) and using cross-friction (side to side movement), flexion/extension, pivots, pulls, traction and limb movement.

The goal is to increase tissue elasticity, enhance fluidity and restore function. This is done reflexively through pressure as well as mechanically by breaking up adhesions that are formed by faulty biomechanics and inflammation.

Proper breathing is essential as upper chest respiration involves using accessory muscles and can create stress in the body. Stress tightens up muscles.

Hydration is also important as it aids in temperature regulation, lubrication and transporting of nutrients, oxygen and waste products.

Where to Compress

With the right tools, any area can be addressed. The key is to identify those areas having the greatest influence on your specific condition.

Cassidy Phillips, founder of Trigger Point Performance, has identified six muscles/areas that significantly influence biomechanics. These include:

1.            Soleus

2.            Quadriceps

3.            Psoas

4.            Pirirformis

5.            Pectoralis

6.            Thoracic spine

By manipulating these areas, one can achieve structural integrity and injury prevention.

Muscular Maintenance

Muscular adhesions can restrict range of motion, resulting in faulty movement patterns, altered coordination of movements by the nervous system, and inefficiency of movements. All of these increase the likelihood of developing and injury, or impairing athletic performance.

There is substantial evidence that performing myofascial compression techniques regularly (minimum of every other day) can reduce muscular adhesions, improve tissue elasticity, decrease pain and enhance athletic performance.

For more information on learning how to reduce pain or enhance performance using self-myofascial release techniques, please contact my office at 425-999-4484.

Physical exercise can be beneficial or harmful for the gastrointestinal (GI) tract in a dose-effect relationship based on intensity and duration.

Mild-to-moderately intense exercises plays a protective role against colon cancer, diverticular disease, gallstones and constipation, whereas ongoing or even acute bouts of  strenuous exercise may provoke heartburn, nausea, vomiting, abdominal pain, diarrhea, “leaky gut”, food allergies and even GI bleeding.

One-quarter to one-half of elite athletes are affected by GI symptoms that may deter them from participating in training and competitive events.

Some recommendations that can help prevent or mitigate exercise-induced GI symptoms include: changing lifestyle, training and meal routines, ensuring adequate hydration, and being sure to avoid excessive use of some medications.

Training and Avoiding Over-Training

A cardiorespiratory workout should consist of:

1. Warm-up
2. Workout
3. Cool-down

A warm-up prepares the body for activity by increasing heart and respiratory rates, tissue temperature and mental readiness.  A general warm-up consists of low intensity, non-specific movements. A specific warm-up consists of low intensity movements that mimic the exercise to follow.

A 15 minute sample warm-up would include:

1. Myofascial compression techniques that address over-active muscles. The ultimate six for runners would include the: soleus, quadriceps, psoas, pirirformis, pectoralis and thoracic spine.
2. Active-isolated stretching
3. Running  in Zone 1 for the first 10 minutes of the workout

An endurance workout should consist of Stage/Zone training (% based on maximum predicted heart rate: 220 minus your age = max heart rate):

Zone 1- 65-75%

Zone 2- 80-85%

Zone 3- 86-90%

Zone 1 is a good intensity to start the workout. It is also the “recovery zone.”

Zone 2 training helps to increase one’s anaerobic threshold and is appropriate for individuals who have progressed in their training.

Zone 3 is considered high intensity and is used to prevent plateaus in training as well as to enhance fitness. For most people exercising in Zone 3, once per week is enough. Beyond that, over-training can result, leading to digestive and other health issues.

Training for an event should incorporate planned changes (periodization). These changes reduce the risk of over-training and ensure optimal progress toward a goal (e.g. an event).

An essential part of any program also depends on rest and recovery (i.e. sleep and nutrition).

I’ve got a gut feeling that you are over-training…

General symptoms of over-training:

• Fatigue
• Aches and pains
• Pain in muscles and joints
• Sudden drop in performance
• Insomnia
• Headaches
• Decreased immunity (increased number of colds, sore throats)
• Decrease in training capacity/intensity
• Moodiness, irritability and depression
• Loss of enthusiasm for the sport
• Decreased appetite
• Decreased sex drive
• Increased incidence of injuries

Over-training and the gut

Exercise is a stressor. It activates the hypothalamic-pituitary-adrenal axis leading to a host of hormonal adjustments.

Cortisol is a key hormone regulator, which is tightly tied to both the intensity and duration of an endurance activity. It influences gut and immune function through secretory IgA , which maintains gut integrity.

Prolonged stress with elevated cortisol is known to lower secretory IgA, leaving the gut and respiratory tract susceptible to infections.

Exercise and Food Allergy

Exercise is believed to increase small bowel permeability in susceptible individuals.

Food-exercise induced allergic-type reactions are mediated by increased gut permeability.  Exercise increases intestinal absorption of potential allergens in both normal and reactive individuals.

This is essential knowledge to have when evaluating exercise programs in those athletes with digestive complaints suggestive of food sensitivity or allergy, especially given that athletes often consume gluten containing grains and dairy products.

Gluten containing grains are an easy food to help replenish glycogen stores, but are unfortunately common culprits of exercise induced digestive issues in addition to other health problems discussed in prior posts.

The Paleo Solution for Endurance Athletes

We are genetically adapted to a hunter gatherer diet.  The introduction of domesticated animals, agriculture, and processed foods are very recent developments in the scope of evolutionary history.  As such, our bodies are not adapted to a diet derived from these technological developments and consequently diets that emphasize these processed foods (e.g. sugar, grain and dairy) have resulted in most of the chronic disease that plague are society.

 General Paleo Guidelines:

1. Eat plenty of lean meats (fish, poultry, lean beef, wild game)

2. Eat plenty of fruits and vegetables

3. Avoid dairy

4. Avoid starches and sugars (breads, grains, etc)

5. Avoid processed foods.

While we are genetically suited for this diet, our ancient ancestors seldom did 2 hour runs and 6 hour bikes.  More than likely they had periods of intense activity, but these where relatively brief and spaced apart. A strict paleo diet is not well-suited to the needs of endurance athletes to fuel optimum performance and recovery, so the activity can be repeated after a relatively short time.

Modifications to the Paleo diet for Endurance Athletes

1. Majority of nutrition from fruits, lean protein and fresh veggies.

2. Starch and sugar only during and after training.

3. Eliminate as much processed food as possible.

 Adding, Starch and sugar only during and after training satisfies the need to quickly replace glycogen stores after exercise.  This ensures the athlete is ready to repeat the activity within a relatively short time and minimizes the adverse effects that these foods can have on gut health when over consumed.

Is Endurance Exercise good for your Gut? In moderation yes, but why do this type of activity? If it’s for a charitable fund raiser, that’s one thing, but if it’s for the pursuit of health or weight loss, research points to resistance and interval training as more effective means.

I see people every day…at my clinic, the gym, the grocery store…who view their bodies as a calorie bank and approach weight loss from this perspective (i.e. the calories in/calories out model).

I also see patients who eliminate certain foods from their diet, such as wheat, and consistently report that they lose weight (without adjusting calories or energy expenditure).

What is a possible biochemical explanation for your inability to lose weight?

Food Sensitivities and Inflammation

Inflammation is one of the biggest drivers of weight gain and disease in America.

In people with food sensitivities or intolerances, the immune system attacks the undigested proteins and the lining of the gut becomes inflamed.

When the lining of the gut is inflamed, small fissures open between the tightly-woven cells making up the gut walls. This results in “leaky gut syndrome”.

In a leaky gut, bacteria and partially-digested food molecules slip out into the bloodstream, where they are considered foreign invaders.

The immune system attacks these foreign invaders with white blood cells, which engulf the offending particles and produce systemic inflammation.

Many people eat foods to which they are sensitive several times a day.  Every time one of these foods enters the body, the immune system is activated.

Often symptoms are delayed up to 72 hours after eating, making a low-grade food sensitivity hard to identify.

Without diagnosis or awareness, the damage is repeated over and over again, meal after meal, and eventually, inflammation seeps throughout the body, establishing an environment primed for weight gain and chronic disease.

Identifying and treating adverse food reactions can result in dramatic effects on weight loss, inflammatory conditions, autoimmune disease and even mood and behavioral disorders.

Three Ways to Identify Food Sensitivities

1. Blood testing for IgG food sensitivities.  These tests can be helpful in identifying food sensitivities, but have limitations and should be interpreted in the context of a patient’s diet and overall health.
2. Go dairy- and gluten-free for six weeks. Dairy and gluten are the most common triggers of food sensitivities. For patients who have trouble losing weight, eliminating these foods can have favorable effects on blood sugar. Dairy and gluten are linked to insulin resistance and, therefore, weight gain. Temporarily cutting them out of the diet allows the inflamed gut to heal. This may be the single most important thing many people can do to lose weight. Keep in mind, though, that sugar is highly inflammatory and it’s critical at this time to keep sugar intake low and not resort to eating those gluten-free packaged foods that increase insulin (rice cakes, cereals, rice bread, cookies, etc.).
3. Avoid the top food allergens. If you notice changes from avoiding dairy and gluten, try cutting out the top food allergens: gluten, dairy, corn, eggs, soy, nuts, nightshades (tomatoes, bell peppers, potatoes and eggplant), citrus and yeast (baker’s, brewer’s yeast and fermented products like vinegar). Try this for a full six weeks. That is enough time to feel better and notice a change. When you reintroduce a top food allergen, eat it at least two to three times a day for three days to see if you notice a reaction (stop immediately once you notice the reaction). If you do, note the food and eliminate it for 90 days.

If you are overweight or suffer from inflammatory diseases, such as heart disease, arthritis, diabetes or cancer, the potential health benefits of discovering and managing hidden food sensitivities could have a significant effect on your quality of life.

In a two-year study, women who developed runner’s knee had much greater hip adduction, or movement of their hip toward their mid-line, than women who didn’t develop runner’s knee.

In the study, published in Medicine & Science in Exercise & Sports, researchers did a gait analysis on 400 healthy women runners, and then tracked the women’s incidence of knee injury and pain over the next two years.

The researchers compared the running mechanics of  injured women with women who remained healthy. They found that the women who developed runner’s knee had much greater pelvic instability than the healthy runners.

When the women who developed runner’s knee ran, their hips collapsed toward the mid-line of their bodies instead of remaining level.

Numerous studies support to the growing consensus that hip function is the key determinant of whether you’ll develop runner’s knee.

The Overhead Squat Assessment (OHSA)

One of the best screening tools for assessing the risk of injury as well as muscle and joint problems that may be causing pain is the OHSA.

The OHSA is a dynamic movement assessment of the Kinetic Chain (muscles, joints and the nervous system). It demonstrates postural distortion patterns that are characterized by overactive and underactive muscles and joint dysfunction

There are 5 Kinetic Chain check points:

1. Foot and ankle
2. Knees
3. Lumbo-pelvic-hip complex
4. Shoulders
5. Cervical spine

By observing each check point from the front, side and back, compensations can be identified.

The Fix

1.       Inhibit the overactive muscles with myofascial therapy and home self-myofascial release

2.       Lengthen overactive muscles with stretching

3.       Mobilize joints that aren’t moving properly

4.       Activate under-active muscles

5.       Integrate functional movement exercises

Sample exercises for knee pain due to knees moving in and hip abductor weakness:

1. Self-myofascial Release to adductor muscles, biceps femoris (outer hamstring), outer calf and outer quadriceps muscles

2. Stretch adductor muscles, biceps femoris (outer hamstring), outer calf and outer quadriceps muscles. Hold stretches for 30 seconds.

3. Activate gluteus medius with wall slides or clam shells: 2 sets of 10. Hold each repetition 2-4 seconds

4.  Integrate functional movement with lateral  tube walking: 2 sets of 10-12

http://journals.lww.com/acsm-msse/Abstract/publishahead/Prospective_Evidence_for_a_Hip_Etiology_in.98478.aspx

Unfortunately for Ikea and some schools in Europe, horse meat is not on the Mediterranean diet.

Many other foods are, though, and according to a recent study in the New England Journal of Medicine, eating a diet rich in olive oil, nuts, fresh fruits and vegetables, along with red wine, helped those at high risk for cardiovascular problems avoid heart trouble better than those eating a low-fat diet.

In the study, participants on a Mediterranean diet that emphasized either olive oil or nuts had a 30% greater reduction in relative risk of a heart attack, stroke or death from cardiovascular disease.

The results were determined to have a “moderate-to-high benefit” and mirrored those from previous research.

So why does the Mediterranean diet seem to boost heart health?

The combination of good quality fats, both monounsaturated (e.g. olive oil) and omega 3 (e.g. nuts and fish), along with phytonutrients found in vegetables and fruits, effectively reduce inflammation – an underlying factor in many chronic conditions.

What about diet and pain?

There is strong evidence linking diet to inflammation and pain.

A marker of inflammation commonly looked at in studies correlating diet to pain is a protein called HS-CRP. This protein level has been found to predict the risk of diabetes and other inflammatory conditions.

In a Mediterranean diet, the nutrients such as magnesium, fiber, omega-3 fatty acids, monounsaturated fatty acids, flavanoids, and carotenoids have been shown to have significant anti-inflammatory effects.

A decrease in inflammation means a reduction in pain, along with a reduction in the risk of developing certain chronic diseases.

Sample Mediterranean meal plan:

Breakfast:

■ Greek-style yogurt with fruit (e.g. berries) and a small handful of raw nuts.  Coffee or tea.

Morning snack:

■ Handful of mixed nuts (e.g. walnuts, almonds, pecans, macadamia)

Lunch:

■ Grilled fish, chicken or beef with vegetables. Green salad with extra virgin olive oil and balsamic vinegar.

Afternoon Snack:

■ Hummus or white bean dip with vegetables (e.g. carrots, celery, cucumbers, peppers)

 Dinner:

■ Chicken or lamb souvlaki with Greek salad. Glass of red wine.

Reference:

http://www.nejm.org/doi/full/10.1056/NEJMoa1200303

http://www.nytimes.com/2013/02/26/world/europe/ikea-recalls-its-meatballs-horse-meat-is-detected.html?_r=0

A study published in the Journal of the Academy of Nutrition and Dietetics found a connection between diet and acne, particularly from high glycemic load diets (refined carbohydrates) and dairy products, and that medical nutrition therapy can be an effective intervention in acne treatment.

More than 17 million Americans suffer from acne, mostly during their adolescent and young adult years. Acne influences quality of life, including social withdrawal, anxiety, and depression.

Since the late 1800s, research has linked diet to this common disease, identifying chocolate, sugar, and fat as particular culprits, but beginning in the 1960s, dermatologists started to disassociate the connection between diet and acne claiming that the diet-acne connection was a myth.

This study concluded that a high glycemic index/glycemic load diet and frequent dairy consumption are the leading factors that can  influence and aggravate acne.

Unfortunately the conventional medical community generally dismisses the possibility of diet therapy as an adjunctive treatment for acne and instead leans towards treating the symptoms.

What is it about a high glycemic index/glycemic load diet and frequent dairy consumption that can affect the skin as well as increase the risk for diabetes, cancer, heart disease, gall bladder disease and obesity?

INFLAMMATION

High dietary glycemic loads have  been associated with increased serum levels of C-reactive protein (CRP), a marker of systemic inflammation.

Some strategies for lowering dietary glycemic load include:

• Increasing the consumption of non-starchy vegetables, nuts, legumes and fruits.

• Decreasing the consumption of starchy high-glycemic index foods like potatoes, white rice, and white bread

• Decreasing the consumption of sugary foods like cookies, cakes, candy, and soft-drinks

“One man’s food is another man’s poison”

People react differently to foods in a myriad of ways. They can have IgE immune mediated responses (classic allergy), IgG responses (also known as sensitivities) and intolerances (e.g. dairy and gluten).

These reactions also have inflammation in common and can influence or aggravate acne and numerous other diseases.

A comprehensive approach

People affected by acne want results immediately. There are a number of over the counter topical medications as well as some topical agents that are more natural that can be compounded by special pharmacies. Using these in conjunction with a low glycemic/dairy-free diet and also addressing   food reactions is very effective for the management and prevention of acne.

Reference:

Jennifer Burris, William Rietkerk, Kathleen Woolf. Acne: The Role of Medical Nutrition Therapy. Journal of the Academy of Nutrition and Dietetics, 2013; 113 (3): 416 DOI: 10.1016/j.jand.2012.11.016

The foot and ankle complex can influence the entire kinetic chain. In addition, if you have chronic foot and ankle problems, looking at the low back, hips and knees is also prudent as these areas can influence or perpetuate chronic foot and ankle dysfunction.

Anatomy

The foot is composed of phalanges, metatarsals and tarsals. These bones together with ligaments and muscles create the joints in the foot as well as arches (transverse and medial longitudinal).

Moving to the lower leg are the tibia (inside) and fibula (outside). These articulate distally (below) with the medial and lateral aspects of the foot, forming the ankle joint and proximally (above) with the patella and femur to form the knee joint.

The proximal end of the femur articulates with the pelvis, forming the hip joint.

Foot and Ankle Dysfunction and the Human Movement System Chain Reaction (“The foot bone’s connected to the hip bone”)

If the foot excessively pronates, the adjoining muscles, bones and joints will cause the knee (or knees) to adduct or move inward. The resulting tension in the hamstrings (short head of the biceps femoris) and hip muscles (TFL), will alter the positioning and biomechanics at the hip. This will further affect length-tension relationships of the muscles surrounding the hip and affect stability and mobility.

Common Foot and Ankle Injuries

Plantar Fasciitis

The plantar fascia runs from the heel (calcaneus) and fans out to insert on the metatarsal heads. It helps to support the medial longitudinal arch of the foot. If repetitive activities are performed with an ankle joint that lacks optimum range of motion or a foot that is excessively pronated, then the fascia becomes inflamed and painful. Most people report heel pain, particularly getting out of bed in the morning or after prolonged periods of sitting.

Achilles Tendinopathy

The gastrocnemius and soleus muscles located in the calf, share a common Achilles tendon that inserts into the calcaneus (heel). Overuse activities, such as running and jumping are common causes of Achilles Tendinopathy, which presents as pain, swelling and impaired performance.

Shin Splints

Overuse caused by excessive running, walking, poor shoes or improper biomechanics (e.g. over pronation) can lead to irritation to the periosteum (the membrane lining the surface of bones). Pain can be felt on the anterior (front) or posterior (rear) compartment of the lower leg.

Ankle Sprains

Ankle sprains are reported as the most common sports-related injury, with lateral (outer) ankle sprains being the most common. These injuries cause small tears in the ligaments and stretching of the local musculature. They can lead to ankle instability and recurrent injury.

A Systematic Process to Evaluation and Treatment of Foot and Ankle Impairments

Identification of dysfunction is best achieved through an integrated assessment process, which includes:

1. Static posture observation
2. Movement assessments such as the Overhead Squat
3. Range of motion evaluation and;
4. Strength assessments

Once muscle imbalances and joint dysfunction is assessed, a comprehensive treatment strategy can be designed to inhibit and lengthen tight muscles, activate weak muscles and “groove new motor patterns through corrective exercises.

Sample Foot and Ankle Assessment Process and Observations

Static Posture- Feet excessively pronate

Overhead Squat- Feet turn out or flatten

Gait- excessive pronation

Range of Motion- Decreased ankle dorsiflexion (e.g. tight calves), decreased knee extension (e.g. tight hamstrings) and decreased hip extension (e.g. tight TFL)

Muscle testing- Weakness in the tibialis anterior, posterior, medial gastrocnemius and/or medial hamstrings; Weakness in the gluteus medius or maximus

Palpation- Restricted motion the ankle mortise joint and lumbo-pelvic-hip complex

Sample Foot and Ankle Treatment plan

1. Inhibit: lateral gastrocnemius, peroneals and biceps femoris (hamstrings) using trigger point therapy and fascial release. Home exercises: Self myofascial release.
2. Lengthen- Pin and stretch to lateral gastrocnemius, peroneals and biceps femoris (hamstrings). Home exercises- Static stretching.
3. Mobilize- manipulation to restore joint motion and break up adhesions at the ankle and lumbo-pelvic-hip complex.
4. Activate- Positional isometrics to anterior and posterior tibialis and medial hamstrings. Home exercises: Isolated strengthening exercises for the anterior and posterior tibialis and medial hamstrings
5. Integrate- Home exercises: Single leg balance reach, Step-up to balance.

Foot and Ankle pain can have several labels. Regardless of what the diagnosis is, a functional assessment and integrative kinetic chain approach is the key to long term resolution of the problem.

This Integrative protocol was developed by the National Academy of Sports Medicine (NASM) in conjunction with research carried out at The University of North Carolina.

It is the protocol used by professional sports teams such as the Phoenix Suns in their assessment and management of sports injuries and musculoskeletal pain and dysfunction.

Chocolate Avocado Mousse Pie

Crust (for one pie):

• 1½ cups almond flour
• ¼ teaspoon Celtic sea salt
• ¼ teaspoon baking soda
• ¼ cup walnut oil
• 2 tablespoons organic, raw agave nectar
• 1 teaspoon vanilla extract

1.         In a medium bowl, combine almond flour, salt and baking soda

2.         In a small bowl, combine walnut oil, agave and vanilla

3.         Stir wet ingredients into dry

4.         Pat dough into a 9½-inch glass pie dish

5.         Bake at 325° for 10 to 15 minutes, until golden brown

Mousse (for one pie):

• 2 avocados (pits and skin discarded)
• 1 cup coconut cream (place 1-2 cans coconut milk in fridge overnight; scrape cream off the top once it has solidified)
• ½ cup cocoa powder
• ¼ cup organic, raw agave syrup
• ¼ cup local honey
• 1 ½  tablespoons vanilla extract
• ¼ teaspoon cinnamon
• Toasted coconut to garnish

1. Place all ingredients (other than toasted coconut) in a food processor and blend until smooth.
2. Once crust has cooled, spread mousse into pie crust. Refrigerate until it solidifies (preferably at least a few hours, but it can be eaten soft as well).
3. Garnish with toasted coconut, if desired.

Recipe from Stephanie Lecovin, MS RD (www.nutritionhousecalls.com)

Health benefits of avocados

• Anti-Inflammatory
• Optimized Absorption of Carotenoids
• Supports Cardiovascular Health
• Promotes Blood Sugar Regulation
• Anti-Cancer Benefits

(From Paleo Magazine Feb/March 2013)

Ingredients

1 sweet potato

3 eggs, whisked

¼ cup extra virgin coconut oil

1/3 cup raw honey

½ cup dark chocolate chips

3 tablespoons Coconut Flower

2 tablespoons unsweetened cocoa powder

¼ teaspoon baking powder

¼ teaspoon vanilla extract

¼ teaspoon cinnamon

Pinch of salt

Directions

1. Preheat oven to 425 degrees, use a fork to puncture holes all around sweet potato, and then cook in oven for 25-30 minutes.
2. Once soft, peel off the skin and mash it up in a bowl.
3. Turn your oven down to 350 degrees
4. Add wet ingredients: coconut oil, honey, vanilla and whisked eggs to the bowl and mix together
5. Then add your dry ingredients: coconut four, cocoa powder, cinnamon, salt and chocolate chips
6. Mix well
7. Pour into 8×8 glass baking dish
8. Bake for 30-35 minutes
9. Let cool

Health benefits of chocolate

A Healthier Heart

In a 9-year Swedish study of more than 31,000 women, those who ate one or two servings of dark chocolate each week cut their risk for heart failure by as much as a third.

Another big, long-term study in Germany  found that about a square of dark chocolate a day lowered blood pressure and reduced risk of heart attack and stroke by 39 percent. Most of the credit goes to flavonoids,  antioxidant compounds that increase the flexibility of veins and arteries.

 Diabetes Prevention

In a small Italian study, participants who ate a candy bar’s worth of dark chocolate once a day for 15 days saw their potential for insulin resistance drop by nearly half. “Flavonoids increase nitric oxide production,” says lead researcher Claudio Ferri, M.D., a professor at the University of L’Aquila in Italy. “And that helps control insulin sensitivity.”

Reduced Stress

Swiss scientists  found that when very anxious people ate an ounce and a half of dark chocolate every day for two weeks, their stress hormone levels were significantly reduced and the metabolic effects of stress were partially mitigated.

 Sun Protection

London researchers recently tested chocolate flavanols’ sun-protecting properties. After 3 months eating chocolate with high levels of flavanols, their study subjects’ skin took twice as long to develop that reddening effect that indicates the beginning of a burn.

Higher Intelligence

A University of Nottingham researcher found that drinking cocoa rich in flavanols boosts blood flow to key parts of the brain for 2 to 3 hours, which could improve performance and alertness in the short term.

Other researchers from Oxford University and Norway looked at chocolate’s long-term effects on the brain by studying the diets of more than 2,000 people over age 70. They found that those who consumed flavanol-rich chocolate, wine, or tea scored significantly higher on cognitive tests than those who didn’t.

Cough Relief

 One study found that chocolate quieted coughs almost as well as codeine, thanks to the theobromine it contains. This chemical, responsible for chocolate’s feel-good effect, may suppress activity of the vagus nerve.

 Diarrhea Relief

Scientists at the Children’s Hospital Oakland Research Institute found that cocoa flavonoids bind to a protein that regulates fluid secretion in the small intestine, potentially stopping the trots in their tracks.

Fascia is a three dimensional sheet of firm tissue, that spreads throughout the body from head to toe.

It has numerous forms, and essentially envelops the body beneath the skin, enclosing muscles, tendons, ligaments, bones, nerves, arteries and organs.

Fascia has the consistency of a trash bag or mesh, with both elastic and plastic properties. It can stretch, load and unload. It can also contract, but not the same way that muscles do.

Muscle contractions are initiated by neurotransmitters and electrical stimulation. Fascia is thought to contract by the release of histamine.

Fascia is influenced by numerous factors:

• Movement
• Our environment
• Hydration
• Respiration
• Nutrition
• Injury

Fascia is a dynamic fluid transport network, feeding adjacent tissues with oxygen, hormones, minerals and nutrients and respectively removing waste products.

Because of the it’s interconnections, injuries to the fascia will lead to disrupted fluid flow to the network of fascia above and below

Besides the lesions caused by injuries to the fascial system itself, fascia can also be affected by viral or bacterial infections, clogging its fluid transportation.

Dysfunction of the fascial system due to injury, inflammation or posture may lead to an abnormal high pressure on the respectively fed structures. This can result in pain and dysfunction as well as strange symptoms which often confuse conventional physicians.

There are 6 different Fascial Distortions, each with distinct characteristics:

1. Triggerbands- Injuries in which the fibers have become distorted (i.e., twisted, separated, torn, or wrinkled). These are usually described as a “burning” or “pulling” pain. The goal of the treatment is to physically break the adhesions, untwist the distorted bands and re-approximate the torn fibers. This is accomplished by “ironing” out the wrinkled fascia.

1. Herniated trigger points-   The underlying tissue has protruded through an adjacent fascial plane and become entrapped. These are responsible for a wide range of painful complaints such as sore shoulders, neck aches, abdominal pain, renal colic pain and lumbar strains. The patient pushes their fingers directly deep into the painful area for relief. Treatment involves doing the same, i.e. it forces the protruded and entrapped tissue back through the herniated fascial plane.

1. Continuum Distortion- A lesion at the transitional area  between ligament, tendon, capsule and bone. This imbalance in the transition zone disrupts the mechanical function of the ligament and alters its proprioception (position sense). The continuum distortion results in uneven mechanical information being transmitted to the brain. This uneven information is interpreted as pain located at very spot of the transition. Pressure through the therapist’s thumb firmly and continuously applied directly in the continuum distortion, forces the transition zone to shift. Thrust manipulation, similar to chiropractic manipulation can also be performed.

1. Folding distortions- When fascia in or around a joint becomes distorted from either traction or compression forces. Patients typically feel a pain deep inside, and have the desire to be stretched or compressed. Patients might try pushing their fist into the area (e.g. lower back) while they are extending or bending their spine. These are treated with thrust manipulation or traction.

1. Cylinder distortions- Exhibit symptoms resembling neurological conditions such as tingling, numbness or muscle cramps. Patients feel the need to repeatedly squeeze the affected tissue. To treat cylinder distortions, the affected tissue is stretched or compressed. Stretching plus rotating the affected area i.e. “Squeegee-technique” is effective, as is cupping (an acupuncture technique).

1. Tectonic fixation- The fascial surface loses its ability to properly glide, due to the loss of fluid between two structures. The two layers of fascia stick together like magnets. This distortion is common in joints throughout of the body. The patient affected by tectonic fixation will express that their back needs to be cracked. These are treated with thrust manipulation.

Assessing Fascial Distortions is done through:

1. History
2. Observation
3. Range of motion
4. Palpation
5. Muscle testing

Fascia is probably one of the least understood tissues in the body, whose clinical significance is often ignored.

Treating Fascial Distortions can often yield dramatic results in a minimal amount of time. It is effective for both acute and chronic injuries and can be an effective tool for helping athletes return to play quicker than conventional rehabilitation.

Some of my prior blogs have discussed the use of Foam Rollers and more recently, the use of Trigger Point Performance tools,  for Self Myofascial Release (SMR)

Self myofascial release techniques have become increasingly popular among athletes and fitness enthusiasts.

Therapists from many disciplines have embraced the use of myofascial release massage to reduce chronic pain and rehabilitate a range of injuries.

 Myofascial Release (MFR) Performed by a Therapist

There are two key terms one should understand in order to appreciate how myofascial release works. These are fascia and trigger points.

Fascia

Fascia is a specialized connective tissue that surrounding muscles, bones and joints and provides support and protection to the body. It consists of three layers – the superficial fascia, the deep fascia and the subserous fascia. Fascia is one of the 3 types of dense connective tissue (the others being ligaments and tendons) and it extends without interruption from the top of the head to the tip of the toes.

Fascia is usually seen as having a passive role in the body, transmitting mechanical tension, which is generated by muscle activity or external forces. There is some evidence  suggesting that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence muscles, nerves and the circulatory system.

Some research has shown that changes in the tone or structure of the fascia could have significant implications for athletic movements and performance. In addition, the occurrence of trigger points within fascia is thought to be correlated with increased risk of injury.

Trigger points

Trigger points are areas of muscle that are painful to palpation and are characterized by the presence of taut bands. Myofascial (muscle and fascia) tissue can become thick, tough and knotted.

Trigger Points can occur in muscle, the muscle-tendon junction and the bursa. Sometimes, trigger points can be accompanied by inflammation and if they remain long enough, they can replace healthy fascia with inelastic scar tissue.

Trigger points can alter the length and tension in muscles and ligaments and can result in weakness and imbalances.

Because trigger points in the fascia can restrict or alter the motion about a joint,  it can lead to  changes in the normal neural feedback to the central nervous system. Eventually, the neuromuscular system becomes less efficient, leading to premature fatigue, chronic pain and injury and less efficient motor skill performance.

What causes a trigger points?

Trigger Points can be caused by acute physical trauma, poor posture or movement mechanics, over training, inadequate rest between training sessions as well as nutritional factors.

Myofascial Release Treatments

In order to be effective, treatment needs to start with an accurate assessment.

An assessment includes:

1. General movement screen
2. Range of motion
3. Palpation
4. Muscle testing

Once the dysfunction is identified, MFR treatments should address both the fascia and muscles.

Treating the fascia

Direct myofascial release (or deep tissue work) is performed by engaging the myofascial tissue restrictive barrier, and then loading the tissue with a constant force until a release occurs.

Therapists use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few kilograms of force.

Direct myofascial release seeks for changes in the myofascial structures by stretching, elongation of fascia, or mobilising adhesive tissues.

The practitioner moves slowly through the layers of the fascia until the deep tissues are reached.

Trigger Point Release

Treating trigger points can be done through a variety of techniques. Some of the most effective include:

1. Direct compression followed by stretching
2. Pin and stretch
3. Dry needling/acupuncture

Trigger point release has been theorized to work by normalizing the electrical potential of muscles and resetting the receptors responsible for maintaining muscle length and tension.

Addressing nutritional factors and prescribing corrective exercises are also essential for long term   pain reduction/elimination and/or enhanced performance for athletes.

If you’ve taken the steps to become healthy by exercising and changing your diet but still don’t feel well, there’s a good chance that inflammation is the cause.

In a healthy body, inflammation serves a useful purpose by initiating the healing process. The cardinal signs of acute inflammation are redness, heat, pain and loss of function.

The inflammatory response is usually self-limiting, whether it involves repairing an ankle strain or activating your immune system to fight a cold.

In those with dietary imbalances, inflammation takes longer to resolve. In addition, because inflammation disrupts normal metabolic function and disturbs cellular growth, not only do minor injuries and infections take longer to resolve, but serious diseases, such as cancer and atherosclerosis, are more likely to develop.

Inflammation wears many “masks” in your body. It can present as:

• Joint aching and stiffness
• Arthritis and tendinitis
• Heartburn
• Hypertension
• Nausea and cramping
• Headaches
• Cough
• Fatigue
• Depression
• Irritability
• Allergies and asthma
• Hormonal imbalance
• Depression
• Diabetes
• Neuropathy

Inflammation also prevents your body from building muscle, which can affect weight loss.

Since fat cells are made up of inflammatory chemicals, excessive fat can promote inflammation and result in additional weight gain and more inflammation. It’s a viscous cycle.

We have found the following anti-inflammatory tips helpful with patients (put it on your fridge):

Geoff and Steph’s Top 20 Guide to Reducing Inflammation and Improving Health

1. Buy unprocessed foods – vegetables, fruits, nuts and pasture raised/hormone-free/antibiotic-free animal products
2. Avoid vegetable oils – canola, corn, soy, cottonseed, sunflower, safflower, grape seed, rice bran
3. Use healthy oils – olive, coconut, avocado, macadamia nut, walnut, sesame, flax, hemp
4. Avoid sugar – even “healthy sugars” (agave, cane sugar, etc…see prior blogs). Use local honey when needed as a sweetener.
5. Treat the following carbs like sugar – pasta, bread, rice, potatoes, noodles, corn, breakfast cereals, energy bars, crackers.
6. Avoid artificial sweeteners, colorings, flavors and MSG
7. Eat naturally fermented foods like sauerkraut , kimchee, yogurt, kombucha  and pickles
8. Avoid conventional deli meats that are highly processed and contain nitrates
9. Avoid sweetened beverages (even fruit juice)
10. Eat full-fat foods
11. Eat free-range and organic eggs
12. Avoid tofu unless it’s fermented. Soy can affect estrogen and thyroid function.
13. Buy local and seasonal
14. Beware of foods making health claims such as: low-fat, low-carb, low-sodium, high-fiber, anti-oxidants, phytonutrients
15. Don’t overcook your food
16. Have a big, colorful salad everyday
17. Eat wild not farmed
18. Focus on nutrients not calories
19. Exercise intensely and include weights
20. Get adequate sleep

Natural sweeteners are becoming more popular among those seeking “healthy” sweetener alternatives as well as out of fear about white sugar and high-fructose corn syrup that is so ubiquitous in our food.

One so called healthy alternative sweetener that has been generating a lot of buzz is agave.

Agave comes from the same plant used to make tequila.  It’s fast becoming the preferred sweetener for health-conscious consumers and natural cooks.

Unfortunately, in reality, agave is processed just like other sugars, and is no better for you.

What Is Agave?

More than 300 species of agave plants grow in the southern United States, northern South America, and the hilly regions of Mexico. Agave nectar has been used for centuries as a folk remedy for its medicinal properties. The Aztecs mixed it with salt and used it for skin infections and wounds.

Most agave sweeteners are produced from the blue agave plant. The core of the plant contains the aguamiel or “honey water,” the substance used for syrup production (and, when fermented, tequila). Although agave starts out as this natural elixir from Mother Nature, the form you can buy has been processed to form a syrup or nectar.

Processing the aguamiel yields a product with either a dark amber or light color, and a consistency much like maple syrup. The light-colored nectar resembles maple syrup or honey in flavor, but the taste is more delicate, which has made agave a popular sweetener for energy drinks, teas, nutrition bars, and baked goods. Amber and dark agave nectar taste similar to caramel, and can be used like maple syrup on pancakes and waffles.

Agave has about 60 calories per tablespoon, compared to 40 calories for the same amount of table sugar. Because agave is about 1 1/2 times sweeter than sugar, you can use less of it.

Is Agave Healthier Than Sugar?

Refined agave sweeteners are not healthier than sugar, honey, high-fructose corn syrup, or any other sweetener. Nutritionally and functionally, agave syrup is similar to high-fructose corn syrup and sucrose. It does contain small amounts of calcium, potassium, and magnesium, but not enough to matter nutritionally.

Concentrated fructose sweeteners don’t appear to offer any health advantages. In fact, a study in the Journal of Clinical Investigation suggested that consuming fructose may be less healthy than consuming similar amounts of glucose. Study participants who consumed fructose were found to gain more unhealthy visceral fat, were more insulin-resistant, and were at greater risk of developing heart disease and diabetes.   http://www.jci.org/articles/view/37385

But What about the Glycemic Index?

Proponents of agave claim that it has a low glycemic index (a scale that measures how much a food raises blood sugar levels). While agave does rank lower than many other sweeteners on the glycemic index, it should not be used as a green light for diabetics or others looking to follow a low glycemic diet.

Is ‘Natural’ Sugar Better?

The American diet contains too much sugar, especially in the form of sweetened beverages.

One of the simplest ways to improve your health is to reduce the amount of all simple sugars, e.g. agave, sucrose, honey, maple syrup, raw sugar, molasses, brown sugar, corn syrup, turbinado sugar etc.

 When it comes to sweeteners, all caloric sugars are virtually the same.

Unprocessed agave nectar or syrup can be as high as 90% concentrated fructose (a simple sugar that occurs naturally in fruit), and the rest glucose.

The agave you can buy ranges from 90% to as little as 55% fructose (similar to high-fructose corn syrup), depending on the processing, according to food technologists.

High fructose corn syrup (HFCS)

HFCS is commonly found because corn has become one of the cheapest most widely available crops, acts as an alternative sweetener to normal table sugar. The fructose has a much sweeter taste and acts as a much more cost effective option for food producers and manufacturers.

Ultimately, HFCS is one of the top causes for obesity in the world, especially in the US. This  sweetener has the ability to decrease metabolism and hinder the natural production of insulin and other appetite controllers, in addition to other problems.

Some Reasons to Steer Clear or HFCS

1. Obesity- HFCS limits your body’s ability to produce insulin and leptin, making it difficult to metabolize food and regulate appetite. The pancreas remains insulin resistance to all types of fructose, including HFCS, severely hindering appetite control.

2. Diabetes- Due to obesity and irregular insulin fluctuations, HFCS leads to diabetes in some people.

3. Tooth Infections and Decay- Foods rich in HFCS rot teeth by decaying the enamel coating.

4. LDL Cholesterol and Triglycerides Increase- Sugars metabolize into fat, therefore increasing unhealthy cholesterol levels along with the fat storages in your body. Since high fructose corn syrup does not stimulate the secretion of insulin or leptin, foods with high levels of the sweetener become nearly fully absorbed and metabolized into fat and cholesterol.

5. Poor Immunity- HFCS interfere with the production of hormones and enzymes in your body that are part of your immune system.

6. Mood Swings and Withdrawal- Too much sugar and HFCS will cause your body to crave more, and when trying to cut back, the desire and cravings only increase.