By ACC, on October 1st, 2009
This article has also been published in the October issue of The Racing Post.
 Photo by Hauggen If you’re training for a race, you probably understand that you will have to push yourself outside of your comfort zone in order to get better. You’ll have to increase your training volume, intensity, or both. You’ll have to add in new exercises or modify others.
However, most of us also understand that though we feel good with a certain level of training, if we add too much too soon at some point we will break down. We know that while we could perhaps handle 50 miles in the saddle, for many of us, attempting 150 would leave us sore, sick, injured, or all of the above.
Sooner or later what we all find out is that there is a risk/benefit ratio to exercise. Almost all forms of exercise have some benefit, but there are none that don’t also carry risk, either short or long term.
Working with both weekend warriors and elite athletes in my office and at the local mega-university, I have the unique perspective of seeing athletes at their worst. That is, I see them when they’re broken. Being in this position rapidly teaches you certain lessons about what kinds of training potentially have the most detrimental effects.
Since it’s much better to be an informed decision maker, let’s run through a short list of high-risk activities. These are things to which you should never let your guard down if you’re interested in maximizing both your training longevity and performance. Here they are, in increasing order of risk…
Eccentric Training
I’m not talking about exercises that make your friends think you’re strange, but rather movements that emphasize eccentric muscular contraction. When you raise a barbell (or a beer for that matter), the bicep muscle in your arm is shortening while it bears the load. This is a concentric muscular contraction.
When you lower the barbell, your bicep is lengthening while it bears the load. This is an eccentric muscular contraction. Eccentric muscular contractions are far more damaging to muscle tissue. Some amount of microscopic tearing is thought to happen with eccentric contractions, especially when under significant load.
This is the reason downhill running beats you up far more than going the other way. Explosive, jumping-type movements – what plyometrics are largely based upon – can be risky because of the heavy eccentric load your muscles are put under. This is true not because of the jumping involved, but because of the landing, which is an eccentric activity.
Weight Training
Among athletes, I see a huge number of injuries come from the weight room. Much (though not all) weight work is designed to isolate particular muscles or muscle groups, loading them in a specific, measured fashion, such that they will adapt and respond to a far greater degree than they might otherwise.
While this is arguably a great way to gain strength and fitness, it is a form of load that our bodies don’t generally encounter in nature. Bodies are “designed” for cooperatively combining the action of many muscles at once, to produce complex, multi-joint movements. Loading up a specific muscle without the aid of his neighbors places a higher likelihood on the risk for injury.
High Intensity Training
This one’s a doozy. Increasing training intensity too much at one time is one of the most frequent causes of sickness and injury. How many runners have we all encountered who were doing just fine plodding along at 20-30 miles a week, only to get injured the first time they attempt (usually unsupervised) speedwork?
Intensity needs to be increased in careful, measured doses. When starting out, if you’re having second thoughts about whether or not you can handle a planned workout, you may be biting off more than you can chew. Never increase volume and intensity simultaneously, and be sure to get guidance from veterans of high intensity work or a good coach before jumping off the deep end.
Poor Technique
This may seem obvious, but poor technique is by far the biggest cause of athletic injuries. Using good technique means performing a movement in a way that doesn’t place joints, ligaments, and muscles in mechanically disadvantaged positions.
Most people understand that complex movements like a golf swing or a power clean in the gym require excellent technique in order to both perform optimally and avoid injury. The not-so-obvious part is that people frequently assume their technique needs no adjustment for relatively more simple movement patterns like a running stride or pedal stroke. This is a really dangerous assumption to make.
Adding poor technique to any of the other activities mentioned above creates a true recipe for disaster. Attempting focused eccentric movements, weights, or high intensity training without regard for proper technique is a sure way to end up on the couch for weeks, if not longer.
No matter what your sport, spend the time to develop good technique habits, and regularly seek guidance from those who have the knowledge and willingness to help you learn the best movement patterns.
It should be noted that, with the exception of poor technique, all of the methods mentioned above can be applied carefully and deliberately to achieve excellent fitness gains. However, getting better at an athletic activity, particularly of the endurance variety, is largely about staying healthy long enough to allow prolonged, consistent training uninterrupted by injury or sickness. That is, you have to survive long enough to get good. Keeping your guard up to these common pitfalls will help you do just that.
By ACC, on September 1st, 2009
<You can also find this article in the September 2009 issue of The Racing Post>
 Photo by Augustin Ruiz Numbness or tingling in the hands is a relatively common occurrence in cyclists. I’d venture to say that most serious cyclists have experienced this phenomenon at least briefly while in the saddle.
However, the way in which it afflicts one person or the other can vary widely. To understand this we have to look at a “wiring diagram” of the body. That is, we have to understand some basic neuroanatomy.
There are many potential causes of tingling or numbness in the hands. These include autoimmune diseases that attack your own nervous system, nutritional deficiencies that impair the ability of your nerves to operate, or structural issues that physically put pressure on the nerve.
An actual impingement – that is, a pinched nerve, even if only while in riding position – is probably the most common reason cyclists experience this phenomenon. Tingling or numbness that only occurs while in the saddle definitely pushes structural issues to the top of our list of possible diagnoses. Since this is what most cyclists tend to experience, we’ll spend most of our time here exploring that possibility.
The nerves that supply feeling to your hands (as well as your sense of temperature, pain, pressure, and muscular control, etc.) start in your neck. There is a different spinal nerve, or nerve root, that supplies each of the areas consisting of your thumb and index finger, your middle finger and palm, and your ring finger and pinkie, respectively.
This means that if you have numbness that you feel only in your thumb and index finger, it means something different diagnostically than if you experience it in just your pinkie, or even in your whole hand.
This is where the “wiring diagram” comes in. There are typically only two or three places where each nerve root can get pinched. Where the roots start, in the neck, is a very common location for impingement.
If your numbness goes away after keeping your neck extended (i.e. looking up) for a minute or two, that’s a good clue that this might be where your problem is coming from.
The neck is not likely the source of your troubles if you experience numbness that covers the whole hand. For this to happen, all three of the primary nerve roots that supply the hand would have to be pinched at the same time. The only places this can really happen easily is in the area under your collarbone, or clavicle, and as the nerve bundles pass through an area deep in your armpit. After these points the nerves tend to spread out as they supply varying areas all around your shoulder, upper arm, forearm, and hand.
Around the elbow is another area where nerve bundles can experience impingement. This is why we refer to smacking your elbow in just the right way as hitting your “funny bone”.
What makes it funny (other than the name of the bone, the humerus) is the nerve that passes relatively close to the surface of the skin and supplies parts of your forearm and hand. Giving it a good whack is enough to send strange signals to your nervous system, which you experience as a tingling or buzzing sensation. You can then imagine what pinching a nerve off, even mildly, for longer periods of time can do.
A common misconception about any tingling or numbness in the hands is that it must be a condition known as carpal tunnel syndrome (CTS), where impingement of a nerve happens at the wrist. The carpal tunnel is a channel formed by the bones of your wrist and muscular and ligamentous attachments binding them together.
There is only one nerve that passes through the tunnel, and it supplies sensation and muscular control to the thumb side of your hand. This means that if you experience any tingling or numbness at all in your middle, ring, or little finger it is unlikely that you have CTS. The impingement is likely coming from one of the spots mentioned above.
Now that we’ve gone through some ways to distinguish one problem from another, what can you do about it? First, posture is king. Riding with your ears up close to your shoulders is a good way to increase the odds that you’ll pinch a nerve under your clavicle.
Similarly, riding with the head down (chin close to your chest) can set you up for problems in the neck. With neck problems especially, daily postural habits make a lot of difference.
Repeatedly reading in bed or watching TV on the couch with your head propped up, or working on a computer with the center of the screen lower than eye level can increase the likelihood of impingement in the neck. Frequent overhead activity (think painting a ceiling) can predispose you to compressing the nerves around your shoulders.
Long-standing cases of tingling or numbness typically need treatment. Specific, precise chiropractic adjustments of the neck, shoulders, and upper back can provide a lot of relief. Therapy should also be directed at correcting muscular issues that can impair shoulder and neck function and support.
If you have numbness in all fingers of your hands on both sides, especially if it continues while not riding, non-structural causes should be ruled out. Any good chiropractor, MD, or physical therapist should be able to help you narrow down what is happening in your particular case.
In short, if you’re having this problem, start being a detective. You might just solve your own problem or, at worst, you’ll have more precise information to provide your doctor that will help immensely in diagnosing, and ultimately fixing, the problem.
By ACC, on August 3rd, 2009
<This article was published in the August 2009 issue of The Racing Post.>
 Photo by Anita Ritenour With temperatures in Texas reaching triple digits on a regular basis, there’s been a lot written on exercise in the heat. There are some highly respectable exercise physiologists and coaches in the state that have studied the research and given excellent explanations about what happens to the exercising body when the mercury starts to bust out the top of the thermometer.
The bottom line is pretty simple: you cannot engage exercising muscle to the same extent in the heat compared to cooler temperatures. Conversely, if we get a rider to perform at a given power output (i.e. workload) on the bike, and take measurements of intensity such as a rating of perceived exertion (RPE) or heart rate, we’d find that both would be higher in hotter climes compared to cold.
For your day-to-day training, the conventional wisdom says that since heart rate increases as the temperature rises for the same power output, this supposedly makes heart rate a less valuable indicator of exercise intensity, since clearly you’re not putting the muscles through the same workload as you were in colder weather.
This is absolutely great exercise physiology, but doesn’t take into account the full spectrum of just plain old physiology. Our bodies are complete systems. Just because our muscles aren’t working very hard, it doesn’t mean that the rest of our body is somehow on vacation.
Heart rate increases in the heat, among other reasons, because more blood is shunted from exercising muscle to the skin for cooling. Doing so requires a higher heart rate to maintain the same level of circulation to the tissues.
In addition, we tend to get dehydrated faster with hotter weather, which actually reduces our blood volume. This reduced volume also instigates a higher heart rate to circulate nutrients and remove waste. These factors alone place more stress on your kidneys, liver, brain, adrenal glands, and the heart itself, to name a few.
This stress on your entire body is the reason you can do a moderate workout in 70 degree weather and feel great, yet do the same workout at 95 degrees and feel like you got up close and personal with the underside of an 18-wheeled vehicle. In other words, the workout in hotter weather feels harder because it IS harder.
Bodies like to burn an increasing percentage of sugars (compared to fat) in the heat, and this happens because different metabolic pathways are put into play. This should tell us that we actually train our energy systems — and the metabolic pathways that go along with them — to differing degrees when we turn up the thermostat.
Basically, for a given workload, we don’t train the same stuff in the heat that we do in the cold. If you’re at all diligent about planning your training and being mindful of what kind of intensity you apply, and when, this should concern you.
The vast majority of world records in endurance athletics are set in cooler temperatures. Somewhere in the mid 50’s Fahrenheit seems to be the magic point. We can’t simultaneously subscribe to the idea that cooler temperatures make it easier to perform better without also agreeing that hotter weather will make it harder.
There are many that believe that given what we know about how heart rate increases in the heat, it should be less relevant or even ignored under those conditions. I think it should actually become more important given it’s usefulness as an indicator of systemic stress on the body. Unfortunately for our egos, this means that as the mercury rises we’ll have to slow down in order to train effectively.
A power meter is a great measurement of exercise intensity and a fantastic training tool, especially at levels of exertion above the anaerobic threshold (where heart rate data is truly less reliable). Used together, simultaneous heart rate and power measurements can show true gains (or losses) of fitness by pegging a relatively concrete indicator of workload (i.e. power) to a much more reliable indicator of intensity than perceived exertion (i.e. heart rate).
We shouldn’t ignore basic warning signs just because we have data that shows one particular area of our bodies isn’t working to the same extent in the heat. Your perceived exertion, and your heart rate, go up in hotter temperatures for a reason. Your body is trying to send you a message. Listen to it.
By ACC, on July 11th, 2009
<This article is also available in the July 2009 issue of The Racing Post.>
In last month’s issue we talked about the stress of exercise, and how fitness and health are not synonymous terms. This time we’re going to look at some evidence of how training can have detrimental effects without careful management, and we’re going to start with a substance that is crucial to your existence: oxygen.
Most athletes understand that they must have oxygen in plentiful supply to fuel their training and racing endeavors. Aside from the important issue of training intensity and how that impacts our ability to use oxygen, what about the baseline ability of our body to carry oxygen?
Oxygen is carried in our red blood cells (RBCs), and when our RBCs get low in number it is referred to as anemia. Hemoglobin is the iron-containing molecule found within our RBCs that is largely responsible for transporting oxygen in the blood. Thus, if the number (or percentage) of RBCs in our blood declines, so does our ability to transport and utilize oxygen.
Last month we talked about the fact that exercise is a stress, and like any other stress, it has its consequences. For athletes, one of the many consequences of regular training is a rate of iron deficiency that is above that of a more sedentary individual. Iron deficiency can directly impact our ability to form hemoglobin and carry oxygen.
There are lots of reasons why athletes might be more susceptible to this problem. Perhaps chief among them is the fact that during exercise, RBCs shoot through our capillaries at high speed. A capillary is about the size of one RBC, so many RBCs actually break open, or lyse, due to the mechanical stress. When the RBC lyses, the iron-containing hemoglobin within it spills out into the blood stream.
Athletes produce a lot of acid substances. Lactic acid for one, and as a byproduct of aerobic energy production, excess hydrogen ions (where the “H” in pH comes from as a measure of your acid/base status).
Guyton’s Textbook of Medical Physiology (a “bible” of the field if ever there were one) identifies hemoglobin as an extremely potent buffer of acidity. As a result, one idea about why athletes tend to be more iron deficient is that the hemoglobin gets used up as an acid buffer in the normal course of exercise, to be later excreted in the urine.
So how do you know if you’re deficient? A standard check of iron in the blood — your serum iron status — is insufficient. Bodies do a very good job of keeping readily available mineral markers like this steady, making them poor indicators of developing problems until things are really out of hand.
Ferritin, or stored iron, is a much more useful measure. Even with this marker, however, the stated “normal” ranges as listed on laboratory paperwork are much too broad. The ranges you see coming straight from the lab itself are, generally speaking, statistical averages of the entire pool of tests performed.
I know of no athlete that is satisfied being average. The local office of the mega-lab that we send patients to for blood work lists “normal” ranges for ferritin from a low of 10 ng/ml to a high of 291 ng/ml. This is a range so wide that if you fall outside of it, you’ll probably come crawling into your doctor’s office.
In checking athletes in my office and in work with the University of Texas athletic department, we’ve found people tend to be symptomatic with ferritin levels below 30 ng/ml. For optimal health and performance, we like to see values above 60 ng/ml.
If you’re an athlete, you owe it to yourself to get this checked. There are many other things that could contribute to an anemic state, impacting your ability to feed much-needed oxygen to your tissues. However, iron status is one of the easiest and cheapest to both check and correct. A simple CBC (“complete blood count”) along with ferritin shouldn’t set you back more than about $50 at your doctor’s office.
Your doctor should be able to help you select a high-quality, highly-absorbable form of iron that will allow you to quickly correct the condition. Getting this checked is doubly important for premenopausal females, who are at an increased risk due to regular blood loss from menstrual cycles.
No matter what you do, keep in mind that your training has consequences! Staying on top of your health and respecting the stress of exercise is the best way to insure longevity in both training and life!
By ACC, on June 8th, 2009
Check out the June 2009 issue of The Racing Post for my article on the different forms of stress and how they relate to your health.
Fitness and health are not the same thing! Learn how to preserve your health in the quest for fitness.
By ACC, on May 6th, 2009
Note: This article was published in the May issue of The Racing Post, a cycling magazine published state-wide in Texas.
How often have you just finished a good 3-4 hour ride, only to be greeted by a sore, stiff back that isn’t too happy that you’ve decided to move from your usual hunched-over position on the bike? Do you have a hard time standing up after sitting for more than just a few minutes? Does your back occasionally “grab” on you if you bend over to pick up something you dropped? If any of these apply to you, it’s time for you and your psoas muscles to get intimately acquainted.
The psoas (pronounced SO-UHS) is a large muscle, deep in the core of your body. It originates from all of the vertebrae and disks (in between the vertebrae) in your lower back. It inserts deep in your groin area, on the inside of your femur, or thigh bone. It’s a thick muscle. Well developed, it’s about as big around as your lower forearm. This means the psoas has power. Power to move, and power to do damage.
If you’ve ever seen a sailboat mast you’ve probably noticed that the mast doesn’t just stick up out of the boat with no other support. There are usually wires, called “stays”, that run from the mast to the front, back, and sides of the boat to provide stability. Your spine needs similar help. Your back would not be stable if your spine simply stuck straight up from your pelvis with no assistance from other structures. Your psoas muscles provide a great deal of this support. In addition, the psoas is one of your primary hip flexors. This means one of it’s main jobs is to bring your knees closer to your chest. Anytime you’re bent over on the bike, sitting, or performing your best cannonball into the pool, the psoas is potentially in a contracted, or shortened, position.
This is significant for any cyclist. The psoas, just like any other muscle, can cramp or spasm. If you’ve ever had a cramp in your calf or the back of your thigh, you might have noticed that these muscles tend to cramp when the muscle is shortened, not when it’s stretched out. You also probably intuitively stood up to stretch out the muscle to relieve the cramp.
Since the psoas runs down the front of your spine, the only way to really stretch it out is to bend over backwards. Most of us don’t do this very well. So if you happen to be in the middle of a good hill climb, and your psoas decides to go into full-blown spasm, you don’t have an easy remedy! It’s exactly like having a cramp in your calf but not having any way to relieve it.
For anyone with back pain this means the psoas should get a lot of attention. On most people, psoas muscles that aren’t working well are usually (painfully) obvious. A psoas in spasm will not function to full capacity like a healthy, relaxed muscle, and will usually test very weak after a sustained contraction. A bodily “lean” to one side or the other is common. If you can’t stretch this muscle and relieve the cramp yourself, techniques need to be used that help relax the muscle without forcing you into a yoga-like move to bend over backwards.
Adjustments of the lower back and addressing pelvic torque (see the last issue of TRP) can definitely help calm down the spasm. As with any muscle cramp, dehydration can be a key causative factor. Many of the stories I hear of people who’s back suddenly “grabbed” on them start out with a description of a long day in the saddle.
So the next time you have back pain, while on the saddle or anywhere else, ask yourself a few questions. Are you dehydrated? Have you had other lower back “twinges” or discomfort that might have been your body’s way of telling you that everything wasn’t quite perfect? Do you feel “twisted”, with one hip or shoulder higher than the other? If you can’t clearly answer questions like those and address the problem, get some help to do just that. Your body will thank you!
By ACC, on April 4th, 2009
Note: This article was published in the April issue of The Racing Post, a cycling magazine published state-wide in Texas.
Here’s the scenario: a cyclist has back, hip, or knee pain, and ends up in the office of a local health practitioner, or in the hands of the bike fitter at the local shop. He’s told he has a difference in his leg lengths, and the asymmetrical wear and tear may be causing his pain.
It’s certainly plausible. Many of us have noticed riders ahead of us in the peloton who seem to have one hip that drops lower with every pedal stroke. That has to be originating from somewhere, right?
So what’s going on? How’d our rider get this way, and what can be done to address the problem?
The difference in leg lengths doesn’t start with the feet. The most common cause of a leg length discrepancy is displaced rotation, or torque, of the pelvis.
The two sides of your pelvis rotate forward and back when you walk, run, or turn over the pedals. When your foot goes over the top of the pedal stroke, the top of your pelvis — the ilium — has to rotate back, or posterior, to accommodate it. The opposite happens at the bottom of the stroke, where your pelvis rotates forward, or anterior.
With posterior rotation your thigh bone, or femur, gets pulled up closer to your head, making that leg temporarily shorter than the other. Due to a fall or some other kind of trauma, one side can get “stuck” in a relatively more anterior or posterior position, producing a functional leg length discrepancy.
Actual anatomical differences in leg lengths — where one or more bones are altered making one leg significantly longer than the other — are rare. You’ll see these in people who’ve had a fracture or some other significant trauma to their pelvis or legs. Knee and hip replacements are also good culprits.
I see dozens of people every week that have leg length differences, but since the vast majority are functional adaptations to some other problem, it’s rare that they can’t be fixed with treatment.
Typically, the longer someone has had the problem, the longer it takes to address. By it’s nature an athlete’s body is good at working around problems, so facilitating the release of a hard-fought adaptation like a leg length difference requires creative and thorough treatment.
A good bike fitter can be the first to catch this kind of problem. Making small positional changes or placing shims in shoes is a frequent fix for a leg length difference. These folks are wizards at getting you into a comfortable, efficient position on the bike, and reducing some of the biomechanical strain that can come from being asymmetrically positioned can be a god-send.
This is especially true if you have an anatomical difference in leg lengths. However, a functionally adapted short leg shouldn’t be propped up over the long-term with a shim or heel lift. Unless you know you’ve had trauma to your lower extremities, or you’ve had your pelvis and legs X-rayed to confirm there’s an anatomical difference, the chances are your discrepancy is functional.
Ultimately, getting yourself evened out through thorough treatment is the best way to reduce wear and tear, and increase your health and performance.
By ACC, on January 5th, 2009
We’re coming in for a landing this time. That is, in our last installment we talked about health care from a forty thousand foot view. We looked at conservative vs. aggressive care, and how chiropractic fits in (hint: on the conservative side).
Today we’re going to head down to ground level and get more specific about the approach I use to treat my patients. As I mentioned before, the type of work a doctor performs is frequently motivated by his (or her) interests. I’m no different in that regard.
How Did I Get Here?
Perhaps it’s just best to start with where I came from.
While I had always been interested in the study of how the body works, I’m not sure I really knew that for a long time. Spare time in my teenage and college years was spent pouring over books on training for athletic endeavors.
I thought I just wanted to figure out how to compete and win. Really, what I wanted was to understand what happened to my body when I used a certain training technique, be it physical, mental, or nutritional. The competition was just a bonus.
Shortly after my undergraduate training, though, my vehicle for exploring my passion had a breakdown. I had an injury that wouldn’t go away. Training was suddenly not a possibility. Not without pain, anyway.
While I could still read and learn about the body, it just wasn’t the same to me without the first-hand experience. So, I looked for help to fix the problem.
Eighteen months, two MDs, and three physical therapists later, I was still in pain, unable to exercise. It was somewhere in there that I realized that most doctors really aren’t like the ones you see in the evening medical drama on TV, where a brilliant diagnosis is followed by a creative treatment.
My experience was that most doctors spent no more than about 5 minutes of their time, frequently not even laying a hand on me — much less performing a full physical examination — after which point they wrote a prescription for pain-killer or anti-inflammatory medication.
This didn’t help me. The pain might be better while on the med, but it did nothing to fix the cause. As a result the pain came right back once I stopped taking the medication.
My limited understanding led me to believe that the only doctors really looking into the cause of conditions were the researchers in laboratories, and even then they tended to spend their time on new medications to treat the symptoms of a problem once it had already started.
My frustrations became clear: What happened to interacting directly with a patient? What happened to figuring out how to prevent a problem before it occurred? If that wasn’t possible, what about correcting the original thing that caused the damage in the first place, making a medication that merely covered up the symptom irrelevant?
A New Approach
I didn’t have any answers. I just knew that the care I had received thus far was frustratingly inadequate.
By happenstance I was referred to a doctor who did things differently. He used a system that, at its essence, allowed him to ask my body “questions” to determine what was wrong.
It was a way of working that melded the inquisitive, perhaps more cerebral process of diagnosis with in-depth interaction with the patient. In addition to what he could derive from my history and his own intellect, he also incorporated what my body could tell him from the result of simple, sequential muscle tests.
Muscle tests? Yes.
Consider for a moment that a great number of the standard tests you experience in a doctor’s office are already muscle tests.
Stick out your tongue and say “ahh”? A muscle test (of the muscles that are controlled by your Vagus nerve).
Shining a penlight in your eyes? A muscle test. (The ones that open and close your pupils.)
Hitting your knee with a hammer to see if you’ll kick? A muscle test. (That one I’m guessing you knew already.)
What these muscle tests have in common is that in each case the doctor isn’t usually looking for a problem with the muscle itself, but rather with the nerve that supplies it. The muscle tested is merely a window to what is happening with your nervous system.
Your nervous system is aware of far more than what occupies your thoughts. Try simultaneously coordinating your blood pressure, how much blood to send to your skin on a cold day, the balance of hydrochloric acid in your stomach, and the tone in deep spinal muscles that keep you from folding over like a cold french fry, just for kicks.
Since your nervous system is your interface to the world on so many levels, conscious and subconscious, it makes sense to find creative ways to tease information out of it that might not have bubbled up to the top of your everyday worries.
Outside of your nervous system, it is certainly possible that there could be a problem with the muscle itself — the nerve is sending and receiving a signal just fine, thank you very much — in which case it would be the doctor’s job to direct treatment to the problem in that muscle appropriately.
What the doctor does is determined largely by the group of “answers” received from the tests performed, and his ability to direct treatment based upon the available information.
Fast Forward to Now
This, in essence, is the system I use now. The grouping of tests and treatments that I use every day, with every patient, is called Applied Kinesiology (AK).
The tests employed are used not as a replacement of, but in addition to, standard diagnostic tests you would find in most doctors’ offices: basic physical examination, orthopedic tests, blood tests, and the like.
AK, while taught to any practitioner with a license to diagnose (e.g. medical doctors, chiropractors, and osteopaths), works from the holistic foundation of chiropractic: that disease is caused by mechanical, chemical, and psychological stressors (see this article for more on that idea).
As such it draws together the core elements of many complementary approaches to treatment, providing an interdisciplinary approach to your health. This is true holistic care.
In other words, you don’t just do structural work on a problem because it’s the only thing you know how to do. This is the “to a man with a hammer, everything is a nail” approach.
If there is a nutritional aspect to the problem, it comes up in the system and we address it. The same goes for mental or emotional stress that might be impacting the condition.
This means that a well-rounded knowledge of how bodies really work is required. We don’t pretend to know everything. Referral to outside experts is common when the need arises.
The Bug, Caught
What happened to me? I got better. After almost two years of floundering around, within 6 weeks of beginning treatment with AK methods I was back training again.
By then, though, I had had a true peek through a window of how the body really operates. I wanted more. That led to me becoming a doctor.
It’s pretty much impossible to unmake that omelet. Once introduced to this form of care, you don’t want to go back to a more narrow, single minded way of looking at things.
Like a rich, complex, and delicious piece of cake, though, you can’t really enjoy the creation just by reading the recipe. You have to be willing to give it a try, take a bite, and see what you might have been missing.
I invite each of you to come in for a taste, and experience what truly integrated, holistic care is all about!
By ACC, on November 9th, 2008
I was recently having dinner with my father and brother, when my brother made the statement, “It seems like you do a lot more than the average chiropractor. Why is that?”
My father quickly indicated his agreement, curious as to why the things I do are seemingly not associated with many other chiropractors in the world.
While responding to their inquiry, I had a background question of my own running through my consciousness: If my own family isn’t totally clear about what I do, what about the rest of my patients?
There are really two questions that arise out of my father and brother’s inquiry. First, what are chiropractors trained and licensed to do? Second, what do I do that is different from other chiropractors?
In this article I’ll address the first question. I’ll save the second for the next installment of this newsletter.
Let’s start with some thoughts on health care in general.
Conservative vs. Aggressive Health Care
The first piece to understand is that there is conservative health care and there is aggressive health care. By this, I don’t mean one set of doctors who voted for Reagan and another group that happens to be pushy.
What I mean is that there is a full spectrum of care, from the least invasive to the most. From a treatment that is as natural as possible to one that radically alters your existence.
The most invasive care available today, generally speaking, is surgery.
If you think about it, what could possibly be more radical to your body than opening it up and physically altering it in some way. This is why surgery can sometimes bring about the most radical and rapid change for a condition, though it also carries with it the biggest risk.
On the other end of the spectrum would be the most gentle, least invasive treatment a doctor could prescribe to effect an improvement in your health. Minor lifestyle changes, like suggesting that you make a concerted effort to get more sleep, would fall into this category. They carry little to no risk of harm just from undertaking this kind of change.
In between these two extremes is where everything else falls. Dietary changes or adding basic vitamin and mineral supplementation definitely fall on the conservative side, while prescription drugs that alter your body’s natural physiological mechanisms are highly aggressive forms of treatment.
Aggressive treatments are characterized by a higher risk to your health from the treatment itself, usually in exchange for a more rapid or radical change. Conservative care encompasses treatments that are low risk and typically, low expense methods.
In general, it makes much more sense to start with a conservative method that is low cost and low risk, rather than jumping immediately to an aggressive, higher risk form of care.
If you had a weed problem in your back yard would you go straight to hiring a backhoe to completely replace the topsoil, or would you try to put on a pair of gloves and manually remove the offenders first?
And My Doctor?
Given the large number of treatments and procedures that a doctor might choose, what does your doctor do?
That’s largely determined by three things: what a doctor is trained to do, what that doctor is licensed to do, and what that doctor is actually interested in doing.
The first part, training, is governed by the doctor’s education, both in and out of school. The second, licensing, is largely determined by the laws of the state in which the doctor practices. The last part, or what the doctor actually chooses to do, is influenced by the interests and drive of the doctor, as well as real or perceived legal ramifications of performing certain procedures.
For example, an Ob/Gyn (Obstetrician/Gynecologist) was trained in basic examination of the eye while she was in medical school. She is licensed, as a medical doctor, to perform them on her patients. However, you won’t find her performing them on her patients on a regular basis.
This is true for many reasons.
First, this particular doctor most likely specialized in her field because she had an interest in it. Eye exams are not generally part of the routine examination you might receive from an Ob/Gyn, for obvious reasons.
Second, due to her known specialty, the patients that walk in the door of this Ob/Gyn are not typically going to be looking for an eye exam.
Third, our Ob/Gyn might be worried about the potential legal ramifications of taking on the maintenance and care of a patient’s eye health when an ophthalmologist, who specializes in eye care, might find a serious problem that she could miss due to the relative infrequency with which she performs eye exams.
Finally, the financial implications of choosing her specialty are very real indeed. The overhead of simply keeping an office running for a medical doctor can be at amazingly high levels.
If you’re a doctor who has a high-overhead practice, just making it will involve spending a good chunk of your time performing procedures that carry a higher price tag.
What About Chiropractic?
A doctor can also be influenced by the perception the public has about what he is actually trained to do. This happens frequently with chiropractors.
If your patient population thinks that a chiropractor simply “cracks backs and necks”, then most likely every patient that walks through the door will be looking for that service, while those who don’t will stay away.
In reality, chiropractors are trained to do much more.
All chiropractors go through the equivalent of 10 semesters (5 academic years) of training in chiropractic school, not counting undergraduate entrance requirements that essentially mirror a pre-med background.
The education of chiropractors is wide-ranging, extensively covering human anatomy and physiology, pathology (i.e. disease), neurology, hands on therapy techniques, and nutrition.
Generally speaking, the only way chiropractic school differs from medical school is the absence of in depth study of pharmacology — the study of prescription drugs and their effects (though chiropractic education does cover basic principles of pharmacology). In its place, chiropractors get much more study in hands on therapies, nutrition, and rehabilitation.
Chiropractors also receive more training in anatomy and physiology than any other health profession. Chiropractic study covers every joint, muscle, and nerve from head to toe. It covers every organ system from your brain and heart, to your kidneys and gastrointestinal system.
The licensing of chiropractors, like other health professions, is largely determined by the laws of your state. The state of Texas allows a chiropractor to apply a wide range of procedures, including manual therapy techniques, nutritional supplementation, lifestyle prescriptions, and even acupuncture with additional training.
What is excluded from the chiropractic repertoire are drugs and surgery. That is, a chiropractor in Texas is licensed to practice conservative health care.
Why Specialize?
The financial issues affecting other health professions place chiropractic in a unique position.
My malpractice insurance for an entire year is in the low four-figures. MDs typically have premiums that are ten times that amount.
If you combine that with a practice design that does not involve insurance paperwork (other than what the patient chooses to file), my low overhead uniquely places me in a position to spend much more time with each patient, and focus on straightforward, low-cost, conservative measures to improve my patients’ health.
Essentially, this allows me to focus on the entire health of the patient — that is, truly holistic care — in an age where doctors are increasingly shying away from more generalized, “family” practices for higher paying specialty fields.
Being a specialist might work better for the doctor who wants to do well in an age of increasingly high overhead and low insurance reimbursement. Unfortunately, it doesn’t work out so well for the patient, who is in desperate need of a generalist who can make recommendations about their complete health.
Even among doctors that have the ability and training to create a holistic practice, not all choose to follow this model, even other chiropractors. Their reasons are varied.
Lack of interest, the absence of an encouraging mentor, or following conventional practice models are just a few possibilities. It could also be due to the desire to simply have a more straightforward practice.
Honestly, specializing in one thing makes a practice a lot simpler. Patients often present with complaints that frequently affect more than one area in a seemingly unconnected manner. Correlating this varied data in order to diagnose the condition that is truly at the root of their complaint is a much more complicated process.
But the holistic model is one I have embraced as an opportunity afforded to me by a lucky combination of things. There is a large number of people in need. I have a passion for trying to understand the wondrous complexity of the human body. Finally, I’m lucky enough to be in a wonderful profession that allows me the freedom to be an expert in conservative care.
Next time, I’ll address where my interests have taken me in creating my own, unique approach to caring for patients.
By ACC, on September 8th, 2008
You’re not alone. Ever. Every second of every day you’re accompanied by billions of other organisms that live within you, flourishing based upon the choices you make.
This is a good thing.
I’m talking primarily about your digestive tract. Specifically, the beneficial bacteria — frequently referred to as the normal flora — that exist in your intestines. While other parts of your body are also populated by friendly bugs, your gut is where their impact seems to be most frequently noticed.
We have what is termed a symbiotic relationship with the bacteria in our gut. That is, both us humans and the bacteria that live inside us benefit from each other.
The bacteria get a nice, warm, moist, dark place through which food passes on a regular basis. Compared to trying to scrape it out on a counter top or a random doorknob, our guts are the bacterial equivalent of Club Med.
In return, these bacteria help us by breaking down food for easy absorption, producing vitamins, and protecting us from unwanted invaders. The unwanted variety can frequently come in the form of other bacteria or parasites that are pathogenic, or harmful.
Interestingly, some of the most beneficial bacterial strains in our gut, if allowed to overly proliferate, can also be harmful. Ever heard of people getting sick from an infection by E. Coli? It just so happens that E. Coli is a very useful bacterial strain that normally inhabits your intestinal tract, producing much needed Vitamin K as well as certain B vitamins.
When Bugs Go Bad
So what’s the problem? Everything should just go along without trouble, right? As long as you don’t bother them, they won’t bother you.
Unfortunately, we’re usually the ones who start off the family feud. Antibiotics are the usual culprit.
Say you have a strong case of bacterial bronchitis and your doctor prescribes a round of antibiotics to make things right. Pretty soon, you’re breathing easier and coughing up less mucous.
Part of clearing out the bugs in your lungs involved some collateral damage to the ones in your gut, however. Generally speaking, antibiotics do not discriminate between “good” and “bad” (or nonpathogenic and pathogenic) varieties of bacteria.
So once you took those antibiotics to take care of your lung infection, you managed to kill off a good deal of the bacteria in your intestines, too.
This isn’t the only way we can upset our balance of normal flora.
For the little ones among us, simply being born by c-section reduces your chances of having a normally populated intestinal tract. Passing through the birth canal allows infants to pick up bacterial strains that help to populate the gut. Without that process, we start off at a relative disadvantage.
Consuming contaminated food or drink is also an obvious way to give potentially pathogenic bacteria a foot hold in your digestive tract. If one strain of bacteria populates your gut in large numbers, it can push out some other, healthy bacterial strains. Club Med can only handle so many customers at once.
Reading the Signs
Knowing when you have an imbalance is the first step to correcting it. Common signs are frequent gas, bloating, diarrhea, or constipation. Many will cycle on a regular basis through many of the above.
Symptoms can also be more subtle. Since our normal flora help us to assimilate nutrients, anything related to nutritional deficiencies is up for grabs. This can be as varied as skin dryness or irritation to unusual sensitivity to light.
If you suspect a problem with your flora, a good lab test involving a stool sample is key. Regular human labs don’t seem to be that great at finding tricky bacterial or parasitic problems related to the gut however. Being their bread and butter, vet labs are great at finding this kind of problem in pets.
However, in lieu of giving my patients a pseudonym of “Fido” and sending their sample off to the local vet lab, we’ve found a good lab that does a fantastic job of handling human samples. They also analyze the sample to determine specifically what bacterial strains are present or absent, as well as any varieties of pathogenic bugs that might be, well, bugging you.
Any lab that does this for you should be able to send you a list of natural and prescriptive agents to help you kill off the bad guys. If they don’t, ask around for one that does.
Now What?
Step two is to get rid of the bad guys and bring in the good.
What we have to do to get rid of bad bacteria or parasites is as varied as the bugs themselves. There are dozens of common herbs and prescriptive agents that handle the job nicely.
The good stuff is known as probiotics. These are supplements that contain beneficial bacterial strains in easily digestible powder, capsule, or liquid forms.
Since taking things by mouth involves having it pass through your stomach — an environment rich in hydrochloric acid — before it gets to your intestines, this is a bit like trying to get rid of all the weeds in your back yard and then repopulate it with healthy grass. The only catch is that you’re not allowed to leave your back porch!
We can’t directly access the intestinal tract. Anything we take has to pass through the stomach first. This makes repopulating your digestive tract like a war of attrition. If we send down enough numbers to make it through the stomach, with any luck they’ll take hold in the intestines and stay for good.
You can commonly find good bacteria in regular yogurt from the grocery store, but the bacteria are usually in insufficient numbers to really get the job done. Most commercial brands of yogurt contain live cultures measured in millions of organisms.
By contrast, with my patients I’ve found that repopulating the gut takes on the order of tens of billions of organisms a day to have a good chance at taking hold. Finding a good probiotic supplement that fulfills this requirement is usually what’s necessary.
You can find supplements that’ll do the trick at your local health food store. High quality, potent varieties can only be found at specialty pharmacies or a health care provider knowledgeable in natural remedies.
Going Forward
For most people, taking probiotics on a regular basis isn’t necessary. Some do find that taking regular probiotics in low doses helps them feel more regular, experience less bloating and flatulence, and have better energy throughout the day.
However, if you have to take antibiotics for any reason, it’s a good idea to follow that up with a round of probiotics. If you experience persistent problems, get in to see your local health care practitioner. Your friends in your gut, and the rest of you, will appreciate it!
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