Dr. Alex Earl, DC shares insights and simple strategies to help competitive and everyday runners like you deal with shin splint pain in the Wheaton, Glen Ellyn, Carol Stream & Winfield area.
most over-use injuries occur from doing too much, too soon after doing too little for too long.
The 2 Vital Features of Overuse Injuries
While the term "overuse" is a general term for any injury NOT due to sudden trauma or a single event leading to the presentation of pain and discomfort, it is worthwhile to further categorize the cause of an overuse injury into two distinct categories:
1. Excessive workload, or volume.
2. Insufficient recovery of stressed tissues (bones, muscles and tendons)
By far, an overwhelming majority of patients who end up in our sports medicine clinic in Carol Stream end up so due to doing too much, too soon after doing too little, too long. While someones intentions were healthy and well-meaning, their body was not ready for the demands of the exercise. A textbook example is on the soccer field or the track. Both sports expect athletes to begin the season at a higher than normal fitness level, but when that is not met the athlete must play catchup due to the increase running demands. This excessive increase, compared to another athlete who has been running all off season, proves to be the leading indicator of whether an athlete will develop shin splints or not. Also, another indicator is any athlete who has previously sustained shin splints or a bone stress injury (BSI).
Picture this: an athlete completes their high school or college soccer season in early November. The next season won't officially begin until August, so what should the athlete do in the off-season? Well, if the athlete wants to avoid a running-related injury, my answer has always been, "Don't run... OR, never stop running"...
My point is that the athletes who continue to run at a higher volume continuously throughout the year, regardless of intensity, significantly reduce their risk of develop shin splints. As legendary New York Yankees shortstop Derek Jeter once quipped, "It's far easier to stay in shape than it is to get in shape." I would agree.
Internationally renowned researcher, Tim Gabbett, Phd (who has taught his course "Workload Management: Train Smarter & Train Harder" at Active Health & Restoration back in 2019 and is scheduled to return to our office in June 2020) pioneered the analysis of these increased spikes in athlete's workloads in order to track and mitigate the risk of injuries. You may have even seen on ESPN the phrase "load management" as the reason for when James Harden takes another game off. Gabbett took this phrase from his research and began teaching coaches and medical providers alike the skills needed to identify athletes who may be more prone to overuse injuries.
The second category of overuse is due to recovery. Over the years, I've witnessed thousands of athletes "recover". From observing professional athletes and high performers, I can honestly say that they recover better than others. For example, during the NBA Playoffs this past year, Los Angeles Lakers forward LeBron James reportedly slept 12 hours a day. Think about that for a second. Arguably the best player in the league sleeps more than most, including others in the league who might be 10+ years younger than him. I do not think this a coincidence. Tom Brady is another example. Brady has been known to study football game film for hours right before bed. He's a master at football strategy and he simply knows how to win. But one can't help but recognize and appreciate when Brady studies film; before bed.
We know from several key researchers that our brains process information while we sleep with the most recently absorbed information processed deeper while we sleep. During chiropractic school, I would do the same thing. I would study the toughest topics right before bed, then sleep and wake up with a surprising amount of the information retained. The converse was also true; if I studied early in the morning, I typically struggled to retain the knowledge. If I was studying in the mornings, it also meant that I did not prioritize my previous night properly, which also meant I didn't sleep as much as I should have. Recovery has a way of build on itself like a snowball; which can be a good thing or it could come rolling back down hill on you if not done properly.
After we exercise, our tissues need time to fully recover before we stress them again. One the best ways to recover is to initiate a sleep habit, as our tissues recover best while we sleep. In fact, the best endogenous (meaning it is made within the body itself) hormone that aides in the healing process spikes while we sleep! This hormone is called growth hormone it is essential for our muscles, bones, tendons and ligaments to properly heal. If you don't sleep well after high intense exercise, such as a race or game, then you are spoiling a wonderful opportunity for growth hormone to kick in and do its job.
So there you have it! The first cause of shin splints explained - overuse. The two categories of overuse involve increasing too much in activity and reducing the amount of time to fully recover.
If you are frustrated with missing out on running, soccer, basketball or whatever activity you enjoy due to shin splints, I have good news. Every day in our sports medicine office in Carol Stream we deal with athletes just like you. We help athletes get back to their sport safely, effectively and properly in order to compete.
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3. Keep an eye out in your inbox next Wednesday for the 3rd Installment in our 4-part blog series.
Dedicated to restoring you health.
Dr. Alex Earl, DC DACRB
Dr. Alex Earl, DC shares insights and simple strategies to help competitive and everyday runners like you deal with shin splint pain in the Wheaton, Glen Ellyn, Carol Stream & Winfield area.
Every Spring, for the past four years, runners from local high schools and competitive runners training for a race come to our office in Carol Stream, IL with what quickly appears to be shin splits. There are two kinds of shin splints but several different causes of shin splints plaguing runners, soccer players, lacrosse athletes and many, many more.
Regardless of their goals, activities or sport, they all ask the same question: "What is causing my shin splints?"
So much so, I decided to map out the full clinical picture of shin splints. This will be the first of a four-part blog series addressing the causes of shin splints.
Please note the use of the term "shin splints" is referring to both anterior (front) shin pain and posterior (back) shin pain. For the sake of this article, the two types of shin splints will be used interchangeably so as to avoid any unnecessary confusion.
Part 1: Busting the 9 Current Myths about Shin Splints
To start off, we need to address the more frequently cited causes for shin splints. These come to us in the form of other healthcare professionals, health websites, blogs, podcasts, as well as directly to athletes from their parents, friends and coaches. With so many thoughts and opinions on the topic, it is very challenging to know who to trust.
We have taken upon ourselves to help decipher through the noise of information online by ... wait for it... providing information online!
This blog series is specifically designed to relay a taste of the information, the style in which we deliver it, and the solutions moving forward that we deal with on a daily basis at our Carol Stream clinic. We help runners deal with shin splints and keep them playing when most others advise them to stop, rest and ice.
[For more information on why this is poor medical advise, please read my last blog entry on this very topic and why rest & ice is NOT always the best idea!]
The 9 Current Myths About Shin Splints:
2. Muscular Imbalances
Contrary to popular belief, muscular imbalances are not evil and are very poorly correlated with painful conditions, such as shin splints. Runners have imbalanced muscles all over their bodies, but does it mean we can accurately state the group of muscles involved in shin splints are the cause of pain when there are other areas in the same body which are imbalanced but do not create pain?
3. Asymmetry of the right leg vs. left
Of all the "myths" we've heard over the years, the strongest argument against my views on the topic could be this one. With that being said, there are dozens, if not hundreds, of professional athletes, competitive marathoners, hockey players, baseball players, etc who have asymmetries and yet, they don't develop pain from shin splints. Take, for example, Leo Messi. Arguably the GOAT (greatest of all time) has a massive asymmetry in his right leg compared to his gifted left leg. One of the normal features of human beings is our individual asymmetries. Each one of us posses small, insignificant differences between the right side and left side of our bodies. A fair question to ask would be, "Why does the asymmetry become a cause of pain when it is present in nearly everyone? Is everyone with any asymmetry experiencing pain? No! Therefore, it is a conclusion which lacks sufficient evidence to say it is a cause of pain.
4. "Glutes not firing"
Unless you've experienced significant neurological compromise, such as a nerve injury, spina cord injury and/or a neurological condition such as MS or ALS (Lou Gerhig's Disease", muscles not "firing" is a moot point. There is no significance on the order of muscles firing either. Muscle contracts and "fires" based on the demands we put on the motor (movement) system. If we desire to stand up, walk across the room and pick up a glass of water, we are unconsciously using muscles in order to complete those tasks. Exercise is no, different. There are hundreds of literature articles looking into how motor control exercises affect painful conditions, and yet, only a few have shown that they actually change the way the muscles are firing. For example, in a hallmark study, Hodges and his group showed that low back muscle contractions were delayed by a milisecond in patients with low back pain compared to those who did not have low back pain. This became *the paper most cited by clinicians about the timing of muscle function. Since that paper, there have been dozens of other studies showing that specific exercises designed to change muscle contraction patterns failed to do so BUT those participants studied still DID show an improvement in their pain - it reduced. So, if we can reduce pain by strategic exercises but not change the muscle firing patterns, does it matter? Our vote is yet, it matter in what we relay to our patients. We are movement optimists and we will not cater to the negativity in the healthcare world. There's already plenty of that to go around. We would much rather communicate the important steps our athletes and clients are making towards solving their pain so they can get back to their activity, whether that is running, soccer, basketball, or football.
5. Weak Core
A "weak" core has been the victim of many year's worth of low back troubles. It has even made its way into the cause of lower extremity conditions, including shin splints. A patient came to our office after visiting a local therapist after he was told his weak core was the reason he had shin splints. Now, we could make an argument for why this could be correlated but we wouldn't go so far as to say this is what caused his shin splints. Correlation implies a mutual connection, whereas causation implies the action of causing something. A good example of this distinction is that of ice cream sales and crime. Both increase during the summer months. But we cannot say that ice cream sales increase crime. Having a weak core causing shin splints is like saying ice cream sales cause crime in the summer months.
Try going to a running store and NOT have the retail sale associate tell you that your feet pronate. It won't happen! With that being said, I must admit has changed in the past few years. Thanks to the work of some really smart people, who ask really critical and thought provoking questions, I've been keen to modify my original stance on pronation. After watching video of dozens of elite runners, it blew me away how many of them pronate to the point of concern. And yet, they were professionals making serious amounts of money and running at an incredible pace. If I were treating them, would I have tried to alter their over-pronation? If so, many would argue I would be making them a better runner, while many others would conversely argue I would be making them a worse runner! I've landed on the "do nothing if it ain't broke" approach. If Usain Bolt came to our office back in 2008 (arguably the peak of his career), would I have addressed his intense over-pronation? Knowing what I know now, I would have added some of our Running Drills to Master for him, BUT I would not make a big deal about his feet and toe displacement.. which leads me to my next point...
The bone out of place theory makes logical sense, except that it doesn't make clinical sense when discussing patients with pain. Sure, a big toe that is slightly pointed laterally as the result of years and years of little wiggle room in modern shoes hasn't helped the situation, BUT it certainly has not become (all of a sudden) the reason people start developing shin splints. After all, with every new patient we see in our office, we do a thorough movement analysis on the first visit. The number of patients with low back, hip, knee and foot/ankle troubles with perfectly positioned feet is 50%. Half of our patients do not exhibit deformed toes and feet but the other half show anywhere from mild to severe changes in their feet and toes. We find this as a clinical data point but, again (and I know I am sounding like a broken record here) this is insufficient evidence to say it is the cause of shin splints.
8. Poor Posture
Poor posture gets blamed for just about every musculoskeletal condition on the planet. Unfortunately, upper and lower crossed syndromes were theoretical in nature by Pr. Vladimir Janda and were the greatest contribution to the field of rehabilitation and sports performance at the time - in the 1970s and 1980s. Having learned first hand from Pr. Janda's protege, Pr. Pavel Kolar back in 2016 on a week long intense training course at his hospital in Prague, I got to ask Pr. Kolar about Janda's work with postural analysis as an explanation for the cause of pain. Pr. Kolar assured myself and the rest of the attendees at the course that the movement system is a representative of the brain and while movement patterns can be enhanced they are quite unpredictable at determine the root cause of patient's pain. His current emphasis is on improving movement efficiency, rather than corrective postural alignment issues. An example of this would be isolated hip range of motion, such as internal rotation without the use or movement of the low back. We would agree! We feel narrative needs to switch from pointing out postural flaws and instead focus on challenging the right tissues at the right time to improve the efficiency of movement in order to be more prepared to handle the stress of running the next time out.
9. Need an orthotic/insert in your shoe
This myth is cut from the same cloth as Myth #6 because it addresses the quick fix to the over-pronation problem. I should probably clarify I am not opposed to orthotics, especially when used under specific and temporary situations. Some people respond well to orthotics and others rely exclusively on them for normal day to day function. I would also like to concede the cases where individuals have sustained trauma to a long bone, such as the femur (thigh) or the lower leg, such as the tibia. If this injury took place during childhood, it is very likely one leg would have grown at normal rates while the other was delayed due to the injury. This is one way in which a leg gets physically longer than the other one. In these cases, an orthotic in the shorter leg is a smart, clinical decision. In my opinion, these two are completely different clinical presentations - unless, of course, the patient has both!
So there you have it. My attempt at dispelling the most frequently cited causes for shin splint pain. In the coming weeks, I aim to redirect the conversation towards the solutions of the shin splint problem, and here's a hint... It's NOT rest and ice!
Do this next:
1. Share this blog with someone you know who would find this information useful.
2. Email our office if you are interested in the Running Drills to Master mentioned in the blog. Email us at: email@example.com
3. Keep an eye out in your inbox next Wednesday for the 2nd Installment in our 4-part blog series.
Dedicated to restoring you health.
Dr. Alex Earl, DC DACRB
Dr. Alex Earl, DC shares insights and simple strategies to help competitive and everyday runners like you deal with knee pain naturally and without "rest & ice" like most are usually told.
Let's face it, the last thing we all want to hear is to be told by a medical professional to stop running, ice and rest until the pain goes away. In the short term, that seems like sound advice and, quite frankly, it is the safest form of medical advice that doctors, nurses, physical therapists, athletic trainers, and chiropractors can give to protect themselves. Our approach is proactive, rather than reactive at our Carol Stream clinic, where we help runners of all ages get back to the thing they love - RUNNING.
But, what about your options moving forward? Should the advice of an avid runner be the same as the individual who has never completed more than a few miles? Certainly not, in our opinion. Both cases require specific and individual strategies to reduce pain, improve endurance, and overall quality of life. After all, these are some of the benefits of running.
Simple tactics which yield high-paying dividends on your health, wellness and running related knee pains.
In the event one of these simple strategies do not help your current running related knee pain, please call our office to schedule a time for us to connect with you about what is frustrating you in order to help you get back to running.
You can call our office at (630) 480-0113 or email us at firstname.lastname@example.org and let us know how we can help you recover from knee pain in order to restore your running lifestyle.
If you, or someone you know is currently suffering with knee pain who loves to run, then please share this blog entry with them so they can enroll in the Running Restoration Online Program today to start their recovery journey without the frustration of being told over and over again to simply rest until the pain goes away.
Is it OK to get your back cracked? Dr. Alex Earl explains all you need to know.
There is something satisfying about hearing the sound of the spine "popping". As a chiropractic physician, I was taught how specifically we can get with our treatments to best help serve the needs of our patients. But without fail, every month at our Carol Stream clinic, new patients ask us why it feels SO good to get your back "cracked"? In fact, there are social media accounts specifically showing real life spinal adjustments creating an audible "crack" followed shortly thereafter with a relaxing "ahh" feeling by the patient.
In our opinion, it is an important question which needs to be properly answered.
What actually happens to create the audible noise starts within the spinal joints. In a physiological process known as "tribonucleation", which is when two opposing surfaces resist separation, specifically in this case the spinal joints but can apply to any synovial joint in the body. This resistance of separation eventually reach a critical point whereby a force causes the joint surfaces to quickly and briefly separate.
When this separation takes place, the lubricant within the joint, called synovial fluid, immediately has an increase in space as well as the new addition of a tiny gas bubble. It is the creation of this small gas pocket within the joint that is responsible for the audible popping sound. Back in 2015, researchers were tasked with capturing this physiological phenomenon, which they successfully did with the help of an MRI scan. Check out the 6 second video of a finger below.
So there is the physiological explanation as to the mechanism behind the audible noise, but what actually happens that makes getting your back "cracked" feel so good.
A few weeks ago, when setting up to adjust a patient on his side to adjust his low back, my shoulder "popped" while pulling him into the final position BEFORE adjusting the patient. What happened next was interesting...
The patient let out an audible, "Ahhh" with a lengthy and very relaxing exhale.
But it was my shoulder that cavitated (or "popped").
Why would he experience a feeling when it wasn't his joint which "popped"?
There is no doubt that the mind plays a part, and if one is expecting an audible pop then one will be more aware and alert when the sound of one is heard, regardless of where it came from.
If this audible release creates a wonderful pain-modifying effect, then should we all just be popped our neck and back all day? Probably not, as we are not advocates for reliance on one treatment as an end-all-be-all guide to eliminating pain.
Usually, back cracking on your own is harmless. There is no evidence this "popping" causes arthritis. Expert doctors and therapists all agree: an ideal treatment approach is one that encompasses more active than passive. If your doctor or therapist is heavily reliant on massage, electric stimulation, heat/ice, kinesiotaping, and posture correction, that is a red flag.
At our Carol Stream clinic, we utilize spinal adjustments regularly - when it is clinically indicated and within the guidelines for expert care. Every patient comes into our office looking to identify WHY they have back or neck pain, and our methods include stretching, flexibility, mobility, strengthening, and overall body awareness through individualized treatment and exercise routines.
In our opinion, treatment plans which rely on spinal adjustments, massages, vibration beds, and lasers are NOT addressing the underlying issue but rather masking the symptoms and provide short-term symptom modification.
If you, or someone you know has been suffering with back pain, which prevents them from doing the activities they love then please forward this article over to them. Why? Because we believe that everyone in pain should have a chance at learning how to get back to the most fulfilling parts of their lives'. We'll help you get there.
Former Chief Editor of the number one orthopedic technique journal, Dr. Brian Day, MD, specifically mentions the Delphi device in his editorial. Dr. Robert LaPrade, formerly of the Steadmon Philipon clinic in Vail, Colorado, the expert on knee multi-ligament repair, also mentions the same Delphi device used in our Carol Stream clinic.
"I still have knee pain and my ACL surgery was two years ago." -AHR past patient
Since 2000, when researchers Cook and Koltyn coined the term, “exercise induced hypoalgesia”, doctors and physical therapists have pushed exercise as an effective method for reducing a patient’s pain.
More recently, additional information came to light, which should get your attention if you are currently experiencing any pain or discomfort.
The research has shown that the addition of BFR to resistance training for the lower leg produced a significant reduction in pain levels, when compared to low intensity exercise alone for the lower leg.
We see this effect every day in our office with patients who can’t physically play soccer, basketball, or football to their specific needs.
One such collegiate football player came to our office with a nagging ankle issue. He wasn’t able to run an “out route” from the backfield and, on a dime, cut when he reached the sideline and sprint upfield. Due to his ankle mobility issue, he was rounding his runs and ran out of bounds each time. Frustrated, he came to our office to work on his ankle, but what we ended up figuring out along the way shocked us both.
Two years prior, this athlete suffered a torn anterior cruciate ligament (ACL) on the same leg. Even two years after the surgical procedure, he still reported tenderness and the occasional pain episode in the knee. Not convinced that the affected leg had healed fully, we investigated further to find out significant discrepancies between the left and right leg on this athlete. He had still not yet gotten his affected leg back up to 100% his pre-ACL strength baseline. And yet he was cleared to play.
With some moderate amount of swelling in his ankle joint, we decided to pursue a rigorous course of manual therapy, soft-tissue work and BFR to minimize any muscle deficits, since he was unable to continue to perform his team’s usual in-season weight lifting program.
Enter BFR and the rest of the story….
We began using BFR three times a week at a consistency of 3-4 exercises per session. The athlete reported that he had never experienced such rigorous exercises previously and greatly appreciated the intensity, as it felt like he was getting “back to where” he needed to be to play again.
About the fourth session in, this athlete reported that his anterior knee pain, the ache and tenderness was gone. Not just reduced, but gone, completely. He had a grin on his face from ear to ear and was ecstatic at the current state of his knee.
After a few more sessions, he was back on the field, cutting and helping his team make it all the way to the quarterfinals of the National tournament. His contribution to the team was immense and we are extremely proud of his mentality and his ability to work hard for his team.
So what’s the take home message here? BFR is an effective strategy to reduce pain even in areas outside of the targeted tissue. As mentioned in our case study, our athlete eliminated his knee pain when he came to us for an ankle mobility issue.
Now, there is no doubt that a heavy resistance and strengthening program would have gotten him to his desired state at some point, but unfortunately, athletes and clients fall into the “Doom Loop” all too often.
The Doom Loop goes like this: A region or part of the body hurts, so you don’t use it (so as to not hurt it further), and since you don’t use it very often, then when you do go to use it, it hurts and doesn’t feel normal - so you don’t use it anymore! And the cycle goes on and on and on…
When BFR enters the picture, it offers a safe, effective method of interrupting the “Doom Loop” by getting you moving again safely. Simple range of motion exercises with BFR is a great place to start, and also slowly starts to reverse the effects of a lack of mobility on that problematic area. Once tolerance has been built up, we slowly add bands and weights to the exercises to really create an amplified effect on muscle.
Since our office utilizes the Gold Standard BFR device, called the Delphi Personalized Tourniquet System, you can be rest assured that the device is safe and extremely effective. In fact, nearly 90% of all the research studies conducted on BFR use the same Delphi device we use right here at our Carol Stream clinic.
In fact, some of the world leaders in surgical procedures have authored editorial papers specifically mentioning and encouraging outpatient use of the Delphi device for post-operative conditions such as ACL, meniscus, labral repair, rotator cuff surgery, and many others.
If you, or someone you know, has previously had a surgical procedure done BUT still is experiencing tenderness and discomfort, like our football stud was, then please call our office today to see if BFR is right for you. Call (630) 480-0113 now!
While taking new patients medical history, we frequently hear a phrase in our Carol Stream clinic: "I've had a bad back ever since I slipped a disc." This is really an interesting way of communicating a complex system of the body. While providers typically don't always agree with how patients and society word or phrase their pain and discomfort, I believe a stance should be started on the topic.
In short, my answer is: yes, disc material can slip.
The spine does NOT slip in relation to itself (bar any extreme trauma such as a motor vehicle accident). For example, one patient of ours visually showed us, with his hands, a mechanism of action whereby he believed his spine "slipped into two pieces" when he lifted snow with a shovel and experienced his excruciating symptoms. While this mechanism makes ideological sense to patients who currently have low back pain, for example, it is important to note that the spine is not fragile, is quite robust and was design to move, bend, lift, and flex.
One of the definitions of the word slip is "go or move quietly or quickly, without attracting notice". In this sense, we would argue that yes, disc material does slip.
We have seen a plethora of research showing disc material, specifically the nucleus pulposus, migrate outside of the standard disc space. In fact, after small cracks in the annular fibers, which serve as the outer-most layer of disc material, and is quite tough. Compared to the annulus fibrosus, the nucleus pulposus is quite soft and it resonates the same substance as toothpaste.
Since this progression of disc material outside of its original position, and WITHOUT notice of symptoms (especially pain), we would argue the usage of the word "slip" is accurate. The disc material slips through the annular fibers into the nearby joint space. The most shocking bit to patients is when we tell them that this does NOT always produce pain. The disc material must make contact with the nearby nerve root for the sensation of discomfort to be triggered.
Each week at our office in Carol Stream, Illinois, we help men, women and adolescents overcome disc injuries. If you, or someone you know, are suffering with a slipped disc, like I described above, then please know we can help. Most of our patients come to us after going to see a physical therapist, or their primary care physician, only to be discouraged by a lack of progress or the recommendation of pain pills and muscle relaxers. We know, and our patients know, these are NOT effective long-term strategies for spine pain.
Secondly, most of our patients come to us with a specific goal in mind. If you have a health or fitness related goal, and this spine pain is currently preventing you from doing your favorite activities, such as soccer, football, golf, CrossFit, running, etc, then I have good news for you - we are here specifically for you.
If you enjoyed this article, please share it with you friends and family so they too can learn more about this all-to-common topic.
Lastly, if you are currently suffering from spine pain and it is severe enough that it prevents you from being yourself and doing the activities you love, then please call our office TODAY to talk with our amazing AHR Team to see if you would be a good fit for our office. You can call us today at (630) 480-0113
Dr. Alex Earl, DC
1. Do understand your pain is very real
Oftentimes, persistent pain involving the lower back is quite complex. This can be caused with or without the presence of tissue damage. Since our tissues might not incur any new damage, this can lead many people suffering with back pain to feel as if their pain isn't real. Persistent low back pain should be viewed through the same lens as other complex conditions such as diabetes, where many factors are constantly involved - not just one single influence. We now know factors including sleep, nutrition, hydration, stress (both emotional and social) all play a part in low back health in addition to physical activity and fitness.
Regardless of which factor "ticked off" your lower back, your pain is REAL.
2. Do Remain Physically Active
One of the toughest bits of advice we give to our patients with acute low back pain, is to continue to stay active. It sounds contradictory to standard medical advice of "rest and recover" but bear with me for a minute.
While there is no "hack" or "curative" exercise for low back pain, there are dozens of strategies to effective mitigate long-lasting pain. One of those strategies is to continue to simply move. How frequently, how intense, how long is entirely up to you, but know this: there is no amount of exercise that is too little. (Griffin, O'Sullivan)
"Small strokes fell great oaks" is a favorite quote around the office. We appreciate the little roots of effort which have yet to bear fruit. But much like a plant slowly grows and eventually bears much fruit, your movement should also be slow and progressive. Our job at AHR is to make sure you are placed in the right soil.
3. Do Sit, Stand, and Slouch in Various Positions
We are not the posture police. Oftentimes, patients preemptively defend their posture and depict seated, driving and standing postures they believe we are going to tell them they "need" to be like.
Controversial Statement #1: We believe that movement is dynamic and variable, and so is posture.
We view posture to have many positions, including slouching, bending, and arching. Common healthcare and fitness warnings to avoid a specific movement of the spine are void of any evidence currently published. Additionally, this propagates fear of an otherwise normal, every day motion, such as bending forward to touch your toes.
4. Do Continue to Enjoy Meaningful Activities
Suffering with low back pain can be overwhelming. Focusing on anything other than the painful experience can be quite a challenge (I have a few personal experiences with "hot" low back episodes in recent years, and it was difficult to focus on much else during those intense days).
Our advice is to focus on the tasks or activities that add value to your life. For me, it was going on a family walk with my wife and our children. My pain was lost while focus on our kids and the conversation with my wife.
An important take home message about meaningful activities and low back pain is this: It is possible to do both. You can have pain AND enjoy meaningful activities & experiences. We had a patient at our office with an acute episode of low back pain AND he was still able to participate in family hunting trip at the same time. The hunting trip took priority over the pain.
I am writing this today to publicly give you, your family and your enjoyable life priority over your pain.
5. Do Maintain Your Social Life
Oftentimes, people experiencing low back issues feel secluded. The avoid going out with friends, and they oftentimes miss social interactions at work if they are forced to stay home. As mentioned earlier, this feeling of seclusion can add addition layers to the multifactorial components of pain, such as stress or lack of sleep. This "loop" can only lengthen the time is takes for recovery.
One of our favorite treatment plan ideas is to have patients nurture meaningful relationships. Getting lunch with a close friend, coffee with a spouse, or a phone call to an old friend are all ways we can connect with other people and share memories. Oftentimes, it's within these close relationships that we can be honest with ourselves, receive valuable insights, and much needed encouragement.
1. Don't Fight it - It is NOT a Sign of Weakness
Pain affects people of all ages, so it is important to note that you and I are not exempt and shouldn't attempt to fight it. This can create a "Vicious Cycle" in which a hyper-vigilant person attempts to fight the pain, which can lead to more regular "flare ups", which can yield less physical activity, low mood, sleep disruptions, frustrations, and more intense reliance on pain medications and over the counter.
Rather than focusing on defeating pain, we (I say "we" because I need to hear this too!) should focus our energy and minds on what we CAN control. We can control our attitudes about our pain and our decisions around our life, such as to exercise or not to exercise. Once a decision as been made, reward yourself for taking steps in the right direction - regardless of whether they were successful or not.
2. Don't Assume Persistent Pain is Due to Tissue Damage
Pain is an effective protector. Therefore, if you've injured an area before, pain acts like an accurate protective sensation warning of potential or worsening damage. Just like if the fire alarm goes off in the house, one doesn't know where the fire is or, more importantly, the severity of the fire. Did someone just cook on the stovetop with olive oil again and the whole kitchen is smoky? That's not the same intensity as if there were an actual fire coming from the stove.
And yet, it is the same fire alarm that goes off for both situations...
The alarm doesn't tell us where the fire is, nor how severe it is. Pain is the same.
3. Don't Rush If You Flare Up
The journey to recover from pain is full of peaks and valleys. Patients frequently describe "good days" and "bad days". This is completely normal.
Rather than viewing painful flare ups as a re-injury or a "setback", we can take this time to evaluate specific triggers and situations which provoked it. Factors such as a poor night's sleep, stressful week at work, or a fight with your spouse. The point is not to feel guilty about WHAT played a part in the flare up, but to observe it, address it, and learn from it.
Healthy Low Back Tip: Place a sticky-note on your refrigerator which states, "A flare up will come. I will be OK."
4. Don't Believe Everything You Hear, Read, or See (especially on social media!)
When pain reaches a certain point, most people are willing to try just about ANYTHING.
With the rapid increase in online influencers, it has become increasingly challenging for patients suffering with low back pain to sift through the vast amount of opinions, myths, and information online. There are snake-oil salesmen out there selling their remedies, so be on the lookout. When listening, reading or watching someone discuss ways, it is best to be extremely cautious and wary of anyone who claims to "cure" low back pain. Whether that is a chiropractor claiming to cure low back pain with a specific adjustment or technique, or a physical therapist claiming to cure it with a specific manual therapy method. Be wary, very wary. (This coming from a chiropractic physician!)
Therefore, before choosing a particular provider, treatment or approach it is important to research, discuss and investigate your options. What we do in our office is sit down with patients - or stand if that's more comfortable :) and we go through what is called Informed Consent, which we map out for them using the acronym "BRAN":
B: Benefits, as in, "Here's the benefit of exercises for low back pain."
R: Risks, as in "Here are the inherent and potential risks of each method we prescribe."
A: Alternative Options, as in, "In addition to chiropractic & physical therapy, another option is..." (which also includes benefits and risk for EACH option. Most providers RARELY disclose these and it proves to be quite costly for both time and effort.)
N: Nothing, as in, "Here's what you expect if you do nothing for your low back."
5. Don't Rely on X-rays or MRIs
While medical images, such a X-rays, MRIs and CTs are helpful in certain clinical situations, only a small number of people actually need them. A thorough patient history and physical examination will effectively dictate the medical necessity for an image. Providers who over-prescribe MRIs and X-rays for every low back patient are going against the current clinical practice guidelines (Which were put together by leading experts in chiropractic, physical therapy, neurosurgery, and medical researchers... So, basically, the authority figures on the topic and NONE of them recommend obtaining an X-ray on every low back pain patient. If you are in a medical office and X-rays are recommended, without explanation, as part of the practices Standard Operating Procedures (SOPs), you have my permission to quietly walk out of the appointment.
Here's why the reliance on medical imaging has become problematic. One study showed that 40% of people over the age of 30 and 50% of people over the age of 40 have lumbar spine (low back) disc bulges on MRI. These people were asymptomatic!
So, it is important we don't equate what we see on the x-ray or MRI to the relevance of the person.
Reference: Derek Griffin, PhD, and Professor Peter O'Sullivan (Two of the world's leaders in managing and treating low back conditions and pain research.)
Alex Earl, DC is a board certified chiropractic physician, who helps athletes and active individuals stay healthy, increase performance and reduce the risk of injury.
"We have to get our athlete's into BEAST MODE during physical therapy & recovery, otherwise, we are NOT challenging skeletal muscle nearly enough." -Johnny Owens, DPT Owens Recovery Sciences
When we first introduced Blood Flow Restriction (BFR) to our patients, invariable, the question came up: "What is this doing?"
Blood flow restriction is a novel, albeit not new, concept whereby arterial blood is restricted (not occluded) via a pneumatic tourniquet (similar to a standard blood pressure cuff) into a limb for a brief period of time.
By reducing the amount of oxygenated blood entering into the limb, either the arm or the leg, the affected limb quickly becomes stressed due to the lack of oxygen...
This stress has a significant effect on skeletal muscle, which oftentimes has become resistant to increasing in size and therefore strength. The stressful feeling in the limb with the tourniquet on feel eerily similar to the experience when we were kids and rode our bikes everywhere. Well, if you were like me, you rode your bike EVERYWHERE. Well, the feeling of riding a bike up a steep, steep hill was not one which many particularly enjoy.
That heaviness felt in the thighs while riding up a steep, steep hill are almost exactly the feelings that can be felt in the legs during a BFR session.
Needless to say, our patients have grown skeletal muscle, increased metabolic efficiency and seen tremendous progress by using BFR. Most importantly, upon completion of the rigorous BFR Plan of Care, every single patient has returned (safely) to their specific activity - running, weightlifting, football, lacrosse, soccer - you name it.
BFR has truly become a game-changer when it comes to proper rehabilitation and performance goals. But don't be fooled but other products on the market right now. The Delphi System we use at our office is a medical grade surgical tourniquet device, passing all the medical standards to be used in an operating room.
Unfortunately, not all devices are created equally. There are a lot of cheaper options on the market, which yield poor results (sadly). If you want to use a cheaper BFR device, our office is not the place for you.
Who is BFR for?
BFR is PERFECT for patients is perfect for 2 types of individuals; post-operative patients and recently injured individuals.
Post-operative BFR :
Unfortunately, traditional "PT" and "Chiro" treatment use colored bands and dumbbells, which are NOT enough to create stress in a limb that has undergone a surgical procedure. Picture a knee-ACL patient, with tons and tons of muscle atrophy (decrease) in the thigh region. Will a 3 pound ankle weight for 12 week REALLY help that person re-gain strength? We don't think so either. Enter the tourniquet. With the same 3 pound weight, BUT only 20% blood flowing into the limb, now we can metabolic stress muscle and therefore INCREASE it. Now we have improved muscle function and we are on our way to getting that person back to their sport/event/activity.
Acute Injuries & BFR:
Frequently, the phrase, "There's nothing we can do until the swelling goes down" is uttered around sports injuries. Picture the tweaked knee, the swollen ankle or the irritated shoulder. When an injury occurs, the swelling, which is the local inflammatory process, is actually a part of the healing process around the injured tissue. We don't really want to hurry that process up! However, the dichotomy here is that we also do not want to lose our hard-earned skeletal muscle. In some cases, this hard-earned muscle mass took YEARS to achieve, and, sadly, within 24 hours of not using it, the muscle begins to "waste" away (atrophy). What if there was a way we could maintain the muscle mass but not affect the tissue healing process? Enter BFR. With BFR, we can achieve something truly remarkable. We can place a tourniquet on the limb for ~20 minutes and mitigate skeletal muscle loss. Pretty cool (as long as you have the gold-standard BFR device, which we do!)
If you, or someone you know, has suffered with knee pain, hip pain or shoulder pain, BFR could be the vital approach to getting you back to your previous activity levels. It happens all the time at our office.
BUT, before you finish reading this, I need you to know that BFR is NOT for everybody. It is intense. You will experience complete muscle failure. This can leave individuals feeling totally uncomfortable - temporarily. Once the cuff is deflated, the feeling goes away. BUT, the warning needs to be heeded. This is NOT for individuals who enjoy sitting on a table getting massages and stretches for 45-60 minutes per session.
This is for those of you, who want to get better, so that you can get back out onto the field, court, rink, or trail and simply GET AFTER IT.
If that's your goal, we can help.
Call our office TODAY to schedule a BFR Demo just for you - (630) 923-5049.