STRUGGLING WITH CHRONIC PAIN OR CHRONIC ILLNESS?
When looking at a lateral view of the spine, the first thing we notice is the curves. The (normal) forward curve in the neck and low back is known as "lordosis" or "lordotic," while the mid-back curve runs the opposite way and is known as "kyphotic" or "kyphosis". What do these curves do? For starters they allow normal movement, both segmentally and sectionally (HERE). Proper curves also create a spring-like function that allows the spine to act as a sort of shock absorber; particularly important if you work on CONCRETE or other hard surfaces.
Without proper curves your spine would take a pounding of epic proportions. The curves work to distribute weight and force as well as transferring muscle energy to where it's needed. As you might imagine from looking at the picture; when spinal mechanics are off, the end result is that there is abnormal distribution of forces to spinal discs --- or maybe more accurately, to parts of the disc where said force should not be. Allow me to give you an example.
While discs will often herniate some degree laterally, they virtually always herniate backwards (posterior), meaning that herniated discs --- mostly from the low back or neck --- have the potential to be pushed or squeezed into the spinal cord or spinal nerve roots that come from the cord. What does this have to do with maintaining normal lordotic curves?
These normal curves put an axial pressure on the backs of the discs (as opposed to the fronts of the discs). As you can see from the picture above, this squeezes down on the posterior aspect of the disc, while opening up the anterior or front of the disc and pushing it forward. This natural "wedging" of these discs makes it extremely difficult for the disc's jelly center (the nucleus pulposis) to herniate (because without a horrific trauma the disc will not herniate forward), and explains why you will sometimes see this spinal position referred to as "closed-packed". However......
Imagine what would happen to the low back or neck if there were either no curves, or even worse, a REVERSE CURVE. Now, instead of the discs having the "open" portion of their wedge to the front, the open part of the disc faces the back. This is what happens to your lumbar spine if you bend forward and touch your toes. No big deal. That is, no big deal until you start loading the spine. Imagine, however, bending forward and lifting something, while not consciously maintaining the normal curve in your back.
Not only are you opening the disc in the back, but the heavier the object you are lifting (or the more overweight you are), the more pressure you are exerting on the front of the spinal column and discs, as opposed to them carrying this force on the posterior parts of the spinal column (the facet joints). This pressure literally squeezes the disc backwards like squeezing a tube of toothpaste. When there is too much force, or more likely, too many years of poor lifting mechanics, the ligamentous fibers of the disc (the annulus fibroses) that hold the jelly-like nucleus in place begin to separate and tear. The result is that you are now in a position where disc herniations are not only possible, but increasingly probable (HERE is a basic video of what this looks like).
Let's add one more variable to this situation. Let's do some situps. After all, everyone knows that situps are good for your back because strong abdominal muscles promote strong discs ---don't they? Enter Stuart McGill. Decades ago, McGill was the lone voice in the wilderness, warning that situps were not only not good for your back, but were arguably one of the single worst things you could do to your spine. His research has shown why situps are one of the best ways to cause spinal problems, including herniated discs (HERE).
In a recent interview with Dr. William Morgan (A Conversation with the Preeminent Lumbar Spine Researcher: Stuart McGill, PhD); after discussing overuse of spinal imaging, McGill made this statement concerning what's arguably the single most common spinal finding on radiologist's reports DJD or DDD (degenerative joint disease . degenerative disc disease). "When they [radiologists] use the term degenerative disc disease, I put that in the same category as nonspecific back pain. It's a garbage term." Interesting because that is essentially what I said in THIS 2012 POST.
In the PORTION OF THE VIDEO INTERVIEW titled Mechanics of Injury For Lumbar Disk Herniations and Extrusions, those of you suffering low back pain will find some interesting tidbits as far as what put you there, as well as pointing you in the right direction to a solution. The biggest disappointment concerning this video was that two of the chief drivers of chronic back and neck pain were not really addressed; the first being SYSTEMIC INFLAMMATION, the other being micoscopic fibrosis or adhesion of the FASCIA, or more specifically, the thoracolumbar fascia (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, or HERE) --- a factor that increasing numbers of experts are saying is responsible for the majority (as much as 70%) of chronic back pain. I would argue that if you add these two modes of thinking to the knowledge and protocols created by McGill, your results will be better yet. Allow me to explain.
What do we know about back pain?
- We know that back pain is the world's number one leading cause of disability (HERE).
- We know that back pain and disc herniations are both considered "inflammatory" (HERE or HERE).
- We know that back pain is associated with increased potential of developing chronic neurological disorders and diseases (HERE).
- We know that in our sit-too-much society, both LOWER CROSSED SYNDROME and UPPER CROSSED SYNDROME are epidemics that are dramatically increasing in both numbers and severity.
- We know that there is an intimate relationship between chronic pain, chronic illness, adhesed fascia, inflammation, and fibrosis / scar tissue (HERE, HERE, HERE or HERE).
- We know that SCIATICA is often caused by VERY SPECIFIC FASCIAL ADHESIONS as opposed to disc herniations.
- We know that adjustments are helpful for many cases of spine-related pain (HERE). We also know that in many cases, these same adjustments don't hold very well (HERE).
Although I could have taken this list further, it helps explain why even though one cannot ignore the biomechanical aspects of back and neck pain, it's critical to realize there are other factors at play; particularly the chemical factors we refer to as "INFLAMMATION" --- a factor known to put people into a true CONUNDRUM.
If you are interested in shedding systemic inflammation and starting the process of RESOLVING YOUR BACK PAIN, be sure and take a look at THIS POST. It will at least provide a few ideas as far as creating your own personalized EXIT STRATEGY is concerned. Also, be sure to like, share or follow on FACEBOOK if you appreciated this post because it's still a great way to reach the people you love and value most.
MICHIGAN / INDIANA CHRONIC PAIN RELIEF
IN MOUNTAIN VIEW, MISSOURI
Dr. Russ, Good morning!
I came to visit you this past August. I was with my mom and we came from the Indiana / Michigan area. I keep forgetting to give you an update on the treatment you gave me. I found significant relief in my neck and upper back, with my chiropractic adjustments actually holding for longer periods of time now. I started exercising again in December, and my performance and pain levels are a lot better than when I was exercising last spring, before I came for treatment. I remember after the treatment my neck not hurting for the first time in a long time.
I still have some problems with my hip, pelvic, sacrum areas, which were my main concerns. I have a dull ache in my sacroiliac joint (at least I think that's where it is). And I totally can tell I still have some fascial adhesions around my hips and etc. I am working these out with my own fascia tools and Pilates, which seems to be a great choice for my body - a mix of harder work and stretching at the same time. I am also about to start some weight training again. However, if I can't make enough significant progress in the coming 6 months plus, then I will be returning to see you another time to work on these areas, or whatever needs worked on. Stress can really get my back and neck all tight again too. We have some bad winter weather over here and driving makes me tense up real bad.
Overall my entire body is doing much better. I noticed the biggest change when I started exercising again in December and how different it felt this time around post-treatment, versus pre-treatment. I ran on the treadmill the other day for a few minutes and was surprised to see how well I did compared to when I tried last year. Anyways, I had been meaning to write you, but finally got to it! Thank you for what you do! It helps lots of people and is the missing link that my doctors just cannot seem to wrap their brains around!
That's fantastic! Just let me know if you are this way again and we'll try to knock out the rest. BTW, I could not remember you immediately and looked at FB and remembered immediately. That pic with your husband and kids.... amazing! Also, would you mind if I posted this as a testimonial?
Absolutely you can use it! I tell everyone in pain about my journey and the role fascia & scar tissue have played. So shout it to the rooftops! I actually was just helping someone in pain today and told them about mine & sent them links to your blog to read about scar tissue. And yes I thought it might be hard for you to remember me since I came back in August. I actually debated on sending a photo to help! :) My sister is a photographer...that’s why that pic of my family is so good! Anyway, thanks again and maybe see ya in the future!
Allow me to give you a bit of background. The first thing you must realize is that Jenna's case presents a picture-perfect example of what I referred to in my post, "MUZZLED" ---- the all-too-common tale of vaccine damage denial. Bottom line, if reactions to drugs or vaccines are not reported to the proper governmental agencies, they are never counted among the adverse reaction statistics. Thus, whatever drug or vaccine looked at appears much safer than it is. Because the "ANTIVAXXER" rhetoric has been (purposefully) ratcheted up to a scream; whether dealing with topics such as FLU VACCINES, VACCINES in general, or vaccine sequelae such as AUTISM, there is no longer room for a conversation. For the record, numerous meta-analysis have shown that vaccine side effects are reported to VAERS (the government's Vaccine Adverse Event Reporting System) about 1% of the time (HERE). Not a misprint. Now, back to Jenna.
Jenna is a super-fit thirtyish mother of two young children. Always ultra-active, a TDAP SHOT she received while she was pregnant started this nightmare. She entered the world of CHRONIC PAIN, climbed on the MEDICAL MERRY-GO-ROUND, and started spinning. As you might imagine, she had been through all sorts of medical tests and treatments by the time I saw her, but had gotten off all of it except for the ANTIDEPRESSANTS and MUSCLE RELAXERS. The only things that actually helped Jenna were FASCIABLASTING and certain kinds of stretches / yoga. Even though Jenna's issues were "SYSTEMIC," I decided to see her once because I had a hunch I could help (her problems were fairly symmetrical left to right as well as being found both above and below the waist).
What did I determine from the examination and treatment? She had a combination SACROILIAC JOINT PROBLEM and SUPERIOR CLUNEAL NERVE ENTRAPMENT (as well as some HIP FLEXOR ADHESIONS), along with an array of FASCIAL ADHESIONS and connective tissue FIBROSIS, undoubtedly driven by an inflammatory reaction to the shot (remember that inflammation always causes fibrosis --- the medical word for what I refer to in my clinic as "SCAR TISSUE" or "DENSIFIED TISSUE" (HERE). One of the clues that I might be able to help Jenna was that chiropractic adjustments would help her, but the results were extremely short-lived (HERE or HERE) --- something that improved dramatically after her treatment. Speaking of treatment.....
Although I turn down the majority of the people who contact me from around the world because, unfortunately, after providing me with a history, I don't feel I can help them; my pledge to my OUT-OF-STATE & INTERNATIONAL PATIENTS (not to mention most of my local patients) is simple ---- you will know whether my approach will help you after a single treatment. This does not mean that one treatment will be enough to "cure" you (as an old professor of mine used to say, 'the only thing cured is ham'), but you will know whether or not we are on track (HERE or HERE).
For those who want to dig deeper into the root causes of fibrosis-causing inflammation (something I highly recommend, whether you have visible / tangible problems or not), HERE is the post. And if you appreciate what we are doing in tiny MOUNTAIN VIEW, MISSOURI, be sure to show us some love on FACEBOOK since it's still one of the best ways to reach the people you love and value most.
GOT CHRONIC PAIN?
LEARN ABOUT WHAT IT TAKES TO SELF-MANAGE IT!
"There is a shortage of pain specialists with only one for every 21,000 patients. Meanwhile, untreated chronic pain impacts multiple aspects of the patient’s life, leads to depression, anxiety, irritability, emotional frustrations, social avoidance, relationship issues, loss of self esteem and lack of enjoyment of living and, occasionally, leads to suicidal ideation or attempts. Many primary care providers are comfortable treating acute pain due to its short course and usually identifiable cause, however they are much less comfortable treating chronic pain due to the myriad of complexities... such as pain without a clear etiology."
The article went on to talk about various ways of addressing chronic pain, mostly pertaining to medication --- most specifically opioids. Fast-forward six years, and we are in the throes of an OPIOID EPIDEMIC that is costing our nation over 500 billion dollars and killing nearly 50,000 people each and every year.
As I showed you (HERE), the pendulum has swung so far back the other way that many doctors are no longer prescribing opioids for fear of government retribution --- not having their claims paid, losing their licenses, or even being sent to jail. Add this to the medical community's realization that they have no real solutions to most of the chronic health issues they face all day, every day (HERE and HERE), and it's simple to see why there is a shift taking place in what constitutes the best way to deal with patients struggling with chronic pain.
Google 'chronic pain self-management,' and you'll come up with over 130 million hits. Today we are going to talk about just one --- an article from the new issue of Practical Pain Management titled Self-Management of Chronic Pain in Primary Care.
"Despite the complexity of chronic pain, at least half of all patients receive their healthcare from a primary care clinician. This raises a striking conundrum since primary care practitioners have been found to harbor negative attitudes toward patients with chronic pain, driven by a sense of insufficiency in addressing this patient complaint. To effectively address the multidimensional effects of chronic pain, patients need self-management training about behaviors, strategies, and activities that may help to control the destructive effects of pain on their quality of life."
How would you like to have a doctor that harbors "negative attitudes" towards you? The authors went on to talk about "limited options available to manage common cases of chronic pain," as well as that fact that both sides of this equation --- doctors and their patients --- feel "stuck" with their options; both groups typically and unfortunately seeing "increasing medication as the only solution." What this has done --- which, while not perfect for every person or situation --- has forced the medical profession to re-evaluate and abandon many of the practices that got us to this point.
What this really means for you --- the pain patient --- is that with doctors increasingly threatened with treatment audits and their careers being taken from them, the burden is increasingly falling on you to step up to the plate and take care of yourself (after all, today's post is about 'self care'). Since necessity is the mother of invention (or change), let's look at some of the self-management tips being promoted by these authors (an MD and clinical psychologist) for people struggling with chronic pain.
- UNDERSTAND PHYSIOLOGY: Look; if you don't have at least a cursory understanding of PHYSIOLOGY, INFLAMMATION, and CHRONIC PAIN (most people think they understand the latter two, but few actually do), getting better is going to prove tough. Since nothing makes sense, the entire situation, along with everything you try, will seem hopeless. Knowledge really is power! The authors also mentioned 'goal setting' under this bullet point. I would whole-heartedly agree since one of the most important aspects of my protocol is having patients create a PERSONALIZED EXIT STRATEGY for getting out of pain. And even though it was not mentioned, this is a good time to say something about having a support network of some kind. Online is great, but I would argue that in most cases, having someone nearby is better.
- MEDITATION & MINDFULNESS: While I'm a fan (our family watched a COOL VIDEO on meditation last evening), I have argued that "mindfulness" is all too often an intellectual-sounding, all-encompassing cop-out provided to people in chronic pain. A recommendation made by practitioners who aren't really getting to the root of things, or in many cases don't believe it's even possible to do so (HERE).
- BODYWORK: Although the authors mentioned massage, there are an almost unlimited number of forms of bodywork that can provide amazing results (HERE and HERE are two articles on this topic concerning fibromyalgia). Although there are people coping with "intractable" chronic pain (CENTRAL SENSITIZATION), I've shown you how important it is to work with these folks (HERE, HERE and HERE) because in many cases improvement is possible. My goal with my patients is not just to manage, but if possible, help provide solutions (THIS is what I'm talking about).
- STRETCHING, EXERCISE, ADL'S: I'm a huge fan of using various sorts of physical training to help get people back to performing activities of daily living without suffering every step of the way (these authors specifically mentioned stretching and a STRENGTH / CARDIOVASCULAR COMBO). Be aware, however, that in many cases, the cart gets put in front of the horse. Put simply, if people are trying to exercise or stretch areas that are microscopically 'TETHERED' by scar tissue, it has the potential to make things worse (HERE, HERE, or HERE). The more severe the case, the more true this is.
- HEALTHY EATING PLAN: Because I would argue that it's the number one key to solving SYSTEMIC INFLAMMATION (which can greatly help with either local or systemic pain), this bullet should have been number one on the list. Although I'm not quite sure where to begin since this bullet could encompass several volumes of books, THIS SHORT POST provides a starting point. It's important for the chronic pain patient to realize that inflammation always leads to fibrosis (HERE).
- SLEEP HYGIENE: Although I've talked about this in many posts, probably the most important can be found HERE.
- COUNSELING: Several things were mentioned here, including CBT, acceptance therapy, and managing setbacks. While counseling can be valuable (emphasis on "CAN"), it's important to have the right kind of counselor. Many people could benefit from seeing someone who's mostly Florence Nightingale, with a streak of Sgt Lee "Gunny" Ermey.
The most beautiful part of this plan is that much of it can be done on your own. Once your FIBROSIS / SCAR TISSUE has been dealt with, even much of the bodywork can be accomplished without professional assistance (HERE or HERE). For those of you looking to expound on this protocol, HERE it is. And while there are no fool proof methods for dealing with chronically ill or chronic pain patients, my protocol will at least get you thinking outside the box (which research is starting to show is actually inside the box even though far too many practitioners have not yet come to this realization). If you like what you're seeing or feel it deserves to be shared with struggling people, you can reach those you love and value most by liking, sharing, or following on FACEBOOK.
WHICH DIET MIGHT BE BEST FOR YOU?
Firstly, that the average profile of a chronic pain sufferer was female, overweight, and over fifty --- the same profile for developing autoimmunity (HERE). Secondly, and more importantly; we saw that of all the various sorts of diets looked at, the type that seemed to work best (12 of the 16 studies in this category showed significant improvement of pain) simply involved shifting a person's overall pattern of eating away from junk, toward health. Take a look, however, at this statement...
"These limitations add to the disparity between the recognition of nutrition-related issues as key treatment goals and the availability of good-quality, dietetic-led, nutrition-related treatment options for people who experience chronic pain."
In other words, the numerous limitations listed by the study's authors (there were many) created a "disparity," a word whose definition means "discrepancy, inconsistency, imbalance, inequality, incongruity, unevenness, disproportion; variance, variation, divergence, polarity, gap, gulf, breach; difference, dissimilarity, contrast, distinction, differential, contrary, etc."
In other words, we have a situation here in America where not only is dietary advice rarely given in a clinical setting (HERE); when it is, it's frequently wrong (HERE are recommendations from the American Heart Association and the American College of Cardiology). This is a shame considering these authors noted that dietary changes / interventions can improve the quality of life for suffering patients. Even if the advice is good, is the patient necessarily going to follow through? Unfortunately, doubtful. But those who do will see results, and it's about as simple as your doctor providing APPROPRIATE PATIENT HANDOUTS (whether online as mine are, or an old fashioned piece of paper).
Although not all of these points were in the study, allow me to highlight a few generic dietary recommendations of my own for the average person struggling to cope with their chronic pain.
- CUT SUGAR & JUNK CARBS: Sugar and high-glycemic foods --- foods that break down to glucose rapidly (flour, pasta, white potatoes, bread, etc, etc) --- are inflammatory; particularly if GRAIN-BASED (HFCS is a great example). Over the past two decades I've noticed a common theme when people go LOW CARB (almost always for the purpose of WEIGHT LOSS). They frequently see an array of health or pain-related benefits not directly associated with their weight loss. Oh; I better also mention in this bullet point that if you are using DIET PRODUCTS, be sure to click the link.
- INCREASE THE AMOUNT OF GOOD FATS: The fats you are eating are either driving or squelching inflammation (HERE or HERE). When people clean up their fats and do a PALEO / KETO combination, the results are often off the chart.
- EAT QUALITY PROTEIN: If your protein sources consist of processed or commercially-raised meats, or commercially-grown poultry or eggs, it's important to realize that you could be doing much better. You can read about those differences HERE or HERE. For those of you struggling with chronic illness or chronic pain, while trying to get your protein from plant sources; realize that while not necessarily impossible, it can present a significant challenge.
- SPICE THINGS UP: If you spend some time studying the myriad of anti-inflammatory spices (HERE is a post I wrote about yellow spices), you'll quickly see that not only can can you add a huge amount of anti-inflammatory firepower to your diet, you can add a great deal of flavor in the process.
- BEWARE OF FRUITSANDVEGETABLES: Fruits and vegetables were purposely run together in the bullet's title to provide an example of what most people believe and how they behave regarding fruits and vegetables. Tell a person to eat more fruits and vegetables and most --- particularly your hardcore SUGAR ADDICTS --- will add fruit. YESTERDAY'S POST dealt with this briefly via a story explaining what's happening to fruit-eating zoo animals. The point of this bullet is simply that fruits and vegetables are different (HERE), and your diet should be top-heavy in the latter.
Just remember that despite the problems with this study; the final sentence stated, "This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain." For those of you looking for other diet-related ideas, or maybe even some ideas that don't necessarily have anything to do with diet, but are all about reducing inflammation, HERE is a short post to browse. And if you appreciate what you are finding on our site, be sure to like, share or follow on FACEBOOK since it's a great way to reach the people you love and value most.
AN EXPERT REVIEW AND SYNOPSIS OF MYOFASCIAL PAIN SYNDROMES
What's just as interesting as calling trigger points a source of pain is that he referred to them a "source of functional limitation". In other words, these creatures (TP's) are not only painful, they have the potential to alter the way you go about your normal day-to-day life. Bordoni went on to talk about the various theories on why people get Trigger Points. Here are some of the takeaways (trying to simplify some of this for my readers).
- Trigger points are more prone to be found in red muscle (aerobic, slow twitch, postural) that white muscle (anaerobic, fast twitch, explosive movements).
- Constant (repeated) microtrauma is a problem --- probably one of the reasons that the consensus is that REPETITIVE INJURIES are usually harder to deal with than acute trauma.
- This constant microtrauma to red fibers causes an increased need for cellular OXYGEN, which depletes cellular energy (ATP) and causes increased sensitivity to pain.
- In this environment, numerous chemicals, compounds, and elements (including the biomarkers we refer to collectively as "INFLAMMATION,") causes both tissue STIFFNESS AND DENSITY, as well as the heightened pain sensitivity and low threshold to meet said sensitivity we saw in the previous bullet. When this process happens in the central nervous system it's known as CENTRAL SENSITIZATION. As the famed neurologist and acupuncturist (he's considered the father of modern dry needling techniques) Chan Gunn said, this can make fibrotic tissue over 1,000 times more sensitive to pain than normal tissue (HERE).
- Thanks to the above-mentioned CS, as well as similar phenomenon occurring in the peripheral nervous system, areas of the nervous system begin firing on their own, sometimes almost perpetually, with an end result that there is "a constant local contraction of the muscle fibers". Mind you, I am not saying that the entire muscle is contracting, but instead, due to the fact that when an individual muscle fiber contracts it contracts at 100%, the individual fibers under the control of a specific nerve can be hyper-stimulated and contract until they finally run out of ATP. The end result is that once this occurs, many people will get a short period of TP relief until the body replenishes it's stores of cellular energy to start contracting again.
- As the vicious cycle spins faster and faster, not only is there an increase in pain, but the FIBROBLASTS actually start converting to myofibroblasts, which dramatically changes the dynamics of the fascia. In fact, Bordoni theorizes that the fascia, which acts as A SECOND NERVOUS SYSTEM, has the potential to itself start sending "looped" messages that play over and over again, causing further "spontaneous presence of local muscle contraction."
- There is also an alteration of the hyaluronan or hyaluronic acid (HA) that, like most everything else seen in fascia, also thickens, becoming more viscous, creating a scenario where the various layers of fascia do not slide on each other (IT LOOKS LIKE THIS). This seems to cause stretching of the nerve tissue in the fascia, creating still another reason for it "becoming constantly activated".
- If you throw altered BLOOD PRESSURE into this whole mess, the smallest blood vessels (the capillaries) become ischemic, starving their corresponding muscles for O2. In a nation where we learned just last week that our COLLECTIVE BMI (body mass index) went up yet again, it's just another nail in the proverbial coffin.
- Because the internal environment of a trigger point is hypoxic (low oxygen), it's also acidic. For those of you who suffer from any sort of digestive issue, I suggest you read about the inverse relationship between the stomach and the body as far as acidity / alkalinity is concerned (HERE).
- The end result is that there are several positive feedback loops (viscous cycles) that set themselves up, causing a release of neurotransmitters that stimulate contraction, based largely on inflammation, hypoxia, acidity, and the muscle contraction itself, "surging the sending of painful information to the nervous system."
- Trigger points, if biopsied, contain cells, tissues, and biochemical markers that are different than normal surrounding tissues. Not surprisingly, the tissues are themselves thickened (sometimes researchers refer to this as "DENSIFICATION").
One of the theories that Bordoni specifically mentioned has to do with altered neurological function of the nervous system as it relates to the SKIN. "The concept of altered electrical activity of the skin and the afferents [sensory nerves] coming from the TPs could explain the altered emotional state in patients with the myofascial syndrome (anxiety and depression)." Interesting, considering ANXIETY and DEPRESSION are both considered to be "inflammatory" diseases (HERE).
Furthermore, we saw confirmation of previous studies that various parts of the brains of people in chronic pain, and especially chronic myofascial pain, actually shrink and atrophy. In fact, I've seen studies showing that this phenomenon can be so severe that over time, brain scans of those who have lived with chronic pain become almost indistinguishable from people with neurodegenerative diseases such as ALZHEIMER'S (HERE).
Although the books by TRAVELL & SIMONS were mentioned (Janet Travell was JFK'S PERSONAL PHYSICIAN), what I found most interesting was the lack of consensus as to what can be used to effectively image and / or destroy these creatures ("Currently, the causes of the presence of TPs are only speculative, as well as the correct evaluative and therapeutic approach."). As far as treatment, Bordoni mentioned every single one of my 'BIG FIVE,' as well as "lidocaine patches, BOTOX, POSTURE-CONTROL EXERCISES, NUTRITION, THERAPY, CHIROPRACTIC ADJUSTMENTS [actually, he mentioned "Osteopathic Manipulation"], ultrasound, STRETCHING, DRY NEEDLING, YOGA, ACUPUNCTURE" and a number of others. What wasn't mentioned was, at least in my mind, even more interesting than what was. Namely, any sort of bodywork, massage therapy, rolfing, TISSUE REMODELING, etc.
The paper's theme was that the drugs are not going to be very helpful and can actually cause a myriad of SIDE EFFECTS. It seems that Bordoni would agree that A SYSTEMIC APPROACH to trigger points has the potential to be much more effective than simply attacking these beasts in a purely local fashion. If you appreciated today's post, be sure to share it with others. FACEBOOK is still an effective way to reach the people you love and care about most!
IS YOURS PATHOLOGICAL OR FUNCTIONAL?
The authors started by stating the obvious; "The current approach to musculoskeletal pain is failing, a new approach is needed." How did they describe the "old approach" ---- the approach largely used today? Mostly, they described it as a myriad of tests for making diagnosis that are typically unhelpful in solving people's problems; particularly their chronic problems. They mentioned the phenomenon of ASYMPTOMATIC DISC HERNIATIONS as well as the fact that most of what is seen on x-rays or musculoskeletal MRI's is not useful as far as determining where a person's pain is coming from (see the following link). "The majority of persistent non-traumatic musculoskeletal pain disorders do not have a pathoanatomical diagnosis that adequately explains the individual’s pain experience and disability." In other words, most of these problems are functional as opposed to being based on visible pathology. What does this mean?
"First, structural changes observed on imaging that are highly prevalent in pain free populations, such as rotator cuff tears, intervertebral disc degeneration, labral tears and cartilage changes, are ascribed to individuals as a diagnosis for their condition. Second, it is arguable that musculoskeletal clinicians have invented treatments for conditions that may not exist or be readily detected."
While the first statement is AS TRUE AS TRUE CAN BE, the second sentence is much more open to debate; especially in light of the first. The first sentence (as explained by the provided link) shows what we have known for decades; that just because 'something' shows up on an MRI does not mean it needs to be surgically dealt with. The famous sports surgeon, James Andrews, showed us this with shoulders (HERE), but it's true with any number of other issues as well, including ever-common KNEE PROBLEMS and subsequent surgeries done for them. There are many others (HERE). The second sentence above, however, is even more problematic because it insinuates that because something is not "readily detected" it doesn't exist.
The examples these authors used were MYOFASCIAL TRIGGER POINTS, postural distortions / muscle imbalances (UPPER CROSSED & LOWER CROSSED syndromes as well as FORWARD HEAD POSTURE always come to mind first) and sacral torsions (chiros call these "SUBLUXATION" and they can be associated with everything from SI ISSUES, SCIATICA, CUTANEOUS NERVE ENTRAPMENTS as well as PIRIFORMIS ISSUES). And that's just for starters. If you have ever dealt with these or similar issues you quickly realize that such problems are not merely 'JUST IN YOUR HEAD' (thanks to an anatomical short leg and numerous roached ankles --- grade III sprains and several avulsions from my basketball days, on varrying levels I have at times dealt with of all of these, including occasionally fighting the dreaded LEVATOR / PEC MINOR SUPER-TRIGGER).
The unifying factor that I believe helps explain the majority of these and other problems (we could easily throw WHIPLASH into this category as well because there are no good tests that detect it or truly describe what's going on) is the FASCIA SYSTEM. When people end up with injuries or systemic issues related to INFLAMMATION, they have to realize that the consequence is always some sort of fibrotic change (HERE). And while practitioners may refer to said changes by numerous names (DENSIFICATION, SCAR TISSUE, FASCIAL ADHESIONS, etc, etc, etc), the bottom line is that just because FASCIA DOES NOT IMAGE WELL with traditional, insurance-covered technologies doesn't mean these problems don't exist.
And while I completely agree with the author's assessment that most non-traumatic musculoskeletal problems revolve around "lifestyle," they discussed numerous management ideas (better sleep, quitting smoking, etc) without as much as mentioning diet and its relationship to systemic inflammation. Honestly, how can struggling patients successfully address the problems they are having ("the individual’s self-efficacy to take control and ultimately be responsible for their health") without a strong emphasis on the quality of food they are consuming on a daily basis (HERE, HERE, HERE, HERE, or HERE)? But then again, it's not news that most doctors fail to discuss diet with their patients in any meaningful way (HERE) ---- an issue that strikes at the very heart of the moot debate over who should be paying for American healthcare; individuals, employers, or the government (HERE).
"We need to reframe what is currently doable and achievable in the management of many non-traumatic musculoskeletal presentations, and honest and open conversations regarding the outcome evidence for these disorders needs to be sensitively communicated. Interventions such as manual therapy, pharmacology and injections, when provided, should be seen as an adjunct, and their risks and benefits must be considered and honestly communicated. To achieve this, the efforts of many institutions, including educational, healthcare, political and professional organizations, health funding bodies and the media, need to be involved."
Ahhhh; utopia. It's lovely isn't it? To bad IT'S NOT REAL. There are some hard facts underlying all of this; namely that "management" of your problems and pain may require some real effort on your part. If, as the authors of this paper argue (I totally agree with them on this point), your doctor / clinician can't make someone healthy via the things they do for you such as drugs or surgery, what would make one think that government or media (or for that matter, education) can play a significant role? That's just it folks, they can't. While this paper seems inclined to agree that Westernized populations are receiving far too much of at least certain types of health care (HERE), it's unfortunate that it didn't acknowledge the deeper truth --- that both EDUCATIONAL EFFORTS and PREVENTATIVE HEALTHCARE do not work as touted. What does work if a person is willing to actually get off the couch and make some lifestyle changes?
Firstly, if you have chronic musculoskeletal pain (HOPEFULLY IT'S NOT CENTRALIZED), it might be beneficial to see if I can help you. What's cool is that like the people HERE and HERE, you will know if my approach is helpful in a single visit (just click the links to see what I mean). Secondly, while I may be able to help get you out of pain, if you are looking to stay that way and get healthier in the process, you might find a few good ideas for reducing your inflammatory load in THIS POST. And since the holiday season is upon us, why not commit to giving yourself the best Christmas present ever this year (HERE)? Also, if you like what you are seeing on our site, be sure and like, share, or follow on FACEBOOK as it's a great way to reach the people you love and care about most.
THE OPIOID CRISIS AND SURGERY FOR CHRONIC PAIN: BRAND NEW RESEARCH REVEALS WHAT YOU MAY HAVE ALREADY SUSPECTEDRead Now
OPIOIDS OR SURGERY AS A PRIMARY WEAPON AGAINST CHRONIC PAIN?
NOT ACCORDING THE THE LATEST RESEARCH
"The U.S. drug overdose epidemic has been inexorably tracking along an exponential growth curve since at least 1979. Although there have been transient periods of minor acceleration or deceleration, the overall drug overdose mortality rate has regularly returned to the exponential growth curve. This historical pattern of predictable growth for at least 38 years suggests that the current opioid epidemic may be a more recent manifestation of an ongoing longer-term process. This process may continue along this path for several more years into the future. Paradoxically, there has been substantial variability with which specific drugs have become dominant in varying populations and geographic locales. This variability all but negates the possibility of confident predictions about the future role of specific drugs. Indeed, it is possible that a future overdose epidemic may be driven by a new or obscure drug that is not among the leading causes of drug overdose death today."
Dr. John Lary, an internist from Huntsville Alabama, commented on an article about this study that was published in MedpageToday (The Opioid Crisis Actually Began 40 Years Ago), stating, "I don't know the solution to the problem. I do know what is NOT the solution -- more government programs, policies, guidelines, and/or regulations." Although he is correct, this leads us to ask the question; how big is the problem? The National Academies of Science, Engineering, and Medicine, published a book back in the summer of 2011 saying that almost 1 in 3 Americans is dealing with CHRONIC PAIN, at an annual cost of (gulp) $635 billion. Believe me when I tell you that these numbers have not gotten better in the seven years since.
Earlier this month, Pain Medicine carried a meta-analysis of 25 studies (Are Invasive Procedures Effective for Chronic Pain? A Systematic Review) trying to ascertain whether or not surgery was a good choice for various chronic pain syndromes (some of those mentioned included BACK PAIN, NECK PAIN, ABDOMINAL PAIN, KNEE PAIN, MIGRAINE, as well as a number of others. "There is little evidence for the specific efficacy beyond sham [placebo] for invasive procedures in chronic pain." As you might expect, ADVERSE EVENTS were exceedingly high in studies where they were reported. One more fun fact from this study was that 87% of the improvement could be attributed to the PLACEBO EFFECT. In article for Medpage (Surgery for Chronic Pain: Risky and Costly), Christopher Cheney wrote....
"The lead author of the research, Wayne Jonas, MD, executive director of Samueli Integrative Health Programs at H&S Ventures in Alexandria, Va., said that physicians and chronic pain patients should consider surgery carefully. Surgery for chronic pain is a prime example of over-utilization of healthcare services and poor care coordination. There are several options for treating chronic pain that do not involve invasive procedures or addictive medications such as opioids. "The American College of Physicians, the Centers for Disease Control and Prevention, the National Institutes of Health, and many other national bodies have recommended non-pharmacological approaches for the treatment of chronic pain," he said. "These include acupuncture, yoga, massage, and other such approaches. In addition, behavioral medicine has been demonstrated for many decades to be effective for chronic pain.""
What's my takeaway from studies like this? Easy. Do whatever it takes to diminish SYSTEMIC INFLAMMATORY PROCESSES in your body. Although it's far from a "cure all" (some of you may need to see a SPECIALIST IN FUNCTIONAL MEDICINE), I've created a post with a generic protocol that has enough "juice" in it to help many of you, arguably most of you, improve your inflammation levels and subsequently improve your health and energy levels (HERE IT IS). If you like what you're seeing, be sure to like, share or follow on FACEBOOK as it's a fantastic way to reach the people you love and care about most.
YOURS MAY NOT BE "CENTRAL SENSITIZATION" AFTER ALL
"Pain may be prevalent in 39 to 55% of post-stroke patients but not all cases involve central pain. The types of pain that may occur after a stroke include shoulder pain (the most common), headaches, spasticity, and lastly, central post-stroke pain (CPSP). CPSP represents about 25% of post-stroke pain cases."
After mentioning the usual array of drugs used to deal with CPSP (ANTIDEPRESSANTS, STEROIDS, OPIOIDS, anticonvulsants, and others), and likewise suggesting that none work well and all have problems associated with their use, Bottros made this statement. "CPSP is a result of misinterpretation of afferent sensory input by the sensitized neurons within the brain, rather than generated spontaneously by the damaged central nervous system (CNS) neurons." In other words, in at least some cases, sensory nerves are "misinterpeting" what they are sensing, not necessarily that CPSP is always generated by the brain itself.
In a study from the July issue of Pain (How Central is Central Poststroke Pain? The Role of Afferent Input in Poststroke Neuropathic Pain), Bottros' team found that by performing a nerve block in the affected extremity, they totally shut down the pain in 7 of 8 subjects within half an hour --- something that would be impossible if the pain were "autonomously generated within the CNS. Rather, this pain is dependent on afferent [sensory] input from the painful region in the periphery."
In English, this means that people's CHRONIC PAIN might not be, in many cases, as "centralized" as they've led to believe. And while I don't make any sort of claims about being able to help people with CPSP (that's a job for a qualified FUNCTIONAL NEUROLOGIST), I have been saying this very thing for a long time --- that a significant amount of pain that's been diagnosed as "centralized" is not. This is why I have suggested that people who are not really sure whether their pain is due to Central Sensitization or might be arising from FASCIAL ADHESIONS, should have A TREATMENT (yes, just one) and see. If they are in fact, "centralized," the only harm will be that they fired up their pain for a few days (HERE).
To carry the process one step further, in the PPM article, Dr. Bottros talked about "altering cytokines". Why is altering cytokines a big deal if you hope to improve your situation and your pain? Because CYTOKINES are the chemical messengers made by your immune system so that cells can signal and communicate with each other. And while integral for the healing process locally, when there are too many or too much of these chemicals coursing through your body systemically, bad things happen, including pain, fibrosis (SCAR TISSUE) and DISEASE. Listen to these cherry-picked findings from the journal International Anesthesiology Clinics (Cytokines, Inflammation and Pain).
"Cytokines are small secreted proteins released by cells have a specific effect on the interactions and communications between cells. Inflammatory responses in the peripheral and central nervous systems play key roles in the development and persistence of many pathological pain states. Certain inflammatory cytokines in spinal cord, dorsal root ganglion, injured nerve or skin [fascia] are known to be associated with pain behaviors and with the generation of abnormal spontaneous activity from injured nerve fibers. There is abundant evidence that certain pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α are involved in the process of pathological pain. In the CNS, there are two types of glial cells, microglia and astrocytes, which can be activated by excitatory neurotransmitters released from nearby neurons. It has been well demonstrated that spinal glial activation is necessary for induction of the neuropathic pain state. In summary, proinflammatory cytokines are involved in the development of inflammatory and neuropathic pain."
I've talked extensively on my site about TNF-ALPHA and INTERLEUKIN 6, showing that inflammation will always lead to FIBROSIS that in my clinic I refer to simply as scar tissue. Furthermore, we see that these cytokines have the propensity to activate Central Sensitization by hyper-activating microglia (HERE). This is why whether your pain is centralized or not, reducing the amount of systemic inflammation in your body is a good thing. And when you consider that virtually every disease process (including many that you've been led to believe are purely genetic --- HERE) is based on systemic inflammation, addressing said inflammation starts making even more sense. Sometimes, however, you will need treatments that actually create inflammation. Huh?
Just remember that local inflammation is needed to heal injured tissues, whether the injury is acute or chronic. TISSUE DEFORMATION (breaking scar tissue and lengthening shortened, THICKENED or "TETHERED" connective tissues) requires activation of the local inflammatory response (HERE) as well as activation of the cells that make COLLAGEN (these are known as FIBROBLASTS). It's why the longer you study the simple protocol I created for helping people reduce systemic inflammation (HERE), hopefully reducing their pain levels in the process, the more sense it makes. If you like what you're seeing be sure and like, share, or follow on FACEBOOK as it's a great way to reach the people you love and care about most.
A NEW GOVERNMENT STUDY SHOWS YOU'RE NOT ALONE
- Linked to restrictions in mobility and daily activities
- Linked to dependence on opioids
- Linked to anxiety and depression
- Linked to poor perceived health or reduced quality of life
- 50 million of U.S. adults have chronic pain
- 20 million U.S. adults have high-impact chronic pain (chronic pain that limited life or work activities on most days or every day during the past 6 months)
I could go on but the real question we need to answer is why? Easy. With sedentary people living on skittles, mountain dew, and fast food, it isn't tough to start realizing why Westernized nations are becoming increasingly SICK AND INFLAMED. What are you going to do about it? The first thing you need to realize is that despite having greater access to hi-tech healthcare than any point in our nation's history, national health continues its rapid decline. Just last week the new government stats on OBESITY showed that there are now 7 states with obesity rates over 35% and 30 with obesity rates of over 30%. I don't care who you are or what your political persuasion is, this trajectory is beyond unsustainable no matter who you think should pay for it (HERE). Unfortunately, our government doesn't understand this. Case in point....
"Chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity, and disability programs. The National Pain Strategy, which is the first national effort to transform how the population burden of pain is perceived, assessed, and treated, recognizes the need for better data to inform action and calls for estimates of chronic pain and high-impact chronic pain in the general population. This report helps fulfill this objective and provides data to inform policymakers, clinicians, and researchers focused on pain care and prevention."
Firstly, the over half a million dollars a year is grossly underestimated, and let me show you why. This year's Gross Domestic Product is going to be in the 20 trillion neighborhood. Writing for the Financial Times last November, Sam Flemming (White House Economists Warn of $500 Billion Cost of US Opioid Crisis) showed us that the OPIOID EPIDEMIC alone is costing that much ---- almost 3% of GDP. What's even whackier is that if you follow the link, you'll see that just like any number of other governmental health-related fiascos (the fat-phobic food pyramid comes immediately to mind), the government is directly responsible for this one as well.
Look folks, collecting more data, informing policy makers, having meetings, and creating reports is nothing more than busywork. And while it keeps the bureaucracy churning, unfortunately it doesn't really help anyone find relief. It doesn't really help people find solutions. It doesn't really help people break the chains of powerlessness that keep them anxious, depressed, humiliated, and lonely. The CDC talks about "PREVENTION," seemingly not realizing that study after study after study has shown it to be all but worthless in terms of the medical model. It's time you realize that if you truly want your life back, don't expect your doctor, your insurance company, YOUR EMPLOYER, OR ANYONE ELSE to help you out. It's on you --- you are going to have to do it yourself. While this might sound scary on the surface, let me show you why it's actually "EMPOWERING".
THIS SIMPLE PROTOCOL has something for everyone. And while it's not going to "cure" everyone (remember that ham is the only thing that's cured), reducing systemic inflammation is never a bad thing when it comes to addressing the factors related to chronic pain and chronic illness. Don't grow old regretting what your life could have been if you had done things differently. Sit down today and create a written blueprint for taking your life back --- an EXIT STRATEGY if you will. HERE are examples of what these look like. And if you know someone who desperately needs this information, a great way to reach them is by liking, sharing, or following on FACEBOOK --- excellent for reaching those you love and care about most.
FASCIA'S RELATIONSHIP TO CHRONIC BACK PAIN: SHOULD WE DISCARD THE CURRENT MODEL OF MECHANICAL LOW BACK PAIN?Read Now
FASCIA AND CHRONIC LOW BACK PAIN
SHOULD WE DISCARD THE TERM 'MECHANICAL BACK PAIN'?
- "Many clinicians dislike low back pain because the pathophysiology of low back pain syndromes is poorly understood, the physical examination is generally unrewarding, and diagnostic tests typically are negative or false positive. Innumerable treatments exist, yet many are illogical, most are unproven, and only a minority are better than simple observation. Mechanical low back pain encompasses the vast majority of back pain syndromes. The tissues responsible for mechanical back pain are generally not identifiable [with imaging tests], but appear to include muscles, tendons, ligaments, and discs." Harvard's famous spine researcher, Dr. Jeffry Katz, from the Arthritis Foundation's 1993 article, The Assessment and Management of Low Back Pain: A Critical Review
- "Back pain is one of the most common patient complaints brought forth to physicians. Mechanical back pain accounts for 97% of cases, arising from spinal structures such as bone, ligaments, discs, joints, nerves, and meninges. Common causes of mechanical back pain include spinal stenosis, herniated discs, zygapophysial joint pain, discogenic pain, vertebral fractures, sacroiliac joint pain, and myofascial pain. A wide variety of treatments are available, with different treatments specifically targeted toward different causes." From Current Pain and Headaches Report (What is Mechanical Back Pain and How Best to Treat it?)
- "Given the incidence of Chronic Mechanical Low Back Pain (CMLBP) due to benign disorders, it is important that an accurate diagnosis be made and appropriate therapy applied. The diagnosis of CMLBP is solely clinical; however, imaging studies may show degenerative spondylosis. Like asymptomatic individuals with lumbar disk herniation and spinal stenosis on imaging studies, there are individuals with imaging abnormalities consistent with excessive motion in dynamic flexion/extension who do not have clinical symptoms referable to those abnormalities." From a decade old article that was published in the Journal of Neurological and Orthopedic Medicine and Surgery (Chronic Mechanical Lower Back Pain)
- "Acute mechanical back pain is a common medical problem. Acute pain is pain that has been present less than 4 to 6 weeks. Mechanical means the source of the pain may be in the spinal joints, discs, vertebrae, or soft tissues. Acute mechanical back pain may also be called acute low back pain, lumbago, idiopathic low back pain, lumbosacral strain or sprain, or lumbar syndrome. A precise anatomic cause of mechanical back pain can be identified only 20% of the time... 80% of the time, the specific source of the pain is not found. Fortunately most people recover in a relatively short period of time with simple treatment." From the Cleveland Clinic's article, Acute Mechanical Back Pain
- "How Low Back Pain May Become Chronic: Chronic low back pain can be better described as multiple acute spinal micro trauma(s) that accumulate throughout the day. The damaged tissues become sensitized and small movements can create pain that may become more intense and longer lasting. It’s like hitting your thumb with a hammer. Once your thumb is sensitized, it only takes a slight bump to cause more pain. If your thumb is never allowed to heal, the pain continues to worsen. That scenario is the same for patients with chronic low back pain. Everyday movements, postures and loads matter!" From Dr. Kai Tiltmann's article for Spine Universe, Is Your Low Back Pain Mechanical?
The first thing to remember is that as seen in the quotes above, imaging low back pain isn't nearly what we've been led to believe it is; true whether we are talking about MRI for discs (HERE), plain film x-rays (HERE), or CT. Furthermore, CT provides doses of radiation that are beyond freaky (in many cases, the equivalent of over 1,000 x-rays). Secondly, chronic problems are typically acute problems that accumulate over time. What is it that actually "accumulates"? Easy --- FIBROSIS, which is what the medical community calls scar tissue.
Thirdly, if you fail to take care of these injuries, the nerves in the area have the propensity to become hyper-sensitized ("Super Sensitivity") by the large amounts of local inflammation --- a problem made much much worse if a person is "SYSTEMICALLY INFLAMED". And lastly, although inflammation is involved in mechanical low back pain / musculoskeletal back pain, the difference is that in "inflammatory" low back pain, the inflammation is being driven by autoimmune processes that attack tissues of the spine (ANKYLOSING SPONDYLITIS, RHEUMATOID ARTHRITIS, and potentially dozens of others). Now; allow me to show you what DR. SEAMANS is saying.
The good doctor starts out by revealing that the term "mechanical back pain" was invented in 1980 after a survey given to a professional organization of surgeons. They described two types of pain --- "radicular," which is the sort of thing caused by abnormally stretching or tensioning nerves, frequently leading to ARM PAIN or LEG PAIN; or "mechanical pain" that could be either induced or relieved by moving, stretching, or changing positions. Seamans minces no words in describing his opinion of this scenario.
"Mechanical back pain is an unscientific concept that was invented by outspoken critics of the chiropractic profession and subsequently embraced by chiropractors who refer to themselves as being "scientific" and "evidence-based. Mechanical back pain merely means musculoskeletal pain and nothing more, so why not just use the acurate and descriptive term "musculoskeletal pain" instead? My suggestion would be to abandon the term "mechanical back pain"".
Seamans went on to explain why he would abandon the term, touching on something that I wrote about almost four years ago in a very short post titled The Three Types of Pain (HERE). Seamans also believes there are three types of pain (two types of nociceptive pain and neuropathic pain), describing the type two nociceptive pain as "axons that fire spontaneously when exposed to inflammation". While I referred to this in my post as Type II Inflammatory Pain, we are both essentially saying the same thing ---- that when "There is a local accumulation of pain-producing inflammatory chemicals and exudates that causes the classic signs associated with local inflammation," it leads to Super Sensitivity. These are the people the medical literature refers to as "CENTRALLY SENSITIZED".
The bottom line is that even though our three types of pain are not exactly the same (he is probably more correct than I am), we agree that no one wants any part of CHRONIC PAIN. This is where the nerves become spontaneously activated in a pathological sense, continually firing messages to the brain in the form of pain that there is tissue damage present. The problem is that this type of firing goes on long after the tissue has healed; in many cases to perpetuity. The wrench in the machine, however, is how we define the term "healed" above. Realize that if there is serious FASCIAL ADHESION present, it will not be imaged on standard tests or with the average PHYSICAL EXAMINATION, and you'll be told that the pain is all in your head (HERE).
Seamans went on to refer to these folks as "non-responders" ---- patients who do not respond to the care that you are giving in your clinic. He then provided a profile of the most common nonresponder; a person who DOESN'T SLEEP WELL (SYMPATHETIC DOMINANCE), leads a sedentary lifestyle, and eats a crappy ("inflammatory") diet. Diet is Seamans' pet topic. And while probably not politically correct, he has referred to the average American who eats the SAD (Standard American Diet) as "DIETARY CRACKHEADS". Because dietary crack is actually more addictive than real crack for a substantial part of the population (HERE), I've written a slew of articles on how to break free from SUGAR, CARB, AND JUNK FOOD ADDICTIONS.
And while you might feel you are a nonresponder, for many of those struggling with true chronic pain (central sensitization), in my clinic I frequently suggest that you try ONE TREATMENT with me because in many cases it can be almost impossible to tell a class II from a class III without seeing how they respond to treatment (HERE). Furthermore, if you don't truly grasp the importance of the THORACOLUMBAR FASCIA (or HERE) as it relates to chronic low back pain, even a good understanding of inflammation can leave you spinning your wheels as far as solutions are concerned.
Seamans ends his article by talking about the long term consequences of living in a state of perpetual inflammation. Once you understand just how many health issues are directly caused by inflammation (HERE is a list), it's not only easy to see how the average patient is essentially sabotaging their own health (spinal health included), but just how little their doctor is doing to address the underlying causes. Sorry folks, but throwing the "BIG FIVE" at these people all day long doesn't count. It's also why I continue to beat the drum of DIY and 'self help'.
The unfortunate truth is that there is no such thing as a miracle drug for the vast majority of you reading this post with tears in your eyes. The sooner you come to that realization, the sooner you'll grasp that old cliche; "if it is meant to be, it's up to me." It's sad that it has to be this way but the harsh reality is that the drugs you've been living on do not change underlying physiology and they certainly don't promote homeostasis (HERE). What's the solution? How about creating an EXIT STRATEGY?
Although most doctors cannot stand the internet as it pertains to learning about health-related issues, I would take exception. The world wide web, while full of junk, sale pitches, and self promotion, has also leveled the playing field as far as the average person's ability to get their hands on life-changing information is concerned. And while I certainly promote myself and what I do on my site (HERE), I do not try and sell you anything as I feel that would dampen my credibility.
Instead I've provided an entire category on my blog I refer to as UNIVERSAL CAUSES & UNIVERSAL CURES. The post in this group that I most frequently refer patients to is THIS ONE. Because knowledge really is power, I would suggest that you study and increase your knowledge, and use it to "EMPOWER" yourself and others in your circle, particularly your family and closest friends. Other than simply sending them a link, the easiest way to reach the people you love and care about most with awesome information is by liking, sharing, or following on FACEBOOK.
WARNING WARNING WARNING
BEWARE OF THE WAY YOU DESCRIBE YOUR PAIN TO YOUR DOCTOR
"If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a scale of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach."
What is this "new" approach? Instead of doctors simply having patients rate their pain 1 to 10, they are now asking whether their pain is tolerable or not, and then providing some "flowery" descriptors in their own customized scale ("Many health care providers are trying to come up with a system that involves words, not numbers"), such as aching, burning, waxing & waning, moving around, etc, etc. The final bit of advice to patients was to, "share other treatments you've sought... Let the doctor know what you've done and whether it was effective."
Firstly, as to the initial part of this (using descriptors beyond numbers), while it's certainly a great idea, none of it is even remotely new. Physicians have been asking patients to describe their pain and find out what makes it better or worse for as long as physicians have been treating people with pain. However, I've actually warned my readers to be careful how they go about these descriptions. For those of you struggling with various sorts of CHRONIC PAIN, be aware that if you describe your pain in ways that are not common or standard), you are much more likely to be labeled. Labeled? You know, hypochondriac, drug seeker, crazy (HERE is an example), lazy (trying to get SSI disability), or any number of others.
Secondly, after almost three decades of doing what I do, I'm not too convinced that the average doctor is very interested in what helps your pain if it falls outside the mainstream. Although some would argue with me (HERE for example), the more "natural" or outside-the-box the treatment that helped you, the less interest your doctor is likely to show . Case in point, two of the three examples from the last red sentence two paragraphs above were acupuncture and massage.
Also realize that doctors are highly discouraged (in many cases they are banned) from referring to anyone outside their network (especially to someone who talks a lot about FASCIA, GUT HEALTH, SYMPATHETIC DOMINANCE, or just how dadblamed dangerous most drugs really are --- HERE or HERE) . I completely agree that doctors should be told. Just don't hold your breath waiting for an earth-shattering reaction TO ASTOUNDING RESULTS.
Also remember that it's not really the doctor's fault. Not only are doctors burned out and swamped by ignorant amounts of moronic paperwork (HERE and HERE), the system itself is corrupt and geared toward keeping you alive for a very long time via taking drugs --- lots of drugs (HERE). Mind you, while these drugs are not making you healthy (YOU ARE RESPONSIBLE FOR DOING THAT), they are turning you into what could only be described as a cash cow. You can't possibly be shocked considering I've shown you time and time again that Big Pharma will do whatever it takes to maintain / expand market share (read my posts on "EVIDENCE-BASED MEDICINE" if you think I'm being harsh).
My advice to anyone who's read this far? Realize that even though there is really no such thing as 'average,' I've created a generic protocol that will get the ball rolling as far as helping the average patient is concerned. Just remember that before you do anything radical like trying to get off of a particular prescription or starting a "WEIRD DIET," it's always a good idea to talk to your doctor first --- even though they might just know less than you if they haven't been keeping up with current research (HERE).
Today would be a great day to START CONTEMPLATING A CHANGE since it's the first day of the month. After all, you owe it to yourself. And if you know someone else who owes it to themselves, be sure to reach them by showing us some love on FACEBOOK.
CHRONIC LOW BACK PAIN AND PARKINSON'S DISEASE
WHAT ARE THE COMMON DENOMINATORS?
When you see the term "Parkonsonism," it is not the same as Parkinson's Disease, but is instead referring to a distinct set of symptoms that are ubiquitous to over 25 neurodegenerative diseases. These symptoms include various sorts of tremors, diminished ability to move, rigid, tense, or spastic muscles, and various forms of balance / stability problems and DISTORTED PROPRIOCEPTIVE ABILITIES or kinesthetic sense (people cannot tell where their body is at in space) which, while not VERTIGO, can in some ways act similarly. I mention all this because a couple of months ago the journal Frontiers in Neurology published a study by a group of rehab specialists and neurologists called What If Low Back Pain Is the Most Prevalent Parkinsonism in the World?
While the title alone should make one stop and think for a moment, it's what's inside the study that BEING A CHIROPRACTOR, literally stopped me in my tracks. "Low back pain (LBP) has a point prevalence of nearly 10% and ranks highest in global disease burden for years lived with disability; Parkinson’s disease ranks in the top 100 most disabling health conditions for years lost and years lived with disability. Recent evidence suggests that people with chronic, recurrent LBP exhibit many postural impairments reminiscent of a neurological postural disorder such as Parkinson's."
Essentially, these doctors are making the point that not only is Chronic Low Back Pain the number one disability-causing health problem on the planet, it has many characteristics that make it 'Parkinson's-like'. On top of this, even though there is pain with Parkinson's, it is rarely talked about nor is it the focus of treatment. The authors went on to discuss the fact that even though care given by rehab specialists to patients with Parkinson's is geared toward retraining and improving gait, posture, and balance, when it comes to LBP the focus is more about managing said pain and / or addressing flexibility and strength issues. Which brings us to the gist of their study.
Although they would never say they are the same thing (in similar fashion to the way that a growing part of the medical community is referring to Alzheimer's as Type III Diabetes --- HERE), the authors clearly stated that with both conditions, "the motor impairments seem more alike than different." Their point? They believe that patients with chronic LBP should be treated with some of the Parkinson's rehab and vice versa. "Overall, the similarities of LBP and PD in postural impairment and associated neurophysiology suggest it may not be so implausible to consider LBP as an axial parkinsonism, rendering it the most prevalent parkinsonism in the world." Suggestion; if you or a loved one has Parkinson's or chronic LBP, forward them this post so that they can read the study themselves.
Although there are many who debate it (for instance Time ran a 2016 story titled The Role of Boxing in the Death of Muhammad Ali Remains Unclear), studies on HEAD INJURIES --- particularly repeated head trauma --- as a risk factor for Parkinson's abound. Ali last fought in 1981 (he lost), and by 1991, the journal Movement Disorders had published a study whose title tells you all you really need to know; Head Trauma as a Risk Factor for Parkinson's Disease. The March 2015 issue of Neurobiology of Aging (Head Trauma in Sport and Neurodegenerative Disease: An Issue Whose Time has Come?) had this to say on the subject....
"A number of small studies and anecdotal reports have been suggested that sports involving repeated head trauma may have long-term risks of neurodegenerative disease. There are now plausible mechanisms for these effects, and a recognition that these problems do not just occur in former boxers, but in a variety of sports involving repeated concussions, and possibly also in sports in which low-level head trauma is common. These neurodegenerative effects potentially include increased risks of impaired cognitive function and dementia, Parkinson's disease, and amyotrophic lateral sclerosis."
With what we are learning about the seriousness of head injuries from FOOTBALL, HOCKEY or even SOCCER (can anyone say CTE?), we can't possibly be surprised that boxing or other full contact sports such as MMA affect the brain similarly. But.... What if I told you that boxing --- or at least training like a boxer --- has been shown to be an effective treatment for Parkinson's? Back in 2011, the journal Physical Therapy (Boxing Training for Patients with Parkinson Disease: A Case Series) said this of 2-3 sessions per week of boxing training for those dealing with Parkinson's.
"The 90-minute sessions included boxing drills and traditional stretching, strengthening, and endurance exercises. Despite the progressive nature of PD, the patients in this case series showed short-term and long-term improvements in balance, gait, activities of daily living, and quality of life after the boxing training program. A longer duration of training was necessary for patients with moderate to severe PD to show maximal training outcomes. The boxing training program was feasible and safe for these patients with PD."
In 2013, Neurorehabilitation (Community-Based Group Exercise for Persons with Parkinson Disease: A Randomized Controlled Trial) showed something similar. Compared to individuals who were doing TRADITIONAL STRENGTH AND CARDIO TRAINING, along with balance training (A GREAT TOOL TO ADD TO ANY PROTOCOL), "Only the boxing group demonstrated significant improvements in gait velocity and endurance over time with a medium between-group effect size for the gait endurance. Both groups demonstrated significant improvements with the balance, mobility, and quality of life with large within-group effect sizes. While groups significantly differed in balance confidence after training, both groups demonstrated improvements in most outcome measures. Supporting options for long-term community-based group exercise for persons with PD will be an important future consideration for rehabilitation professionals."
And while there is evidence from peer-review that programs like "ROCK STEADY" are working, there are literally mountains of anecdotal evidence from the tens of thousands of people who are already doing this very thing --- training as boxers for the express purpose of kicking Parkinson's ass. And honestly, what have you got to lose?
These are training sessions, not fights. In other words, you don't have to worry about getting hit. And not only can you do these workouts corporately, they could easily be modified and done on some level with a partner at home, with a minimal investment in equipment or space. If you know or love someone with Parkinson's (or it runs in your family like it does mine --- HERE) be sure to share today's post with them. And since Parkinson's is an autoimmune disease, be sure to at least browse my 'UNIVERSAL CURE' POST as well. The best way to reach the people you love and care about most? FACEBOOK, of course (just tag them).
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IS MINDFULNESS REALLY THE ANSWER TO MOST CHRONIC HEALTH ISSUES AND PAIN?
Sarno and a growing number of others believe that much --- maybe even the majority of --- people's pain is caused by something he's coined as TMS (Tension Myositis Syndrome). What is TMS? In many ways it's like FIBROMYALGIA in that it's symptoms are rather diffuse and widespread and frequently includes things like pain, TRIGGER POINTS, PARESTHESIAS (numbness, tingling, and a variety of other abnormal sensations) as well as SCIATICA. People in Sarno's camp look for tender points in three areas specifically --- on the outer buttocks, the upper traps, and the lumbar errectors / paraspinal muscles of the low back. They also look for a history of what they refer to as "Mindbody Syndromes". What are Mindbody Syndromes you ask?
Mindbody Syndromes involve diseases that are said to be not real (or at least not real in the sense that there are no tests or examinations that create a definitive diagnosis) or dramatically over-diagnosed. Some that were mentioned by various doctors promoting TMS included INTERSTITAL CYSTITIS, IRRITABLE BOWEL SYNDROME, chronic pelvic pain (vulvodynia), CHRONIC BACK PAIN, CHRONIC NECK PAIN, HEADACHES / MIGRAINES, WHIPLASH, STOMACH ULCERS, or pain caused by disc issues or wearing or worn out joints (ARTHRITIS, SPINAL STENOSIS, DJD), as well as others.
Chronic pain tends to lead to something known as "catastrophizing" or believing that everything is or will be a catastrophe. The website Psych Central put it this way. "Catastrophizing is an irrational thought a lot of us have in believing that something is far worse than it actually is. Catastrophizing can generally can take two different forms: making a catastrophe out of a current situation, and imagining making a catastrophe out of a future situation." In English, this means that many people are ruled by both fear and stress; both of which lead to an all-too-common problem I have written about extensively (SYMPATHETIC DOMINANCE). Resnick had this to say about a person who had been living in a loop of fear, stress, and catatrophizing.......
"Golson had been catastrophizing his pain, thinking of the worst possible outcomes, like losing his job or having to largely start over in life. A similar thing happens to people who suffer from anxiety: Feelings get magnified in a loop of negative rumination. Research has shown that catastrophizing is associated with worse pain outcomes: more intense pain, and a greater likelihood to develop chronic pain. It’s also associated with higher levels of fatigue. Neuroimaging studies suggest that if you engage in catastrophizing thoughts, it amplifies pain processing — so you’re unwittingly pouring gasoline on the fire. But as a chronic pain patient who bounces from specialist to specialist seeking a diagnosis, it’s hard not to catastrophize. Considering how dangerous and damaging the past decades of treating chronic pain with addicting opioids has been, and how risky and expensive surgery can be, they’re a worthy option, one that’s never sold to doctors by pharmaceutical representatives or advertised directly to consumers on TV. The most common psychological treatment for pain, and the most well-studied, is cognitive behavioral therapy, or CBT. Overall, it’s one of the most rigorously tested and effective tools psychology has to offer. More typically, it’s used to treat anxiety, phobias, and mood disorders like depression. But it can also help some people manage their pain. Like the somatic tracking exercises described above, the goal of CBT is to come to a new understanding about pain. That it isn’t something that’s physically harmful and that certain thoughts and behaviors can make pain worse."
I agree with most of what's in this paragraph. After all, as a man thinketh in his heart, so is he (HERE). And face it; opioids are dangerous and ineffective for anything beyond short term use (HERE). By the way, I've mentioned CBT on my site a number of times. Most of the therapies that fall under this umbrella involve talking things out or writing down past hurts that might be repressing emotions. Practitioners have patients recognizing characteristics that might be doing a great deal of harm (people pleaser, perfectionist, etc), and then work on figuring out why certain situations cause certain responses. Many of those teaching various sorts of Mind / Body Therapies also urge those under their care to stop all PHYSICAL THERAPY, CHIROPRACTIC, or massage treatments in addition to gradually returning to normal ADL's (Activities of Daily Living). Finally, support groups and in some cases psychotherapy, are needed. Some of the bigger studies that back Cognitive Behavioral Therapies include......
- 2014's study in American Psychologist (Cognitive-Behavioral Therapy for Individuals With Chronic Pain)
- 2016's study in JAMA (Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain)
- This month's study in JAMA Internal Medicine (Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis)
While I think that mindfulness techniques are unequivocally important for people struggling with certain types of chronic pain, there are some holes in this way of thinking that bear discussion. For instance, of the Mindbody Syndromes mentioned earlier, Interstitial Cystitis and IBS are both real AUTOIMMUNE DISEASES. Furthermore, we have a different understanding of ulcers than when Dr. Sarno wrote his original book back in the 1970's (HERE). What I really want to bring up, however, are the mechanical issues such as back pain and neck pain. To do this I want to use whiplash as my example.
Whiplash is not only extremely common (HERE), but is another of the myriad of health-related issues that do not show up with normal imaging (HERE). But guess what? That's not because there is nothing there to see in a whiplash injury, but because current technology does not even remotely approximate what it's been touted to do (i.e. x-rays only show bones, but MRI shows eeeeeeverything).
Renowned whiplash researcher Nikolai Bogduk and numerous others have proved this with studies showing extensive post-whiplash microscopic damage via tissue samples taken from autopsies. It's no different, really, than what's currently going on in the NFL with Chronic Traumatic Encephalopathy (CTE). While there is currently no imaging or blood tests for CTE, thanks to autopsies we now know it not only exists, but on some level affects almost 100% of professional football players (see Will Smith's excellent movie, Concussion). And we have not even begun discussing the three main reasons people get headaches / migraines (HERE), one of the biggest being adhesed fascia.
FASCIAL ADHESIONS are so common in CHRONIC PAIN SYNDROMES that they could almost be considered ubiquitous. And here's the kicker; you can't see them with standard medical imaging such as MRI or X-ray either (HERE). I don't have to explain what this means to the average sufferer. Accusations of drug-seeking, malingering, or essentially being labeled a whiner who needs to suck it up and get tougher. Furthermore, how in the world can any practitioner or physician take care of people's chronic pain or chronic health issues while their patients continue living a state of perpetual systemic inflammation --- inflammation that 100% of the time leads to fibrosis / scar tissue (HERE)? And in case you weren't aware, fibrosis is America's #1 leading cause of death (HERE). So yes, it is a big deal.
Do you remember earlier where I stated, "They also look for specific tender points on the outer buttocks, the upper traps, and lumbar errectors / paraspinal muscles"? These are problems that can all easily be explained by fascial adhesions or myofascial trigger points --- problems that in most cases can be successfully addressed BIOMECHANICHALLY. The area of the buttocks mentioned is where CLUNEAL NERVE ENTRAPMENT occurs (be aware that there are any number of other cutaneous nerve entrapment syndromes that are all fairly common as well --- HERE). The lumbar errector muscles are where the THORACOLUMBAR FASCIA lives (a very common area to get adhesions), not to mention the fact that UPPER TRAPS / LEVATOR trigger points are far and away the most common place to get trigger points.
While I think that the medical community grossly under-appreciates the mind in relation to chronic pain or other chronic health issues, I also feel that the brain (IN THE FORM OF CS) can become a convenient scapegoat. Instead of "gee, I don't really know why you are struggling with this problem Mrs. Smith, maybe you ought to go see if that whackjob Dr. Schierling could help you in a single visit like he does so many people" (HERE), it's easier to just tell Mrs. Smith, "it's all in your head". Despite the fact I see these sorts of cases on a daily basis, allow me to share with you the story of a patient who recently flew in for a week of treatment.
This individual (I'll call him Ralph) had struggled for years with chronic tightness and restriction in his neck, chest, and abdominal area (he had about 50% normal motion in his neck) despite living a healthy lifestyle. On day one I spent most of my time in the neck and upper back region making a bit of headway with his ranges of motion but in all honesty, it was not great. On day two, I worked my way down into the chest and abdomen, which helped a bit as well. Here's the crazy part. Since his lower abdomen had significant scar tissue, I checked his hip flexors. Not only did they have a lot of buildup of adhesion, but when I broke said adhesion his ROM in his C-spine normalized. Instantly --- an "ANATOMY TRAINS" sort of moment.
What's doubly interesting about his case is that the one and only thing that had benefited Ralph up to this point (years of seeking) was meditation and mindfulness. But he realized after reading my FASCIA PAGE that his problem was not simply all in his head. Yes, mindfulness helped. No, he could not meditate away hardcore FASCIAL ADHESIONS. No one can. In fact, I would hate to be the person to tell someone like DONNIE T that his problem was all in his head!
If you are interested in seeing a post that addresses multiple aspects of chronic pain, including the mind-body connection, all you need to do is CLICK HERE and start reading. I'm not selling you anything and am not guaranteeing a "cure". What I am suggesting is that there are probably some effective things you could be doing for yourself, but for whatever reason, are not. Oh; and if you found this post interesting or informative, be sure and get it in front of the people you love and care about most. The easiest way to accomplish this is by showing us some love on FACEBOOK.
FUNCTIONAL MEDICINE FOR CHRONIC PAIN?
"The medical knowledge we gained in the 20th century had very narrow goals: stop people from dying. It was focused on treating short bouts of illness caused by a specific disease often localized to a particular organ or organ system. However, the CDC estimates that over half of adults in the U.S. suffer from one or more chronic diseases that cannot be cured, only managed. The costs of treating these diseases now represents 75 percent of the $2 trillion in U.S. annual healthcare spending. While we will always need acute care, managing chronic illness requires a different mindset. It is no longer enough to simply treat the most pressing symptom and wait for the patient to return when the condition gets worse." From RX: The Quiet Revolution (How Disease-Based, Doctor-Centered Medicine is Failing Us)
"A 2012 study found that almost half of the practicing physicians surveyed had one or more symptoms of burnout. An online poll in the same year of more than 24,000 physicians found that only 54 percent would choose medicine again as a career, compared with 69 percent in 2011." From Dr. Diane Shannon's article on Common Health (Why I Left Medicine: A Burnt-Out Doctor’s Decision To Quit). You can read my piece on BURNOUT simply by clicking the link.
"The US spends more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia, yet the US ranks last in health and mortality when compared with 17 other developed nations. Sadly, 30 cents of every dollar spent on medical care in America is wasted, which amounts to $750 billion annually. That is the same amount the Department of Defense estimates we spent on the ENTIRE Iraq War! This $750 billion of waste is made up of inefficient delivery of care and excessive administrative costs, unnecessary services, inflated prices, prevention failures, and outright fraud. The largest defrauder of the federal government is the pharmaceutical industry." From Dr. Joe Mercola's Top Ten Ways the American Health Care System Fails. If you want to see how Big Pharma is defrauding the American Taxpayer, simply click THIS LINK.
"American's high rates of chronic disease are a massive cost-driver, attributable, according to research, for about 2/3rds the rise in health spending over the past few decades. So given the high prevalence of such diseases, and the pressures they exert on our system, you'd hope our system had evolved so as to treat these diseases more effectively. Not so." From the American Prospect (Ten Reasons Why American Health Care Is so Bad)
I worked hard, but not for the money. Did my best to please.
I used to think it was funny, til I realized it was just a tease.
Looking for the next best thing. Looking for the next best thing.
I appreciate the best, but I'm settling for less, cause I'm looking for the next best thing.
Warren Zevon from 1982's The Envoy (Looking for the Next Best Thing)
A pair of doctors working with the VA (Osteopath, David Schaefer and Psychologist, David Cosio) wrote an article for Practical Pain Management called A Model to Incorporate Functional Medicine into Chronic Pain Care. In the article's synopsis (just under the title), the authors made sure to let readers know that this program requires "patient participation". The point? Functional Medicine is not the same old, same old. It's not the kind of care that you can receive without taking an active part in. In fact, a failure to engage patients to take responsibility and "actively participate" in their own intervention has historically been a huge failure of the standard medical model. In other words, far too many people have been led to believe that what we today refer to as "healthcare" is something that someone else does for them; not something that they largely have to do for themselves.
It is very common for Americans to numb themselves with low-quality foods, reality TV, and a variety of socially acceptable addictions, which may be ascribed to the idea that 'ignorance is bliss."'
These authors hit the nail on the head with this statement. People are "medicating" (drugging / numbing) themselves with foods --- some of which have been shown to be more addictive than hard drugs (HERE). Another common non-pharmaceutical medication is media (TV, video games, porn, cell phones, computers / internet, or even reading, HERE). But what are some of the other "socially acceptable addictions" they might be talking about? Alcohol and tobacco are probably the most obvious, but there are any number of others. I've seen things like shopping, gambling, caffeine, ADERALL / RITALIN, work / ambition, etc, mentioned here, but even "healthy" habits like EXERCISE can become problematic for some people.
The next topic touched on was EPIGENETICS. Although these authors never mentioned it by name, they described it thusly. "Two factors --- genetics and the environment --- have an infinite number of combinations with a potential to support health or yield to disease." In English, this means that you are not nearly as much a product of your genetic makeup as you have been led to believe. Sure, you can't change the color of your eyes or hair without contacts or dye, but as far as chronic sickness and disease are concerned, most can be changed. This is because few chronic illnesses are largely genetic, although most treating doctors seem to heavily promote this myth. Why? Because when your health problems can be blamed on someone else (your ancestors in this case), everything is easier. Your doctor doesn't have to confront you, and you can continue to live the same old self-destructive lifestyle in the "blissful ignorance" that put you in this condition in the first place, not having to take any responsibility for you actions because after all, it's not your fault --- IT'S THOSE PESKY GENES!
Epigenetics is one of the most important aspects of your health that you've probably never heard of. It means that one of the biggest goals of following the diagram above is not simply to lose weight, get your blood sugar right, or lessen your body's inflammatory load (noble goals one and all), but the fact that accomplishing these things actually helps prevent "bad" genes from being "epigenetically" turned on or activated. We all carry genes for any number of nasty diseases, but in many cases (hopefully most cases), we never express those genes because the trigger never gets tripped. And even though you might not be familiar with this term, most of you already intuitively know what these triggers are --- bad habits, bad lifestyles, bad diets, bad sleep habits, too many bad medications, etc, etc, etc.
One thing I must mention is that this post talks about something that cannot be measured, but is critical to one's health; love. The power of love has similar healing properties and is intimately related to the healing power of touch that I wrote about on Christmas Day (HERE). And interestingly enough, decades before Bernie Siegel and Patch Adams were talking about this concept, Dr. Jim Parker was teaching thousands of chiropractors the importance of what it means to LLL (Lather Love Lavishly). The problem is that in today's "corporate" medical environment, love is frequently left by the wayside. In fact it's frequently so non-existent in today's students that medical schools are actually hiring actors to teach soon-to-be physicians HOW TO FAKE IT. Get real folks. True empathy can't be faked (HERE) --- patients know whether or not you give a rip.
FUNCTIONAL MEDICINE is all about helping restore HOMEOSTASIS (the medical word for balance or equilibrium) to every area of the patient's life (spirit, soul, and body). Thus, the quote below should be a no-brainer, and realizing that it's not --- that it's "novel" in the field of medicine --- is rather disconcerting. It should also help you understand the difference between gross pathology and the "functional" health problems that so frequently occur in its absence (HERE).
"Rather than seeking to alleviate a symptom, the practice of functional medicine aims to identify the root cause of the disrupting symptoms. A functional medicine provider is trained to recognize an underlying clinical imbalance and then seek the best approach to restore balance or a health equilibrium. The functional medicine specialist usually relies on the health matrix, which compiles information from each of the seven nodes, which work in unison, rather than individually. The interconnectedness of the nodes aims to reinforce the impact that each will have on the others, which will ultimately reflect as health or dysfunction, which may manifest as pain and disease."
If there is one thing our medical profession is good at it's finding gross-pathology. In fact, current "evidence" clearly shows how far out of balance the practice of medicine has been tipped in this direction (HERE). Lest some of you accuse me of being mean or over-exaggerating the problem, bear in mind that this is common knowledge. You can't even call it a dirty little secret (or even an open secret) because it's not a secret at all. If you wanted, you could find dozens of articles and studies showing that while our medical profession is fantastic in dealing with trauma or life-threatening events, when it comes to CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, we are failing miserably. Why? Mostly because with standard care, the COMMON DENOMINATORS of almost every chronic disease you can think of are not being addressed (the link is the proof, and as you'll see if you click, many chronic issues are actually being caused by medical interventions --- the best example being our love affair with IMMUNE SYSTEM SUPPRESSION).
What's really cool is that Drs. Schaefer and Cosio saw the beauty of the Functional Medicine model and put it into practice. What's doubly cool is that they have actually used this system in a trial to see whether it could outperform standard medical care in veterans (the study is through the VA). Rather than me go through each and every circle in the diagram above, you can read their article free online if you desire. Although I added and shifted things around just a bit from their diagram, my "matrix" remains essentially the same as theirs, and is covered step by step in the post I wrote back in the summer of 2014 (HERE), with the biggest difference I see being my emphasis on BLOOD SUGAR and BIOMECHANICAL ISSUES. The best news of all is that making the right kinds of changes works!
"According to the American College of Preventative Medicine, most chronic diseases are preventable and reversible if a comprehensive, individualized approach that addresses genetics, diet, stress, physical activity, sleep, and relationships is implemented through integrated functional medicine teams and based on empirical research."
If you are into research, my site is loaded. Although I tend to be rather opinionated, I try to back everything on my site with research. What's truly shocking is that the research is now showing that when it comes to taking care of patients, we've been going about things bass ackwards for decades (HERE). Not surprisingly, the number one way mentioned by these authors to achieve the things set forth in the quote above is by changing your diet. Failing to consume a diet BASED ON WHOLE FOOD NUTRITION is not only why drug therapy so often fails (you can't overcome a poor diet with MONOTHERAPIES), but is usually the reason people are given SO MUCH MEDICATION in the first place --- medication that completes this self-perpetuating cycle by screwing their systems up even further (HERE and HERE).
As far as the results of the study itself, the trial lasted one year, had four (educational) group-sessions to kick things off, and then focused heavily on using an ELIMINATION DIET to determine what foods your IMMUNE SYSTEM might be reacting against. And remember when I said that Functional Medicine was something that you had to play a participating role in? Unfortunately, half of the veterans enrolled dropped out (they chose to swallow MORPHEUS' BLUE PILL). The other half saw a change in their weight, but failed to see changes in "waist/hip circumference, walking speed, and insomnia." They did score better on some of their blood work as well as joint pain, HEADACHES, and PERCEIVED STRESS, although they failed to change overall pain scores.
Why weren't the results better? For one thing it's the VA. It's a real challenge to take 50 veterans with chronic illnesses and try run true Functional Medicine protocols in a VA setting. Because of this (and not to pick on the authors) it was, as I referred to it in the past, "FUNCTIONAL MEDICINE LITE". For another, I thought their Elimination Diet could have been better (among other things, ALL GRAINS --- not just the gluten-containing grains ---must be eliminated in the beginning). Looking at their Elimination Diet made me realize I probably need to redo my post on the topic. But overall, it was a definite improvement over the norm, as the authors concluded.
I still think that it all boils down to education and motivation. And while educating patients is critical, unless the treating physician is excellent at extracting from each patient what truly and deeply motivates them, making the sort of connection that will help drive them to want to get healthy will, in many cases, remain difficult. My hope is that this is the beginning of some real changes in our veteran's healthcare, and not simply a case of government placating TICKED OFF CITIZENS, while looking for the next best thing.
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I applaud the individuals who did this study. If you --- my readers --- are looking to break out of the prison that is your health, I've got the perfect post for you (HERE). And if you know others that could benefit from this information, be sure to get it in front of them. The easiest way is to like, share, or follow on FACEBOOK.
CHIROPRACTIC MAINTENANCE ADJUSTMENTS,
RESTRICTED FASCIA, CHRONIC INFLAMMATION, AND CHRONIC PAIN
The problem is that way too many chiros have things backwards. It's not that adjustments done on some sort of periodic basis can't benefit health in any number of ways (HERE); it's that no matter how you slice it, seeing the very same people for the very same problem(s) over and over and over again is not maintenance and it's not very fun. It's why my goal in most cases is simple --- get you out of pain quickly (see link in 1st paragraph), restore as much function / ROM as possible, and make sure you leave with appropriate DIY self-help ideas from MY CLINIC'S ONLINE HANDOUT. Could it be simpler? No long, drawn-out treatment schedules, no pre-buys, and no trying to upsell you on things you don't really need (be aware that disc herniations can be a different sort of beast).
According to various online sources, the definition of maintenance is, "Activities required or undertaken to conserve as nearly, and as long, as possible the original condition of an asset or resource while compensating for normal wear and tear. The process of preserving a condition or situation or the state of being preserved. The process of keeping something in good condition." Many chiros would argue that by seeing the same people over and over again, they are helping to keep them in good condition. Here's the rub. True health does not come from something that someone else does for you. It comes from the blood, sweat, tears, and tough dietary decisions that you make for yourself.
You see; all too often the person is coming in to get adjusted because it's the only thing that gives them any degree of relief. Nothing ever really gets better, but since an adjustment gives them a few days (or maybe a few hours) with less pain, they're down with it out of sheer frustration / desperation. When I see patients, whether local or from ELSEWHERE, whose problems are largely relieved by adjustments but the relief is never really long-lasting, I automatically think SCAR TISSUE. Your problem always returns to the same place and in the same essential manner? I think scar tissue. You have a great deal of restriction despite having LOTS OF ADJUSTMENTS or LOTS OF THERAPY (or maintaining a stringent STRETCHING PROTOCOL)? I think scar tissue. You've INJURED yourself or are locked into a job that holds you in a constant posture for hours on end, day after week after month after year? I think scar tissue.
You see, adjustments alone are never going to break "through" scar tissue and fascial adhesion if said scar tissue is anything greater than minimal; I don't really care how many of them you get. All of this is why a first-time visit to my clinic usually looks quite different than anything you've experienced previously (HERE). Allow me to give you an example.
I recently had a young woman come see me for CHRONIC LOW BACK PAIN. Despite being thin, fit, and in good physical condition, she could not shake said pain. The first thing I did was examine her, learning that when I told her to touch the floor, she could barely bend over at all --- even by pushing it to the point of pain. I checked to see if scar tissue was a problem for her, and it was (HERE is the post I wrote about the experience). While the immediate results of her treatment were "OK" (not excellent but not terrible either), she ended up coming back in a couple of weeks because her problem had returned. I rechecked everything, broke some more tissue, and talked to her again about her diet (see link). Since she was extremely fair-skinned and red-headed, I had suggested that GLUTEN SENSITIVITY was a strong possibility (people of Western European descent are GENETICALLY PRONE) as far as driving hidden inflammation was concerned.
Here is what she sent me on Friday --- a bit over two months after her first visit. "Since following your advice, the pain in my back and neck has stopped entirely, as well as all of my bloating and stomach pain that I used to experience almost every day." Her problems were solved quickly, efficiently, and inexpensively. She is eating healthier, while exercising and stretching effectively. All without a huge amount of unneeded treatment. Pretty cool? My patients certainly think so. What's doubly cool is the long-term fruit that this sort of approach produces. Long-term fruit? Darn straight! Because inflammation always leads to fibrosis / scar tissue, and scar tissue always leads to degeneration of joints, organs, and tissues (HERE), she headed some serious lifetime problems off at the pass!
PRESIDENT JOHN F. KENNEDY'S
CHRONIC BACK PAIN
On the other hand, despite the fact that he is deeply beloved and considered by public opinion to be one of America's greatest presidents, many have forgotten that his legacy also includes the failed Bay of Pigs Invasion which subsequently led to him being verbally and politically bludgeoned by Nikita Khrushchev at the Vienna Summit --- an event that arguably led to both the Berlin Wall and the Cuban Missile Crisis --- not to mention moving US military "advisors" into Vietnam. JFK was also responsible for starting our failed war on poverty in earnest (even though LBJ usually gets the credit), along with avoiding the Civil Rights issue like a hot potato solely for political reasons until it literally backed him into a corner, fell into his lap, and forced his hand. That being said, Kennedy was undoubtedly a war hero.
Shortly prior to the famous PT-109 incident of WWII, Kennedy became a commander for a Motor Patrol Torpedo Boat in a squadron of PT boats in the South Pacific (he served in the Solomons and Russell Islands -- Tulagi, Kolombangara, New Georgia, Rendova, etc). In going up against the resupply barges and the hit-and-run tactics of the warships of "The Tokyo Express," PT-109 encountered the Japanese destroyer, Amagiri. JFK's PT-109 was sitting at idle on a pitch black night waiting for an opportunity to attack the enemy, when the Amagiri appeared from nowhere and cut Kennedy's vessel in half, killing two of his crew, and severely injuring two more. Clinging to the wreckage for 12 hours before coming to the realization it was sinking, Commander Kennedy understood that to survive he and his men would have to abandoned the sinking debris and make a break for shore. Heroically, JFK towed a severely burned crew member to shore by swimming (between 4-5 hours) while clenching the strap of the man's life jacket in his teeth.
Because the island was deserted -- only about 100 yards across -- with no water, Kennedy swam 3 miles to another island to find water and see what could be done about the possibility of rescue. Kennedy and his men survived for six days on coconuts and coconut water before being found by natives that had been dispatched by an Australian naval observer living on top of a dormant volcano on KOLOMBANGARA ISLAND --- and island holding 10,000 Japanese troops (the observer had seen the explosion and sent the natives out to look for survivors). Kennedy scratched out a message on a coconut that was taken back to lieutenant Arthur Evans (the observer), who then sent natives back to pick him up in a canoe, bring him back to Kolombangara, where he could help coordinate a rescue for his crew.
Not only is this story amazing, it's made all the more amazing because of the terrible back pain Kennedy suffered with his whole life (his politically powerful father had to pull several strings to get "Jack" OK'd for military duty by burying his failed military physicals due to "a bad back"). In similar fashion to the article on ELVIS PRESLEY'S HEAD INJURY that led to (or at least heavily contributed to) his rapid and premature downfall; just days ago, the Journal of Neurosurgery: Spine ran a story by a pair of well known physicians called John F. Kennedy’s Back: Chronic Pain, Failed Surgeries, and the Story of its Effects on his Life and Death.
Because I dealt with a decade of chronic pain myself before finding someone to help me solve it (HERE), and because five days a week I deal with people who struggle with debilitating chronic pain (HERE), and because I watched the incredible strength and toughness of my FATHER-IN-LAW who managed to lead a "normal" life despite spending a year in an iron lung with polio and suffering through terrible post-polio syndrome as he got older, I have at least a tiny (tiny) degree of understanding of what JFK went through. CHRONIC PAIN changes people --- it destroys mind, body, and soul. I find it astounding that Kennedy was able to accomplish what he did despite living with the kind of pain and health problems that he did.
There have been slews of articles written about JFK's back pain, as well as the fact that for years his personal physician was DR. JANET TRAVELL, who, along with Dr. David Simmons, wrote the "bible" on MYOFASCIAL TRIGGER POINTS (Myofascial Pain and Dysfunction: Trigger Point Manual). She and Simmons not only mapped out the areas where Trigger Points tend to occur most frequently, but their crazy pain-referral patterns as well. These authors say of Dr. Travell.
"In 1955, Kennedy was introduced to Dr. Janet Travell, a Cornell University pharmacologist and internal medicine specialist known for her work using trigger-point injections of local anesthetics to treat myofascial pain. Senator Kennedy was treated with ethyl chloride spray [Spray and Stretch] and procaine trigger-point injections. This hospitalization marked the first of hundreds, if not thousands, of procaine trigger-point injections.... [and] marks the end of his major back surgeries and a shift in focus toward muscular and environmental factors contributing to his back pain."
On May 29th of this year, JFK would have been 100 years old. Something that the general public was unaware of (at least initially) is that despite his public persona of health and vitality, Kennedy (in similar fashion to Teddy Roosevelt) was a very sickly child, having nearly died from Scarlet Fever at age two. His childhood troubles didn't end there, however. According to several sources supplied by these authors, "he would be treated for a host of illnesses prior to his graduation from preparatory school." The most interesting health-related fact in this entire story, however, had to do not simply with the fact that he had back pain, but with the cause of his back pain.
"Dr. Marius Smith-Petersen concluded: 'I don’t think this is a disc since the pain complained of does not even remotely resemble a disc.' Dr. Smith-Petersen requested that JFK also consult with Dr. James White, a naval neurosurgeon who agreed that Kennedy’s current pain was inconsistent with sciatica. The Mayo team stated that 'a diagnosis of a protruded disk was not definite … at this time you are not in need of surgery.'"
In other words, Kennedy was debilitated with back pain that was probably not DISC-RELATED, but not having better solutions (or at least not having been introduced to better solutions by a HIGHLY ANTI-CHIROPRACTIC MEDICAL PROFESSION), he decided to undergo SPINAL SURGERY in 1944 --- over a year before the war's end. This leads me to a couple of conclusions that I have discussed on this site many times. Debilitating low back pain has several causes that have nothing whatsoever to do with spinal discs (HERE). It also leads to the conclusions that Dr. Travell came to in her studies, and what eventually led Kennedy to her --- albeit unfortunately after his failed back surgeries --- that the TWO SIDES OF THE MYOFASCIAL SYNDROME --- Scar Tissue / Fascial Adhesions and Trigger Points can produce debilitating / crippling pain (LH of Indy, I am thinking of you right now) that leaves the vast majority of the medical community starring at you with a deer-in-the-headlights look because these sorts of problems do not show up on MRI (HERE).
Shortly after the war's end, JFK leveraged his name and war hero status to be elected first as a Representative and then a Senator. During this time he was diagnosed with Addison's Disease --- a near total loss of adrenal hormones that is a step beyond ADRENAL FATIGUE and HARDCORE SYMPATHETIC DOMINANCE, although it carries some of the same general symptoms. Wikipedia says the chief signs of Addison's Disease include, "fatigue; lightheadedness upon standing or difficulty standing, muscle weakness, fever, weight loss, anxiety, nausea, vomiting, diarrhea, headache, sweating, changes in mood or personality, and joint and muscle pains." Think for a moment about this. JFK not only dealt with horrendous back pain, but the nightmare of Adrenal Insufficiency as well (yes, Addison's is another of the numerous AUTOIMMUNE DISEASES).
This is where things started to go off the rails. After his second surgery, Kennedy had several near-death experiences due to staph infections and an inability of his wound to heal. A friend said of Kennedy's wound, "the area where they cut into his back never healed. It was oozing blood and pus all the time. It must have been painful beyond belief…. It was an open wound that seemed to be infected all the time. And now and then a piece of bone would come out. His pain was excruciating." Despite Travell's help with strengthening and rehabilitating his spine, which "led to significant improvement in JFK’s low-back health and overall functioning during this time," Kennedy ended up requiring one more surgery (his fourth spinal surgery) to "fix" staph-induced abscesses (not to mention a ton of ANTIBIOTICS that would have further degraded his GUT HEALTH along with his overall health and IMMUNE SYSTEM FUNCTION).
"Although his back was in comparatively decent shape, the 1960 campaign took its toll, prompting Kennedy to seek the services of Dr. Max Jacobson, a German immigrant practicing in New York. Over the ensuing summer JFK’s physical condition was at its worst point in years. Not for a long time had he been in such agony. This prompted a return to frequent use of crutches, procaine injections, his corset brace, and an increase in the illicit injections from Jacobson. The poor state of his back and its effect on JFK’s overall well-being may have had a considerable and negative impact on the President’s performance at the crucial Vienna Summit with Soviet Premier Nikita Khrushchev in June 1961. In fact, on the 1st day of the tense summit the president received at least three of the methamphetamine-containing shots. Reeling from the nerve-wracking summit, his aching back, and the likely side effects of Jacobson’s methamphetamine shots, the very gloomy Kennedy admitted immediately after it ended that the summit did not go well—reflecting that Khrushchev just beat the hell out of me."
One of the White House physicians, Rear Admiral George C. Burkley, took it upon himself to have Kennedy evaluated by yet another expert --- this time, renowned orthopedist and physiatrist HANS KRAUS. President Kennedy was, "placed on an exercise and rehabilitation program built around the White House pool and gym. The program consisted of a combination of thrice-weekly weight-lifting sessions and near-daily swims, along with massage and heat therapy — and paid immediate dividends. Within months, the improvement was dramatic." Interestingly enough, there are many, including these authors, who suggest that Kennedy's continued reliance on a rigid back brace is what held him upright so that Lee Harvey Oswald could get off subsequent kill shots after a first shot that was, according to these authors, "potentially survivable".
The conclusions that the authors came to were that at least at first, there was nothing radiographically to show that JFK had a serious back problem, nor anything in his examinations that led experts to believe his problem was related to a disc herniation. Because these authors also believe that Kennedy's problems started out as (and I quote) "MECHANICAL LOW BACK PAIN," it's nothing less than shameful that CHIROPRACTIC CARE was never tried (there is no historic record of such, nor have I seen anything about Dr. Kraus doing any spinal manipulations).
No matter what your political bent or opinion of him as a leader, Kennedy's ability to continually move forward in the face of incredible pain and dysfunction is nothing short of miraculous. To read the entire paper by T. Glenn Pait, MD, and Justin T. Dowdy, MD, simply go HERE.
CORTICOSTEROIDS AND YOUR CHRONIC PAIN
"Long-term corticosteroid use may be associated with more serious sequel, including osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations." The conclusions of a study from a 2001 issue of the Journal of Clinical Gastroenterology (Side Effects of Corticosteroid Therapy)
"Medications like dexamethasone, methylprednisolone and prednisone have a long list of serious side effects. They include fluid retention, hypertension, headache, increased susceptibility to infection, muscle weakness, diabetes, osteoporosis, tendon rupture, glaucoma, cataracts and ulcers. Psychological reactions such as anxiety, irritability, mood swings, insomnia, confusion and psychosis are disorienting at best and disabling at worst. Many physicians have been led to believe that a week or two of a drug like prednisone poses very little risk. That is why they are often quite reassuring to patients who may worry about corticosteroid side effects. A new study reveals that even short-term steroid use can trigger dangerous side effects." From a May 2017 episode of the People's Pharmacy
When you understand how corticosteroids work, and then look at the research, you might find it surprising just how commonly these drugs are prescribed. What's truly amazing is that while many physicians continue to use corticosteroids (Cortisone and similar) in the same way they've been using them for the past three decades, a large and growing part of the medical community has been sounding the alarm. One of the best examples of this came from MY PATHOLOGY TEXTBOOK (written by physicians from the University of Texas and University of North Carolina). These renowned pathologists were raising the Jolly Roger concerning corticosteroids thirty years ago. And they weren't the only ones --- not by a long shot.
I've not only shown you how (and why) much of what's found in the biomedical peer-review cannot be trusted (HERE), I've shown you that in similar fashion to numerous other medical arenas (HERE are a few of them), corticosteroids are not being used according to medical guidelines (HERE). While many people --- especially short term users --- will get away with this, there is frequently a price to be paid. Why? Simply because corticosteroids, while unarguably having potent anti-inflammation qualities, also happen to destroy / deteriorate collagen-based tissue (bone, cartilage, FASCIA, TENDONS, ligaments, muscle, etc, etc). In other words, using corticosteroids essentially means that you are trading tomorrow for today ---- short term relief for long-term degeneration and dysfunction. Although a book could easily be written on the subject, allow me to give you a small taste of what I'm talking about.
There are several important points to grasp before getting into the meat of today's post. Firstly is that although they are endocrinologically related, do not confuse CORTICOSTEROIDS (potent anti-inflammatories such as cortisone and prednisone) with anabolic steroids --- muscle building drugs that can help make strength athletes and bodybuilders huge. Secondly, as you read about the side effects, never forget that hundreds of studies on Adverse Events (AE's --- the medical word for side effects) have shown that on average, they are reported to the proper authorities only about 1% of the time (HERE, HERE, and HERE). What this does is give most pharmaceutical drugs safety profiles that are not nearly as good in the real world as is touted in the individual studies you'll see below. Thirdly, be aware that there are NUMEROUS WAYS that Big Pharma is cooking their books in order to make their products look better (the chief one being not publishing research that shows their products in a negative light --- see link). And fourthly, it is shocking how many studies --- particularly older studies --- did not look at side effects as a matter of course. In many cases, if researchers were not specifically studying side effects, they were not dealt with or mentioned in the study's results.
- CORTICOSTEROIDS AFFECT YOUR WOUND-HEALING CAPABILITIES: An editorial in the journal Wounds (Corticosteroids and Wound Healing) revealed that anything over 10 days is considered "long term" corticosteroid use. The same study concluded that, "It has been found that corticosteroids influence all phases of wound healing". This means that if you were taking steroids for that WHIPLASH INJURY your were in three months ago, you essentially affected ALL FOUR PHASES of the healing process. The author went on to say that, "The chronic treatment with corticosteroids presents different hazards for wound healing. Chronic corticosteroid use is defined as taking the drug at doses of greater than 10 mg/kg of body weight for more than 1 week. Patients treated for 30 days prior to wounding or an operative procedure were reported to have had a 2-fold increase in wound infection, 2 to 3 times higher incidence of wound dehiscence [a surgical complication in which a wound ruptures along a surgical incision], and a 4 times greater mortality compared to those not taking steroids for that period of time. In another study, rheumatoid arthritis patients taking corticosteroids and having joint replacement surgery had a significantly higher incidence of delayed wound healing if they had taken the steroids for more than 3 years compared to those who had taken the drug for less than 3 years. Obviously, chronic corticosteroid therapy will present a problem with wound healing."
- SHORT-TERM CORTICOSTEROID USE CAN CAUSE SERIOUS HEALTH ISSUES: For decades, physicians have been telling patients that while it's true that long-term corticosteroid use is problematic, short term use is no big deal --- it's safe. That is until a study published in March's issue of the British Medical Journal (Short Term Use of Oral Corticosteroids and Related Harms Among Adults in the United States) looked at over 1.5 million individuals both before and after starting a month or less of oral steroids. The authors concluded that things like fractures, blood clots, and infections, carried an "increased risk of adverse events. Corticosteroids are also used often in the short term to treat many other prevalent conditions where evidence is lacking, such as non-specific musculoskeletal pain and rashes. Incidence rates of sepsis, venous thromboembolism, and fracture were statistically significantly higher in short term users of oral corticosteroid than in non-users. The incidence was approximately 7% for short term oral corticosteroid use....." What that means, folks, is that about 1 in 11 of you taking short term steroids are going to have something bad happen.
- PEOPLE WILL KNOW YOU ARE ON STEROIDS: One of the most common side effects of corticosteroids is water retention, which occurs all over, but most noticeably in the face. People on corticosteroids frequently end up with what's known as "moon face" to go along with the weight gain that you will see in another bullet point".
- CORTICOSTEROIDS AND BONE LOSS / OSTEOPOROSIS: One of the more well known side effects of taking corticosteroids is OSTEOPOROSIS. A study from Clinical Endocrinology, published clear back in 1989 (Pathogenisis and Treatment of Steroid Osteoporosis) concluded that, "Prospective studies of bone mass during steroid treatment confirm that these drugs do cause progressive bone loss. Comparable studies in asthmatic patients have found dose-related losses of peripheral trabecular bone of between 1 and 7% per annum. The first line of prophylaxis against this potentially disabling side-effect of glucocorticoid therapy [osteoporosis] must remain the use of the lowest steroid dose for the shortest possible period." The April issue of the Journal of Allergy and Clinical Immunology (Oral Corticosteroid Exposure and Adverse Effects in Asthmatic Patients) confirmed this when they stated, "Although previous research has documented the deleterious effect of continuous oral corticosteroid exposure in patients with severe asthma, our results suggest that each oral corticosteroid prescription might result in a cumulative burden on current and future health regardless of dose and duration." There are hundreds of similar studies, each one scarier than the one before it.
- CORTICOSTEROIDS AND INFECTIONS: I am not going to spend any time on this bullet because there are hundreds of studies on the topic. Suffice it to say that when you suppress the immune system, infections of all kind increase dramatically.
- CORTICOSTEROIDS SERIOUSLY AND ADVERSELY AFFECT THE BRAIN: I was all of 14 years old when the Archives of General Psychiatry published Side Effects of Corticosteroid Therapy Psychiatric Aspects ---- back in 1981. Listen to their freaky conclusions. "Euphoria, depression, and psychotic reactions are the common manifestations of corticosteroidinduced mental disturbances; females seem to be more prone to these disturbances than male. At present there are no simple models to explain the psychotic reactions, anxiety, or agitation seen in corticosteroid-induced mental disturbances." In 2006, the Mayo Clinic published a paper called Psychiatric Adverse Effects of Corticosteroids in which they stated, "Corticosteroids have become the cornerstone of therapy for many neurologic, respiratory, gastrointestinal, renal, endocrine, hematologic, neoplastic, rheumatologic, dermatologic, ophthalmic, and allergic conditions. More than 10 million new corticosteroid prescriptions are filled each year, with up to 0.9% of the general population and as many as 7% of hospitalized patients receiving oral corticosteroid therapy at any given point. The most frequently identified symptoms include agitation, anxiety, distractibility, fear, hypomania, indifference, insomnia, irritability, lethargy, labile mood, pressured speech, restlessness, and tearfulness. The most commonly reported corticosteroid-induced psychiatric disturbances are affective, including mania, depression, or mixed states. Most often, patients receiving short-term corticosteroid therapy present with euphoria or hypomania, whereas long-term therapy tends to engender depressive symptoms. Although mood disorders occur in the vast majority of cases, either delirium or frank psychosis, typified by hallucinations, delusions, and disorganized thought, is the presenting syndrome in a sixth of patients. Severe episodes of depression, mania, or psychosis frequently include suicidal ideation."
- ELBOW TENDINITIS / TENDINOSIS (EPICONDYLITIS) AND CORTICOSTEROIDS: Back in 2013, one of the publications of the British Medical Journal (BMJ Open) did a systematic review on the subject, concluding that, "Corticosteroid injection gave a short-term reduction in pain versus no intervention or non-steroidal anti-inflammatory drugs. At intermediate follow-up, we found an increase in pain, reduction in grip strength, and negative effect on overall improvement. Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term." Why might this be? It's why even when cortisone shots relieve your pain, your doctor will tell you you can't have very many. Earlier this month, the International Journal of Applied and Basic Medical Research published a study (Autologous Platelet-Rich Plasma Versus Corticosteroid in the Management of Elbow Epicondylitis) that essentially confirmed these findings and went a step further, providing information on an alternative. "Epicondylitis is the most common problem of the elbow in the age group between 35 and 54 years. Histologic specimens from chronic cases confirm that tendinitis is not an acute inflammatory condition but rather a failure of the normal tendon repair mechanism associated with angiofibroblastic degeneration. Tendon regeneration may be improved by injecting autologous growth factors obtained from the patient's own blood. Autologous growth factors can be injected with autologous whole blood or platelet-rich plasma (PRP)." Although I am intrigued by PRP INJECTIONS, I have not really seen it work in many people. For more information on elbow pain, read about how to effectively deal with LATERAL EPICONDYLITIS (Tennis Elbow) or MEDIAL EPICONDYLITIS (Golfer's Elbow).
- CORTICOSTEROIDS FOR PLANTAR FASCIITIS: For those of you who have struggled with it, you already know that PLANTAR FASCIITIS can be debilitating. For as long as I've been in practice, the number one treatment for those going to doctors / podiatrists for PF is whatever else, along with a corticosteroid injection. Not only does this dramatically increase your chance of a very nasty and long-healing injury (ruptured Achilles tendon), but according to the gold-standard of medical reviews it doesn't work well either. After looking at 39 studies on the topic, the COCHRANE REVIEW (Injected Corticosteroids for Treating Plantar Heel Pain in Adults) concluded that, "We found low quality evidence that local steroid injections compared with placebo or no treatment may slightly reduce heel pain up to one month but not subsequently."
- CORTICOSTEROIDS AND CARPAL TUNNEL SYNDROME: In a study that recommended corticosteroids for CARPAL TUNNEL SYNDROME (Carpal Tunnel Syndrome: Initial Management and the Treatment of Recalcitrant Patients) from the February issue of Instructional Course Lectures, the authors showed what many before them have shown. The Carpal Tunnel Surgery many times does not work. "Patients with recurrent symptoms often have perineural fibrosis that tethers the median nerve." Did I see the word "TETHERS"? After invoking Carpal Tunnel Syndrome, last November's issue of Seminars in Radiology (Injectable Corticosteroids: Take Precautions and Use Caution) stated, "Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects." In other words, you probably won't die, but these drugs are associated with a ton of side effects, both at the spot of injection and throughout your body.
- GLUCOCORTICODS (CORTICOSTEROIDS) AND RHEUMATOID ARTHRITIS: RA is an autoimmune disease where one's own immune system attacks its own joint cartilage. In yet another meta analysis by Cochrane (Glucocorticoids for Rheumatoid Arthritis), the authors showed that even though the steroids slowed down the erosive progression of the disease over the first two years, "Harms were not reviewed. There remains concern about potential long-term adverse reactions to glucocorticoid therapy, such as increased cardiovascular risk". It seems strange to me that the mighty Cochrane did a review without taking into account side effects. However, many other studies I found specifically talked about Rheumatoid because so many people struggling with this disease are on steroids for the duration.
- CORTICOSTERODS FOR HEAD INJURES: AHC Media published an article by ER physician and professor, Stephanie Abbuhl, called Steroid Infusion May Be Harmful in Acute Head Injury. After looking at a study from Lancet that oversaw 10,000 head injury cases that were either given steroids or placebo after serious head injuries, she stated, "The risk of death from all causes within two weeks was higher in the group allocated corticosteroids when compared with the placebo group." She went on to reveal why this is important. "The authors report that a 1995 survey showed that 64% of trauma centers in the United States used corticosteroids more than half the time in the intensive care management of head injury patients. Although controversial, the standard of care has been to treat acute blunt spinal cord injury with methylprednisolone since the National Acute Spinal Cord Injury Studies showed slight neurologic improvement with this treatment..."
- CORTICOSTEROIDS FOR COMPLICATIONS OF THE FLU: Despite getting their ANNUAL FLU SHOTS (and despite any real evidence these work), some people --- particularly the elderly or those who are immunocompromised --- end up in the hospital with complications (HERE). A recent Cochrane Review on the subject stated, "These patients are often prescribed steroids as part of their treatment, although the evidence that steroids are beneficial in these circumstances is controversial. We found that patients with influenza who received additional steroid treatment might have had a greater risk of death compared to patients who did not receive steroid treatment. Hospital-acquired infection was the main 'side effect." Think about why this would be. Corticosteroids are powerful immune system suppressors.
- CORTICOSTEROID INJECTIONS IN THE SOFT TISSUES: After looking at hundreds of studies going back into the mid fifties, a huge review in a 2010 issue of BMC Musculoskeletal Disorders (Adverse Effects of Extra-Articular Corticosteroid Injections: A Systematic Review) concluded that, "The local effects consisted of local pain, degeneration, atrophy and change in skin colour, local infection, impact on collagen metabolism expressed as tendon ruptures, and perilymphatic atrophy." The overall rate of these side effects was reported to be about 6%.
- CORTICOSTEROIDS FOR TRIGGER POINTS: Although this has been popular for years, once you understand what TRIGGER POINTS are and how DRY NEEDLING works, you'll start to realize that corticosteroids are not the best option --- especially in light of the previous bullet point.
- CORTICOSTEROIDS FOR BACK PROBLEMS: A two month old study published in the Annals of Internal Medicine (Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy) looked at the effects of corticosteroid injections on disc herniations. Despite this being the "go to" therapy, we saw the same theme we've seen over and over again. Short term relief without long-term benefit. "In chronic LBP associated with active discopathy, a single glucocorticoid inter-discal injection reduces LBP at 1 month but not at 12 months." The April issue of the Archives of Physical Medicine and Rehabilitation (Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis) concluded that when it comes to SPINAL STENOSIS, "For lumbar spinal stenosis symptoms, epidural injections of corticosteroid plus lidocaine offered no benefits from 6 weeks to 12 months beyond that of injections of lidocaine alone in terms of self-reported pain and function or reduction in use of opioids and spine surgery. Repeated injections of either type offered no additional long-term benefit if injections in the first 6 weeks did not improve pain." When it comes to disc problems (DEGENERATIVE DISCS or HERNIATED DISCS) causing CHRONIC LOW BACK PAIN, steroid shots have always been the treatment-of-choice. The April issue of the Annals of Internal Medicine (Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy) came to similar conclusions. "In chronic LBP associated with active discopathy, a single glucocorticoid intradiscal injection reduces LBP at 1 month but not at 12 months." Yet again, short term relief is traded for long-term degeneration. By the way, the previous link shows you what it takes to address these and other back issues on your own.
- CORTICOSTEROIDS AND TRIGGER FINGERS: Trigger fingers are common as hardworking people get older. A study from this month's issue of the Journal of Hand Surgery: European Volume (Evidence-Based Management of Adult Trigger Digits) concluded that, "when compared with surgery, there is strong evidence that corticosteroid injection is associated with increased rates of ongoing or recurrent symptoms at 6 months after intervention."
- CORTICOSTEROIDS FOR HIP PROBLEMS: While this has been the standard of care for decades, should it be in light of what we know? The April issue of the Journal of Sports and Physical Therapy (Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome) removes any doubt. "Greater trochanteric pain syndrome (GTPS) is the current terminology for what was once called greater trochanteric or subgluteal bursitis. Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN. Our data suggest that DN is a noninferior treatment alternative to cortisone injections. Cortisone (corticosteroid) injection into the lateral hip has traditionally been the accepted treatment for this condition; however, the effectiveness of injecting the bursa with steroids is increasingly being questioned."
- CORTICOSTEROIDS FOR AUTOIMMUNE DISEASES IN GENERAL: Remember that I showed you how these drugs work? They induce immune system suppression, thereby suppressing inflammation which is part of the normal immune system response. At least in theory, this can help slow down the runaway train that is AUTOIMMUNITY. Almost two decades ago, the Australian Prescriber (Corticosteroids in Autoimmune Diseases) gave a great explanation of how these drugs work, along with an important caveat. "How do corticosteroids act in autoimmunity? Corticosteroids induce a transient lymphocytopenia by altering lymphocyte recirculation. They also induce lymphocyte death. The most important immunosuppressive effect of corticosteroids is on T cell activation, by inhibition of cytokine and effect or molecule production. Hazards associated with such therapy are reduced resistance to infection, especially bacterial, and relapse of latent infection such as Herpes simplex and zoster, as well as Pneumocystis carinii and Helicobacter pylori. There is also a risk of acute myocardial ischaemia in pre-disposed patients. Patients on steroids are at increased risk of infection, and symptoms such as fever and pain may be masked by the steroids. Bacterial infections, such as urinary and respiratory infections, are the most common. Corticosteroids accelerate bone loss. Other major adverse effects are aseptic necrosis of bone, psychosis, sleep disturbance, skin fragility and poor wound healing. The eyes should be checked for glaucoma and cataracts." In the same way that testicles shrink when men take anabolic steroids (because they are taking large amounts of exogenous testosterone-like hormones their testicles' thermostat-like feedback loop tells their body they already have plenty, thereby shutting down endogenous production), the parts of the brain that make glucocorticoids / corticosteroids (THE HPA-AXIS), shut down endogenous production as well, which the authors of this paper spoke about. "Inhibition of the hypothalamic-pituitary-adrenal axis may lead to adrenal insufficiency when steroids are ceased after long-term use." It's easy to find numerous similar studies / warnings from today.
- CORTICOSTEROIDS AND INSULIN RESISTANCE / TYPE II DIABETES: I have shown you that over half the adult American population is believed to have INSULIN RESISTANCE and / or PREDIABETES, with over 10% of the population --- including increasing numbers of teens --- having full-blown DIABETES. Although there are a mountain of studies linking corticosteroids to one's propensity to develop Type II Diabetes, I am going to leave you with a very brief overview from Diabetes.co.uk (Corticosteroids and Diabetes). "Use of corticosteroids to treat inflammation can lead to higher than normal blood glucose levels and, in longer term usage may lead to type 2 diabetes developing. One of the side effects of oral corticosteroids is that they can increase blood glucose levels and increase insulin resistance, which can lead to type 2 diabetes. Being on steroids for a longer period of time, over 3 months, may also increase your risk of type 2 diabetes." Some studies also talked about these steroids increasing the incidence of the various features that characterize PCOS, including hirsutism (women become hairy). PCOS is intimately related to diabetes.
- CORTICOSTEROIDS AND ASTHMA: Because ASTHMA is yet another of the inflammatory diseases that is skyrocketing in incidence with no end in site, there are lots of studies on this topic as well. I'll show you one from a 2006 issue of the Respiratory Medicine Journal (Systemic Side Effects of Inhaled Corticosteroids in Patients with Asthma). After telling us that, "the presence of chronic inflammation in the airways leads to an increase in recurrent episodes of wheezing, breathlessness, chest tightness, and coughing," the authors provided a list of some of the potential side effects of steroids, giving well-documented bibliography for each point. "Pharyngitis [sore throat], suppressed HPA-axis function, dysphonia [chronic horseness], adrenal crisis [HERE] cough, suppressed growth velocity in children, bronchospasm, decreased lower-leg length in children, oropharyngeal candidiasis [YEAST INFECTION of the mouth and throat], reduced bone mineral density / bone fractures / osteoporosis [HERE], skin thinning, skin bruising, cataracts, glaucoma." Another study I found talked about increased incidence of ACNE as well as many others. Notice also that the drugs are causing many of the very problems they are supposed to be helping -- a common theme with many medications. Speaking of acne.....
- CORTICOSTEROIDS FOR SKIN CONDITIONS: A study from April's issue of the Journal of Dermatology (High Rate of Systemic Corticosteroid Prescription Among Outpatient Visits for Psoriasis) provided a microcosm of the entire problem, and not just related to skin conditions. "The use of systemic corticosteroids for the treatment of psoriasis is not recommended according to textbooks and guidelines. In clinical practice, however, many physicians frequently prescribe SC for patients with psoriasis." This is why I have said repeatedly that when it comes to MEDICAL GUIDELINES, it seems that many are not being followed, and way too many drugs are being prescribed "OFF LABEL". MY BROTHER, an ER physician, has told me on more than one occasion that using corticosteroid creams is a slippery slope that rarely solves the problem, instead, often leading to the need for more steroid cream. You can read online that this has become an epidemic in some nations. You can also see this same phenomenon when using steroid nasal sprays such as Flonase.
- CORTICOSTEROIDS FOR YOUR DOG: Because there was so much information on the subject, and because our physiology is similar, I am going to include a list of side effects provided by veterinarian Earnest Ward (Steroid Treatment - Long-Term Effects in Dogs) concerning MAN'S BEST FRIEND. "Urinary Tract Infections (UTI), thin skin, blackheads, and a poor or thin hair coat, poor wound healing ability, obesity, muscle weakness secondary to protein catabolism (breakdown), development of hard plaques or spots on the skin called calcinosis cutis, calcium deposition in the skin, increased susceptibility to opportunistic or secondary bacterial infections, increased susceptibility to fungal infections, development of adult onset demodectic mange, diabetes mellitus." Honestly, it's pretty much what we've seen so far in people.
- OTHER SIDE EFFECTS OF CORTICOSTEROIDS: An article by Kenneth Sagg and Daniel Furst (both MD's) called Major Side Effects of Systemic Glucocorticoids is a great source for doing more research because they keep an up to date database of studies on the various side effects of these drugs (HERE). When you start suppressing the immune system, it's like opening Pandora's Box --- especially when you throw the this class of drugs ability to degenerate and deteriorate COLLAGEN-BASED TISSUES.
Fortunately, there are any number of ways to address inflammation naturally. The good thing is that I've created a generic template that will help many of you --- not all, but many --- solve your inflammation without dangerous drugs. HERE it is. My gift to you, completely free. An EXIT STRATEGY if you will Not necessarily easy, but simple. Take a look at it and get started today!
DEALING WITH CHRONIC PAIN OR CHRONIC ILLNESS?
TREAT IT SYSTEMICALLY
- THE AVERAGE AMERICAN IS SEDENTARY: Face it, the average American is not being regularly active in any meaningful sense of the word. Even if they are constantly "busy," they are frequently not active. In light of the peer-reviewed scientific literature, the body needs movement to function on a high level. Not necessarily a huge amount of movement, but movement nonetheless. A sedentary lifestyle will seriously inhibit your ability to solve your problem, no matter what your problem may be (HERE & HERE are examples having to do with CHRONIC PAIN).
- THE AVERAGE AMERICAN IS INFLAMED: Even in those who don't yet show the signs of overt disease or pain, INFLAMMATION is almost assured since it is virtually synonymous with being American. We are literally an "INFLAMMATION NATION". For the record, OVERWEIGHT / OBESITY is an inflammatory disease that affects almost 70% of our population. Another 10% are METABOLICALLY OBESE even though they fit nicely onto a height / weight chart. While a certain amount of ACUTE INFLAMMATION is needed for the body to heal properly, SYSTEMIC INFLAMMATION can be a deal-breaker for getting out of pain and solving your chronic problem(s).
Unfortunately, too many people are let off the hook by their doctors. They're told that their HIGH CHOLESTEROL is genetic (when it's actually EPIGENETIC). They're told that their problem is "ARTHRITIS" and that their joints are just worn away to nothing --- almost time for that REPLACEMENT. They're told that no one has any idea why they have FIBROMYALGIA and that beyond covering symptoms, there's nothing they can do. They're told that AUTOIMMUNE DISEASES are just an unfortunate luck of the draw for some people; no rhyme, reason, or solution. They're even told that deadly inflammatory diseases such as CANCER are nothing more than blind, random chance (HERE). Chalk it all up to bad luck and bad genes.
The result of all this? That's easy --- drugs. Even though the United States contains less than 5% of the world's population, our own government admits that we consume 75% of the world's medication (HERE). I see so many people on "THE BIG FIVE" it makes my head spin. Becoming a "DRUG CULTURE" has provided an easy way out for us. We never really have to take responsability for our own health because we pay others to do that for us --- that's our doctor's job. Unfortunately, the medications never really work over the long haul, and thanks to our "no fault" society, we can always find someone or something to blame for our collective plights. I want to show you a better way --- a way that actually addresses underlying causes of pain and inflammation, shutting it down at the source.
It's why I suggest that if you are dealing with any sort of pain syndrome, it's helpful to treat it as though it were a systemic problem, probably because often times it is (HERE, HERE, or HERE). Don't get me wrong; I'm happy to see you and help you find your way out of the ditch you are in --- usually with way less time and expense than anyone else suggests is possible (HERE). What I want to see, however, is you (that would be "you" as in you) take some personal responsibility. Frankly, I don't want to see you over and over again for the same old problem(s), simply because you won't take the initiative to start addressing them on your own. What do I mean by 'addressing them on your own'? Hang tight for ten more seconds.
If you are one of those people who has struggled with any sort of chronic health or pain issue, by all means, come and see me --- if I tell you I can help you I probably can (HERE). However, if you want to break away from the endless stream of doctor visits, get off the MEDICAL MERRY-GO-ROUND, and start taking your life back, you'll have to take some action steps. I promise I've helped people worse off than you are (HERE). And here's the thing; I've even provided you a blueprint for getting started completely free of charge. HERE is the brand new revamped version. The truth is, if you don't treat your pain / problem systemically, it may be tough to really get better (HERE is a person who took this message to heart).
THINKING ABOUT A TRIP TO MOUNTAIN VIEW TO SEE
DR. SCHIERLING FOR YOUR CHRONIC PAIN ISSUES?
IT MIGHT BE A GAME CHANGER
Because of the specialized work we do here in Mountain View, I see lots of people who come quite a distance to see me (HERE). As much as I would love to tell you that I help all of them, that would be untrue. But I'm able to help a lot of them (HERE). And even if I am not able to help them like they wanted, my goal is always to be a game-changer with my patients in as many ways as possible.
When you come see me, whether you're coming from here in town, West Plains, SPRINGFIELD, or distant states or other countries, I'm all about helping you find a solution for your problem. Although my specialized work with FASCIA-BASED chronic pain syndromes (HERE are some of them) is usually what compels people to come from long distances to see me, my ultimate goal is always that you leave here with information that allows you to begin addressing some of your own problems on a higher level. Whether you have CHRONIC ILLNESSES, AUTOIMMUNE DISEASES, or CHRONIC PAIN, you'll get something you can take home with you and start the process of fixing yourself (HERE is my online office handout I currently use with patients).
Despite the insane flooding that's been going on in our region (HERE), the roads should be open to head to St. Louis this evening with my son so that we can attend a 16 hour seminar put on by FUNCTIONAL NEUROLOGIST, Thomas Culleton on FUNCTIONAL ENDOCRINOLOGY --- another of the many developed by arguably the most brilliant physician on the planet, DATIS KHARAZZIAN. It's going to cost me.
It's going to cost me some time (a Spring weekend of being indoors in gorgeous weather). There will be a number of travel and meal expenses as well. And as you might imagine, the seminar itself was not inexpensive (it's the price you pay to hear elite speakers presenting cutting-edge material). But I'm really looking forward to going because I know I'll come away with "game-changing" information and treatment methods. Bottom line, it's not uncommon for me to do this sort of thing --- to travel to wherever I need to travel to if I feel the payoff in patient results will be worth it in the end. If I feel it can help me become a game-changer.
Some of you are wondering if coming to see me might be worth the trip. The first step in that process is sending me an email with a brief history of your problem (HERE). If I think you have a problem I might be able to help you with, I will tell you. Don't be upset if I tell you I can't (HERE). Here's the best thing about the whole process. If I believe I can help and you come to see me, you will know in a treatment if that is the case. No tricks. No bait-and-switch. No up-selling. No long and drawn out treatment schedules. No "but it's the worst case I've ever seen". In a word, no games. In fact, HERE is what a first visit looks like, and HERE is what it costs. Easy and inexpensive.
If you want to see what makes me different, all you have to do is look at THIS SHORT POST or watch a few of our hundreds of VIDEO TESTIMONIALS. And for those of you struggling with who-knows-what kinds of health-related problems or chronic pain, THIS PAGE is for you. All free of charge of course. It's time for you to get off the fence, take matters into your own hands, and start taking your life back. If I can be a game-changer for you, I consider it a privilege.
UPPER CROSSED SYNDROME
WHAT IS IT, WHAT CAUSES IT, WHAT DOES IT LOOK
LIKE, AND HOW TO EFFECTIVELY ADDRESS IT
As seen by the pictures above, Upper Crossed Syndrome is where the chest muscles (pectorals) and rear neck muscles (upper traps, LEVATOR SCAPULAE, suboccipitals, and SCM, which in this context is considered a rear or at least a lateral neck muscle) are overly tight, while the upper back muscles (rhomboids, lower trapezius) and front neck muscles (PLATYSMA, SCALENES) are weak (or at least inhibited in their firing). According to Janda's book Assessment and Treatment of Muscle Imbalance: The Janda Approach (as paraphrased by the group officially carrying on his work --- The Janda Group at Muscle Imbalances dot com), Upper Crossed Syndrome leads to.....
"Dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration (Janda 1988)."
Follow along as I show you why this is bad stuff, as well as how to start dealing with it on your own.
WHAT DOES UPPER CROSSED SYNDROME LOOK LIKE?
- HUMPBACK: This, folks, is a no-brainer. If you have overly tight chest muscles pulling you forward and weak upper back muscles failing to resist their pull, you will be pulled forward. In other words, you'll eventually end up battling FHP's evil twin, "Hunchback" (I often times refer to this as "THE POSTURE OF AGE"). Sometimes these folks will actually have a normal-appearing (or even hyperlordotic neck) from holding their head up as the whole mess slides anteriorly (forward). After looking at thousands upon thousands of X-rays of the neck in profile (lateral cervical spine), over the course of twenty five years, all I can say is that cervical lordosis is rare. What's common is that humpback and FHP are seen together, pulling people further and further forward, self-perpetuating the problem.
- VARIOUS KINDS OF SCAPULAR ABNORMALITIES: When you see winged scapulas or abnormal scapular positions of almost any kind, start to suspect Upper Crossed Syndrome.
- CHRONIC PAIN: Remember what I showed you several months ago (HERE) --- that postural abnormalities over time are one of the many ways to create SCAR TISSUE / FASCIAL ADHESIONS / FIBROSIS / DENSIFCATION, or whatever else you choose to call it? Upper Crossed Syndrome also happens to be one of the prime factors in developing TRIGGER POINTS in the area of the upper back, pec minor, SCM, and levator --- none are worse than the levator (see earlier link on the levator). Add Scar Tissue with Trigger Points and you have the "Myofascial Syndrome". Thus, it is common to see people with Upper Crossed Syndrome dealing with HEADACHES, CHRONIC NECK PAIN, and various forms of RADICULOPATHY, including THORACIC OUTLET SYNDROME.
WHAT CAUSES UPPER CROSSED SYNDROME?
- SITTING COMBINED WITH POOR POSTURE: Sitting itself is bad enough, but combine it with a slumped posture, and you are setting the table for future problems. In our age of computers, sedentary lifestyles, texting, etc, etc, this problem continues to grow.
- ABERRANT TRAINING PATTERNS AND REPETITIVE SPORTS: Unfortunately, I find that when it comes to physical training and activity, way too many people are doing things wrong. Often times darn drastically wrong. Allow me to give you a prime example. I never used to see serious shoulder problems in high school volleyballers. Now they're common. Young teens (and even adolescents) serving and spiking who-knows-how-many-times, at least five, often six, and sometimes seven times a week. With the advent of longer seasons, summertime "open gym" sessions, and JO's (Junior Olympics), these girls are going through what amounts to a pitching motion, hundreds upon hundreds of times a week. This is interesting in light of the fact that big league pitchers are on a five-day rotation, usually with a pitch-count limit of 100 or so, and after pitching, have the arm encased in ice and do all sorts of therapy until they pitch again.
- LARGE BUSTS: Large breasts have a tendency to pull women into a slumped or rounded-shoulder posture. My experience is that there comes a point where reduction may be necessary to achieve any sort of lasting relief. I can say that of my patients who have gone through reductions, I have yet to see one who regrets it.
EFFECTIVELY DEALING WITH UPPER CROSSED SYNDROME
What this tends to do --- especially in the upper body --- is cause a head-forward, shoulders-rounded, bent-forward, slumped sort of posture. This is why when it comes to dealing with Upper Crossed Syndrome, I'm a fan of focusing on posterior chain muscles, while limiting presses (benches / military) and doing a lot of EXTENSION TYPE WORK; as much on a ball as possible. Just remember, however, that exercises are not necessarily the best starting point. When it comes to solving this problem.......
- STUDY AND CREATE A WRITTEN PLAN --- AN EXIT STRATEGY IF YOU WILL: There are so many articles and YouTube videos on the subject that while you may not be an "expert" with just a few hours of study, you'll start seeing the bigger picture. EXIT STRATEGIES work, and like they say --- failure to plan is planning to fail.
- DEAL WITH UNDERLYING SCAR TISSUE AND SUBLUXATION: Contrary to what most practitioners (PT or DC) say, this does not mean starting with lots of exercises (HERE) or adjustments (HERE) respectively. What it does mean is that you may need to deal with the effects of Scar Tissue (see earlier links) if it is present. Why is this important? Scar Tissue has a TETHERING effect that limits normal ranges of motion. Loss of motion, or abnormal motion patterns sooner or later lead to pain. But unfortunately, pain is not where this little shindig ends. The end product of Upper Crossed Syndrome is always the degeneration I spoke of earlier.
- TREAT THE PROBLEM AS THOUGH IT WERE SYSTEMIC: Look; I'm not going to tell you that changing your diet, giving up the SMOKES, taking care of your GUT, and starting an exercise program are automatically going to "cure" your Upper Crossed Syndrome. However, if you can effectively and naturally deal with INFLAMMATION --- particularly SYSTEMIC INFLAMMATION --- you are better off. This is a cold, hard fact that is always true 100% of the time.
- STRETCHES AND EXERCISES: I'm not going to give you tons and tons of specifics here as there are many other sites that have done a far better job than I. I will, however, give you some tidbits to chew on. For starters, before starting, make sure you understand LOWER CROSSED SYNDROME and it's relationship to CORE STRENGTH. I also suggest you learn to do what I call the Chicken Head Move. Huh?
- CHICKEN HEAD MOVE (CHIN TUCK) WITH SCAPULAR RETRACTION: Growing up on a Kansas farm, I've seen plenty of chickens bobbing their heads back and forth as they move. When you do a Chin Tuck, tip your chin slightly downward (I did say slightly). Now take your chin in your hand and move it forwards and backwards CHICKEN HEAD STYLE. Ultimately, what you want to do here is be able to control the muscles that allow you to tuck your chin back as far as you can get it. Then retract your scapulas --- pull your shoulder blades back towards each other. Practice this and make it your go-to posture for dealing with Upper Crossed.
- OTHERS: Frankly, there are so many cool exercises and stretches for Upper Crossed Syndrome that I could write a book. Again, search the web. In the meantime, I included a little slide show of some of the exercises and stretches that might be of benefit (yes, I realize that some of these will need to be modified for the average person). And because there is so much overlap, make sure to at least look at the exercises and stretches used for people with Lower Crossed Syndrome.
LOWER CROSSED SYNDROME
WHAT IS IT, WHY IS IT A PROBLEM, AND HOW SHOULD YOU BE ADDRESSING IT?
If you look at the pics at the top of the page (particularly the kneeling skeleton), you'll notice that the pattern of Lower Crossed Syndrome takes the shape of an "X" --- overly-tight HIP FLEXORS and THORACOLUMBAR MUSCULATURE, with weak BUTTOCKS and ABDOMINAL MUSCLES. What does this do? It creates massive amounts of mechanical stress in the low back that can be clearly seen in these side-by-side TEN SECOND VIDEOS of Adhesed Thoracolumbar Fascia as well as in the DEGENERATIVE CHANGES that follow. It also sets people up for CHRONIC SACROILLIAC PROBLEMS or even issues of the hip rotator cuff (particularly the PIRIFORMIS MUSCLE). Beyond that, it contributes to a weak core (remember that the core is not simply your superficial abdominal muscles). While this is all great to know, the real questions are what does it look like clinically, what caused it in the first place, and what can you do to address it? Let's look at these questions one at a time.
WHAT CAUSES LOWER CROSSED SYNDROME?
- YOU ARE INACTIVE: Unfortunately, in our modern electronic society, this problem is not getting better. As you'll see shortly, not only is activity critical for preventing or reversing Lower Crossed Syndrome, but it needs to be the proper sort of activity. Repeating the wrong sorts of movements over and over again can sometimes be as bad as inactivity. Sort of like repeatedly trying to drive a bent nail --- you straighten it out but every time you hit it, it bends again.
- YOU HAVE BAD POSTURE: While sometimes this is a chicken and egg sort of thing (for instance, some people have genetic predispositions toward things like 'sway back' or horrendously pronated / supinated ankles) mostly it's laziness and lack of effort. I spend a lot of time telling young people that their POOR POSTURE will end up haunting them as they get older. Are they listening? Some do and some don't.
- YOU SIT TOO MUCH: This is not surprising considering the insane amount of research that's come out in the past decades on the detriments of sitting. Sick around and I'll show you some simple remedies for this that you can do throughout the day (for instance, 'The Founder'). Sitting is another reason that EXTENSION THERAPY can be such a huge benefit.
- SPORTS AND TRAINING: I already see the indignation on some people's faces and hear it in their voices. How in the world can sports (lots and lots of activity) cause problems if too little activity is one of the reasons people get Lower Crossed Syndrome? By their very nature, most sports tend to be very repetitive, as are their training regimens. GET INTO A RUT and you essentially spend all your time straightening and re-driving the bent nail I talked about in the first bullet --- over and over and over again. This is why poor technique and imbalanced training (for instance, neglecting core strength or doing THE WRONG KIND of training) bends the nail even further, making it impossible to ever drive it into the board. It may look OK on the surface, but for all intents and purposes, it's not functional.
- OTHERS: There are certainly others so just remember that this list is not exhaustive.
WHAT DOES LOWER CROSSED SYNDROME LOOK LIKE?
WHAT IS THE CLINICAL PRESENTATION OF LOWER CROSSED SYNDROME?
- POOCHED BELLY: While in this day and age it's not uncommon to see a pooched belly because of BELLY FAT, I am not talking about belly fat here. Not that OBESITY can't make this and other issues more difficult to see.
- SWAY BACK (LORDOSIS): This is having the extra amount of front-to-back curvature of the lumbar spine as seen in the lateral / profile view. The September 2011 issue of the European Spine Journal (Sagittal Spino-Pelvic Alignment in Chronic Low Back Pain) said, "Sagittal spino-pelvic alignment was different between patients with chronic low back pain and controls, suggesting the relationship between this specific pattern and the presence of chronic low back pain." Exactly three years to the month prior to that, the journal Spine (Classification of Sagittal Thoraco-Lumbo-Pelvic Alignment of the Adolescent Spine in Standing and its Relationship to Low Back Pain) compared lateral photographs of children to lateral X-rays of adults, concluding that, "Those adolescents classified as having non-neutral postures when compared with those classified as having a neutral posture demonstrated higher odds for all measures of back pain." In other words, POSTURE really is a big deal when it comes to chronic low back pain (or CHRONIC PAIN in general).
- AN ANTERIORLY TILTED PELVIS: With overly tight hip flexors pulling down, and the overly tight low back pulling largely in an upward direction, the pelvis will typically tilt as seen by the curved arrow in the pelvis of the pic above left. Sometimes this will cause hyperextended knees as well, as seen by the second pic from the right.
- LOW BACK PAIN: Just be aware that this problem is so common in our society that Lower Crossed Syndrome is not the only cause here, but one of many potentials.
HOW CAN YOU GO ABOUT SOLVING LOWER CROSSED SYNDROME ON YOUR OWN?
- TREAT LOWER CROSSED SYNDROME AS A SYSTEMIC PROBLEM: Honestly, this is good advice for whatever ails you. If you will treat this problem as though it has a significant INFLAMMATORY COMPONENT (which it very well might), your odds of solving it --- along with any number of OTHER ISSUES as an added bonus --- skyrockets.
- LIFTING WEIGHTS IS AWESOME IF YOU DO IT CORRECTLY: I've been fascinated by big muscles and feats of strength since I was a skinny, ripped, Kansas farm boy. I'm a huge fan of squats, dead lifts (since I don't compete, I prefer a hex or diamond-shaped bar), power cleans, and the like. I must admit, however, that several years ago I fell in love with KETTLEBELL SWINGS. The thing about lifting weights is that if you are going to do it (and I think you should), you need to do it properly and with good form. This is waaaaaay more important than simply worrying about how much weight you are pushing. In the immortal words of David Carradine's Kung Fu character, "Learn balance young grasshopper".
- MAKE SURE YOU ADD FUNCTIONAL STRENGTH TRAINING TO YOUR POWER REGIMEN: As you just saw, I'm a huge fan of lifting weights. While POWERLIFTING is great fun, make sure that you are doing some FUNCTIONAL STRENGTH TRAINING AS WELL. There are so many videos on Functional Strength Training on YouTube I'm not even sure where to start. Another post for another day.
- TAKE CARE OF YOUR CORE: While this sort of goes hand in hand with the previous bullet, I have plenty of information specifically on TAKING CARE OF THE CORE, as well as including some basic stretches / yoga poses in a slide show below. I also included a neat little exercise I have been doing for about five years now called "The Founder".
- REALIZE THAT IT IS POSSIBLE TO HAVE OTHER ABERRANT PATTERNS OF MUSCLE IMBALANCE: If you have crazy high arches like mine, you may very well tend toward tight glutes instead of flabby or weak glutes. The thing to remember about the body is that while you want to be aware of the most common patterns, also realize that it can get messed up in any number of ways for any number of reasons
- STUDY AND LEARN: Back in the dark ages (prior to the internet), finding quality information was tough. Now it's easy. The cool thing is that there are a ton of YouTube Videos and websites full of exercise and stretching protocols. In all honesty, most of it really isn't hard --- it's just a matter of CREATING A PLAN, starting small, and sticking with it. Having been to a number of seminars on Lower Crossed Syndrome (I was just at one a couple months ago), I can tell you that you can't learn it all in a day. Read, watch videos, and learn. It's just one more tool in your box for solving CHRONIC LOW BACK PAIN.
TRIGGER POINTS OF THE LEVATOR SCAPULAE AND SURROUNDING MUSCLES
A CHRONIC PAIN / AUTOIMMUNITY CASE HISTORY
TRIGGER POINTS are small bundles of muscles that are innervated by the same nerve branch, which for any number of reasons, get turned on and refuse to turn themselves off. My suggestion to you if you deal with TP's, watch the ten short videos in the link. Somewhat boring, at times quite technical, but short, and in the end, you'll understand why watching was important. Also, if you look at the other posts filed under the link, you'll notice several ways to deal with Trigger Points. It won't come as a surprise to learn that the mixture of Trigger Points with the C1 vertebra is problematic for many people.
It's almost like if you stuck a long knitting needle straight through from front to back (or vice versa --- not that I am recommending it mind you), you could pierce both. Oh; one more fun fact. Problems with Pec Minor also happen to be heavily involved with both RADICULOPATHY (numbness and / or tingling into the arms) and TOS (Thoracic Outlet Syndrome). And even if there is no radiculopathy involved, when a Levator TP goes into hyperdrive, it can pull hard enough at C1 to totally lock the neck --- especially in left and right rotation (common).
Although ET can take many forms, it can be done both over a ball (helps address trunk and upper back flexion --- see link), or with a Dakota Traction Device. The Dakota is a simple, inexpensive, tool you use at home to specifically address FORWARD HEAD POSTURE (FHP). THIS shows just how critical dealing with FHP really is for most people struggling with CHRONIC NECK PAIN of many kinds. By the way, after a person has been through PHASE I and had their SCAR TISSUE and FIBROSIS addressed, the Dakota is the cat's meow for dealing with SCM TP's.
CASE HISTORY WITH LEVATOR TRIGGER POINTS
AND OTHER SOURCES OF CHRONIC PAIN
The first injury that I can remember was in 3rd grade. I was skiing with a fanny pack on…with some bubble tape gum in the fanny pack… I went off a jump and landed flat on my back. I was done for the day. It hurt really bad, especially for a 3rd grader who would be pretty resilient. When 5th and 6th grade came around I was playing JR football. This was where I discovered that I could not do a sit up without someone sitting on my feet due to pain. Doing leg lifts and sit ups, were painful. Fast forward to high school… My lower back always seemed to hurt when running sprints during basketball.
After graduating high school in 2001, I was skiing later that year. It was incredible skiing conditions, very deep snow, my dad and I were at the top of the mountain… I took two turns and one of my ski’s popped up (in a weird way) hit me in the left temple (the ski did not fall off). Long story short, I ended up being airlifted after skiing down to the medical room and showing signs off head injury. CT scans came up clean and I suffered a bad concussion. The first odd thing I noticed, post-concussion, was that when I did a “leg curl”, you could visibly see that big cord (tendon or ligament?) pop over. It wasn’t painful, but it did limit the strength of the leg.
2003/2004/2005. I started to show signs of pretty bad low back pain. In 2005 I can remember getting out of my office chair and actually falling to the ground as a result of losing feeling in my left leg. This happened several more times over the next couple years at random. I had self-determined that I must have sciatica. The lower back pain was now affecting my day to day life. I would complain all the time to my wife… who of course said “everyone has back pain”. I basically just dealt with it and didn’t see a doctor.
In 2005/2006/2007. I would go skiing and have excruciating pain in my feet. So I went to an expert ski boot fitter. After working with me for a couple months he told me that he’s never had someone like me that he couldn’t get fit properly. I determined that it probably wasn’t my feet, but my lower back and my legs and feet compensating for the back pain. By 2008 I gave up skiing because it was too painful.
2008/2009/2010. The back pain just kept getting worse. In January 2010 I went to a chiro through a referral who was well known for seeing professional athletes etc. He was an honest guy and told me to give him 23 visits and he’ll be able to get to the bottom of it. Well, after a couple months of going to him 2-3 times per week… he proceeded to tell me “man, you’re messed up!” He didn’t think he could help and said that it was very likely that an MRI would reveal a subluxation or herniated disc(s) in my lower back… but he felt there was no point. He would hate to see someone my age get surgery.
In January 2011 I went to Seattle see a NUCCA doctor (Neurological Upper Cervical Chiropractic Association). This guy really helps tons of people and is tops in his field. He only adjusts the Atlas. I went to him from 2011 until 2015. I couldn’t hold an adjustment for more than three weeks max (usually 1-2 weeks). He told me that he has only had a handful of patients like myself that could not hold an adjustment. [Roger moved a few years ago and has not been able to find a NUCCA practitioner that has helped him].
In 2009 I had to quit doing anything physically demanding such as Flag Football, Basketball, etc. I couldn’t run without having bad pain in my lower back. I’ve continued to play golf, as it’s one swing at a time and not terribly painful.
Since 2010 the pain and pain locations have increased. I tried Pilates in September 2014. The instructor commented on my incredible strength & range of motion… and then I told her that I felt like certain motions would simply tear my muscle or whatever. She observed and said that I shouldn’t do Pilates until I got that figured out. I have a couple different foam rollers and some trigger point therapy balls and workbooks. Doing this mostly seems to exacerbate the symptoms.
When people look at me they guess my weight always to be between 175-195… I weigh around 210/215 due to incredibly high muscle density. My massage therapist has commented many many times about how she hasn’t come across anyone like me with how thick my muscles are and how tight they are. I get told to relax… and I respond with how relaxed I already am! I guess I have those twitch muscles. I was always the quickest on any team I’ve played on. At 5’10” I dunked in a high school basketball game. I have never worked out… I’ve been to the gym and screwed around with buddy’s, but have never actively lifted weights.
- I did notice that my hair really wouldn’t grow around my left sideburn / lower temple area too well. That was kind of weird.
- I’ve had times were I would be talking and just start choking and not be able to talk. This has only happened 6/8 times
- I’ve had times were swallowing was difficult, like there was something stuck in my throat.
- This hasn’t happened in a while, but there was times when I would open my mouth too wide or at the wrong angle and it felt like my jaw was going to be ripped off my head. The worst feeling.
- Lower back pain, mid back pain, upper back pain, neck pain, left jaw pain, hip pain
- Weakness & Atrophy in my left arm
- If I flex my left arm, it trembles.
- Weakness & atrophy in my left leg (calf)
- Sensitive to the touch
- Left bicep, left forearm, left armpit, left inner thigh, left hamstring, left inner knee, left back of knee, left inner calf, lower back, mid back, upper back near right shoulder blade
- My bones pop and crack all the time. Even sometimes when I take a deep breath.
- I can pop just about anything… and then in a short while, I can pop it again.
- Whole body seems to be out of alignment
- Left jaw cracks when I rotate it to the left side
- Left inner ear is uncomfortable
- Left tonsil is different than right tonsil (visually from inside of mouth)
- Upper right back near shoulder blade has something deep that I can’t get out (massage can’t get it out etc.)
- I’m very flexible… but at the same time very tight.
- I crack my neck all the time
- Doing a bench press, my left arm will “short out” on me.
- Poor sleep
- Randomly dropping things (ex: subconsciously loosen grip & drop my keys)
- Whole left side of body is weak.
- Can’t run (shooting pain)
- Tightness everywhere. I wish I had a personal Trainor to stretch me out everyday
- Starting to see mild symptoms on my right side over the past year.
- Absolutely cannot do any ab exercises at all. Very painful.
- Doing physical work such as doing landscaping in my yard, hurts after a short time period and has lasting implications for a week.
- Sciatica or something
- I cannot hold an adjustment.
- I’m 33 going on 53.
I have done extensive Tissue Remodeling on Roger with excellent effect. He says that he is probably 80% better than when he first came in. While he is defintely much much better, my opinion is that 80% might be pushing it a bit. One of the really cool things I was able to successfully address on Roger's first visit was his THORACOLUMBAR FASCIA --- it was pure gristle. Not that I recommend situps (HERE), but Roger hadn't been able to do a situp since he was a little kid --- it hurt too bad. After his first treatment, not only was that pain gone when doing situps, but he could sit and ride without pain. His biggest complaint now seems to be the Levator Trigger Points, which he is dealing with.
As for the dense muscles, I'm not sure what the solution is for that. I have one other patients with similar, who has a wide array of problems himself. Both these individuals have muscles that are not necessarily tighter than other people I routinely see, but just plain dense. This might provide some of the basis for Roger not bouncing back from early injuries, and not recovering like others (especially young others) might.
Another interesting fact in this case (like many others) is autoimmunity. HEAD INJURES are intimately linked to people developing autoimmunity --- often against their own brain. Roger's problems seemed to get far worse shortly after the ski-to-the-temple concussion he incurred. While this kind of damage likely won't show up on a BRAIN SCAN (CT), it's not an uncommon problem, even though it seems to be little discussed in the mainstream. And although the not-being-able-to-grow-hair-in-the-area-of-injury situation is intriguing, it's not terribly uncommon and sometimes indicative of neurological injury.
Having noticed a patch of psoriasis (an autoimmune disease) on his foot, autoimmunity was confirmed. Why is this potentially a big deal? Autoimmunity is a huge problem even though is not a problem with the tissues, cells, enzymes, organs, etc, specifically being attacked. It's a problem with the immune system that's doing the attacking. THYROID PROBLEMS are a great example of this phenomenon. Even though about 80-90% of all thyroid problems are autoimmune (Hashimoto's / Graves), people take their thyroid meds faithfully and think everything is under control. Until they start developing other autoimmune diseases (HERE is a great example of numerous autoimmune diseases attacking in a pack --- like hungry wolves).
Furthermore, even though we can sort of check for autoimmunity via the ANA Test (Anti-Nuclear Antibodies), it's not the most accurate and it doesn't tell us what's being attacked. Although we have put names on quite a number of autoimmune diseases, there are an almost infinite number of tissues, proteins, and enzymes that the body could and does sometimes choose to attack. This is why when I see people with ADHESED FASCIA virtually everywhere, my first thought is that their problem is likely systemic (HERE) --- quite possibly autoimmune. A failure to address these problems systemically means you never really get to the root of the problem (temporary relief only).
I bring the whole autoimmunity thing up so that Roger can pick some low-hanging fruit. The easiest thing to address in a situation like this is diet. Why is diet important in autoimmunity? In a word; INFLAMMATION. Your diet is either driving it or squelching it. Controlling inflammation is the primary reason I recommend the PALEO DIET (or something similar) to my chronic patients. whether CHRONIC PAIN or chronic illness. Not to mention, science has been talking about the relationship between GLUTEN AND AUTOIMMUNITY since the 1930's. Once you understand the whole Gluten, Autoimmunity, LEAKY GUT / LEAKY BRAIN connection, doing an ELIMINATION DIET starts making a lot of sense. Especially knowing that Non-Celiac Gluten Sensitivity is mostly neurological as far as its symptoms are concerned (START SKIMMING POST TITLES).
Lest we leave without addressing Roger's nervous system a bit deeper; because of his history and the fact that everything seems to be left-sided (right brain, left cerebellum) --- including the weird hamstring tendon thing, I would suggest a visit to a FUNCTIONAL NEUROLOGIST. While I know there are any number of capable individuals in his neck of the woods (none I know personally), if you can pull it off, the guy to see would be BRANDON BROCK. Likewise, since Roger has had good results previously with Upper Cervical Technique, realize there are other techniques equally as effective as NUCCA -- Blair, Sweat (Dr. Roy Sweat), Grostic, HIO, Kale, etc, etc. And as always, if you have any questions about anything Roger, shoot me a line. I am rooting for you and would love to see you well enough for me to school you on the basketball court!
SCAR TISSUE, ADHESED FASCIA,
CHRONIC PAIN, AND AUTOIMMUNITY
A PAIR OF CASE HISTORIES
Oh dear God, PLEASE help me with my right hip pain. It stated aged 19 and I'm 39. I don't take pain killers for it and never have. It's enough to drive anyone crazy. I don't complain about it but anyone else I know would at least have gone to their GP and would be whining about it non-stop. I just get on with it. I've been to so many physios (and one GP). I even went to a sports medicine physician (who sent me to a physio).
It starred when I got glandular fever. At the time I had anterior thigh pain and a very very very very tight IT band with it. I then developed foot drop and urinary incontinence. I was sent to a neurologist and waited over a year for a T-L MRI. I've never had a hip x-ray, and as I dislike the amount of radiation, no one has scanned me.
I have muscle wasting down my whole medial right leg. At the time and for years I had fasiculation right up to my right eye. My right toe still catches on the ground. The pain back then and for ages also went to my knee and the sole of my right foot and right great toe. My hip is tender always. I have not the same strength in my right-sided glutes as left.
I also had pain from the middle of my back across my right scapula, under my arm in to my elbow and right wrist then. I also had intense pain where you would describe the gallbladder to be. I've tried everything (so far have declined steroids or surgery). I can't externally rotate or abduct. I can't do yoga. Sitting, standing, walking, running, and high heels hurt. I can't even sit in the yoga position. I finally have to admit that I have chronic pain.
Up until that time I played sport for my country, and enjoyed immense immense immense fitness, and intense success in sport. It was easy for me. At club level, the coach used to run me extra / separately and had me training with him. And he was at his peak fitness. I was ridiculously fast and had ridiculous stamina and flexibility. It feels like my life changed overnight. I remember no injury.
Now I'm lethargic and overweight with a sugar addiction. A shadow of the athlete that I was. Truth is I am now finally admitting.... this has made me depressed. Thank you for any help you can give! Jane.
Let's start at the beginning. Glandular Fever is the Aussie's name for mononucleosis (Mono), which is most often caused by either the Epstein Barr Virus (Herpes Virus 4) or Cytomegalovirus (Herpes Virus 5). If you spend any amount of time looking at message boards or talking to people in FUNCTIONAL MEDICINE, you'll find that while these two infections are usually self-limiting, they have the potential to do some crazy things and cause some ugly problems --- problems that are not well understood inside the mainstream medical community.
Part of the reason for this is that all herpes virus have the ability to lay dormant for decades, raising their ugly heads when given an opportunity (some sort of IMMUNE SYSTEM DYSFUNCTION). You can see this with things like cold sores, HPV, SHINGLES, etc. The other thing about these two virus is that they are both associated with Guillain Barre Syndrome. According to Wikipedia....
Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. The initial symptoms are typically changes in sensation or pain along with muscle weakness, beginning in the feet and hands. This often spreads to the arms and upper body with both sides being involved. The symptoms develop over hours to a few weeks. Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure. The cause is unknown. The underlying mechanism involves an autoimmune disorder in which the body's immune system mistakenly attacks the peripheral nerves and damages their myelin insulation. Sometimes this immune dysfunction is triggered by an infection or, less commonly, surgery or vaccination.
Simply do a Google search of "Epstein Barr, Cytomegalovirus, Guillain Barre Syndrome" and look at the freaky amount of freaky information that comes up --- some of it brand new and some of it fifty years old --- much of it from the peer-reviewed literature. In other words, this connection is not a reach and it's not anything new. Honestly, GBS is a simple diagnosis to make, so I doubt that you actually had GBS. However, you most assuredly had something along those same lines --- something in the same family (there are many many neurological reactions and autoimmune issues that are unnamed --- can anyone say MUPS?). This tells us that you are not dealing with just a simple hip issue.
This stuff may affected your left brain / right cerebellum on some level, and undoubtedly attacked your lumbar plexus. You have radicular symptoms on the right side (foot / toe drop, muscles not firing, sciatic-pain, etc). Also, your bladder is neurologically controlled (at least partly) by nerves that come from about the L3 level down through the sacrum --- the same area that makes up the SCIATIC NERVE. If you look at myotomes and muscle innervation charts, you'll see that these are the same levels that innervate the muscles around your hip, quad, and certain other areas of the lower extremity, thus, the reason they wanted an MRI of your (TL area) THORACOLUMBAR SPINE (BTW, you are correct about CT being dangerous). It's important to be aware that it's very difficult to correlate what's found on the imaging with real-world symptoms (HERE).
So; getting down to fixing (or at least addressing) this beast. I think your approach has to be three-pronged. You'll have to address the AUTOIMMUNE ISSUE, you'll have to address the occult (hidden) viral infection (HERE'S a common example of this phenomenon in a different arena), and you'll have to address the neurological issue (undoubtedly you are in SYMPATHETIC DOMINANCE). This is not just a matter of strengthening and stretching; the reason that your PT was unhelpful.
The very first thing you are going to do is to do an ELIMINATION DIET to figure out if there are foods you are reacting to (Gluten is assumed with autoimmunity --- HERE). The next thing you'll have to do is get off the sugar (BREAK THE ADDICTION) simply because it, along with PROCESSED AND EVEN WHOLE GRAINS, are the single most inflammatory things we collectively tend to put in our mouths all day long (HERE). You'll also need to get started on a PALEO DIET because nothing squelches INFLAMMATION better. And depending on your lifetime history of ANTIBIOTICS and OTHER SIMILAR MEDICATIONS, you may even need to contemplate an FMT. All of this info can be found HERE.
As far as addressing the virus, there are all sorts of cool things out there that help a lot of people assess and address the occult virus hiding in their body. For instance, I have a patient (HERE) who has been able to win world championships in off-road triathlon, despite having Lymes Disease (bacterial). She underwent ozone therapy from an MD in Florida (Ozone Sauna among other things) with great success. And as far as the neurological aspect; hands down, I would make a trip to see DR. RANDY BECK --- an instructor and author for the CARRICK INSTITUTE. Don't know him personally, but if he is teaching for Ted Carrick's group, he's sharp.
God Bless and hope this helps. I want an update in six months Jane. I also commend you for recognizing that "THE BIG FIVE" is not going to help you with this problem.
**** From her response to this post, I learned that "Jane" is a physician --- 'Dr. Jane'. Her (edited) response to me can be found near the top of my TESTIMONIAL PAGE.
This next Case-History comes from an OUT OF STATE PATIENT I treated for CHRONIC NECK PAIN, upper back pain, RIB TISSUE PAIN, and pain around her shoulders. She also has TMJ issues. "Sally" wrote to me saying....
I worked as a cashier for 3.5 years beginning in Feb. 2014. During this time, I began having shooting pain in my ribs on the right side. Then I could start feeling it in my chest. I was seen by a few Chiros briefly with very little improvement. The areas between the ribs are tender. I was told by an ER Dr it's costochondritis.
Next, My shoulder blades feel like they do not lay correctly, and my left shoulder is so tight. It does not relax when I sleep. I eventually thought this was being caused by repeated motions at work. Eventually I had joint shoulder pain and nerve pain across the collar bone region and down my arms, along with numbed arms and fingers. I looked into Thoracic Outlet Syndrome. A surgeon said I didn't have that. A work comp doctor said I have a fascia problem with some scapular winging, but didn't provide any assistance. I had 12 PT sessions while still working that did not help at all.
Since quitting the cashier job that made me repeat my motions and over-extend my shoulder blades, the nerve pain and numbness have mostly gone away. But the overall pain across my shoulder blades, joints, and ribs remain. And I have bad "flare ups" when I use my arms too much, or experience bouncing motions of exercise like running or jumping jacks. Putting up the Christmas tree at work caused a week of extra pain and discomfort. My primary MD mentioned fibromyalgia to me, and I ran the other direction.
Along with all this, I've experienced neck/throat spasms on my left side. Currently, I have a knot on the underside of my jaw/neck area that's been there for a couple months. It's causing my jaw and mouth muscles to tighten. My dentist is creating a special mouth guard to help with TMJ, but she said I need PT help to improve posture. I wondered if it was a swollen gland, but the dentist swears it's a knot in the SCM muscle. I fear opening my mouth too wide while yawning, singing, etc.
I'm at a loss. I cannot/have not laid on my sides in over 2.5 years. Instead I lay on my back using a wedge pillow that helps keep low back pain away. Tonight I had shooting chest pain that also shot across my ribs to the left of my breast under my armpit region. I'm scared and need help. Please let me know if this is anything you could help with?
Because in my mind, this was all being driven by some sort of SYSTEMIC INFLAMMATORY ISSUE, I told her that I doubted I could help, not realizing she had been addressing these systemic issues for quite some time as you'll notice momentarily. For the record, the costochondritis diagnosis she had received was a commonly-seen cop out from someone who surely knew better, as was the FIBRO. Sally responded with this email.
Dear Dr. Russ,
That is the opposite of what I thought you would say. I read your website, and I see myself in your patients as well as your extensive information. Chronic pain patient. Slowly losing mobility. Fascia is inflamed and needs work. I thought that is what you treated? This pain has taken over my life.
I replied thusly. "I might (emphasis on might) be able to help you, very difficult to say. I'm sure what I do would help you for at least awhile. The thing is, your problem sounds systemic. What are you currently doing to deal with systemic inflammation?" I included THIS LINK with my email Sally replied...
I've seen a functional medicine Dr for the past 6 years. He has tested me for hypothyroidism, insulin resistance / hypoglycemia, estrogen dominance, and other hormone imbalances including sex hormones and cortisol levels. My insulin resistance and hypoglycemia symptoms are gone. My insulin and glucose levels are in healthy ranges. My thyroid is in range. I dropped 40 lbs through dietary changes. My diet is predominantly organic and grass-fed meats, vegetables, healthy fats, little fruit, some nuts and seeds. I developed food sensitivities overtime, which included grains, dairy, soy, and yeast; all of which I cut out of my diet. I still experience some PMS and PMDD symptoms. I haven't had my cortisol tested in a while, but my energy levels are better than ever and I sleep well. My yeast sensitivity caused 1.5+ years of constipation, which has recently improved. I no longer drink kombucha. I believe it was a big part of the constipation problem. I'm trying to figure out what else to do. I am considering acupuncture.
Sally ended up coming and getting treated. She was loaded with SCAR TISSUE all over the place. This factor alone (along with the history of HASHIMOTO'S THYROIDITIS --- itself an autoimmune disease) makes me think that she might also be dealing with one of the myriad of unnamed autoimmune diseases that work against connective tissues FASCIA, LIGAMENTS, TENDONS, etc) and maybe MUSCLES (so many remain unnamed because no one has figured out what the auto-antigen is --- the possibilities are limitless). The thing you must remember about autoimmunity is that it is never primarily a problem with the thyroid, fascia, or whatever other organ or tissue is being attacked --- it is an immune system problem. Fail to address overactive immune system (HERE) and before you know it, you'll be fighting half a dozen autoimmune diseases --- like THIS PERSON was before I got involved.
I have a hunch that Sally has PCOS, although she was never tested (her functional doctor had been doing things that would have addressed this anyway). After talking with her, I suggested that she do an Elimination Diet with NIGHTSHADES since she had not done that yet. As far as what might have caused some of her FIBROSIS other than hidden inflammation (Inflammation always leads to fibrosis --- HERE), she was in two relatively harsh MVA'S a number of years ago, as well as falling off the top of the monkey bars flat onto her back when she was about ten.
I treated Sally (broke the FASCIAL ADHESIONS and then gave a MANUAL ADJUSTMENT which she had not experienced before). I then got her started on THE DAKOTA TRACTION DEVICE. Below is her one-week response to treatment that I received yesterday.
Russ, I would say maybe 50% better? Maybe a little less. I can tell there's a difference involving the fascia/scar tissue, so that's great! But the pain and tightness I am feeling is strong. My collar bone area is angry.
That collar bone area is where muscles like the SCM and PLATYSMA attach (BTW, TRIGGER POINTS in the SCM can be tricky), creating a strong propensity for FHP (Forward Head Posture). Interesting how the kombucha was causing her CONSTIPATION --- undoubtedly the same sort of mechanism that leads to VITAMINS or even PROBIOTICS causing various sorts of DYSBIOSIS. It's why anymore, my mind almost automatically turns to FMT when known or suspected autoimmunity is involved (Sally couldn't remember whether her ANA test was positive or not).
I want you to know that I am rooting for you "Sally" and that I thoroughly enjoyed our time together. Keep me in the loop. Wishing you the best, Russ BTW, once Sally got started on a regimen of Pilates, her pain virtually ended.
LOTS OF VISITS OR LOTS OF RELIEF?
THE CHOICE IS YOURS
That means that my office will not calling to badger you about a missed appointment or why you haven't been in to see me in a while. And the really great thing about coming here --- one of the many things my patients love and appreciate --- is all the freebies. If you need information on effective weight loss, I'll provide it to you. Need to know what it will take to solve your back pain? I'll give you that as well. Struggling with Diabetes or any number of Autoimmune Diseases? Dealing with Fibromyalgia? I've created a SIMPLE "CHECKLIST" HANDOUT I give my patients, with everything they need to solve the majority of their health problems on their own (HERE'S A GREAT EXAMPLE). Did you catch that? On your own. Do you grasp what that really means? It means you're far less likely to require lots of expensive doctor visits to solve your problems. And let's be real honest; your doctor probably doesn't want to see you anyway (HERE).
On occasion, I even take one of the endless emails I get from people and turn it into a blog post for all to see (HERE and HERE are a couple examples). There's nothing more exciting to me that watching really sick people --- chronically sick people --- turn things completely around and get their lives back (HERE). Like I've always said, it's better than someone handing you a GOLD BRICK. Gold bricks are certainly nice; but living a HAPPY, HEALTHY, MOBILE, MOTIVATED, THOUGHTFUL, SEXUALLY FULFILLED, DRUG FREE, PAIN FREE, life --- that's priceless!
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration