Monday, October 14, 2013

Does Your Kaiser Doctor Know Best?

Case Study - Migraine headaches caused by cervical spine kyphosis.

A 48 year old female patient presents to Chiro-Health, Inc with complaints of daily migraine headaches, jaw pain, neck pain and severe muscle spasms.  She has had all these symptoms in the past but the last 2 months the frequency and intensity of the symptoms increased to unusual level.  The patient was  seen in our office before for occasional chiropractic adjustments for the same symptoms and chiropractic care always provided a relief.  During my meeting with the patient I suggested x-rays, since the condition was returning and it was getting worse.  The patient has Kaiser insurance, and is concerned about cost.  I suggest that she speaks to her Kaiser provider and request the x-rays to be done at Kaiser, this way they will be covered by insurance.  Next day, the patient calls me to ask me what views will she need, she got the Kaiser doctor to prescribe the x-rays, but the doctor did not know what x-rays to order. So naturally I e-mail the views needed and the Kaiser doctor orders the study.  The patient takes the x-ray in the Kaiser facility  the next day, and I receive an e-mail from the patient that her Kaiser doctor told her there was nothing wrong with the x-ray.  Look at the image.  The one on the left is the patient x-ray in a lateral view, taken from the side.  The one to the right is a lateral cervical (neck) spine that is very close to normal.  I showed these images to my twelve year old daughter and asked her which spine looked healthier, and she instantly picked the right image. These are my concerns:
1) Kaiser doctor does not see the need for x-rays, based on patient history, when they are indicated
2) Kaiser doctor does not know what are the views needed to evaluate cervical spine
3) Kaiser doctor misinforms the patient that the x-rays look great, no need for concern

I requested the x-rays and scheduled the patient for a follow up.  This is what's wrong with the left x-ray, which belonged to the patient:
There is a loss of cervical curvature
There is fusion between cervical vertebrae 5 and 6, most likely congenital (patient was born with it.)
There is phase 2 Degenerative Joint and Disc disease, meaning decreased motion, bone spurs, neurological deficiency

I started extension traction with the patient in our office, meaning that she laid over a pump that provided pressure to her cervical spine, over time it is expected that the curve will correct or at least improve.  The patient has been doing the traction at home for the last month, she has not had any migraine headaches, the pain and the spasm in the neck muscles have decreased by 80%.

I am upset with the fact that the Kaiser doctor, but I am sure that what she did is not because she did not care for the patient, but because she did not have the tools to care better.  All she could offer was  medication for the migraine and muscle relaxers.

The purpose of sharing this case study is to make these points: always get a second opinion, please ask to see your x-rays and the radiology report, know that chiropractic car could provide a natural solution to many conditions.  Consult with chiropractor to see if safe, natural chiropractic care could be appropriate for your condition.

For more information on this article or the cervical posture pump you can reach Dr. Mazgaloff at (415) 546-1461 or on the web at and watch the posture pump animation video.

Thursday, August 29, 2013

Is Your Low Back Pain A Real Pain in the Butt?

Many people don't now that having weak glute muscles and hip abducters can lead to lower body injuries and changes in gait. So next time you're in the gym don't just work on your squat to look better at the beach, but also for a better overall quality of life. Lifestyle factor that lead to weak glute muscles, and glute medius more specifically are, sleeping on your side and flexing and adducting your top leg over your bottom leg. Standing predominantly with all of your body weight on one leg can cause the pelvis to move sideways and the hip joint to adduct; contributing to weak hip adductors. Ilitiobial band (ITB) syndrome, which is quite common can result from weak gluteus medius. Being unable to control thigh abduction and external rotation can place greater tension on the tensor fascia and ITB. Gluteus medius dysfunction can also contribute to patellofemoral pain syndrome, which results in decreased hip control and increased femoral adduction and internal rotation.
The following exercises can help with the aforementioned conditions. Before starting any exercise routine make sure to consult your doctor.

Side Lying Clams

Starting Position

 Ending Position. Hold for 3 seconds and slowly return to starting position.

 Starting Position

Ending Position. Make sure to keep back straight and go as far down as possible.

 Starting Position

   Ending position. Take a step to the side as far as possible and return to starting position. Repeat on opposite side.

Single Leg Sit Up/Down

 Starting Position. Begin seated.


Ending Position. Stand up on one leg slowly, and then slowly return to a seated position. Repeat on other leg.

Single Leg Step Up/Down

 Starting Position.

Ending Position. Slowly climb up on one leg and slowly return down to starting position.

Reference: Glute Medius & Hip Abduction Functional Training,

Wednesday, August 21, 2013

Is Your Cell Phone A Pain in The Neck?

A picture is worth a thousand words.   We hunch over our smart phones more than they deserve.  I took this picture in Bart, because as a chiropractor I am appalled at what I see every day.   These gentleman's heads  are literally falling out and ahead of their bodies as a result of their phones.  Research shows  that the average head weights 10lb.  For every inch  the head is held forward the strain in the neck increases 10 fold.   Therefore the  two gentlemen are caring at least 40lb, if we estimate that their heads are 4 inches forward, which is a gross understatement.   
Forward head posture is the leading cause of neck and upper back sprain and strain, stiffness, headaches, joint deformity, straightening of the cervical curve, muscle spasm, pinched nerves, carpal tunnel, radiating pain, tingling and numbness into the fingers, early degeneration of the joints of the neck and back and disc problems,  just to name a few.  These symptoms are seen in young adults as early as 14 years old.  There isn't a simple cure, but there is a way to reverse the anterior head posture over time with changing habits, increased awareness, chiropractic adjustments and exercise. 
This is what you can do: 1)  Limit your cell phone use to specific time during the day.  Talk to your friends do not text them. 2) Call your chiropractor and get evaluated for the effects of the forward head posture on your spine,  joints and muscles.  X-rays may be necessary in some cases, depending on the joint dysfunction the chiropractor finds through the orthopedic and neurological examination.  Get adjusted first before you start stretching and exercising.  The function of the joints needs to be restored first, or you will be causing more undue stress and strain.  Stretching of already over stretched muscles is not the way to go.  Stretch the chest and anterior shoulders, not the neck.   Strengthen the upper back and posterior neck and shoulder muscles.  3) Your chiropractor can prescribe a special traction equipment to help restore the curvature at your home safely.   Along with the right exercises and increased awareness you will regain the normal function and posture in your body.

The chiropractors at Chiro-Health are trained posture experts, practicing for over 11 years.  For more information please go to  Phone and office consultations are free and encouraged.  It is your future, be there healthy, we can only help along the way.

Wednesday, August 7, 2013

Is Sitting the New Smoking?

As chiropractors in the Downtown/Financial District of San Francisco, we see the effects of sitting every day. Conditions include chronic headaches, low back pain, muscle spasms, stiff neck, hip pain, knee pain, degenerative disc disease in people as early as their 20's among other things. Many patients ask us why they have these pains and degenerative changes, since they are so young and otherwise healthy. Although they may not have the symptoms, most have on thing in common: 90% are sitting 6-12 hours a day.

Recently, Anup Kanodia, a physician and researcher at Ohio State University, Wexner Medical Center said, "Sitting is the new smoking".  According to an Australian study published in October 2012 in the British Journal of Sports Medicine, every hour of sitting, cuts about 22 minutes of the person's life, while it is estimated that smokers shorten their lives by about 11 minutes per cigarette.

No one wants to grow old with low back pain.  As chiropractors our goal is help you get out of pain, but more importantly to stay without pain, with better function, so that you can age as healthy as you possibly can be.  I have a 32 year old patient, who I love quoting: " I am here because I want to be the healthiest senior citizen I can possibly be."

Here is a look at how sitting affects us, as we sit for extended periods of time the posterior muscles in the low back, middle back, neck and pelvis become elongated, weak, inhibited, and underused. The hip and neck flexors on the other hand become short and taut. We mostly feel the muscle's response to sitting in the form of muscle spasms or tension, but the problem is far beyond the muscle. Prolonged slumped postures cause micro sprains and strains to the joints of the back and neck over prolonged periods of time. This leads to lose of neutral curvatures in the lumbar spine and the cervical spine, deformation of  ligaments that are elongated in the back and shortened in the front, disc compression, disc thinning, disc bulges, pain radiating to the arms or legs, or disc tears. The body overreacts to this damage and starts producing increased muscle tone, which feels like spasm, tension, knots in the muscles.  Naturally because it feels like spasm we start stretching the muscles instead of what we need to do, strengthen them.

So next time, you experience a spasm in the lower back, stiffness in the neck, sensitivity to certain movements or unexpected movements especially in the morning,  pain after sitting and standing,  or pain from sitting, standing, lifting or carrying, take into consideration that it may not just be a muscle spasm, and most likely a weakened disc that is likely to suffer further if not treated as such.  

Our chiropractors specialize in posture evaluation, muscle testing to identify front to back and left to right muscle imbalances.We are experts in differential diagnosis meaning we do all the orthopedic tests to help us differentiate a simple muscle spasm from, joint sprain/ strain and dysfunction , from disc protrusion or bulge.  We combine chiropractic, massage, physical therapy on the same visit to address all the structures involved: muscles, joints, nerves and discs.  For more information about this article and to contact Dr. Mazgaloff go to

Friday, June 7, 2013

Yoga, The Nervous System, and The Spine

At the request of some of our yoga students I am writing an entry about the nervous system, how it relates to the curves of the spine, and how we can affect it through conscious exercises such as yoga. 

Nerves are bands of fibrous tissue that carry messages throughout our bodies. They are much like the wiring in a computer. They are just as real and palpable as blood vessels, muscles, and organs. Because nerves are a physical structure they can be affected by tight muscles, injuries, and unhealthy posture. Nerve roots are the part of a nerve that exits the spinal cord between two vertebra before it travels out to the rest of the body. They are the place where the two parts of our nervous system communicate.

A compressed nerve root refers to an actual squeezing of the nerve as it comes out from between two vertebra on its way to the rest of the body. If you squeeze a hose that has water running through it the water flow will be impeded and pressure will build up. The same thing happens in our nerves where the nerve is the hose and the water is the impulses that carry messages back and forth between the brain and the body.

Our central nervous system (CNS) is comprised of the brain and spinal cord. Our peripheral nervous system (PNS) is comprised of all the nerves that run throughout the rest of our bodies. These two nervous systems communicate with one another via the nerve roots mentioned previously.

There are two branches within the peripheral nervous system. They are the Sympathetic branch and the Parasympathetic branch. Each of the branches holds an opposite function and our body is constantly adjusting how much each branch is activated. 

The sympathetic branch is responsible for the 'fight or flight' response. This system is activated in times of stress and danger and leads to adrenaline being released, heart and breath rates to quicken, the pupils to dilate, and blood flow to increase. The parasympathetic branch is responsible for the 'rest and digest' response. This system is activated in times of low stress. It leads to blood moving to the organs, the heart and breath rates to slow down, and an overall sense of relaxation and restfulness.

Problems occur when one of the branches is overly stimulated for an extended period of time. Because of our culture, jobs, and life structure, Americans tend towards having their Sympathetic branch chronically stimulated. This leads to health issues such as anxiety, chronic stress, weight gain, tight muscles, headache, low immune system function, difficulty sleeping, and high blood pressure among others. In order to balance this a two-part solution must take place. The first is to lower the function of the Sympathetic branch and the second is to stimulate more activity of the Parasympathetic branch.

There are many ways we can affect the branches of the peripheral nervous system. Because the peripheral nervous system starts in the spine at the junction between the vertebrae we can affect it by adjusting the spine. Chiropractic care is an example of how this approach can be employed. 

Alternatively we can send signals from other areas of the body back to the roots of the nerves to tell the body to calm down. Acupuncture is a good example of this method. Because there are different approaches it is important to make use of the different healthcare modalities available to us and integrate them together to receive the most effective care.

We can also engage our bodies and nervous systems on our own without the assistance of someone else. This is an important approach to take as well because it empowers us in our bodies and in our lives. It makes receiving other treatments more effective, longer lasting, and ultimately puts us at a place of power in our own lives. Yoga is a way of using this approach to health.

Before we talk about specific yoga alignment let's take a closer look at the spine. The human spine is comprised of roughly thirty two bones. There are four curves in the spine. Two of them are concave and two of them are convex. Bones are connected to other bones by ligaments and to muscles by tendons. Between all the layers of muscle there are additional layers of connective tissue that hold everything together. Misalignments in the body can be due to bones, muscles, or connective tissue. The spinal cord runs through the center of the bones of the spine and, along with the nerve roots, are affected in shape and functionality by the posture of the spine.

Many systems of yoga and other exercise use alignment based on old research that showed that accentuating the natural curves in the spine lead to injuries in the spine and nerves whereas making the back flat, tucking everything under, and taking the curves out of the spine lead to greater stability. 

There are several problems with these studies. The first is that since these studies have been accepted and used as the basis for healthy alignment in our body no one has researched other possible alternatives. For over sixty years we've accepted that those studies discovered everything we needed to find about proper alignment in the spine. Secondly, the studies looked at overarching the lower back. What they didn't look at was the method in which the back was arched. Simply put, the back can be arched either by collapsing into it and compressing the vertebrae or by engaging the muscles of the legs to create a deep but spacious curve in the low back that matches the spine's natural alignment. Lastly, the studies all looked at arched backs where the last thoracic vertebrae (T12) in the middle of the spine poked out. None of the studies looked at alignment where T12 moved in and up, which only happens when the spine is arched through muscular engagement.

When the curves are taken out of the spine it causes the nerve roots to become compressed and sends signals to the brain that the Sympathetic branch needs to be activated. When the natural curves are put back in the spine it signals the brain to activate the Parasympathetic nervous system.

Our Sympathetic activation is exacerbated by the large amount of time that people spend sitting at desks. Sitting this way leads to several problems. It takes the natural curve out of the low back, it takes the natural curve out of the neck and when the chin is lowered it pulls on all the muscles in the jaw, neck, and upper shoulders, and, finally it tightens our hips and groins which also stimulates the Sympathetic branch. This also causes the bones of the legs and arms to be pushed forward out of their sockets. 

Tucking under requires the engagement of the butt muscles from the top of the butt to the bottom of it. This engages the muscles from the insertion to the origin. We engage every other muscle in our body in the opposite way - from the origin to the insertion. Why would it be that one of the strongest muscles in our body should be the only one that should be engaged opposite from all the other muscles? In the new system of alignment the butt muscles are engaged from the origin to the insertion (bottom to top) which naturally creates a deep spacious curve in the lower back as a result.

If an exercise class is using an old system of alignment it is basically creating the same posture we end up in sitting at desks and in cars. We end up creating the same problems we're trying to fix. The new system of alignment reverses these tendencies and reintroduces the natural curves back into the spine. Some basics of the new system of alignment I use in my teaching are:

1) Make the legs strong
2) Use this strength to create a spacious, deep arch in the low back until T12 moves in and up
3) Allow the upper back to soften and the ribs to move towards the ground
4) Look up and make the curve in the neck match the lower back
5) Extend the whole body in both directions from T12

Here is another way of looking at it:

When an animal is afraid or upset they round their lower back and neck, and tuck their tail between their legs. This is the same action of "tucking the tailbone" under that we have all been instructed to do in the past. This is an example of what animals do when they are in Sympathetic dominance. Another example is a cat arching its back when it hisses at something.


When an animal is relaxed and at ease and has just woken up from a nap it takes a nice big stretch as seen here. The lower back is rounded, the groins are soft, the hips are pressing back, and the chin is lifted to create a curve in the neck.

Here are more photo comparisons:

In the first set of photos we can see the difference between the old and new styles of alignment. The bottom picture shows a rounded spine, rounded neck (though usually the rounding is even more severe), and and overall look of unease. The top photo shows strong legs creating a natural arch in the lower back and the chin lifted to create a matching curve in the neck. The shoulders are lifted and the ribside is extended.

The second set of photos shows the new alignment and how it matches with the way animals align their bodies in a stretch. In the top photo I could have even more bend in my knees so as to lengthen the spine and extend the hips back more. Notice how overall the arches of the spine and alignment of the shoulders and hips match up.


The new system of alignment activates the Parasympathetic nervous system while at the same time strengthening and toning the body. Because the spine is naturally curved the nerve roots have the least amount of pressure put on them when the spine is in its natural alignment. By putting the spine in this alignment and then using our muscles to lengthen the curves it creates space between the vertebrae which takes pressure off the nerve roots, thus sending a message to the brain to activate the parasympathetic nervous system. Less obstruction and compression on the nerves creates feelings of ease and restfulness.

When the natural curves of the spine are supported by clear engagement of the muscles and healthy alignment of the limbs there is more than enough stability to support the curves. Old systems of alignment try to take the curves out of the spine because it is believed that the hyper-mobility of the lower back and neck are too unstable and easily injured. This assessment is only true if there is no muscular engagement supporting the arches in these parts of the spine. 

Finally, when we allow the ribcage to descend towards the ground we allow gravity to gently pull on all the connective tissue surrounding our internal organs. When we surrender in this way it further activates the Parasympathetic branch. This isn't to say that the abdominal muscles aren't engaged. They are, but instead of contracting and shortening them we engage them while they stay long and extended. 

These are some basics of the way our nervous system works in conjunction with our anatomy and alignment. There are many different systems of exercise and alignment available and it's good to explore many different ones in a safe way so that you can become more empowered in your own body. Following, I've included more pictures for comparison.

~Joshuah Ciafardone, L.Ac

The new method of alignment is from the Sridaiva system of yoga developed by Desi Springer and John Friend.

Wednesday, May 15, 2013

Shoe or No Shoe?


    Whether you're an avid runner or not, it is likely that you have seen someone wearing Vibram toe shoes. One of if not the biggest debate within running communities is whether it is better to run with a classic running shoe or one with barefoot. Legitimate arguments exist for both sides of the debate.
    Barefoot running advocates point out that humans ran and walked without shoes for millions of years, arguing that going barefoot is natural for humans and can reverse injuries caused by modern running techniques while preventing future problems. But those against barefoot running like to remind us that asphalt and concrete didn't always exist and that there were very few 50 or 60 year old running millions of years ago.
    A study led by Harvard professor Daniel Lieberman suggest that runners who don't wear shoes have a significantly different foot strike that minimizes structural impact compared to those who wear shoes. Barefoot runners tend to point their toes when landing, putting the impact at the middle or front of the foot instead of on the heel making the runner less prone to repetitive stress injuries. This foot strike pattern was also shown to be more economical because runners use less energy to run the same distance as runners using traditional shoes and striking on the heel.
    On the other hand a trial published in the journal Medicine &Science in Sports & Exercise raises question whether barefoot running actually develops a different set of running injuries. Runners were given pre and post MRI studies of their feet. The MRI images showed that over half of them had developed increased bone-marrow edema in the tarsals and metatarsal bones.
    One helpful point to take from this is that not everyone who makes the switch to barefoot technology will end up with injuries. However anyone planning on doing so needs to be extremely cautious during the transition period. It is important to allow foot and calf muscles to adapt. Whether you plan on running with barefoot minimalist shoes or completely barefoot using a mid range cushioned shoe initially can be a good transition. When it comes to injury prevention and running efficiency, it's much more important how you run than what you run in. Heel strikers will sustain more impact injuries than those who allow their arches to act as natural shock absorbers. The most efficient and least injury-prone runners shorten their stride, land on the forefoot and keep the running motion smooth, light and flowing.
    At Chiro-Health we have years of experience working with runners of all skill levels. Whether you have more question on barefoot running, or want a gait analysis to determine which type of running shoe is ideal for we are here to help. You can reach us by phone at (415) 546-1461 or shoot us an e-mail at .