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 http://chirohealthsf.com/videos---links.html and watch the posture pump animation video.

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.









Squats

 Starting Position

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








Sidestepping

 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, www.dynamicchiropractic.com

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 www.chirohealthsf.com.  Phone and office consultations are free and encouraged.  It is your future, be there healthy, we can only help along the way.

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 www.chirohealthsf.com.

Patient Appreciation Day

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.

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 frontdesk@chirohealthsf.com .
 
References: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56486

Stress: How to Not Let It Affect You

Our lives are full of stressful situations. Whether you were trying to beat that April 15th tax deadline or didn't and now have to request an extension, chances are you were stressed out. Stress is recognized as the #1 proxy killer disease today. The American Medical Association has noted that stress is the basic cause of more than 60% of all human illness and disease. Below is a diagram showing you how stress can affect your body and some insightful stress facts that many people are unaware of. Don't let stress take over your life and ask us how we can help you out with Chiropractic care. 

                                                                                                                             

                          ( http://www.heartmath.com/infographics/how-stress-effects-the-body.html)

Fact #1 Your body doesn't care if it's a big stress or a little one. Regardless of the significance, stress affects the body in predictable ways.If these reactions are left unchecked we age prematurely, our cognitive function is impaired, our energy is drained and we are robbed of our effectiveness and clarity.

Fact #2 Stress can make people do stupid things. Stress causes what brain researchers call "cortical inhibition". This means that stress inhibits a part of your brain and you can't function at your best. 

Fact #3 People can become numb to their stress. Physiologically we may be under stress, but mentally numb to it because we've grown accustomed to it. Although they may be small these stresses can accumulate and we may not realize how much they're impairing our mental and emotional clarity and overall health. This may show up as a bad decision, overreaction or an unwanted diagnosis at the doctor's office. 

Fact #4 We can control how we respond to stress. 

Fact#5 The best strategy is to control stress in the moment. Don't hold stress all the day and wait until after work to go to yoga or the gym to relief stress. By this time our bodies have already initiated the stress response and it is our overall health that suffers. 

                                                                                                                           

Movements of Nature in Chinese Medicine - Spring Time Part I

"I sit with my back against an old oak tree,

The wind blows, grass lifts around me,

The tree remains steady,

The wind pushes me forward,

My eyes tear with the rising impulse,

Spring bursts forth,

It is full of life,

Vision clear,

See the plan,

 

What do you see,

What do you judge,

What is the plan,

Shout to the world,"

In Chinese thought there are many ways of describing the world around us and our experience of it. One of them is the model of the Five Elements, or Five Phases. I prefer the term Five Phases because it denotes movements of energy over periods of time as opposed to static building blocks of reality. The Chinese phases are Wood, Fire, Earth, Metal, and Water. In a previous post I described some of the qualities of Fire as it relates to the Heart organ-meridian system. In this post we will explore the season of Spring which is associated with Wood.

Wood Correspondences (in Chinese Five Phase Theory)

Emotion	Anger
Yin Organ	Liver
Yang Organ	Gallbladder
Sense Organ	Eyes
Body Part	Tendons
Body Fluid	Tears
Sense	Sight
Taste	Sour
Life	Birth
Season	Spring
Color	Blue-green
Virtue	Judgment/Discernment
Direction	East
Climate	Windy
Movement	Upwards, Outwards

Spring is a time of birth and renewal. It is the seed growing upwards and breaking ground. There is an energy of bursting forth and moving upwards. The Yang Qi becomes dominant, bursting out of Yin which has been dominant in Autumn and Winter. The light begins to return, the days become longer, and the temperature begins to warm. The state of expansive potential associated with Winter shifts into the state of manifested potential. The full realization of potential won't happen until the Summer. There is still a quality of the unknown present in Spring.

Spring can be a difficult time for people because of all the change and movement happening. After the deep contemplation of Winter it can be a jarring shift to move into Spring. The movement happening in nature can stir up Wind - both metaphorically and literally. Things might seem like they're a little out of control and overwhelming. People will experience allergies, frustration, and a sense of being disoriented. All these things are normal and by knowing what's happening in nature we can learn to adjust to the changing seasons more easily, helping any physical symptoms to become less severe. 

The Liver likes things to be consistent and organized. The Liver is associated with vision on all levels (i.e. physical, having foresight for future projects, opportunities, etc.). Because Spring is a time of change the Liver can become irritated. It may be unable to see what will happen in the future because the potential of Winter is still being shaped into what it will become. It is analogous to the feeling that occurs whiel driving behind a large truck and being unable to see the road ahead of you. 

Spring invites us to learn to move with the currents of nature, to be okay with the unknown as it is happening. Winter is more a time of deep contemplation where we learn to sit with mystery and the unknown in a state of darkness, quiet, and stillness. Spring is a time of driving 90 mph on a winding road that we are unfamiliar with. In the Winter we use the time to discern what no longer serves us and Spring is when we get rid of it all (Spring cleaning). This process can leave us feeling raw, vulnerable, and a little rough around the edges.

Finding things in our life that we know will be consistent is helpful during Spring. Having an anchor to hold onto while things are shifting and being let go of helps us feel secure in the process. It makes change and growth more comfortable. 

We want to put ourselves at the eye of the storm where there is stillness as opposed to being on the periphery where the tornado is blowing strong and we might get hit with a flying cow. Focusing on the positive qualities that change and growth will bring into our lives will help us allow it to happen with less resistance. Asking where we want to go, where we see ourselves going, and why we want to get there will help the journey be more enjoyable. Spring and Autumn are all about the journey. Winter and Summer are more related to the destination. They are the rest in the light and dark. Spring and Autumn are navigating the old rickety bridge between two mountains.

Self-Care Tips for Spring

• Be asleep or in bed resting between 11 am and 3 am. This is the period where the Qi is strongest in the Liver and Gladder. It allows them to carry out their functions of judgment, discernment, vision, and refurbishment. Less sleep starting earlier will always be more beneficial than more sleep starting later.
• Contemplate or journal about visions, dreams, what you want to let go of, what you want to bring in to your life, and how those changes will help you be more content in life.
• Dietary support for the liver requires to things: healthy proteins that allow the liver to function properly and sour/bitter foods. A great combination is a green apple, a little lemon juice, cilantro, and dandelion greens. Be careful not to overdo cold, raw, bitter foods because they can negatively impact digestion. If you notice coldness, loose stools, cramping pain, or fatigue, it means you're probably overdoing it.
• Be smart about detoxes, cleanses, and fasts. The liver requires energy to work properly. Juicing removes all the fiber from the fruit or vegetable which means the body absorbs all the sugar very quickly. This leads to dangerous spiking of blood sugar levels and is taxing on the pancreas. Juice fasting may be helpful in serious situations but should not be self prescribed and done with the guidance of a trained healthcare professional. For most people having a healthy, consistent diet, taking care of yourself, and getting adequate sleep is going to allow your body and life to detoxify most effectively.
• Create consistency in your life to help the liver in this time of change. Go to bed at the same time. Wake up at the same time. Eat at the same time. Create things your body knows it can rely on. Create a feeling of safety in your life.
• Be okay with feeling off balance and a little confused during this period. You will get through it and you will be better for it afterward.

This week we explored the energetic movement of Spring in nature and our bodies. We looked at how associations with Spring show up both literally and metaphorically in our lives and bodies. Next week we will look at the biomedical physiology of how the liver detoxifies our bodies as well as talk more about allergies and how Chinese medicine helps with them. Questions are always welcome.

~Joshuah Ciafardone, L.Ac

Active Release Technique: Soft Tissue Treatment

          Active release technique, also known as ART, is a combination of movement and massage to treat pain in ligaments, nerves, tendons, muscles, and other connective tissue in the body. For over 20 years Sports Doctors have incorporated ART as a tool when treating athletes and for this reason it is quite popular with athletes, but ART can be beneficial for anyone with soft tissue injuries. ART has been getting mainstream attention and has been featured in media sources such as Huffington Post, The Wall Street Journal and Sports Illustrated. A recent Sports Illustrated article documenting Peyton Manning's return to football after 4 neck surgeries has him explaining how ART has been crucial in his road to recovery. 
          Common soft tissue injuries that have been resolved by ART include back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow. These conditions all have one important thing in common: they are often a result of overused muscles. Overused muscles usually occur in one of three ways: acute condition (pulls, tears, collisions), accumulation of small tears (micro-trauma) and not getting enough oxygen (hypoxia). Each of these factors can cause your body to produce tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension on tendons causes tendonitis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and pain. If a nerve is trapped you may also feel tingling, numbness, and weakness.
            ART has been described as a combination of a massage and stretch, but it is far from a typical massage. ART is an intense and rigorous form of therapy where the practitioner applies heavy pressure through his thumbs and fingers to scar tissue while moving the surrounding muscles in a full range of motion. The purpose is to break up the scar tissue, thus reducing pain and unlocking joints, muscles or tendons that are restricting your range of motion. 
            In order to perform ART you must be a certified provider, which entails learning over 500 different protocols and getting re-certified every year.If you have any questions or would like to receive ART care feel free to contact us at Chiro-Health. 







Below are a few pictures of Chiro-Health performing ART on cyclists at the AIDS Life Cycle event in San Francisco. 

                                            Dr.Romo performing ART on a cyclist's hamstring.

                                         Dr.Mazgaloff working on a neck and shoulder.

                                     Dr.Dakoji analyzing a forearm before performing a treatment.

References:
http://www.huffingtonpost.com/2011/08/26/what-active-release-therapy-can-do-for-injured-runners_n_938448.html?utm_hp_ref=fb&src=sp&comm_ref=false
http://online.wsj.com/article/SB10001424127887324640104578165372104222126.html
http://sportsillustrated.cnn.com/vault/article/magazine/MAG1206327/index.htm
http://www.activerelease.com/what_patients.asp

What is Acupuncture & Why Should We Care?

When I began my training in acupuncture I had never received an acupuncture treatment, taken herbs, been cupped, or had moxibustion performed on me. I really didn't know anything about Chinese medicine. All I knew was that I had to go study it. I did not have a choice.

At that point in my life I was working on my B.S. in Biology in the Midwest. Due to several factors it became clear that it was time for me to start studying Chinese medicine. I applied to Five Branches University in Santa Cruz, withdrew from the university I was attending, and called my mother to tell her she was coming out to Missouri in a few weeks to help me move back to California.

Everything worked out and my life and the lives of many people are much better thanks to Chinese medicine. I love continuing to share it people whether it's through patients, family, friends, or educational talks to high school students.

This post will educate you on the basics of Chinese medicine, its history, and its current and potential future role in healthcare. References include the World Health Organization, Blue Poppy Press, and Marilyn Allen.

To begin we'll look at some of the basics of acupuncture, its role in healthcare today, and the regulation of it as a healthcare profession:

• In California acupuncturists are primary care providers (PCPs).
• There is a growing demand for acupuncture and insurance coverage from patients. If your plan doesn't cover acupuncture let your insurance provider know you want it! Your insurance provider works for you and you should be empowered when it comes to your access to healthcare.
• More hospitals in the United States are integrating acupuncture as part of their patient care. In China and other countries acupuncture and herbal medicine are fully integrated in the healthcare system. Western and Chinese medicine used together is shown to provide the best results for patients.
• In the United States ICD-9 codes are used to diagnose health conditions. The rest of the developed world uses ICD-10 codes. We are behind in many areas of healthcare in this country. In the near future everyone will be moving to a new set of codes, ICD-11. With ICD-11, for the first time, codes for traditional medicine will be included (IC-TM). Because Chinese medicine is the fastest growing and most in demand traditional system of healthcare in the world, the first set of IC-TM codes are based on Chinese medical diagnoses. This means acupuncturists will be able to code for conditions such as Liver Qi Stagnation and Heart Blood Vacuity.
• Acupuncture is safe, clean, and effective. Licensed acupuncturists receive over 3300 hours of graduate level education in Chinese medicine, Western medicine, and clinical training. They are skilled in evaluating patients from many angles and systems and integrating their knowledge to provide the best, most effective care for each patient.

There is an already large, growing body of research on acupuncture and its efficacy in treating many conditions. The World Health Organization (WHO) recognizes acupuncture's effectiveness for over forty common disorders, such as:

• Ear, Nose & Throat Disorders - toothaches, earaches, sinusitis, rhinitis, laryngitis
• Respiratory Disorders - colds and flu, bronchitis, asthma, allergies, emphysema
• Gastrointestinal Disorders - food allergies, nausea, indigestion, diarrhea, constipation, ulcers, colitis
• Circulatory Disorders - hypertension, high cholesterol, arteriosclerosis, angina pectoris
• Urogenital Disorders - cystitis, stress incontinence, neurogenic bladder, prostatitis,
• Gynecological Disorders - menstrual irregularity, endometriosis, PMS, infertility, menopause
• Musculoskeletal Disorders - Tennis elbow, frozen shoulder, TMJ sciatica, low back pain, arthritis, carpal tunnel syndrome, fibromyalgia
• Psycho-emotional & Neurological Disorders - depression, anxiety, insomnia, headache, migraine, trigeminal neuralgia, intercostal neuralgia, post-stroke paralysis, dizziness, tinnitus.

Next let's look at some of the basics of Chinese medicine:

• The "branches" of Chinese medicine are acupuncture, herbal medicine, dietetics, bodywork, and health exercises (Qi Gong or Chi Kung).
• Acupuncture involves the insertion of very fine, solid needles into the body at specific points shown to be effective in the treatment of specific health problems. These points have been mapped by the Chinese over thousands of years. In the past few decades, electromagnetic research has confirmed the existence and location of these points.
• Herbal medicine uses a variety of plants, animals, and minerals in the treatment of illness. Chinese herbal medicine is extremely refined in its administering of medicine. It combines many different substances (anywhere from two to twenty ingredients) into formulas to customize the medicine specifically to each patient and their condition.
• Bodywork includes adjustments, realigning bones and muscles, as well as cupping, gua sha, and moxibustion. Cupping involves the suctioning of glass cups to the body via heat to release the muscles, draw out toxins, and stimulate the body's self-healing properties. Moxibustion is a form of heat therapy that involves burning an herb, mugwort, in different forms, either on needles, or directly on the skin.
• Chinese medicine is a holistic health approach that looks at patterns on all levels of a patient's experience (physical, mental, emotional) and gives the patient tools to participate in their healing. Chinese medicine aims to empower the patient in their health and lives and give them tools for personal transformation.

Following are some common questions asked about acupuncture:
How does acupuncture work?

• In spite of the research showing the efficacy of acupuncture in treating many conditions, the actual mechanisms through which it works is unknown in terms of Western medicine. Some people think neurotransmitters, hormones, nerves, or other chemicals in our body are involved.
• Traditional thought on mechanisms of action involve the flow of Qi (an esoteric way of describing the function of the systems of the body) through channels that cover the body much like nerves and blood vessels. Acupuncture adjusts the flow of Qi in the body, bringing it to areas where there isn't enough, and moving it out of areas where it is stuck.
• Basically, acupuncture brings the body into balance and sends messages to the body to tell it to heal itself.

Does it hurt?

• Acupuncture needles are typically not much thicker than a hair. In fact, you can fit three hundred acupuncture needles in the hole of a needle used to give injections and vaccines.
• In some cases you will not even know the needles are in place. Other times there may be some tingling, warmth, or heaviness.
• Most people find acupuncture extremely relaxing and many fall asleep during treatment.
• In the treatment of some conditions trigger points will be used which can feel similar to receiving a deep tissue massage when needled.
• There are different styles of acupuncture and all feel a little different when performed.

When will it work?

• Patients often experience results in the first treatment. Some atients experience an immediate total or partial relief of their pain or other symptoms. This relief may last or some pain may return. In a few cases, there may be no immediate relief only to notice the pain diminish over the next couple of days. Generally, you should expect to feel better.
• Treatment will happen over a period of time to fully correct an issue.

Acupuncture is a safe, effective system of medicine that continues to grow in popularity throughout the world. If you have any questions about Chinese medicine ask a licensed practitioner and receive a treatment. Continue to empower yourself in your life and your healthcare.

~Joshuah Ciafardone, L.Ac

WHO study on acupuncture

The Heart in Chinese Medicine

February is a beautiful month. We are still in Winter but the light has begun to return and we are moving towards Spring. The seeds that were planted last year are beginning to take root and in the same way, symbolically, our intentions for the New Year are beginning to grow and take form. February is the also the month in which we celebrate Valentine's Day. With today being Valentine's Day I decided it would be fun to introduce the Heart as it is viewed in Chinese medicine. In Chinese medicine all the organs in our body have associated channels and meridians. They connect everything and integrate us as whole beings. One way to think of it is like highways connecting different cities together. Everything in Chinese medicine is about connections, relationships, and patterns. In this scheme of things everything is described metaphorically or symbolically to help us understand different aspects of ourselves and how we relate to ourselves and the world around us.

One way of describing the channels and organs in our bodies is by designating them as government officials. The Heart, then, is the Emperor, or Supreme Controller. The job of the Emperor is to keep things ordered, to keep everything organized, in control, and most importantly to delegate what needs to be done to the appropriate people and places. They must find the balance between creating solid boundaries and rules without being overbearing and also allowing for creative freedom. The Emperor must know that he or she cannot do everything on their own and that by knowing what they can do and what someone else can do better there will be health, vitality, and harmony. They must be humble while at the same time recognizing their position and source of power. The Emperor stays in the palace - a safe and sacred space. The essential parts of the Self need to be kept safe and so other officials bring and take information from the Emperor to the rest of the kingdom.

If all that talk about emperors and kingdoms doesn't sit well with your Democratic mind we can look at the Heart from another perspective - the Chinese five elements, or phases/cycles of nature. The Heart is associated with Fire, along with the Small Intestine, Pericardium, and Triple Heater. Fire is about love and relationship. It is about the ways in which we make connections and order our perceptions of reality. The emotion associated with it is joy and its sound is laughter. Fire is about an innate love for being alive. It is like being in a meadow full of wildflowers on a sunny summer day with your arms thrown open, your head thrown back to the sky, and immense joy bubbling out of you as laughter. It is like pressing your head to a loved ones' chest and hearing the beat of their heart. It is the satisfaction of leading a project and seeing it succeed with all the pieces moving together as an integrated whole.

The above are all healthy manifestations of Fire. On the flip side our fire can become imbalanced, either excessively or deficiently. Someone who has lost their love for life and finds no joy in anything or is unable to accept love and affection is someone who is lacking Fire. Those with excessive Fire may be scatterbrained, over-controlling, unable to focus, feverish, overworked, inappropriate, experience palpitations or insomnia, or unable to be comfortable in solitude.

More specifically in regards to the Heart, it's aspect of Fire is the one associated with delegation, with finding joy in seeing one's life working out well. It is about living authentically as oneself and being able to navigate different social situations and relationships with different personalities. The Heart is also the spiritual source of Fire, meaning it finds something more in mundane things. It is the one who sees a Universal connection in a beautiful sunset. The Heart is the essential part of who we are and the authentic expression of who we are in the world around us. The Heart is like the Sun. It is the Fire that burns with no external support. It doesn't need oxygen or wood. It is completely self-sufficient unto itself.

Take notice of the qualities of the Heart and the Fire element over the next few weeks. See where they show up in your life. Where it's easy to connect with them and where you don't feel much resonance. Where are you being authentic in your life? Where can you be more authentic? When could your Heart be more open? When is too open and needs to be protected? Notice how as the season is changing more light and warmth is coming back to the days and how that ignites more fire within us. Next week look for a practical application of the Heart. We'll either look at a case study, research, or application of acupuncture points in treating conditions related to the Heart.

~Joshuah Ciafardone, L.Ac

Easy and Practical Ways to Improve Your Posture

Correct posture is a simple but very important way to keep the many intricate structures in the back and spine healthy. It is much more than cosmetic-good posture and back support are critical to reducing the incidence and levels of back pain and neck pain. Back support is especially important for patients who spend many hours sitting in an office chair or standing throughout the day. 

Not maintaining good posture and adequate back support can add strain to muscles and put stress on the spine. Over time, the stress of poor posture can change the anatomical characteristics of the spine, leading to the possibility of constricted blood vessels and nerves, as well as problems with muscles, discs and joints. All of these can be major contributors to back and neck pain, as well as headaches, fatigue, and possibly even concerns with major organs and breathing.

As a gift this month we are offering free postural evaluations to friends, family and co-workers of our patients. So if you know of anyone that could benefit from our care, have them call us and set an appointment. Below are also simple ways for you to work on your posture and work and at home. 

All you need are two tennis balls. Whether you are at work or your home computer try this easy trick. The idea is to sit up straight and keep the tennis balls pinned against the chair with your shoulder blades.If the balls start to slide down then you know that your posture is incorrect. 

  For this next tip all you need some type of tape that will stay on your skin. This could be special kinesio-tape or first aid tape. Start by retracting you shoulder blades then tape from the middle of one shoulder blade to the other. If you let your shoulders roll forward or begin to slouch you will feel the tape tighten up and pull on you.