ART - Active Release Technique

A lot of people have heard of ART, or Active Release Technique, but most don't know what it is or how it can be helpful. ART is just one of the many methods of treatment we use in our office to help our patients get better as fast as possible. It is a specialized form of massage commonly used in sports medicine, and its goal is to reduce muscle tension while re-aligning muscle fibers and breaking up scar tissue. Because of its multiple effects, ART is a very powerful therapy. It can easily be over-done or done incorrectly, resulting in significant and long-lasting muscle soreness after treatment. For this reason, it is important to only ever receive ART from a licensed ART practitioner.

A common use for ART is for rotator cuff muscles. In this case, the patient is usually seated with the doctor standing behind them. The patient will shorten the muscle being treated and the doctor will use their hand to "pin down" the muscle in the appropriate location. The patient then moves their arm through a prescribed range of motion while the doctor maintains pressure, causing the muscle to move under the doctor's hand. This motion is what separates ART from other forms of massage. By having the patient actively use their arm, the neurologic input to the area of treatment is significantly increased. In addition, by "pulling" along the muscle fibers, the fibers themselves can be re-aligned and any scar tissue in the area is broken up.

As you might imagine, this is an extremely effective therapy!

Case of the Week: Reynaud's Syndrome

Raynaud’s Syndrome is actually more common than most people think. The symptoms typically present as numbness or a feeling of cold in the hands or fingers, caused by constrictionof the small bloodvessels, called capillaries. In our office, our most recent patient presented with her fingers noticeably white from base to tip. She was complaining of numbness in her fingers and a feeling of constantly being cold. She was also under a significant amount of stress at work and at home, and the increase in her hand symptoms over the last few weeks had added to the stress. She reported that the feeling of numbness and cold seemed to get better and worse throughout the day and night, without any apparent pattern. She had tried wearing gloves and using hot packs on her hands, but the relief they provided was only temporary.

Raynaud’s is most common in women from the ages 18-30, and is typically aggravated by emotional stress. In order to actually be diagnosed with Raynaud's syndrome, the patient is supposed to have had symptoms for at least 2 years. Otherwise, it is supposed to be called Raynaud's phenomenon.

In our patient’s case, there was really very little physically wrong with her. Her pulses were strong and regular, her sensation in her hand was normal, and there were no muscles or joints affecting the ability of the nerves to transmit information. Our recommendation for the patient was to find a way to decrease her emotional stress. We recommended seeing a counselor and arranging to take some time off work. In the mean time, reducing her exposure to cold temperatures, especially to her hands, would help decrease symptoms.

A follow-up revealed the patient’s symptoms had decreased to a manageable level within a few weeks of focusing on stress-reduction.

Chiropractic Care for Infants and Children

I’ve had a lot of people ask me, lately, “Kids don’t need chiropractic care, right?”. WRONG! Kids need chiropractic care most of all! Think about it. Chiropractic teaches the body how to maintain itself in a healthy position to allow maximum function. If a child’s body is taught how to maintain its health, they have a much sturdier foundation for the rest of their life. Studies have shown that kids who receive chiropractic check-ups have less chance of developing health problems like scoliosis. There are even case studies that indicate colicy infants just need to be adjusted!

The other great things about kids getting chiropractic care is how easy it is. Kids’ joints adjust very easily and they don’t need many adjustments before their body learns the proper alignment. And it’s fun! Every little kid I have ever adjusted giggles afterward. It doesn’t hurt and it’s not scary. In fact, I know one toddler who refuses to see her pediatrician without kicking and screaming, but will literally run into the arms of her chiropractor. Kids have an innate sense of what is best for their body, and they know chiropractic helps them with that.

So, take your kids in for a check up. Make sure you see a chiropractor who is comfortable treating children, because, as much as we love them, kids do come with their own unique set of complications. In my office, we often check the kids for free when the parents come for treatment. It’s that important to us that these young bodies are put on the right path.

For more information on infant and childhood chiropractic care, visit the International Chiropractic Pediatric Association. I should warn you that the ICPA is a little over-zealous on some topics, so take it with a grain of salt. They are a great resource for finding a kid-friendly chiro in your area, though.

Case of the Week: Bicyclist Knee Pain

Patient: 30 year old IT consultant

Presentation: Patient has signed up to participate in a week-long bicycle trek from Los Angeles to San Francisco in the first week of June. In his training for this ride, he has been taking longer and longer rides on the weekends and short rides during the week. This past weekend, he tried to take a 74 mile ride, but had to stop at 30 miles due to right knee pain. This pain has been nagging for the last few weeks, but only presents while cycling and usually goes away once the ride is over. This past week, the pain was significant enough that he stopped riding, and walked back to an area where he could call a friend to pick him up and bring him home. There is no radiation of pain, numbness, tingling or significant weakness. He has never had an injury to the right side and has not other complaints.

Examination: The right vastus medialis oblique (VMO) is tight and tender +2/4 with mild edema (swelling) at the insertion on the patella. Right knee range of motion is within normal limits. Muscle testing reveals a weak right VMO. Deep tendon reflexes are within normal, as is sensation in the lower extremities. Orthopedic tests for meniscus involvement, chondromalacia patella, cruciate ligament tears and medial or lateral instability were all negative.

Discussion: As we have previously discussed, the muscle balance in the knee is crucial. When performing a repetitive motion, such as cycling, the knee is repeatedly put under stress in both flexion and extension. If the muscles of the knee are not putting synchronized forces on it, irritation can result. In this case, the patient already had a weakness in his right VMO. He just never noticed it until he was training for this ride. The VMO is a common muscle to have a weakness in. It doesn’t mean he trained incorrectly or was somehow deficient. Many athletes, including runners, cyclists and skiers end up irritating their VMO’s with increased activity. The key is early detection and appropriate strengthening.

In this case, the patient has already significantly irritated the VMO. It is fortunate that he has decided to seek help at this time because continuing to train on an injured knee could lead to even more significant injuries later on. As the knee flexes and extends, the VMO and the Vastus Lateralis Oblique(VLO) must pull on the knee cap (patella) equally to ensure that it tracks in a straight line up and down. When the VMO is weak, the patella does not track properly, leading to pain, inflammation and eventual damage to the joint.

Treatment: First, we need to prevent further irritation and control pain. We do this by icing the affected area, gentle massage to promote lymphatic drainage, and myofascial release to reduce tension in the VMO. Once the VMO is loose and no longer irritated, the patient must begin a specific strengthening regime to build up the VMO. It is important to strengthen evenly on both legs to ensure proper muscle balance.

Outcome: The patient is improving steadily. He has been able to go on several short rides without pain, and is looking forward to increasing his distance now that his knee is balanced.

Suggestion of the Week:
Get good equipment
If you are a cyclist, buy the best bike you can afford. Then have it fitted to you by an expert. (This is a link to the best bike fit guy I know). A good bike fit should NOT take only 10 minutes. There are a lot of little aspects of fitting a bike to its rider that must be taken into account. Without a good bike fit, you are more prone to injury and you will be less efficient in your riding, making you slower and more fatigued. Same goes if you are a runner. Get your feet evaluated and buy shoes for your feet and your needs. Then, take care of them! Keep a log of how many miles your shoes have on them. Once a shoe has hit between 300 and 500 miles (depending on the brand) you need to make them your new gardening shoes. A running shoe has a lifespan and trying to push a shoe past its life will only result in decreased performance and possible injury.

Exercise of the Week:
VMO Strengthening
This is so easy, it’s ridiculous. Sit in a chair. Turn your foot out as much as you can. Straighten your leg. Return your foot to the floor. Repeat until you feel fatigue in the lower middle section of your thigh muscle. If you need more of a challenge, add a small weight to your ankle or use tubing tied to your foot and the chair leg. By turning your foot out, you isolate the VMO. Don’t be surprised if you have less endurance and strength in this position than you do with your leg straight. When the leg is straight, you are using all of your quadriceps. By isolating the VMO, you can strengthen focally and improve the muscle balance across your knee. (Image provided by Dr. Henry Domke, The Living Healthly Podcast)

Osteoarthritis

This week's post is from our practice newsletter. Osteoartritis is something that affects all of us and I think it's important to stay informed.

Osteoarthritis and You

Did you know that 90% of all adults age 50 and older have some degree of osteoarthritis (OA)? That’s practically everybody! OA is arthritis that results from gravitational forces pulling on the body. Without intervention, OA can result in significant joint degeneration and will eventually result in joint fusion. Since we cannot avoid gravity, how are we supposed to prevent this from happening?

Then answer is movement. Studies show that when a joint is kept immobile, the process of OA accelerates dramatically. When movement is restored, the degeneration slows again. On a large scale, the best thing we can do is KEEP MOVING: take a walk, swim, stretch, roll your shoulders, make circles with your wrists and ankles. On the small scale, you need an expert. Chiropractors are trained to find joints that are not moving enough and help them move better. Every time you get adjusted it is one more step in the fight against OA.

If you want to learn more about OA or other types of arthritis, stop by the office to pick up a free brochure on your topic of interest. These are provided by the Arthritis Foundation to help our patients learn about the dangers of arthritis and how to prevent it from happening to them.

The Arthritis Foundation is also a great resource for information on local aquatic exercise programs. A lot of arthritis sufferers feel the worst when they are cold, making exercise such as swimming difficult. Because swimming is a low-gravity activity, it is the perfect exercise for people with arthritis. To solve the obvious problem, the Arthritis Foundation has begun aquatic exercise programs where the pools are HEATED. Not hot tub temperatures, just pleasantly warm. There are three heated pools in San Francisco, alone, and many others across the Bay Area. You can contact us at the office or the Arthritis Foundation to find a heated pool near you.

Case of the Week – TMJ Headache

Patient: 35 year old male police officer

Patient presents complaining of nagging headaches located on both sides of his head. The pain is throbbing but not pulsating; pain can spread to the forehead as the condition worsens. He has headaches 2-3 times per week, but there is no time of day or activity that seems to aggravate the symptoms. He has tried Advil, which helps, and increasing his water intake. The frequency of the headaches is increasing and he is concerned the pain will begin to affect his judgment at work. The patient has had temporomandibular joint (TMJ) issues in the past and has been prescribed a night guard by his dentist. He clenches and grinds his teeth in his sleep, causing him to wear through one night guard per year.

Physical examination reveals abnormal TMJ gait, with the jaw swinging out to the left upon opening and following the same course upon return. The action is accompanied by popping in the right TMJ. The TMJ muscle group (masseter, temporalis, medial and lateral pterygoids) is tight and tender with trigger points bilaterally. Trigger points in the lateral pterygoids reproduce the patient’s headache. There is restricted motion of the left TMJ and the right C1-2 vertebral facet joint. Other testing, including vascular, neurologic and orthopedic testing of the neck and head are within normal limits.

Discussion: In this case, the patient had increased muscle tension in the jaw complex, causing a referral headache similar in mechanism to a tension headache. As the muscles tighten, the TMJ is compressed which decreases its ability to move properly and causes pain and inflammation. Our goal here is to first release the tension in the muscles and joints of the complex, including the upper cervical vertebrae. This will help the patient get out of pain. The second and more important goal is to find the cause of muscle tension and eliminate it. Without finding the root cause, the problem will continue to crop-up, over and over again.

Many people don’t realize that it is possible to massage the muscles of the jaw from inside the mouth. This is really the best way to access them, especially the pterygoid group, and can be a very simple but effective procedure. The doctor uses a gloved finger to gently apply pressure to the areas of tension until the tension is released, just as in traditional myofascial release. Once the muscles of the jaw are relaxed, the TMJ itself can be adjusted. In this patient’s case, the left joint was not moving well, causing the right joint to be hypermobile. We adjusted the patient’s left TMJ using gentle chiropractic manipulation and also adjusted the upper cervical joints to complement the new motion in the jaw.

It is important to note that the TMJ and the upper cervical joints have a very close relationship. Often, adjusting only the neck will relieve the tension in the TMJ. Other times, the TMJ is really the source of neck pain and the TMJ should be addressed first. In this case, the TMJ was the primary issue, so the treatment to the neck was only in relation to the TMJ’s needs.

It is also very common for people to suddenly develop TMJ problems after protracted dental work, orthodontics or a motor vehicle accident.

For a cool perspective from a dentist who later became a chirorpactor, visit this link: http://findarticles.com/p/articles/mi_qa3841/is_200104/ai_n8931215/pg_1

Outcome: With a course of myofascial release and chiropractic manipulation, the patient’s headaches decreased and finally disappeared within 3 weeks. In this case, we found that the patient’s night guard from his dentist was not fitted properly. This, combined with increased stress at work, was causing irritation to the muscles and resulting in headaches. With a new night guard and stress-reduction techniques, the patient was had a full recovery.

Exercise of the week: If you suspect you have TMJ pain, try this: Wrap the eraser end of a pencil in a sturdy paper towel, creating a bulb of about 2cm in thickness. Using the writing end of the pencil as a handle, place the bulb at the very back of the mouth, to the side where your teeth end and the soft tissue of the jaw begins. Bite down slowly on the bulb. This creates a gapping motion in the TMJ itself and can give pain relief to a compressed joint. Make sure to try both sides. If this exercise provided pain relief for your jaw, you may want to seek a chiropractic consultation to evaluate your TMJ complex.
Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

Suggestion of the week: Evaluate your own TMJ gait
Stand facing a mirror and very slowly open and close your mouth repeatedly. Open it all the way and close it all the way. Watch your chin. Your chin should follow a straight line up and down. If it curves off to one side in a C shape or S shaped pattern, your TMJs are not functioning properly. Also, if you have significant clicking or popping in your jaw with opening and closing the mouth, it can indicate a problem with the TMJ. Try it today and see how your jaw is doing!
Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

Events, Events and More Events!

Spring is here and that means community outreach! Now that the warmer weather is upon us, we are working hard to educate people about chiropractic with every free moment we have.

This past weekend, we were at the AIDS Lifecycle expo. (http://www.aidslifecycle.org/) For those who don’t know, the AIDS Lifecycle is a week-long bike ride from San Francisco to LA that takes place every summer. The riders pledge to raise at least $2500 each and the money goes to AIDS education and awareness. This is such an awesome event to be a part of, and I love helping the riders. Many of the riders are not experienced cyclists and it is fun to watch them grow in their training rides. Many of them end up on my chiropractic table at some point and we work through those injuries as well. It is so rewarding to be helping people participate in such a great event. Maybe one of these years I’ll be on the ride with them:)

Also, because April is Stress Awareness Month (http://www.stresscure.com/), we are going to be in local bank branches doing quick and fun public education on stress and its effects on health. Next week we’re going to be at the local B of A and the week after that we’ll be at WaMu (woohoo!). I’m excited about it because it’s always fun to get out into the public and answer people’s health questions. I find that a lot of people really do care about their health, they’ve just never have the opportunity to get all their questions answered by a professional. Most doctors spend less than 5 minutes per patient, which doesn’t leave time for much in the way of questions. I’m hoping these events in the banks will be helpful for everyone. Especially this time of year, when taxes are due, and with the way the economy is tanking, I think we can all use a little extra stress relief!

In closing I just want to say that I’m really looking forward to spring and I hope some of you will stop by and see us one of these days. We’re always out on the town and would love to say hi.


Suggestion of the week: Visit http://www.aidslifecycle.org/ and donate to help the riders. It doesn’t have to be much. Even a dollar is more than they had before you donated. Or, if you prefer, find out how you can help by volunteering or find a way to support the riders like we do, with healthcare. Find a way to donate bike clothes, get reduced prices on tune-ups, or some other creative way to show you care. Have fun with it! You’ll feel better when you’re done:)

Exercise fo the week: Breathe.
No, seriously. Breathing is an exercise. Most of us spend our days hunched over a computer or in a car and our lungs are constantly under-inflated. Sit up straight and breath in slowly while counting to 4 in your head. Hold the breath for a count of 4 and then exhale slowly for a count of 4. Take a break and repeat. This is called 4x4x4 breathing. Advanced athletes can breathe at higher counts, like 7x7x7, and some of you may want to start at 3x3x3, but try it and see. Bringing your consciousness to your breathe helps quiet the mind AND increases the amount of oxygen available to your tissues…always a good thing!

Never engage in an exercise before consulting your chiropractic physician to determine if it is same for you and your unique conditions