Relaxation with Deep Breathing

Effective relaxation techniques provide a powerful antidote to stress; it can revitalize the body, steady the emotions, and create greater mental clarity.  It is a matter of letting go, instead of holding on to, of not doing, rather than doing.  As you relax, muscle tension is reduced and there is a decrease in the activity of the sympathetic nervous system. 

Deep breathing can be learned in minutes and have immediate benefits, but long lasting effects will be appreciated after several weeks of practice.  It can quickly reduce anxiety and pain on the spot, allowing emotional control.  Longer term it can alleviate irritability, muscle tension, fatigue, panic attacks and depression.  Steps for effective deep breathing include:

• Allow for 10 minutes of undisturbed time
• Find a quiet place to sit or lie down
• Close your eyes, scan your body for tension and begin to relax those muscles
• Place your hand on your stomach and breathe through your nose
• Focus breathing through your stomach by visualizing a balloon expanding and contracting
• Count down 10 seconds for each inhale/exhale

Meditation can be added on to deep breathing, by consciously focusing the mind on an object, word, phrase or activity and allowing background noise, thoughts or concerns to fade away.  Follow the steps for deep breathing, but allow your relaxation to deepen by meditating to the natural rhythm of your breathing.  As your mind wanders, choose to bring it back to your focus point.  With practice, you will begin to lose awareness of thoughts and experience a profound stillness of the mind. 

Dental Applications with Cold Laser

The dental profession has been on the leading edge of research using cold laser, with over 100 clinical trials in the last year alone.  The cold laser is effective in reducing pain and inflammation, as well as accelerate soft tissue repair by increasing collagen formation.  The five following dental conditions are common and have shown excellent results by applying cold laser:

TMJ Dysfunction is dentally addressed with TMJ splints to realign a bite issue, but it is often treated in conjunction with manual therapy, as there is increased soft tissue pain and headaches when the splint is adjusted.  Studies have shown that there is a clinically significant reduction in jaw pain and increased mandibular movement with cold laser, as effective as splinting.  Even greater results are shown when using both splints and cold laser together. 

Gingivitis improved dramatically with the inclusion of cold laser with traditional periodontal treatment than with traditional treatment alone.  There was a reduction in bleeding, gum inflammation, and plaque, all important to prevent advancement of dental cavities.

Dental extraction pain can be substantially reduced with using cold laser following the extraction. Studies showed substantial reduction of pain and inflammation and improved healing compared to the control groups.

Orthodontic forces involving braces were split mouth studies, where laser was applied on one side of the mouth only, so the patient is their own control.  There was significant reduction of pain on the laser side after brace readjustments and interestingly increased tooth movement, which could decrease treatment time.  Cold laser was also used in a clinical trial involving maxilla expansion, and there was not only a reduction of pain, but increased opening of the midpalate suture and accelerated bone regeneration compared to the control group. 

Oral ulcers and cold sores are seen secondarily in the dental profession, and using cold laser has shown to not only reduce pain, but speed healing of these conditions and in the instance of cold sores, even help prevent reoccurrence. 

 The amount of time involved for dental applications of laser is minimal, as the area is often small, so only minutes would be required, allowing an easy integration into the dental practice.  But best of all would be improved patient outcomes, and less pain, making it less fearful to go to the dentist!

Negative Self Talk

Self-talk can have a powerful impact on your emotional well-being and motivation.  Unfortunately negative self-talk has a way of becoming a self-fulfilling prophecy, which can occur when there is a stressful life event, when you are anxious or when you are feeling down on yourself.  At these times, you are least able to be truly rational and objective. The key is to recognize flawed self-talk and replace the errors with more appropriate thinking, a strategy often used in cognitive behavioral therapy. 

Some examples of flawed thinking:

·         All or nothing thinking: if anything is less than perfect, you see it as total failure

·         Filtering out the positive: you think positive outcomes were just dumb luck

·         Jumping to conclusions: either mind reading, when you conclude someone is reacting negatively to you or fortune telling, where you predict things will turn out bad

·         Magnification: you exaggerate the importance of your problems or short comings

·         Should statements: you tell yourself that things should be the way you expected them to be, often not reality

·         Labeling: instead of saying I made a mistake you attach a negative label, I am a loser

·         Self blame: you hold yourself personally responsible for events not in your control

Positive self talk can give you the confidence to use your talents to the fullest.  Remember your positive traits and skills when your thoughts turn negative. Review your previous successes in your mind and correct your flawed self talk.  The ultimate purpose of examining your self-talk is to change actions that are self defeating.  The real power of self talk lies in how it changes your behavior.

How Does Cold Laser Work?

Cold laser, or low level laser, was added as a new service at the White House in May 2011.  Since using this new technology, we have been having great results with a variety of muscle, tendon, ligament, joint, and nerve conditions. 

Cold laser works by activating three biological pathways:

·         Adenosine Triphosphate (ATP) Pathway:  The mitochondria (the cell engine) absorbs the light energy and chemically converts it into ATP, which is the cell’s fuel.  This process accelerates tissue regeneration by increasing synthesis of collagen, the building block of all soft tissue.  Secondary reactions include increased protein synthesis and stimulating cell division.

·         Nitric Oxide Pathway:  Nitric Oxide relaxes the lymphatic system, which allows reabsorption to occur, reducing inflammation and pain.  There is also an increase in vasodilation, to get more blood and oxygen to injured tissues.

·         Lipid Absorption Pathway:  Increased porosity of the cell membrane allows a rebalancing of the sodium-potassium pump, thereby decreasing the pain signal.  Low level laser also reduces pain by stimulating endorphin synthesis, the body’s natural pain reliever.

The end result of cold laser treatment is to not only reduce pain and speed up healing time, but by naturally increasing collagen synthesis, you have true tissue repair at a cellular level! 

Why Europeans are Skinnier than North Americans

I am late publishing a monthly blog as my family spent three weeks in Europe visiting four countries (Netherlands, France, Austria and Croatia).  While it has been 10 years since returning to Europe, I was even more "hit in the face" at how much slimmer Europeans are compared to North Americans. 

The food was very similar to what we would eat (McDonald's is everywhere), and they seem to eat more bread, cheeses and processed meats, but I found it difficult to see any native Europeans that were obese.  An observation was also made of not only the higher amount of alcohol consumed (beer is cheaper than coke), but also the large number of smokers, particularly in Paris. 

So why are the Europeans slimmer?  My only conclusion can be that they walk more, as many do not own cars in the city, due to lack of parking and high cost, and also excellent transportation systems.  In Amsterdam, they have also developed an impressive bike system, with bike lanes paralleling roads and bike parking lots.  I had never seen women in short skirts and high heels bike before, but it can be done! 

On spending time in rural Austria, however, I did find much more "weighty" people, as they were more reliant on vehicles.  So a conclusion can be made,  that we have to encourage more people to get out of their cars and on to their feet or bikes.  This will only be possible if we have more compact cities, and also improved public transit.  A three times expected load of the light rail transit system in one year happened in Vancouver after the Canada Line was constucted for the Olympics.  So the old saying goes "build it and they will come"! 

Neck Pain: No Drugs Required

A January 2012 study published in the Annals of Internal Medicine has found that conservative care consisting of either spinal manipulation or home exercise to be more effective than over the counter and prescription medication for relieving both acute and subacute neck pain.  The study involved 272 adults with nonspecific (muscle-ligament-joint) neck pain of 2-12 weeks duration, excluding more serious pathologies such as discs, fractures, and instabilities. 

Subjects were randomized into three groups for 12 weeks: spinal manipulation (SMT), home exercise and medication. Self report outcomes (pain, function) were measured at 2, 4, 8 and 12 weeks during the trial period,  and at 6 and 12 months follow up.  Results were as follows:

12 week comparisions of pain reduction

Improvement                   >50%                     75%                        100%

SMT Group                       82 %                       57 %                       32 %

Exercise Group                 77 %                       48 %                       30 %

Medication Group           69 %                       33 %                       13 %

At long term follow up, 75 % at 6 months, and 81 % at 12 months of SMT group reported at least a 50 % reduction of pain.  71 % at 6 months and 69 % of 12 months of exercise groups reported at least a 50 % reduction of pain.  59 % of 6 month and 69 % at 12 month of the medication group had a pain reduction of at least 50 %. 

What can be concluded is that both the SMT and exercise groups had similar short and long term outcomes, more favorable than the medication group.  This further reinforces past research which has shown active therapies for neck and back pain (exercise and manipulation) to be the most effective treatment for these common and reoccurring conditions.

Four Pillars to Manage Osteoarthritis

Osteoarthritis (OA), common in 80% of the population after age 50, is considered an inevitable part of aging, but research is showing that there are steps you can take to minimize OA or stabilize further joint erosion once you have it.   A contributing cause of OA is now thought to be due to age related decline in the body’s synthesis of glucosamine after the age of 40.  Glucosamine is important in making proteogylcans, the ground substance to form joint cartilage; as well as hyaluronic acid, which is used to increase viscosity of synovial fluid to reduce wear and tear on the joints and allow nutrition to the cartilage.

Inflammation occurs with the degeneration of cartilage and causes the pain associated with OA.  Inflammation occurs when the body makes a hormone like substance called prostaglandin-2 (PG2), whereas the synthesis of PG1 and PG3 exert and anti-inflammatory effect and can control the symptoms of OA.  PG2 is produced by the polyunsaturated fats that we consume, mainly from high fat meat and dairy products.  Omega-3 fats from fish and flaxseed provides the building blocks for PG3 and borage oil, evening primrose oil and black current oils for PG1.  There is also a natural anti-inflammatory that is often used in OA, MSM, which research shows not only helps inflammation but the sulfur in MSM is used to make enzymes that are needed for connective tissue, such as cartilage.

The first two pillars of managing osteoarthritis involve dietary changes and supplements to improve the structural integrity of the joint itself.  The other two pillars involve improving the function of the joint.  As cartilage has no blood supply, it relies on its nutrition from the synovial fluid, but if there is no movement in the joint, this increases the likelihood of OA changes to develop.  Movement of the joint involves exercise, which is important even in advanced OA to decrease joint stiffness and slow progression of the disease.   If the joint becomes fixated, periodic treatment from a manual therapist such as a chiropractor to mobilize and manipulate joints is also recommended to maintain joint function. 

Four Pillars of Osteoarthritis Prevention and Treatment

1. Eat a diet low in saturated fats: reduce red meat, dairy products above 1% MF, fried foods, high fat pastries
2. Supplement with Omega -3 (1200 mg/day) and Gluscosamine Sulfate (1500 mg/day) with additional MSM (400 mg/day)
3. 30 minutes at least 3 times a week of endurance exercise (walking,biking,swimming), adding strengthening  and flexibility exercises is also beneficial
4. Periodic mobilization or manipulation of fixated joints (monthly maintenance)

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in athletes, particularly young women and those who are involved in running.  The pain is felt around or behind the kneecap, and is often of gradual onset unless trauma is involved.  There is increased pain with prolonged sitting (knee flexion), stair climbing, squatting, running, kneeling and jumping.  Generally there is no swelling around the knee cap, nor is there any pain in the patella tendon or surrounding ligaments.

PFPS is usually a functional problem rather than a structural one.  It has to be differentiated from another patella condition, chondromalacia, which is the wearing down of the cartilage under the knee cap, and may accompany PFPS.  The causes are multifactorial and can be broken down into three categories:

Biomechanical, or patellar tracking problems, are caused by lower extremity malalignment, which pulls the patella out of its groove.  Factors such as flat feet which cause the knee to internally rotate (knock knees) and wider Q angles of the hip, which are more common in women, contribute to PFPS.  A “J” sign can be seen with lateral patellar tracking, as the knee is extended from 90 degrees of flexion to full extension. 

Muscular imbalance is another factor, with weak quad muscles (particularly the medial quad) and a tight iliotibial band and hamstring, as well as weak hip extensors/abductors and tight hip flexors. Overuse or overload of the patella caused by repeated weight bearing impact, such as with running, is also a contributing factor in PFPS. 

 Conservative treatment is multipronged, based on the underlying reasons for the PFPS.  Relative rest from aggravating activity (running) to another non impact activity (swimming, elliptical); icing after activity; cold laser therapy to reduce pain/inflammation and heal the tissue; taping or a knee brace with a U shaped insert to keep the patella in alignment; orthotics to help support the arch; and specific exercises to strengthen weak muscles (quads and gluts) and stretch tight muscles (TFL ,hams and psoas).  Rarely surgery is indicated, but true chondromalacia may be amenable to arthroscopic surgery to smooth out the cartilage under the knee cap, and lateral retinaculum release if the problem is caused by excessive lateral pulling.

Peripheral Neuropathy

Peripheral neuropathy is nerve damage which is caused by long standing diabetes.  The injury to the blood vessels by elevated blood sugars causes a lack of oxygen and nutrients to the nerves, most commonly in the toes, feet and lower legs, but also in the fingers and hands.

Symptoms include progressive numbness or insensitivity to pain or temperature; tingling, burning, prickling sensation; sharp pain or cramps; or extreme sensitivity to touch.  If symptoms are in the lower limbs, loss of balance or coordination can occur because of the weakened muscles leading to falls.  Blisters or sores may develop in numb areas, resulting in infections which may lead to amputation, making it important to have regular foot exams.

The risk of developing neuropathy increases with age and with those who have uncontrolled blood sugars, elevated blood fat, and high blood pressure.    Other causes include autoimmune factors which lead to inflammation of the nerves and smoking which decreased oxygen to tissues.

Besides keeping the blood sugars in a normal range, treatment for pain includes antidepressants, anticonvulsants or opiods; and topical lidocaine or capsaicin cream.  Some supplements that have shown promise include alpha lipoic acid (50mg/day) and omega 3 oils for inflammation.  Acupuncture may also help with pain control.  A newer therapy, cold laser, has shown in clinical trials to increase blood flow and help regenerate damaged nerves as well as accelerate wound healing for diabetic ulcers.

Sources:

 http://diabetes.niddk.nih.gov/dm/pubs/neuropathies

Diabetic distal symmetric polyneuropathy: effect of low intensity laser therapy; Lasers Med Sci, 2011

A randomized clinical trial on the effect of low level laser therapy on chronic diabetic foot wound healing; Photmed Laser Surg; 2011

Cold Laser in the treatment of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is caused by the entrapment of the median nerve as it travels through the carpal tunnel in the wrist.  Signs are pain, numbness and paresthesia in the thumb, index, middle and inside ring finger; increased pain and numbness at night due to prolonged wrist flexion; and if long standing, weakness in pinching and grip strength and atrophy of the hand muscles. 

Causes of CTS include inflammatory conditions such as pregnancy, rheumatoid arthritis, hypothyroidism, diabetes, and obesity.  Cumulative trauma from repetitive activities such as typing and guitar playing which puts the wrist into forced flexed positions are also implicated.  History and clinical tests to stress the nerve give a diagnosis, with a nerve conduction study being conclusive. 

Non surgical treatments have included night splints, NSAIDs, cortisone injections, ultrasound and modifying or changing certain activities.  Cold laser, a new treatment now being offered at our clinic, has shown promise in treating CTS to reduce pain and inflammation, as well accelerate healing. Surgical release of the carpal ligament may be indicated if conservative treatment has failed, if so cold laser can also be used post surgically to assist in healing. 

Several recent clinical trials have compared cold laser with sham laser, splinting and ultrasound. Results have shown cold laser to be effective in pain alleviation; reducing the numbness and paresthesia; improving hand grip strength and even improved EMG findings with no side effects, and to be superior to both splinting and ultrasound.   

Sources: The effectiveness of conservative treatment of carpal tunnel syndrome: splinting, ultrasound, and low level laser therapies; Photomed Laser Surg, Feb 2009 and The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome; Electromyogr Clin Neurophysiol; June 2008                                              

Sports Supplements that are Clinically Proven to Work

Athletes may ask about the value of certain supplements to enhance performance or gain muscle strength, but many supplements have more hype than science to support their use. While whey protein in shakes to replace protein loss during workouts is common, creatine, L-glutamine, ornithine and arginine also top the list of legitimate sports supplements. 

Creatine leads to an increase in muscle mass which is thought to occur from increased protein synthesis, this allows athletes to train harder as there is increased energy available for muscle contraction, promoting strength gain.  Creatine can also preserve strength as athletes age, keeping them functional longer. A loading dose of creatine monohydrate crystals is 20-25 grams per day for the first week, and than 10 grams per day for maintenance. 

 L-glutamine has been shown to decrease muscle breakdown during workouts and also reduce the incidence of upper respiratory infections by providing fuel for immune cells.  Optimal dosage of L-glutamine is 1,000 – 2,000 mg per day.

Ornithine and arginine are amino acids that have been shown to increase the release of growth hormone.  As we age, growth hormone declines, facilitating breakdown of lean muscle and bone mass.  Supplementing with arginine and ornithine may not only enhance muscle mass and strength gains, but as it elevates metabolism, it can help reduce body fat too.  Recommended dosage is 500 mg twice a day for five days a week.

So to maximize your athletic performance, consider using creatine monohydrate, L-glutamine, ornithine and arginine at these clinically proven dosages stirred into a glass of juice on an empty stomach.  Happy training!

Author:  James Meschino, DC, MS, ND; Dynamic Chiropractic

Laser Therapy for Shoulder Impingement

A 2011 study published in Clinical Rheumatology compared the traditional treatment of exercise for impingement syndrome of the shoulder to exercise with the addition of low level laser therapy.  Research has shown low level laser therapy to be beneficial in accelerating tissue repair by increasing fibroblast formation and circulation, while also decreasing inflammation and pain.

80 patients were divided into two groups; with neither the participant nor therapist knowing which patients were receiving laser therapy or sham laser.  Treatment consisted of 10 sessions over two weeks.  The intervention group showed significant improvement in both pain and increased range of motion than the exercise group alone.  The results were further strengthened as the same therapist performed all the treatment, eliminating practitioner bias. 

One weakness of the study was that the study did not differentiate only impingement syndrome, but rather lumped it with biceps tendonitis and other rotator cuff pathologies as they commonly occur together.   Strengths of the study were not only the large research group and “gold standard” of being double blinded and randomized, but that the low level laser improved the pain and range of motion, regardless of the underlying musculoskeletal condition. 

 

Manipulation or Exercise for Low Back Pain?

Low back pain affects 80% of the population at some point in their life, costing billions of dollars in lost productivity and health care.  There are many different treatment options available as individual response to care is unique.  A 2011 clinical trial reported in The Spine Journal compared two proven conservative care therapies, spinal manipulation and exercise, in chronic low back pain.

 

300 participants were divided into three groups: supervised exercise; spinal manipulation and home exercise with advice for a 12 week program.  There were equally improved outcomes in all groups, with a 40-50% reduction in pain and disability.  As would be expected, endurance and strength improved in the exercise groups more than the manipulation group.   

Results parallel the 2004 UK BEAM study comparing spinal manipulation and exercise, which found that manipulation and exercise were equally successful in treating low back pain, but that spinal manipulation combined with exercise did better than manipulation or exercise alone.  This supports what chiropractors have been doing for years, keeping the spines of patients functional through manipulation and providing exercise advice and encouragement to strengthen the core to stabilize the spine. 

Managing Pain with Acupuncture

Inflammation is the first phase of healing, but the pain associated with this inflammation may predispose some patients to chronic pain and disability.  If the initial pain experience is severe and continues, central pain hypersensitivity may develop.  Early intervention and prevention remain the best treatment, with rapid pain relief being the key. 

Acupuncture reduces pain via two different mechanisms.  It decreases the stimulation of nerve signals that lead to pain and it also reduces the expression of inflammatory chemicals that stimulate nerve endings that cause pain. 

Acupuncture may provide an analgesic effect by encouraging release of opiate based chemicals in the body and release of serotonin in the central nervous system.  It may also inhibit stimulation of the sympathetic nervous system to regulate inflammation and pain.  Acupuncture also seems to suppress Cox-2 in the spinal cord; Cox inhibitors are commonly used with some NSAIDs. 

If the patient’s pain is desensitized and there is increase tolerance to painful activities and therapy, the patient will hopefully avoid chronic pain syndrome and recover function faster to get their life back!