If you watch TV or scour the internet for fibromyalgia info you probably have heard of the term 'central sensitiztion'. This is the term given to fibromyalgia (FMS) by the "researchers" who mostly promoted pharmaceutical drugs for the syndrome. The reason I use quotations around researchers is because 'central sensitization' is NOT the cause of fibromyalgia. Dr. Alex Vasquez, in his numerous books on the topic, has clearly discounted 'central sensitization' as the cause.
A research group from Spain has proven that inflammation has a real link to fibromyalgia. They did a study with women using diagnosed FMS patients and healthy, age-matched controls and confirmed the IL-8 is elevated in all of the FMS patients. They also found CRP, an inflammatory marker, to be elevated significantly in FMS patients as well.
This was the first study of its kind to show CRP elevated in FMS. We know FMS is partly caused by excessive inflammation. Cytokines lead to increases pain and sensitivity to pain. IL-8 specifically increases sympathetic pain when elevated, which can be problematic in a pain syndrome like FMS. Science has already shown that increases in inflammation lead to increased pain. This makes logical sense that inflammation leads to pain, and would be elevated in a pain condition like FMS.
FMS is a complex, multi-faceted syndrome or disease that affects a lot of people in the United States and the world. Understanding the causes is of utmost importance, and the US is last in the pack of understanding. Researchers create causes in order to sell drugs. 'Central sensitization' fits perfectly with the 3 drugs approved for FMS, which incidentally, all have black box warnings. Black box warnings mean they can increase your risk of dying, usually by suicide. Sounds appealling right?
Spanish researchers have shown now, inflammation is a cause of the pain in FMS. This makes sense because there is diagnosable muscle damage with FMS, and muscle damage is a pretty good cause of inflammation, among other things.
Sources:
Thursday, January 9, 2014
Tuesday, November 19, 2013
How to come out of the Holiday Season ahead.
I have been getting a lot of questions from patients about how to beat the holidays and not gain weight. Thanksgiving is next week, with the rest of the holidays of holiday season vastly approaching. So, what can you do to maintain, and possibly even lose weight over the holidays?
Here are 4 simple strategies to avoid the holiday weight gain, and actually come out ahead...
1) Earn your carbs/sweets/desserts/sugar/anything that spikes blood sugar...
What does that mean? Earn your carbs? That means if you are going to eat dessert, you have to earn them. For every 1 serving of dessert you eat, you must workout, hard (to a sweat), for 30 minutes. There is a receptor called the GLUT 4 receptor. This receptor becomes up-regulated with exercise. The important thing about this receptor is it helps the cells use glucose without the help of insulin. So when you work out you can eat sugar for a certain period of time without a high insulin response. Body builders know this as carb loading or carb cycling.
EARN YOUR CARBS!!!
2) Eat breakfast. More specifically eat protein and fat for breakfast.
Researchers have shown eating breakfast decreases over eating at the end of the day. Skipping breakfast in order to have "room" for Thanksgiving dinner will only lead to over eating. You don't get tired from the turkey. You get tired because you over ate. To remedy this situation, eat breakfast on Thanksgiving and all holiday dinner days.
Eating breakfast is only the first part of the equation. Research out of Australia found that the type of breakfast you ate plays a huge role in eating throughout the day. Eating a high glycemic index breakfast, like corn flakes (or any cereal for that matter), will lead to over eating, specifically carbohydrates. The group that ate a high protein breakfast ate less, and avoided processed carbs.
So the trick to not over eat is breakfast. Not just eating breakfast, but making sure it is a high protein breakfast. The other, even more important (in my opinion) reason to eat a high protein breakfast is for brain function. The brain needs amino acids to drive proper neurotransmitter function. Amino acids are in protein. Therefore, a high protein breakfast is good for brain function. It increases drive, focus and mood.
3) Eat protein first.
When sitting down for a big holiday meal go for the protein first. Protein is satiating, meaning it will fill you up. High glycemic index foods like potatoes or bread will increase blood sugar fast and cause you to eat more. Think, what do restaurants serve you first? There is a reason for that...
4) Limit alcohol consumption.
Spanish red wine tends to be the best choice of alcohol for the antioxidant benefits, but if you are going to drink, keep it reasonable. Over drinking leads to bad decision making. Not just in eating either... This is pretty explanatory. Hang overs, low testosterone, bad sleep, dehydration, blood sugar spikes, detox problems, high risk of cancer, etc. are all consequences of heavy drinking. Set limits and keep them.
These are 4 simple strategies to enjoy the holidays and keep your waist line the same size. Stick to these 4 strategies and you will come out ahead.
Stay safe and healthy this holiday season...
-Dr W
Here are 4 simple strategies to avoid the holiday weight gain, and actually come out ahead...
1) Earn your carbs/sweets/desserts/sugar/anything that spikes blood sugar...
What does that mean? Earn your carbs? That means if you are going to eat dessert, you have to earn them. For every 1 serving of dessert you eat, you must workout, hard (to a sweat), for 30 minutes. There is a receptor called the GLUT 4 receptor. This receptor becomes up-regulated with exercise. The important thing about this receptor is it helps the cells use glucose without the help of insulin. So when you work out you can eat sugar for a certain period of time without a high insulin response. Body builders know this as carb loading or carb cycling.
EARN YOUR CARBS!!!
2) Eat breakfast. More specifically eat protein and fat for breakfast.
Researchers have shown eating breakfast decreases over eating at the end of the day. Skipping breakfast in order to have "room" for Thanksgiving dinner will only lead to over eating. You don't get tired from the turkey. You get tired because you over ate. To remedy this situation, eat breakfast on Thanksgiving and all holiday dinner days.
Eating breakfast is only the first part of the equation. Research out of Australia found that the type of breakfast you ate plays a huge role in eating throughout the day. Eating a high glycemic index breakfast, like corn flakes (or any cereal for that matter), will lead to over eating, specifically carbohydrates. The group that ate a high protein breakfast ate less, and avoided processed carbs.
So the trick to not over eat is breakfast. Not just eating breakfast, but making sure it is a high protein breakfast. The other, even more important (in my opinion) reason to eat a high protein breakfast is for brain function. The brain needs amino acids to drive proper neurotransmitter function. Amino acids are in protein. Therefore, a high protein breakfast is good for brain function. It increases drive, focus and mood.
3) Eat protein first.
When sitting down for a big holiday meal go for the protein first. Protein is satiating, meaning it will fill you up. High glycemic index foods like potatoes or bread will increase blood sugar fast and cause you to eat more. Think, what do restaurants serve you first? There is a reason for that...
4) Limit alcohol consumption.
Spanish red wine tends to be the best choice of alcohol for the antioxidant benefits, but if you are going to drink, keep it reasonable. Over drinking leads to bad decision making. Not just in eating either... This is pretty explanatory. Hang overs, low testosterone, bad sleep, dehydration, blood sugar spikes, detox problems, high risk of cancer, etc. are all consequences of heavy drinking. Set limits and keep them.
These are 4 simple strategies to enjoy the holidays and keep your waist line the same size. Stick to these 4 strategies and you will come out ahead.
Stay safe and healthy this holiday season...
-Dr W
Thursday, October 3, 2013
Failure is the new norm
"Failure is the new norm."
This was a quote from an annonymous blogger in regards to describing allopathic medicine and health care in this country. At the time he wrote the article he was in his 3rd year of medical school. He described how when entering into the primary care phase of training he almost failed. The reason for almost failing wasn't because he lacked skills or medical knowledge. It was because he was spending too much time connecting with patients, discussing their eating habits, their stress buffers, how much they exercised, why they were eating gluten, and the like. When seeking an answer why these were considered negative and deserved an almost failing grade, his teacher simply said spending that much time and educating patients to that degree isn't worth it. They [patients] will not follow through and it is not financially feasible.
This is exactly what is wrong with healthcare. Profits, prescription drugs, surgery (many times unnecessary), anything and everything to avoid actual healthcare. Actual healthcare being lifestyle care.
'Lifestyle care? What is that? No doctor has ever talked to me about lifestyle care before. What does my lifestyle have to do with my diabetes? Thyroid problem? Exhaustion? Pain?'
Lifestyle care can be termed lifestyle management. It means a doctor must address the underlying cause of the issue. I know lots of doctors and nutrition experts talk about THE CAUSE of the problem or disease. That is because searching for the cause is what 'new' doctors look for. It is what true health professionals look for. Functional nutrition, functional medicine, lifestyle medicine are all new areas of healthcare that search out the cause and look to modify and change those 'cause' behaviors. The cause almost always comes back to lifestyle.
What is one thing that every person does, every single day?
Everyone eats. So step one in addressing the cause of any condition is looking closely at what you put in your mouth everyday. Are you eating something you are allergic to? Gluten? Dairy? GMOs? And if you are how often are you eating it? Every single meal is the usual answer.
Think about this. You have hypothyroid and are taking Synthroid. You also have a gluten allergy. It isn't an anaphylactic allergy. It is an allergy that causes immune reaction and inflammation every time you are exposed to gluten. Now, your breakfast consists of bread and cereal. Lunch is a sandwich. Your snack is cracker and cheese. Supper consists of pasta and bread with some chicken. This is a pretty common daily food intake for many Americans. That is exposure to gluten at every single meal. You can say gluten seems to be the staple of your diet. So wouldn't it make sense to modify lifestyle to eliminate gluten, which has autoimmune thyroid implications, as a starting point?
Failure should not be accepted. It definitely should not be the new norm.
Demand success. Demand lifestyle care from your doctor. If they refuse or simply don't know anything about it, find a new doctor. Surround yourself with a team of lifestyle managers. Creating a better you starts today when you make the decision to seek success and leave failure behind.
Dr K
This was a quote from an annonymous blogger in regards to describing allopathic medicine and health care in this country. At the time he wrote the article he was in his 3rd year of medical school. He described how when entering into the primary care phase of training he almost failed. The reason for almost failing wasn't because he lacked skills or medical knowledge. It was because he was spending too much time connecting with patients, discussing their eating habits, their stress buffers, how much they exercised, why they were eating gluten, and the like. When seeking an answer why these were considered negative and deserved an almost failing grade, his teacher simply said spending that much time and educating patients to that degree isn't worth it. They [patients] will not follow through and it is not financially feasible.
This is exactly what is wrong with healthcare. Profits, prescription drugs, surgery (many times unnecessary), anything and everything to avoid actual healthcare. Actual healthcare being lifestyle care.
'Lifestyle care? What is that? No doctor has ever talked to me about lifestyle care before. What does my lifestyle have to do with my diabetes? Thyroid problem? Exhaustion? Pain?'
Lifestyle care can be termed lifestyle management. It means a doctor must address the underlying cause of the issue. I know lots of doctors and nutrition experts talk about THE CAUSE of the problem or disease. That is because searching for the cause is what 'new' doctors look for. It is what true health professionals look for. Functional nutrition, functional medicine, lifestyle medicine are all new areas of healthcare that search out the cause and look to modify and change those 'cause' behaviors. The cause almost always comes back to lifestyle.
What is one thing that every person does, every single day?
Everyone eats. So step one in addressing the cause of any condition is looking closely at what you put in your mouth everyday. Are you eating something you are allergic to? Gluten? Dairy? GMOs? And if you are how often are you eating it? Every single meal is the usual answer.
Think about this. You have hypothyroid and are taking Synthroid. You also have a gluten allergy. It isn't an anaphylactic allergy. It is an allergy that causes immune reaction and inflammation every time you are exposed to gluten. Now, your breakfast consists of bread and cereal. Lunch is a sandwich. Your snack is cracker and cheese. Supper consists of pasta and bread with some chicken. This is a pretty common daily food intake for many Americans. That is exposure to gluten at every single meal. You can say gluten seems to be the staple of your diet. So wouldn't it make sense to modify lifestyle to eliminate gluten, which has autoimmune thyroid implications, as a starting point?
Failure should not be accepted. It definitely should not be the new norm.
Demand success. Demand lifestyle care from your doctor. If they refuse or simply don't know anything about it, find a new doctor. Surround yourself with a team of lifestyle managers. Creating a better you starts today when you make the decision to seek success and leave failure behind.
Dr K
Wednesday, September 25, 2013
Low-carb ketogenic diets decrease oxidative stress
We have known for a long time that malignant cells, specifically, cancer cells consume huge amounts of glucose; Warburg postulated that is was a defect in the aerobic respiration of cells (oxygen utilization) that convert a normal cell to a malignant one. Other Nobel prize winners have proven that when oxygen is deficient, cancer cells emerge. Oxygen alone can inhibit malignant cells from proliferating by stopping anaerobic respiration, which is the preferred energy production choice of malignant cells. If malignant cells proliferate using glucose as the primary energy source, then here's an idea for the ages, why don't we starve cancer of glucose and increase oxygen utilization?
Now, what does this have to do with a low-carb ketogenic diet? First glucose is not our only fuel source. In fact, our brain seems to function better when ketone bodies are the primary energy source. Beta-hydoxybutyrate (BHOB) is one such ketone body. BHOB is the primary energy source in starvation or strenuous exercise. So, when all the glucose gets used up BHOB becomes the primary energy source.
BHOB concentrations increase in a dose-dependent manner with strenuous exercise. Increases in BHOB bring about epigenetic changes to specific genes related to oxidative stress. Epigenetic changes are simply changes in gene expression. So by exercising "hard", we see a rise in blood concentrations of BHOB, which turns on genes associated with decreasing oxidative stress.
Foxo3a is one of the genes that is affected by changes in BHOB concentrations. This gene and its targets are important in the expression of mitochondrial superoxide dismutase (Mn-SOD), a very important antioxidant. Another way to increase Foxo3a expression is through calorie restriction or carbohydrate restriction.
When we restrict carbohydrates, or simply don't intake high glycemic index grains, sugars, processed products (yes products because they aren't real food), our body begin to burn more ketone bodies for energy. This process of energy production is favorable for the brain, fighting cancer, seizure disorders, ADHD, dementia related symptoms, obesity, stress, etc.
Take away from this study? Ketone bodies will up-regulate the good genes that help buffer excessive oxidative stress. To increase ketone bodies we must eat a low-carb ketogenic diet in addition to a strenuous exercise routine. The higher the ketone bodies, the lower the glucose and the better your blood sugar handling is.
Source:
Now, what does this have to do with a low-carb ketogenic diet? First glucose is not our only fuel source. In fact, our brain seems to function better when ketone bodies are the primary energy source. Beta-hydoxybutyrate (BHOB) is one such ketone body. BHOB is the primary energy source in starvation or strenuous exercise. So, when all the glucose gets used up BHOB becomes the primary energy source.
BHOB concentrations increase in a dose-dependent manner with strenuous exercise. Increases in BHOB bring about epigenetic changes to specific genes related to oxidative stress. Epigenetic changes are simply changes in gene expression. So by exercising "hard", we see a rise in blood concentrations of BHOB, which turns on genes associated with decreasing oxidative stress.
Foxo3a is one of the genes that is affected by changes in BHOB concentrations. This gene and its targets are important in the expression of mitochondrial superoxide dismutase (Mn-SOD), a very important antioxidant. Another way to increase Foxo3a expression is through calorie restriction or carbohydrate restriction.
When we restrict carbohydrates, or simply don't intake high glycemic index grains, sugars, processed products (yes products because they aren't real food), our body begin to burn more ketone bodies for energy. This process of energy production is favorable for the brain, fighting cancer, seizure disorders, ADHD, dementia related symptoms, obesity, stress, etc.
Take away from this study? Ketone bodies will up-regulate the good genes that help buffer excessive oxidative stress. To increase ketone bodies we must eat a low-carb ketogenic diet in addition to a strenuous exercise routine. The higher the ketone bodies, the lower the glucose and the better your blood sugar handling is.
Source:
Med Hypotheses. 2012 Oct;79(4):433-9. doi:
10.1016/j.mehy.2012.06.015. Epub 2012 Jul 17. PMID: 22809841
Health Quote of the Week - Jeffrey Bland
For this week's quote I chose the quote from Jeffrey Bland, PhD, and the founding father of functional medicine. In Advancement in Clinical Nutrition, 1994 he was quoted...
"The questions we ask determine the answers we get."
This is so true on so many different levels. First let's look at healthcare. Traditional healthcare (or sickcare) looks to ask what question? 'What are you symptoms?' And the answer is generally a drug to block or reduce the symptoms. Look at what that got us. Now we are the most drugged nation in the history of the planet. We had over 4 billion prescriptions written in 2011. Forbes did a study and the average American spends over $6,500 a year on healthcare. My question is for what? We are fatter, sicker, more stressed, toxic, and tired then we have ever been. Where is all this money going?
A functional medicine doctor asks different questions. Instead of 'what are your symptoms?' we ask 'what is causing your symptoms?' The answers you get from that line of questioning will blow your mind. Gut issues, GMO allergies, food allergies, nutrient deficiencies, detox problems, toxic exposures, heavy metals, etc. The list is endless. The difference is the answer leads a solution because the question demanded a solution.
When the question asked is too simple for the problem, or not asking the right question, the answer will not be a solution.
Here is a question for patients to ask of their doctor. "Are you going to find the cause of my complaint?" Many times you will not get a straight answer. Or you might simply get the wrong answer or a blatant lie. One big lie permeating is biomarkers being causes of disease. For example, high cholesterol does not cause heart disease. THAT IS A LIE.
The real question is 'why do I have high cholesterol?'. The answer most certainly is not, 'because you are statin deficient'.
I leave you with this quote.
"The questions we ask determine the answers we get."
Seek the right answers. Ask the right questions. This is where health starts.
Dr W
"The questions we ask determine the answers we get."
This is so true on so many different levels. First let's look at healthcare. Traditional healthcare (or sickcare) looks to ask what question? 'What are you symptoms?' And the answer is generally a drug to block or reduce the symptoms. Look at what that got us. Now we are the most drugged nation in the history of the planet. We had over 4 billion prescriptions written in 2011. Forbes did a study and the average American spends over $6,500 a year on healthcare. My question is for what? We are fatter, sicker, more stressed, toxic, and tired then we have ever been. Where is all this money going?
A functional medicine doctor asks different questions. Instead of 'what are your symptoms?' we ask 'what is causing your symptoms?' The answers you get from that line of questioning will blow your mind. Gut issues, GMO allergies, food allergies, nutrient deficiencies, detox problems, toxic exposures, heavy metals, etc. The list is endless. The difference is the answer leads a solution because the question demanded a solution.
When the question asked is too simple for the problem, or not asking the right question, the answer will not be a solution.
Here is a question for patients to ask of their doctor. "Are you going to find the cause of my complaint?" Many times you will not get a straight answer. Or you might simply get the wrong answer or a blatant lie. One big lie permeating is biomarkers being causes of disease. For example, high cholesterol does not cause heart disease. THAT IS A LIE.
The real question is 'why do I have high cholesterol?'. The answer most certainly is not, 'because you are statin deficient'.
I leave you with this quote.
"The questions we ask determine the answers we get."
Seek the right answers. Ask the right questions. This is where health starts.
Dr W
Wednesday, September 11, 2013
Health Quote of the Week
I am starting a new segment on my blog. I do a ton of reading and find myself not writing as much as I feel I should. From now on, when I read something good, either an article, or a quote, or even a book, I am going to do a write up for everyone to read.
Look for my new segment. 'Health quote of the week.'
Steve Tobak, a writer for FOX Business, in an article about reasons not to buy a new 'smart' watch had a priceless and paradigm breaking quote.
When talking about how the new 'smart' watches can be used as health trackers he states...
"Really? I’m a runner. I own a pair of sneakers, shorts, and socks. I don’t need to know how far I run or how many calories I burn. I know I’m fit because my clothes fit. Funny how the more fitness stuff we buy the fatter we become. If everyone would quit trying to be so smart and just go out and do something, there’d be no obesity epidemic."
Why can't we all be as smart as Steve? For what I know I don't think Steve has a medical degree. I don't believe he is a weight loss expert. He is a business writer. From a business stand point he says away with all this fancy crap to help you be healthy. Get out and move. These are words of pure wisdom.
Look for my new segment. 'Health quote of the week.'
Steve Tobak, a writer for FOX Business, in an article about reasons not to buy a new 'smart' watch had a priceless and paradigm breaking quote.
When talking about how the new 'smart' watches can be used as health trackers he states...
"Really? I’m a runner. I own a pair of sneakers, shorts, and socks. I don’t need to know how far I run or how many calories I burn. I know I’m fit because my clothes fit. Funny how the more fitness stuff we buy the fatter we become. If everyone would quit trying to be so smart and just go out and do something, there’d be no obesity epidemic."
Why can't we all be as smart as Steve? For what I know I don't think Steve has a medical degree. I don't believe he is a weight loss expert. He is a business writer. From a business stand point he says away with all this fancy crap to help you be healthy. Get out and move. These are words of pure wisdom.
I have patient's that do not want to know their weight, or have had past eating issues in which the number becomes problematic. This is the same advice, or what I refer to, measurement, I instruct them to use. Put your favorite, best fitting "butt" jeans on. See how they fit. Are they too tight? Let those jeans be your measure. When they fit perfectly you know you are where you want to be.
Jeans don't change. People change. Weight is not something that creeps up with age. It is a constant once you reach adulthood. Let's get to ideal and make it the constant!!!
Thank you Steve for your words of wisdom. It is refreshing to read this kind of common sense.
-Dr K
Friday, August 2, 2013
Shoulder Health and Crossfit
I recently started working out at a Crossfit gym. I have always loved Olympic and multi-joint lifts as a way to work out, so logically moving into Crossfit was the next step. Crossfit offers some of the best and most exhausting workouts I have ever had. The class atmosphere in addition to the intense training is great and unlike any other fitness "class" you can take at a chain gym. One week into doing crossfit I noticed the lack of posterior deltoid work and proper rotator cuff/external rotation exercises. It dawned on me, after seeing a couple of [Crossfit] patients with shoulder issues (AC joint issues related to rear deltoid/anterior deltoid imbalance) that this could be an issue with Crossfit. At the same time a very easy and adaptable fix.
Presses, pull-ups, push-ups, snatch, and all the variations of pushing weight above the head all strengthen the flexors. As in, the pecoralis muscles (specifically the clavicular division), the anterior deltoid, along with the legs, core, and back as stabilizers. Don't get me wrong, Crossfit works the back muscles extensively, but one thing to note; pull-ups, butterfly pull-ups, and any other variation primarily work the latissimus dorsi group. The latissimus dorsi muscle is an internal rotator of the shoulder. Therefore, external rotation is excluded.
In this article I will be covering the top 4 musculoskeletal injuries to the shoulder that I see in my clinic. I will also cover and talk about ways to strengthen the shoulders and rotator cuff muscles in order to take you to the next level at Crossfit, or any other workout you are doing.
Top 4 Causes of Shoulder Problems (seen in my office)
1. The Neck: If the neck is out of alignment this can have a devastating effect on the shoulder. If you look up the maps of the cervical plexus (and while your there look up the brachial plexus) you will see the cervical nerve roots. It is these very nerves that innervate the arm muscles. Now the specifics aren't needed for this. What you need to know is if the neck is imbalanced, that can place pressure on the nerves. Proper nerve function is needed for muscles to activate and function properly. If the neck is off, the arm muscles can be off, and this includes any one of the many different muscles acting on the shoulder. Imbalance leads to dysfunction and pain. This is the primary starting point. Any of the following injuries can stem from the neck so ALWAYS CHECK THE NECK.
2. AC Joint (M/C Crossfit imbalance): Before we get into the actual AC joint we need to look at the deltoid. The deltoid is the muscle that covers the whole shoulder. It is also notoriously weak in people. The unique thing about the deltoid is it antagonizes itself. That means when the anterior deltoid is firing the posterior deltoid is not and vice versa. Another example of muscles that antagonize each other are the biceps and triceps. When you flex your bicep you can't flex your triceps. It is turned off. Now the deltoid is unique in that it does this with itself. When using Applied Kinesiolgy (neurologic testing) I find that when a muscle is spasmed or chronically tightened (muscle fibers shortened) it can inhibit the muscle opposing/antagonizing it. The 2 most common are the anterior deltoid being over tight and shutting off the rear deltoid, and the psoas muscle being over tight and shutting off the glut max. (Interestingly both are ball and socket joints.)
What does this have to do with the AC joint? Everything! The rear deltoid muscle stabilizes the AC joint. So think about it. The anterior deltoid is chronically tight, there is a strength imbalance in the deltoid due to presses and internal shoulder rotation exercises. The rear deltoid is weak and inhibited. Where does that stress from the imbalances go? The AC joint. If this problem persists for too long the stress can become too great and a diagnosable AC injury or separation occurs.
3. Biceps Tendon Injuries: This is a fairly complex condition, often called biceps tendonitis among other things by medical doctors, that can affect a number of different joints from the neck to the wrist and can be hard to find if you don't see someone who uses Applied Kinesiology. Applied Kinesiology is neurologic testing. It test muscles and how well the brain turns them on. If a muscle is turned off, or not firing at full potential, it leads to imbalance. Imbalance leads to pain and dysfunction and eventually serious injury. In terms of the biceps tendon, I am talking specifically about the long head biceps tendon.
Some anatomy about this injury you need to know to fully understand the injury includes the bicipital groove of the humerus, the subscapularis, the long head of the biceps, and surrounding musculature. If you don't know these structures please look them up. The long head of the biceps moves up the arm and attaches to the glenoid labrum. The problem mostly arrises in the area of the the bicipital groove. This is a valley in the humerus which houses the biceps tendon. Simply stated, irritation happens to this area and the tendon moves medially. The subscapularis is an internal rotator of the shoulder. It attaches to the transverse ligament, which is the ligament that houses the bicipital groove holding the biceps tendon in place.
The problem: As we slouch, have too much focus on internal rotation of the shoulder, weak extensors, etc. the subscapularis will tighten and create a lot of strain on the transverse ligament of the bicipital groove. This is turn puts strain on the biceps tendon and the biceps function as a whole. This leads to major imbalances in the shoulder and elbow. The shoulder, being a more mobile and vulnerable joint, bares most of the stress and becomes injured.
Sounds complicated, but treatment is usually pretty straight forward (at least in my office). Identify what is happening with the muscles. Which are inhibited, which aren't. Work on the joint specifically, the subscapularis, the bicipital groove area, and long head of the biceps (specific treatments) and things generally get better almost immediately. It isn't rocket science!!! (As in, your doctor should know how to treat this. If they don't, FIND A NEW DOCTOR!)
4. Infraspinatus injury: The infraspinatus muscle is one of the main external rotators of the shoulder. This muscle is notorious for becoming injured, and I believe it is because of the heavy amount of internal rotation today's life and workouts require. This muscle has to be addressed in all shoulder injuries for the shoulder to become function. That usually entails muscle work, muscle lengthening, and neck adjustments. If you don't address an infraspinatus injury, the shoulder will NOT get better.
You may be thinking what about the supraspinatus tendon. This is a common shoulder injury. This is the result of years of wear and tear (really major imbalance and dysfunction) culminating in the tendon tearing. I am not a surgeon and don't see supraspinatus tears in my office. I do have patients with them and miraculously some of them have skipped surgery and have better shoulder function after seeing me. This is because when the shoulder is balanced, there is no added stress on the ligaments and joints, and things heal.
Now, to the good stuff. What can you do to work out the shoulder to take your Crossfit workout to the next level (or any workout for that matter)?
The posture stretch: Take a 3 foot foam roller. Lay on it so your whole spine is on top of the roller. Pelvis to head. Lay your arms on the ground, thumbs pointed toward your head, at a 45 degree angle. Feel the stretch and inch your hands up over the course of 15 minutes. Do this everyday until you no longer feel an intense stretch with your hands at 90 degrees or greater. (hint: should look like a cross position.)
Rotator cuff workout:
Can be done as a workout by itself or after a workout.
A1: 30 degree incline prone trap raise 3 x 10-12 (3 second eccentric phase) 10 sec rest
A2: Elbow on knee DB external rotation 3 x 10-12 (3 second eccentric phase) 10 sec rest
A3: Low pulley external rotation at 30 degress 3 x 10-12 (second eccentric phase) 60 sec rest
This is a super set workout. For more info on what this means, eccentric phase, timing and any lifting questions I encourage you to visit charlespoliquin.com for more info. Below is the link to the article I took this workout from.
http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article/984/How_to_Square_Round_Shoulders.aspx
Posterior Deltoid workout:
The rear delts should be worked on a minimum of once a week. I like to to the same as the rotator cuff and follow with some super sets after a workout. It should be noted that shoulders can be a whole day at the gym themselves, and I personally have been working shoulders out extensively for years. So you may have to have separate shoulder days for a while in order to do this.
A1: Bent over rows 3 x 6-8 (2 second eccentric phase) 10 sec rest
A2: Standing cable rows 3 x 8-10 (2 second eccentric phase) 10 sec rest
A3: Face Pulls with rope 3 x 10-12 (4 sec eccentric phase) 60 sec rest
It should be noted that I have adapted these workouts from the shoulder workouts of Charles Poliquin. That guy knows his stuff and for more reading check out his site.
This article has been fun for me to write and I hope very informative for you all. With the tips here, all you Crossfitters out there looking to take your lifts to the next level think about shoulder health and strength. Some added effort can make huge gains and even break some PRs along the way.
Cheers,
Dr. Kurt
References:
Netter FH. Atlas of Human Anatomy. 4th Ed. 2006. (Textbook)
Rakowski Bob. Kinesiology Applied to Functional Medicine. Seminar Series 2010-2012. Minneapolis MN. (itsdrbob.com is his website) (favorite teacher/seminar instructor/mentor/doctor check his seminars and info out!)
Charles Poliquin. www.charlespoliquin.com (too many articles to list. One of the best sources of info I have ever come across. Check out his website.)
http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article/962/Building_3D_Shoulders.aspx
Presses, pull-ups, push-ups, snatch, and all the variations of pushing weight above the head all strengthen the flexors. As in, the pecoralis muscles (specifically the clavicular division), the anterior deltoid, along with the legs, core, and back as stabilizers. Don't get me wrong, Crossfit works the back muscles extensively, but one thing to note; pull-ups, butterfly pull-ups, and any other variation primarily work the latissimus dorsi group. The latissimus dorsi muscle is an internal rotator of the shoulder. Therefore, external rotation is excluded.
In this article I will be covering the top 4 musculoskeletal injuries to the shoulder that I see in my clinic. I will also cover and talk about ways to strengthen the shoulders and rotator cuff muscles in order to take you to the next level at Crossfit, or any other workout you are doing.
Top 4 Causes of Shoulder Problems (seen in my office)
1. The Neck: If the neck is out of alignment this can have a devastating effect on the shoulder. If you look up the maps of the cervical plexus (and while your there look up the brachial plexus) you will see the cervical nerve roots. It is these very nerves that innervate the arm muscles. Now the specifics aren't needed for this. What you need to know is if the neck is imbalanced, that can place pressure on the nerves. Proper nerve function is needed for muscles to activate and function properly. If the neck is off, the arm muscles can be off, and this includes any one of the many different muscles acting on the shoulder. Imbalance leads to dysfunction and pain. This is the primary starting point. Any of the following injuries can stem from the neck so ALWAYS CHECK THE NECK.
2. AC Joint (M/C Crossfit imbalance): Before we get into the actual AC joint we need to look at the deltoid. The deltoid is the muscle that covers the whole shoulder. It is also notoriously weak in people. The unique thing about the deltoid is it antagonizes itself. That means when the anterior deltoid is firing the posterior deltoid is not and vice versa. Another example of muscles that antagonize each other are the biceps and triceps. When you flex your bicep you can't flex your triceps. It is turned off. Now the deltoid is unique in that it does this with itself. When using Applied Kinesiolgy (neurologic testing) I find that when a muscle is spasmed or chronically tightened (muscle fibers shortened) it can inhibit the muscle opposing/antagonizing it. The 2 most common are the anterior deltoid being over tight and shutting off the rear deltoid, and the psoas muscle being over tight and shutting off the glut max. (Interestingly both are ball and socket joints.)
What does this have to do with the AC joint? Everything! The rear deltoid muscle stabilizes the AC joint. So think about it. The anterior deltoid is chronically tight, there is a strength imbalance in the deltoid due to presses and internal shoulder rotation exercises. The rear deltoid is weak and inhibited. Where does that stress from the imbalances go? The AC joint. If this problem persists for too long the stress can become too great and a diagnosable AC injury or separation occurs.
3. Biceps Tendon Injuries: This is a fairly complex condition, often called biceps tendonitis among other things by medical doctors, that can affect a number of different joints from the neck to the wrist and can be hard to find if you don't see someone who uses Applied Kinesiology. Applied Kinesiology is neurologic testing. It test muscles and how well the brain turns them on. If a muscle is turned off, or not firing at full potential, it leads to imbalance. Imbalance leads to pain and dysfunction and eventually serious injury. In terms of the biceps tendon, I am talking specifically about the long head biceps tendon.
Some anatomy about this injury you need to know to fully understand the injury includes the bicipital groove of the humerus, the subscapularis, the long head of the biceps, and surrounding musculature. If you don't know these structures please look them up. The long head of the biceps moves up the arm and attaches to the glenoid labrum. The problem mostly arrises in the area of the the bicipital groove. This is a valley in the humerus which houses the biceps tendon. Simply stated, irritation happens to this area and the tendon moves medially. The subscapularis is an internal rotator of the shoulder. It attaches to the transverse ligament, which is the ligament that houses the bicipital groove holding the biceps tendon in place.
The problem: As we slouch, have too much focus on internal rotation of the shoulder, weak extensors, etc. the subscapularis will tighten and create a lot of strain on the transverse ligament of the bicipital groove. This is turn puts strain on the biceps tendon and the biceps function as a whole. This leads to major imbalances in the shoulder and elbow. The shoulder, being a more mobile and vulnerable joint, bares most of the stress and becomes injured.
Sounds complicated, but treatment is usually pretty straight forward (at least in my office). Identify what is happening with the muscles. Which are inhibited, which aren't. Work on the joint specifically, the subscapularis, the bicipital groove area, and long head of the biceps (specific treatments) and things generally get better almost immediately. It isn't rocket science!!! (As in, your doctor should know how to treat this. If they don't, FIND A NEW DOCTOR!)
4. Infraspinatus injury: The infraspinatus muscle is one of the main external rotators of the shoulder. This muscle is notorious for becoming injured, and I believe it is because of the heavy amount of internal rotation today's life and workouts require. This muscle has to be addressed in all shoulder injuries for the shoulder to become function. That usually entails muscle work, muscle lengthening, and neck adjustments. If you don't address an infraspinatus injury, the shoulder will NOT get better.
You may be thinking what about the supraspinatus tendon. This is a common shoulder injury. This is the result of years of wear and tear (really major imbalance and dysfunction) culminating in the tendon tearing. I am not a surgeon and don't see supraspinatus tears in my office. I do have patients with them and miraculously some of them have skipped surgery and have better shoulder function after seeing me. This is because when the shoulder is balanced, there is no added stress on the ligaments and joints, and things heal.
Now, to the good stuff. What can you do to work out the shoulder to take your Crossfit workout to the next level (or any workout for that matter)?
The posture stretch: Take a 3 foot foam roller. Lay on it so your whole spine is on top of the roller. Pelvis to head. Lay your arms on the ground, thumbs pointed toward your head, at a 45 degree angle. Feel the stretch and inch your hands up over the course of 15 minutes. Do this everyday until you no longer feel an intense stretch with your hands at 90 degrees or greater. (hint: should look like a cross position.)
Rotator cuff workout:
Can be done as a workout by itself or after a workout.
A1: 30 degree incline prone trap raise 3 x 10-12 (3 second eccentric phase) 10 sec rest
A2: Elbow on knee DB external rotation 3 x 10-12 (3 second eccentric phase) 10 sec rest
A3: Low pulley external rotation at 30 degress 3 x 10-12 (second eccentric phase) 60 sec rest
This is a super set workout. For more info on what this means, eccentric phase, timing and any lifting questions I encourage you to visit charlespoliquin.com for more info. Below is the link to the article I took this workout from.
http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article/984/How_to_Square_Round_Shoulders.aspx
Posterior Deltoid workout:
The rear delts should be worked on a minimum of once a week. I like to to the same as the rotator cuff and follow with some super sets after a workout. It should be noted that shoulders can be a whole day at the gym themselves, and I personally have been working shoulders out extensively for years. So you may have to have separate shoulder days for a while in order to do this.
A1: Bent over rows 3 x 6-8 (2 second eccentric phase) 10 sec rest
A2: Standing cable rows 3 x 8-10 (2 second eccentric phase) 10 sec rest
A3: Face Pulls with rope 3 x 10-12 (4 sec eccentric phase) 60 sec rest
It should be noted that I have adapted these workouts from the shoulder workouts of Charles Poliquin. That guy knows his stuff and for more reading check out his site.
This article has been fun for me to write and I hope very informative for you all. With the tips here, all you Crossfitters out there looking to take your lifts to the next level think about shoulder health and strength. Some added effort can make huge gains and even break some PRs along the way.
Cheers,
Dr. Kurt
References:
Netter FH. Atlas of Human Anatomy. 4th Ed. 2006. (Textbook)
Rakowski Bob. Kinesiology Applied to Functional Medicine. Seminar Series 2010-2012. Minneapolis MN. (itsdrbob.com is his website) (favorite teacher/seminar instructor/mentor/doctor check his seminars and info out!)
Charles Poliquin. www.charlespoliquin.com (too many articles to list. One of the best sources of info I have ever come across. Check out his website.)
http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article/962/Building_3D_Shoulders.aspx
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