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Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
February, 2008, Vol. 08, Issue 02
Don't Get Married, Part 1
By Erik Dalton, PhD
It's really irritating when you invest yourself in an idea which later proves to be invalid. Although I try to not marry any particular theory or technique, I usually find myself extolling its virtues and developing constructs to support my belief system. It's probably acceptable to wed as long as you don't mind going through the pains of divorce. With biomedical research moving at such a rapid pace, it's dangerous to strongly embrace any belief too passionately. With that in mind, I've decided to fully embrace Tom Myers' advice and "cling by my fingernails" (his statement made to our 2007 Costa Rica class when discussing the validity of the thixotropy theory) and to endorse the popular concept of core stability (CS).
Studies by Hodges and Richardson in the late 1990s demonstrated a change in onset timing of the trunk muscles in patients with chronic low back pain, and led to the current rage in manual therapy and fitness programs regarding core-stability training.1 As a consequence of this research, a whole industry blossomed with clinics and gyms worldwide teaching the tummy tuck and trunk-bracing exercises aimed at curing or preventing low back pain. At that point core stability grew into a cult with the transverses abdominis (TrA) as its mantra (Fig. 1). In this and future "Toolbox of Touch" columns, I wish to re-examine some basic CS assumptions, offer support, critical observations and practical treatment options.
What Is Core Stability?
A primary goal of CS training is teaching clients how to recruit specific deep trunk muscles to effectively control lumbar spine positioning during dynamic movements. Core training is intended to provide essential joint stiffness and stability, allowing the body's large prime movers (global muscles) a solid working foundation (Fig. 2). Carolyn Richardson, describing her research on core stability states, "Thus, conceptually, the transversus abdominis forms the walls of a cylinder while the muscles of the pelvic floor and diaphragm form its base and lid, respectively (Fig. 3). There is some initial evidence that these four muscles act in synergy to provide a spinal support mechanism.
Functionally, the nervous system could be expected continuously to modulate activity in these muscles in order to control joint position, irrespective of the direction of movement. In this way, such muscles could provide concentrated joint support, while, independently, the larger torque-producing muscles control the acceleration and braking movements of the joint."
Richardson's studies also reveal that arm and leg movements also might elicit pubococcygeus contraction concurrent with that of the TrA. This presupposes a link may exist between these two muscles. In the CS model, the client's deep support system (TrA, obliques, multifidus, pelvic floor, diaphragm, lumbar erectors and thoracolumbar fascia) works to brace vulnerable spinal structures, thus allowing superficial global muscles (and fascia) to engage in acts such as walking and lifting. Proponents believe repetitive co-contraction of specific, deep postural muscles results in greater spinal stabilization and the reduction and/or prevention of back pain.
When working synergistically, core trunk muscles sense orientation in the gravitational field and supply the central nervous system with proprioceptive input important in coordinating appropriate responses for the global muscles of movement. Since intrinsic postural (core) muscles consist of red slow-twitch fibers and burn oxygen for fuel (oxidative metabolism), they're more resistant to fatigue. However, when subjected to high levels of prolonged activity, they tend to lose some of their red slow-twitch fiber content as white fast-twitch fibers are more frequently recruited. In a sense, as the larger global muscles become stronger and tighter (i.e., resistance weight training), the delicate balance between the inner and outer units becomes disrupted. Before delving into theories on possible recruitment patterns and firing order sequencing during gait, let's discuss a few studies refuting certain aspects of core stability training.
Examining Conflicting ResearchAlthough I prefer to remain married to the core concepts I've practiced and taught for so many years, I also work at staying open to other biomedical developments. In an effort to avoid getting "trapped" in an unhappy marriage later, I feel a need to cover my bases by examining other points of view on this issue. Below are a few studies surfacing recently that question the importance of core stability training:
The Spring-Loaded Spiraling Spine
In the early 1900s, Robert W. Lovett, MD, and anatomist Raymond A. Dart introduced the concept of a spiraling movement system governed by muscle and joint actions. They developed theories and corrective exercises based on the assumption that a rotational component was integral to human movement. Regrettably, their work has largely been ignored until recently. At a Rolf Institute® annual convention in the mid 1980s and again at the International Fascial Congress at Harvard University, I was blessed with the opportunity to share discussion and insights with a delightful and provocative nuclear physicist (and fellow musician) named Serge Gracovetsky. His unusual biomechanical approach to movement, which he calls the "Spinal Engine," continues to dramatically alter my ingrained view of body locomotion and lifting.5
In his presentations and writings, Gracovetsky offers a counterintuitive, but seductive, argument that the legs are not responsible for gait, but merely "instruments of expression." He expounds on this concept by showing video of a man born with no legs walking (perfectly balanced) only on his ischial tuberosities (Fig. 4). With the use of a high-resolution opto-electronic tracking system, Gracovetsky was able to study and organize evolutionary details concerning functional adaptations as they apply to the body's spinal engine.
Fig. 5 demonstrates what I reference as the posterior spiral spring system (PSSS) - a slightly altered version of Gracovetsky's model. I like to include biceps femoris in this pattern, not only because of its intimate co-contracting relationship with gluteus maximus during heel strike but also because of the influence this complex lateral hamstring muscle has on pelvic mechanics in force closure of the sacroiliac joint during the stance phase. Notice in Fig. 5 that just prior to heel strike, the biceps femoris and gluteus maximus reach maximum stretch as the latissimus dorsi also is being stretched by the forward swing of the opposite arm.
Heel strike signifies transition into the propulsive gait phase. At this time, biceps femoris and gluteus maximus join forces, creating antagonistic resistance with the contralateral latissimus dorsi, which is now extending the arm in concert with the propelling leg. The synergistic contraction of the gluteus maximus and latissimus dorsi creates tension in the thoracolumbar (and lumbodorsal) fascia, which soon releases in an energy pulse which assists deeper muscles of locomotion, thus reducing the metabolic cost of gait.
Due to the natural counter-rotation of the right leg and left shoulder, an efficient myofascial spring system develops. Pull of the lats creates a strong tensional force that travels through the thoracolumbar fascia, long dorsal SI ligaments and continues through the contralateral gluteus maximus, sacrotuberous ligament and biceps femoris. At this point, spiraling tensional forces increase in these posterior global structures and begin to dig tentacles deep into the osteoligamentous spring system. Before delving into the biomechanical intricacies of the core's disc/facet spring system which powers the spinal engine, let's look briefly at global muscles driving the anterior torso's rotary spring system.
The Anterior Spiraling Spring System
So, what does it look like from the front? In our discussion above, we saw how one leg swings in opposition to the opposite arm causing trunk counter-rotation. To aid the latissimus/gluteal spring system in trunk rotation, we have an anterior spiraling spring system (ASSS). Fig. 6 demonstrates an anterior firing-order model where oblique abdominal contraction forces a contralateral fascial pull through the lower torso to the adductors. The ASSS concept describes a nice working relationship between the oblique abdominals and the contralateral adductor musculature via the intervening anterior abdominal fascia. Notice in Fig. 6 how the left thigh adductors work in perfect harmony with the ipsilateral internal obliques, as well as the contralateral external obliques, to stabilize the body on top of the stance leg and to right-rotate the pelvis. This firing-order pattern positions the pelvis and hip so they are prepared for the succeeding heel strike.
Internal/external obliques, like the adductors, provide stability and mobility during the initiation of the stance phase of gait. This ASSS system also works with the PSSS to rotate the pelvis as the leg is pulled through during the swing phase of gait. As the speed of walking progresses to running, activation of the ASSS becomes more prominent. When working together harmoniously, these global muscles enhance the power of the posterior spiraling spring system by providing greater rotary torque at the osteoligamentous level discussed below. Bottom line: Adaptations of the trunk in locomotion primarily serve three goals:
Note: It's important to recall that the primary afferent feeding neurological information for the gait cycle arises from a stretch of the hip flexors (primarily the iliopsoas). Therefore, as the iliopsoas cross the hip, sacroiliac and lumbar spine, any joint restrictions will hinder excursion, thus minimizing the stretch. Therapists must restore movement and alignment to all myoskeletal structures to maximize normal neurological feedback and optimum muscle sequencing.
Disc and Facet Rotary Torque
Gracovetsky doesn't view the spine as a compressive loading system where intervertebral discs perform as shock absorbers. He imagines the outer annulus (tree-ring) disc fibers and their accompanying facet joints as dynamic antigravity "torsional" springs that store and unload tensional forces to lift and propel the body in space. During toe-off, as the spiraling spring system begins to recoil, strong forces are transmitted to the intervertebral joints where the combined action of discs and facets counter-rotate the pelvis (Fig. 7). The process is repeated as the left heel strikes the ground resulting in an oscillatory motion that efficiently moves the body with minimal energy expenditure. At the deepest osteoligamentous level, this interlocking of facets and discs transmits virtually all the available counter-rotational pelvic torque needed to aid core and global muscles in locomotion efforts.
The elegance of Gracovetsky's spinal engine system can be felt in your own body during gait. Practice propelling yourself forward by allowing the right arm and shoulder to swing forward and the left back.
One should feel the torso rotate left as the pelvis counter-rotates right. As the trunk and hip muscles concentrically and eccentrically co-contract, stored energy is transmitted through the intervertebral discs, ligaments and facet joints. Do you feel your pelvis counter-rotate with each step? Try contracting the ipsilateral gluteus maximus on heel strike as you rotate from the top down. As the gluteals co-contract with the lats, more kinetic energy is stored in the posterior spring system. This exercise also helps bring tone to typically weak butt muscles.
Many individuals in our practice who complain of back pain may not feel the pelvis rotate. Typically, these clients are suffering from such things as joint fixations, lack of proper spinal curves, altered firing-order patterns (in the deep inner unit) and/or imbalances between global and core muscles due to improper strength training. Structurally oriented pain therapists trained in this method seem to be successful in relieving many chronic back conditions.
Closely observe your clients as they walk. Do the arms swing evenly? Is there a nice cross-patterned gait? Does the energy appear to travel from the top down? The more you practice working with dysfunctional ASSS and the PSSS patterns, the more effective your therapeutic outcomes. Fig. 8 and Fig. 9 demonstrate two useful myoskeletal techniques for super-charging the body's spinal engine. Play with these concepts in your practice and in your own body. Soon, you'll begin developing techniques that have a more permanent effect on clients complaining of musculoskeletal and posture problems. Gracovetsky's spinal engine model beautifully complements Vladimir Janda's Upper- and Lower-Crossed Syndrome that has become so popular in today's manual therapy field. Used in conjunction, they're powerful tools to add to your toolbox of touch.
"Don't Get Married: Part II" focuses on the body's lateral support system (LSS), which is vital for stabilization during activities such as running and lifting. These concepts will help unify the spinal engine work discussed today by showing how aberrant lower quadrant firing-order patterns of the legs and feet affect sacroiliac and lumbar spine dysfunction.
Click here for previous articles by Erik Dalton, PhD.
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