Tis the Season for Sunburns: A Lobster’s Tale

Lake Tahoe.JPG

Fresh off a relaxing Memorial Day weekend trip to South Lake Tahoe, I have returned to Premiere Spine & Sport sporting  bright patches of red skin to prove I have an adventurous and outdoorsy side.  The joy of hiking, kayaking, and rafting came with a price that my skin had to pay, though!  Despite taking precautions with copious applications of sunscreen, the combination of 1) the long time I spent outside, 2) the failure rate of the sunscreen mixed with sweat/water, 3) my fair/white skin since I hadn’t been outside at all this summer, and 4) lack of sunscreen coverage in hard to reach spots or around the edges of a life jacket.  Ultimately, perfect protection was not a possible reality.  Judging by the look of my patients throughout this past week, I was not alone in the quest to become king of the patchy, spotted, or full-coat lobsters!

Erythema, the ten cent word for sunburn, is a relatively common symptom of prolonged sun or tanning bed exposure.  There are a ton of simple ways to prevent it from happening.  Other than the obvious risks of skin cancer and premature aging,  sunburns can affect your routine chiropractic and physical therapy treatments in a negative way.  Don’t let the new fad of sunburn art fool you – artistic lobsters are still lobsters!

 

Prevention

Image result for the sun

In order to know your risk of being scorched by the large ball of fire in the sky, you’ll want to find your minimum erythema dose (MED).  Ultraviolet (UV) light/radiation, which is just beyond the spectrum of visible light (smaller wavelength than purple), is transmitted by the sun through outer space, the Earth’s atmosphere, and then into our bodies through our skin.

The skin absorbs the light energy and that energy creates superficial heat.  If you can withstand the sun’s rays for a long period of time with minimal burn, you have a high MED.  If you burn after a short exposure time to the sun, you have a low MED.  The timing is relative for every individual, based mainly on skin pigmentation/genetics.  The darker your skin, the more concentration of melanocytes you have, which help absorb the sun’s rays so you don’t get burned.

This chart, known as the Fitzpatrick Scale, explains the basic classification system:

Skin Phototype Typical Features Tanning ability MED (mJ/cm2)
I Pale white skin, blue/hazel eyes, blond/red hair Always burns, does not tan 15-30
II Fair skin, blue eyes Burns easily, tans poorly 25-40
III Darker white skin Tans after initial burn 30-50
IV Light brown skin Burns minimally, tans easily 40-60
V Brown skin Rarely burns, tans darkly easily 60-90
VI Dark brown or black skin Never burns, always tans darkly 90-150

If you are interested in learning what your specific MED is – follow the steps in this article. The lower your MED, the more precautions you should take when exposing yourself to the sun, tanning bed, or any other UV light source.

 

Histology 101

Excessive UV light exposure damages skin cells to the point of deformation of the cell’s DNA, resulting in inflammation and apoptosis (self-destruction) of skin cells.  This is readily visualized as redness on the surface of the skin due to vasodilation of the cutaneous blood vessels.  Below is a slide of what sunburned cells look like compared to healthy skin cells:

Normal Skin Cells (Labeled)

 

Healthy Skin Cells

 

Sunburned Skin Cells

Note the apoptotic sunburn cells in the epidermis.

 

The Three Forms of Ultraviolet Light

UV light comes in three types: A, B, and C.  UV-C rays don’t make it past the earth’s atmosphere, so they don’t pose a threat to our skin.  This chart highlights the differences between UV-A and UV-B light:

UV-A UV-B
Less potent than UV-B but is the wavelength that reaches the surface of the earth most (about 90% at midday)
Also penetrates into the middle skin layer (dermis) and subcutaneous fat causing damage to the site where new skin cells are created
Long-term exposure causes injury to the dermis resulting in ageing skin
Much more potent at causing erythema
About 90% is absorbed by the surface skin layer (epidermis)
Epidermis responds by releasing chemicals that cause the reddening and swelling characteristic of the early signs of sunburn
Repeated exposure causes injury to the epidermis resulting in ageing skin

 

 

Risk Factors for Sunburns

Be wary of the following items, which will increase your risk of getting burned:

  • Wavelength: UV-B is more erythemogenic than UV-A.
  • Skin Phototype: Compared with type I-II skin, people with type IV-V skin require 3-5 times more UV radiation exposure to cause erythema.
  • Hydration: UV radiation causes erythema in moist skin more effectively than dry skin.
  • Environmental Reflection: Radiation is 80% reflected by snow and ice, compared with 15% by sand.
  • Ozone Coverage: Increased levels of ozone filter out more UV radiation.
  • Altitude: Thinner atmosphere at higher altitudes absorbs less UV radiation.
  • Latitude: Exposure is greater nearer the equator.
  • Time of Day: UV radiation exposure is greatest from 10 am to 4 pm, when the sun is highest in the sky.

 

Sun Benefits:  Vitamin D synthesis and Tanning

UV radiation enables the creation of Vitamin D on the surface of the skin.  America is currently riddled with an epidemic of Vitamin D deficient people, so any way to boost production is typically warranted in those individuals.  Vitamin D deficiency manifests anywhere from being asymptomatic to increased joint aches/pains and feelings of lethargy/lack of energy.  Severe cases can lead to bone pain, muscle wasting/weakness, and difficulty ambulating/walking around.  You should get a blood test to measure your Vitamin D level from your medical doctor, but if you don’t spend much time outside and don’t take any Vitamin D supplements, you are likely to be deficient.

Here is a flow chart of the chemical process involved when turning light into Vitamin D:

The trick to utilizing the sun as a source of Vitamin D is to find the balance between getting enough bare skin exposed to create a significant dosage and overextending your welcome such that you go beyond your skin’s MED.  This time frame is called low intensity or short duration exposure and it is what will help darken the pigment of your skin over time with repeated exposures.

Specifically, melanin is the pigment responsible for creating a tan, which is produced by melanocytes in response to the repeated exposures.   The skin essentially becomes thicker over time, making the skin more dense and opaque, like stacking sheets of computer paper on top of one another, which protects it from being burned.

A condition known as vitiligo occurs when melanocytes fail to form, thus disabling the creation of melanin.  Skin will appear void of pigment in a disorganized appearance, making the skin highly susceptible to burning.

• Melanocytes are special cells in our skin that specialize in making a molecule called melanin. • What is Melanin? • Mela...

Other common situations arise in life where sometimes you are simply unable get out of the sun’s destructive path.  All day excursions, Disneyland adventures, sporting events, you name it, will require you to lather up with sunscreen if you haven’t built up your tan, lest you want the dreaded lobster to take over your body.

 

SPF

The defining feature of sunscreens is the SPF (Sun Protection Factor).  SPF refers to the theoretical amount of time you can stay in the sun without getting sunburned. For example, an SPF of 15 would allow you to stay in the sun 15 times longer than you could without protection. So, if your unprotected skin starts to redden in 10 minutes, SPF 15 coated skin would allow you to stay in the sun for 150 minutes before the same burn would occur.  Higher SPFs also block out more rays; SPF 15 will filter out ~93% of UVB rays; SPF 30 will filter more, ~ 97 percent.

The problem is that sunscreen can easily wash away from water or sweat,  leaving your skin vulnerable.  SPF only applies protection from UV-B rays, too. There is no SPF equivalent for UV-A rays.  Zinc oxide and titanium dioxide are known ingredients that protect against UV-A, but there’s no standard measurement for how long they will keep you protected.

Here’s the Fitzpatrick Scale with corresponding SPF sunscreen recommendations:

Skin Phototype Description Skin Color Routine SPF SPF for Outdoor Activity
I Always burns, never tans White 15 25-30
II Always burns, tans minimally White 12-15 25-30
III Burns minimally, tans slowly White 8-10 15
IV Burns minimally, tans well Olive 6-8 15
V Rarely burns, tans profusely/darkly Brown 6-8 15
VI Rarely burns, always tans Black 6-8 15

 

2nd Degree Burns

Severe cases of erythema result in more than just swelling, redness,warmth, and tenderness to touch.  Blistering and fever can be signs of superficial partial-thickness or deep partial-thickness burns.  These injuries are classified as burns of the 2nd degree.

As you may be able to tell by now, I love to post on-theme, sometimes semi-random pictures; however, I will spare you from pictures of 2nd degree burns.  They are quite gross and not something to joke about, but if you are really into seeing the consequences of poor sun protection in action, google images is only a click away.

If you have sustained a 2nd degree or a worse burn, then you should seek out medical care from an Emergency Room or a Dermatologist immediately to provide first aid to your skin and for the resuscitation of fluids. Severely damaged skin loses the ability to retain water effectively, so you will likely become dehydrated incredibly easily.  Intravenous saline solutions can be administered to counteract the fluid loss.  Electrolyte fluids could also be recommended for mild cases.

 

Contraindications for Musculoskeletal Treatment

If you sustain 2nd degree burns you should refrain from the following common therapies performed here at Premiere Spine & Sport until you have recovered from the burn and have been cleared by your medical doctor.  Intense first degree burns could fit into this category, too.  It’s a judgment call that you and your health care provider should make together.  I always recommend erring on the side of giving the skin extra time to heal before receiving musculoskeletal therapies.  Mild burns could be ready for treatment within a day or two, while moderate to severe ones could take 1-3 weeks.

Pay extra attention to your skin and protect it if you know you have an injury or you need treatment at our office!  If you cannot receive treatment because of a serious sunburn you will be impeding your recovery process, which could make you miss that meet, game, race, or competition that you have been preparing so hard for!

  • Adjustments
    • common hands-on techniques to increase joint range of motion will also stretch the skin too much and too quickly to be comfortable
  • Soft-Tissue Release Techniques (ART/Graston/Cupping/Myofascial Decompresion/Massage)
    • too painful and damaging to the burned and raw skin cells
  • Class IV Laser 
    • previously burned skin creates higher risk for burns from the laser
  • Stretching/Exercises (specifically ones that challenge end ranges of motion)
    • increased risk of skin tearing since skin is less pliable
  • Kinesiology Taping
    • more difficult to remove tape, increased risk of ripping off skin, painful!

 

Prevention

An ounce of prevention is worth more than a pound of cure, and if you’ve ever had a really bad sunburn, you would have wished you followed every piece of advice on the list below in order to avoid metamorphosing into the dreaded lobster:

  • Avoid sun exposure, especially during the period of peak solar radiation (from 10 am to 4 pm)
  • Regularly use sunscreen with an adequate SPF for your given skin type.
  • Apply at least 30 minutes prior to sun exposure, and reapply every 2-3 hours or after swimming, sweating, or toweling off.
  • Use waterproof sunscreen when swimming or perspiring heavily
  • Apply at least 2 mg/cm2 of sunscreen to achieve the advertised SPF (about 30 mL is adequate coverage for an average adult’s entire body). Most people apply one fifth of this amount.
  • Physical barriers like zinc oxide and titanium dioxide provide excellent protection against UVA and UVB and are photostable.
  • Chemical barriers are used in most sunscreens. Para-aminobenzoic acid (PABA) and PABA esters, UVB blockers, have fallen out of favor because of high rates of associated contact dermatitis and staining clothes. Other chemical UV-B blocking agents include cinnamates and salicylates.
  • Chemical UV-A blockers include avobenzone (Parsol 1789) and the recently FDA-approved drometrizole trisiloxane and terephthalylidene (Mexoryl).
  • Wear protective clothing, including wide-brimmed hat or sun visor.
  • Specialized sun-protective clothing is available and usually states the SPF each garment provides.

 

Natural Sunburn Remedies

foods that fight sunburn: aloe

If you are looking for natural alternatives to sunscreens that contain high amounts of potentially toxic chemicals, then read this article highlighting 13 natural remedies that help relieve sunburn pain and improve burn protection.

 

Thanks for reading!  I’ll be sure to respond in the comments if you have any questions. Here’s to eating lobster instead of becoming one!  Sebastian here is technically a crab, but his skin tone could fool anyone with how lobsterific he has become with excessive, unprotected sun exposure!

——————————————————–

Dr. Chris Baker, D.C. | Sports Chiropractor
ART/Graston/PTR/SFMA Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)

DrChrisBakerDC FaceBook Page
DrChrisBakerDC Yelp Reviews
DrChrisBakerDC Blog
ChrisBakerDC@gmail.com
Tennis@RockTape.com

 

Sleep Posture 101

Do you wake up with any of the following symptoms?  

1) Stiff muscles in neck or back?
2) Inability to move neck or back fully without irritation?
3) Numbness/tingling in arms or legs?
4) Feel a twinge or twang or when you make a movement too quickly in the morning?
5) General fatigue – like you didn’t get much sleep despite being comatose for numerous hours?
6) Restless sleep – wake up in the middle of the night multiple times?
7) Do you thrash around when you sleep? Does your partner not enjoy being kicked or steamrollered in the middle of the night?

Presence of these is common, but they are not normal.  Break the cycle and follow my advice in the following article to hopefully remedy the situation!

In rare cases these symptoms are the result of undiagnosed cancer, sleep apnea, hormonal imbalances, or calcium/magnesium deficiencies.  In those cases I would suggest you check-in with your medical doctor to be sure.  More often than not you have a problem that is much more simple to fix – sleep posture.

Everyday another patient comes into the clinic feeling miserable immediately after waking up in the morning.  Most think it’s just a stiff neck or low back, but even that can make people pretty miserable.

If there was one common problem among each of them – it was that they didn’t know how to sleep – that is, how to position their body in a strategic way to minimize pressure to their stiff or sore areas.  If they employed the same sound strategy similar to having good ergonomics when working at a computer workstation, then they would be much less likely to wake up feeling those aches and pains.

Just like my patients, I had the same sleep posture problems and early morning symptoms, but I just thought it was a part of life.

Dr. Waters to the Rescue

When I was in the clinic program at Palmer College of Chiropractic West Dr. Randy Waters was my lead clinician and his advice helped show me the light on how to resolve my chronic sleep posture issues.

During my clinical rotation at Palmer I woke up one day with such a stiff neck I thought someone must have hit me with a 2 by 4 in the middle of the night.  In my mind I though it must be time to purchase a fancy, expensive pillow from our clinic to fix my “bed-neck”.

Before I could get my credit card out of my wallet, Dr. Waters in his infinite wisdom suggested that I try the “rolled up towel trick.”  He told me to simply take a bath towel, roll it up until it looks like a burrito, then place it under the side of my neck.  This was suppose to help stabilize and support the neck when sleeping in a side-lying position.  And wouldn’t you know it, the next morning I woke up and my neck felt fine.  Maybe it was the fantastic treatment that I received from fellow intern at the time, Dr. Karo Isajan, or maybe Dr. Water’s trick was all I needed to prevent these neckaches from reoccurring.  Or maybe the combination created the environment that had the most beneficial effect.  Whatever the case may be, I was quite happy to simply be feeling better.

Over time I began to develop what I now consider perfect posture for sleep.  At first this was completely anecdotal and only pertaining to my own sleep needs since I was the only one I was experimenting on, but over time I have made these recommendations to numerous patients and the majority receive the results they are looking for:  better sleep throughout the night and less aches in the morning.

Level Up Your Sleep Game with Neutral Spine Positioning

No matter which position you choose for sleep (side, supine, prone, seated, standing) the best position always requires a neutral spine position.  I’ll include videos to show how to get into these positions – watch them by clicking on the hyperlinks below!

Side-Lying

Supine (face-up)

Seated (cars and airplanes)

Prone (face-down *not recommended unless you can use a massage/chiro table with a face slot that allows you to position your neck in neutral spine*)

Standing (astronauts? *not recommended for safe neutral spine sleep posture*)

The Best Spine is a Neutral Spine

Neutral spine is the “best” position because it minimizes the amount of load and force that you put into it.  Experiment time:  turn your neck to the side 90 degrees to stare at your computer monitor.  Continue reading this article.  See how long it takes before your neck hates you.  Now imagine sleeping prone without a space for your face.  Most people sleep on beds, not massage or chiropractic tables.  In those instances where you can keep your head face down without smothering yourself it actually is possible to find a good neutral spine sleep posture.  But you sleep on a bed.  So if you lie down on your stomach and turn your head 90 degrees to the side and stay there all night – I would imagine your neck would feel much worse than it does ever since you turned your head earlier in this paragraph!

Stop the experiment and look straight at your monitor again – I don’t actually want you to develop a problem here – just trying to prove a point.

The same principle applies with side-lying.  You want to stack all of your joints one on top of another, starting by stacking your ankles –> slightly bend your knees -> knees –> hips –> shoulders –> elbows –> wrists.  Your elbows and wrists should be in front of your body like a “prayer” position.

From this position you are not in neutral spine yet.  This is key because most people sleep in this posture but don’t support their body enough or even too much.  The mistake I made in the past was using two or three pillows to elevate my neck and head, which creates too much lateral bend in the neck.  Instead, use Dr. Water’s towel burrito trick to support the neck, then use just one normal pillow to support your head.  The head and neck should align perfectly.

Body pillow is so long it’s being used as a neck support, too

Your hips and shoulders will have a rotational torque force on them if you stay stacked without anything separating them.  Here’s where the body pillow comes in.  Some people get it half-right and stick a pillow between their knees, but ignoring the shoulder will cause issues.  The body pillow should be about as tall as you are from your feet to your neck when you are side-lying.  Your knees will be slightly bent so the pillow doesn’t need to be as long as you think, but it’s easier to work with an extra long pillow rather than a slightly short one.  Error on the side of too long.

The body pillow will create separation between your ankles, knees, elbows, and wrists to reduce torque or a rotational force through those joints.  Always reverse engineer your posture to a good seated computer workstation posture to double-check whether the position is good for sleeping.  In this instance, you don’t type at a keyboard with your feet, knees, elbows, and hands all touching together in the midline – so why would you allow that when you sleep?  Separate them with the body pillow!

Mattress Firmness:  Firm versus Soft?

This gets asked a lot.  Some people prefer either a more firm or more soft mattress.  It’s difficult to predict from my experience.  In an ideal world you would take a mattress out for a test drive and if you sleep well on it then you would keep it.  I don’t hear Sleep Train commercials allowing people to spend the night to test it out, nor do I think that’ll happen anytime soon.  Maybe see if they’ll let you take a nap on something more firm or soft than what you have now and see how you feel when you wake up.  Or maybe crash at a friend or family member’s place.  I don’t expect anybody to do this but I just don’t want to hear any excuses when you have no idea whether you like firm or soft mattresses!

Whether you can achieve neutral spine position while at rest is the key.  It’s not easy to maintain all night if you aren’t used to it, but it’s very simple in terms of posture correction.  There’s no movement to it like with exercise which can be confusing if you have motor control issues – it’s completely static and motionless!  So easy a monkey could do it!

Common Sleeping Posture Faults and Fixes

All involve excessive:

Neck Rotation –  don’t sleep prone unless you have a massage/chiro table


Wrist Flexion – curling wrists is very common, which often causes numbness/tingling in hands – use a body pillow and prayer position – if that doesn’t work try a wrist brace only for when you sleep


Shoulder Flexion – throwing an arm above your head to support your neck underneath a pillow – move to prayer position and use a body pillow


Neck Lateral Flexion – pillows too high – use towel or Tempur-pedic pillow for neck


Spinal Flexion – fetal position – straighten out your spine and only slightly bend your knees.


Hip Flexion + Rotation – bringing one leg up into a frog leg – switch to side-lying and use body pillow to take pressure off your hips

There are more issues people can have in terms of being unable to obtain neutral spine sleep posture.  If you have specific issues you want me to address I invite you to the comments section and I’ll answer any and all of your sleep posture questions!  Don’t get stuck with your foot in your mouth – sleep posture-wise!

A Hypothesis – Why do some people thrash around when we sleep?

I used to kick and move all over the place when I slept.  Even when I was a kid at a friend’s for a sleepover.  We actually used to share beds – kind of weird but it’s a memory I cannot forget.  And I also remember being told to stop kicking and moving onto their side of the bed.  I’m pretty sure I was sleeping and wasn’t doing it on purpose, but eventually people would lose patience and just kick me out.  Banished to the couch with you!

Why is it that I now notice that I wake up in the same exact position that I fall asleep in?  My assumption is that I am not moving like I used to during the night.  Before I confirm this hypothesis with camera footage to prove it, I’d like to suggest my reasoning for what changed.

Before I knew how to get into a neutral spine sleep posture, my body would inevitably come to rest at a position that was basically random aside from my choice to be prone, supine, or side-lying.  Maybe I would throw in a common postural fault for good measure, like using my arm for support underneath my pillow.

Posture far from perfect, but I still somehow manage to fall asleep.  Now my body in unconscious.  I cannot make movement happen with my mind like I can when I’m awake.  I can still move, but I’m not in control anymore.  Some say we are paralyzed in the deeper cycles of sleep.  We can still breath of course, but gross motor movement will not occur.  That is, until our body cannot take our erroneous sleep posture anymore.

I imagine a sailor on a submarine or an astronaut in a spaceship with a pressure breach to a compartment. The red pressure meter is rising.  Someone needs to go turn the valve (which is always jammed or impossible to reach in the movies) in order to take away the pressure.  In the human body, we are building this red pressure meter somewhere every time we fall asleep in a bad posture.  We would explode eventually, but before we do, our body can turn on the thrusters and create a random movement (thrashing around) which will change our sleep posture.  The effect should immediately relieve the offending pressure area, thus making the red meter go down.  Since we are highly unlikely to flop into a perfect neutral spine sleep posture with supporting pillows, we are likely to create another high pressure area.  And so the cycle goes, with lots of tossing and turning, and tension being generated in the body in various locations.

Does this make sense?  Any other theories on why we move when we sleep out there?

I became a believer in the benefits of neutral spine sleep posture when I realized that I fell asleep watching a TV show (probably Game of Thrones) on my laptop with a full glass of water right next to the keyboard.  My knee was less than a foot away from the tall, full glass of agua.  Any significant movement from me would have likely resulted in a submerged MacBook Pro.  When I awoke I was astonished that I didn’t completely ruin it.  I felt like I dodged a bullet.

That’s the power of neutral spine sleep posture – not spilling water on laptops never felt so good!

——————————————————–

Dr. Chris Baker, D.C. | Sports Chiropractor
ART/Graston/PTR/SFMA Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)

DrChrisBakerDC FaceBook Page
DrChrisBakerDC Yelp Reviews
DrChrisBakerDC Blog
ChrisBakerDC@gmail.com
Tennis@RockTape.com

The 12-Standards of Ready to Run by Dr. Kelly Starrett (A Book Review)

Ready to Run

First things first, if you have any interest in running/movement/playing sports – go read this book! My goal is to summarize the “12 Standards” Dr. Kelly lays out for people in order to prove to themselves that they are “Ready to Run” –  without a high risk of injury that is!  I believe this standardization should be applied to all athletes that need to navigate their bodies through a course, field, or court. Think distance runner, sprinter, soccer, rugby, football, basketball, lacrosse, baseball, or tennis player.  More than just runners will benefit from this book, but it’s the running motion that links all of those athletes together!

It’s an easy read, much smoother than Becoming a Supple Leopard. Less jargon is used which makes it quite accessible for the medical-terminology challenged.  Concepts are explained in enough detail that the reader can start testing, making changes, and re-testing right away. Pictures are plentiful, which always helps!  The anecdotes are compelling and the “no-nonsense” tone is motivating – it makes you want to get off your ass and make some necessary changes in your life!  Take my synopsis for what it is – if you want more knitty-gritty details, then go read the book and start watching some videos on how to pass the standards.

The following are the “12 Standards” Dr. Kelly presents.

1) Neutral Feet
2) Flat Shoes
3) A Supple Thoracic Spine
4) Efficient Squatting Technique
5) Hip Flexion
6) Hip Extension
7) Ankle Range of Motion
8) Warming Up/Cooling Down
9) Compression Socks
10) No Hotspots
11) Hydration
12) Jumping/Landing

Let’s briefly go over each one.  I add some of my own insight to the general principles he lays out in the book, too.

1) Neutral Feet
feet pic

The goal of standing, walking, and running should be to maintain a neutral foot position. This not only includes avoiding hyperpronation and hypersupination, but also avoiding pigeon feet (internal rotation) and duck feet (externally rotation).  Asymmetrical positioning with one foot straight and the other ducked way out into external rotation is a common standing positional error that leads to upstream mechanical faults.  Ground reactive forces don’t get absorbed well in the non-neutral side, and before you know it the knees, hips, and low back are achy.

Common medical practice to correct a positional error is with orthotics.  Realize that when you put a rigid support under your foot you are not creating a system that helps itself over time – you are making it dependent on that support.  Have you ever sprained or broken your ankle?  If you ever wore a cast and then ankle wraps or got taped up with white athletic tape from the trainer then you have seen the aftermath or what rigid supports do to your joints in the ankle/foot.  Rigid supports make them weak and atrophy.  If you want a higher arch then you need to work on activating your intrinsic foot muscles.  The “Janda Short Foot” is the go-to move.

Practice standing, walking, and running with neutral feet.  Practice people watching in public places – see who walks/runs neutral and who has a movement fault.  If you can spot the error in others than you will be more cognizant of your own movements.

Organizing neutral feet is easier if you are in a braced, “midline stable (MLS)” position, as well.  The simple four step activation process to achieve neutral spine position (good posture) is the following:

1)  Engage your glutes (pelvis rotates posteriorly)
2)  Engage your abs (ribs rotate downward)
3)  Move your shoulders back and down (palms should be touching the side of your          legs with thumbs pointing forward)
4)  Tuck you chin backwards (like a turtle retracting its head back into the shell or                double-chin)

2) Flat Shoes

Traditional running shoes have an elevated heel.  They are essentially “high heels” for runners.  No one would be caught dead running in their fancy stilettos unless their ankles had a death-wish.  Even a small elevation change of 20mm between the forefoot and heel can enable poor mechanics to happen.  If you tried to run barefoot you would not strike the ground with your heel.  With heel-cushioned running shoes you can without an immediate consequence.  Heel-striking increases the ground-reactive forces in your body since you are essentially braking with each step, which counteracts the momentum of you trying to propel your body forward!

Flat or “zero drop” shoes will not fix the problem immediately – in fact, they can cause different ailments like strains to the plantar fascia, Achilles, or calf.  Zero-drops will invite change to your mechanics.  Most notably you should lean forward to shift your center of gravity in front of your midline and begin striking the ground with your mid to fore-foot instead of your heel.

3) A Supple Thoracic Spine

Humans spend too much time with their arms in front them for daily tasks.  Computers, cell phones, writing, reading, exam/note-taking, driving, household chores, holding a baby, etc.  Your mid-back is repetitively being forced into the dreaded “hunch-back.”  To prevent yourself from being permanently stuck bent forward, mobilize your thoracic spine in both extension and rotation.  It’s simple, you just need to do it to counter-act all that time spent in t-spine flexion.

Optimal breathing mechanics involve a fully-expanded ribcage and lungs.  When you finish sprints where do you go to get the most oxygen – bent over looking at the ground or hands above head and an upright-posture?  Similarly, just compare the difference of position when throwing a ball.  Hunch forward and throw, then do one with a relaxed mid-line stable position and you be the judge of what is the optimal posture for movement.

4) Efficient Squatting Technique

Most people can’t squat well for two reasons:  mobility or stability limitations.

Mobility:  Ankle and thoracic spine
Stability:  Glutes, intrinsic foot muscles (neutral foot/arch)

You first need to watch yourself or have someone watch you squat to see if you’re making some of the common movement errors.

Squat Movement Errors:

1)  Valgus Knee (collapses medially – above picture on the left)
Correction: Glute activation drills. Create external rotation torque during squat

2)  Collapsed Arch (hyperpronaton of foot)
Correction: Janda Short Foot Exercise, neutral foot positioning, mobilize plantar fascia, ankle, calf)

3)  Excessive Forward Lean (Hips –> Spine angle not parallel to ankle –> knee angle
Correction: Mobilize thoracic-spine extension/rotation, learn how to breath when squatting

4)  Anterior Translation of the Knee (moves forward in front of toes)
Correction: Goblet or TRX squat to move center of gravity behind mid-line. Practice the hip-hinge and the Founder

Once you can squat well, you need to practice squatting more times well.  That is, you need to resist fatigue and poor form from creeping back into your mechanics as you get tired.  The goal is to do a Tabata set, 20 seconds on, 10 seconds rest, repeated for 4 straight minutes.  You need to attain 10 squats in each 20 second interval to pass the test. If you don’t achieve the standard on the first try, get practicing!

5) Hip Flexion

The picture above shows a 90 degree angle of hip flexion.  That is not the standard of range of motion.  You need to be able to balance on one leg with at least 120 degrees of hip flexion for 30 seconds on each leg to pass this standard.

Just because we spend an excessive amount of time sitting doesn’t mean we can attain MLS and stay balanced while expressing full hip range of motion.

If you fail the test then you need to practice it and also work on the posterior chain of the thigh and hip to free up that range of motion.  Target the glutes and hamstrings with foam rolling, mobility bands, and voodoo floss.

6) Hip Extension

Running is a linear motion that many get boxed into.  Despite lateral and backwards movement being available to people, we tend to train down the straight and narrow path. Compound that with the amount of time we spend seated in 90 degrees of flexion and you can see why we have a hip extension limitation epidemic.  The fix?  Limit your time spent sitting to as close to ZERO as possible and do the couch stretch – pictured above. Squeeze the glutes to reciprocally inhibit the hip flexors to get the deepest stretch to the hip flexors and all the gunk in the deep capsule.

7) Ankle Range of Motion

Ankle dorsiflexion (toes fly up to the sky) is often limited  because of the sheer abuse we put it through in steps/day (10K average).  Sports and working out add to that load, as does wearing shoes with an elevated heel pad for a lifetime.  And who hasn’t rolled an ankle before?  There’s a reason why the ankle inversion sprain is the most common sports-related injury – we do a poor job of maintaining ankle health, making it even more susceptible to traumatic injury from athletics.

To test if you have good enough ankle dorsiflexion you need to perform a pistol squat position.  You don’t need to do the full-on single leg squat, just the end shape.  So begin by touching your inner feet together heel to toe, then squat with both legs balancing your body weight, then at the bottom position stick one leg out straight at a 45 degree angle. The squatting leg will be loading the ankle to the max in dorsiflexion.  If your heel raises off the ground or your arch collapses then you do not pass the standard.

Correction:  posterior chain leg mobility (plantar fascia, Achilles, calf), Voodoo Floss ankle, and this ankle mobility band drill

Ankle Plantarflexion (toes plant down to the ground) is overworked in ballerinas from dancing on point and in those who have high standards of fashion and choose high-heels over zero-drops.  For everyone else plantarflexion is a position we rarely spend time stressing.  This standard will burn like crazy for those people.

To test your ankle plantarflexion simply point your toes down and sit on them, tall, elongated spine in a MLS posture.  Hang out for a few minutes – or as long as you can handle.  Increase that time over time.  If you don’t feel enough of a stretch then kick it up a notch and do what the above picture shows – lift yours knees and lean back with the hips still clamped down over the top of the ankle.  Still not enough?  Draw circles with your knee to scour all the nooks and crannies of the anterior ankle.

Correction:  Anterior leg mobility for anterior shins, quads, couch stretch

8) Warming Up/Cooling Down

People get injured when they try to do too much too soon.  Jumping into a run, game, or workout cold is a quick way to tweak a muscle.

The warm-up simply needs to involve non-linear movement in order to prepare your tissues for a 3-dimensional world of movement.  Think arm circles as opposed to punching straight jabs.  This principle applies to all major muscles/joints in your body. Jogging is a good start, but a dynamic stretch in all 3 planes (flexion/extension, lateral flexion, and rotation) will be a more complete awakener for your hips.  A good warm-up will elevate your heart-rate, begin to make you sweat, take your joints through multiple planes of motion, heat your body temperature, and prime your nervous system for explosive or endurance movements, whichever you need.

KStar recommends that you warm-up for a time inversely proportional to the time spent doing your activity/competition.  For example, a sprinter running the 100m should warm-up much more than a marathoner.   The more power and energy expenditure required for the activity, the more “warm” you should be to be ready for it.

Cooling down is similar to the warm-up in tasks performed but opposite in its goals.  You want to slow your heart rate down, help propel metabolic waste products through the lymphatic system, and release tension to overused tissues torched during the activity.  If static stretching were ever recommended, it would be during the cool-down.

9) Compression Socks

Wearing compression socks is an easy, inexpensive, and useful tool for aiding your body’s attempts to flow blood against gravity from your feet and legs back towards your heart. This is important because if you do not clear the metabolic waste then you will feel sore, which will slow you down in future practices and performances.

A car would be poorly designed if the exhaust spewed out of the vents where the AC comes from.  We were not meant to breath in the waste products created by the combustion engine, much like our muscles were not meant to be subjected to lingering metabolic waste accumulation.

When your body gets overworked in specific tissues it also spews out tons of waste products.  It’s rather controversial, but some scholars blame soreness on lactic acid, while others blame Hydrogen ions/increased blood acidity, and others on carbon dioxide build-up, electrolyte depletion, or inflammation due to repetitive microtrauma to the tissues. Whatever causes soreness is neither here nor there – as athletes, all we want to do is eliminate soreness as fast as possible.  If we can help create a pressure gradient and look fancy with some cool socks at the same time then I say sign me up!

If you have to travel for your athletic competition or workout, you most likely sit in a car right after you finish – and forgo moving for far too long!  God forbid you have to drive hundreds or fly thousands of miles and get trapped in a seat for countless hours.  Even if you just travel frequently for work or business, compression socks will help keep your legs fresh.

A more expensive over-the-counter solution to ridding the body of metabolic waste is the Marc Pro – a portable muscle stim unit that doesn’t fatigue the muscles.  It allows you to remain relaxed while it repetitively contracts your muscles, which squeeze around the vein/lymph vessels, surging the metabolic waste and blood back towards your heart like you would move toothpaste by squeezing the bottom of the container.  Waste products get cleared faster, and you end up feeling less sore.

10) No Hotspots

“If you feel pain during or after moving, then what you were doing was not functional movement. If it feels sketchy, it is sketchy.”  ~KStar

There’s a difference between pain as a symptom and pain as an indicator of a “hotspot” aka trigger point, knot, myofascial adhesion, excessive scar tissue formation.  Therapeutic treatment that involves manual release of hotspots WILL CAUSE PAIN/INTENSE DISCOMFORT, but the difference between pain as a symptom should be obvious.  If it’s not obvious – then go seek medical help.  If you roll over an area and you feel no pain or discomfort, well then, don’t waste your time rolling out that tissue.  Would you brush your teeth if you knew they were clean, say, right after you just brushed them?  Focus on the hotspots instead of rolling simply for the sake of rolling.

Most of you know that the foam roller is the toothbrush for the human body, but other tools help do the job as well, sometimes even more so because they can help you access difficult to reach anatomical locations with ease.  Lacrosse balls, golf balls, softballs, baseballs, yoga balls, RockBallz, the Stick,  Tiger Tail, Jade/Guasha tools, and any metallic soft-tissue release instrument – they all have their place.

One new tool that KStar designed and developed is “VooDoo Floss Band Compression,” which has been revolutionary due to its simple application and outstanding results with restoring range of motion to stuck, adhered, laminated tissues.

11) Hydration

You need to ingest half of your body weight in fluid ounces everyday to maintain MINIMALLY ACCEPTABLE hydration levels.  So if you weigh 160 lbs. that’s 80 fl. oz. per day, which is 4 full blender bottles worth.  If you are that size then I would suggest you carry a water bottle with you EVERYWHERE you go, and fill it up 4 times a day at the bare minimum.  Drink fast enough to get all that fluid consumed throughout the day!

This amount does not account for replenishing fluids lost from athletic activity, especially if you sweat a lot or play in a hot/humid environment.  In those cases, up the dose or risk dropping critical performance metrics like VO2 max (maximum volume of oxygen available, which measures peak anaerobic capacity).

Hyponatremia is a condition most commonly seen in endurance runners that over-hydrate but fail to spike their water with a key ingredient – electrolytes!  These minerals are known as “water-magnets” due to their ability to create a concentration gradient in the collecting ducts of the kidneys, which allows water to be absorbed more readily.  Without electrolytes like Magnesium, Calcium, Potassium, and Sodium, a large quantity of water would pass through our system straight into the great white porcelain bowl.  In order to prevent this loss of water retention, simply sprinkle your water with a pinch of iodized salt. There are even flavored droplets out there now, promising to turn those that hate the foul taste of plain water into a nectar of the gods.

Even if your urine is clear, you could be absorbing and retaining more of that water.  Be like a cactus, suck up that water to the best of your ability, and aid your body’s absorption of water with salts!

12) Jumping/Landing

Much like squatting mechanics, if you cannot jump and land with neutral feet, knees, and hips you will likely develop patellar tendonitis or worse, tear your ACL or be susceptible to some other traumatic injury given enough time and opportunity to mess up. It doesn’t matter how strong you are – your tissues can only handle excessive stress until they can’t anymore.  When something finally breaks down you will know and you will wish you prepared better by grooving a fluid, efficient movement pattern instead of a “ticking-time bomb” movement fault.

The jump/land test has 2 parts:

1) Box Jumps:  perform with mechanics similar to good squat form.  The movement is essentially an unloaded, dynamic squat.

Common Errors:
1) Knees forward, shins not vertical
2) Pigeon/Duck feet (too much internal/external rotation)
3) Lack of Midline Stability (hyperflexion of the low back)

2) Jump-Rope:  perform single-leg jump rope hops with each foot 30 times with good form

Common Errors:
1) Lack of Midline Stability (head/shoulders translate/round forward)
2) Landing on heel (should land on forefoot)
3) Pigeon/Duck feet
4) Valgus collapse of knee
5) Collapsed arch of foot

Concluding Remarks

KStar wraps up the book with numerous demonstrations of mobility drills and an entire overview of various mobility techniques, complete with a plethora of pictures!  He then applies those techniques with strategies to attack common running injuries.  You’re going to have to get the book to check those out.  It’s well worth it!

I hope you enjoyed the review as much as I enjoyed reading the book.

Thanks for reading and good luck on your journey towards meeting the 12-Standards 😀

Dr. Chris Baker, D.C. | Sports Chiropractor
ART/Graston/PTR Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)
Tennis@RockTape.com

How to Make RockBallz

Dr Chris Baker @ the NorCal Regional Cross Fit Games

Click on the picture above for a quick instructional video on how to make RockBallz: a tool for effortless self-mobility treatment for your back.

Use it to improve your paraspinal tissue mobility when seated for extended periods of time, especially driving and flying, or even if you’re stuck at a desk job all day.

Put the pedal to the metal and accelerate aggressively when merging on a highway or when you’re first in line at the red light to create an extension force on the most tight joints/muscles in your mid-back!  Then move the RockBallz around every few minutes, up and down the spine like a zamboni smoothing out an ice rink.  Hangout on one level long enough to make a noticeable change to the tissue tone – usually a few minutes at minimum.

Use a wall or the floor as a backdrop when at home and have a superfriend gently push your pecs/shoulder backwards to induce passive extension into the joints.

For my tennis players, or any athlete really, keep it in your tennis/gym bag and use it on court to warm up.  Make a RockBallz out of lacrosse balls for a more intense release!  You can sink into tissues in your glutes, too, but I recommend just keeping a single lacrosse and golf ball in your bag as well to create a more focal smash point.

If you are human, then you likely spend too much time with your hands in front of you (computers, phones, driving, eating, working out, etc) compared to hands behind you or in neural position, which reenforces the dreaded hunchback posture.  If you don’t want to be bent-over, permanently looking at the ground when you are 70 years young then get your thoracic spine mobilized daily starting now!  Leave RockBallz in your car and use it every time!

If you can turn times of postural stress like commuting into times of therapeutic recovery, then you will proactively combat the daily stresses your body takes, which helps you assimilate a neutral spine posture with less effort.  A tall, lengthened spine with relaxed, supple muscle tissues is a happy one.

Try it out, make your own, have one made for you, but most importantly, once you have one, you gotta use the thing!  Think of it as a toothbrush for your muscles.  Imagine if our muscles reeked like dragon breath from not brushing your teeth for a whole day.  That symptom presents in muscles as tightness, soreness, limited range of motion, and at it’s extreme – pain!

Work on your body DAILY to keep it fresh and clean!  You can do it – I believe in you 😀

Dr. Chris Baker, D.C. | Sports Chiropractor
ART/Graston/PTR Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)

ChrisBakerDC@gmail.com
Tennis@RockTape.com

Mobility WOD Programming 4 Life

For most of us, it’s time for a reality check.  You are not moving at your absolute peak potential.  Your tissues are glued down, laminated, and stuck together.  You do not have perfect posture.  Not at your job, not when you sleep, nor while you plays sports and exercise.  You can hope to attain perfect movement patterns, but you will never attain them at the rate you are going.  What is ideal movement/posture anyway? If you’re like most people I encounter, you need to radically change how you prepare your body for life-long functional movement, otherwise aging will be a not-so-fun process for you.

Highlighted in Becoming a Supple Leopard, Dr. Kelly Starrett estimates that 98% of the dysfunctions that lead to injuries or symptoms including pain, tightness, stiffness, soreness, numbness, tingling, and so on are due to mobility limitations!  Ninety-eight percent – that’s a sh*t-ton, like almost all of the problems that exist in the world of movement training!  The solution is simple – MOB ALL THE MUSCLES! (mob = mobe = mobilize).  Please don’t form a mob and riot against the muscles…

Dentists Got it Right

Do you wait until your teeth hurt before you start to brush them?  No, you don’t. Don’t get mad at the rhetorical question.  Get mad at the culture of medicine and doctors that didn’t teach you preventative care for the musculoskeletal system like dentists did for oral hygiene.

You see, everyone I ask that question to just rolls their eyes and nods along.  They get it, but they don’t have a solution for the human body’s movement systems like brushing their teeth and flossing.

So why is it then that we wait until our back hurts before we seek medical attention?  Why do we wait to mobilize our neck until it’s so tight we cannot turn to check our blind spot while driving?  Waiting for pain symptoms to occur and then getting treatment is like waiting until you get a cavity, get it treated, then realizing brushing/flossing might have been a good idea all along.  It’s about time we all learn how to prevent these chronic movement dysfunctions from happening

So when you do get injured, it’s obviously a great idea to seek care from a medical professional.  Have a Sports Chiro, DPT, Sports Med Ortho, or whoever you have in your ‘recovery team’ network actually provide care for your injury so that it heals faster and your symptoms go away more quickly.  These professionals are often underutilized and will like be better than doing nothing and over-the-counter or at-home remedies.  But what about after your acute injury has fully recovered and your symptoms subside?  What does your daily routine need involve in order to prevent the likelihood that you re-injure yourself or create an entirely new injury?

MobilityWOD is Actually a Workout, Stretching is Not

I have beef with the term ‘stretching’ mainly because of the assumption that most people have when they hear that word.  Most assume that stretching is done to loosen up tight muscles and that it is a passive, slow, perhaps boring activity that involves holding intense burning positions for an extended period of time.  Stretching has so many variations that the general concept outlined above misses broadside of a barn.  There’s static, dynamic, some with muscle contraction, some while getting myofasical release treatment, and some that are eccentric loading exercises!  A mobility drill is a different animal altogether.  You will be sore after doing it.  You will challenge strength and stability while simultaneously creating oscillations in stuck tissues that will unlock their chains, freeing them to enjoy a world of unrestricted movement.

Certain mobility drills are more important for some people than others. In order to solve the puzzle that is your body you want to have a blueprint for movement to figure out what it needs before starting a Mobility program.  I recommend that everyone gets a functional movement evaluation to learn what your body can do –  figure out it’s strength’s, weaknesses, where the immobile tissues are and which ones are unstable.

The place where much movement learning happens

I’ve been following mobilityWOD.com for years from the advice of my friend and colleague Dr. Karo Isajan.  Recently I have been learning how he implements mWODs into the fitness routine for all of the athletes over at NorCal CrossFit.  I’ve learned a lot and have brought that experience to Silver Creek CrossFit, which is where Premiere Spine & Sport recently opened up its new satellite office.

The following is how I organize Mobility classes at Silver Creek CrossFit on a once per week time interval.  I teach them right after the 9:30am class on Saturdays.  I invite all of my patients and all of the CrossFit crew to come out and get moving!

While the class is only once per week, the purpose is to discover the mWOD drills that help you out the most so you can learn them and take them home with you to perform everyday like you brush your teeth!

Week 1:  Ankle/Lower Leg

Week 2:  Lumbo-Pelvic Hip-Complex (LPHC)

Week 3: Thoraco-Scapular Shoulder-Complex (TSSC)

Week 4:  Wrist/Forearm

After week 4 start back at week 1 and continue repeat the cycle.  Notice the symmetry between the upper and lower body – it’s a magical mirror.

Components of a Mobility Class

1)  Movement Screen (Pre-Test)

Why perform a Mobility Screen? – Because we want objective criteria to measure whether all the brutal torture we are about to subject ourselves to actually makes a difference.

Ankle/Lower Leg:  In-Line Lunge, Deep Squat, Pistol Squat

LPHC:  Deep Squat

TSSC:  Shoulder Flexion

Wrist/Forearm:  Wrist Pronation + Flexion and Wrist Supination + Extension; Rack Position

2) Self-Myofascial Release

Foam Roll

Lax Ball

Partner Mashing with Feet

Bar/KettleBell/Plate/Dumbbell

Perform for at least 2 minutes per region for a therapeutic dose.  Scan all fascial chains involved with the region of the body being targeted that week.

3) Question of the Day

What’s your favorite…?  mWODs should connect groups of people – learning little details make it easier to start conversations with people you don’t know much about!  Start with fruit, sports teams, summer-time hobby, restaurants, vacation spots, pet peeves etc.  The more comfortable people are with each other the more interesting the questions get!

4) Dynamic Movement – full range of motion through targeted joints

Hold for 2 seconds max per rep.  Create full range of motion in all 3 planes of movement when possible.  For example, instead of the typical mountain climber calf stretch against the wall, add a “windshield wiper” movement of rotation to mobilize all of the medial and lateral fibers instead of just the midline fibers.  Perform for 30 seconds – 2 minutes (minimal requirement – therapeutic dose).  Each region will have 3-5 different drills performed each week.

5) Mobility Bands (Rogue Fitness Monster Bands)

Create a shearing force by wrapping  around a joint like the Tibial-Talar or Femoral-Acetabular to open up sticky bits real deep, like the joint capsule level.  Step away from an anchor point where the band is stationed further to intensify the experience.  Each region will have 2-3 different drills performed each week.

6)  Movement Screen (Post-Test)

Check out the same movements and be objective.  What do you feel?  Better, worse, or the same?  If you did things right you should feel less resistance in your movement, as if the emergency brake was on before but got taken off.  Until you open up your mobility restrictions, your perception of tension in the body is so acclimated to that elevated level of tension that it’s as if you didn’t know what the emergency brake was on in the first place!  If there’s one thing I learned from Tokyo Drift – it was how to pop that E-brake.

Goals/Purpose of Mobility WODs

1) Obtain optimal starting and finishing shapes/forms for foundational exercises and movements

2)  Teach philosophy and strategy of daily maintenance to prevent injury and optimize performance

3) Prime the nervous system as a warm-up for exercise and improve range of motion to overactive, hyper-contracted tissues.

4) Hang out with cool people – not one likes to mobilize alone (some do, it’s just not as fun and that is a scientific fact!)

Sample Photos From Thoraco-Scapular Shoulder-Complex (TSSC) Day

IMG_1317

Lax Ball that Lat + Rotator Cuff

IMG_1318

IMG_1375IMG_1373IMG_1374 Super-friend assisted Foam Roll T/S Extension + Monster Band Shoulder Flexion

If you want to learn more details on how to feel free from the tension that plagues everyone that fails to mobilize then get in contact with me and drop in on a mWOD class over at Silver Creek Cross Fit @1030am on Saturdays or schedule an appointment to get a functional movement screen.  I’m always happy to see new, smiling faces change to pain faces mid-mWOD 😀

dat pain face doe

Is that smile indicative of laughter or is he in utter agony?  Only the pain face knows.

Dr. Chris Baker, D.C. | Sports Chiropractor
ART/Graston/PTR Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)

ChrisBakerDC@gmail.com
Tennis@RockTape.com

Iced: The Illusionary Treatment Option: A Book Review

Image Google “benefits of cryotherapy” and it will yield a plethora of results, ranging from faster recovery to decreased soreness to decreased tissue damage.  If you were to ask a medical doctor, personal trainer, athletic trainer, or even your mom then you would likely get the same answer from each one regarding the benefits of ice – it reduces pain and prevents excess inflammation. But do we want to prevent inflammation?  And what constitutes excessive?

The answer has been accepted by athletes, non-athletes, and medical professionals everywhere.  The rolled ankle of a child playing soccer during recess, to the collegiate tennis player that strained her hamstring chasing down a drop shot, to the professional baseball pitcher that routinely deals with a sore shoulder after 7 intense innings pitched.

Cryotherapy is thought to be the perfect home-remedy because of its ease of access. Over time, physiotherapy companies spawned interest in commercializing ice such that products have been invented to harness and dispense the power of ice to the extreme.   Surely the discovery of ice as a natural healing aid would have went under peer review and standard research protocols before its widespread implementation into sports medicine. Well, the author argues that this is not the case.

Gary Reinl, author of Iced: The Illusionary Treatment Option, adamantly believes that ice’s pervasive use by athletes and injured people everywhere is based on a fallacy.  Gary’s background is in personal training, strength and conditioning, and as a distance runner.  His knowledge of the history, physiology, and practical applications for healing and recovery of the athlete are among the most I’ve ever come across.  We met at the USPTA Tennis World Conference in Orlando in September 2013 where I was a speaking on Kinesiology Taping for Performance and Injury Prevention as the Tennis Director for RockTape.  I recognized him from the video below, which is when my curiosity for understanding ice as a clinical treatment option was set on fire.

We’ve got to stop icing people.  We were wrong. Soooo wrong. Image

Author Bio

Gary consults with the athletic training staff for every team in the MLB, NBA, NFL, and NHL.  His influence has reached Olympic athletes, their trainers, and collegiate training rooms.  While his network is quite prestigious – it’s a small, tight-knit group.  He wrote this book because he figured that it was about time that his message should heard by the weekend warriors of the world, the non-athletes, and the non-medical professionals.

Lay people often take the word of their doctors because it is logical to defer to an expert’s opinion; however, most doctors make recommendations to ice after an acute injury or to help with pain or swelling without even knowing the physiological effects that ice has on the body.  Gary believed that dropping a knowledge bomb on the world would help people make a more informed decision regarding ice application.

Book Synopsis

Without completely stealing the book’s thunder, I want to highlight some key pieces of the book that should spark your curiosity enough to make you want to pick it up for yourself.   It’s less than 200 pages and has plenty of stories to entertain you while your mind is blown by the reviews of current scientific literature and digestible explanations of human physiology.

History of Icing

In the late 60s, there was a young boy who somehow managed to sever his arm on a railroad track.  He arrived at an emergency room with his dismembered limb.  Never before had a re-attachment surgery been performed.  With the tissues of his arm rapidly decaying, the doctors thought to put the limb on ice to preserve it.  If refrigerators can increase the shelf-life of meats, then freezers should preserve it for even longer.  Their logic was sound, and is still used to this day.  If you cut off a finger, put it in a bag of ice to slow down coagulation and scarring of the torn blood vessels – you want them to be open so the doctors can surgically reattach it.

The surgery for the boy was a complete success.  He eventually regained functionality in the use of his limb.  Amazing!  The story made national news but the story was too garbled up with technical jargon concerning the tissue reattachment surgery.  So the reporters choice a piece that people could grasp – the bottom line was that if you ever sever a limb, put it in an ice bag.

Over time, a logical leap was made, where if you simply got injured, you were recommended to put ice on it.  No research, no peer-review.  In fact, Gary argues that if ice was a controlled substance like any pharmacologic drug on the market today, it would not be able to satisfy requirements for FDA approval.  No research showing it’s effectiveness, no clear treatment guidelines for treatment times depending on varying tissue thickness, and lack of safety (frostbite/delayed healing response time/delayed nutrient delivery).

Try Pubmed or other publication databases and see what you can find – I searched and came up short on finding relevant articles showing the benefits of ice for acute soft-tissue injuries.  If they exist I would love to read them so that I can incorporate ice into clinical treatments effectively.

Contemporary Research

“Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage.”

–  Journal of Strength and Conditioning Research (2013)

This study found that after exercise people who were given ice compared to not showed increased levels of creatine kinase, an indicator of soft-tissue damage.  Subjects also reported a higher level of fatigue 72 hours post exercise of the iced tissues compared to the non-ice controls.  The findings make sense when you assume that an injured tissue, delayed in it’s recovery from ice, would feel more fatigued than those that were not subjected to the freeze.

Gary sites research in the book that showed icing actually increases the amount of fluid build-up in the damaged area by creating a backflow from the lymphatic vessels. Lymph vessels work as a negative pressure system.  Imagine a balloon filled with air.  If you open the end of a full balloon, then air will rush out.  It’s operating on a pressure gradient – the air moves from high to low.  When fluid is built up in the body, like after an acute ankle sprain, it is a high pressure area.  The fluid is pushed through the lymphatic vessels by compression, either from an outside force (massage, compression sleeves, Graston tools) or from intrinsic muscle contraction.

The lymph vessels are split into small chambers.  As a chamber is filled with fluid, the gates open to the next chamber, which pushes it along the pressure gradient. Icing has been shown to open the gates of the lymph vessels, which can allow for the fluid to back-up, moving towards the injured area versus being pushed away from the injury site, towards the heart where it can be detoxed through the liver/kidney/spleen.  It’s like a salmon swimming upstream instead of traveling with the current.  Ultimately, the time it takes for the fluid to clear if the gates are open and there is a backflow of fluid is increased (obviously not good).

Basic Physiology of Inflammation

“Icing does not prevent the inflammatory cascade, it merely delays it.”

Inflammation is phase one of a three step process of tissue healing.

1) Inflammation (3-5 days) – clean up crew and emergency response team assesses damage, moves debris, and fights potential invaders

2) Repair (4-6 weeks) – collagen cross-linkages are delivered to reconnect torn tissues

3) Remodel (up to 6 months and likely on-going for forever) – Tissues require loading and adaptation through corrective exercises/stretching to regain peak function. We already covered the fact that ice can help delay the effects of inflammation when applied to a severed limb.

The exact reason why you want to ice the pinky finger you chopped off trying to mince onions is why you don’t want to ice a tissue still attached to your body.  It needs inflammation to initiate healing!  You (fortunately) cannot stop this process.  Since you cannot leave the bag of peas on forever, once you take it off your body will continue on with its job of healing you through the inflammatory cascade.  The temporary benefit of nerve sedation so that you feel less pain does not outweigh the cost that ice has on the delayed healing process and increased lymphedema.

Acute soft-tissue injury is a unique situation where our body vitally needs to undergo the inflammatory response.  There can be inflammation without healing but there cannot be healing without inflammation.  Swelling and inflammation are not synonymous.  The former is necessary and vital for healing and latter is a deleterious effect of an injury.

Do you actually think that the body’s innate response to acute injury would be incorrect or faulty such that extreme changes in temperature are needed to regulate the process better?  Sedating nerves to feel less pain can even be dangerous when you consider the fact that the brain is communicating with you when you perceive pain.  It’s telling you to stop putting pressure or moving the injured tissue as vigorously as you normally would – the tissue can’t handle the stress.  You’re going to make it worse if you push it.  Listen to your senses and stop aggravating the injured tissue while it heals!

Injuries need time to heal, and if you progress through the following rehab protocols under a doctor’s supervision, you will likely recover well.

1) Attain joint alignment/improved joint motion (Get adjusted by a Chiropractor or placed in a cast in the case of a fracture under the care of an Orthopedist) –>

2) Increase soft tissue mobility/range of motion (Get myofasical release like ART, Graston Technique, VooDoo Floss and complement with self-myofascial release daily with a foam roller, lacrosse ball, golf ball, RockBallz, or the Stick, and dynamically stretch immediately afterwards –>

3) Stabilize/activate muscles surrounding the affected joint (corrective, postural, and/or balance/proprioceptive exercises)

This should help you achieve the fastest return to activity possible.  Don’t skip steps – Earn your progression!

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Alternative to Ice:  Movement and The Marc Pro

Dr. Kelly Starett has popularized the revamping of the RICE protocol into the MCE protocol.  Rest and ice have not been found to be important factors for improving recovery times from injury.  They have been replaced by Movement/Muscle Activation.  Sometimes movement is painful, so only small, pain-free ranges of movements should be performed.  If drawing ankle circles is too difficult, then start by wiggling your toes.  That’s still better than nothing when it comes to regaining function to an injured tissue.

When you literally can’t move yourself, like when you’re stuck in a the confined space of a car or plane, or you are just so sore after an intense game/competition/work-out, you still need your muscles to squeeze around your lymph vessels to pump all the metabolic waste products (garbage) out of your system.

The Marc Pro is designed to rid the body of the metabolic waste that lingers in our interstitial spaces.  Letting it linger would be like letting the exhaust of our car emit directly into the car where it would stay trapped if the windows were closed.  Waste needs to get cleared.  Open the windows = shuttle the waste products back towards the heart via the vein/lymph vessels.

In no way is the Marc Pro actually “treating” an injury – it’s simply creating a pump by passively contracting muscles in order to shuttle the fluid build-up out of it’s current location. To use the device, hook yourself up to the electrodes like a regular e-stim unit. Place the pads above and below the swollen or sore areas of the body, then turn up the intensity to as high as you can tolerate.  Leave it on for a minimum of 30 minutes.   The longer you leave it on, the more dramatic of an effect it will have (up to ~8 hours at a time is doable, but 30-60 minutes is the typical therapeutic dose).  The longer the time treated, the more pump effect you get.

Movement in general and utilizing the Marc Pro are likely the most effective ways to activate muscles to physically force lingering metabolic waste products (swelling/edema) through lymphatic vessels.  The pain that was due to pressure on the nerves from the swelling should go away once the fluid has cleared.  Assuming you have good plumbing (working circulatory system) it should be a rather simple solution.

Practical Application Take Away Message: Image

Gary recommends that we all stop using ice for post-injury treatment and soreness.  Inflammation is your friend post-injury and needs to happen.  You can’t stop it, it can only be delayed.  If you are experiencing pain after an injury, consider applying a topical analgesic like Rock Sauce to numb your sensory nerve endings.  Follow the MCE protocol instead of RICE.  If you don’t know how to treat and manage an injury, visit a Sports Chiropractor, Doctor of Physical Therapy, or Sports Medicine Physician that has experience helping people just like you.

Ice still has practical uses, which include: chilling beverages, slowing the metabolic rate during open-heart surgery, and preventing healing of a severed appendage so that the neurovascular bundles will still be viable when they are surgically reattached.

Paradigms change.  Don’t be afraid to challenge antiquated assumptions of sports medicine under the supervision of an experienced medical expert.  A no-ice regimen might just get you back in action faster than you would have otherwise.

Read Some Research:

Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage.

Cooling an acute muscle injury: can basic scientific theory translate into the clinical setting?

Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?

Watch Some Videos:

We’ve Got to Stop Icing People.  We Were Wrong. Soooo Wrong.

People, We’ve Got To Stop Icing – A Year Later

Demonstration of the Marc Pro

More Articles to Check Out

Stillness is the Enemy

Ice Delays Recovery From Injuries

Stanford Researchers’ Cooling Glove ‘Better Than Steroids’ – and Helps Solve Physiological Mystery

@DrChrisBakerDC | Sports Chiropractor
ART/Graston/PTR Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)

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Myofascial Release Increases Flexibility Without Inhibiting Performance

An Acute Bout of Self-Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force.

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This recently published article (March 2013) found that after foam rolling the quads for 2 minutes the subsequent knee range of motion was increased by 10 degrees for the following two minutes and 8 degrees ten minutes later.   Participants did not experience a decrease in strength or muscle activation following the self-inflicted torture.  This is good news.

What Are Those Fancy Cyclindrical-Hedrons?

Foam rolling is a popular self-myofascial release technique commonly thought to improve tissue recovery.  Thus, its utilization in our office and other chiropractic, physical therapy, athletic training, and sports medicine facilities is on the rise.  Some people can handle the pain that accompanies the release, but others choose not to be subjected to the barbaric practice.  Pain is commonly a sign that you have a problem.  It should not be ignored or masked.  I teach patients to find their tight, tender spots like a predator on the hunt.  Everyone has different bands of tissue that are restricting their motion – you need to find yours and work on it.

One Does Not Simply Foam Roll Without Excruciating Agony

First, scan across the general area by rolling lightly along the whole muscle belly.  When you find an owie, compress (push into the roller – perpendicular) as much as you can tolerate and then shear (push across the roller by moving a body part into a dynamic stretch or just by quick back-and-forth movements).  If this is pain-free, your tissue is unlikely to be injured – so don’t waste your time.  You should be hunting for a slightly uncomfortable, but tolerable pain level.  Keys areas to target to combat the rigors of most demands from sports, being a student, and desk work includes the entire posterior chain (especially the thoracic spine, hamstrings, calves), the lats and TFL/quads.  Some movements and sports significantly overuse specific tissues, so demands on the body are different and require more attention to the pecs, posterior rotator cuff, glutes, and plantar fascia.

Is This Gonna Be Forever?

While this new research is important in that it substantiates that foam rolling has a measurable effect, it does not suggest that it lasts forever.  You can see a 2 degree decline in ROM after just eight minutes – so how long does it take for the benefits to completely wear off?  We don’t know.

Furthermore, a 10 degree increase in range of motion was measured to be significant, but why does that matter?  What if their range of motion was within normal limits to start?  What if it was severely limited because they had a recent traumatic injury?  Should foam rolling still be implemented for that case?  I say yay – as long as your tissues can tolerate it.

Any time tissues are overused, traumatized, or under-recovered they will exhibit predictable patterns of dysfunction.  Loss of range of motion across joints, tenderness to the touch, asymmetric loading/movement during squats, increased pain perception, etc.  The research demonstrates that we can influence these tissues without hindering them, albeit for a short period of time.

Priming the Nervous System

In order to make use of this narrow “window of opportunity” I suggest that patients immediately follow-up their foam rolling sessions with dynamic mobility drills, proprioceptive balance drills, or plyometrics, which all serve as a perfect transition to the actual workout, match, or game afterwards.

The soft tissues of the body are significantly neurologically inhibited after compressing and shearing across them with the aid of a foam roller.  That means training and re-education for movement, mobility, and stability will be at a more efficient capacity.  Make rolling a routine just like brushing your teeth and your body will adapt to the demands placed on it faster than they would have without the release sessions.

Do You Even Stretch, Bro?!

Plenty of athletes don’t stretch and consider it a waste of time.  Well, that’s not completely true.  Stretching in and of itself is less effective when unaccompanied by foam rolling.  So roll out before you stretch.  And if you do stretch, keep it movement-based prior to activity and static after completing the activity.  Fascial-based stretching like Yoga is great for actually lengthening and remodeling dysfunctional scar tissues into elongated, functional tissues – just don’t do an intense session right before a competition or intense WOD lest you enjoy being prone to injury due to neuromuscular fatigue.

Incorporating foam rolling and a plethora of other myofascial release techniques into your fitness routine will make you a better mover.  Move well, move often!

@DrChrisBakerDC | Sports Chiropractor
ART/Graston/PTR Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)
Tennis@RockTape.com