Performance Health Austin Chiropractic

Dr Ross Bomben describing sleeping positions for patients with neck and upper back pain.

Non-steroidal anti-inflammatory drugs are used often by people in pain to decrease pain and reduce inflammation. What many people don’t know is that NSAIDs may actually slow tissue healing and contribute to tendon degeneration.

The best description of the problem was stated by Leadbetter (site below), …”treatment of persistent signs of inflammation by repeated efforts to turn off the body’s alarm is not a substitute for finding the cause of the fire.” For most people I recommend not taking NSAIDs and that if your pain has not resolved in 8 days, schedule an appointment for treatment.

Most often the cause of pain is fascial or muscular tightness and adhesion (small amounts of scar tissue) that have accumulated over a long time which decreases blood flow in the affected tissue. There are many treatments that are effective but nothing I’ve seen works as quickly as Active Release Technique, trigger point therapy, and chiropractic manipulation. This combination of treatments quickly and effectively addresses the cause of pain, often instantly and permanently fixing the problem. Most “tendinitis” is actually a degenerative “tendinosis” with argues against the use of anti-inflammatories. More at tendinitis vs. tendinosis.

NSAIDs are often used for pain relief but it does nothing to actually heal the injured tissue. Healing happens by restoring normal function through rehabilitation and hands-on therapies like active release technique, chiropractic adjustments, trigger point massage, exercises, stretching, and self treatment.

Be careful because NSAIDs are contraindicated with any renal or liver disease. Also, gastrointestinal bleeding is an important problem considering that about 2500 rheumatoid arthritis patients die each year due to NSAID use.

It has been shown that corticosteroid injection is NOT effective in – acute trauma, injection into the tendon, immediately before competition, and in joint instability or malalignment. Leadbetter suggests a 6-week preinjection trial of rest, adjusted exercise level and intensity, and conditioning. After injection, Leadbetter suggests 2-6 weeks of rest (protected activity).

Injection into tendons should ALWAYS be avoided. This causes an inhibition of the formation of connective tissue during healing resulting in weakening of the tissue and greatly increasing the likelihood of future tearing or rupture. If you choose injection, injections should be in the tendon sheath surrounding the tendon.

See my previous post Natural Pain Relief for natural alternatives to NSAIDS.

Leadbetter WB. anti-inflammatory therapy in sports injury:the role of nonsteroidal drugs and corticosteroid injection. Clin Sports Med. 14;1995:353-410.

Berger RG. Nonsteroidal anti-inflammatory drugs: making the right choices. J Am Acad Orthop Surg. 1994;2:255-260.

I had a great time working with Michael Madison of the Gilbert’s Gazelles and the Austin Distance Challenge at the 3M Half Marathon today. Here are a few pics.

I really enjoy meeting new people and working on them to relieve their pain. Running pain after a half marathon (13.1 miles) is often significant so I recommend runners getting at least a “flush” post-run massage AND foam roll their tight muscles. Best case scenario, they should also get a few treatments of Active Release Technique to clear up any residual tightness and scar tissue that results from running at that intensity.

Overall, it was a beautiful day for running even with high winds and a late (53 min late) start. Most everyone I talked with had a great race. Keep up the great work Austin!

WHAT YOU SHOULD KNOW ABOUT OVER-THE-COUNTER PAIN MEDICINES

Vioxx, a popular non-steroidal anti-inflammatory drug (NSAID) and pain reliever was recalled after an estimated 89,000 to 140,000 people died from its use in the US alone.[1] Shortly after the recall, the FDA issued additional warnings for NSAIDs, including Ibuprofen (Advil), and Naproxen (Aleve) to make it clear of the potential for increased cardiovascular risks and gastrointestinal bleeding.[2] It is also widely know that long term use of NSAIDS, like Ibuprofen and Naproxen can cause ulcers, potentially fatal gastric bleeding and increased risk of heart attack.

Tylenol (acetaminophen) (not an NSAID) is one of the most common causes of over the counter drug poisoning in the US according to the American Association of Poison Control Centers.[3] Tylenol is also one of the leading causes of liver toxicity and drug induced liver failure.   And when used long term, both Tylenol and Ibuprofen can greatly increase the risk of hypertension.[4]

NATURAL SOLUTIONS TO ELIMINATE PAIN

1. Use vitamins & minerals instead of NSAIDS

MSM (Methylsulfonylmethane) – MSM is organic sulfur which is known to inhibit pain impulses that travel along nerve fibers, acting as an analgesic.[5] MSM also acts as a natural anti-inflammatory.[6] MSM is often used for combating the symptoms of arthritis, fibromyalgia, back pain from herniated discs, headaches and more. In addition, MSM may reduce muscle spasms, increase blood flow & contribute to the maintenance & repair of cartilage.

Digestive Enzymes – While digestive enzymes taken with food are completely dedicated to the digestive process, digestive enzymes taken on an empty stomach have been shown to reduce pain, swelling and redness associated with inflammatory conditions. Safe and natural, digestive enzymes offer an alternative to NSAIDs.

Calcium/Magnesium – calcium is a mineral that facilitates the movement of nutrients across cell membranes.  Calcium also helps nerve cells to communicate normally and aids in muscle contractions.  Magnesium is known to reduce a pain transmitter in the nervous system called Substance P.[7] Magnesium is also critical for energy production and proper nerve function.  It is also know to promote muscle relaxation and help the body produce and use insulin. Like calcium (often paired with magnesium), magnesium is involved in the formation of bones and teeth, the clotting of blood and the regulation of heart rhythm.  Magnesium is often used to treat such ailments such as chronic back pain, high blood pressure, depression, anxiety, muscle cramps and even migraine headaches.

Bromelain – bromelain is an anti-inflammatory agent that is helpful in healing minor injuries, particularly sprains and strains, muscle injuries, and the pain, swelling, and tenderness that accompany sports injuries.

Glucosamine & Chondroitin Sulfate – glucosamine & chondroitin sulfate can play a major role in the treatment of pain by actually repairing and rebuilding the protective cartilage in the joints.

2. Exercise

Most people in pain avoid exercise because they are afraid it will exacerbate or make their pain worse.  However, studies have found that non-strenuous exercises such as walking and swimming can actually reduce pain. Why?  Because, when you exercise chemicals called endorphins are released into your body. Endorphins are the body’s natural internal pain regulators (the body’s natural way of making pain tolerable).  When you experience pain and when you exercise, your body releases endorphins.  These endorphins interact with your brain to reduce the pain you experience.  Natural endorphins interact with the same parts of the brain as pain relieving drugs like morphine.

3. Physical Treatment

Active Release Technique – Active Release Technique (ART) is a patented, state of the art, soft tissue, movement-based massage technique that has been proven to effectively treat overuse problems with muscles, tendons, ligaments, fascia and nerves.  It has been successfully used to treat headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, tennis elbow as well as numerous other conditions.  Most conditions are resolved quickly and permanently with the use of Active Release Technique®.

Chiropractic Adjustment – Chiropractic is the science of locating areas of joint dysfunction and restriction combined with the art of correcting the dysfunction. Trauma (i.e. car accidents and falls), lifting incorrectly, physical activity, and stress can all impact your joints negatively.  When a joint loses its normal position or motion, this can put pressure on your nervous system which can lead to pain.  Correcting joint dysfunction allows you to perform at optimal levels without pain.  Chiropractic adjustment has also been shown to relax the muscles surrounding that joint.

Trigger Point Massage – Trigger points are taught nodules of muscle tissue that refer pain to other areas of the body when compressed. They develop due to continual muscle tension without sufficient rest. Focused firm pressure on the muscle tissue until it relaxes is effective at relieving associated pain.

Foam Rolling – this is the least expensive method to alleviate pain in the long muscles of your body (muscles such as the hamstring, quads, adductors, and calves).  Foam Rolling is an easy to learn technique that can be done at home and that is effective at treating and preventing injuries.

Visit our office for advice specific to your problem/concern and for additional natural ways to eliminate your pain.

[2] http://www.medscape.com/viewarticle/538179

[3] http://www.lef.org/proto

[3] Jacob SW, et al. The Miracle of MSM: The Natural Solution for Pain. New York: G.P. Putnam’s Sons; 1999:57-58.cols/appendix/otc_toxicity_01.htm

[4] http://www.harvardscience.harvard.edu/medicine-health/articles/study-use-acetaminophen-linked-hypertension

[5] Jacob SW, et al. The Miracle of MSM: The Natural Solution for Pain. New York: G.P. Putnam’s Sons; 1999:57-58.

[6] Morton JI, Siegel BV. Effects of oral dimethyl sulfoxide and dimethyl sulfone on murine autoimmune lymphoproliferative disease. Proc Soc Exp Biol Med 1986;183:227–30.

[7] http://www.usaweekend.com/02_issues/020901/020901eatsmart.html

I was working with the Gilbert’s Gazelles training group at RunTex and had a great conversation with a patient about different types of treatment.  The runner/patient asked my opinion about her knee injury.  For the last year she has been getting treatment from another provider that consisted only of rehabilitation exercises and she did not feel that she was getting any better.   This greatly surprised me.  For one, I assume that all therapists use manual techniques (as opposed to only treating with rehab exercises) because manual therapy is proven to greatly speed healing.  And secondly, I am amazed that people (especially athletes) spend so much time and money getting treatment that is not getting them the quick results that are possible. 

• Manual Therapy- the use of physical “hands on” techniques to treat health problems. Manual therapy includes such treatments as massage, Active Release Technique, joint manipulation, trigger point and Fascial Distortion Model.

In my experience as an athlete and a sports doctor, patients with recent sports injuries can get better rapidly, in only a few visits with manual therapies, such as Active Release Technique.   But when rehabilitation exercises are used as the only treatment protocol, patients have considerably longer treatments and much slower recoveries.

The best way to treat most sports injuries is to first use manual therapy techniques and THEN to teach patients rehabilitation exercises.  Manual therapy is used first for many reasons, the most important of which is that it is the quickest method to reduce pain and get people back to their activity/sport.   Rehabilitation exercises are only then used to strengthen and stabilize the body after the injury is improved.  There is no point in strengthening and stabilizing tight and restricted joints, fascia or muscles (pain producing conditions).  At my office, we use various manual therapies, our favorite of which is Active Release Technique, on most patients to fix the cause of their pain.  We then teach exercises to help prevent recurrence and to reduce the number of total treatment visits required.

Soon after initiating treatment for low back pain, I try to stabilize my patients core by strengthening their abs and back.  Early onset of rehabilitation helps to decrease the likelihood of a relapse. Stabilizing and strengthening the spine can also be used to help prevent back pain. Stabilization of the spine can be very simple. The primary goal is to build a barrel of endurance strength around the midsection. Research shows that endurance strength, the ability to hold a contraction for a prolonged time, reduces the likelihood of low back pain. The first goal of a back strengthening program is to stabilize the spine then progress to more dynamic exercises that strengthen the spine in more complex positions. Here is my very basic but effective program – back extensions (2 -3 sets of 20-30 performed slowly), side plank on elbow (90 seconds hold each side), prone plank (90 second hold). This is a simple yet effective program that increases the stability of the spine and is a great starting point for more dynamic exercises.

Back extensions

2-3 sets of 20-30 repetitions performed slowly

3 seconds per repetition

Starting position

Ending position

Side plank (hold for 90 seconds)

Prone plank (hold for 90 seconds)

If you would like to know what NFL athletes are actually supplementing, just look in their lockers. New England Patriots wide receiver, Wes Welker, interviewed post game showing Advocare products in his locker. It looks like, Spark, Rehydrate, O2 Gold, Muscle Gain, and Post Workout Recovery.

http://www.nfl.com/videos?videoId=09000d5d80488766

I have been busy lately folks.

Lately, I have been helping out with Gilbert’s Gazelles, the Austin Waldorf  School volleyball team, and The Austin Distance Challenge

Gilbert’s Gazelles

I’ve recently met the guys over at Gilbert’s Gazelles. Gilbert, Michael, and Bernard have been very hospitable and quick to include include me into the running group. These are a committed group of athletes doing a great job of teaching the fundamentals of running to beginners and even a few talented elite runners. Gilbert likes to use the Austin landscape to train his people. So far, we have been to the track for interval training, done mile repeats in the park, and ran up 300 meters of uphill fun. All this before most people eat breakfast. I’m having a blast talking with and treating this fun group of runners. Go Gazelles.

Waldorf Volleyball

I’ve been participating as the Waldorf Sports Doctor for the 2009 girls volleyball season. They made it to the playoffs this year again. This great group of girls have played their hearts out many times throughout the season and I am honored to be helping them in anyway I can. Go Roadies!

The Austin Distance Challenge

Michael Madison asked me to help him out with the Austin Distance Challenge this year and of course I accepted. I can’t pass up helping runner reach their goals at 8AM on Sunday mornings. Yes, I know, it’s a sickness. So far, I’m seeing the common problems with runners, strains/sprains often due to increasing mileage too quickly and not properly preparing for the race. May I suggest a joining a running group such as Gilbert’s Gazelles? So far I have helped at IBM Uptown Classic 10K, which was great. Lot’s of runners racing their hearts out on a perfect running day, 63 with a very slight breeze. I look forward to a great series. I hope to see you out there.