Wintertime brings the cold, which is a common external factor that can affect the body at this time of year.  Cold can affect the body’s digestion, pre-menstrual syndrome for women, infertility, cold/flu, headaches, and general pain.  Many clients come in at this time of year due to pain.  It may be an old injury that creeps back or it may be a new injury/pain.  One of the common pains at this time of year is lower back and knee pain.  This time of year the kidneys can be greatly affected by the cold.  When the kidney energy is affected by cold then low back and/or knee pain can occur.   This can especially happen if there is an underlying kidney yang deficiency.  Kidney yang deficiency is a diagnosis in Chinese medicine that means there is already cold in the body and adding more cold due to weather can worsen the knee or back pain.

     From a Chinese medicine perspective, cold enters the body and causes qi stagnation in the channels.  Qi (energy) flows throughout the body in a system of channels. When cold enters qi becomes stagnated and often causes pain.  Many acupuncturists will advise that heat is better for pain then ice for the reason that cold causes more constriction and does not allow for qi and blood to move.  Ice is good for the first 48 hours of an acute injury to relieve swelling and inflammation, but after that time heat is better to get blood and qi flow to the area. On the onset of a new injury ice the area of pain and call your acupuncturist for treatment.  This will speed up the healing process and prevent the injury from becoming chronic.  Acupuncture, a technique called cupping, and heat therapy combined with massage is an excellent remedy for acute or chronic pain.  The longer the pain has been around the longer it will take to treat.  With chronic pain you can expect results after your first treatment, but to be fully rid of your chronic pain you can expect to be receiving acupuncture weekly for 8 weeks or more. Acute pain can be treated fairly quickly if you seek treatment soon after the injury.

    It is important during this cold time of year to dress warm and to eat and drink warm foods and beverages.  Take extra time to do self-care for your aches and pains.    Start and end your day with a heat pad anywhere from 15 to 30 minutes.  Massage some arnica oil in first and then add heat.  The heat allows for the arnica to penetrate into the skin.  Rosemary is also a great essential oil to add for muscle aches and pains and can be used in combination with arnica.  Some excellent natural anti-inflammatories are fish oil and turmeric.  Turmeric is an excellent spice to add to foods or take in pill form.  Taking fish oil and glucosamine supplements can be great preventative medicine to avoid injuries and or pain.

My Feet HURT! 

I cannot tell you the number of people who I see with foot pain as their primary symptom.  I can tell you that it is represented in all the different types of people who come into my office: School children, college athletes, professional athletes, age-group  athletes,  weekend warriors, football players, baseball players, professionals,  retirees, and developmentally disabled young adults.  (I’m probably leaving out some examples, but you get the idea!)  I can relate to all of these populations, because the reason I’m a chiropractor in the first place has to do with foot pain.

There is a lot of literature available discussing why foot pain is so predominant in our society–sitting too long, running too much, walking too far, training on surfaces which are too hard, stretching to little, resting (not at all)…There are a multitude of means to address the pain–ice, rest, stretch, brace, cross-train.  To me, all of the above is super frustrating!  Why can’t you just do what you do, and not hurt?! Unfortunately, muscle tightness/weakness, postural imbalance, and overtraining are limiting factors to the ability to move through activities without pain…and foot pain does not happen in a vacuum.

An easy way to understand the biomechanical chain that exists in your lower extremity (hips/knees/feet) is to have someone hold your foot stable on the floor and then try to swing the opposite leg forward and back.  Let you leg cross in front of  you and then behind.  You’ll find that you don’t get much rotation in the hips if you can’t move your ankle.  Once you allow your ankle to move, then the hip rotation forces ankle movement–or it should.  If your ankle is not mobile, the muscles and fascia on the bottom of the foot begin to tighten/weaken.  At the same time, the demand for movement coming from your hips, puts continual strain on those tissues which breaks down the already limited ability of tight/weak tissues to absorb it, which in turn can lead to overuse injuries and pain.

The way I treat foot pain is not uncommon, except in the most easily accessible literature around!  (Yes, I am frustrated by the rest, ice, stretch your feet tips in almost every article about foot pain!) You cannot address ONLY the feet.  Remember that the hips and ankles are biomechanically connected.  The hip flexors, glutes, adductors, quads, and calf muscles all contribute to ankle movement and vice versa. 

First, I treat the adhesions which bind up and prevent movement in the soft tissue.  Active Release Technique is the primary technique I use,  Graston instruments are also helpful. Basic exercises to maintain stretch and release the shortened tissues are also important like rolling with foam rollers and TP balls. The final piece is to restore functional movement through exercises which drive the connections between the hips and feet.  When all of the three factors are incorporated into a routine, I find that people can return to doing what they do, and not hurting!

I was working with ART at the 2000 Ironman championships in Kona, HI.  Something was wrong with my ankle.  I could barely walk because every time I tried to flex my foot, a sharp pain shot through the top of my ankle!  Nothing was getting rid of it.  I was super frustrated.  Here I was, surrounded by the best PTs, massage therapists, and chiropractors in the country (in my opinion)…and NO ONE was able to help me.  Along came a recent chiropractic graduate  to tell me he had something that would fix it.  Exasperated, I let him apply a bright blue piece of tape along the top of my shin tomy foot.  He told me to leave it on for a few days.  According to him, this tape was called Kinesiotape, and it was lifting the skin off the soft tissue which would allow lymphatic drainage and pain reduction…(“yah, right!”)  I couldn’t comprehend the mechanics of putting tape down on the top of my foot as a way of alleviating rather than compressing the problem.  I thought it was going to be a complete waste of time…and instead, ALL of my pain disappeared.  ART, massage, adjustments–nothing had any impact (nor was I able to get a working diagnosis).  This strange piece of tape worked like magic. 

I didn’t forget about the existence of Kinesiotape, but I was caught up learning ART and trying to survive chiropractic school–so it was put on a back burner.  About 5 years later, I was working on a physical therapist who had carpal tunnel.  She asked me to if I knew how to use Kinesiotape.  I had not taken the time to go to a seminar and I did not want to make any mistakes, so I referred her to a hand specialist who taped her twice.  The first time she had amazing relief.  However, the second time, she immediately experienced burning pain through her hand.  She quickly took off the tape and the symptoms disappeared as fast as they came on.  To me, her experience illustrated the power of the tape.  If it really didn’t have any effect, she would not have had such a painful reaction to the tape.  At that point, I decided to learn more about Kinesiotape–and how to do it myself. 

In a nutshell, Kinesiotape works on several different levels–depending on how you apply it. Like traditional taping, it is useful as a brace to support injured muscles and joints.  It also reduces inflammation and improves circulation by creating space between the skin and the fascia.  It helps with plantar fascitis, ankle sprains, knee pain, low back sprains, neck pain, carpal tunnel, rotator cuff injuries to name a few. 

It also works to allow correct muscle and joint function, thereby enhancing posture and/or movement. For example if someone has trouble with the tracking of their knee cap, the tape can be used to help the weaker muscles engage.  In addition, it can work to allow for a stretch or contractile input into the tissues, which assists both in healing, pain relief, and/or ideal movement.  In short, it does a TON.  And, I was so excited that I took the time to explore it. 

Now, it’s been 9 years since my first experience with the miracle tape, and more people know about it than ever.  When Kerry Walsh showed up at the Olympic games with black tape all over her shoulder (yes, that was K-tape), people were talking almost more about her shoulder than her gold medal!  There are also (at least) 2 other types of tape–rock tape and spider tape–on the market.  The 3 brands of tape are similar.  I find that each has attributes lacking in the other, so I keep all 3 in my office to make judgements of which one to use on an individual basis. 

One last note…I think it is fantastic that more people have easy access to both the tape and instruction. The tape is sold at local stores, and there are videos of how to apply it.  My only concern is that if someone doesn’t understand the mechanics of normal movement, normal stretch/contraction mechanisms, they can miss the point of how they should be taping. The end result would not be life altering, although the benefit of using the tape would not be maximized and worst case, they might create future problems for themselves.

What color tape do you want to use?

At the end of a recent appointment, a patient asked, “Do you give everyone a roller?’  “Yes, it should be everybody’s new best friend,”  my answer.  Since then, I’ve been trying to think of an instance when I wouldn’t prescribe exercises on the roller–and I couldn’t come up with a single one.  Maybe it’s because I was a pilates instructor before I was a chiropractor so I got used to teaching exercises?  Or maybe it’s because there is absolutely nothing I can find better for reversing common postural issues, releasing tight muscles, strengthening the core, and/or challenging balance?  It’s an all-in-one tool for everyone! 

I was first introduced to the roller when I worked as a pilates instructor as the Center for Sportsmedicine in Walnut Creek.  I remember one of the elderly patients there who was extremely rounded through her upper back.  We used towels and pads to fill up the space between the roller and her head so she could safely lie on the roller.  One day, she was able to lie down without any props–she was in perfect alignment!  It was as though she had lost the extreme curvature that was the source of so much pain.  Of course, it was a transient change–but to see it for even a moment was magnificent.  From that point, I learned many more exercises for scoliosis and/or “bad backs.”  The roller is a fantastic tool for treatment of postural inequities all by itself.

The second thing I learned on the roller is the most painful–massage.  The roller can be used to “roll out” almost every part of your body. I used to teach an advanced pilates mat class, and I could clear the room out quickly or have half the class show up late depending on where I put these exercises.  I’ve heard people say that it gets easier the more you do it.  I don’t think so.  I believe those people are cheating.  If you go slow, find where the “knot” is, and then work into it by rotating and rolling over it, it will NEVER not hurt!  (And, of course, the hurt is “so good.”)  The roller is great for massaging out “tight” areas throughout  your body, making stretching and strengthening more productive.

The other area the roller is great for is for abdominal and back work.  The most effective of these exercises incorporates balance work as well. One of my favorite abdominal exercises to teach is a roll up from the roller.  It requires so much more muscle coordination to roll up from lying down flat on the roller into a full sit-up.  It’s fun to watch a class trying this exercise because invariably people fall off! 

Ultimately, I think postural issues contribute to or exacerbate injury cycles.  The roller can be an important tool for unraveling posture, pain, and weakness.  I think the roller is a best friend we should all have!

I just got back from a 10 vacation in Lake Tahoe. It is great to get far away from home in only 3 hours of travel.  It was a very relaxing trip—and I was in serious need of rest!

On one of the days, I was hiking with my dad and he was talking about his knee. He had been complaining of knee pain for months, and finally went to get ART and a good conditioning program. (Long story as to why I don’t work on him!)  He was telling me that his knee felt about 50% better after several treatments, so he was going to stop going.  I immediately asked why he would top something that’s helping.  His response was that his knee was “good enough,” plus he was tired of going to appointments. Basically, he was feeling impatient, and not at all confident in the end result of spending time having his knee treated because it has been a problem for many years.  I’ve been re-playing that conversation in my mind since I returned.

A lot of times, we feel “stuff” going on with our bodies during our sport, but it doesn’t become prohibitive enough to seek help.  So, we continue on, with a nagging worry or knowledge that something isn’t as it should be.  Finally, we hurt enough to make an appointment for treatment (or someone gets sick of us complaining about pain and makes one for us).  By the time we show up for an appointment, we want to be better right away. For some people, immediate resolution is attainable.  For others, it doesn’t work quite that way. 

My dad’s current knee problems are the consequence of years of running, complicated by a bad car accident.   A few weeks of treatment should help, but it’s certainly not going to fix his problem.  He needs a lot of work to manage his knee because, at the age of 72, he’s got too much going on to completely resolve it. The reality is that sometimes there are true physical impediments to full resolution of an injury–or maybe it’s time or financial constraints. But, many times, the obstacle preventing us from accomplishing our goals is impatience or fear—that we can’t get better.  In my dad’s case, those feelings may preclude him from riding his bike the distances and altitudes he enjoys.

My dad is currently considering my advice! (And the reason why I don’t treat him should be clear!)