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Restless Legs Syndrome (RLS) and Some Ideas About How To Deal With It

Restless Legs Syndrome (RLS) and Some Ideas About How To Deal With It

So you have had an active and/or stressful day and you lay down to go to bed.  Your leg or legs feel a bit twitchy and they won’t relax.  Finally, you get to sleep and you are awakened by a really uncomfortable pain in your legs.  This happens night after night and finally you cannot deal with it anymore.  What is wrong and what can be done?

Restless Legs Syndrome (RLS) is considered by many to be a neurological problem but there are many causes of the condition. So many, in fact, that it’s really tough to categorize the condition into one simple issue.  What we need to do is consider any and all factors that could influence the condition and help minimize/eliminate it.  The medical approach is to turn to medications to help with the condition, but those have side effects.  There are natural ways to address RLS, and to many, it makes sense to start with these before going the medication route. Continue Reading →

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Golf: Hip Rotation And Its Effect On Early Extension

Golf: Hip Rotation And Its Effect On Early Extension

As a certified Titleist Performance Institute (TPI) level 3 medical provider, I get the honor of treating a lot of golfers.  As golfers will tell you, the game is like a heroin addiction…but it’s actually more expensive!  A golfer will do just about whatever it takes to improve his/her game.  From shoes to gloves to clubs to lessons to whatever, nothing is too much if it will shed a few strokes off each round.  Whether the golfer is a 20 handicap or scratch or better golfer, improvements can always be made.  As is the case with any sports activity, proper stability and mobility are important and for a precision game like golf, they’re vital.

One major movement fault that many people and golfers alike have is a lack of internal hip rotation.  Proper hip mobility is not only vital for back health, but it is vital for proper swing mechanics.   I’d say, in my experience, that about 80% of golfers suffer from this issue.  It can be on the either side and depending which side it is on, the fault affects the backswing or the follow-through. Regardless of which one it is, it must be corrected to improve that score and lower the risk of musculoskeletal injuries…mostly, the force transmission into the low back.  This is one of the major reasons why so many golfers get low back pain. Continue Reading →

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Why Your Back Might Not Be Getting Better

Why Your Back Might Not Be Getting Better

There are many reasons as to why people develop back pain and luckily, conservative treatment can help most all of them.  Only in the rarest of instances is surgery needed.  The problem with treating back pain is that all too often the practitioner focuses so much on the pain that he/she doesn’t actually address what is causing the pain.  We’ve all been guilty of this!

I could write volumes on contributing factors to back pain but this blog was written to address one common problem that we are seeing more and more: a hypermobile sacroiliac joint (SIJ).  Now, the naysayer will try to suggest that this does not occur, but with over 18 years of treating sports and back injuries, I can assure you that it does, and it does with frequency.  I’ve seen this problem in active kids to my professional athlete clientele base.  It is usually not properly diagnosed as few practitioners know how to assess it. Continue Reading →

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I Have Disc Problems and I Cannot Run…Will I Be Able To Run Again?

I Have Disc Problems and I Cannot Run…Will I Be Able To Run Again?

We treat a lot of patients who suffer from disc pathologies, be they bulges or herniations.  Most of these people are active and want to continue to be active. The problem they encounter is that they get pain in the low back with activity that many times goes into the gluteal region (on one side or another…or both) and sometimes goes down the leg(s) into the feet.  This makes it hard for them to partake in sport. Continue Reading →

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Dr. Manison is now Selective Functional Movement Assessment (SFMA) Certified

Dr. Manison is now Selective Functional Movement Assessment (SFMA) Certified

Doctors learn how to assess and treat based on their specialization. Chiropractors are taught how to diagnose neuromusculoskeletal problems and how to properly treat them.  If a patient presents with a condition that a chiropractor cannot handle, then an appropriate referral should be made.

Dr. Manison has acquired skills in most of the highest level treatment approaches in his field.  In fact, he now teaches part of the Certified Chiropractic Extremity Practitioner (CCEP) program nationally.  This program, developed by Dr. Kevin Hearon, is regarded in the field as the highest level program on the assessment and treatment of extremity injuries. Continue Reading →

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Dr. Manison now TPI (Titleist Performance Institute) Medical Level 3 Certified Provider

Dr. Manison now TPI (Titleist Performance Institute) Medical Level 3 Certified Provider

Golf is a sport that many consider to be an addiction: players will go through great lengths to improve their swings, ball distance, fitness, conditioning, etc… all in the name of lowering that handicap.  Along with the need to have a good teaching golf professional to work with, players at all levels need a proper assessment to see if their bodies are even capable of doing what they are asking it to do and proper personnel to help them ‘move’ as they should.  Fixing a golf swing is not as easy as simply saying ‘you need to rotate more.’  The body is quite complex and the golf swing relies on so many joints and muscles that even a slight bio-mechanical issue can cost the golfer many strokes! Continue Reading →

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Introducing the InBody 570 Body Composition Analyzer Part 2

Introducing the InBody 570 Body Composition Analyzer Part 2

Part 2 of the discussion on the InBody 570 covers two of five important studies (and there are more) that help to validate the accuracy and legitimacy of the InBody 570.  This technical and may I say, ahem, somewhat boring information is important to discuss as your healthcare providers like to see objective health data. It’s time for the entire healthcare industry to understand and embrace what improvements in body composition can do not only for the individual patient, but also for the healthcare system as a whole.  Figure it this way: the more healthy we are, the less disease we will have.  This translates to less healthcare costs and this is good for everyone!  This blog and the next one serve to help educate not only our patients and those who will want to come to our office to get assessed, but also their healthcare providers who will be viewing these results.  Body composition is SO important.

Whether you are on our body modification program (caloric restriction and intermittent fasting…and most all of you should be interested in this to optimize your health) or are an athlete looking to improve your performance and recovery in your respective sport, the 570 is unmatched on the market, it is FDA approved, and it provides data that is vital to your health.  This is about your health.  It’s time to think of your future and what you should be doing to live longer and healthier!

The first study of interest is from 2004 and the lead author is Shinichi Demura.  The study was published in the Journal of Physiological Anthropology and Applied Human Science.  The name of this study is Percentage of Total Body Fat as Estimated by Three Automatic Bioelectrical Impedance Analyzers. Continue Reading →

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Slouching Population Part 2 of 3: Good Posture and Children

Slouching Population Part 2 of 3: Good Posture and Children

Have you recently witnessed a child sitting hunched over with their head down staring at a smartphone, ipad, or tablet on a table or on their lap? I would venture to guess that you see this picture multiple times per day if you have, or are around, children.  I would also go as far as to assume that most, if not all, children have been told multiple times to “sit up straight” by teachers, parents, and/or grandparents. However, even with the constant reminders, it seems that kids have been slumping more and more with the passing of each decade. One of the worst postures I have seen to date is a preteen who developed a point in his mid-back where there should be a smooth curve.

What is causing our youth to have worsening poor posture? Are they having an undeclared slouching contest with the previous generation, are they trying to be cool, or are they just a product of their environment with the vast surge in the use of technology? I get it. Even we adults need to be told to sit-up properly, especially when we are working at a computer, texting, or using a tablet. And you know what? Children hate being corrected as much as we do. With that said, it is hard enough to get adults to follow instructions, so how do we get children to change their habits, and understand the lifelong repercussions of sitting and standing in bad posture? Continue Reading →

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Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

We have covered a lot of information about Dry Needling in our last 3 blogs.  We discussed the Radiculopathy Model, the Trigger Point Model, and the Spinal Segemental Sensitization and Pentad Model.  Already, we can clearly see how Dry Needling can help to break down myofascial trigger points (MTrPs) and reduce pain.  The fourth model will discuss another reason as to why Dry Needling can help you.

Central Model

Our final model, the Central Model, covers information about how Dry Needling and other physical interventions (including manipulation, massage, mobilization, etc…)  affect the spinal cord and brain.  This is a rather basic but powerful model.  The premise is that input stimuli will affect tracks in the spinal cord that will carry that information up to the brain.  The deeper the treatment, the more information that will be conveyed.  The hypothalamus will then take the stimuli and  communicate with the pituitary gland and affect other endocrine functions.

In regards to the hypothalamus, it has three primary functions:  1.  It supplies input to the brainstem, thus affecting autonomic regulation, 2.  It controls endocrine function, and 3.  It exerts influence on posture and locomotion.

With the Central Model, MTrPs along the spine will likely cause more autonomic issues (please click to read more about autonomic issues on the Trigger Point Blog).   Dry Needling causes an anti-inflammatory response that emanates from the hypothalamic-pituitary-adrenal axis.  This is deep stuff!

If we assume that the hypothalamus is directly or indirectly adversely affected by MTrPs, then we can conclude that such MTrPs create autonomic and endocrine problems in addition to postural and movement issues (this means it affects the way you work inside and outside).  Certainly, we would want to rid our bodies of such noxious stimuli, and since Dry Needling can eliminate such MTrPs, then this makes it a great option for restoring proper function of not only the musculoskeletal system, but also the autonomic and endocrine functions that are affected by an improperly functioning musculoskeletal system.

Any way you slice it, Dry Needling can help you to function better.  From simple pain and dysfunction to autonomic concomitants, Dry Needling offers a viable option for the treatment of trigger points and pain due to musculoskeletal causes.

Let’s take a look at some studies supporting the application of Dry Needling…there are a few here but many more in print:

We will start with the grand-daddy of them all…the landmark study performed by Karl Lewit, MD published in 1979.  This study broke down the effects of trigger point injections to determine if the analgesic/steroid that was the agent that helped the patient, or was it the needle alone that contained all the magic!  Please read study, and if you would like the full study (versus just the abstract), please let us know.

The Needle Effect In The Relief of Myofascial Pain

And the other studies…

Dry Needling Having Anti-Nociceptive (anti-pain) Effects

Probable Mechanisms of Needling Therapies for Myofascial Pain Control

The Influence of Dry Needling of The Trapezius Muscle on Muscle Blood Flow and Oxygenation

Dry Needling at Myofascial Trigger Spots of Rabbit Skeletal Muscles Modulates the Biochemicals Associated with Pain, Inflammation, and Hypoxia

The Effect of Dry Needling in the Treatment of Myofascial Pain Syndrome: A Randomized, Double-Blinded Placebo-controlled Trial

Dry Needling and Exercise for Chronic Whiplash – A Randomized Controlled Trial

Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players

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Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

In our last two blogs, we went over models that help explain how Dry Needling works.  These two were the Radiculopathy and the Trigger Point Models.  The topic of this blog will involve the third model, or the Spinal Segmental Sensitization and Pentad Model.  As we have with the last two discussions, we will try to explain any difficult terminology or ideas.

Spinal Segmental Sensitization and Pentad Model

The Spinal Segmental Sensitization (SSS) and Pentad Model was proposed by the late Andrew Fischer, M.D. (Physiatrist…pain management and rehabilitation medical doctor).  This is a good time to discuss this model as it really incorporates both of the first two models.  Dr. Fischer proposed that the SSS is a ‘hyperactive’ state of the dorsal horn of the spinal cord that is caused by damaged tissue sending nociceptive (pain) input into the spinal cord.  This information then causes the over-sensitivity of the associated spinal level dermatome (skin), pain sensitivity of the associated spinal level sclerotome (bone, ligaments, joints), and Myofascial Trigger Points (MTrPs) in the associated spinal level muscles.  All this occurs because the nerve coming from the spine is over sensitized, and by being in this pathological state, it stimulates these changes listed above.  In effect, we have a pretty vicious cycle of pain and dysfunction. Continue Reading →