Columbia Advanced Chiropractic, LLC

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The Major Reason Why Your Knee Hurts and What You Can Do About It

The Major Reason Why Your Knee Hurts and What You Can Do About It

As a sports rehabilitation doctor, I get the benefit of seeing all types of sports injuries.  One of more common injuries I see is a ‘knee tracking’ issue.  I’ll go as far as saying about 75% of all people presenting with knee pain have this condition as either a primary issue or issue that is causing a more serious situation.  So, what exactly is this funny sounding condition?

As humans, we are the ONLY animal to be upright and on two legs as a primary means of ambulation.  Although our evolution has allowed us to do this, it is not without issues.  It just so happens that the muscles on the outside of the thigh tend to get stronger/tighter than the muscles on the inside.  Now, it’s a bit more complex than this but this should help give us a general idea of what is occurring. Continue Reading →

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Slouching Population Part 1 of 3: Good Posture Goes Beyond Just Looks!

Slouching Population Part 1 of 3: Good Posture Goes Beyond Just Looks!

Over the weekend, I met some new friends, and the topic turned to posture very quickly once they found out that I was a chiropractor, and when I found out that they were IT specialists. They began to make fun of themselves about the ridiculous positions in which they sit while working at the computer. Until that moment, I had just visualized poor posture as sitting with the head forward, rounded shoulders, and hunched upper back. After speaking with this group, a new picture popped into my head regarding bad posture. One demonstrated leaning so far back in his chair with his leg propped up on a waste basket he may has well have been lying down. Another was slanting to the side and turning in a way that only a contortionist could have achieved. How you position yourself with your posture, comfortable or not, you may be taking years off your life….or just making those years a bit more painful. 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 →

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Dry Needling Support Models (2 of 4): The Trigger Point Model

Dry Needling Support Models (2 of 4): The Trigger Point Model

In the last blog, we discussed the first model (The Radiculopathy Model) that helps explain why Dry Needling works.  Now we will continue with the second of four models.   This one is probably the most well-known one and there is a plethora of medical literature supporting it.  Again, we will try to explain any concepts that are a little difficult to understand.  These models really shed light into how our bodies work and they are great to learn about.

The Trigger Point Model

Myofascial Trigger Points (MTrPs, or TrPs for Trigger Points) are defined as ‘hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band’ (Travell and Simons).  The resultant pain/discomfort that one gets due to such points is referred to as myofascial pain syndrome (MPS).  Simply put, MPS is defined as ‘sensory, motor, and autonomic symptoms caused by myofascial trigger points’ (Travell and Simons).  Sensory symptoms refer to what you feel, motor symptoms refer to how the muscles work, and autonomic symptoms refer to the things that you do not realize.  This seems a little odd, but consider what happens when you bang your arm really hard.  You will feel the pain (sensory), the muscle might be painful and not contract properly (motor), and your heart rate goes up as does your respiration due to the ‘adrenaline rush’ (autonomic) of the injury. Continue Reading →

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Dry Needling Support Models (1 of 4): The Radiculopathy Model

Dry Needling Support Models (1 of 4): The Radiculopathy Model

We get a lot of questions about Dry Needling and the next few blogs will address several theories that support the treatment.  There is currently a good amount of medical literature supporting Dry Needling and this is great, but the theories behind Dry Needling are fascinating and interesting to discuss.

The 4 models are as following:

1.  The Radiculopathy Model
2.  The Trigger Point Model
3.  The Spinal Segmental Sensitization and Pentad Model
4.  The Central Model

Each of the next 4 blogs (including this one) will discuss one of these theories as it relates to Dry Needling.  We hope this gives you a better understanding as to why Dry Needling works so well.  We are aware that the models tend to use medical terminology and can be a little hard to follow, so we will try to explain things as we go to make the explanations easier to understand. Continue Reading →

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Hyperbaric…This Is What You Want To Breathe!

Hyperbaric…This Is What You Want To Breathe!

I recently wrote a letter to the Maryland Board of Chiropractic Examiners on the topic of allowing us to use mild Hyperbaric Oxygen Therapy (mHBOT)  in-office. I had been exposed to patients/doctors utilizing it with great results over the years when I worked at various sporting events and I wanted to add this amazing technology to my office to help my patients.  I am happy to say that at the June 2014 meeting, the Board determined that Hyperbaric Oxygen Therapy can be included under the scope of practice for chiropractors in the state of Maryland. I’m so excited my patients can now benefit from it and you should be excited too!

Continue Reading →

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CrossFit: Really a Dangerous Cult? A Response to Grant Stoddard’s (Yahoo Health) Negative Take on CrossFit [Part 2 of 2]

In part II of Mr. Stoddard’s assessment of Crossfit, ‘Inside the Cult of Crossfit’, we will address the final 3 points of my critique of his assessment.

These final three topics are:

3. Concern for injury
4. Pukie the clown?
5. The problem with group workouts

Before I begin with the final three topics, I do want to add just a bit more about our discussion regarding intensity.  Mr Stoddard appears to think that outside appearance determines the health of an individual.  He goes as far as saying that ‘If Glassman’s brand of functional fitness produces better aesthetic results than the traditional approach does, why did the gelatinous bodies at my gym often outperform those who appeared to be in better shape?’

I don’t know what to say about this other than to say that Mr. Stoddard appears intent on offending those who don’t have I guess what he would consider to be an ideal physique.  My response is to question why he even goes there?  Why does someone have to have a six-pack to be fit, lift heavy weights, etc..?  Does ‘looking fit’ make you more fit?  I think not…just something to think about…

Okay, onto our last 3 topics…

3.  Concern for Injury.  I could go in 100 different directions with this topic, but I don’t think anyone wants to read that much!  I would like to say that any workout program has its inherent risks.  The bottom line is that a person who is ‘training’ another needs to have optimal training in anatomy, kinesiology, biomechanics, and injury prevention.  I work with trainers certified by most all of the licensing boards in the country…these include the likes of ACE, AFAA, NSCA, NASM, and more.  I can attest to the fact that many personal trainers, who are likely implementing programs that Mr. Stoddard would find to be acceptable, are at the same (and in many times likely greater) risk of injuring their clients.  Until personal training certifications from all agencies are governed by essentially university standards, this field will have significant shortcomings.

Mr. Stoddard quotes Pr. Stuart McGill, who I consider to be the top spinal bio-mechanist in the world.  I do correspond with him from time to time myself.  Pr. McGill voices his concern about complex movements that go to failure.  He includes Olympic Lifts in this category and I cannot refute this.  The Professor has been published over 145 times!   The risk for injury is greater with exercises that require weighted ballistic movements and a high level of core stability.  It does make sense that as fatigue sets in, loss of proper form can lead to a greater risk of injury.  This topic does not apply solely to CrossFitters.

I do question if these above mentioned activities are any worse than a personal trainer or ‘coach’ in the gym teaching someone how to squat with the butt coming out, dead-lifting with straightening the legs first (effectively lifting with the back) and hyper-extending at the midpoint of the movement (OUCH!),  or showing someone middle deltoid raises in the coronal plane (for dozens of reps)?  How about trainers who supervise high school kids with power movements with weight far greater than they should be doing?  It’s true…in high school gyms across the country, students are being improperly trained and injured by less than properly educated coaching staffs.  They are not CrossFitters.

I can say from clinical experience that any gym exercise, if performed incorrectly, can create injury.  This is where instruction comes in.  I think the clients who work out at the CrossFit facilities I work with have the benefit of instructors who make ‘proper form’ a high priority.  As I mentioned in Part I, many CrossFit facilities have specific strength classes, which differ from the CrossFit classes.  Those who wish to work on strength can do so in a more traditional setting.  Mr. Stoddard might not have been aware of this as the facility he was at might not have been the best representation of CrossFit.

Mr. Stoddard goes on to discuss Rhabdomyolysis, a condition for this discussion that is created basically by over-training.  This condition can be seen in any activity that incorporates high levels of exertion under load without adequate rest.  It is nothing that anyone should try to achieve, be it in CrossFit or not.  It is also not unique to CrossFit.  All CrossFit staff should be educated about the signs and symptoms of Rhabdomyolysis, as it can be a life threatening condition. For that matter, trainers in any sport should be aware of the signs and symptoms of this condition.  It would be a good idea for the intensity of CrossFit workouts to be increased over time so that each new Crossfitter can get used to the workout format.  Just as if I put on pads and a helmet and went through a tough outdoor summer football clinic day after day without ever doing so before, too many intense workouts of any kind over a short period of time can have deleterious effects.

4.  Pukie The Clown?  In the 3+ years I have been working closely with CrossFitters, I have never seen or heard any mention of Pukie.  Mr. Stoddard discusses Pukie as being almost the mascot for the rough and tough CrossFit workouts, claiming that CrossFit embraces hard-core workout practices that essentially allows for looking down on those who are too weak to get through workouts.  Again, did I mention that I have never had any CrossFitter (facility owners included) ever even mention this funny/sick character.  I was able to find an article in 2005 with Pukie in it when corporate CrossFit put out a piece on Rhabdomyolysis, but I can honestly say that the dangerous, meat-head mentality does not exist with the facilities I work with.  Please keep this in mind if you are new to CrossFit or are thinking of starting up as each facility is unique and it would behoove you to find a CrossFit facility where proper form and movement patterns are important in the education process.

5.  The Problem With Group Workouts  Mr. Stoddard admits to not having a competitive mindset.  So be it.  There are pros and cons to group workouts and CrossFit facilities act almost as a community.  I have never seen a fitness facility before where people not only work out together, but also care about one another and many times, socialize together.  Being Mr. Stoddard stated that he has apparently become a misanthrope, I guess any class program would be an issue for him.  A CrossFit facility tends to be the place where you can leave your wallet and keys out in the open and nobody will take them.  There tend not to be thousands of members at any given CrossFit facility and one of the benefits of this is that the environment is very safe and friendly.  (On that note, I would never leave my things laying around in a large gym setting where I don’t know anyone).  As far as Mr. Stoddard becoming an misanthrope, that’s fine…to each their own.

Mr. Stoddard’s defining CrossFit as a cult, multi-level marketing, and any other negative thing he can think of simply goes too far.  I do not see the harm in groups of people pushing themselves with tough workouts…for the record though, I do not believe in beating your body to a point where it can no longer function.  (Instruction, instruction, instruction!!)  Mr. Stoddard should have gone to several other CrossFit gyms to see the differences between them before coming out with such a strong stance against CrossFit as a whole. His slanted piece serves no other function than to scare people and give out misinformation.  His article would have had much more credibility had he dug deeper and discovered more about CrossFit as opposed to just blanketing CrossFit as a whole with his single experience (N=1).  I understand he was humiliated by a dozen women in a class…get over it.

He concludes with a story about a woman asking him if he goes anymore…well, we know the answer to that…guess he’s not part of what he calls the ‘cult’ anymore and is enjoying Zumba somewhere…well, maybe not…Zumba is too much movement for an hour straight, right?

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CrossFit: Really a Dangerous Cult? A Response to Grant Stoddard’s (Yahoo Health) Negative Take on CrossFit [Part I of 2]

On February 7, 2012, Grant Stoddard wrote a rather critical assessment of CrossFit (on Yahoo Health and licensed by Men’s Health).  Although I understand his concerns, I think a lot of what he wrote about generalizes CrossFit too much and does not present a fair representation of what CrossFit is all about!

As a sports medicine doctor, I have the pleasure of working closely with 3 area CrossFit facilities.  Each is run by highly motivated, intelligent, and hard working individuals who pride themselves on proper form and technique. I have a lot of experience dealing with CrossFitters and as an educator of Fitness Professionals, I feel as though I can comment better than most on many of the aspects of different types of fitness.

Continue Reading →

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So, Why Do People Still Do Sit-ups and Like Exercises?

Low back pain is quite prevalent in our society and still, to this day, I see people doing sit-up exercises in the gym.  Be they old or young or male or female, it doesn’t matter.  For some odd reason, people still like to lock their ankles into a decline bench and then bend their bodies all the way.  Many times, they’ll hold onto a weight for an extra effect…(I have no idea why they do this)….other times, they’ll have someone throw a medicine ball back and forth with them.

So, this begs the question…do these people really know what they are doing?  What muscles do they think they are training?  What muscles are they actually training?  Are the exercises dangerous?  For that matter, are the exercises beneficial in any way?

Topic is open for dicussion…