What's the Best Exercise?

Hello,

This will be a post I will continually update.  Why?  There is no 'best' but there are certainly some principles which remain, some which die because they're just wrong, some which survive because they're wrong but popular and the biggest group, the stuff which we just don't know about yet.  I'll refer to us as organisms a lot because 'brain-body' is cumbersome and they work together.

Hang Your Hat

The HYH category are things which we understand quite well, things we understand quite well.

1. Humans evolved as movement based organisms (movement has been described as nutrition for your brain).  If you deprive them of movement, they weaken and become increasingly susceptible to injury even without even trying. The 'best' movement is walking because it's easy and we're made for it.  Walking (and movement generally) works best if it's done for at least 1/2 an hour or more each day and movement has all sorts of benefits - it improves posture, inhibits pain, clears your head, improves mood, slows brain shrink (doesn't make you smarter but keeps you less dumber) and makes you more attractive (true).

2. We love complex movement, novel movement.  Complex movement requires complex brain firing and brains love 'novel' things so every now and then vary your movement. It's also why we suspect that Tai Chi, Pilates and dancing are very useful for chronic pain and general well being because they challenge the brain.

3. Exercise is for your brain, less for your body.  The brain controls the body so although every problem combines an 'in' body or tissue problem the effect of disease or dysfunction is as much a brain issue as a body issue.  It's a chicken - egg paradox. In reality our entire body is quite seamless from a development point of view even though we can separate it into organ systems.

4. The organism is highly adaptable - bouts of High Intensity (HIT - high intensity training) force the organism to shift.  Athletes have been doing this for centuries.  It's simple, effective and allows you to eat more (yum!). Weights once or twice a week can do this but it has to be difficult.  Short, heavy, simple (one or a few exercises) workouts (which of course anyone can be trained for) do it.  It's not for everyone but if you like it, do it.

That's it for now.  Anyone is welcome to suggest alterations.  I'll keep 'eating' to another post.

Regards

Doug

Enter the Matrix

The following link is for the eggheads.

http://www.academia.edu/1133811/From_the_neuromatrix_to_the_pain_matrix_and_back_

It's great fun to be able to use the word 'matrix' at work and still remain credible and within the realm of science but what on earth does it have to do with the spine?

Almost everything it seems.

Most problems felt in the body are triggered in the body however, how they feel, particularly when these conditions become chronic, is due to what is happening up inside the head, in the matrix.

The crowning achievement of biology in the 20th century was the mapping of the human genome.  It has allowed us to forge ahead at an even greater rate with our understanding of life, both how individual organisms function (and dysfunction), and how we all appeared to evolve.  It begins to reveal the why of the inherent, and unwanted, faultiness of ourselves but it also reveals it's wonder.  We are not even a single organism but a collection of billions most of which are not even 'human' and without which we could not survive.  We are not even constant.  In 7 years time we may see a slightly more wrinkled version of our self in the mirror but it will be a facsimile, most of those billions of cells having divided, died and replaced, giving you the illusion of continuity.

No wonder our reality verges on science fantasy and has been so difficult to understand.  Even highly esteemed scientists and thinkers get befuddled by the brain.

Nevertheless the average 10 year old grasps concepts which even Einstein was unaware of.  We were not the only humans on earth just the ones which have survived so far.  The universe is not static but expanding.  Black holes are real and consciousness, despite many of us not wanting it to be so, appears to be a final fluid function of the universes most complex piece of biology.  The brain.

In the developing embryo the beginnings of the central nervous system precedes all other structures, so, while the end product may appear to be a collection of disparate pieces, the body as a whole is a continuous, effectively homogeneous collective.  In fact biologists explain that we are not so much a single complex organism but a complex arrangement of billions of separate cells which have learnt, over billions of years, via the effects of physics and chemistry to arrange themselves into patterns which work.

And what of this Matrix - the brain map?

Well, we can see our limbs move but we cannot see our brain.  It's role and functions are counter intuitive.  You cannot feel it but feel with it, we cannot see it but see with it, we cannot move it but move with it.  We cannot even study it without using it to study itself.  It's no wonder that it's enigmatic nature is the source of considerable confusion, and the stubborn refusal to admit, that despite thousands of years of introspection and hundreds of years of science, what we perceive appears to be the projection of an organ weighing about 1.3kg.

Surely our seemingly unlimited subjective reality, our marvellously creative human imagination with which we make our world and experience it, surely it is greater than this.  But consider it's parts as science has revealed and is continuing to reveal - it is comprised of 100 billion neurons, each with hundreds, thousands of interconnections, each with a plastic, fluid nature.  The result is a moldable neural network of such complexity that it defies all rational mathematical numbers yet it is definable nonetheless as a product of these things.  Despite the considerable achievements of many of history's introspective traditions, none of them escaped the burden of superstition.  We can barely begin to understand reality without first understanding how the brain works and admitting that this is where we sit.  All other explanations are, for the present, just ideas.

Many fear that by reducing the study of the brain to it's constituent parts we will destroy the wonder of it.  In the film 'The Matrix', what neo experiences is the product of the machines.  In the same manner our attachment to our subjective experience as 'real' including our ideas and cherished beliefs does not often accord with reality.  This is why science has become such an essential tool, a way of thinking, with which we've been able to begin to poke our way through our cloak of ignorance about how things work.

We're afraid I think of damaging our awe and wonder.  We don't want to know what's around the next corner because it may not be as grand as what we've imagined.  But who imagined the nebula, the sheer unimaginable size of the universe, the speed of light, the roundness of the planet, the sun as a star, matter as the products of stars, the brain as the seat of our senses then our subjective reality, the fluid nature of the brain in response to experience?  The risk of knowing far outweighs the so called bliss of ignorance.  As a child I gazed up at the moon and considered how it could just be there without apparent support.  That was enough for me.

Chiropractic Diagnosis and the Elephant in The Room

The following comes courtesy of Dr Matt Long at CDI (Clinical Development International).

 

The Diagnostic Imperative

 

September 03, 2013 by Dr Matthew D. Long

 

Since its inception the chiropractic profession has had an uneasy relationship the word 'diagnosis'. While there were strong historical reasons for this, largely based upon establishing a separate and distinct lexicon to avoid being jailed for practicing medicine without a license (1), there remains an undercurrent of concern about the word itself.
Diagnosis.

What are the implications of using this word? For one thing, a diagnosis allows us to understand the extent and character of a condition. We can then choose our management wisely, even if our clinical application remains focussed upon the chiropractic adjustment. After all, if I know that the patient in front of me has an annular tear then I might approach the delivery of an adjustment differently to that of someone suffering from a facet synovitis or meniscoid extrapment. How would the presence of a disc protrusion alter my decision-making? Or an extrusion? Or a sequestration? How would such knowledge alter my approach and improve patient safety and outcomes?
Because it should.
The recent discovery that vertebral body degeneration visible on MRI (type I Modic changes) may actually be due to an infection of Propionibacterium acnes from the mouth (2,3) further clarifies the importance of diagnostic specificity. If we know that such degeneration might actually be infectious in nature it significantly changes management.

We should also bear in mind that even if we limit our descriptors to the word 'subluxation' to quantify a spinal problem, we are still making a diagnosis. We are attaching a label to a patient and deciding to intervene based upon it. However, a term like ‘subluxation’ leaves out the very important element of the tissue in lesion - and it is the connective tissues of the spine that must ultimately bear the forces that we wish to impart with our adjustments. After all, the bones of the spine are nothing more than levers that we use to stretch connective tissues and fire the receptors embedded within. It makes sense that we understand the nature of the tissues that we interact with. A subluxation is a model. It is a representation of various functional aberrancies in the spine, but like all models it is an approximation. An accurate diagnosis gives us clarification.

Making a rigorous diagnosis also grants us a prognosis.
What is the chance of resolution of a grade 3 lumbar nerve root compression? How much time have you got to try out your conservative management before you close the window of recovery forever and condemn the patient to a life of chronic pain? 1 month? 3 months? 6 months? Would identifying the at-risk patient early make a difference? Absolutely.

Diagnosis gives us clarity. It also gives us a place in the health care system. The world does not need better therapists. It needs better problem solvers. It needs better clinicians. It needs better diagnosticians.

Something to think about...
Dr Matthew D. Long
BSc (Syd) M.Chiro (Macq)

References:
1. Keating, Joseph C Jnr. B.J. of Davenport: The early years of chiropractic. Davenport, IA: Association for the History of Chiropractic; 1997.
2. Albert, H. B., Lambert, P., Rollason, J., Sorensen, J. S., Worthington, T., Pedersen, M. B., et al. (2013). Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? European spine journal, 22(4), 690–696. doi:10.1007/s00586-013-2674-z
3. Albert, H. B., Sorensen, J. S., Christensen, B. S., & Manniche, C. (2013). Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. European spine journal, 22(4), 697–707. doi:10.1007/s00586-013-2675-y

BPPV revisited

A while back I wrote about Benign Paroxysmal Positional Vertigo or BPPV for short. It is a condition which although not life threatening is common, profoundly disturbing, often anxiety producing and inadequately treated. A sense of balance is fundamental to normal day to day activity and this problem doesn't just make you feel 'off' as many spinal problems can do. BPPV is a sudden and disturbing spinning sensation (most often associated with movement such as rolling over in bed) accompanied by nausea, sweating and anxiety and visual disturbance. Futhermore even once an attack has passed the experience is such that most people remain highly anxious or hypervigilant. This in itself is a normal response by the brain which has evolved to force you to pay particular attention to sensations which may threaten your survival and falling over is a main one. Think of the times your pesky brother sneaked up on you at lovers leap. Now magnify that sensation of threat, add in a manic childs roundabout and you have BPPV.

Fortunately it's diagnosis is easily confirmed and 90% respond well to treatment. In contrast is Menieres disease which is currently thought to be due to a disturbance in the fluid of the inner ear (endolymph).

Ds

The neck and balance disturbance

The causes of balance disturbance are many but one of the most common is injury, strain or overuse of the neck joints.

Why?  Along with the inner ear and vision the neck joints deliver a constant stream of information to the brain regarding balance (officially orientation in 3 dimensional space).

Diagnosis

Most of our suspicions regarding what is causing the problem come from a history of accidents involving the head and neck where the person has been medically cleared but symptoms persist. Patients typically feel uneasy or 'off', often describe minor visual issues such as keeping focus on computer screens and perform poorly when balance is challenged. If they also present with neck stiffness or clicking there is a very good chance they will respond well when neck movement is improved. In addition some patients require corrective exercises.

The most recent case was the father of a young child who slipped down some stairs. He was essentially uninjured except for a jolted neck and mild concussion. The hospital had cleared him for serious injury and the neck was only slightly uncomfortable but he also began having trouble with 'eye strain' at work, mild headache and poor concentration. His brain scan had been normal after the fall so he hadn't connected his symptoms. His balance was poor particularly when we asked him to close his eyes and tests for inner ear trouble were negative. He responded well to gentle spine mobilisation and didn't require exercises.

Doug Scown

Core Myths

Is your ab workout hurting your back?

Jun 17, 2009 - Filed in: Back PainReynolds G. New York Times 2009, June 17

In subjects with healthy backs, the transverse abdominis (TrA) contracts milliseconds before the deltoid when raising the arm into flexion. The nervous system activates the TrA to brace the spine in advance of movement. In LBP patients TrA firing was delayed. LBP patients were trained to isolate & strengthen the TrA by sucking in their abdomen & a booming industry of fitness classes was born. The idea leaked into gyms & Pilates classes that core health was “all about the TrA.” But there’s growing dissent among sports scientists about whether all this attention to the TrA gives you a stronger core/ back & whether it’s even safe. “There’s so much mythology about the core,” says Stuart McGill, PhD, a highly regarded professor of spine biomechanics. “The idea has reached trainers & thru them, the public that the core means only the abs. There’s no science behind that idea.” The muscles forming the core must be balanced to allow the spine to bear large loads. If you concentrate on strengthening only one set of muscles within the core, you can destabilize the spine. The muscles forming the core must be balanced to allow the spine to bear large loads. If you concentrate on strengthening only one set of muscles within the core, you can destabilize the spine. “In our lab, the amount of load the spine can bear without injury was greatly reduced when subjects pulled in their belly buttons” during crunches & other exercises. Instead, he suggests, a core exercise program should emphasize all of the major muscles that girdle the spine – Abdominal Bracing - including the abs. Side bridge & “bird dog” exercise the important muscles embedded along the back & sides of the core. As for the abdominals, no sit-ups, McGill said; they place devastating loads on the disks. “Do not hollow your stomach or press your back against the floor,” McGill says. Gently lift your head & shoulders, hold briefly & relax back down. These 3 exercises – “the Big Three” - Bird Dog, Side Bridge, & Curl-Up can provide well-rounded, thorough core stability & avoid the pitfalls of the all-abs core routine. “I see too many people,” McGill said “who have six-pack abs and a ruined back.”

This article was borrowed from Dr Malik Slosberg research files.

Iliotibial Pain (ITB) Syndrome

Iliotibial Pain Syndrome (ITBS) is the most common cause of pain on the outside of the knee which is not due to problems within the knee itself (intra-articular). Effusion (swelling) around the front of the knee, clicking, a history of twisting injuries and postive stress tests may locate intrinsic problems. Furthermore there are a few less common problems which can arise within other structures of the knee itself.  However stresses within the ITB, the band of connective tissue which arises in the pelvis and extends down to below the knee presents an interesting problem.

The forces which arise in the hip and lateral knee are considerable. Walking alone produces stresses in and down the outside of the thigh which can be three times body weight so it's easy to see how jogging and running (particularly when introduced too rapidly) may contribute to compression problems.  In addition a history of lower back and pelvic pain or stiffness can compound the situation. Why?  The gluteal muscles alone (indeed any local group of muscles) are not strong enough to stop the hip collapsing on itself when we walk (let alone run). It is the co-ordinated action of muscles bound together by the inelastic connective tissues of the ITB which produce significant strength and stability and if they do not work in unison the region is left vulnerable to injury.

What of the lower limb?  Do poor foot mechanics cause alot of ITBS?  While this is possible the literature suggests that most problems arise in the pelvic region however the foot and ankle must be considered as possibilities in each individual case.


Douglas Scown