Very often a patient will ask whether their pain is stemming from a muscle, tendon, ligament, nerve, disc, or joint. And my answer is often, “all of the above”. Because the body is so interconnected, an injury often does involve all of the above. That said, identifying the “pain generator” or primary tissue involved in causing the pain is something that can (and should) be done by the treating doctor. However, in order to fully resolve a patient’s pain, and return them to optimal function, it’s not uncommon to have to “fix” all of the above. The reason for this is because muscles (and their attached tendons) move bones, ligaments stabilize joints (as they attach bone-to-bone), and joints affect nerve function. When these structures are directly (or indirectly) affecting the spine, spinal discs may become involved. That said, I’ll now discuss the triad of a sprain/strain injury as it relates to muscle dysfunction. I’m going to speak of muscle dysfunction in particular, because if the muscles are not “fixed”, none of the other structures will get “fixed”.

With any injury, or even chronic pain (which may result from an old imperceivable injury) there is always muscle dysfunction. One muscle will become inhibited (or “weak” in lay terms), its antagonist (or muscle and with the opposing action) will become dysfunctional due to shortening of its overlying connective tissue or fascia, and its synergist (or muscle with the same or similar function) will become hypertonic or over-contracted. This is why I use the word “triad”.

First, I’ll discuss the inhibited muscle which is also the one I look to identify first in the triad. This is the muscle that can’t properly perform its function due to an injury (or micro-trauma) to the muscle or its tendon’s attachment to the bone. This is typically due to overstretching or over-contracting from a force that it can’t withstand. The result of this is that it cannot properly contract in its everyday function, which results in subsequent compensations. Those compensations have to do with the other two major muscle dysfunctions.

Next, the antagonist to the inhibited muscle will typically become shortened. The entire muscle can become shortened, but very often it’s the fascia (or overlying connective tissue) that shortens or becomes “knotted” and becomes the major problem. This is the typical “knot”, or more appropriately termed “trigger point” in a muscle that we often feel compelled to stretch or (hopefully) have someone else knead or massage. The eventual result of this type of muscle dysfunction is that after it becomes stretched through normal movement or deliberate stretching, it then becomes inhibited for a brief period of time. This will eventually lead to more joint instability.

Lastly, the synergist to the inhibited muscle becomes hypertonic or overcontracted. That is, the nervous system “directs” the muscle to overcontract or work harder, as it now has to take on the job of the inhibited (synergist) muscle in addition to performing its own function. This will also typically result in a “knot”or trigger point. However, this trigger point doesn’t usually respond (from a functional standpoint, though perhaps it may provide the person temporary pain relief) to stretching. It will need to be shortened (usually with pressure applied to the trigger point) in order to return to normal function. This type of muscle dysfunction will cause the muscle to become inhibited after it is contracted, leading to joint instability.

So, to rehash; a sprain/strain injury almost always involves a triad of muscle dysfunction. That is, one primary muscle is inhibited, while its antagonist becomes (“fascially”) shortened, and its synergist becomes hypertonic or over-contracted. Additionally, the adept practitioner will realize that the patient usually experiences pain in the synergist or over-contracted muscle. Or, the patient will complain of a tight muscle that will not relent to continued stretching. The reason for this is that the primary problem is the injured/inhibited muscle, which creates the subsequent compensations in the antagonist and synergist muscles. Thus, stretching (or focusing on) the compensatory muscles is usually futile or only provides transient relief. Specific muscle tests by the practitioner will uncover the primary cause of the problem and resulting pain and dysfunction.

This is not to say that only the primary (inhibited) muscle needs to be addressed. Often, the compensatory muscle dysfunction needs treatment, and there will almost always be a spinal and/or extremity joint that needs to be adjusted to allow for proper range of motion and continued muscle balance. Ligament and spinal discs (which are composed of ligamentous tissue) may also need specific attention.

As with any condition, each patient needs to be evaluated and treated as the individual they are, which yields the best results in resolving a patient’s pain and restoring them to optimal function.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Interestingly, pain doesn’t occur where you “feel” it or believe it to exist. In fact, pain really isn’t a “thing”. Pain is a perception triggered by the activation of certain areas in the brain. These “pain centers” (the neurology can get quite complex, so I’ll keep it simple) in the brain receive signals from specific nerves that have pain receptors (nociceptors) on them. So in the case of low back pain, for instance, the nociceptors harbored in the spinal joints, muscles, etc. get stimulated which then send nerve transmissions to be interpreted by the brain as pain. It’s because of this reason that “nerve blocks” work; basically blocking the signal to the brain. Now, what do we do about pain (other than a nerve block)?

Well, that of course depends on the type of pain you’re talking about. You see, nociceptors can get stimulated in different ways. Specifically, they respond to mechanical forces, inflammatory chemicals, and temperature changes.

As far as mechanical forces go; compression or stretching of a nerve(s) causes the stimulation of nociceptors, and results in the perception of pain. This can be caused by any number of structural imbalances, whether acute or chronic. The treatment for this type of “pain” stimulation is to balance muscle and joint function in order to eliminate the compression or stretching of the nociceptor. Furthermore, balancing muscle and joint function results in the stimulation of nerves that harbor mechanoreceptors (sensitive to light touch, vibration, position-sense, etc.) which actually act to: a) directly block the transmission of nociceptor signals to the brain, and b) travel faster to the brain in order to allow for the perception of something other than pain. By the way, “a” and “b” are the reason we rub an area of pain in order to relieve it.

Chemical pain, on the other hand, results from the stimulation of nociceptors via various inflammatory mediators/chemicals. So why do inflammatory mediators get released? Simple, because of tissue damage. This can certainly result from a structural abnormality that causes damage; in addition to a “chemical assault” that results in inflammation such as a food allergen or sensitivity, infection, toxin, or nutritional deficiency. All of the above can (and usually do) cause an inflammatory reaction. The chemicals involved include the likes of histamine, prostaglandins, thromboxanes, leukotrienes, etc.. As a result, these chemicals need to be kept at bay in order to prevent pain from being perceived. This is the reason why you may still sometimes feel pain after a chiropractic treatment. The treatment is designed to balance the structural components of dysfunction, however if there are still inflammatory chemicals circulating in response to tissue damage, the pain will persist. Once the healing begins, the pain should diminish and ultimately resolve. Chemical mediators of pain can be controlled by balancing muscle and joint function in order to prevent further damage, in addition to being controlled by nutritional substances that assist in healing and reducing inflammation.

Thermal or temperature-related pain… To relieve this…take your hand off the stove and don’t play with matches!

This idea of mechanical and chemical-mediated pain can be of extreme importance in diagnosis. Let me explain. If the pain experienced can be fully relieved by holding your body in a certain position, then your pain is solely caused by mechanical insults. However, if there is no position you can get into that relieves the pain, your problem most definitely has an inflammatory chemical component to it. And of course, if a certain position relieves some of the pain but not all of it, then there is both a mechanical and chemical component involved (this is most often the case). Whenever there is a chemical component to the pain, your doctor needs to have methods that can easily determine why you are inflamed. Remember, this can be the result of the normal repair process from structural damage, a chemical toxin, a food allergen or sensitivity, and/or a nutritional deficiency.

Several decades ago, it was found out that the mind cannot be separated from the body (through the field of psychoneuroimmunology). Now, if we were to dismiss the chemical component of pain, we’d basically be trying to separate the body from the body. Hopefully this helps to explain why your doctor may ask you to avoid certain foods, change your diet altogether, and take supplements even though your primary complaint is “physical” pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

some information in this article was sourced from: Chris Astill-Smith, DO, DIBAK – metabolics.com

I use the word minutia because I’m going to focus on a particular molecule (really its depletion), sulfate. You may have heard of glucosamine sulfate and even chondroitin sulfate. Add keratan and dermatan sulfate to the list as well – the list of compounds involved (and contained) in the cartilage that cushions your joints. As you may know, one reason for musculoskeletal pain is “wear and tear” to this cartilage. This is especially true in the case of osteoarthritis. However, whether or not you are diagnosed with osteoarthritis, joint pain from cartilage damage and loss – or is it really joint pain from lack of repair – occurs frequently.

Now, back to the stress response. One of the major hormones secreted during stressful times is cortisol. And one of the hallmarks of this hormone is to help stimulate the production of glucose by breaking down fat and protein in order to ready the body to respond to the stressful situation. By the way, this “stressful situation” has been found to be anything from lack of sleep, a food sensitivity or allergy, chronic infections, blood sugar imbalances, musculoskeletal imbalances, and certainly mental/emotional stress as well. Regardless of the source, it’s well known that stress of any kind leads to an increase in cortisol. [In cases of severely depleted individuals with chronic stress, cortisol can get eventually become depleted] In this article I’m not concerned much with the production of cortisol, but rather its clearance or breakdown from the body that may have unpleasant side effects.

Cortisol is a steroid hormone (along with DHEA, testosterone, estrogen, progesterone, etc.) that gets detoxified through specific pathways in the liver. These pathways are known as glucuronidation and sulfation. (That’s about as fancy as I’ll get with words, so no worries from here on.) Note the name of the second detox pathway I mentioned. It’s derived from the word sulfate, because it is the sulfate molecule that is used in this type of detoxification. Now recall those substances mentioned earlier that are components of cartilage. They all end with the word “sulfate” as they also require the sulfate molecule for their structure and function. So, if your body is busy burning through its sulfate to detox the excess cortisol that’s running through your bloodstream; where is the sulfate that helps repair cartilage going to come from? That’s certainly the issue, isn’t it?

Fortunately there are several options. Starting with dietary choices, you can consume foods rich in sulfur. These include garlic, onions, eggs, cauliflower, broccoli, and many others. This may be helpful, though sometimes not sufficient. One major reason (aside from quantity) that relying on food alone may not cut it is if high levels of circulating cortisol has compromised your digestive tract, which it typically does. This may lead to malabsorption of any nutrient(s), and not just sulfur. Another option is to supplement with sulfur, typically in the form known as methyl-sulphonyl-methane (MSM). Whether or not research supports the use of MSM in joint pain and cartilage repair/synthesis, you’re still an individual and may experience varying results (certainly related to your sulfate-dependent detox pathways). Lastly, sulfate can be had from the appropriate metabolism of homocysteine. If you’re unfamiliar with homocysteine, click here to learn more. In order to metabolize homocysteine into sulfate, the body requires certain nutrients especially vitamin B6 and molybdenum.

Please be aware that even though sulfate is critical in relation to stress and joint repair, chances are that your sulfur intake is not the only thing that need adjusting. In order to combat the stress response, I find it critical to support the structural (bones, muscles, etc.), chemical (nutrients, toxins, etc.), and mental/emotional components of a person. A “big picture” (well, truly holistic) approach is often preferred, if not necessary, to overcome the problems associated with any stressors, not the least of which is joint damage and repair. As a generally observed, several other (than sulfate) nutritional factors come to mind: proper collagen formation, healthy blood sugar metabolism, and last but certainly not least, stress management.

Hopefully this helped you to understand a bit of how the pathophysiology of the stress response may be affecting your body; and how to help it. Click here to read more on adrenal stress syndrome.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

source – “Degeneration Intervention – Gut, Liver, & Joints” seminar by Walter Schmitt, Jr., DC, DIBAK, DABCN

The typical presentation of symptoms arising from trigger points are painful restricted range of motion and/or dull, aching or sharp muscle pain. Additionally, trigger points can cause referred pain. You may be familiar with the concept that oftentimes when someone gets a heart attack, they will experience pain down their left arm. This is a classic example of referred pain due to (cardiac) muscle damage. The same concept goes for skeletal muscle and/or fascia. I’ve even had instances where patients thought they were having a heart attack, but it was actually referred pain from a trigger point in their chest (pectoral) muscle.

There are basically two types of trigger points. One involves muscle fibers while the other involves fascia, the soft connective tissue that covers every muscle and permeates the entire body. It’s not important for you as a patient to know the difference, however it is for the doctor because the way it’s treated will depend on whether the problem is in the muscle or the fascia.

Trigger points can develop for any number of reasons. Postural distortions very often cause and/or exacerbate trigger points. Another common reason would be a (quick) change in position after being sedentary for a long time. A classic example is someone who is crouched or kneeling while gardening and then suddenly stands up. This commonly results in trigger points in the hip flexor(s) and often leads to low back pain. Theoretically, the muscle is “stuck” in the crouched position and hasn’t adjusted to the standing posture appropriately. This same scenario can take place under any circumstances involving changes in position, especially if they are sudden.

An inhibited or truly weak muscle can also result in trigger points. Typically, the trigger point will be in a synergistic (i.e.: one that performs the same or a similar function to the weak one) and/or the antagonistic (i.e.: a muscle that acts opposite the weak one) muscle. A synergistic muscle would develop trigger point(s) because it has to work harder and make up for the weak one; while an antagonistic muscle can develop trigger points because it tends to shorten and tighten due to a lack of sufficient opposing forces. Typically the former will result in a trigger point in the muscle, and the latter will often involve more of the fascia. This triad of muscle dysfunction is very common in musculoskeletal injuries and pain, and correcting these aberrant muscle patterns and trigger points often makes all the difference between success and failure. Fortunately, treating a person with pain that arises from trigger points is fairly straightforward, simple, and easy to resolve.

If however, a person tends to have trigger points “all” over their body or chronic recurring trigger points, nutritional deficiencies should be considered. In Dr. Travell’s book, “Myofascial Pain and Dysfunction, The Trigger Point Manual”, she mentions inadequacies of vitamins B1, B6, B12, folic acid, and vitamin C; and inadequacies of the minerals calcium, iron, and potassium as potentially aggravating factors. I would add the mineral magnesium to that list as well, because of its ability to act as an anti-spasmodic.

Generally speaking, we all have trigger points in our muscles and/or fascia to some degree. What matters is how much they are contributing to pain and joint dysfunction.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Symptoms

The main symptom of plantar fasciitis is pain on the sole of the foot, especially on the heel. Additionally, it tends to hurt the most just after stepping out of bed in the morning, and may get better as the day goes on. However, it may also get worse with walking.

Causes

The primary cause of plantar fasciitis is overpronation of the foot; which is also referred to as “flat feet” or “fallen arches” in lay terms. If you think of the foot and its (plantar) fascia as a bow and arrow, the fascia would be the string and the bow would be the bones of the foot. In a biomechanically-sound foot, an arch is present which gives it the bow-like structure. Now, imagine if the arch (or bow) “dropped” (or straightened) as in overpronation; then picture what happens to the string on the bow (i.e.: the fascia). Essentially, it will have to stretch to accommodate the “flattening out” of the bones of the foot. It is this stretching and excessive tension of the fascia that can lead to the painful condition known as plantar fasciitis. Other factors that can contribute to plantar fasciitis are excessive pounding on the foot (as in jogging or jumping) and a tight achilles tendon or calf muscle.

Treatment

Conventional treatment can include the use of orthotics, anti-inflammatory medication, and stretching exercises.

Chiropractic and applied kinesiology treatment consists of correcting the cause of the problem. If this relates to overpronation, the muscles and joints of the foot and lower leg need to be evaluated and treated appropriately. Certain muscles may need stretching and lengthening, while others need strengthening and shortening. Also, joint motion will most likely need to be restored in the foot and ankle with chiropractic adjustments. The integrity of the ligaments may need to be supported through specialized applied kinesiology treatment and possibly through nutritional supplementation. Also, supplements to assist with quelling inflammation and to speed healing may be warranted. If necessary, orthotics may be prescribed to assist in maintaining the structural integrity of the foot. Whether or not orthotics need to be used permanently depends on the severity of the problem. Most importantly, a treatment plan needs to be designed to fit each individual’s needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

The rotator cuff is a group of four different muscles that help stabilize and move the upper arm bone (humerus). Specifically, the rotator cuff helps stabilize the ball-and-socket (or gleno-humeral) joint of the shoulder to prevent a dislocation; as well as help raise and rotate the arm. The muscles of the rotator cuff include the supraspinatus, infraspinatus, subscapularis, and teres minor. Usually, injuries to the rotator cuff involve a tear or degeneration of the tendon(s), most often the supraspinatus tendon.

The supraspinatus tendon is tucked under the (acromio-clavicular or AC) joint formed between the collarbone and the tip of the shoulder blade (acromion). This joint is on the top of the shoulder where the strap of your bag may rest. The supraspinatus tendon often becomes compromised during activities that include prolonged overhead movements; such as in sports like baseball, volleyball, tennis, acrobatics, etc.. Essentially, the tendon continuously gets damaged (possibly leading to a tear) from being “impinged” under the AC-joint. This can result in pain, weakness, and/or limited range of motion of the arm. There are other ways that injuries to the rotator cuff muscles occur, but impingement is a common one.

Now, when an injury involves damage to the rotator cuff muscle(s), they are usually deemed to be the problem. Conventional treatments are often directed at exercises for rehabilitating the rotator cuff, therapeutic ultrasound, oral or injected anti-inflammatories, or surgery in severe cases.

My approach to rotator cuff syndrome is a bit different. I usually find that injuries to the rotator cuff muscles and tendons often do not stem from an inherent problem with the rotator cuff. Instead, I usually find that the main problem lies within the larger muscles of the other shoulder joints that help to prevent the humerus from “impinging” under the AC-joint; and that help stabilize the shoulder blade and collarbone. Usually, when I get the other, larger muscles firing properly and restored to their normal length, the rotator cuff muscle(s) will not become compromised and then allowed a chance to heal and function properly. Additionally, I evaluate the joints and correct the movement of the shoulder blade, collarbone, and humerus when necessary. Specialized treatments for ligaments, tendons, connective tissue (fascia), and even skin may also be employed. Lastly, evaluating the cervical spine for joint dysfunction is critical, as the nerves that exit the cervical spine control the muscles of the shoulder. Eventually, a rehabilitative program targeting the appropriate muscles causing the problem is undertaken. This is aimed at preventing a recurrence of the problem and a return to normal activities.

So even if you’ve been diagnosed with rotator cuff syndrome or impingement syndrome; it would be prudent to have your entire shoulder complex and cervical spine evaluated for dysfunction to determine the ultimate cause of the problem.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

The most abundant protein in the body is collagen. Also, collagen makes up about ninety-percent of connective tissue. This is important for a number of reasons, not the least, musculoskeletal health. If “musculoskeletal health” seems vague, think: degenerative joint disease, degenerative (spinal) disc disease, disc herniations (or “slipped” discs), tendonitis/osis, osteoporosis, sprains and strains, etc.. Collagen essentially provides the tensile strength of tissues. If you don’t have enough collagen or your collagen is “weak” or poorly formed, you’ll be susceptible to injuries and all types of musculoskeletal disorders; among other problems that I’ll touch on briefly as well.

There are twenty-nine types of collagen throughout the human body. Collagen is a major component in many tissues, especially bone, cartilage (including intervertebral discs), tendons, ligaments, muscles, skin, blood vessels, lung tissue, and even the cornea of the eye. Now you can see how the integrity of your collagen is so vital to the functioning of your body. Remember, structure determines function, and collagen is a major part of your structure. So now let’s discuss how to make and maintain strong collagen.

First, you need (to digest and absorb) adequate amounts of protein in order to supply the raw materials. Remember, the building blocks of protein are amino acids. Any amino acids can be used in some areas on the collagen molecule, but the key ones are proline, lysine, and glycine. You shouldn’t have to be concerned with eating large quantities of food that contain these specific amino acids in high levels. Focus on getting an adequate amount of protein from a variety of sources and that should cover your bases. Although, vegetarians and vegans may want to seek out foods high in these amino acids to be sure. And, those with injuries and/or chronic musculoskeletal conditions may want to ensure higher than typical amounts of these amino acids.

Now I’ll discuss the synthesis of collagen. First, in order for your DNA to begin the process (I’ll keep it simple), you need zinc. There is an important zinc-dependent enzyme, DNA polymerase, that allows for the proper function of DNA. This is why zinc is an extremely important mineral in general. The proper function of DNA is an absolute necessity for every cell in your body; especially cell growth.

As mentioned above, the amino acids lysine and proline are necessary. These amino acids then need to be hydroxylated (which means adding an -OH group). For this reaction to occur, you need iron, vitamin C, and alpha-ketoglutarate. Focus on the iron, vitamin C, getting enough protein and you shouldn’t have to worry about the alpha-ketoglutarate (for the most part).

The next step in forming collagen is known as glycosylation (adding glucose basically). This requires available glucose (or galactose) along with vitamin A and manganese. Now don’t go out consuming pure glucose in order make sure this step happens. But do make sure you have good blood sugar metabolism in order to have it available for the cells to use. I have written several articles related to blood sugar. Click here to read my article on “what” to eat, and here to read about “how” to eat.

After glycosylation, pro-collagen is eventually formed which is/are basically chains that are linked with the help of sulfur. So sulfur is essential for collagen formation, but it does have other roles in the body as well. In supplement form, sulfur can be obtained from “MSM” (or methylsulfonylmethane). Additionally, there are “sulfur-amino acids” that can be taken as supplements or gotten from food. These amino acids are cysteine and methionine. Foods that are especially high in sulfur include kale, cabbage, cauliflower, onions, garlic and eggs.

Pro-collagen then requires transport outside of the cells which again requires vitamin A and zinc.

At this point pro-collagen is converted to collagen and then strengthened by cross-linking the fibers (or fibrils) with the help of copper-dependent enzymes. Please note that this enzyme can be inhibited by high levels of the amino acid homocysteine. If you’re not familiar with homocysteine, I have written about it in another article linked here. If homocysteine inhibits this enzyme, the strength of the collagen fibers may be compromised resulting in weak or dysfunctional collagen. This is extremely problematic and may thwart the whole effort. See my article linked above for the “antidotes” to homocysteine. It will “save” more than just your musculoskeletal health.

That essentially covers the formation of collagen. To recap, here is a list of the most important nutrients: protein (esp. the amino acids: proline, lysine, and glycine), zinc, vitamin C, iron, vitamin A, manganese, sulfur, and copper. Don’t forget healthy blood sugar metabolism. And you can also include the nutrients that are necessary to metabolize homocysteine.

Before I finish, I want to touch on another point. Collagen can form adhesions, so to speak. This is the result of excessive cross-linking of collagen. Essentially, when this happens, the fibers don’t glide along one another smoothly. Adhesions can result in decreased range of motion in a joint; and it can be caused by decreased range of motion (usually post-injury or post-surgery). Adhesions in other structures that require collagen (such as blood vessels) may affect their function as well. The key nutrients for preventing this excessive cross-linking (thus aiding in normal cross-linking) are bioflavanoids. In nature, bioflavanoids are found in the white, pithy part of citrus fruits under the rind. They’re also contained in most fruits and vegetables as well as green tea. So in addition to structural treatments designed to increase range of motion, bioflavanoids may be particularly helpful. These can be obtained from supplements as well as food.

I’ll give you an example of how helpful bioflavanoids can be, as well as collagen formation in general. A 42-year-old patient who had undergone a double-mastectomy was referred to me for herniated discs in her neck as well as shoulder and rib pain (in addition to hip and knee pain). I surmised that most of her symptoms were a result of scarring and adhesion formation from the surgery (in addition to a lack of regeneration or degeneration of collagen in her neck/discs, hip and knee). The reason I felt this was because she had never injured any of those areas and there was no history of “overuse” as in repetitive sports. The surgery can be considered an injury, but regardless, she didn’t recover well if pain and decreased range of motion persisted.

I treated her structurally to get her muscles, ligaments, joints, and even skin functioning optimally. In thinking about the nutritional component of her pain and realizing this concept of adhesion formation and collagen; I instructed her to take a bioflavanoid supplement containing dried fruits and vegetables; and she also began juicing fresh fruits and vegetables (even better!). I also had her take a specific mineral related to sulfur metabolism. After about one month of treatment she reported “I feel better”, “I finally feel good”. After about two months, she was doing great and reported a “75%” improvement in her neck, shoulder, and rib pain and was able to walk long distances without pain in her hip or knee. This is a significant improvement, especially after undergoing surgery, in addition to chemotherapy and radiation. I recently saw her after a three-to four-week hiatus and she reported that a fair amount of the pain and discomfort had come back. Sure enough, the holiday season and her busy schedule interfered with her juicing and taking the supplements which allowed the adhesions to reform and decrease her range of motion, while increasing her pain. It may be unfortunate that she’s currently relying on supplements to remain pain-free, but it sure beats pain medication. With more time and consistency, she should be fine on a well-rounded, whole-food diet.

In conclusion, the array of nutrients necessary for collagen formation and maintenance helps explain why a well-rounded diet is so important. And remember, collagen is important for more than your musculoskeltal health. It’s absolutely vital for your (cardio)vascular system. Oh right, and something as simple as anemia (iron or folic acid/B12 deficiency) and hypochlorhydia can (and most certainly will) affect your musculoskeletal and cardiovascular health. You see, it does all fit together if you can find the missing pieces.

Also, remember that skin is dependent on collagen (among other things), and without sufficient amounts, wrinkles will result. I wonder if those collagen injections people get could be used for more than just vanity. And when the visual effects wear off, does the body “steal” it from (say) the lips to put it where it’s more important for survival? I hope so.

Source: http://www.metabolics.com/

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

This condition has often been found to be instigated by a cold breeze on the face (such as sleeping or driving with a window open), shaving, chewing, brushing your teeth, extreme opening of the mouth (such as in yawning), or sometimes for no known reason. Other, more serious problems like multiple sclerosis and tumors may be a cause. The more common reasons for changes in the function of this nerve have been deemed to be due to inflammation from an infection or pressure of a muscle or blood vessel.

The standard medical treatment for this condition is typically anti-convulsants, muscle relaxers, or maybe antibiotics (if it’s secondary to an infection). If medication doesn’t work, surgery may be the next step in conventional treatment.

My personal approach to this disorder is to restore proper motion and function of the cranial bones that this nerve passes through. This would include gentle cranial bone and cervical spine adjusting, in addition to balancing the muscles of the head, neck, and TMJ. Other factors affecting the alignment of the cranial bones, cervical spine, and TMJ would definitely need to be considered as well; which may include correcting the biomechanics of the pelvis and feet.

Nutritional considerations might include supplements that help control inflammation, reduce muscle spasms, and/or up-regulate the immune system. The most important thing to consider is that we are all individuals and treatment is based on your specific needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

sources: http://www.icakusa.com/ + http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446

The gallbladder is located on the right side of your body, behind the lower edge of the ribcage underneath the liver; in line with the center of the clavicle (or collarbone). Its purpose is to store bile that is manufactured by the liver, and then release the bile into the small intestine. From a digestive standpoint, bile’s purpose is to emulsify (or break down) fats in the small intestine, which allows them to be absorbed efficiently. Additionally, this allows for the proper absorption of the fat-soluble vitamins A, D, E, and K. Another role bile plays is to carry cholesterol and toxins into the intestines in order to rid them from the body. The toxins include anything ranging from pesticides, estrogens, toxic metals, and any other fat-soluble toxins. As you can see, a sluggish gallbladder (or worse, cholecystectomy) can cause a wide variety of complications.

The most common symptoms of gallbladder dysfunction include nausea, constipation, indigestion (especially after eating fatty meals), bloating (especially about half-an-hour to an hour after eating), gas, pain in the area where the gallbladder is located, pain in the right shoulder, a bitter taste in the mouth, clay or light-colored stools, and stools that float (except if you’ve consumed large amounts of fiber).

The gallbladder constricts and releases its bile via the action of a hormone called cholecystokinin (CCK). Cholecystokinin secretion is stimulated by the presence of fat- and protein-rich food that enters into the small intestine. As a result, avoiding fat completely may not be the best way to avoid gallbladder complications; because the mere presence of fat is helpful in releasing the bile that resides in the gallbladder in the first place.

The most common problem you’ve probably heard of related to the gallbladder is gallstone formation. And the most common type of stone is known as a cholesterol stone. It is not fully understood why cholesterol gallstones form, but it is generally accepted that they stem from any of the following: too much cholesterol, too much bilirubin (a breakdown product of old red blood cells), insufficient bile salts, a lack of emptying of the gallbladder, or the gallbladder not emptying enough. Cholesterol and bilirubin are normal components of bile. It is when they increase in concentration that they may become a problem. The other less common stone is known as a pigment stone.

I spoke about what causes the gallbladder to constrict (i.e.:CCK). In addition to a possible inhibition of the constriction of the gallbladder, the bile can also become thick and lose its ability to flow freely; regardless of the amount of CCK release. When this occurs, it is called cholestasis, or a suppression of the flow of bile. There are several possibilities as to why this may occur. First, realize that the largest component of bile is water. Therefore, being sufficiently hydrated is of prime importance to keep the viscosity down. Next, you must have an adequate supply of essential fatty acids, particularly omega 3′s. These fatty acids help to thin the bile to keep it flowing freely. Additionally, certain nutrients can be helpful in aiding fat metabolism and bile flow. In particular, inositol, choline, taurine, and betaine (not betaine-HCl, though it is possible that betaine-HCl may be helpful through improving overall digestion and stimulating the release of CCK). The gallbladder (and liver) can also be helped by botanicals such as milk thistle, dandelion root, and ginger. By the way, beet leaves are high in betaine, and juicing them would be best.

Other factors that can affect bile flow need to be considered as well. In particular, estrogen dominance can be a problem. Estrogen dominance refers to either: 1) too much estrogen in relation to progesterone, 2) too little progesterone, or 3) too much estrogen with normal progesterone levels. The reasons for estrogen dominance are beyond the scope of this article. Essentially, excessive estrogen can result in lithogenic (or calculi/stone forming) bile according to this article from the Annals of Surgery. Additionally, eMedicine cites a study which “postulated that estrogens cause increased cholesterol secretion and progesterone promotes biliary stasis”, thus possibly leading to gallstones or bile stasis. Low thyroid function (which can result from estrogen dominance, but certainly not always) can also cause the gallbladder to become sluggish and congested.

Women tend to be more likely to suffer from gallstones and gallbladder complications, which may further point to excess estrogen levels as being a major problem. There is a profile of a person likely to get gallbladder problems coined the “4F’s”: 1) female; 2) (let’s just say overweight); 3) forties (age); and 4) fertile (implying high levels of hormones).

Otherwise, I’ve quoted the following characteristics that put people at risk for gallbladder complications from the National Digestive Diseases Information Clearinghouse:

• women—especially women who are pregnant, use hormone replacement therapy, or take birth control pills
• people over age 60
• American Indians
• Mexican Americans
• overweight or obese men and women
• people who fast or lose a lot of weight quickly
• people with a family history of gallstones
• people with diabetes
• people who take cholesterol-lowering drugs

However, don’t rule out a gallbladder problem if you don’t fit into any of the categories above. I commonly see gallbladder problems in all types of individuals. The most common related complaints I see are sharp, piercing pain at the right fourth rib (where it connects to the fourth thoracic vertebrae) sometimes extending upward into the neck and resulting in neck pain as well; knee pain; and digestive disturbances. If you suspect a gallbladder problem, please seek a licensed, qualified healthcare practitioner that can help you before the worst case scenario (cholecystectomy). It can be a very simple problem to manage through diet and lifestyle changes.

One last thing! For those who have had their gallbladders removed, it may be a good idea to take bile salts (in supplement form) with every meal, as there is a good chance that fat digestion will be impaired without them.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Symptoms of TMJ dysfunction typically include the following: jaw pain, clicking or popping in the joint, decreased mouth opening, headaches, neck pain, tinnitus (ringing in the ears), and vertigo or dizziness. However, because of its large representation in the brain, I check it in on almost all my patients. Other than musculoskeletal complaints, endocrine gland imbalances can also result. This is because the “master” endocrine glands, the pituitary, hypothalamus, and pineal reside in the skull. And because structure determines function, these glands can dysfunction (and affect other glands they control) if the cranium is distressed due to muscular imbalances in the TMJ. Symptoms can vary and include but are not limited to: infertility, insomnia, hypo/hyperthyroidism, adrenal stress syndrome, PMS, increased or decreased appetite, digestive disturbances, etc..

Causes of TMJ dysfunction include muscular imbalances in the head and neck, faulty posture, malocclusion (irregular contact of the upper and lower teeth), grinding or clenching the teeth, chewing on only one side, pelvic imbalances, and even over-pronation in the feet.

Treatment of the TMJ generally includes leveling the head on the neck through chiropractic adjustments to the cervical spine, in addition to balancing the muscles of the neck and jaw. However, as stated above, the pelvis and feet can play a role in TMJ function as well.

The TMJ usually becomes dysfunctional because of other areas of the body that affect it; unless there has been direct trauma to it, as in boxing or a head injury. Therefore, I rarely go straight to the TMJ. But it is certainly worth checking no matter what the patient suffers from.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology