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Archive for the ‘chiropractic’ Category

There are several types of anemia, some of which I have written about in the past. This post will focus on the importance of correcting anemia as it relates to pain and musculoskeletal dysfunction, in addition to health in general.

As you can probably guess, oxygen is the most important “nutrient” for your body. The way I point this out to patients is by saying: “you can probably live about a month without food, you can probably live only three or so days without water, but you can’t live much longer than three minutes without oxygen (unless you’re David Blaine)”. That said, it’s critically important to correct anemia if that is a health issue of yours. (more…)

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The diaphragm is arguably the most important muscle in the body. I say this because, as you know, it’s the muscle that reduces pressure in the chest cavity (along with the muscles between the ribs) causing air to be forced into the lungs. Hence, it allows for breathing. The diaphragm is situated in the lower portion of the ribcage and attaches to the lower six ribs, the xiphoid process (a projection off the bottom of the sternum), and the first three lumbar vertebrae (L1, L2, and L3). Additionally, there is a connection between the diaphragm and two very important muscles involved in low back (lumbar) and pelvic stability; namely the psoas (the main hip flexor) and the quadratus lumborum (QL) (a ribcage and pelvic stabilizer). The connection with these two muscles and the lumbar vertebrae can make uncovering and resolving dysfunction of the diaphragm the key to alleviating low back pain.

It’s fairly simple for a doctor to evaluate for diaphragm dysfunction. The simplest method is for the doctor to place his/her hands on the back of the lower ribcage with the thumbs in the center, next to the spine. The other four fingers should lay on either side of the ribcage. Now, the patient is asked to take a deep breath while the doctor notes for symmetry in the movement of his/her hands. When there is significant dysfunction of the diaphragm, one hand will move away from the spine more than the other. Again, this is the simplest method.

Other clues that may point to diaphragm imbalances are when the patient walks with one foot flared out more than the other during gait or on static postural analysis (indicating possible psoas muscle dysfunction); and/or when the patient walks or stands with the upper body leaning more toward one side (indicating possible QL muscle imbalance). Additionally, the patient may sigh frequently, have difficulty breathing and/or shortness of breath.

OK, now that we know the signs and symptoms, I’ll discuss the possible areas that may need treating.

In order to be truly holistic (at least in a structural sense), the doctor needs to evaluate the entire body. He/she should begin with a basic gait and postural analysis. The imbalances above should be noted in addition to overpronation of either foot. When the foot overpronates (“flattens” too much) it can cause dysfunction in the psoas muscle which can have repercussions on the diaphragm due to its attachments. For more information on overpronation of the feet, click here. Additionally, the psoas and QL should be tested for inherent dysfunction and corrected accordingly.

As mentioned above, the diaphragm attaches to the ribcage, so any dysfunction of rib movement needs to be addressed, usually through chiropractic adjusting. The nerve that supplies the diaphragm (named the phrenic) arises from the third, fourth and fifth cervical (neck) nerves, so any dysfunction of those vertebrae should be corrected – again, usually through chiropractic adjusting. It would also be wise to look at the function of the first three lumbar vertebrae as the diaphragm attaches to those as well. Also from a spinal perspective, the junction of the thoracic and lumbar spine should also be evaluated. The bottom thoracic (12th) and top lumbar (1st) vertebrae need to be assessed, because that’s often the area where movement becomes restricted affecting diaphragm. This area is especially critical in low back pain, because if there is a lack of movement at those segments, the low back will have to compensate and move excessively which can lead to degeneration, instability and lumbar disc herniation. Lastly, the pelvis should always be evaluated because it acts as the base or foundation of the spine. And if the foundation is “cracked”, it’s very difficult for the “floors” above to be stable.

One more thing – sometimes the diaphragm needs to be addressed directly. Recall, it is a skeletal muscle just like any other and can be manipulated through various methods, manually or with the use of a massage-like instrument.

If you’ve been suffering from low back pain without an apparent cause and without relief after trying different methods, consider the diaphragm as the possible culprit – and if it is, AK may be able to help.

Dr. Rob D’Aquila – NYC Chiropractor – Diplomate of the International Board of Applied Kinesiology

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A common question I receive from patients is: “What’s the best position to sleep in?” Although it’s possible there may be an absolute answer to that question; I work with each individual patient to modify the position in which they fall asleep. I may also modify a patient’s sleep position based on a particular musculoskeletal complaint they have. But regardless of pain and symptoms, there are certain modifications we can all make. So whether or not “you” are asking this question to help a certain condition heal better, or even prevent a condition from arising in the first place, it might be wise to heed these guidelines.

The basic concept is to take the strain off major muscles of our pelvis and spine. The goal of this is to get our spine and pelvis in the best alignment possible. Now I’ll discuss how to evaluate and if necessary, “correct”, different sleeping positions.

“Side-sleeper”

Let’s first deal with the “side-sleeper”. When sleeping on your side, the main areas to take into consideration are the pelvis/hips, neck, and low back. Most people realize that having a pillow between their legs is best, and that is true. However, to take it a step further, it would be wise to check the muscle tension and tenderness when you’re in that position (with or without a pillow). The main muscle to check would be the gluteus medius. This muscle lies on the side of the pelvis and connects into the femur at the greater trochanter, which is the large piece of bone that protrudes out of of the thigh bone at the very top on the outside. Simply apply pressure to the muscle in order to locate a tender area. Next, put a pillow between your legs and reapply pressure to see if it’s diminished or significantly less tender. If it’s not, you’ll need to adjust the height of the pillow between your knees until you find a level that allows the gluteus medius to relax and remain in a position that doesn’t cause strain and reduces tenderness the most. Usually, this position will be the normal alignment of your pelvis and hips when you are standing.

Next, check for tenderness in the muscles on the side of your neck that is facing up. These are the scalene muscles. If you find tenderness, adjust the height of the pillow until these muscles are relaxed. Again, this will usually be the position of the neck as if you are standing upright. That is, the head won’t be leaning more to one side than the other.

Lastly, feel for tenderness (or have someone else do it) in the muscles on both sides of your spine in your low back. If these muscles are tender, either flex or extend your hip joints by bringing your knees closer to or farther away from your chest. When you find the position that allows for the least contraction and tenderness of those muscles, stick with that.

“Back-sleeper”

Now let’s consider “back-sleepers”. Most people assume this is the best position to fall asleep in. That may or may not be true, and again, I don’t take a very ardent viewpoint on any sleeping position. These days, I’m happy if patient’s of mine get a minimum of seven hours of sleep.

When it comes to sleeping on your back, we again need to evaluate the tension of the low back  and neck muscles. Check for tenderness in the muscles on both sides of the spine in the low back. If they are tender, put a pillow underneath your knees and recheck for tenderness in those muscles. Adjust the height of the pillow accordingly.

Also, the position of your head needs to be taken in consideration while sleeping on your back. Again, check for tenderness in the scalenes, especially those closer to the front of your neck. If you find tenderness, chances are that you need to lower your head so that it’s more in line with the rest of your spine – i.e.: not overly flexed with your chin too close to your chest. You may need to raise your head as well, but that’s why we check via palpating for muscle tenderness and adjusting the pillow accordingly.

“Stomach-sleeper”

Lastly, we come to the “stomach sleeper”. Even though I said I don’t take an ardent stance on one position or another, I would recommend against this. But if it’s the only position you can fall asleep in, so be it. The main areas to be concerned with here are the neck and low back.

First, check for tenderness in the scalenes, then use a pillow under your chest and see if you can find a pillow height that takes the strain off of those muscles. Additionally, check for tenderness in the muscles on either side of the spine in your low back. If these are tender, try putting a pillow under your abdomen and see if that helps. Again, it’s very likely that a pillow will help, but you’ll need to find the best thickness or height of the pillow in order for it to be most effective.

Sometimes it’s necessary or best to have someone else check for tenderness in these muscles. But regardless, you now have the tools to figure out the optimal way to adjust your sleeping position to prevent undue strain on your muscles and joints thoughout the night. This is of prime importance for people who wake up in pain, and/or have musculoskeletal issues with their neck or low back. But it’s also a way to help prevent problems in the future.

If you wake up in another position, simply go back to your optimal position and try to make it a habit. And by the way, if you’re a person who flip flops like a fish out of water all night, you may be hypoxic, or lacking an optimal amount of oxygen in your blood. This can be the result of many different things, like a diaphragm problem or a lack of proper rib motion.

I hope this information helps. There’s nothing I know of that can replace the benefits of an adequate amount of sleep. And why not do it in the optimal position for musculoskeletal health.

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

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A woman from CBS News “the early show” recently interviewed me about women’s footwear. The segment is about a brand of shoes known as Worishofer. Apparently, a new trend is developing and The NY Daily News recently had a piece titled “Worishofer granny sandal shoes are comforting Hollywood stars like Maggie Gyllenhaal”. In the segment, I speak about the differences between these shoes and high-heels (I mentioned a bit about flip-flops as well).

Now that I have a bit more time, I’d like to expand on the topic. First, I’ll talk about the drawbacks of high-heels. Essentially, high-heels are a biomechanical and neurological nightmare. Humans were designed to walk in a manner where the heel strikes first and then the toes “push-off”. Obviously, with high-heels the heel-strike phase of gait never occurs. As a result, all of the body weight lands on the balls of the feet. This is a problem because that area the foot is not designed to bear all the weight with each step. The possible detrimental results include (but are certainly not limited to): low-back muscle strain, knee strain and degeneration (potentially leading to osteoarthritis), tight calf muscles (potentially leading to achilles tendonitis), muscle cramps in the foot and calf, bunions, metatarsalgia (pain at the metatarsalphalangeal joint(s) – the  “toe joints”, usu. the ball of the foot), Morton’s neuroma, and hammer toes. Foot dysfunction can then in turn result in hip problems, including hip joint degeneration); mid-back pain; neck pain; and even jaw or TMJ pain and dysfunction. Again, the major problem is that all of the body weight is forced onto the front of the foot with each step, and opposed to first landing on the heel. Additionally, many high-heels often lack proper shock absorption, because the soles are extremely thin. There’s a few more issues, keep reading.

The Worishofer fortunately helps with a few of these issues. The sole is nicely cushioned to provide with good shock absorption. And even though there is still a bit of a heel, not all of the weight is transferred directly to the front of the foot the way it is in a typical high-heeled shoe. Another great feature of this shoe is that it has a built-in metatarsal lift. This is essentially a raised cushion in the front of the shoe, just before the toes. This helps to support the transverse metatarsal arch (there are really three arches in the foot: the medial/inside longitudinal arch, the lateral/outside longitudinal arch, and the transverse metatarsal arch). I’ve only ever seen these “lifts” built into orthotic shoe inserts. Also, women tell me that it’s still possible for them to “push-off” with their toes which is extremely important for not only foot function, but entire body biomechanics and neurological function. In toeing-off (along with proper heel-strike), you are able to use the full range of motion in the ankle and foot which helps to keep those joints functioning well and prevent breakdown and degeneration.

“Use it or lose it” applies to joints (and their cartilage) as much as it does to maintaining muscle mass. Not using your toes (as in “pushing-off” or going through the “toe-off” phase of gait) and not using the full ankle and foot joint ranges of motion can lead to a common problem I see in my practice. That is, many people develop very tight, overly-contracted hamstring muscles (in the back of the thigh), when they don’t use their toes and full foot and ankle range of motion during gait. In this situation, all the stretching in the world won’t help to relax these muscles and return them to their normal length. Last and certainly not least, the tone of the plantar muscles in the feet (the muscles that attachment only within the foot and not crossing above the ankle) help to determine the function of the extensor muscles of the body. These are the muscle that extend the neck and limbs backward, in addition to the spinal muscles that allow one to do a back bend. Essentially, when the plantar muscles are overactive, because a person is walking improperly (again, not fully using the ankle muscles that are designed to hold up the arch and flex and extend the foot) or has “flat feet”, the extensor muscles will become inhibited. Over time, this can lead to spinal joint and disc degeneration, in addition to having a bent over posture. It’s very hard for these individuals to stand upright naturally because their all of their extensor muscles have inhibited, causing a hunched over (head down and rounded shoulder) posture.

Lastly, I’ll mention a few words on flip-flops. The main problem with flip-flops is, again, you typically don’t use your full joint ranges of motion. Most people need to curl their toes down and keep their foot muscles constantly contracted just so the flip-flops don’t fall off when walking. This is a big problem because it alters gait and lower extremity muscle function in general; and not for the better.

So what’s the ideal shoe? Well, I suppose that can vary, however flats and lace-ups are usually ideal. With these shoes, the foot is kept in a neutral position, you can easily land on your heel and push off with your toes, and the laces provide good arch and sometimes even ankle joint support.

The feet are the foundation of the body, and some estimates say that we take about 6,000-10,000 steps a day. A rule of thumb that I go by when treating patients is: “Whatever the problem, look to the feet” and the shoes! Since walking is such an integral part of most people’s lives, it’s very important to have good foot function.

FYI: Despite bringing a cameraman, etc. into my office, they had to cut the segment and they decided to only use the live studio footage (of which I wasn’t a part). The woman who interviewed me said the following via email: “so sorry – Unfortunately, due to the timing within the show, we had to make it a much shorter set-up piece than originally planned for.  But, you were wonderful, and I’m so glad (name left out for privacy) put us in touch.  Would love to be in touch about other potential shoots.”

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

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Technically speaking a “sprain” and a “strain” are two different types of injuries. A sprain refers to damage of a ligament, while a strain implies damage to a muscle and its tendon. An easy way to remember this is that a strain, has the letter “t” in the word, as does “tendon”. And tendons attach to muscles, not ligaments. Regardless, I’m going to lump the two together because most injuries involve damage, or result in dysfunction, in both a muscle (and its tendon) and a ligament.

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

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Pain is one of the most common reasons that people visit my office for treatment. That said, I thought I’d write a little bit on the topic.

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

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If you’ve ever gotten (or given) a massage, you probably noticed that some muscles have painful little lumps or knots in them. They’re sometimes (enjoyably) painful when massaged or prodded; although the worst-case scenario can be constant pain during typical activities of daily living. The technical term for a knot like this has been coined “trigger point” by JFK’s doctor, Dr. Janet Travell.

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

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