Herniated Disc - The end of running?

By Dr. Tim Maggs, © July 2000

Q: I was diagnosed with a herniated disc in my neck which caused "pinching" of my C7 nerve resulting in numbness of my thumb and first 2 fingers (along with a great deal of pain). I am being treated with Vicodin, Skelaxin and Prednisone. The doctor said my x-rays were normal, but he said we needed to do an MRI. My questions; Could this be from running? Could it be from stress or poor mattress/pillow? When can I begin running again? The doctor said he wanted me to learn some neck strengthening exercises, but didn't mention anything about my running.

I was diagnosed with a herniated disc in my neck that caused "pinching" of my C7 nerve resulting in numbness of my thumb and first 2 fingers.

This is not uncommon for someone to suffer with a herniated disc at this level. The symptoms described are quite common.

I am being treated with Vicodin, Skelaxin and Prednisone.

These drugs are certainly common and are designed to help reduce symptoms, such as inflammation, muscle tightness and pain. But, by no means, is a chemical treatment a cure for a physical problem.

The doctor said my x-rays were normal, but he said we needed to do an MRI.

Typically, if you suffer with a true herniated disc, your spinal biomechanics are abnormal, suggesting your spine is either imbalanced, locked at certain levels or twisted out of its normal position. Unfortunately, most doctors don't know how to read x-rays from a biomechanical perspective. First of all, you need your x-rays taken in a standing position. Secondly, the doctor must know how to interpret them from an athletic and biomechanical viewpoint. If the first comment is, "The x-rays are normal and you need an MRI", you must at least consider the fact that the doctor might not be capable of interpreting biomechanical information from your x-rays. X-rays show alignment, curvature and positioning of the spine, while an MRI will better highlight soft tissue problems as well as disc herniations.

Could this be from running?

Running, and the compression associated with it, could certainly be a contributor to the problem, but it is highly unlikely that running alone could cause such a problem. In most cases of herniated discs, joints will lock up due to a prolonged, ongoing stress to a certain area of the spine, thus producing increased demands on a specific disc. This demand will eventually produce a bulging and ultimate herniation of this disc. If, however, an underlying problem exists, running can certainly aggravate the problem and prevent the necessary healing process from taking place.

When can I begin running again?

This can only be answered by your treating doctor. If he or she isn't experienced in biomechanics, then you need to find someone who is. The release to allow you to resume running is one that must be done at the right time and only after corrective rehabilitation. Each and every person who has a problem such as yours needs to have specific guidance with regard to when running can be resumed.

The doctor said he wanted me to learn some neck strengthening exercises, but didn't mention anything about my running.

Your doctor is correct about neck strengthening exercises, but your return to running requires a very sophisticated effort for full return. Typically, most herniated discs in the neck are a result of restricted motion in the spine. This restriction can be in the low back, mid-back or neck. Once complete motion is restored in all joints of the spine, the likelihood of recovery in the injured area goes up. This is with or without surgery. If a surgeon feels surgery is not in your best interest, complete motion is still your objective in all joints of the spine. Proper exercises, which facilitate improved motion and muscular activity, improve the status of the neck and help to prevent future flare-ups. Proper neck exercises in a condition such as this are critical.

Conclusion

Whenever a structural problem presents itself, whether it be pain, spasm or limited range of motion, a thorough biomechanical exam is indicated. This can only be done by someone skilled in that area. The difficulty is finding someone who understands full biomechanics and how to help you get better with your condition. Once you find the right person, the objective for all of your body's imbalances, lockings, restrictions and abnormalities will be to work towards correction and balance. Once the body improves in motion and balance, everything begins to improve.

In the future, never let pain and restriction be your motivation for finding someone skilled in this area. Start today, as all of us will have some type of biomechanical problems at some point in the future. The body wears out with abnormal wear and tear, and once it's worn out, there's no hope for recovery. But, with a little foresight and preparation, longevity and health are certainly well within the grasps of all of us.

Do You Know Your "Structural Fingerprint®"?

by Dr. Tim Maggs, © March 2000

For those with a chronic bad neck, low back, hip or leg problems, this article is for you. Many of you are probably part of that massive group who have contributed millions and millions of dollars to the "sportsmedicine specialists" for a solution to your problem, but never received any form of a biomechanical exam. The likely treatment; a medication with some physical therapy. Probably more telling, however, are the number of athletes whose careers have been cut short and their quantitative emotions affected by this less than adequate evaluation of classic biomechanical injuries.

The sportsmedicine market today is made up of the do's and the don'ts. The do's understand biomechanics, such as leg length, pelvic angle, lumbar lordosis, cervical lordosis, joint mobility, muscle balance, etc., know how to recognize both normal and abnormal structure, and know how to correct the defects. The don'ts are those sports doctors who do a limited exam, consider an MRI, inject cortisone, recommend anti-inflammatories, prescribe "quit running" or 2 weeks of physiotherapy, and basically scratch their head when the athlete leaves their office.

Structural Fingerprint®

One day while on a run, which is where most of my pearls of wisdom arise, I thought about the uniqueness of each and everyone of us. There are no two people alike, and that includes our structures. But, when attempting to explain this concept to patients, for some, a period of de-programming is needed, as they thought some generic information would be more than adequate.

As often happens, a lightning bolt struck me, and the phrase "Structural FingerprintT" came to mind. This said it all. I've since used this phrase in many of my talks, and everyone understands without further explanation. We're all different. We all need to be evaluated to determine the many specifics of our structure which make up our total fingerprint. Very seldom do we hear about our body mechanics and the need to understand who we are and what unique structural defects exist, but this article is here to scream out loud the importance of knowing the specifics of your structure. It's more than critical, it's mandatory.

Many of us have learned you shouldn't see a doctor until you're unable to walk, breathe, function or exist. This approach, needless to say, is the most expensive approach. The preferred approach is to call today. Learn what specifics make up your structure, and just as the Fram Oil Filter commercial states, "Pay today, or pay tomorrow". Regardless of your choice, you will pay. Either with work and rehabilitation, or with pain and suffering.

A complete "structural fingerprint" is made up of many different factors in our lives. Genetics is where we all began, and just as blue eyes or brown hair are hand me downs from our parents, so are spinal curves and pelvic rotations. We're all imperfect, and genetics is the first contributor to this pool of influence. We also need to consider habits, prior traumas, exercises, conditioning, weight, height, sleeping surface, shoes, orthotics and many other possible considerations.

Biomechanical Evaluation

This exam could and should be done on all athletes. The most critical needs are for those who currently suffer with conditions such as low back pain, neck pain, stiffness, hip pains, ilio-tibial band syndrome, sciatica, tingling or numbness down the arms or legs, headaches, plantar fascitis, hamstring injuries, calf injuries, achilles injuries and many more conditions.

For those who don't quite have any of the above conditions, keep in mind that aging is an unkind process, and any continual stress through the structure, such as running, should require a biomechanical exam to locate defects, imbalances and sites of increased stresses.

The exam should include all ranges of motions of joints, muscle strengths, right vs. left and front vs. back, a measurement of both legs to determine if there is a structural or anatomical leg length difference, standing x-rays of at least the low back and the neck and other orthopedic and neurological tests which are appropriate.

Corrective Program

Most corrective programs cannot begin until a patient is out of pain, or the symptoms they're suffering with are significantly reduced. Once improved symptomatically, a corrective, or rehabilitative program, should begin. The key is to restore normal motion back to all joints, increase flexibility, improve balance with muscle strengths and leg lengths, correct pelvic angle defects and gravity line defects. These changes make a dramatic difference in injury frequency, intensity and duration. Without the biomechanical influence, injuries will continue to exist and active participation will continue to decline.

So, next time you hear someone complain about their back, neck, hip or legs, think "structural fingerprint"!

Building a Sports Doctor Network - It's Time

by Dr. Tim Maggs, © February 2000

"Dr. Maggs, do you know of a good sports doctor in Toledo, Ohio who could help me with my knee problem?"

"Hey, Running Dr. Do you happen to know who you could refer me to in Boise, Idaho who could help me with my calf problems?"

"Hey doc, do you know anyone anywhere who could help?"

When asked this question time and time again, the sad truth is, I don't know anyone. Heck, I'm afraid to send people to docs in my own hometown who I've known for 20 years. The doctor-patient relationship is a fragile piece of business, like a boyfriend-girlfriend, or even husband-wife. I introduced a couple once in my life, and they ended up in divorce. I'm willing to quit at 0 for 1.

But, beyond these personal idiosyncrasies, a much larger problem looms out there. The Internet, websites and e-mail have given people the tremendous opportunity to reach out and locate experts and information that 10 years ago was impossible. Sometimes finding the good information solves one problem but creates a much bigger one--how to take advantage of it. That's not always so easy.

It's become increasingly difficult for many runners to find the perfect sports doctor in their own town who can answer their needs. Managed Care directs many runners to their primary care providers, who will be the first to admit they don't know how to treat many of these common running injuries. They may refer them to another specialist or two, run some tests that don't show anything, and then suggest the patient should maybe stop running. The patient who gets caught on this medical treadmill very often jumps off out of frustration before ever getting the help they need.

The average doctor, whether they're a medical doctor, osteopath or chiropractor, is usually not skilled enough to accurately diagnose biomechanical injuries and develop successful rehabilitative programs. And as much as some people don't want to believe that, you better start believing there's a whole lot more to sportsmedicine than anti-inflammatories, injections of cortisone and the "Final Kahuna" recommendation--stop running.

Sportsmedicine Online

In the many e-mails I receive, most are asking for help, but many are also asking for referrals. A lot of these runners get excited when they come upon some useful and relevant information, whether it be on my site or someone else's. Unfortunately, it's like building Noah's Ark in the basement. They have no doctor who works local to them who understands the psychoses of us runners and how to diagnose and treat the many maladies we suffer with. Someone must give of themselves (by leading the charge to build this network) for the sanity of us all. It's time.

Now, if I were in charge, I'd want to begin with a network of docs and therapists who specialize in biomechanics. Most running injuries are due to repetitive motion and biomechanical defects. This network would address the largest percentage of injuries out there. Following this network, others might include a podiatric network, a network for internal problems and infectious diseases and a network for psychological problems. But I believe the biomechanical network is Goal #1.

High Standards

The most important issue in developing this network must be the standards needed to qualify as a provider. Today, with the popularity of sportsmedicine, many doctors and therapists promote themselves as sports experts, but in reality, they are using this for marketing purposes. They're not really qualified to address runner's problems.

The providers who qualify must understand biomechanics. Their exams must involve the detection of normal and abnormal joint motion in all joints of the body, muscle strength, flexibility and balance, leg length differences, spinal alignment, spinal curvature, an understanding of the arches of the feet and the role they play, as well as the ability to interpret x-ray findings. Communication skills (to explain the details to the patient), good management skills (to manage the patient through the necessary corrections) and the ability to understand the different psychological profiles, will only help the treating doctor get good results.

There are a variety of ways to reach out to find these doctors, and some of these doctors may need some guidance and teaching from more experienced sports biomechanics docs to become fully qualified. But the movement must begin. This program would probably be most effective if it were done regionally to start. Any docs out there who have an interest should be willing to go through an evaluation of their knowledge and willingness to do a good job, and any patients out there should encourage their doctor, if they have a good one, to become a part of this network.

As to who will provide the classes, who will organize the search and conquer program and all the other tasks that go along with this idea, I don't know. My job today is simply to propose the concept, and see if my simple idea can lead to an ultimate sportsmedicine biomechanics network so that every runner in the U.S. will have a qualified sports doctor in their hometown to diagnose and treat most of their running injuries.

Hey, don't blame me, I'm an optimist.

Dear Michael and Maurice: How About a Little Muscle Management?

by Dr. Tim Maggs, © February 2000

Excuse me for being a little critical, but much like the heavyweight championship fight that doesn't make it past the head of your first beer, I have a little trouble revolving my day around a sporting event that never happens.

With much anticipation, viewers suffered watching Michael Johnson pull up followed closely by Maurice Green. One minute before the race started, my 11 year old son asked me, "Dad, what would you do if those two guys came in last place?". "Never happen", I told him. Ha. Just when I thought I knew everything.

Muscle Management

For the past 5 years, I've been preaching improved muscle management. Sure, it's more work than the archaic stretch and rest program we've all been told to follow, but when on earth will people begin to realize MORE is needed. I suffered for 8 years with calf pulls before finding the experts who had enough knowledge and information to show me how to get back out there and become a runner again. My life was given back to me. I cringe at the number of injury reports I read every day in all sports--pulled hamstring, pulled groin, pulled calf muscle, achilles tendon rupture. Come on; please admit that more is needed. Like Timon says in The Lion King; "And this is okay with everybody?".

The Program

Muscle recovery is the name of the game in all sports today. Michael Johnson had problems with his quadriceps prior to this fateful event. And that wasn't even the muscle that cramped. It was his hamstring. The level of competition and demand on the athlete today doesn't work well with Mother Nature's recovery time frame. Athletes are pushing the limits, and too many are crashing and burning.

The Maggs Muscle Management Program uses what Mother Nature provides, and enhances it for faster recovery and superior muscle function. With it, muscles warm-up more thoroughly, recover quicker, heal from injury much faster and ultimately, perform better. The most common muscle injuries that benefit from this program are; quadricep pulls, hamstring pulls, calf pulls, achilles tendonitis, patellar tendonitis, plantar fascitis, ilio-tibial band syndrome, hip pain (piriformis) syndrome, low back syndrome and shin splints. All of these conditions are usually results of overuse with lack of full recovery. This program flushes the muscle of toxins that accumulate after exercise while also increasing blood flow (food and oxygen) to the involved muscles. This allows a muscle to warm-up more thoroughly and recover quicker.

It only took me 75-80 calf pulls and 8 years of persistence in looking for a solution before I found something that worked for me. If anyone suggests I don't know what it's like to be injured, please. So when 2 of the world's best pull up lame in one of the biggest races of Track & Field, a race that would help to bring our sport to the forefront and give us a little recognition, allow me to angst in the privacy of my living room when I think I have an answer to their problem. I felt like I built Noah's arc in my basement.

My Success

I now run everyday. I run anywhere from 35-40 miles per week. At the height of my injuries, I could never run more than once every three days and not more than 3-4 miles at a time. My emotions often encouraged me to ignore the condition and follow the plan I used to follow, thus leading to injury after injury. I never got comfortable in the 8 years of my doom and gloom. I tried cycling with no success. Swimming provided less. Nothing replaced the total package that running gave me. I wouldn't let up. I ultimately met Dr. Andrew Bonci, a muscle physiology specialist, who taught me about the trigger point. His research and knowledge led me to the beginning of my recovery. The progress has been a process, but much like the cancer patient who wants to help every other patient on the planet to recover, I, too have felt the need to use every opportunity available to inform other runners. Forget the R-I-C-E method as your only means of treatment. Although beneficial, it certainly couldn't come close to helping me prevent my next pull. More was needed. My muscle management program can comfortably be done in the confines of your own home by you and you alone. A little discipline and time is all that's needed.

For anyone out there who wants more, needs more but doesn't know where to turn, this is your lucky day. Many athletes have benefited from this program. And, should any of you happen to see Michael or Maurice in your travels, please tell them to visit my website so that we, the viewers, won't have to watch them suffer as they did. I'd also like to enjoy the rest of my beer as I watch them finish a race.

Fibromyalgia: It's All About Muscles

by Dr. Timothy J. Maggs, © 2000

For 30 years, Dr. Pat Belcher suffered with an unexplainable muscular pain that was difficult to both diagnose and treat. Thousands of dollars and a lifetime of emotions searched for successful answers, but nothing proved beneficial.

In 1986, Mary S. underwent a total hysterectomy. Immediately following surgery, her symptomatic picture exploded into excruciating muscle pain in her entire back. These symptoms were new, and help and explanations were limited.

Today, we know the diagnosis in both cases--- fibromyalgia. Despite the fact that these two athletically oriented people were in great shape, this condition showed no mercy and selected them as subjects for suffering. For those of us not afflicted, it's difficult to appreciate the intensity and constancy of this pain. Only through detailed dialogue can any of us begin to understand what these people are going through.

The Condition

Fibromyalgia is a condition of the muscles. Although no one is completely sure of the cause, people involved in traumatic situations, both physical and psychological, are most prone to it. 88% of all diagnosed cases are of woman and people in their 40's. For some unexplained reason, the involved muscles don't store glycogen as well as healthy muscles, and simulate muscles undergoing extremely stressful situations. This results in extreme pain and contracture of the muscles. A medical research team from Finland has reported that the pain intensity from FMS is twice that of rheumatoid arthritis. Obviously, this can severely limit activity and future happiness.

According to the American College of Rheumatology, the 1990 criteria for diagnosis requires a history of widespread pain [minimum 3 months]. The pain pattern must include both right and left sides of the body, be located above and below the waist and also include the axial skeletal region. On digital examination, pain must be noted in at least 11 of 18 characteristic tender point sites.

The condition produces a shortening and tightening of muscle fibers. Cold weather, due to it's contractive influence on a muscle, makes the symptoms worse. Likewise, warmth can make them feel better. Although activity may seem painful to the afflicted, exercise and motion are strongly encouraged, as dis-use of the muscles is the beginning of the end. Blood flow to a muscle will provide improved flexibility and reduced tightness.

Sleep deprivation is common in fibromyalgia patients, as the pain of the muscles during sleep will oftentimes cause the person to wake, never allowing them to fully reach the deep sleep level that is critical for an enjoyable life. This also reduces normal recovery of the body.

Testing

Although testing can be rather subjective, there are several tests that can help point to an accurate diagnosis. The most important test consists of the 18 designated points along the upper and lower back and gluteal regions that will be more tender upon palpation. For a conclusive diagnosis, 11 of the 18 points have to be rendered as "painful". The amount of pressure needed at each of these points is approximately 10kg of pressure. This is the amount of pressure needed to change color of the thumbnail when pressing the thumb down on a hard surface. Many people suffer with pain in some of these points, but for a conclusive diagnosis of fibromyalgia, 11 of the 18 established points must be painful with at least 10kgs of pressure.

Testing can extend beyond the criteria needed to establish a diagnosis. A biomechanical exam is important, as balance and normal muscle function can only help those involved. Testing medial arches of the feet for pronation, supination and unequal arches (right vs. left foot) is important. Leg length measurements are important. Normal range of motion in the joints of the pelvis and spine are also important. Any other tests that locate imbalances and restricted motion should be done in an effort to increase balance and mobility.

Standing x-rays should be done of the low back and neck to determine disc heights, pelvic symmetry, gravity line, lordotic curves and the pelvic angle. Any abnormalities will produce an abnormal stress on one or more muscle groups, increasing the demand, potential tightening and pain of that group.

Treatment

Contrary to popular belief, all massage may not be beneficial to fibromyalgia patients. Recent research has shown that light massage is more beneficial than heavy massage. "Less dosage and high frequency has proven to be far more beneficial in my self-treatment of my condition", states Dr. Belcher.

Structural corrections, including the use of orthotics, rehabilitative exercises, corrective structural treatment and an improvement of life's habits, will help provide long-term benefits. Objective x-ray and examination findings should be the criteria used when designing a rehabilitative program. Since every person has a structure that is unique (your Structural Fingerprint), a rehabilitative program should also be unique based on the specific needs of the involved patient.

Nutritionally, some minerals have been shown to produce beneficial results. The list includes CO-Q-10, Magnesium and Malic Acid.

Although no universal treatment protocol has yet been established, the athlete with fibromyalgia has to approach the condition as they would the marathon. It's a long journey with unknown results, but a strong positive attitude, a good physical program and quality nutritional support will make the journey easier. The key, once again, is to never give up.

Removing the Obstacles

by Dr. Tim Maggs, © 2000

In a recent USA Today article, Harvard Professor Walter Willett told about his redesign of the Food Pyramid. As chairman of the Department of Nutrition at the Harvard School of Public Health, Willett believes the current Food Pyramid is outdated and doesn't reflect the latest food research. Most surprisingly, the base of Willett's Pyramid is exercise and weight control. Thank you Walter.

That's the good news. The bad news is that millions and millions of us still don't do it. While new and improved exercise equipment is being sold daily on cable TV, the real reasons why people don't exercise have little to do with knowledge and more to do with mental and physical barriers. It's time we identify these barriers and begin to knock them down. We owe it to ourselves, our families and our neighbors to work for the good of all in reaching for a higher level of fitness.

Mental and Physical Obstacles

I've identified 5 obstacles that keep people from either beginning or continuing their exercise programs. There are certainly more reasons, but these are some of the more obvious.

1) Lack of Discipline

This obstacle doesn't just impede a person's ability to exercise, but also their ability to eat right, be on time, stay organized, etc. Their life is in a blender. In a case like this, small and consistent steps in the right direction is the way to start. All of us know the tortoise approach will most likely last longer than that of the hare, so begin with short amounts of exercise. Jump rope 25 times a day. Run up and down a flight of stairs 3 times. Do a hundred jumping jacks. Just do something. After a week of doing this simple task, begin to expand to walking a half-mile in addition to your jumping rope. But, don't let the chain break. If you miss a day, start right back. Don't make your lack of discipline become your identity. Become a new you.

2) No Time

President Bush runs. The busiest CEO's in the world are some of the most avid exercisers. What we learn once we get on a consistent exercise program is that exercise energizes us to do more. We sleep better at night and feel better the next morning. Treat exercise like a savings plan--don't attempt to get it in only after everything else that day is done. You must plan your exercise first, and let the day revolve around it. This doesn't mean you can't change the time or place during the day, but don't eliminate it. The return on investment is far too great, and when looked at over a 20 year period, your life will be far less gratifying if you never carve out time for controlled motion.

3) Injuries

This certainly is a legitimate concern. I believe our sportsmedicine industry is still in its fetal stages. It's still far too medical, meaning that it's only available for injured athletes, and the treatments are basically symptom oriented. We need to expand our thinking. We need to prepare more, recover better and be logical with our training. Simply put, if injured, correct the injury before beginning the program. If you've attempted to correct your injury with no good results, e-mail me and I'll get you on the right track.

4) Lack of Enthusiasm

Momentum breeds momentum. Get started, do it long enough, and you'll begin to get the bug. On the front end of an exercise program, it's like having to climb a huge mountain. Country singer Paul Overstreet sings it best, "They say a mountain looks so high when you're standing at the bottom, but once you've made it to the top, you can't see the problem". The same applies to exercising. The reason all of your exercising friends or workmates act so smug is that they finally realize it's harder not to exercise than it is to exercise. But, staying active certainly has many more rewards than being sedentary.

5) You're not a self-starter

No problem. There are many local groups at your YMCA's, health clubs, gyms, church groups and more. You can go on the internet if you want a real flashy program and hire a coach. Contact local running clubs or other organizations to see if there is a bulletin board for finding someone to train with. What many of us have learned is that the most successful way to insure a long term training regimen is to do it with someone else. Trying anything alone for a long time is difficult. You'll have no one to answer to if you decide not to exercise that day. It's too easy to quit, and quitting isn't what we want.

So, there you have it. 5 reasons why you don't exercise and 5 ways to overcome them. The biggest reason still lies in the fact that we have but one guaranteed trip to make on this planet. We know they won't come out in the next 5 years with proof that exercise isn't good for us. And we know that most of us who haven't consistently exercised don't feel good about it. In fact, you feel down right lousy. So, get over these hurdles without too much effort and get on with the fun of life. With all the "rage" out there, we need to spend more time having fun. Exercise is the answer.

Case History of an Injured Runner

by Dr. Tim Maggs, © 2000

Mary Peck is a 19 year old girl. She's also a runner. A good runner. Maybe a great runner. She dreams of the 2004 Olympics.

Mary ran a 3:11 in Boston 2000, and this past November, ran a 58:00 plus 15k in cold, hilly upstate New York. Very promising. Until her back gave out. With no warning, her entire back ceased up on her. She could barely walk let alone run. She couldn't get beyond 4 miles without the back going into a full spasm. Her sole identity had become that of a young, promising runner, and now, she was unable to run. Mary's success has been a result of her commitment to hard work. It was now out of her hands. The situation was beyond her control.

Seeking Answers

Mary went the normal route, seeing several doctors, looking for solutions that would allow her to keep training. Tests, treatments and hopes didn't produce the results she needed. Mary was now an injured runner with no "program". This feeling was foreign and unacceptable to her.

I first met Mary at a clinic I gave last August at the Olympic Training Center in Lake Placid. Mary spoke to me after the clinic, and there was no doubt she was a focused and committed runner.

It was now mid-December, and Mary Peck was on the phone. She briefly explained her situation. We set up an appointment. After going through her history, a couple things jumped out at me; first, no doctor had convinced Mary they knew what her problem was, and second, she was still as bad as the day it started, almost 30 days prior. Mary was living in a freeze-frame and unable to run.

One of the doctors Mary had seen was a chiropractor. She'd been seeing him for several months. Mary liked him. He was a sportsmedicine expert. His treatments were once per week before she became injured, and once injured, he re-took her x-rays to see if there was anything "seriously" wrong. He found nothing, so his treatment continued at once per week. Even Mary recognized the illogic here, and decided to look elsewhere.

Using the x-rays that were taken at his office, I immediately noticed Mary's sacral base angle, which is normally 36°-42°, was 50°. An increased sacral base angle will cause the low back to cease up prematurely under stress (such as in running). Ceasing up equates to spasms in the low back. The muscles go into a defensive mode to protect any stressed areas in the body. Typically, this is a cumulative condition, the result of many influencing factors. Simply put, once a person's workload reaches a certain level and their body mechanics are imbalanced, problems occur.

The abnormal sacral base angle was the most telling finding in Mary's structural exam. Coupled with her other findings, a corrective program was set up. Although it was met with discouragement on Mary's part, I reminded her that 19 is a very young age and life is a very long time, so let's be willing to give up 6-10 weeks of training in an effort to create a successful future. She agreed to the plan.

Conclusion

Mary turned into the perfect patient. She complied 100% to the restrictions, guidelines and treatments that were prescribed. Improvements came quickly and re-x-rays were taken approximately 8 weeks after treatment began. Her 50° sacral base angle was reduced to 40° and she was now able to increase the demands on her back. He symptoms were pretty much gone by now, and Mary was well into returning to a full running schedule.

A combination of specific treatments, spinal exercises, improved habits, our Muscle Management Program, a slow and deliberate return to running and her vision on the long term has helped Mary to come back strong. She is now training up to 40 miles per week with no setbacks. Her back feels strong, her spirit feels impenetrable and the road ahead looks bright.

The key to it all is to locate the cause of the problem through a Structural Fingerprint® exam, and to pay the necessary rehabilitative price to correct that cause. There are so many reasons runners don't do this, from being impatient to having a hard time finding a doctor who thinks biomechanically. But, the benefits are so grand when approaching back, neck, hip and other structural problems this way, that the price you pay to do it right is minimal compared to the price you pay if you don't. Simply put, the sooner you learn your "Structural Fingerprint", as Mary finally did, the sooner you can begin to improve any imbalances or defects that may be preventing you from reaching your full potential. Not to mention, the elimination of many nagging symptoms that have bothered you for years.

Recovering at the Speed of Life

by Dr. Tim Maggs, © 2000

The million dollar question-"How can I recover quicker from both injuries and training/racing?". Nature's time frame for recovery and our recovery needs are often in conflict. Speeding this process has kept many researchers (as well as yours truly) burning the midnight oil searching for advances. My greatest teacher was personally being on the disabled list. I wished my only goal was to recover from a marathon.

Unfortunately, I tried in vain for 8 years to recover from chronic calf pulls (over 75 of them). I guess being personally injured automatically eeked the interest level up a notch or two. I'm not sure if it was intelligence or ignorance that kept me persistently looking for an answer, but I ultimately found one, and this is now the foundation of my Maggs Muscle Management™ Program.

Physiological Changes

An exercised muscle will go through micro-traumas. The micro-tears that occur after exercise require time to heal. That time is our recovery period. With a little forethought and discipline, we can expedite the recovery process, from both training and racing, while also reducing our vulnerability to injury.

The first step in a speedier recovery is to prepare your muscles better. Fast and short or long and slow, muscles recover quicker with a thorough warm-up. My muscle management program encourages the increase of blood to muscles (The Stick is one way to do this), coupled with thorough stretching of the muscles. This will increase both the temperature and length of the muscle, making the muscle more efficient in both exercise and recovery. Circulation (food and oxygen) to the muscle will increase, while harmful toxins will be flushed from the muscle.

Recovery

Once a muscle has been worked, and depending on what degree of work it's done, it will contain micro-tears. A worked muscle will also be tight, much like a clenched-fist. This environment suggests the need for circulation, but Mother Nature's time clock insists that a muscle must slowly relax before healthy volumes of new blood can get into the muscle to begin the clean-up and healing process. Again, with the combination of The Stick and stretching, new, rich blood flow is introduced to a muscle while the muscle is being manually relaxed. This allows food and oxygen to get into the muscle much quicker, expediting the whole recovery process.

Now, to add one more piece to the puzzle, you have your carbohydrate window, which can help dramatically in this process. Studies have shown there is a period after intense or long endurance exercise that muscles are "hungry" for glycogen restoration. During a brief period after exercise, this "window" is your opportunity to consume carbohydrates that will speed recovery and increase your stores of glycogen for future use. "The longer you wait before you consume carbohydrates, the less 'hungry' your muscles become," says Dr. John Ivy, Ph.D., director of the exercise science laboratory at the University of Texas. "If you wait longer than 15 minutes, the rate of absorption is decreased by roughly 50%."

This basically says that, instead of sitting around reminiscing after a race or hard work-out, get out your Stick or ask a friend to apply some good massage to the most worked muscles in your body. Then, ingest some carbohydrate recovery product that will feed the muscles exactly what they are looking for.

Optimal Muscle Recovery (The Book)

In his new book, Optimal Muscle Recovery, Edmund Burke, Ph.D., states there are 4 major concerns when it comes to getting a muscle to recover quicker; 1) Restore fluids and important minerals to recover from dehydration, 2) Replenish glycogen, a primary fuel source for energy, 3) Reduce muscle and immune system damage resulting from the physical stress of exercise, and 4) Rebuild muscle protein, which is important for the maintenance of muscle structure and function. Burke calls this the R-4 System.

Long-time Lance Armstrong coach, Chris Carmichael, is an advocate of this R-4 System. Carmichael bases a lot of his recovery principles on Burke's work and claims that an athlete's ability to perform at a high level is directly proportionate to their ability to recover and repair muscle tissues after strenuous training.

In the first 30 minutes after a training session, Carmichael has his athletes replenish their glycogen stores with an energy bar and recovery drink. He then encourages a small meal of unrefined carbohydrates and protein. As this picking and choosing of foods can be somewhat complicating, Burke and several prominent exercise physiologists developed a sports drink that meets his recovery and nutritional guidelines. More information on any of Burke's work can be found on his website, www.OptimalMuscleRecovery.com.

The bottom line is that many benefits lie out there, readily available for all to use. It's just a matter of implementing them into your schedule and managing your life a little better. I can assure you that being on the disabled list for an extended period of time will certainly make you improve your management skills.

Why Kenyans Run So Fast

by Dr. Tim Maggs, © 2000

Guess what? Another Kenyan won the Boston Marathon this year. Calm down from the disbelief.

When Elijah Langat crossed the finish line first this year, he kept the string of Kenyan victories going. But then, did anyone ever suspect the string would be broken? Hardly.

Many would probably expect to read my in depth discussion as to the physiological differences between the Kenyans and the Americans. Sorry. Although Kenyans are built for success in running, the true answer goes beyond their structural efficiencies.

Living With Kenyans

If I've been asked once I've been asked a thousand times. "Why are the Kenyans so fast"? Ironically, the more you know, the more you realize there may be no simple answer to this question. My experience all began in mid-1993 when a small group of Kenyans came to my hometown to begin a training program in Upstate New York. By early 1994, we had a total of 16 Kenyans living in our small, close-knit community. The first thing I did was go to our local police station and warn them they'd be getting reports of many black men running a lot. I told them not to presume robbery or some other crime. It was just a group of world class runners doing what they do best.

Kenyans are different. I don't think anyone of them could ever become American by culture no matter how long they lived here. Thomas Osano, Paul Mbugua, John Kagwe, Lazarus Nyakeraka and Gideon Mutisya certainly have developed a lot of American ways, but their heritage and lifestyle is so different, it would be similar to changing your fingerprint. Can't happen. When Thomas Osano, Josphat Machuka and William Sigei all ran under the 10-Mile world record at the 1994 Cherry Blossom, I stood close to Thomas and Josphat after the race. They quietly stood there with hardly a smile. That was their celebration. On the trip home, you would think they DNF'd.

Their diets tell a huge story. They all eat the same. We'd go shopping once a week and the cart would be filled with things like cabbage, chicken, steaks, cans of tomatoes, tea, white corn meal and whole-wheat flour. No matter how much of this stuff you buy, it still never amounts to much money. And, they all ate the same thing. I never heard one of them say "I don't like that". Different runners would prepare meals each night, but a simple system was developed and multiple cooks took over. Preparation, cooking, cleaning and a cup of tea before bed.

We had two houses with approximately 8 runners in each house. Showers were usually taken by 2 runners at a time. Conserve water. Running clothes would be hanging everywhere, as two, and sometimes three runs per day took place. In between runs, the runners would relax by going for a walk, reading the bible or visiting some neighbors. The activity was never what you'd call stressful.

One night when I came down to the house for some particular reason, I heard a lot of screaming inside the living room. As I rounded the corner, I saw all of them huddled and cheering over 2 who were seated on the floor. The two on the floor were playing a game of checkers, with the board and the checkers made from a running shoe box. Nike pays millions to have such excitement from their shoes. I'll bet they never anticipated such excitement from their boxes.

Another time, we traveled 3 hours to run a 20k in New Jersey. 15 Kenyans, my wife, my 2 sons and myself made the trip. All in a 15 seat van. A little crowded maybe, but not a word of complaint. And the aroma on the return trip certainly deserved some complaints.

Finally, they are suited for running. From their structures to their altitude training to their constitutional courage, the Kenyan has become the Lion of the roads. There are now so many Kenyan heroes; young Kenyans have these leaders to emulate while growing up. I remember Abraham Limo, father of 4, tell me how $100. would last him and his family over one month. He was shocked how quickly it could be spent here.

Paying The Price

The Kenyan runner has sacrificed more than most of us would. They leave their families and travel halfway around the world for nothing more than an opportunity. No guarantees. I remember when my wife and I first met 12 of them in Tampa in 1994, and from there, they would be traveling to Upstate New York with us (it was late February). They stood there with t-shirts on and only a small handbag with their possessions. I take more than that to the bathroom with me in the morning. I questioned whether they knew how cold our weather was. They didn't, but it didn't matter. The only thing that mattered was the opportunity.

As soon as we arrived in New York, we quickly gathered coats for all of them. Alfornce Muindi came over one day wearing a woman's jacket. He didn't even know. He was smiling and happy as could be. Fashion wasn't part of his make-up. He was only one of the best runners in the world. I remember when Nike hired Alfornce to rabbit for the New York Marathon in 1993. At dinner the night before, I asked Alfornce if he knew how many people would be behind him the next morning. He smiled and sheepishly asked, "2,000?". I still love Alfornce for his innocence.

My sons learned so much from our involvement with these great people. When asked why Kenyans run faster than we do, the answer is really kind of simple. Just live with them for awhile. You'll quickly understand.

Pro Locker Room Conditioning For Kids Chiropractic's Integral Role

by Dr. Tim Maggs and Coach Al Miller © 2000

(This is the third in a series of articles co-authored by Dr. Tim Maggs and Coach Al Miller, Head Strength and Conditioning Coach for the Atlanta Falcons.)

The most underserved segment of our athletic population in this country has to be kids, age 6-14. This group of young athletes are conditioned and coached primarily by well intentioned dads. If there happens to be any type of pre-season examination, it will typically be done by the family doctor, whose exam might rule out anything from allergies to childhood diabetes, but will most likely never look at the biomechanics of this young athlete.

For many reasons, this gross oversight needs to be addressed. A young athlete's psyche, conditioning, understanding of physical injuries and prevention of sport related injuries can only improve if our current system demands better biomechanical awareness for our youths. Dads make sure there are no deaths during a game, but it's time we provide more sophistication, education and information to all of those involved. Once these kids reach high school, there is still a gross deficit in biomechanical and conditioning awareness, but if kids in elementary and junior high school can be introduced at a young age to the A, B, C's of physical wellness, then the program should carry over into later years.

Although there are many similarities between assessment and conditioning for both youths and adults, likewise, there are many differences. These differences need to be highlighted to those professionals who have the opportunity to work with this age group and promote the importance of improved knowledge, awareness and conditioning of the neuromusculoskeletal and biomechanical system. In short, each child entering the sports arena needs to be fully evaluated, informed of the structural corrections that need to be made, and managed through those corrections. An awareness of psychological influences will help any professional working with kids. As critical psychological and physical improvements are made, a more intense introductory conditioning program can be implemented.

Athletic Jacket

Every pro athlete has their own jacket. This jacket is a detailed diary of all injuries, treatments and improvements made during their pro career. This jacket follows an athlete wherever they go. If drafted, they have it with them. If taken in free agency, they have it with them. Simply put, it is their life history as an athlete, and that information is valuable to many people for many reasons.

Knowing the importance of this jacket, all athletes, including our kids, should start immediately tracking all of this valuable information. Having the ability to track biomechanical and psychological information becomes invaluable in many situations. Knowing what conditioning was done prior to certain injuries provides any coach or consultant with tremendous information. This seems only logical, as record keeping for all pertinent information can only help. It would contain each year's exam findings, subjective findings, illnesses, injuries, surgeries, medications, food supplements, etc. It would also document, as detailed as anyone would like, work-out programs done throughout the year. This would basically be a blue print of each child's athletic life, based around each year's biomechanical evaluations.

Once these evaluations are done, the findings must be interpreted properly and corrective treatments, therapies and exercises need to be employed. These treatments and modalities can and should extend into the season, in an effort to both improve any distortions found on the initial exam, as well as prevent any mid-season blow-out that might be avoidable with proper recommendations. And we should never lose sight of the bigger picture here; we want to help these young athletes develop into sound adults without the ramifications of burn-out and long term athletic abuse that so many retired athletes experience today.

The Tripod Evaluation

The overall fitness of youths in this country has greatly declined over the past 40 years. It should become everyone's responsibility to help seek improvement. Sports is one of the viable avenues to begin to make changes, as exercise and conditioning is an automatic component of any sports program. All this can begin with a sportsmedicine system willing to evaluate kids for more than classic medical conditions. A tripod program, consisting of 1) an understanding of the psychological profile, 2) a full biomechanical evaluation and 3) a logical fitness/conditioning program based on the sport of interest or fitness level of the child.

It is important to establish a communication and rapport with all kids you work with. If working with a group, it's easy to hide behind a group presentation and never really have to look each and every child in the eye, but individual success goes way up if each and every child is looked at and communicated to independently. Remember, each child/athlete is moved by reasons totally unique and different from the child next to them, and these uniquities must be found and tapped into.

Psychological Profile

The psyche of each child is an often overlooked component of this complete evaluation. We tend to think either the parents fully control what a child does or the child is a mere clone of what all kids should be like and will respond robotically to whatever we ask for. Somewhere along the way, this whole idea has to make sense to the child or the spirit behind the program will never become lit. Without a true spirit on behalf of the child, no program will reach full potential. It's far more logical to determine the formula needed to light the fire in this child before going on to the next phase of the program. A built-in motivation, to some degree, is mandatory and should be sought for the success of a program.

Some kids become motivated immediately when you inform them that this is exactly what Jason Williams, Mark McGwire, Peyton Manning, or whoever they may be able to relate to, had to do when they were kids to become the stars they've become. Sacrifice and discipline led them to success.

Other kids aren't moved by that type of motivation, so it's important to attempt to find something that will fuel their fire. For example, a child may have a weight problem, and that can become the source of motivation. Or, the child may already have some back pain, knee pain, neck pain, etc., and that can become the source for motivation. But, something has to fuel each and every kid, as hard as it may be to find the exact motivator. And the motivation should never be only because the parent wants the child to do it. Someone needs to find out what will make the child motivated, as the parent/child source for motivation will hit a dead-end at some point. If a motivational source can't be found, the long term success of any fitness program goes down.

Biomechanical Exam

Once a dialogue has been reached, a biomechanical evaluation (see side bar) should be done. Scoliosis screenings are today's version of a biomechanical exam. These screenings, many of which are performed by unskilled people, in no way locate the many specific biomechanical imbalances, fixations, irritations and defects that all kids are forced to cope with. Each child's structure is like their fingerprint, totally unique, and locating their imbalances, anomalies, areas of increased stress and sites of potential injuries is paramount in removing the artificial ceiling of physical capacity when starting this program.

Treatment Recommendations

When thinking in terms kids and athletics, we tend to not think of any treatments unless there is some associated pain and/or disability. This thinking needs to be revised, as every child has some degree of structural imbalance, areas of vulnerability and decreased performance potential. A short leg, rotated pelvis, increased sacral base angle, hypolordosis of the lumbar spine or a myriad of other potential faults will hamper progress. The solution consists of corrective structural treatment, restoring motion, alignment and curvature to all areas of the spine, improved flexibility, understanding of proper physical habits, improved diet and specific exercise based on the interests of the child. In order to reach maximum potential for each child, we must accept that there is no shortcut to getting there. It's a tedious process, but the outcome is well worth the cost. We no longer can sit and wait for acute low back pain, a symptomatic Osgood-Schlatter's or frequent headaches before we begin treatment or changes, despite the fact that most health insurances suggest and encourage just that.

Fitness/Conditioning For Kids

When thinking in terms of fitness and conditioning for this age group, it's important to introduce first things first, as a "rush to glory", such as time trials in running or maximum weight lifting will typically produce injury. Also, without the full educational phase for conditioning, the body will never acquire the necessary "memory" needed for maximum potential. It's critical to remember when thinking in terms of conditioning for kids, their nervous system needs to go through a thorough education process. If this phase is cut short, the nervous system responsible for reflexes, quickness, coordination and speed will never fully develop. The nervous system, in kids under the age of 15, also learns at a rate possibly 5 times quicker than older kids and adults. We notice this phenomenon when teaching kids computers, skiing, tying shoes or other multi-faceted tasks. This window of time makes it even more important to invest whatever is needed to enhance this period for conditioning.

Secondly, due to the influence of end zone dances, high fives and MTV celebrations seen on TV, many kids have a hard time learning to walk before they run. If the preliminary parts of a conditioning program are eliminated or cut short, the ultimate potential will be compromised.

Regardless of what sport a child is preparing for, basic conditioning will be mostly the same for all kids. Running, jumping, skipping, jump roping and jumping jacks are some of the simple drills kids automatically perform. Skipping, for example, has a plyometric component to it, a rhythm and timing component as well as a benefit for overall coordination. For young basketball players, skipping simulates the difficult mechanics needed to take a lay-up. Kids can use their arms in a lay-up fashion as they do their skipping drills. With many of the more sophisticated exercises or sport-specific exercises, all kids should be able to perform these 5 basic movements and be in reasonable shape, both physically as well as cardio-vascularly, before beginning them.

Second-level exercises can consist of carioca, a foot-work drill performed over a certain distance, that helps to build coordination and foot speed. Also, step-ups, such as on a stool or even a step, will help to build muscles, strength and coordination. Step-overs involve an athlete either performing the drill head-on or sideways. One version is to step over something like a broomhandle, with a 1-2-3 pattern and then step back with the same 1-2-3 pattern. This can be done 25-50 times for quickness and coordination. Step drills, going up a flight of stairs, where the child has to lead with the right and follow with the left, and then lead with the left and follow with the right, will help to improve focus and coordination.

When working in a gym or on a field, you can set up point-to-point runs of approximately 10-20 meters. Kids can run to the designated point in a frontword run, side-slide back (without crossing feet), run backwards back to the same point, and skip back. These types of drills can be done using forward runs, backward runs, skipping, carioca, side-slides and a host of other varying exercises. But, the important aspect of this drill is that it forces a young athlete to have to concentrate on what is next. This focus helps greatly and the diversification keeps the enthusiasm there. This drill also provides the stopping and starting forces the body must learn to handle, as this is needed in almost all sports.

Jumping drills are another important set of exercises. The use of a jump rope, repetitive jumps at a spot on the wall, volleyball type games, hurdling exercises, short-run jumps, long-jump drills or many others help to develop sprinting techniques with low-grade bounding. The drills can also be split into one-footed hopping as well as two-footed hopping.

Actual running drills are important, and kids should be able to run from the acceleration phase to the top end phase. You must be careful as ossification of the bones has not occurred yet. Emphasis should be placed on general improvements of time over specific distances. Even if improvements in times aren't immediately noticed, ultimate improvements will be recognized.

Weighted exercises should only be done on a very cautious and limited basis. Light barbells and light medicine balls are usually the weights of choice when introducing a young athlete to a weighted exercise. If a child cannot perform the movement drills outlined above, they should never be allowed to add weight to their program. With the lighter weights, squatting exercices, step-up exercises, abdominal exercises and some motion exercises are a relatively safe way to begin. If any strains or limitations are noticed, it may become necessary to progress slower.

Conclusion

Most young athletes in this country today are chosen on their immediate qualities, not their long term potential qualities. Most of our conditioning and sport selection works on the hurry up approach. Overall, we're not doing a very good job of physical preparation. Farm life is gone, most kids live in air-conditioned homes, computers and play-station reduce physical activities and the work ethic has become much softer. It's hard to ask our kids to step up and perform when we, as adults, fail to do so. Secondly, the field of biomechanics has grown considerably in the past decade, and it's importance in sports is becoming more recognizable everyday.

The hard reality is that kids need to be introduced to this more disciplined, sophisticated, organized and sensible physical preparation program at an earlier age in an effort to have a program they can build on in years to come. This program should provide maximum benefits with minimum potential for injury. With commitment and perseverance by the teachers in today's sports, athletics in this country can grow in many diverse and beneficial ways.

Sidebar

Biomechanical Exam

Visual Exam (For symmetry, heights and balance)

-Posterior View--ears, scapulae, waist folds, hips, gluteal crease, popliteal space, medial malleoli, heels.

-Lateral View--posture, cervical lordosis, thoacic kyphosis, lumbar lordosis, pelvic angle.

-Anterior View--head (occiput) alignment with body, shoulders, hips, arm lengths, knees, feet.

Range of Motions

-cervical, thoracic, lumbo-sacral, hips, knees, ankles, toes, shoulders, elbows, wrists, fingers.

Muscle Tests

-abdominals, obliques, low back extensors, adductors, abductors, quads, sartorius, hamstrings, hip flexors, calves, plantar flexors, dorsi-flexors, biceps, triceps, deltoids, rhomboids, latissimus dorsi's, traps, wrist flexors, wrist extensors, brachioradialis, pec majors, SCM's, cervical flexors, cervical extensors, cervical lateral flexors.

Deep Tendon Reflexes

Sensory Tests

Measurements

-leg lengths, arm lengths, thighs, calves, bicep/tricep, forearms, neck, chest (full inhalation/exhalation), waist, hips, height and weight, foot sizes.

Varus/Valgus

Toe-In Check

Lateral Arches

-loss of arch, increased arch, same or different, right vs. left.

Orthopedic Tests

-Straight Leg Raise, Bilateral Leg Raise, Patrick-Fabere's, Gaenslen's, L-S Compression, Thoracic Compression, Cervical Compression and Distraction, Adson's, Allen's, Deerfield Test.

Trigger Points

-sub-occipital, cervical paraspinal, traps, rhomboids, deltoids, tricep tendon, biceps tendon, wrist extensors, SCM's, quadratus lumborum, gluteus medius, piriformis, L-S paraspinal, S-I muscles, hamstrings, ilio-tibial band, calves, adductors, abductors, quads, plantar fascia, lateral shin muscles, medial shin muscles.

X-Rays

-(2) view cervical, (2) view lumbo-sacral views.