The Law of Maximals

By Dr. Tim Maggs

This past summer, I had just completed mowing my lawn and wanted to have my 10 year old son, Tim, help clean up. I actually enjoy the simple task of cleaning up after myself, but I know it’s my job to teach my kids about work and all that other important stuff.

So, the driveway is covered with grass clippings, and I have him grab the broom and shovel, along with our garbage can on wheels. Tim’s a smarter than average 10 year old, which only means he’ll say “yes” to anything I ask, and then decide what really needs to be done. His decision is always less than my request.

I ask him if he’s ever heard of the Law of Maximals and the Law of Minimals. I knew he hadn’t, since I was basically making it all up as I went along. “No dad, never heard of either”. By the time I finished explaining my newfound Laws, I saw the application in my own life. Kind of like hearing your own confession.

The Law of Maximals

I told him that in life, you will be called upon many times to perform a task. Although we all grow up thinking success is based on intelligence, looks, who you know, or some other extraneous factor, the truth is, success is based largely on how well you perform each and every task you’re asked to do. “On each task, you can either do the minimal amount of work needed, or you can do the maximal amount, which would speak volumes about who you are. It’s that simple”, I told him. I went on to tell him the world is made up of people who follow the Law of Minimals, while the world is begging for more people who follow the Law of Maximals. “Make sure every piece of grass is picked up. Make sure some innocent bystander wouldn’t know if I just mowed the lawn or not. That’s the job you want to have your name associated with”.

Our Health Care System

I’ve treated a few people over the past thirty plus years. If I had to define what the difference is between those who succeed with injuries, pay fewer dollars over the years and have a higher quality of life, it would be the person who follows the Law of Maximals. If you want to know who spends more money, is sitting on the sidelines watching events more than participating and has a lower quality of life, it’s the person who follows the Law of Minimals. It’s really that simple, and unfortunately, it’s never taught in school. This is what Obama should be talking about in his new healthcare plan.

The Law of Maximals Principles

Be Proactive. See your dentist every 6 months. Have your eyes examined at least every 2 years. Get a physical every year, including blood tests. Over 50? Think colonoscopy. Finally, learn your biomechanics (Structural ® Fingerprint Exam) before you break down. Fix what you can before you get injured. When injured, learn the cause and correct it, don’t just treat the symptoms. Yes, that takes longer, but “you’ll thank me in the morning”. Your Finances. There’s 2 ways to become wealthy; make more money, or want less. Wanting less is the more attractive pathway, because it leaves you with a clearer mind to recognize and enjoy those things in life that are free. Take a walk, go to a museum, help someone else or work in your garden. Own a garage with nothing in it. Maximal joy with minimal stress.

Sleep. The body needs more rest than most of us allow for. Sleep is the “cure-all” of life, and with enough sleep, everything from our immune systems to our sense of humor improves. Secondly, 8 hours from 11p.m. to 7 a.m. is far more beneficial than 4 a.m. to 12 p.m. Throw in a nap here and there, and it’s like money in the bank.

Relationships. When younger, you think “more friends” is the answer. However, as we grow older, “real friends” is the key. If you have anyone in your life who is unconditional, you can call them at anytime and they’ll stop what they’re doing to help, you’re blessed. If you have more than one, you’re double blessed. However, to ever have someone who is unconditional, you need to nurture a relationship and give unconditionally in the building process. This takes time, caring and the understanding of the value of unconditionalism.

Training. As runners, we are basically an irrational and psychotic bunch. We don’t want to follow the laws of nature or the laws of injury and healing. We want to go hard every day, and when we’re reminded with injuries that we’ve overdone it, we want to scream as though there is some court of law that will hear our case against Mother Nature. Preparation, logical training and recovery are mandatory for the long haul. This simple formula could probably cut our healthcare expenses in half if we’d all follow the rules, but for some reason, it’s a challenge.

In the end, check each aspect of your life, and ask yourself, “Am I living the Law of Maximals or the Law of Minimals?. Am I giving it my all?”. What you’ll always see is that your return on investment will be proportionate. Have a great month.

The Importance of X‐Rays in the Standing Position

By Dr. Tim Maggs

History

The patient is a 15 year old female rower who has excelled in crew for the past 2 years. Her severe low back pain began approximately 2 years ago as well. Her first year of crew, the patient was a “skuller” (one ore in each hand, seated in middle) and her second year she became a “sweeper” (one ore in 2 hands, rowing on one side only). This produces significant demand of the low back and trunk.

In November, 2010, the patient went to her orthopedist who ordered x‐rays in the lying down position. The front to back view (Fig. 1) and the side view (Fig. 2) are seen here. Upon viewing the x‐rays, Dr. Orthopedist said they were negative (nothing wrong).

 

His recommendation was to rest for 6‐8 weeks while getting physical therapy. The patient went to
approximately 8 physical therapy visits and felt mild improvement. She refrained from most activity
until the Spring of 2011, and then began crew again. By early April, the pain was back in full force, and the patient was again ordered to stop rowing and get an MRI.

The MRI showed 2 disc bulges in the lowest joints of the spine. At this point, the orthopedist
recommended quitting crew. Unfortunately, this young girl was one of the better athletes on the team,
and the team had just gone to the Nationals in 2010. Needless to say, this recommendation to a 15 year old athlete, especially with no hope for improvement, is quite harsh.

Biomechanical Exam

The patient came into our office for a biomechanical exam on July 22, 2011. The exam showed
abnormal restriction in multiple key joints, which is very bad for a 15 year old girl. Loss of normal joint mobility is typically a result of abnormal joint loading, or biomechanical imbalances. Standing x‐rays were taken of the low back, which now allows the influence of gravity to be seen. The front to back view in the standing position (Fig. 3)shows a significantly differentimpression than the view that wastaken lying down (Fig. 1). Likewise,the side view in the standing position (Fig. 4) shows a significantlydifferent impression than the view that was taken lying down (Fig. 2). 

Standing X‐Ray Findings

In Fig. 3, the vertical line in the center represents the patient’s center of gravity.  We can see there is a
severe misalignment between the spine and the front of the pelvis.  Secondly, the horizontal lines at the
top of the pelvis show an imbalance between the right and left pelvis, causing low back, hip, knee and
leg length imbalances.  Finally, the arrows are pointing to the obturator foramen, which actually are the
same size, but appear differently due to the abnormal rotations of the pelvis.

In Fig. 4, the long vertical line represents the center of gravity from the side.  It’s supposed to be going
through the short vertical line, but this patient’s weight bearing is in the back of the spine, with
abnormal weight going through the back of the discs and the nerve roots (predictably causing disc
bulges).  
 

Conclusion

The imbalances between right and left make the vulnerability for low back/pelvic problems
proportionately higher.  These imbalances, coupled with the demands of crew, will keep this athlete
sidelined until she begins the appropriate rehabilitative care.  The first phase of care consists of
therapies and treatment that will help reduce the disc bulging, spasms and inflammation that
accompany this condition.  Once the symptoms are reduced, a re‐education of the postural muscles and
alignment of the body is needed.  This process can take up to one year, however, if this young girl
doesn’t go through this process, it’s safe to assume her future will consist of limited physical activity.
 

Kinesio-Taping

By Dr. Tim Maggs

Kinesio-taping is the next big thing all runners should have in their sportsmedicine cabinets. The simplicity and ease of use, combined with it’s powerful benefits make it a near necessity if muscle and tendon health is your goal.

I began using it in my practice about a year ago, and we see mostly people who exercise and are active. We see high schoolers and geriatrics and everyone in between. And, every age group is the perfect candidate to use kinesio-tape. This was developed by Dr. Kenzo Kase, a chiropractor from Japan. According to Dr. Kase, “Muscles not only control the movement of the body, but also control
the circulation of venous and lymph flows, body temperatures, etc. Therefore, the failure of the muscles to function properly induces a variety of health maladies”.

The actual taping is not as difficult as one might think. Although there are certification programs available, in the meantime, a book such as Illustrated Kinesio-Taping 4th Edition by Kenzo Kase, D.C. should get anyone well on their way. In Pic 1, you’ll see that all applications begin by cutting a certain length from a roll of tape. The shapes and widths of the next cut depends on where the application is going. For example, in Pic 2, you can see the achilles is taped by rounding one end that goes under the heel and splitting the other end about 4-6 inches right up the middle that goes along each side of the achilles. The next cut, Pic 3, shows that one end is rounded along the back of the heel, and the other end is split into 3 to go along the base of the foot for plantar fasciitis. A solid strap is then used across the arch of the foot for additional support.

 

Benefits of Kinesio-Taping

There are four major functions of kinesio-taping that have been observed in practice and in the laboratory. Anyone who uses it can expect benefits in one or more of the following categories;

1. Supports Muscles - the repetitive activity in specific muscles used by runners necessitates the ned for support.  Improved muscle contraction is important for tired and fatigued muscles, and kinesio-taping helps to reduce fatigue in muscles.  It also reduces overextension and over-contraction of muscles, it reduces cramping that leads to injury of muscles, it increases range of motion and for some reason, relieves pain.
2. Removes Congestion to the Flow of Body Fluids-any time one can improve blood flow to a muscle, especially a repetitively used muscle, it’s a good thing. The Stick gained all it’s popularity for that sole reason, increasing blood flow (food and nutrition) to a designated muscle. Kinesio-taping does just that, as well as reducing excess heat and chemical substances in tissue. In addition, inflammation is reduced (MAJOR Benefit!), as well as pain in both skin and muscle
3. Activates Endogenous Analgesic System-complicated means of saying it reduces pain. And, through personal, as well as clinical experience, it does.
4. Corrects Joint Problems-as a chiropractor, I must be careful here, as I don’t want some $20.00 roll of tape replacing me. But, the truth is, this is a perfect complement to chiropractic adjustments. Taping reduces spasms and shortened muscles, that cause both pain and misalignments, and normalizes muscle tone and abnormality of fascia in joints. Taping improves joint range of motion and also reduces joint pain. 

 

Conclusion

I’ve been treating sports injuries for 30 years. It’s my humble opinion that neither science nor medicine have dedicated enough resources to improvements in either prevention or treatment of structural injuries. We (you and I) live in a “reactive” healthcare industry, yet most of us would prefer to manage our structures and prevent injuries rather than react to injuries.

Kinesio-taping allows anyone, everyone, to do a better job at keeping injuries managed. From reduced pain to reduced inflammation to reduced spasms, I don’t remember any product so simple that offers so many benefits.

For instructions and to purchase the product, you can find it at www.isokineticsinc.com. This site seems to be less expensive than others. Until next time, hope your running stays injury free.

Running Barefoot with Nike Good or bad?

By Dr. Tim Maggs

Everytime a shoe company comes out with a new concept, I hold my breath wondering if it’s only to sell more shoes, or is there some semblance of logic involved.

Last year at the Boston Marathon expo, I visited the Nike booth, and watched closely as they had treadmills set up with video cameras filming the gait of runners who wanted to be “analyzed”. Once the video was completed, the Nike rep would play it back, showing the runner how their foot hit the ground, and then recommended the appropriate pair of shoes. For the average onlooker, Nike appeared to be using cutting edge technology. However, when you look at some of the facts, you realize how far short of the mark they actually are.

Do You Know Your Structural Fingerprint®?

What Nike, as well as the most of the sportsmed world, fails to identify is the fact that biomechanics exists above the ankles. Simply put, humans are a “bag of biomechanical sins”, and unless you examine each person biomechanically, you’ll never know the many specifics of that individual. The end result of these “sins” is the foot strike during the gait cycle. The strike is just an overall compensation for all of the undetected and uncorrected biomechanical flaws that are the result of many contributing factors, such as hereditary weaknesses, prior injuries, using the wrong shoe type, poor conditioning, height, weight, job, etc.

So, until you actually get a biomechanical exam, no one knows your specifics, such as your center of gravity, structural balance, joint restrictions, muscular imbalances, foot type, etc. And, these factors will determine what your life will be about.

The Structural Fingerprint® Exam

This exam first looks at foot type. The shoe industry has done a tremendous job of developing shoes for the different foot types, but most Dr.’s and the general public have no idea what their foot type is or how to test for it. Learning your foot type is critical, and it must be done in the standing, static position. Evaluating gaits during the running cycle should never be done until many of the biomechanical defects in the body have been improved, and that usually takes at least 6-12 months.

The Q angle of the knee, as well as leg length, range of motion of all joints and muscle balance, should all be tested. 75% of the information needed for a comprehensive biomechanical exam comes from standing x-rays of the low back and neck. And, you can’t ask most Dr.’s to read them, as most Dr.’s are only schooled in looking for pathology on x-rays, not biomechanics. This is why most x-rays come back “negative”. They are negative for pathology.

Once all these tests are performed, then a rehabilitative program is designed to allow time to re-educate and mobilize muscles and joints, improve habits, and perform the necessary rehab exercises. Our goal is threefold; to improve overall posture and balance, to increase joint mobility and to increase muscle flexibility. Much like the orthodontist who requires 2-3 years to alter the alignment of kids teeth, structural balancing is a process, and a tremendously worthwhile one.

Who needs this exam and correction? Everyone interested in getting the most out of their physical life while reducing the frequency and degree of breaking down. If getting a joint replacement isn’t on your “to do” list just yet, you may have in interest in learning how to preserve the joints you have, just in case you’ll want to use them later in life.

Final question; When can you stop working on this balance, joint mobility and muscle flexibility? Never. Just like any other mechanical machine you own, management and maintenance is required to keep it running well. The very thought that we should just let our bodies and joints degenerate and rot out until we can’t take it anymore borders on lunacy. Then, the very thought that drugs or joint replacements are the obvious answer is nothing more than modern medicine doing a great marketing job and keeping the masses ignorant.

So, Nike now comes out with the Nike Free shoe that “gets the hell out of your foot’s way”. They tell how studies have shown barefoot running allowed runners to get faster and have fewer injuries. “Add to that, research showed that runners in unshod populations like Africa or the Caribbean often have lower incidences of running injuries like Achilles tendonitis and plantar fascitis”, the marketing literature states.

So, is it worth a try? Hard to say. But what I can say is this; until these biomechanics labs at the running shoe companies begin examining biomechanics above the ankles, like the sacral base angle or Ferguson’s center of gravity line, they will always be too uninformed to make the statements they make. Until they recognize the importance of a balanced knee and mobility in the spine at all levels, the relationship between foot type and full body biomechanics, and the importance of educating the masses on foot type and appropriate shoe type, with custom orthotics when needed, that’s when it’ll be time to then congratulate a new shoe and explore new concepts.

The downside of the current state is that most runners will wear the wrong shoes, end their running careers prematurely on the disabled list and use their primary Dr.’s as their fitness/injury guru’s. Oh my, what a shame.

Have a great month.

Sportsmedicine—The Way It Should Be

By Dr. Tim Maggs

Try this the next time you’re sitting around and bored. Call your primary Dr. and tell them you have no symptoms, no pains or aches, but would like to come in to find out what you can do to maximize your chances of avoiding injury. Tell them you cherish your ability to run, and just don’t want to end up sitting on the sidelines of life watching if you don’t have to.

Kind of like, insurance, the way health insurance should be defined. However, when you do this, be prepared. You may hear a long pause on the other end (like you’re the fool).

That’s because, our sportsmedicine “specialists” can only help you when you become injured. Seems crazy, but that’s just the way it is. Unless, you opt to pay out of pocket and choose a different approach than the masses. Kind of like Lance Armstrong and his U.S.P.S. team did at the Tour de France. For the past 6 years.

Let’s all agree on one thing; the Tour de France has to be a tougher event than almost anything you or I will ever go through in our lifetime. Nothing will compare to the rigors of the Tour. So, with that fact in place, let’s discuss a few of the details. While in a recent conversation with Dr. Jeff Spencer, the head of the medical team for the U.S.P.S. Team, Jeff highlighted the fact that his 9 riders who started also finished. This is not some insignificant fact, since only one other team could claim such an accomplishment this year.

But, the story gets better. The U.S.P.S. Team not only had all of their riders finish this year, but they’ve had all of their riders finish each of the past 6 years, except for one rider who broke his arm. That’s all of the riders during the period that Lance has won the race. On the front, attacking, competing at the highest level. All who started over the past 6 years have finished. Can you imagine?

Is it luck? Coincidence? Or, is it strategic and due to some different approach? Well, to begin with, Dr. Jeff Spencer is a chiropractor. In our society, the “primary’s” are medical Dr.’s. Medical Dr.’s certainly have a place in our healthcare system, but it’s not in the world of musculo-skeletal sportsmedicine, which is where most sports injuries lie. Society has it backwards, while the U.S.P.S. Team has it right. A chiropractor, skilled in the many requirements of demanding athletes, is the perfect partner with athletes, if performance and survival happen to be the goal.

Secondly, and more importantly, the whole approach of Dr. Spencer was radically different than the approach that most sportsmed people take today. Obviously,  Dr. Spencer didn’t wait for each athlete to become injured. Rather, he treated the athletes 3 times a day; on the team bus on the way to each day’s race, on the bus after each day’s race, and at night at the hotel in preparation for the next day.

In our everyday life, insurance providers call this “overutilization”. Many insurance companies, especially managed care groups, recommend 6-12 treatments per year. Again, can you imagine? Should we admonish Dr. Spencer for such overutilization? Or, do we need to re-write the books on what overutilization and utilization are? My experience tells me that most athletes break down at some point in their life. Most athletes go through the mundane, pathetic route of conventional care, only to find at the other end, the Dr.’s, tests and treatment provided was worthless. It costs thousands of dollars, takes weeks and months and years to find answers, and in the end, the athlete is left chronically injured with no solutions.

So, with all of that said, what’s it all about? Well, since our space is limited, let me bullet what all athletes need to do in an effort to enjoy their exercise more and stay off the injured list.

• Don’t wait until you’re broken—everyone else around you has been taught to not seek care until they’re injured, however, we recommend a Structural Fingerprint™ Exam sooner rather than later to begin to improve imbalances and other structural distortions.http://www.drtimmaggs.com/structuralexamb.asp
• Realize, there is nothing of more value than preservation of the human structure. Anything this important takes hard work and effort, so anyone who can help you preserve this wellness should be considered a valuable teammate (i.e.massage, chiropractic, yoga, pilates, personal trainer, nutritionist, etc.).
• Remember, youth hides a lot of sins. However, the body keeps a detailed scorecard, and at some point, the weaknesses manifest. Find out today before the big breakdown.
• The 3 things that should be used by everyone who wants to prevail and not break down;

1. The Stick® for muscle management
2. Custom fitted, flexible orthotics
3. Chiropractic care to maintain lifetime joint mobility

• Realize, it’s going to cost to preserve yourself—so either pay now, or pay later with injury.
• If you become injured, seek a structural exam, as that is the key to getting back to normal.

Now, with all of that said and done, most of you now have a better direction to keep yourself “uninjured”. Give it a try, and if all else fails, contact Lance and ask him what the secret is. Not just for him, but also for his 48 teammates over the past 6 years. Best of luck, and have a great month.

Let the NETWORK Begin

Dr. Tim Maggs

"The goal is to die young, but a long time from now."
-anonymous

Four or five years ago, I wrote an article titled, Building a Sports Doctor Network. This was written after years of too many e mails and phone calls from runners asking me who could do a structural exam on them in their hometown. In my article, I gave many reasons why we needed to begin thinking about building this network, such as why should runners have to wait until they're broken down before they get help from their doctor? And, why do so many runners have so many lists of doctor's names, with so many tests performed, and yet, no help? Why do runners look to their insurance company for directions? And on an on the questions went.

But, most importantly, at the end of this article, I clearly stated that I was only the messenger, so don't look to me to also begin the voluminous task of starting this network. Well, everybody else did a great job of sitting on their hands, and must have known I can't stand procrastination, so here I am, introducing The Structural Management® Network. This is a group of doctors who will be trained to perform The Structural Fingerprint® Exam, and then inform the runner of his/her imbalances, weaknesses and dysfunctionally working joints, all in an effort to restore an improved balance back to the runner's structure through specific corrective measures. All in an effort to prolong the life of the structure of the athlete. All in an effort to keep the runner running more.

The Network will take an estimated five years to develop, and hopefully we'll attract several thousand doctors who have an interest in sportsmedicine, fitness and conditioning and recognize the inefficiency and apathy of the existing pathology based system that the insurance industry supports and drives. The program will be introduced in 4 cities in the first 6 months of this year--------Omaha, Chicago, Orlando and Boston.

Some of you may remember my article on Dr. Sheehan and the quotes I took from his book, Dr. Sheehan on Running. "Conventional medicine is not adequately addressing runner's injuries today. They are addressing the symptoms while ignoring the cause. Structural balance is the ultimate goal, and once achieved, will provide the runner with the best chance for an enjoyable lifetime of running."

Sheehan would have been proud, as he tells the tale of his many different injuries, but he couldn't find the right person to help him, as all his specialist friends and colleagues wanted to just give him drugs and have him stop running. As he said, "I neeeded a super specialist, someone higher on the ladder. But, what I realized was, he didn't exist". Therein lies the words that have motivated me the most to build this network of Dr.'s. This super-specialist will now exist in many cities by the end of this year.

Biomechanical Approach

The human being is an architectural structure influenced by gravity the same way a building, bridge, car or any other structure is. Yet, you would be hard pressed to go into your family doctor's office and ask them to perform a structural exam on you and then be given an updated status report with a plan on how to improve. Especially if nothing was hurt or broken at the time. Or, better yet, try taking your middle school or high school athletic child in for a structural exam before they begin a season or a program in the weight room. Unless they have symptoms, there's not much any doctor will do for them.

Making this issue even more important is the fact that imbalances accelerate degeneration of the structure and increase the likelihood of injuries. Osteo-arthritis is the leading arthritis out there, and even Dr. Bob Arnot writes about it in his new book, Wear and Tear. He says the same thing I'm saying----structure is virtually being ignored out there today, yet it impacts all of our lives in many, many ways. If you've ever heard someone say,"It's hell getting old", well, I'm sure they were never informed how to preserve their structure. Movement and motion is the key, as in, they can't throw dirt on you as long as you're moving, so keep moving.

Contributing Factors

Remember, at this moment, your structure is a result of your age, heredity, prior injuries, habits, weight, height, diet, job, shoes, mattress, attitude, etc. But, doesn't it seem logical that someone should be able to extract this pertinent information in an effort to provide a "current status" report and a "plan" on how to improve it? With or without symptoms, this "snapshot" of your structure will provide a status report that will then lead to a program for improving balance, joint mobility and flexibility.

By June of this year, many more runners will have in their communities a doctor who will provide this help. And, by 2009, hopefully, it will be coast to coast.

And, George, although you may have been correct in 1975 when you wrote that book, the "super specialists" are now being trained. I only wish you could have been here to see one of them.

Blood Sugar System

According to many authorities today, blood sugar problems, especially low blood sugar, are near epidemic proportions. At times most people have vulnerability to a blood sugar swing. With the incredible increase in refined sugars, chemical additives, drugs (both legal and illegal), alcohol and fast foods in today's fast paced society, it is quite easy to understand why blood sugar problems are on the rise.

Couple this with the fact that most doctors today do not address, the blood sugar imbalance, either through proper testing or treatment, but rather, treat the symptoms caused by the imbalance. The symptoms are mostly treated with medications, which adds a greater stress on the body. The true cause, blood sugar imbalance, becomes even more imbalanced. Secondly, as long as the symptoms are hidden by medications, the condition continues to worsen without the patient being aware of it.

Proceed to the Nutritional Profile Analysis form that you can complete and send to us.

Symptoms

There are a vast array of symptoms caused by blood sugar imbalances, which demonstrates the importance of blood sugar balance to all parts of the body. Some of the most obvious symptoms that occur are:

• Lightheadedness when standing
• Ringing in the ears
• Mood swings
• Craving of sweets
• Mid-day fatigue
• Difficulty sleeping at night
• General lethargy
• Heart palpitations
• Upper respiratory infections

These symptoms are rather common but are, more often than not, misdiagnosed and treated with medication, adding to the number of disgruntled patients with a medical story to tell.

Organs Involved

The blood sugar system is a highly intricate system that is well integrated with the nervous system and the hormonal system. The purpose of this section is to provide useful and relevant information to readers to better understand the why's and what to do's. This section is in no way intended to be a complete and thorough explanation of the detailed blood sugar system in action.

The Pancreas

There are primary organs involved with keeping a balanced blood sugar level. The first, and probably most important organ, is the pancreas. The pancreas has a job of keeping the blood sugar levels from going too high. As you ingest foods that break down into sugar and the blood sugar levels begin to increase, the pancreas slowly releases insulin, which helps to bring the sugar levels back to normal levels. This action begins within the first half hour of eating, with the highest level of blood sugar taking place at about the 2nd or 3rd hour after eating.

The Liver

The next organ that is involved in sugar levels is the liver. The liver has literally hundreds of functions that take place throughout the day. One of them is to store sugar so that the body doesn't have to manufacture sugar every time there is a need, but can call on the sugar storage centers to withdraw whatever is needed. Along with the muscles, the liver controls sugar storage and periodic release to keep sugar levels where they belong. As a person ages, eats foods that are congestive and chemically laced, and practices poor lifestyle habits the liver function worsens, and all systems of the body that require proper liver participation are compromised.

The Adrenal Glands

The next important set of glands is the adrenal glands. For anyone who is not aware of the adrenal glands, they are the glands that handle much of the stresses in your body. Whenever the body undergoes higher levels of stress, the adrenals produce the necessary hormones and releases them into the system to strengthen the system whenever necessary.

A person's constitutional health is determined during their mother's 9 months of pregnancy. The adrenal glands are probably most vulnerable to the stresses a mother may experience while pregnant. It is not uncommon for a pregnant mother to go through the first, second and even third stage of exhaustion while pregnant, totally exhausting her adrenal glands. Full grown fetal adrenal glands, which reach full maturity before any other organs or glands, can also provide support to the exhausted mother if needed, but can leave the fetus in the 1st, 2nd or even 3rd stage of exhaustion when born. This is one reason a child may be so susceptible to fevers, upper respiratory infections, earaches, hyperactivity, learning disabilities, etc. while growing up.

While these kids are treated with antibiotics, ritalin, tubes in the ears and a myriad of other chemicals and surgeries, the "establishment" is missing the true cause of the condition--an adrenal gland weakness syndrome in the child.

Blood Sugar Stages | Blood Sugar Ranges

There are varying opinions as to what the normal blood sugar ranges are. There are conservative ranges and not-so conservative ranges. By using the conservative ranges, a person can only improve more, as liberal ranges will sometimes allow an individual to not feel the same motivation with regard to lifestyle and dietary improvements. For that reason, we will use the conservative ranges.

• Fasting Blood Sugar (75-125)
• 3 Hours after Sugar Intake (120-160)
• 5 Hours after Sugar Intake (75-120)

If results are outside of these ranges, it is prudent to begin to learn why this is happening and what can be done nutritionally to improve the status of the condition. Again, if no consideration is paid to blood sugar status, diabetes and liver disease is a common ending to a typical American lifestyle.

There are basically 4 stages of blood sugar involvement:

• Normal Normal blood sugar 75 -130
• Hypoglycemia Low Blood Sugar below 65
• Dysinsulinism Low and High Blood Sugar Above 160 and below 65
• Diabetes High Blood Sugar Above 160

Normal Blood Sugar

A normal fasting blood sugar level is usually somewhere between 75 mg and 80 mg per 100 ml. Under the assumption that the typical individual eats 3 meals per day at 8 AM, 12 PM and 6PM, the normal cycle consists of the following:

Upon arising, the body is in need of replenishing the sugar storage centers, and a person will eat breakfast. Once eaten, the sugar levels immediately begin to rise, up to as much as 140-160 mg. per 100 ml. within the first 3 hours. At this point, the pancreas has released appropriate levels of insulin, lowering the blood sugar levels. As the levels begin to drop, the adrenal glands are on standby, as sometimes the levels drop too quickly, or the individual is late at eating the next meal, and a hormone is released which will trigger a release of sugar from the sugar storage centers (primarily the liver) to keep the levels from going below the normal low level. At this point, the body begins to require more food consumption, and this is just about as the clock is striking 12:00 noon. The cycle then repeats itself, and so on. Ideally, this would happen for about 100 years, but, unfortunately, that's not the way it happens for most.
Hypoglycemia

This is a stage that occurs in many, many younger people, but is unfortunately misdiagnosed too often. The diets of today, which are high in refined sugar and drugs, predispose people to weaknesses in their blood sugar systems, with the first signs and symptoms falling under the heading of hypoglycemia.

In this country, the average American consumes approximately 140 pounds of refined sugar per year. This averages out to about 22 pounds per month or 5 pounds per week. If you could imagine eating a 5 pound bag of Domino sugar, every week of your life, you might begin to get the picture that your body is consuming an awful lot of sugar. The human body is capable of digesting sugars, but "sugars" refers to those sugars which appear naturally in society. Fruits, vegetables and grains are the refined carbohydrates mother nature was referring to. But, somewhere along the way, white sugar and all of the chemicals snuck into our diets. And, you remember--"You can't fool Mother Nature!". Well, that's where hypoglycemia comes in.

With the increased ingestion of white sugars, the pancreas' have become more sensitive, since it is being called on to work too frequently. This sensitivity produces a gradual weakening of the pancreas and causes an elevation of concentration of the insulin that is released. This elevation forces a greater "drop" in blood sugar, and calls upon the adrenal glands to work harder to prevent the sugar levels from dropping below the normal low levels. As the adrenals begin to fatigue, the low levels become gradually lower, and the symptomatic picture becomes more and more involved. As the symptoms become more obvious, the average individual will seek help medically, and in most cases, will receive symptomatic treatment. Unfortunately, this solves the short term but adds fuel to the fire for the long term, as drugs add to adrenal fatigue, which promotes the symptoms.

Proper Testing

This stage of the condition can drive people to the brink of depression, as most doctors won't look for, therefore, won't find, this drop in blood sugar. In most cases, the proper testing is never done, therefore, the true problem is never found. In order to accurately diagnose this condition, a 5 hour Glucose Tolerance Test is needed. Doctors will not routinely do this test, as the correction is basically nutritional, and most doctors are not trained to treat nutritional problems. The most common tests, if done at all, will be a 2 hour post prandial, which will only show an elevation in blood sugar, and is not relevant in this stage.

When going through this test, it is not uncommon for a person to experience the same symptoms that brought them to be tested at about the 3rd or 4th hour. If this is the case, you can stop the testing, as this is a clear indicator what the problem is. Always be prepared with orange juice or some fruit just in case the symptoms become overbearing. Once a person has taken any form of nutrition, the test is over. But, more importantly, the patient lived. And the conclusion is that the blood sugar system has a weakness that must be addressed.

Dysinsulinism

This is that stage of the condition that is most disturbing to the treating doctor, as the patient has stages of hypoglycemia (low sugar) and hyperglycemia (high sugar). The symptoms are different during both stages, and unless the doc is experienced, he or she will usually refer the patient out, as it's too complex a situation to deal with.

As the pancreas is continually overworked, the blood sugar levels have to elevate higher and higher before insulin is released into the system. As the levels of blood sugar rise, the patient many times will rise into the diabetic stage, but the pancreas is still working. It just requires a higher blood sugar level to stimulate it to release insulin. But then, when it does release insulin, it's a concentrated form, and with weak adrenal glands, the blood sugar levels now drop to all time lows during the 4th and 5th hours. What a mess. But, believe it or not, there's still hope for the person willing to "pay the price".

What adds severe insult to injury is when the treating doctor sees high blood sugar symptoms, sends the patient in for a 2 hour post-prandial or 3 hour Glucose Tolerance Test, and sees high blood sugar as the cause. (If they had done the 5 hour test, they would have also seen the severe plummet of blood sugar in the 4th and 5th hours, recognizing the dysinsulinism).

The treatment then becomes either insulin by injection, or an oral medication, which lowers blood sugar. But, what happens when this patient takes a medication to lower the blood sugar, and the body happens to be going into a low blood sugar stage on its own? You can probably guess--Insulin shock, or some derivative of it. Believe me, it's not good. This is one more reason that the 5 hour GTT is recommended.

Diabetes

This is the stage that occurs when the true cause has been totally ignored. The pancreas has become totally fatigued (dead), and the blood sugar rises and there is no way for it to come down. This is when insulin injections usually are recommended. Despite the fact that nutritional recommendations should definitely still be made at this time, the condition has truly worsened to a point beyond total repair.

In 1900, before the industrial revolution, Diabetes was the 37th leading cause of death in this country. Today, it's the third leading cause of death, 2nd leading cause of blindness and 2nd leading cause of amputations. Modern medicine claims to have a total handle on the condition, but statistics prove otherwise. Why wait until it's too late? Stage 4 is too late! Begin now to make the necessary dietary and lifestyle changes.

Remember, pay now or pay later. The one constant is--you will pay before it's all said and done.


Proceed to the Nutritional Profile Analysis form that you can complete and send to us.

Degenerative Disc and Running: A Case History

Copyright 2002
By Dr. Tim Maggs

Too many runners are told to stop running when they’re diagnosed with a degenerative disc in the back. Not only is this inappropriate in many cases, but oftentimes, running is part of the solution for someone in this situation.

Case History

Gina Babin, a 33 year old hairstylist, came into my office in late 2000 with low back pain. Her job, which involved standing all day, produced low back pain. And it was getting worse. When we took an x-ray of her low back, what we found was a bit unusual. Gina had an extremely degenerated disc at the L5 level of her low back (arrow “c”). This is a condition more commonly seen in someone 60 years old. Disc spaces “d, e, and f” were full and healthy. Gravity line “a” should be going through line “b”, and the fact that it wasn’t only added to the stress on the joint.

Discs typically will degenerate with age or trauma. Trauma to an area of the spine without rehabilitation will produce a tightness of the supportive muscles, a fixation of the joint and an ultimate reduction of the normal blood flow to the disc. This is similar to a tourniquet around the arm. Eventually, whatever’s on the other side of that reduction of blood flow will die. And there goes the life in the disc. It will gradually wear down until symptoms begin to occur. Symptoms can come in the form of localized pain, restriction of normal motion or pinching of the nerve that exits the spine at that level. Whatever symptoms you suffer with, they typically will get worse over time without corrective care.

Appropriate Treatment

In most cases, the disc is never going to grow back. You’d probably have better luck waiting for Superman to come than hoping for your disc to return. The next best thing is motion restored back to the joint. This will promote the influx of a rich blood flow back to a withered disc, and time will allow that portion of the disc to resume function to whatever level is possible. To get motion back to this injured joint requires work and patience.

In my office, we treat with a frequency that will allow a patient to get back. When a disc degenerates, adhesions form around the joint as the body tries to “lock up” this injured area. As long as that is allowed, there will be an inability to do many things. So the goal is to go against what the body is attempting to do and work to dissolve as much of the adhesion formation as possible. This is done with ultra-sound therapy. This prepares the joint for rehabilitative exercises that will help to restore motion back to the joint and increase the blood flow back to the remainder of the disc. As a patient, you must be patient. Three to five visits will not do the trick. It may take 30-40, or 60-80 treatments. But, everyone is different, and you must be willing to pay some price in order to get results. And then you must maintain some level of treatment to keep the results. Your ultimate ceiling of potential may be reduced to some degree, but it can certainly be raised from where it is, especially if you’ve only been told to stop running and have not gone through any corrective care.

Along with the ultra-sound treatment, spinal manipulation greatly helps to restore motion back to the locked joint. This will encourage a better blood flow and a reduced likelihood of future injury. A critically important addition to this plan is the fitting for custom orthotics for a patient with a condition such as this. The long-term degeneration of the L5 joint space is clear indication of the instability and increase of stress in the lumbo-sacral region. The degeneration is the body’s response to that instability. Custom orthotics are mandatory for the patient to reach maximum capacity.

Finally, some nutritional support is added, and you’ve got yourself a new lease on life. Glucosamine with a ligament strengthening supplement (minerals) will begin the process of healing. There are also many all-natural anti-inflammatories that can be added to the mix, such as proteolytic enzymes. A daily routine of these will certainly contribute and support the physical treatments that are being given.

Back to Gina

Gina Babin was not a runner when she entered my office in late 2000. Once the process of rehabilitation began to show improvements, Gina wanted to know what more she could do to help herself. When that question is asked in my office, there is usually only one answer---begin running. And that she did. She has now completed 4 races and is well on her way to running a half marathon this year.

A most unusual turn of events occurred approximately one year after fitting Gina with her custom orthotics. She had not even a whisper of back pains, however, she had one orthotic that began to irritate the ball of her foot. As usual, we circled the sight of irritation and sent the orthotic back to the lab. My plan was that she would go without the orthotics for 7-10 days.

Within 48 hours of not wearing her orthotics, Gina’s back went into an acute flare-up unlike anything I had ever seen before. There was severe Psoas spasm, pain in the dorsal-lumbar region, that prohibited her from working or running. The pain worsened each day. We quickly concluded that not wearing her orthotics was the reason, and had a new pair overnighted. After 8 days of suffering, we re-inserted the orthotics and within 2 days, Gina’s back returned to normal. This showed me more than ever the direct benefit orthotics have in a situation like Gina’s.

Persistence, a good game plan and a positive attitude will get anyone ahead in life. Do not accept a proclamation of doom when diagnosed with a degenerative disc. In fact, your new life is just beginning.

Chiropractic - No Longer an Alternative

Leading All Professions in Structural Management

For too long now, our profession has been thrilled to be on the short list of "acceptable"alternatives available to those seeking another option in our medically designed world.

As an alternative, we've learned to fit into the space provided for us. Although being on the short list may appear to have its advantages, until we remove ourselves as an"alternative" using medical protocols, we'll never reach our maximum potential as a profession. Chiropractic's potential will never be recognized when measured in a medical paradigm. The medical paradigm works without an accurate diagnosis 85% of the time (1) and then attempts to relieve symptoms as a primary objective. It is in this paradigm that"manipulation" is measured. Is it more effective, quicker and cheaper than medication or other methods used?

To further make my point, let's flip this whole picture around. Let's imagine the chiropractic profession designing the protocols for a "back pain" program using structural testing to determine treatment and conditioning needs of the patient. If we forced the medical provider into our paradigm, which would require the detection and correction of subluxations, the medical doctor's only option would be to recommend a medication. Obviously, medication has little benefit in the detection and correction of subluxations, and therefore, medication could never be seen as beneficial under this evaluation.

Medication could then be defined as an "alternative" in this situation, but you can only imagine what little positive results pharmaceutical companies would enjoy in journals and the public media. Yet, that's the position chiropractic has lived with as an alternative. This simple imagined exercise magnifies how ridiculous it is for either of our professions to attempt to fit into the other's framework. We have different objectives and different protocols.

Chiropractic as Structural Management Specialists

Chiropractic was built on the very concept that we address the cause of the problem, not just the symptoms. Unfortunately, we live in a society that has been programmed to address the symptoms, and the public has learned to expect that. This belief is furthered by the insurance industry guidelines that pays for these palliative treatments, as well as the massive marketing campaign by the drug and medical industries that influences all of our decisions, regardless of who you are.

The human structure provides limitless information for any examiner of the sites of increased stresses, imbalances and vulnerability to injury. In any physical structure, imbalances accelerate degeneration. Needless to say, this also applies to the human structure. It is the examiner's responsibility to find and collect this data on each patient, with or without symptoms.

Furthermore, with the epidemic-like numbers surrounding osteo-arthritis today, it seems almost felonious to not consider structural defects and imbalances when attempting to find new and better treatments. Again, the medical model of care is to wait for the pathology to develop and then provide the best symptomatic care possible. In this 21st century, we must demand better than that. "Early detection" has become the marketable phrase for cancer-detection testing. Why doesn't it exist in the neuro-musculo-skeletal world? Does the breakdown of the human structure cause less pain and suffering and cost less money than the cancers that are killing people? If "early detection" applies in the cancer, tooth, colon and breast industry, why not in the neuro-musculo-skeletal industry?

As chiropractic continues to grow and define ourselves to the public, we must be concerned with symptoms, but to make a difference in someone's life, we need to be more concerned with conditions. Despite the insurance coverage an individual has, whether it's worker's compensation, no-fault or private insurance, any structural symptoms, i.e. low back pain, neck pain, shoulder or hip pain, etc. lead to a diagnosis. We've become too concerned with the diagnosis and ignore the many other contributing factors involved in structural breakdowns. We, the chiropractic profession, need to re-write our protocols and begin to fill this massive void in our industry rather than continuing as a minor role player in the highly ineffective medical system that currently exists.

Structure vs. Pathology

In an article on Low Back Pain and Imaging published in a 2002 Annals of Internal Medicine magazine (2), the article states that less than 3% of all low back pains are due to pathology, while 97% are due to mechanical disorders. The article also states that the examiners interest should lie in determining whether the patient with low back pain falls into the pathology or mechanical disorder category. Beyond this primary concern, all considerations end. What to do with the 97% of mechanical disorders is of little value, since they've been defined as benign and self-limited. It is this 97%, however, that should make the chiropractic profession stand up and be willing to do what's necessary to de-program and re-program society. Chiropractors need to become the structural specialists who address these "benign and self-limited" conditions. It is these conditions that require individualized evaluations and treatment/conditioning programs.

Chiropractic was built on the interest and respect for the human structure. Neurological interference is a result of irritations from an imbalanced musculo-skeletal system. We have always been concerned with these imbalances and we've known they are the cause of most structural conditions. But, if this is true, why have we compromised into the concept of diagnoses? Label any pain by an ICD code, and some insurance adjustor will step up and determine some level of treatment, but show no respect or interest for the other structural imbalances that are the underlying contributing factors involved in this case.

Take for example a lumbo-sacral strain/sprain injury. (847.2) is the code used by the industry, but it fails to address many of the relevant contributing factors that are also influencing the condition. What about the feet? As the very foundation of the human structure, have they been examined and determined to provide a balanced support? Or, are they imbalanced, such as bilateral pronation, supination or different between right and left? And, how about the knees, have they been examined to determine the Q angle, which we all know has a huge impact on the wellness of the low back.

Taking this a step further, how about the patient's hereditary weaknesses? What is their job? What is their conditioning status? How about their weight and lifestyle habits? And, on and on the questions go. The truth is, there are so many contributing factors for the common backache that no diagnosis could ever do justice in letting anyone know the actual cause of the problem. Structural weaknesses cannot and should not be handled as pathologies with some pharmaceutical treatment. A structural imbalance will lead to one or more sites of symptoms, but are caused by a myriad of imbalances and contributing factors. All known factors must be addressed.

New Guidelines For Structural Conditions

The chiropractic profession must be willing to function outside of the accepted guidelines in today's industry. All current guidelines are designed for pathologies and pharmaceutical treatments. "Alternative" treatments are measured on pathological terms, not structural terms. For example, what treatment can get rid of back pain quicker?---- physical therapy, spinal adjustments, medication, meditation or exercise?

This is a ludicrous question, as back pain is the result of so many contributing factors. We must stop playing the symptom game, and stand up and give our mission statement which tells that we want to identify the reason low back pain exists, the structural imbalances and distortions that make a person vulnerable to low back pain and provide a logical and effective program for correction, that includes spinal adjustments, custom fitted orthotics, physical therapy, exercises, lifestyle changes, weight management, etc.

The new guidelines must force us to ignore the medical model of evaluation and treatment for structurally based conditions. All medical tests are performed to look for pathology, and in the absence of pathology, the patient is referred for symptomatic physical therapy. At this point, the physical therapist may claim to then evaluate the patient, however, until structural x-rays are performed in the standing position, a "fingerprint"understanding of any patient's structure is impossible.

The medical model of treatment cannot become the standard of care either. This treatment focuses primarily on symptomatic relief, and as chiropractors, that must become only "phase 1" of our care. Rehabilitation is what has to set us apart from all others. The concern that physical therapists will compete with us if they're allowed to perform"manipulation" is a position based on fear and weakness. Manipulation, or spinal adjustments, is not who we are. Have we become so pathetic that we must fight to hang onto the 10-12% of the public we treat. Have we ever considered that the other 88-90% of the public also needs what we have, but they just don't understand why. In fact, sad to say, but many chiropractors don't even believe that. Everyone's structure will break down in life, either through imbalances and injury or degeneration. The sooner they're evaluated, the sooner they can pro-actively begin to prevent damage. If chiropractors would learn to look ahead more and unite and consolidate our message and resources, there will be more patients than any of us could ever handle. And doesn't it make sense that the fact that physical therapists want to "manipulate" will only endorse who we are and what we do?

We must become the structural diagnosticians, understanding the unique and specific imbalances and weaknesses that exist in the kinetic chain of an individual so that life enhancing corrective recommendations can be made. Physical therapists cannot examine or take x-rays, so they will never become competitive if we make the definition of chiropractic"the detection and correction of structural imbalances and distortions through a thorough structural evaluation, structural x-rays, spinal adjustments, corrective exercises and lifestyle changes".

The Structural Fingerprint® Exam

The Structural Fingerprint® Exam is a comprehensive evaluation of an individual's structure, regardless of whether they're symptomatic or not. This examination provides quantitative information that will, from an engineering perspective, inform both examiner and patient of the current status of the structure, as well as predictability of what is to come.

The exam consists of a complete evaluation of the feet (Fig. 1) in the standing position. Range of motion tests of the low back and neck are important. Tests that apply controlled stresses on joints, such as cervical compression and distraction, Patrick-Fabere and Gaenslen's are extremely informative. Measurements of leg length (Fig. 2) from the greater trochanter to the lateral malleolus, determines if there is either a functional or anatomical short leg. Palpation down the entire spine informs the examiner of any subluxations, muscle imbalances, swellings, tender areas, etc. Finally, an anterior-posterior open mouth (Fig. 3), lateral cervical (Fig. 4), anterior-posterior lumbo-sacral (Fig. 5) and lateral lumbo-sacral (Fig. 6) x-rays should be taken, always in the standing position. Critical measurements need to be considered on each film, as it becomes possible to tell where a person's been in life and where they're going by viewing these films. Compared to normals, the reference points determined on these films will now become the starting point for each patient. 75% of all structural information collected on each patient comes from the x-ray series. Keep in mind there will be times when additional initial x-rays should be taken. Re-x-rays are extremely important, so minimal views should be taken on the initial exam.

Conclusion

This examination is not only for those who hurt, but should be performed on everyone as soon as possible, with or without symptoms. All athletes should be examined before a season begins with special consideration given to their sport, position and structural weaknesses. All employees should be examined before they're hired with special consideration given to their job description and structural weaknesses. Children as young as possible (x-rays should only be considered in acute cases or after the age of 12) should be examined to learn what distortion patterns exist before injuries occur. The elderly should be examined before any more degeneration takes place. Anyone and everyone needs this examination as no profession is out there educating society to the importance of structural balance and the importance of good joint health and mobility. Most of us are looking at localized areas of symptoms and subluxations, forgetting that the entire structure plays a role. We're hoping our adjustment works quicker than the pill given next door.

Chiropractic is on the verge of greatness, we just have to have the strength to defy the short-term, ineffective protocol that the industry recommends. Long-term wellness is what everyone wants, but can't seem to find. With a unified message and protocol, chiropractic can easily provide what it takes for the masses. We would go from 10% of the population to a number larger than we could handle. Until we start to think out of the box, we'll never reach our valued position in the health care industry. Hopefully, our profession will aspire to higher goals and answer the call as needed.

1) Cherkin, Dan, Ph.D., Sherman, Karen, Ph.D., Eisenberg, David, M.D., Beyond the Backache. Newsweek December 2, 2002: p. 56

2) Jarvik, Jeffrey G., M.D., MPH, Deyo, Richard A., M.D., MPH.
 Diagnostic Evaluation of Low Back Pain With Emphasis on
Imaging. Annals of Internal Medicine. October 1, 2002.
pp. 586-597

The Law of Tissue Tolerance; The key to staying uninjured

We runners are a peculiar sort. Highly irrational much of the time. We tend to always want it our way, despite the lunacy in our thinking.

“Doc, I can’t believe my hamstring is injured”.
“Well, you are running 90 miles a week, and in racing flats”.

“But, I’ve never had this before”.
“Well, you do now”.

“And I have a huge race in 3 weeks that I’ve been training hard for.”
“Mother Nature could care less about your race schedule”.

“Doc, you need to get me better”.
“Ahhhhhhhhh. Please Lord, give me just one rational patient.”

Regardless of what we want, the laws of physiology and stress will always dictate our outcomes. Many patients think I made the rules for healing. Not so. I only spread the news and help patients implement the necessary steps in getting and staying better. Dr. Jeff Spencer, Lance Armstrong’s chiropractor, once stated, “The body doesn’t care what you think, it only cares what you do.”

The Law of Tissue Tolerance

Every tissue in the body has a tolerance level. That tissue can be muscle, tendon, ligament, cartilage or bone. The goal in life is to increase all tissue tolerance as much as possible so when the varying stresses of life hit, from training to cutting down trees to slipping on banana peels to aging, we’re ready for them.

When a stress is greater than the tolerance of the tissue it’s affecting, there will be a defensive response by that tissue. If it’s muscle, there will be a tear in fibers or a reactive (defensive) constriction. This is the person whose low back “goes out”, and they’re bent to one side. Then there are stress fractures in bone when the stress gets too great. There are tears in cartilage (meniscus), and there are bulgings and herniations (bulges that have popped) in discs. Ligaments stretch and tear, and
tendons rupture. But, all in all, it’s the same thing, more stress than that particular tissue can handle at that particular time.

Unfortunately, not enough Drs. out there are familiar with biomechanics and the biomechanical imbalances that are the pre-cursors to these stresses. I always chuckle when a patient tells me they might have caught a cold in their back.

So, with this law of tissue tolerance so clearly involved in all of our lives, what can we do to improve it?

Increasing Tissue Tolerance

There are many ways to increase tissue tolerance. The most obvious is to balance and mobilize our structures. On exams, I test for “imbalances”, with digital foot scans, center of gravity scans, range of motion tests and biomechanical x-rays. Imbalances increase the demand on one or more tissue groups in the body. Identifying these imbalances is always step number 1 in helping people become less vulnerable.

Below are a list of ways you can increase tissue tolerance at home in the absence of a detailed biomechanical exam;

1. Custom Orthotics—and I prefer the flexible type that don’t restrict foot motion during the walking or running. These will balance the foundation of the body, giving any athlete an advantage. You can also get them off the shelf in running stores or department stores, but, obviously, custom are preferred.
2. The Stick—this will improve both flexibility as well as recovery of the muscles. The Stick improves toxin elimination as well as improved circulation (food and oxygen to the muscles) and should be used every day, and ideally, prior to and immediately after working out.
3. Massage—there is nothing better for the muscles than to have someone periodically work out the toxins and constrictions, as these will continue to produce a reduced tissue tolerance.
4. Nutrition—both diet and supplementation will have a huge effect on tissue tolerance, from joints (glucosamine) to muscle (proteolytic enzymes) to ligaments (minerals). Any good sports nutritionist will be able to guide you in making better decisions.
5. Yoga—mobility and flexibility are the key to keeping tissue tolerances high. Restrictions and loss of flexibility are the breeding ground for injuries and degeneration.
6. Chiropractic Adjustments—chiropractors “mobilize joints”, and a mobile joint will tolerate a significantly larger amount of stress without a negative response than a fixated joint. Only a chiropractor can evaluate you biomechanically while using adjustments to mobilze joints, and once the imbalances and fixations are determined, lay out a corrective plan for improvement.
7. Water—we all drink acid water. We were all born with an internal alkaline environment, yet the modernization of our society has converted all of our internal environments to acid. Mother’s milk is alkaline, and since 70% of our bodies are made up of water, the entire environment of our body is severely affected by the water we drink. I’ve recently purchased an alkaline water system and would recommend you do as well, since all of our health, especially the aging of all cells, is directly influenced by the pH environment in our bodies. www.Lifeonizers.com. This will also make you start looking at the pH of the foods you eat, which is only a good thing.

Best of luck, and at least you’ll now know why you’re injured, and ways you can help yourself get better.

Structural Correction: The Most Ignored Demographic: The Student Athlete

Tomorrow to no one

I remember some 20 years ago, I visited my father in the hospital. He had a "mild" heart attack, and this was big, as he'd had a major heart attack in 1972 that kept him in bed for a year. This "mild" attack occurred at the same time I was to leave town for a 1 week vacation. My father encouraged me to go, and I listened to him.

If anyone had asked me within the next hour who would die that day, JFK, jr. or my father, the answer would have been simple. But, I would have been wrong. Unfortunately, JFK, jr. died in a plane crash near Martha's Vineyard. And, my father lived. He will be celebrating his 90th birthday on February 18th of next year. Can you imagine?

The moral of the story; no one knows what day or what time it will end. We're all on borrowed time, so quit the arrogance as though you'll be here forever. Gain humility, and remember there is a bigger force (for me it is God) and you are but a player in this game of life. You have no control, only submission. So, give when you can, appreciate all the time and smile each day you wake up. It's that simple.

Today's Generation...Tomorrow

I read with much interest last night all of the latest findings on the exhorbitant costs of musculo-skeletal conditions in this country. Not only the rising costs, but the loss of quality of life. And, it's getting worse. But, the most startling news is, monies spent for research or improved treatments or improved preventive measures don't even score in the top 10 conditions we spend on, as the link to morbidity is so low. The truth is, with m/s issues, activity goes down and all other degenerative conditions grow quickly.

Now, today's middle and high school athletic community. What might they have in store for themselves? Let's start with the exam they must go through before the season begins....it's a medical exam (eyes, ears, nose and throat). Secondly, every decision parents make regarding any care their child receives is based on health insurance guidelines. The first question everyone asks is, "Does insurance cover it?". And, finally, we don't do anything until we're broken. We're reactive, not proactive.

This points to only one thing.......the cost of musculo-skeletal is going to dramatically rise in the next 25 years, while the quality of life is going to exponentially decline. More pharmaceuticals, more surgeries, more disabilities, more degenerative illness and more crisis. This is what our kids are in line for.

Please work with me to promote a new plan to change the rules this generation is guided by. Structural Management® is a clearly defined, proactive plan to change the course of events in exponential fashion. We can make a difference.

Great Idea

Mayor Emanuel, of Chicago, has stated that all city employees must enroll in a new wellness plan or pay higher premiums, by about $50. per month.

This is the approach we need. Our healthcare crisis is due to negligence by many of the laws of health that we've known for thousands of years. Many are not disciplined enough to do the work needed to prevent so many of the diseases out there today.

Every American will pay something during the course of their lifetime for the inclusion, or the absence, of effort they put in towards staying healthy. The "pay" may include exercise, dieting, good lifestyle choices, or it may include increased dollars and the loss of quality of life and increased disability. But, in the end, everyone of us will have to pay.

The misfortune is you have to pay for me and I have to pay for you. Not that I don't want to help you, but I can't afford all of you, especially when I'm working hard to stay healthy and you're watching TV and eating twinkies. So, if I have to pay for you, I'll feel a whole lot better about it if you're at least trying.

So, the answer is just what Mayor Emanuel is doing. Pay with effort or pay with money. Either way, my obligation to pay for you will go down, and that's a good thing. For all of us.

A New Day

Today is the first day that we'll actually be going into a high school to scan student/athletes for custom orthotics. We have worked for years with this school, and we have gotten the word out on the importance of injury prevention and biomechanical balancing, and today we begin the newest chapter in caring for this age group by bringing the program to the school.

We'll scan as many as possible, and continue educating and motivating more parents to join in and take the first, and best, step at keeping their child uninjured--by getting custom orthotics.

Our next step will be to set up an office in a school where we can actually treat kids on campus, at least one day per week. These kids will have already gone through an exam in our office, and this will save the parents from having to take time out to pick up their child and drive them to our office. I'm hoping sometime this year this will occur.

Long range goals; to build a model for every school district in the country to mirror, one that will provide the highest quality of care to all kids without the school district having to pay a cent. We'll keep you posted.

Let the Games Begin

We've just had the first week of high school athlete's practices, and the injuries have already begun. We've had quite a few with new injuries, several with chronic (multi-year) injuries, and still several with no injuries. This is the category we're trying to influence, as proactive is always better than reactive.

This year is going to be a great year for our program, as so many more parents and athletes are aware of what we're all about. We're going to be bringing case histories to the blog site so people can see in detail what we do, why it's better and why they need to come in.

The policy of "No Charge" for any exam, either acute or Structural Fingerprint®, is just great as it gives people the opportunity to check it all out with no obligation. And, if it makes sense and they see the value in it, then they can pursue getting treatment/rehab/supplies.

This is going to be a great year, and by the end of this school year, so many more people will fully understand the importance of "Management" of the human structure and the benefits that come with it.

Meet the parents 2011

Last night was a huge success as 2 local high schools had me present on The Structural Management® Program and why this program is invaluable, especially at this point in time. As budgets are cutting key personnel in school districts, this proactive, preventive program couldn't be offered at a more perfect time.

This year we'll see more middle and high school student/athletes than we did last year (which was a record year for us), and the new model of how a high school should run their athletic department is gaining momentum. Our staff thoroughly enjoys the great relationships we have with the many families we work with and truly believe this new model is the one that will ultimately help fix the healthcare crisis. Only time will tell.

It's a new day

We've been working hard trying to improve the overall care and considerations for the middle school and high school student/athlete. We have spent immense energy in improving our approach, and we're all excited at the start of this new school year. We've got 3-4 schools with specific teams that are going to be the beneficiary of this work, and we're all excited to see the results.

I've said for years that the industry needs to become more proactive if we ever hope to fix this healthcare crisis, and proactive is the goal for our Mission Possible Project 2011. So, stay tuned, as in the next 2 weeks we'll be initiating our first launch into these programs with great anticipation.

​High School Athletes: The New Injury Prevention Plan

Disc injuries in neck

This 40 year old male patient presented with 4 protruding discs in the mid-neck 3 weeks after going to the emergency room in extreme pain. The pain hadn't reduced much, but his frustration with getting little to no help was high.

We x-rayed his neck to see what the biomechanics looked like, and it clearly showed the neck was doing everything possible to get stress off the back portion of the discs, where the swelling was greatest.


In severe pain with discs highly acute
After 3 weeks of intense care, this patient has made an incredible improvement. One of the key treatments used was cold laser therapy, done on 12 visits during the 18 days between x-rays. In addition, the patient used much ice therapy at home.



Reduced disc swelling now allows the patient to assume an improved postural position with much less pain.

Congratulations John

John Drabik, senior at Colonie High School near Albany, N.Y., shown here after coming in second in the nationals held at the Armory in New York City this past weekend. John excels in the 55 meter run.

John has had difficulties in the past with shin splints and hamstring pulls, but has dedicated himself to biomechanical improvements and hard work, thus leading to this tremendous achievement. Great job John!

We're back

I know I've been away for a bit, but I'm back, and will be posting more regularly. Stay tuned for our take on the new Health Care package being recommended as "The Cure". Talk soon.

Building the High School Athlete Practice

Click here to read this article published in the American Chiropractor January 2010.  

Biomechanical X-Rays

Ordinary medical x-rays have become outdated and are not taken today for anything except broken bones and signs of disease. Many people have had x-rays taken and heard those famous words, “They’re negative.” Get enough negatives, and doctors now question the value of the plain film x-ray. X-rays have clearly lost their sexiness and value.

The more glamorous imaging tests are the MRI, the CT scan, the PET scan, and bone scans. These tests provide information the traditional x-ray does not. Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases, the MRI gives different information about structures in the body than can be seen on an X-ray, ultrasound, or computed tomography (CT) scan. The MRI also may show problems that cannot be seen with other imaging methods. A CT scan uses x-rays to make detailed pictures of structures inside of the body, but the amount of radiation used by a CT scan is significantly greater than the radiation used with plain film x-ray. A positron emission tomography (PET) scan is a unique type of imaging test that helps doctors see how the organs and tissues inside your body are actually functioning. A bone scan is a test that helps doctors find damage to bones, like cancer that has spread to the bones, and see problems like infections and trauma to the bones. A bone scan can often reveal a problem days to months earlier than a regular x-ray test.

So, we might ask, where’s the value in the plain film x-ray? It’s simple. We live with a pathology (disease)-based healthcare system. If there is no pathology—no tumor, cancer, or another disease showing on the x-ray film—the “expert” will claim the x-ray is “negative.” What this means is negative for disease or fractures, but not negative for biomechanical (architectural) information.

Because our bodies are biomechanical (architectural) structures, an x-ray, especially one taken with the patient standing, gives a great deal of information regarding that person’s wear and tear patterns and biomechanical imbalances. An x-ray can give a clear status report of where an individual has elevated stress in his skeletal system. There are many predictability factors that we can see when we look at an x-ray from a biomechanical point of view. We can also use the x-ray to rule out pathology. There are many silent diseases and diseases that can mimic basic strain/sprain injuries. The plain film x-ray is the least expensive and simplest screening to use to find such diseases. Finally, the x-ray gives a powerful visual picture of the situation to the patient himself. Successful cases originate when a well educated patient knows and understands what’s happening inside his body.

When we use x-rays as part of the Structural Fingerprint® exam, the number of films taken is dramatically reduced. In a standard medical x-ray series of the neck, for example, five to 11 x-rays can be taken. In the standard medical x-ray series of the low back, five views are typically taken. The Structural Fingerprint® exam begins with only two x-ray views from the front (see Figure 1) and two from the side (see Figure 2). These views minimize the patient’s exposure to radiation while still providing significant information on him. The x-rays also give doctor and patient a starting point for increased biomechanical improvement. Proper treatment and rehab can be recommended based on what these x-rays show.

Front View, Neck (Open-Mouth View)

The front open-mouth view provides much detail, especially with regard to the nervous system and the upper neck. This area of the body is typically involved in many injuries, including sports and automobile whiplashes, and the upper spine has a direct influence over the body’s nervous system, as the spinal cord exits the skull and enters the top two vertebrae, the atlas and axis. Many patients’ chronic headaches are caused by misalignments of these two vertebrae. This x-ray also shows the relationship and alignment of these two vertebrae and the skull.

The normal open-mouth view (see Figure 3) shows key reference points used to determine the status of this patient. The two short vertical lines need to be in line with each other. If they aren’t, the second vertebra, the axis, is misaligned and predictably irritating the spinal cord at that level. The pairs of arrows point to spaces on the left and right sides that should be equal in size. These spaces assure that the two top vertebrae are aligned and the spinal cord receives minimal irritation as it travels to other parts of the body from the brain. Finally, the spine needs to be centered in the open mouth.




The abnormal open-mouth view (see Figure 4) suggests stress and irritation to the supportive soft tissues (tendons and muscles) that are pulling the spine into a distorted position. It also increases the likelihood the nervous system is being irritated at that level. It’s impossible to know exactly what tissues are involved, but these types of imbalances can produce stresses at the highest level of the nervous system, and these stresses predictably will produce an array of symptoms. Symptoms that can be caused by the imbalances seen in Figures 3, 4, and 5 include headaches, neck pain, imbalance issues, digestive disorders, asthma, and allergies. As I tell patients, “Our goal is to get you closer to the norm. We know that will be better for you than what we see in your current state”.

Case Study #1

It’s not unusual to find abnormal open-mouth views (see Figure 5) in routine exams. As you can see, there is tremendous imbalance between the spine and the open mouth. There is also an imbalance between the atlas (top vertebra) and the axis (second vertebra). With six months of proper treatment and rehabilitation, however, we see improvements (see Figure 6) in both alignment and balance.




The head, which is approximately 10 percent of body weight, has a great influence on our overall weight distribution and body alignment. While there are established norms for the cervical curve of the neck, known as a lordotic curve, we also see many abnormal findings on x-ray. Let’s begin by looking at a normal side view x-ray (Figure 7). The forward lordotic curve provides shock absorption for the head. The head is approximately 10 percent of the body-weight. The vertical line running through the bones of the neck is the weight-bearing line. This is the center of gravity of the head and verifies that the weight of the head is being supported by the entire neck, not just a few segments of the neck. The disc spaces (indicated by arrows) should be equal in size with each other and basically rectangular in shape.

The abnormal side view of the neck (Figure 8) shows multiple problems. First, the weight-bearing center of gravity line lies in front of the spine, which indicates that the center of gravity of the head is creating significant abnormal stress in the lower half of the neck. Over time, the muscles and joints of the neck will become more and more restricted, which will lead to premature lower joint changes including degeneration. In addition, because the head lies in front of the rest of the body, the entire body must compensate, which can lead to stresses in all supportive muscles, tendons, and joints in the body. This leads to increased vulnerability to injuries and premature breakdown of other muscles, tendons, and joints.

Case Study #2

Figure 9 shows the lack of a normal curve and the forward lean of the neck (making the center of gravity sit significantly forward), plus premature wear and tear (degeneration) of the discs (better known as osteoarthritis) in the mid to lower neck.




The side view neck x-ray taken at the start of care (see Figure 9) shows a 46-year-old golfer who had to nearly quit playing because of neck and right shoulder pains. Within months, his symptoms improved to the point he was able to play again. The improvement, shown in Figure 10, took the better part of one year.

Front View, Pelvis and Low Back

This view reminds us of the importance of overall balance in our structure. The pelvis can rotate in many different directions and produce imbalances in our pelvis and low back, which means that the correlating muscles on the two sides of the body can be working differently. This will also affect leg length because, more often than not, a short leg is really a rotated pelvis, not a leg that’s shorter than the other. The most important issue is that imbalances in our structures are the precursors to injuries and premature breakdown. This x-ray view can show many breakdowns.

There are three key questions to ask when viewing the normal x-ray (see Figure 11). First, is the height of the pelvis (indicated by the horizontal line) even on the right and the left? Second, is there alignment between the spine and the joint in the front of the pelvis (the symphysis pubes, indicated by the vertical line)? Third, are the shapes of the obturator foramen (the two holes at bottom of the pelvis) equal in size and shape, suggesting that the pelvis is balanced on both sides? More often than not, one or more of these imbalances will be seen on x-rays, and sometimes, all three imbalances will be present (see Figure 12).

Side View, Pelvis and Low Back

The side view of the low back can show significant information that will help the doctor predict the capacity, or tolerance, of a person’s low back or the potential for disability over the course of the patient’s lifetime. This view has three key measurements: the center of gravity, the sacral base angle, and the status of the discs. This information, in combination with the other views and tests, becomes the starting point in developing a corrective program for the patient.

In the normal side view x-ray (see Figure 13), we want to look first at the center of gravity from the side. This horizontal line, better known as the Ferguson’s gravity line, shows if the weight-bearing line in the low back is ahead of, normal, or behind where it should be. We also want to measure the sacral base angle, where normal ranges between 36 and 42 degrees. If the gravity line is ahead of or behind normal, or if the angle is greater than or less than normal, the capacity and tolerance of the low back are reduced and compromised. Typically, an increased sacral base angle accompanies an anterior gravity line, while a reduced sacral base angle accompanies a posterior gravity line. Both are associated with back injuries related to where the abnormal mechanical loading falls.

Finally, we look at the disc spaces. We cannot actually see a disc on an x-ray; what we see is the space it occupies. We can then determine if that space has been compromised. (An MRI is required to determine actual disc status.) If any discs appear narrower than other discs, this is a strong suggestion that the narrower disc joint has lost normal mobility, possible due to abnormal stress through that joint or injury to that joint. The joint that typically narrows first, or degenerates first, is L5, the last joint of the low back. If another joint shows degeneration in the absence of narrowing of the L5 disc space, this suggests there was an injury there some time in the past, and normal mobility was never fully restored.




In the abnormal low back x-ray shown in Figure 14, we see multiple issues that will have a huge impact on this person’s life. First, there is a forward center of gravity line (long vertical line). This line should be going through the short vertical line, but here the body’s center of gravity is significantly in front of where it should be. This lowers the capacity and tolerance of the low back and compromises the functions of the associated muscles and joints.

Second, the sacral base angle is 56 degrees, which makes the angle greater than optimal (36–42 degrees). This also lowers the capacity and tolerance of the low back, making it less functional and more vulnerable to injury.
Case Study #3

It’s not unusual to find abnormal side views of the pelvis and low back (see Figure 15). This patient came into our office with severe and chronic low back pain. With 12 months of proper treatment and rehabilitation, improvements were made (see Figure 16).

Degeneration (Osteoarthritis) Shown on X-Rays

Abnormal mechanical loading caused by structural imbalances is a leading cause of joint breakdown. Because our standard healthcare system does not care for the musculoskeletal system, degeneration is seldom prevented. I have no doubt that this negligence condition exists in nearly all people over the age of 50. Abnormal loading leads to fixation of joints, shortening of muscles and tendons, and restricted mobility. When fixation of a joint exists for five to 10 to 15 years, a joint begins to break down and the disc space begins to narrow. There is a roughening of the tops and bottoms of the vertebrae the disc lies between, and the injury progresses.

In the neck, or cervical spine (see Figure 17), the most common joint space to degenerate first is the C5/6 disc space (arrow). Because the C5/6 joint is under the greatest stress in the neck, this joint becomes the most likely to undergo the degeneration process.

 

In the low back, or lumbar spine (see Figure 18), the joint space that most commonly degenerates first is the L5/S1 disc space (arrow). The L5/S1 joint is under the greatest stress in the low back and is most likely to degenerate.

 

Many doctors tell us that the degeneration of joints is an old person’s disease. We need to remember, however, that the joints above and below the degenerated joints may be healthy, but they are the same age. “Old person’s disease” is thus a very weak argument. Degeneration is caused by abnormal loading and negligence. It produces major losses in the quality of life and costs us massive amounts of money to treat. Degeneration needs to be addressed long before it begins.

How Early Should X-Rays Be Taken?

I recommend that children should receive their first Structural Fingerprint® exam with x-rays at age 12. The arches of the feet are developed by this age and show weakness or strength. The patient’s posture is developed by age 12, and all information is there, ready to be detected. When corrective programs are designed, no one gets results faster than the 12-year-old child.

If clinical reasons necessitate x-rays for younger children, the x-rays should be considered.