Redefining Sports Chiropractic What is our role?

© 2003 by Dr. Tim Maggs

With the popularity of sports in this country today, more chiropractors are staking their claim as sports injury experts. Even if only for marketing purposes, these "specialists" are growing in numbers.

For those who actually participate with teams or are attempting to become part of a team's medical staff, job description at some point becomes a key issue. The diversity between technique, philosophy, adjunctive therapies and sports knowledge, although an issue within the profession, has less meaning when determining how to fit into an existing staff.

On many pro teams, a chiropractor will visit the locker room on a certain day each week and adjust those players who want to be adjusted. In other situations, a chiropractor will work only in his/her office, and players will call and make appointments to be treated there. In both cases, the option is up to the player and typically the reason for the appointment is to relieve some pain, stiffness or symptom the athlete is experiencing. This also leaves the entire decision making process up to the athlete, which is usually due to some prior experiences with chiropractic.

In other instances, and usually in lower level sports, like high schools and smaller colleges, the chiropractor is encouraged or forced to take on a more expanded role, like taping and working the sidelines of games to handle many of the crisis oriented injuries. This opportunity, unfortunately, furthers the confusion to everyone as to exactly what the role of a chiropractor could and should be.

This author, for one, believes we should leave the sideline duties, as well as taping and other locker room responsibilities, to others. The role the sports chiropractor should play is so time consuming and critically important and currently not performed by any other specialist. To spend our time performing tasks that can be handled by others reduces our value and continues the ongoing ignorance in the sports community as to what chiropractic is all about. It also puts us in a continual competition with other professions, increasing their ongoing efforts to keep us out of the locker rooms. Chiropractors should never have to compete with the trainer, physical therapist or team medical doctor. Our roles and value should make everyone, from players to medical staff to owners or administrators, beg for our involvement.

The Chiropractor's Role

In the most sophisticated sports conditioning programs today, the best that happens is that the strength coach evaluates players for body structure, strengths and weaknesses. This information is then translated into a conditioning program. However, less sophisticated programs (and majority) put athletes on strength and conditioning programs based on their sport or position. Very few base the program on the athlete's specific structural needs. The reason for this is that no member of the team's medical staff knows how to structurally evaluate an athlete. This type of evaluation, if ever done, is only done after an athlete is injured, and the goal is to heal injuries. Any structural information gotten on the exam, however, is never used to improve conditioning.

The new role of the chiropractor is to provide structural management to athletes and teams. This program begins with a complete structural evaluation, learning quantifiable information that can educate the athlete as to the specific imbalances, distortion patterns and weaknesses that need to be addressed. These evaluations should be done pre-season. In most situations, medical exams are done pre-season. These exams, for the most part, do not include any structural testing. Since most sports injuries are mechanical, or structural in nature, it makes sense that someone perform structural evaluations before the season begins. Corrections should not be based only on symptomatic involvement. Since structural imbalances can accelerate degeneration and increase the likelihood of injury, they should be immediately addressed with treatment, supports, nutrition and exercises as soon as they're found.

The Structural Management® Program

The Structural Management® Program begins with the premise that each and every athlete has a totally unique structure. The only way we can ever know the specific needs of that structure is to perform an examination highlighting weaknesses, imbalances and distortion patterns. The Structural Fingerprint® Exam is done for that purpose. Many college and pro athletes who utilize chiropractic use the adjustment for relief of some form of symptoms. Very few of them have been educated to use chiropractic for the correction of structural distortions, and with this exam, quantifiable evidence can be shown to the athlete and become the basis for setting up a corrective structural management, and strength and conditioning, program.

The Structural Fingerprint® Exam

As structural specialists, we need to begin looking at the athlete as an architectural structure. If the athlete were a building, balance would be important. In the athlete, this translates into reduced likelihood of injury and increased endurance. Improved balance and joint mobility would improve performance, as the athlete's structure would better tolerate increased stress loads from both competition and conditioning.

This exam begins with a visual exam of the athlete in the standing position. Postural information should be noted, such as high shoulders and hips, internal or external rotation of the knees and feet, increased or decreased lordotic and kyphotic curves, etc.

It is then followed up with a complete foot exam (Fig. 1), which includes checking the medial arches of the feet and the Q angle of the knees. Full range of motion of all key joints, as well as muscle tests, leg length measurements and basic orthopedic testing, such as Lasegue's, Bilateral Leg Lowering, Patrick-Fabere and Gaenslen's will provide valuable information. Palpation of the entire para-spinal regions will show muscle tension imbalances and subluxations.

The most important testing in this exam is the standing x-ray. This provides the unique information that becomes a reference point for beginning structural correction. Most patients have never been evaluated from a biomechanical point of view, nor have they learned quantifiable information about their structures. Standing x-rays will give 75% of the information needed to determine an athlete's structural fingerprint. This information also puts chiropractors head and shoulders above all physical therapists, massage therapists, strength coaches, medical personnel, trainers, etc. We become THE authority for structural management.

The basic x-ray series should include an A-P open mouth and lateral cervical as well as an A-P and lateral L-S X-ray. These should always be done in the standing position with shoes off. On the normal open mouth view (Fig. 2), there are some basic findings that should be measured. The alignment of the odontoid process with the SP of C2 should line up. Any non-alignment is suggestive of a rotation of C2. The atlanto-axial and atlanto-odontoid spaces should be equal in size. Finally, the occiput should sit evenly on the spine. On the normal lateral x-ray (Fig. 3), the important biomechanical findings are the lordotic curve, the disc spaces and the gravity line, which should go through all cervical vertebrae. If the gravity line is ahead of or behind the cervical spine, then the abnormal weight bearing will produce an acceleration of degenerative changes as well as an increase in potential injuries in the cervical spine. If injured, the degree of injury can be greater and the time needed for recovery can be prolonged. With all abnormal findings, a corrective program becomes critical, and chiropractors are the most viable candidates for diagnosing and treating these imbalances.

X-rays of the L-S spine should be A-P and lateral. On the normal A-P (Fig. 4), the iliac crests are level, the spine is straight and in alignment with the pubic symphisis. The obturator foramen are equal in size. And, obviously, no pathologies are present. On the normal lateral L-S (Fig. 5), the disc spaces should be well maintained, the sacral base angle should be 36°-42° and Ferguson's gravity line should bisect the anterior third of the sacral base. Again, any abnormalities should become the starting point and reason for a corrective program.

The Advanced Conditioning™ Program (ACP)

Under the assumption that all people, including athletes, have never been thoroughly structurally evaluated and biomechanically corrected, it is assumed that the individual is living in a "deferred maintenance" state. Correction is mandatory to reduce the likelihood of injury and allow the athlete to tolerate a greater capacity of structural stress. The program is most effective in the absence of symptoms. If symptoms are present, it is better to eliminate them first.

The goal of the ACP is to improve balance, joint mobility and muscular flexibility. If these three objectives can be met, the amount of stress an athlete's structure can tolerate before breaking down increases exponentially. In the world of sports, this service provided to a team can become the most important service that team has available to it.

The corrective program is a 6 month program. Prior to the first adjustment, custom fitted orthotics are recommended if any of the following were positive on the exam; pronation of either foot, supination of either foot, a difference between the right and left arch, foot flare, an increased Q angle, an abnormal sacral base angle or an abnormal Ferguson's gravity line. Chiropractic adjustments start at 3x's/week for 6 weeks, then the frequency is reduced to 2x's/week for another 6 weeks. Treatments then go to once/week for 14 weeks. Any complimentary physical therapy can be used. The purpose of the adjustments is to re-educate the joints and supportive structures of the normal motion that should be within each and every joint of the body. With normal joint mobility, again, there is an increase capacity of stress that will be tolerated much better before injury occurs.

In addition to the adjustments, a specific exercise program is set up to attempt to improve any abnormal structural findings, such as an abnormal Ferguson's line or sacral base angle. Muscle imbalances are a key part of structural imbalances, and cannot be ignored when attempting to correct the structure.

The Maggs Muscle Management™ Program

This is the final component of The Structural Management® Program. This program allows each and every athlete to manage their own muscle system multiple times per day. Ideally, this should be done prior to working out and after working out. It can be done during a work-out or a game as well.

The objective is for the athlete to encourage blood to all major muscle groups while helping to eliminate harmful toxins from the muscles (Fig. 6). The Intracell Stick® is the tool of choice in allowing an athlete to treat themself. Blood carries food and oxygen, and will support the muscle for better performance. Also, when blood is encouraged into a muscle, stretching will have a much greater benefit, as the muscle is now warm. Greater flexibility of a muscle will also allow reduced injury potential as well as improved performance potential. This aspect of the program now provides the chiropractor with an extremely beneficial means for addressing muscle injuries, as well as an advanced method for preventing injuries and accelerating recovery.

Conclusion

Chiropractic has fought for years to be accepted, yet we currently treat 10-12% of the population. We fight to get into locker rooms, and once in, we assume the role allowed as a small part of the existing medical model that currently doesn't know how to diagnose or treat mechanical injuries. Or, we try to mimic our medical colleagues, as though that's what a good sports doctor does.

With The Structural Management® Program, every chiropractor has the opportunity to become the sports expert in their community. No other profession remotely compares to performing any of the above listed duties that are so critically needed by every athlete alive. With a willingness to look at the athlete from an architectural point of view, this program allows for a more comprehensive and marketable approach for all chiropractors in their community. This is also the beginning of finding common ground for all chiropractors to subscribe to in an effort to unify our profession. It is then we will begin to see an abundance of patients far greater than 10-12% of the population.

Repetitive Motion Injuries in Sports and Industry Prevention and Management Program

© 2003 by Dr. Tim Maggs

Repetitive activity is the breeding ground for many injuries in both the sports world as well as the workplace. Much research has been conducted in an effort to find better postures, ergonomic strategies, exercises and more effective supports. Despite the benefits to date, much more can be done.

Understanding basic muscular physiology will suggest that more attention needs to be paid to the warm-up, recovery and conditioning of repetitively used muscles. Most muscular injuries are a result of under-recovery of muscles, and these injuries consist of many of the low-back, neck, hip, carpal tunnel and other injuries we see everyday in our offices. By applying a consistent muscle management program, prevention and recovery of these over-used muscles can be improved greatly.

Basic Physiology

Regardless of the muscles that are repetitively used, the physiological process is the same. Increased muscular use increases the production of harmful toxins that will accumulate in the fibers of involved muscles. With this accumulation, a domino-like effect takes over. The blood flow is decreased, the fibers shorten, and the muscle now becomes as effective as the shortest fibers, thus increasing the potential for injury and reducing the performance potential of the muscle. If accumulation of these harmful toxins could be addressed and managed earlier and on a more frequent basis, a reduction in the time frame and incidence of these injuries will occur.

The Maggs Muscle Management™ Program (MMMP)

The application of deep pressure over a muscle multiple times per day will produce two results; the first is and influx of nutrient and oxygen-rich blood to the treated muscle. Secondly, harmful toxins will be broken up and flushed out of the muscle and back into the system. This is the first step in aiding a muscle to recovery. The use of the Intracell Stick® (Fig. 1) is one means to address these muscles. The rolling pin-like device is rolled over an entire muscle, in both directions, 20-30 times. The pressure is to tolerance, and this exercise can be performed by individuals on themselves.


Fig. 1

Preparing a Muscle for Activity-Warming Up

Once rolled, a muscle is now better prepared for stretching (Fig. 2) as the muscle is passively warmed. Flexibility exercises become more beneficial once a muscle is warmed, and this passive warming of a muscle reduces the risk of injury while maximizing the benefits to the muscle. The muscle should then be put into a mild, static stretch for 5-7 seconds. If time allows, each muscle should be rolled and stretched 2 times. There is a technique for all major muscle groups, and should be encouraged both before and after activity. If used in the workplace, this exercise could and should be performed at respective workstations.
Fig. 2

Enhanced Recovery

Under-recovery is the usual cause of most muscle pulls, tendonitis' and other related syndromes. Under-recovery is usually the result of increased muscle activity with minimum muscle management. Accumulated toxins produce shortened fibers predisposing an individual to injuries. Rest will allow injuries to symptomatically heal, however, the muscle will become injured again once activity resumes. Until full and complete recovery can occur in a muscle, there will always be a limited potential of that muscle. These are the injuries that keep individuals on full disability, keep surgeons busy and keep costs soaring in both sports and industry.

Once a muscle has been exercised, either in a practice, a game or in the workplace, the muscle now resembles a clenched fist, making it difficult for blood to enter for recovery purposes. Using Mother Nature's time frame for recovery, the time frame is longer and far less complete. The greater the activity and accumulation of harmful toxins, the longer a muscle will take to recover. Unfortunately, game schedules and work schedules are more demanding than what many muscles can handle. This lack of recovery ultimately leads to injury.

With the application of the MMMP, blood is encouraged back into a muscle, increasing the recovery nutrients needed, as well as eliminating harmful toxins before they can accumulate, increasing the rate of recovery in the muscle. The application is the same as the warm-up recommendation---roll the muscle 20-30 times, to tolerance, and then gently stretch the muscle for 5-7 seconds.

Research has shown that a muscle has a "recovery window" that ranges from 15-30 minutes after a muscle is exercised. It is during this window of time that a muscle is most hungry for recovery nutrients (that are carried to it by the blood) and will produce best results when attempting to get a muscle to recover, whether it be from exercise or injury.

Muscle Injuries

The same recipe for muscle care applies to all muscles, but the actual exercise and tool used may vary depending upon where the injury is. For example, plantar fascitis occurs on the base of the foot. These tendons and muscles are highly vulnerable to injury and inflammation for a variety of reasons. The first and most obvious reason is the amount of stress they endure during a typical day. For athletes and employees alike, the amount of force that goes through the feet is the very reason so many end up with injury. Secondly, the footwear may not be adequate from a support point of view. Thirdly, most athletes and employees have never had a thorough foot evaluation to determine foot type, proper shoes and if custom-fitted orthotics are indicated. Without these supports for those who need them, injuries are typically just a matter of time before they become evident. Finally, the muscles and tendons of the feet are not managed correctly, and when this can be implemented into an individual's schedule, proper blood flow and improved recoverability will take place. As seen in (Fig. 3) the Foot Wheel? is an ideal tool to address trigger point accumulation in the feet.
Fig. 3

Carpal tunnel syndrome costs industry millions and millions of dollars per year. As stated earlier, the same physiological changes cause the many symptoms experienced by a huge percentage of our workforce. Repetitive activity leads to shortening of fibers, and these changes produce pain and fatigue in the forearm, tingling and numbness in their hands and weakness in their grip. The Trigger Wheel? (Fig. 4) is highly effective in addressing the primary sites of trigger point accumulation. The proximal posterior forearm (Fig. 5) is a well-established site for trigger point accumulation that has a direct relationship with the incidence of carpal tunnel symptoms.
Fig. 4

Injuries such as low back, calf and hamstring pulls, as well as many other common injuries, respond well with the use of the Intracell Stick®. The advantage with using a tool such as the Intracell Stick® is merely that a larger area of the body can be addressed in a reasonably short period of time, and people have the ability to perform these exercises multiple times on a daily basis. Much of the research that has been done with regard to trigger points never considered the ability for multiple applications per day. But, with this new, self-applied program, results are superior to any prior recommendations. The combination of rolling and stretching the muscle produces a far greater effect than just doing trigger point work on a patient.

Conclusion

The entire neuro-musculo-skeletal industry under-serves the public. The very fact that treatment is only considered once an injury occurs should awaken all of us to the need for management and prevention. In industry, key boards are split in half and work-stations are rearranged, but no one ever talks about physiologically altering the very muscles that are repetitively used and under-recovered. Until we begin to address these muscles, limited benefits will be the best we can hope for.

Secondly, the public needs to learn that treatment for injuries is the most elementary approach to keeping costs down and employees and athletes well. Prevention through pro-active involvement is the only way we can really begin to make improvements in the current state of affairs. Keeping muscles clean, well-circulated and flexible would make a magnanimous difference in the amount of money saved vs. the cost of providing for the injury, disability, worker replacement costs, etc.

In a recent Newsweek article, new general manager Theo Epstein of the Boston Red Sox states, "If we can make our pitchers 25% healthier, that's worth tens of millions of dollars and is a huge competitive advantage". These are words of a visionary, and this muscle management program provides the very difference that Epstein is talking about. How do you make a muscle work longer with less likelihood of injury? It's simple, keep it clean on a daily basis and encourage a continual flow of food and oxygen to keep it at it's healthiest state.

What industries will benefit the most from this program? Sports and industry. Immediately, they will recognize improvements. But, it's up to the chiropractic profession to grasp onto a program such as this, and then begin the laborious process of educating our communities to a new and better way. With a growth of chiropractors subscribing to this approach, momentum will eventually turn in our favor. For, it's been far too long since a revolutionary approach has been handed to our communities, and chiropractic has the opportunity to become this messenger.

Why All Runners Need The Stick®

© 2002 By Dr. Tim Maggs

It was January, 1993, when I first met Dr. Andrew Bonci. I was 6 years into my lifetime crisis, chronic calf pulls. My last marathon, April, 1987, was the beginning of a continual string of calf pulls, tears, strains, aggravations, whatever you wanted to call them. My life was reduced to 3 mile runs, and any attempt at more than that produced yet another pull. My entire circle of people were runners, yet I stood on the sidelines unable to run, or explain why.

Over this 6 year period, I visited orthopedists, chiropractors, acupuncturists, nutritionists, physical therapists, massage therapists and anyone who would listen to my story. The most humbling lesson learned through this experience was that no one, and I mean NO ONE, knew anything about muscle physiology. Sure, they all wanted to tell me how to heal the present pull, such as stop running, ice the injury, etc., but no one could tell me how to prevent the next pull. And, during this 6 year period, I estimate 50-60 pulls in both calves, different locations and different degrees of injury. I was truly alone and at a loss for solutions.

Dr. Bonci was the very first person who made any sense at all. He impressed me the first time I spoke with him. He talked about muscle physiology, about the damage that is done with each workout, the accumulation of toxins that occur in a muscle with repetitive use, and the means to address this physiological change in a muscle.

The Stick®

Dr. Bonci went out to his car and brought in a rolling pin like device. He called it The Stick®. I asked him what I was supposed to do with it, and he showed me how to roll it on my calves. Being desperate, I rolled my calves as I talked with him. The immediate sensorial response was wonderful. Regardless of whether there was any residual value or not, it still felt good. The next morning, my calves felt better than they had in the previous 6 years. I had no knowledge as to why, but after my 6 year saga, I didn’t care why. Over the next 2 years, I persistently used this tool, and my daily mileage climbed to 7 mile runs. 7 miles was a gift sent from heaven. Anything more than that was beyond comprehension.

The Maggs Muscle Management™ Program

Over the last 15 years, we’ve learned a lot. We now have research programs explaining why this technique helps with chronically pulled muscles, tight muscles, fatigued muscles and many other muscle based conditions. Florida State University did a PhD thesis on why this program helps with strength, flexibility and strength. The results were all positive.

Repetitive use of any muscle increases the toxin accumulation in a muscle, thus reducing the blood flow (oxygen and food) to a muscle. This produces a tightness in specific muscle fibers, and this tightness is the precursor to all muscle conditions. With a program that manages the muscles on a daily basis, all runners can eliminate conditions such as chronically pulled muscles, tight muscles, hip and ilio-tibial band syndromes, plantar fascitis, and many other conditions. The key is to keep muscles clean and well circulated instead of just stretching a toxic, poorly circulated muscle. The only way this can be done is to have the ability to massage the muscle multiple times per day, such as before you exercise, after you exercise and even later in the day. If you can practice these simple guidelines, you free yourself from the likelihood of joining the “pulled muscle support group”, a group you desperately need when you can’t get back to running, but despise if you’re running well.

If you roll a muscle, then stretch the muscle, the muscle becomes thoroughly prepared for activity. If you do the same after a workout, you can accelerate the recovery of that muscle. If you feed the muscle with proper nutrients, before, during and after, The Stick helps to drive nutrients into the muscle, increasing the recoverability of the muscle. With the epidemic proportion of muscle problems among runners, these guidelines will dramatically help all runners to stay out on the roads instead of spending time on the internet looking for that magical answer.

After 14 years of forgetting what it’s like to cross the finish line of a marathon, I returned to the list of marathon runners with my completion of the Vermont City Marathon in 2001. This monumental moment in my life re-enforced in me that anyone can improve if they are willing to step up and do what is available, not what is recommended by their managed care provider. I now have 3 marathons under my belt since that time, and hope to continue at a rate of 2 per year. My philosophy is that anyone running 2 marathons per year will perpetually stay in reasonably good shape. The joy I live with now exceeds my ability to express myself, and the tears and smiles I’ve shed since finishing that 14th marathon are indescribable.

When it was all said and done, my success originated with my meeting Dr. Andrew Bonci and his willingness to show me some simple product known as The Stick. My goal today is identical to what it was immediately following my first use of The Stick; every athlete would want one if they knew about it. I still believe this to be true, and my mission is to introduce it to all runners.

Redefining Sportsmedicine

© 2002 by Dr. Tim Maggs

Sportsmedicine has grossly misled athletes today. Athletes are educated wrong and suffer because of this inadequate education. The only time a runner would ever consider seeing their sportsmed provider is when they’re injured. This would suggest there is absolutely nothing beneficial that can be done for a runner prior to an injury. Imagine if the auto, financial and dental industry functioned with those guidelines.

Secondly, there is no insurance coverage for un-injured runners. Insurance guidelines are designed for the masses, primarily those who don’t exercise, who are not conditioned and whose body’s break down from under-use and abuse. The conditions they suffer with, and the insurance coverage will provide for, are far different from those who use exercise as a big part of their life. They suffer with diabetes, heart disease, mental disorders and other degenerative illnesses. Overuse injuries, the need to get back quickly and structural problems are not descriptive terms when talking about the 7 out of 10 who don’t exercise. And, to date, I’ve not heard of any insurance rider that will specifically cover athletic injuries. It’s ludicrous that an athlete must attempt to fit their square injuries into the round hole of insurance guidelines. They must first wait until they’re injured, then begin with their primary who typically has no knowledge of typical sports injuries, who then refers the injured athlete to the next in line. As I will discuss in a bit, most athletic injuries are from overuse syndromes or structural imbalances and distortions. The “specialist” who usually gets the referral is looking to quickly, and cost effectively, help the athlete to eliminate the symptoms, but who is looking for the underlying cause?

Conditioning and Injury Prevention

This is the necessary path if good fortune in injury prevention is the goal. And, what athlete has any other goal than a long and healthy career? We must think differently, act differently and be different if we want results better than what the masses are getting. We must act today in doing the things that are now available to us in an effort to improve conditioning and prevent injuries. And, if you become injured, the first call should never be to your primary. They are just not prepared to deal with you or your maladies.

The Structural Management® Program

As years have gone by, I’ve recognized more and more how futile our present industry is for the appropriate care for athletes. The result is the development of several programs that will help athletes to have a more successful career, either preventing injuries or treating them effectively. The Structural Management® Program is made up of 3 programs; The Structural Fingerprint® Exam, The Maggs Muscle Management™ Program and The Advanced Conditioning™ Program.

The Structural Fingerprint® Exam is a structural exam that can be performed on every athlete with or without symptoms. Obviously, we encourage athletes to be examined before their season begins, as structural defects and imbalances can be detected anytime. It’s always easier to locate these defects when the athlete is not symptomatic, but it’s hard to change the thinking of athletes to do anything until they have symptoms. Once examined, we often find the athlete is suffering with many deferred maintenance conditions, and proper treatment and exercises is necessary to correct these conditions before they become a full blown injuries. This exam consists of physical tests as well as standing x-rays, looking for structural imbalances and wear and tear.

The Maggs Muscle Management™ Program is a program designed to keep the entire muscle system functioning at peak capacity. After my 8 year hiatus from running with over 70 calf pulls, my persistence helped me find people around the country who could help to keep muscles clean, improve circulation, increase warm-up, accelerate recovery from workouts and injuries and improve performance. During the development of this program, I missed 14 years of marathoning, but am pleased to say I’m back to 2 per year. This after not being able to run more than 3 miles without a calf pull for 8 years.

The final program, The Advanced Conditioning™ Program, is the treatment and rehabilitative program designed once imbalances are detected from The Structural Fingerprint® Exam. This program is a 6 month program, and is one that every athlete would benefit from. With the data collected on the exam, the goal is to objectively improve range of motion in all joints, improve flexibility of key muscle groups, improve alignment and other structural measurements, as well as help the athlete to move further and further away from the vulnerability line of injury. At the end of 6 months, re-x-rays should show improvement in balance and alignment of the structure. This program should be a once in a lifetime program, and once done, the athlete should be put on a maintenance program, with specific exercises and treatments to keep them well.

Conclusion

Until athletes begin caring for their structures and muscles on a pro-active and preventive basis, they will most likely end up as victims in this current health care system that really has no place for them. In an effort to avoid these frustrations and enjoy more time out on the road, the above recommendations should help you go a long way.

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.

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.

Shin Splints and Stress Fractures

by Dr. Tim Maggs, © November 1999

Q: My 14-year-old daughter is being treated for a stress fracture in her right tibia, mid shaft. She is a competitive runner, having run for 6-7 years. This is her first year in high school and they run 2.5 miles in cross country. Over the summer, her training consisted of increments in mileage to where she was running around 30 miles per week once the season started. She first began complaining of pain in the shin, but was still able to run. She ran hard for two races after her initial complaint and thereafter was unable to even jog without pain.Diagnosis: Stress Fracture.

This situation is all too common, as this condition is typically found in adolescent runners. During these prime growing years, we need to implement a better management of the biomechanics and muscular systems of our young runners. We should never wait for symptoms to move us, as symptoms are a clear indication we've pushed the envelope too far. With competition as fierce as it can be in junior and senior high school students, we should at least give these young athletes a clean bill of "structural" health before they attack the season.

Shin Splints and Stress Fractures

Shin splints and stress fractures are typically a result of repetitive motion injury in one or more supportive muscles in the lower leg. Very often, these muscles work without ever fully recovering before being asked to perform again. All athletes use similar muscles as they participate in sport specific movements, and runners are subjected to this same scenario. Unfortunately, young runners seem to have lower leg problems more frequently than older runners, probably a mere result of growing and having a musculo-skeletal system which is not yet fully developed.

Also, our sports medicine industry doesn't provide pre-season structural exams, which would pick up imbalances, structural defects or any other causative factors that influence the onset of these type conditions. All kids should be biomechanically evaluated before, during and after the season because our structures are like our fingerprints, totally unique. The only way anyone will ever know who is predisposed to injuries or who needs structural rehabilitation prior to a blowout is with this evaluation.

Biomechanical Exam

A thorough history should be taken to determine pre-existing conditions, prior traumas or any other influencing factors. The evaluation should then consist of a leg-length check, a visual exam of the athlete in the standing position (ear heights, shoulder heights, shoulder blade heights, hip heights, arm lengths, etc.) The spine should be checked for any obvious, gross curvature problems. Range of motion of the entire spine should be done to rule out fixations and abnormal motion. Pulses, respiration and blood pressure should be taken.

The evaluation should also check for range of motion of the hip joints, the knee joints and the ankle joints. The feet should be checked for pronation, supination or any other abnormalities. Shoes should be checked for abnormal wear and tear. Muscle strengths should be checked, right vs. left and front vs. back. Reflexes and sensory tests would round out the exam. If possible, low back x-rays should be taken in the standing position to determine the angle of the pelvis, the weight bearing line through the low back and any other supportive information, which can be seen on an x-ray.

Treatments

Now that the young athlete is suffering with either shin splints or a stress fracture in the lower leg, crisis care is needed vs. preventative care (if a pre-season evaluation had been done). The first thing the athlete needs to do is develop a strategy, which will include giving the leg time to heal. Reduce or eliminate workouts until acuteness is down. Ice treatments should be used 4-5 times per day, with a wrap around the involved area. The repetitive motion of the involved muscles has most likely produced a tight, non-compliant muscle, which has accumulated toxins and a deprived blood flow. The shortening of this muscle is the cause of the increased tension and slow recovery of the muscle after workouts. A deep pressure massage needs to be done multiple times per day to this involved muscle. It's easiest for the athlete to perform this on himself or herself, and applying some lotion under the thumbs makes for a more comfortable treatment. This should be done two or three times per day. Proper nutritional supplementation, to promote healing and reduce inflammation, is also a benefit.

Finally, getting that biomechanical exam is still a must. Just because it is now post-injury doesn't mean that this critical information isn't needed. The future will hold far fewer problems if weak, imbalanced and stressed areas of the body can be detected before injuries occur. With a proper evaluation, correct treatment and rehabilitation and management of the program, all athletes can greatly reduce and minimize future problems such as horrid shin splints and stress fractures.

Piriformis Syndrome - A Real Pain in the Butt

by Dr. Timothy J. Maggs, © 1999

If you've ever felt pain in the hip, pain in the center of the butt or pain down the back of the leg, you are likely suffering, at least partially, with piriformis syndrome. The piriformis is a muscle which runs from your sacrum (mid-line base of spine) to the outer hip bone (trochanter). This muscle truly works overtime on anyone who runs at all.

The muscles in and around the gluteal region help with three areas

1. rotation of the hip and leg;
2. balance while one foot is off the ground; and
3. stability for the pelvic region.

Needless to say, all of these characteristics are highly needed by runners.

Conclusion--the piriformis muscle is pretty important for all of us.

Injuries to the Piriformis

This muscle is a prime candidate for repetitive motion injury (RMI). RMI occurs when a muscle is asked to perform beyond it's level of capability, not given enough time to recover, and asked to perform again. The typical response from a muscle in this situation is to tighten, which is a defensive response of the muscle. This tightness, however, manifests itself in several ways to a runner.

The first symptom suggesting piriformis syndrome would be pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint producing a bursitis. Again, a bursitis is an inflammation of the fluid filled sac in a joint caused by an elevation of stress and tension within that joint.

The second symptom suggesting piriformis syndrome would be pain directly in the center of the buttocks. Although this is not as common as the other two symptoms, this pain can be elicited with direct compression over the belly of the buttocks area. A tight muscle is a sore muscle upon compression due to a reduced blood flow to that muscle.

The third symptom suggesting piriformis syndrome would be a sciatic neuralgia, or pain from the buttocks down the back of the leg and sometimes into different portions of the lower leg. The sciatic nerve runs right through the belly of the piriformis muscle and if the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, tingling and numbness.

Simple Physiology

Any muscle repetitively used needs to have an opportunity to recover. This recovery can either be on Nature's clock, or can be facilitated and sped up with proper knowledge and treatment. Since the muscle is tightening due to overuse, continued use will only make it worse. This injured muscle needs to relax and have increased blood flow encouraged to it for more rapid healing. This tightness that exists also reduces the normal blood flow going to the muscle reducing the speed with which the muscle can recover. To encourage fresh, oxygen-rich blood to the muscle is the most powerful means of getting the muscle to begin to relax and function normally. Multiple massages per day to this area is greatly encouraged.

The next step in this "recovery" process is to use a tennis ball under the butt and hip area. While sitting down on the floor, roll away from the side of involvement and place a tennis ball just inside the outer hip bone under the butt area. As you begin to allow your weight onto the tennis ball, note areas of increased pain and soreness. Trigger points will tend to accumulate in a repetitively used muscle, and until these toxins are manually broken up and eliminated, the muscle will have an artificial ceiling with regard to flexibility potential and recovery potential. So, if it's sore and hurts while your sitting on it, you're doing a good job. Let the ball work under each spot for 15-20 seconds before moving it to another area. Once you've been on the ball for 4-5 minutes, now put the ankle of the involved leg over the knee of the non-involved leg (crossing your legs). Now place the tennis ball just inside the outer hip bone again and work the tendon of the piriformis muscle. While this pain is typically excruciating and takes some time to effectively reduce, the benefits here are huge. Be patient, be consistent and good things will happen.

Additional Treatments

Due to the fact that the sciatic neuralgia and the hip bursitis or tendonitis are both inflammatory in nature, ice, or cryotherapy, over the involved area 15-20 minutes at a time will be beneficial. This should be done multiple times per day.

Stretching of the hip muscles should not be done until the acute pain is gone. At that point in time, begin with gentle stretching, such as the cross-legged stretch while pulling up on the knee. The muscle should have increased flexibility before an active return to running.

Finally, I'm always discouraging the use of pharmaceutical anti-inflammatories. Not only do they greatly aggravate the intestines, but they also suggest an artificial wellness that can lead to bigger problems. Proteolytic enzymes, such as bromelain, are both natural and extremely beneficial with no side effects. For more information, visit your health food store or check out Rehab Plus on our website.

Until next time, remember, they can't throw dirt on you if you're moving, so keep on running.

Repetitive Motion Injuries

by Dr. Timothy J. Maggs, © 1999

After more than 75 calf pulls between 1987 and 1995, I believe I qualified as a professional patient. All of the emotional and physical setbacks that come with these life altering, or at least schedule altering, injuries for a runner were like a bad neighbor I couldn't get away from. Ironically, it was through my eyes as the patient, not as a sportsmedicine specialist, that made me truly see the void in the treatment menu available to the sick and broken.

Repetitive Motion Injuries

Repetitive motion is a term frequently heard when discussing industrial injuries. Many jobs involve the same motions with similar activities and, especially with people who aren't conditioned, injuries occur. But, when talking about athletics, specifically running, we've never heard repetitive motion spoken in the same sentence as calf pull, hamstring pull, ilio-tibial band syndrome, low back pain, plantar fascitis, patellar tendonitis, achilles tendonitis orhip pain. After living far too long as a disabled patient and desperately looking for that"glorious glass of water in the desert", I realized that all of these injuries were nothing more than repetitive motion disorders. Muscles fail to recover fully before we ask them to perform again. And when we push a muscle beyond what it is capable of doing, bad things happen. None of the specialists I contacted during my 8 year war ever suggested a solution, they could only think in terms of "after the fact" recommendations or symptomatic relief. This gross void in our sportsmedicine system reverberated loudly in my brain. I wanted to know how to keep these pulls from happening.

The Domino Effect

First of all, tightness and soreness in a muscle is a precursor to all of the conditions mentioned above. The more a muscle is used, the more it will produce and accumulate toxins and waste products. Many of these waste products localize into barrier trigger points, or nodules along a muscle fiber which prevent a muscle from generating force and functioning to full capacity. These trigger points are sore with localized pressure. Once a trigger point develops, the blood flow is reduced to the muscle, fibers in the muscle shorten and now we are forced to train or race with a muscle that's set up for a blow-out. And, should you make it through this particular race or workout, the likelihood the muscle will fully recover for your next effort is bleak at best. Ultimately, Mother Nature will win.

Solution

The Maggs Muscle Management™ Program was developed out of desperation. I couldn't accept anything less than an answer, and no one, but no one, offered any hope at all. My running consisted of a couple 3 mile runs per week. Hardly the distance needed to compete or to run a marathon.

In 1992, almost by accident, I met a muscle specialist, Dr. Andrew Bonci. He had an in-depth knowledge of muscles and injuries I hadn't heard from any of my prior experts. He showed me the importance of locating and eliminating barrier trigger points on a daily basis. Dr. Bonci explained how these toxins, which typically form in priority muscles, will ultimately force a muscle to break down if left unattended. In fact, he claimed this was the underlying cause of my calf problems. Skepticism and ecstasy shared brain space and I couldn't wait to learn which emotion would prove worthy.

Using techniques designed by him and others, coupled with stretching and nutrition, I began the long process of rehabilitating my calf muscles which had been deprived for so long of nutrient rich blood and oxygen. By using his myofascial release program, I was able to get blood to all muscles multiple times per day and significantly improve the flexibility of these muscles. There was an almost immediate awareness of benefits and improvement. I was able to work out the tightness and could feel the warmth and life come back to these oft-injured compatriots of mine.

As I began to sense improvements, I couldn't help but test the waters. I attempted my favorite 11 mile run, one I hadn't even considered for 8 years prior. Upon successful completion, it was like a religious experience. I couldn't imagine, after all these years, I was given back the opportunity to run. The joy could only be known by one who has lost something of value, only to get it back when least expected. Since then, I've been able to run 35-40 miles per week, when the schedule allows. With the knowledge and experience we've gained over the past 5 years, this program has expanded into complete warm-up techniques, thorough recovery exercises, acute injury/chronic injury treatments and performance enhancement exerices. They can all be performed alone, without the assistance of anyone else and can be done anywhere, including home, office or track.

Never again will any of us have to hear the words, "You might have to stop running", from an uninformed "specialist". You most likely are suffering with a classic repetitive motion injury. Just apply the basic myofascial release, stretching and nutritional techniques, and you, too, can get back to your life quickly and permanently. Best of luck

Ilio-Tibial Band Syndrome (ITBS)

by Dr. Timothy J. Maggs, © 1999

For many who ultimately join the ITBS Club, the injury has similarities to a bad neighbor. Your initial hopes are that it isn't really there, but as the pain worsens and reality sets in, you slowly begin to go through personality changes, weight loss and even marital problems due to the tremendous aggravation and stress it produces.

For those unfamiliar with this very common syndrome, pain on the outside of the knee that worsens with time should be considered as ilio-tibial band syndrome until proven otherwise. It can become a debilitating condition and, unless the underlying cause is addressed, it generally will return.

Causes

The primary cause of this condition is that it is a repetitive motion disorder; that is, we repetitively use the involved muscle without ever allowing full recovery. Our body's defense system produces an inflamed situation, which we feel as pain, tightness and swelling, so we hopefully obey the laws of life a little and stop the offending exercise and work to correct the condition. The underlying and influencing factors that contribute to the onset and duration include leg length difference, worn shoes, uneven running surfaces, increased mileage and lack of proper warm up and cool down. All of the thigh muscles, including the quads and hamstring, are victims of this repetitive motion in runners and are vulnerable to the same fate. Repetitive motion disorders are also commonly found in industry today and manifest as carpal tunnel syndrome and low back pain. These are but two of the more common work related injuries causing severe financial burdens and frustrations to many employers and employees alike. All too often, treatment deals only with the symptoms, and this condition requires causal treatment to alleviate it.

Primary muscles used in any activity repetitively require specific attention or they will slowly tighten due to an accumulation of unwanted toxins and a reduction of normal blood flow (nutrition and oxygen) to the muscle. The situation producing symptoms experienced in and about the knee are similar to the tightening of a violin wire. As the muscles of the front and lateral (outside) thigh begin to tighten due to increased exercise and a diminishing supply of blood flow, the tightening begins to affect the ilio-tibial band, and that's when symptoms begin.

Correction

Much like any other structural condition, corrections should be instituted based on logic, simplicity and cost. Surgery would never be my first recommendation to any runner, regardless of the degree of symptoms. The first step would be to incorporate some form of anti-inflammatory treatment immediately. This would accompany a "no running and no stretching" period to increase the likelihood of breaking the pain cycle without producing further damage. Icing for 20-30 minutes at a time (5-8 times per day) is a must. Some type of ace bandage or elastic support would also benefit the injury. An anti-inflammatory, such as motrin or naprosyn, is a good complement. All natural anti-inflammatories are preferred, such as bromelain, but any agent is better than none for the immediate interest in breaking that pain cycle.

Now that the inflammation is being addressed, the underlying cause must be addressed. The repetitiveness of the muscle use produces a congested, tight and contracted muscle/tendinous situation. Multiple massages on a daily basis to the muscles above the symptomatic sight is critical. It is mandatory to increase the blood volume coming to the muscle belly, while reducing the internal muscular pressure above the tendon in an effort to improve circulation, thus lengthening the muscle through relaxation of the fibers. This lengthening will take much of the stress off the tendon and allow the healing process to begin to go to work.

There are a couple methods for massaging the involved area. One is to have a friend work the lower half of the outside of the thigh with their thumbs for 20-30 seconds at a time. This can be repeated 4-5 times per day to encourage blood volume to the muscle. The massage should start about half way