Do You Know Your "Structural Fingerprint®"?

by Dr. Tim Maggs, © March 2000

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

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

Structural Fingerprint®

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

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

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

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

Biomechanical Evaluation

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

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

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

Corrective Program

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

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

Building a Sports Doctor Network - It's Time

by Dr. Tim Maggs, © February 2000

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

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

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

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

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

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

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

Sportsmedicine Online

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

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

High Standards

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

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

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

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

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

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

by Dr. Tim Maggs, © February 2000

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

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

Muscle Management

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

The Program

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

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

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

My Success

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

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

Fibromyalgia: It's All About Muscles

by Dr. Timothy J. Maggs, © 2000

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

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

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

The Condition

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

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

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

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

Testing

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

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

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

Treatment

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

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

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

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

Removing the Obstacles

by Dr. Tim Maggs, © 2000

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

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

Mental and Physical Obstacles

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

1) Lack of Discipline

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

2) No Time

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

3) Injuries

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

4) Lack of Enthusiasm

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

5) You're not a self-starter

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

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

Case History of an Injured Runner

by Dr. Tim Maggs, © 2000

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

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

Seeking Answers

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

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

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

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

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

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

Conclusion

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

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

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

Recovering at the Speed of Life

by Dr. Tim Maggs, © 2000

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

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

Physiological Changes

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

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

Recovery

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

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

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

Optimal Muscle Recovery (The Book)

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

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

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

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

Why Kenyans Run So Fast

by Dr. Tim Maggs, © 2000

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

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

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

Living With Kenyans

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

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

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

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

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

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

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

Paying The Price

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

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

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

Pro Locker Room Conditioning For Kids Chiropractic's Integral Role

by Dr. Tim Maggs and Coach Al Miller © 2000

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

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

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

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

Athletic Jacket

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

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

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

The Tripod Evaluation

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

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

Psychological Profile

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

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

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

Biomechanical Exam

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

Treatment Recommendations

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

Fitness/Conditioning For Kids

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

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

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

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

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

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

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

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

Conclusion

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

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

Sidebar

Biomechanical Exam

Visual Exam (For symmetry, heights and balance)

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

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

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

Range of Motions

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

Muscle Tests

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

Deep Tendon Reflexes

Sensory Tests

Measurements

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

Varus/Valgus

Toe-In Check

Lateral Arches

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

Orthopedic Tests

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

Trigger Points

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

X-Rays

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

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

Low Back Syndrome - A Simple Solution to a Chronic Problem

by Dr. Timothy J. Maggs, © 1999

Statistics claim that 80% of all Americans will, at some point in their life, suffer with low back pain. For the 20% who have never experienced the likes of this, don't get too comfortable. With man evolving from a 4 legged creature at one time in our distant past to a 2 legged, 20th century, cosmopolitan athlete, no one can assume that the finger of bad luck won't point at them, especially when we add the sport of running to our activity list.

Low Back Syndrome

Low back syndrome encompasses many different conditions, but the one common thread between all of them is pain, stiffness, soreness or radiation somewhere between the mid-back and the butt. All of these symptoms suggest strongly that something is wrong. Through experience, I've learned that most runners apply the "American Dream" approach to resolving the problem; they hope the symptoms are gone by morning. Others, however, apply the "Helpful Neighbor" approach; "it's probably just (I love the word 'just') an acute spondo-hypo-lumbago-whatever, just like I had, and my doctor, who's the absolute best in the whole world, said to apply heat, relax and it will probably go away on it's own. No need to worry". Needless to say, and trust me on this one, neither of these 2 approaches offer much hope for the future of a runner. And if any other uninformed recommendations are made by the well-intentioned but clinically inept, please walk away. Please don't debate, question or discuss. Just smile, thank them and walk away.

Low Back Protocol

When suffering with any type of low back involved condition, the first step is to identify the cause of the symptoms. All peoples' backs are similar to their fingerprints; very unique. And if you never identify the uniquities of your back and spine, you'll never develop the appropriate treatment and therapy that you need to correct and improve your condition. For example, any symptoms can be a result of congenital problems (abnormalities in the back that you're born with), pathological problems (some disease process that's going on), some structural imbalance (the most likely cause) or some repetitive motion condition which causes muscles to contract and spasm causing discomfort and pain. But, you can be sure that your back pain is due to something. And, the specific cause requires a specific treatment, especially if wellness and long term correction is your objective. Most importantly, forget the"specialist" who recommends only some medication to alleviate the symptoms. This will never solve your long term problems.

Of all the tests which can be done to determine specifics with low back conditions, I rely primarily on the x-ray to give me the critical information needed. Obviously, a thorough history as well as a good physical exam will assist any practitioner in developing a working diagnosis. But, without standing x-rays of the low back, any "specialist" is shooting in the dark if they make an attempt to identify the problem.

Solutions

The very first objective any practitioner should have is to rule out pathologies, or disease, as a causative agent of low back pain. I remember several years ago, I had a middle aged patient with vague low back pain enter my office. I went through the standard protocol, and after x-raying him, we learned he was suffering with an abdominal aortic aneurysm. It's the first and last time I saw an abdominal aortic aneurysm as the cause of low back pain, but due to the fact I did the correct testing, we were able to find out that he didn't belong in my office. He was in surgery within 2 days and the surgeon told him if he'd gone another 2 days without knowing this problem, he'd probably be dead. That's how important it is to know if you're dealing with a pathology or a structural problem. And if your doctor doesn't want to take x-rays of your low back and you have low back pain and haven't had them in the past few years, consider a doctor who will take them.

In most cases, however, the cause of the pain is structural in nature. With typical structural imbalances, some area of the body is always vulnerable to an increased level of stress. With the stresses of normal life coupled with the demands of running, it's not unlikely that most runners could have low back problems at some point in time. How to deal with them now becomes very important.

Once a thorough history, exam and standing x-rays have been done, it's important to have a doctor who can interpret the results and communicate them to you. Even though this sounds like a simple task, my experience is that it is few and far between who can do it all. Cherish the doctor who will make you feel confident in what he or she has found and help to manage you through both the acute and chronic phase.

Finally, a good chiropractor, osteopath who prescribes manipulation or good massage therapist is usually required to determine all of the above and correct it. For any runners who can't find the person who'll guide them through, feel free to contact me and I'll help you get the best help possible. The key is, never ever give up.

Hamstring vs. Sciatica

by Dr. Timothy J. Maggs, ©1999

One of the more difficult diagnoses to determine is that of an athlete with pain in the back of the thigh and into the buttocks. A pulled hamstring can often mimic a sciatic neuralgia, often known as sciatica. Both conditions can be debilitating and the appropriate treatment, both immediate and long term, is critical for improvement. The problem is the treatments are significantly different, so an incorrect diagnosis can delay recovery and encourage further injury.

Hamstring

The hamstring muscle is attached to the base of the buttocks as it attaches to the ischial tuberosity, which is that area of the butt that hurts after you've ridden your bike too much too soon. It runs down to the back of the knee. The function of the hamstring is to flex the knee, as happens during every stride when running. Every time the heel approximates the butt, the hamstring is doing it's job.

Usually, a pull will occur in one of two places--either in the belly of the muscle or at the attachment point at the top of the leg. Localized pain in either of these areas might be caused by a pulled hamstring. If activity such as walking or bending your knee increases the pain, and inactivity reduces the pain, a pulled hamstring is the likely diagnosis.

Sciatic Nerve

A pinched sciatic nerve is a completely different condition and should be addressed very specifically. The sciatic nerve is the largest nerve in the body. It originates as branches at the lower joints in the low back and it unites to form a nerve the size of your little finger. It then runs through the middle of the buttocks and down the back of the thighs to the knee. At the knee, it branches into two separate nerves--one continuing down the back of the calf and the other down the outside of the leg to the ankle.

Signals that suggest sciatica are varied. Radiating pain can originate in the lower back and run through the buttocks. The pain can continue down the back of the leg and possibly into the calf or the ankle, and it can be sharp. The straight leg raise (lay on your back and have someone else lift the involved leg, which remains straight, off the ground) will generally produce pain. A history of low back problems can also influence the onset of sciatica. There can also be tingling or weakness in the leg. If any of these symptoms are present, sciatic neuralgia is a likely diagnosis.

When you have a preliminary diagnosis, you can then take steps to alleviate the symptoms and the condition. Home treatment can be attempted initially. If improvements are too slow, however, or there are continued flareups, the need for professional help may be indicated.

Treatment

With a pulled hamstring, the muscle has gone through overuse and needs to heal. Localized massage will provide significant benefit as it helps to flush the muscle and increase the blood flow, which will produce a more rapid healing. Stretching should be avoided initially. Ice should be used if there is pain and inflammation. Once the pain is reduced, moist heat might be beneficial, again to increase blood flow to the injured area. Some period of rest is needed to allow for healing. Also, if necessary, an elasticized brace or support may be indicated as well as physical therapy. Obviously, you always want to do as much as you can at home to reduce unnecessary costs. When treated at home, however, discipline is the key.

Sciatic nerve involvement is generally a little trickier to solve. Conservative, at home treatment might work if the condition is a first time condition. If the condition is chronic, professional help may be indicated. At home treatment consists of some period of rest, ice to the low back (15-20 minutes at a time, 4-5 times per day) and anti-inflammatories (all natural, if available), if necessary. The tennis ball technique under the buttocks muscles several times per day for deep specific massage is beneficial as it forces relaxation of the gluteal and hip muscles which often reduces pressure on the sciatic nerve.

The cause of sciatica can be from many different conditions, such as a low back strain, a degenerative disc, a protruding disc, piriformis syndrome, hip problems or some pathology. This is when an accurate diagnosis and professional help becomes critical.

Always find out the specific cause, and the likelihood for a more rapid recovery goes way up. Too often, we hope for the American dream ("Hopefully, the problem will be gone in the morning"). Very seldom does this treatment method work. Running is a repetitive motion and the low back, gluteal muscles and hamstring absorb much of the burden making the area prone to injury. Apply a little logic and patience and your career as a runner will last a lot longer. Good luck.

A New Revised Health Plan - Going Offensive in Your Quest

by Dr. Timothy J. Maggs, © 1999

For those tired of only doing something about your life after you've hit bottom, read on. There comes a time in life when you have to take a step back and assess your method of operation. If you're happier than anyone else you know, as healthy as you want to be and don't live from medication to medication or therapist to therapist, this article may not be for you. But for most of us, we need to read on.

New Scoring System

In this country, we have grown to believe the only time you call a doctor is when you're sick. That philosophy has extended over into our financial life as well as our legal life. I've heard most lawyers don't have wills. If this is true, it confirms my point. The reason for this is simple, most of us live life on the defensive rather than the offensive. We never address problems until they are active, real life problems. By this point, you're fighting an uphill battle and getting control of a situation becomes far more difficult.

But fight you must to get into a position of strength and offense with regard to how you run your life. Our new scoring system is not going to recommend help only when you're sick or broke or confused. It's going to talk about doing necessary exercises everyday in your life so that the cumulative effect over 50 years produces a more fulfilling life rather than one that never quite reaches a level of health, wealth or happiness.

We see health at three levels:

1. Vibrant health is the highest level of health and should be sought by all of us. We should work hard everyday to reach this level.
2. Declining health in the absence of symptoms is the second level.
3. Symptomatic life (Code Blue) is the third and lowest level of health.

We need to incorporate those habits that will continually improve our health in that undying effort to get back to vibrant health and to stay there.

8 Secret Steps

1. Nutritional Supplementation - It is time to accept that none of us will ever eat the perfect diet, so do the next best thing, supplement your diet. We all have very specific needs and there are hundreds of products out there to choose from. If confused, talk to an authority.
2. Sleep - I consider death is the only "cure-all" that God has given us, but sleep is the closest thing to a "cure-all" while still offering us an opportunity to enjoy our future. A good 6-8 hours a night on a quality sleeping surface is a must if you hope to reach that ripe old age of 80. Nothing in life can be good after a lousy night's sleep.
3. Exercise - Exercise should not be looked at as excitement nor should it be looked at only for vanity reasons. Exercise is the essence of life. It personifies the Pain Theory, which states that all of us will be much happier in life if we voluntarily include some level of painful activity on a daily basis so that we're better prepared for unexpected pain when it comes. It also strengthens many parts of the body and mind and gives you a good reason to feel more comfortable when drinking a post-exercise beer!
4. Chiropractic - This has nothing to do with me being a chiropractor. I don't even practice anymore. This has to do with the fact that the nervous system is the electrical system of the body. If nerve energy has restrictions or interference in the spine, i.e. the joints of the spine become locked up, known as a subluxation, then we're going to experience some level of dysfunction. This can either be pain, tingling, numbness, weakness or reduced vitality of organs, glands, muscles, etc. Chiropractors specialize in locating and correcting these subluxations of the spine. As runners, the abuse our backs take and the joints that lock up make a good chiropractor a runner's best friend.
5. Diet - Just because it's tough to eat a good diet doesn't mean you shouldn't continually work on it. The difficulty in eating a good diet will never cease, but the benefits are huge and well worth a gold medal effort. I try to live by the 85/15 Theory, which states that you should do the right thing 85% of the time and do what you want to do (within reason) 15% of the time. The critical part of this theory is to overwhelmingly enjoy yourself when you're cheating. If you feel guilty, you're not following this theory and if you happen to become sick, alter the ratio until you're well again. Finally, read Nancy Clark's column every month. She'll keep you on track.
6. Attitude - you are what you think. Cheer up!
7. Great Music and Good Humor - Listen to Livingston Taylor if you don't know what I mean.
8. Medication - Only when the above 7 steps didn't do the trick.

Finally, remember that health and happiness takes effort. Good habits will get you there the quickest. Follow the above the best you can and you'll soon qualify as the happy man in Mark Twain's saying-- "Someday you'll meet a happy man with nothing and realize you paid too much for your whistle".

Headaches Runners Need to Know: "Why?"

by Dr. Timothy J. Maggs, © 1999

Of the many maladies runners suffer with, none should get the level of sympathy that chronic headaches command. The perfect punishment for a worst enemy, who happens to suffer with headaches, is to make them run step after pounding step for 5 miles a day, as their head explodes with each and every stride.

Many runners today suffer with both constant and intermittent headaches, and unfortunately, many doctors seem to miss the boat with regard to accurate or beneficial diagnoses. Any doctor who just writes a prescription in the absence of proper testing should----well, should be injected with headache juice and forced to run 5 miles per day.

Know the Cause

If any treatment is ever recommended for your headache without a full description of the cause of the headache, feel free to exit quickly and go to Doctor #2. Headaches can be caused by a host of problems, and to ignore the exact cause for "relief only" borders on lunacy. You must know why you have your headache before you can ever work to correct the cause. Some doctors out there forgot that "cause" matters. And for many Americans, they've never thought in terms of "cause". But, if symptomatic relief is the level your bar is at, you stand the distinct possibility of getting worse with time and finding that the level of medication you take today won't even begin to touch your pain tomorrow.

There are several common causes of headaches. Most people who suffer with headaches suffer with one or more of these conditions. You must use a doctor who is skilled in the following areas to hope for an accurate diagnosis and treatment; blood sugar, hormonal imbalances, stress and subluxations of the joints of the cervical spine (neck). Although there are more severe disease processes which can cause headaches, such as brain tumors and aneurysms, it is most common to have the more correctable causes listed above as the underlying criminal

With blood sugar and hormonal imbalances as the cause, diet plays a significant role in improving the condition. Although it is very difficult to eat a great diet these days, (a great diet consists of whole grains, seasonal vegetables, fruits, legumes and nuts), it is much easier to supplement your diet with nutritional supplementation specific for your needs. In this situation, there are dietary tests which can be given to determine what hormonal imbalances exist or what specific blood sugar problem is present. For example, blood sugar involves the liver, adrenal glands, pancreas and digestive organs. Many, many people suffer with imbalances in the blood sugar system and will never find resolution until they nutritionally balance their diets. The answer is to do as well as you can with your diet and then be willing to supplement for specific weaknesses.

If any testing is needed, a 5 hour glucose tolerance test (GTT) is the most accurate test to give the specific information needed. Most medical doctors frown on the 5 hour GTT as the only information you'll find after the 3rd hour is that your blood sugar drops significantly. This is critical information, but, if low blood sugar is found, the only effective treatment is dietary. Most M.D.'s are not trained to think nutritionally, so their interest in finding low blood sugar is minimal. A 3 hour GTT or a 2 hour post-prandial is virtually worthless unless you have diabetes.

Now, if blood sugar or hormonal imbalances aren't the cause, then think in terms of your neck and the base of the skull, especially if you've suffered with some prior neck trauma, like a whiplash injury. This area of the body has a tremendous influence over all of the body, and any misalignment or fixation of the joints at the top of the spine can pinch nerves that will cause headaches. In fact, many migraines are a result of the atlas (the top bone of the spine) being in an abnormal position. If the headache occurs over one or both eyes, think in terms of the 2nd bone, the axis, as being out of position, as there is a nerve that exits near the axis and affects this area. Any mis-alignment of that bone will produce an irritation of that nerve.

Solutions

For the majority of headaches, I would recommend two providers, a nutrition oriented health care provider and a chiropractor familiar with runners. Make sure whoever you go to gives you a specific cause and treatment schedule. If it's nutritional, get an idea of what you can expect. If it's structural, make sure you can see the misalignment on the x-ray. If it's blood sugar, make sure you see the 5 hour GTT results that show a drop in blood sugar (below 70 at any point). Be careful with anyone who recommends symptomatic treatment without verification of your condition.

And last but not least, never stop searching for the answer to life. It is out there.

Herbs For Runners?

by Dr. Timothy J. Maggs, © 1999

I recently read an article in the L. A. Times about herbal products and the popularity they were gaining in this country. I've always been a proponent of nutritional therapy, and the thought that the "trend" is all of a sudden catching up with my beliefs of 20 years or more is, well, heartwarming.

According to this article, a national survey was done 2 years ago and found that 45% of Americans were aware of or had tried herbal products and 16% used them regularly. The same study, just completed, found that 70% are now aware of or have tried herbs while 40 percent use them regularly. Not only are these products gaining popularity amongst the masses, but staid medical journals recently published scientific studies on herbs and indicate the conventional medical community is also beginning to take notice.

"It's no longer a fringe movement," said Mark Blumenthal, executive director of the American Botanical Council. "Herbs are no longer folklore. People are finding out there is research to support the scientific side of it."

Herbal History

Herbs have been used by many groups and countries for many years. Authorities believe the future of herbal medicine will depend on ethical collection, organic cultivation and the protection of the natural environment. Ethical collection of wild plants was first taught by the Native Americans. Their reverence for plant life was symbolized in the prayer of gratitude offered before collection. It was their practice to only collect every third plant, knowing this would ensure a continued supply. Early medicine, in fact, used practices which today might be confused with those of herbalists or homeopaths.

Modern medicine, along with the pharmaceutical industry, grew significantly about the same time our country transformed from an agricultural nation into an industrial nation. As we entered the 1940's and 50's and farmers began moving to the cities, society accepted"artificial" in their trade for convenience in both food preparation and healthcare. The use of drugs and artificial food ingredients rose dramatically. Flavorings, colorings and preservatives were on the rise. As we entered the 60's, 70's and into the 80's, Americans began to recognize that, although they were living longer, they now led the world in degenerative disease and their quality of life was declining. Moving into the 90's with the baby boomers at the helm, they decided "enough was enough". They would have nothing to do with anything less than the best, including healthier foods and more natural medical care. Wrinkles, aches and pains once again have brought people back to herbs, and the cycle continues.

Most Popular Herbs

Now that herbs and other natural remedies have gone mainstream and are no longer the sole domain of health food purists, which are the most popular and what do they do for you?

Whole Foods Magazine recently surveyed a group of retailers and consumers to find out what the most popular herbs being sold today were:

1. Echinacea. There are different forms of echinacea, but all of them provide relief for cold and flu symptoms. In fact, this is the third year echinacea was ranked number one.
2. Garlic. This boasts a host of benefits, including reducing blood pressure and cholesterol and helping to prevent colds and other infectious diseases.
3. Ginkgo Biloba. This reportedly improves circulation to the brain and lessens ringing in the ears.
4. Goldenseal. This, too, is a popular remedy for cold and flu symptoms.
5. Saw Palmetto. A truly interesting herb, saw palmetto has shown to dramatically improve benign prostatic hyperplasia, or enlarged prostate. This condition plagues men 40 years old and above. Traditional lore surrounding the plant also includes a prolific reputation as an aphrodisiac.
6. Aloe. This acts as a laxative taken internally and a skin treatment externally.
7. Ginseng. This increases resistance to stress and provides endurance energy.
8. Cat's Claw. This reportedly boosts the immune system.
9. Astragalus. This is supposed to have immune enhancing properties.
10. Cayenne. This relieves pain.

The survey also found that St. John's Wort is expected by retailers to be the hottest selling herb this coming year as the media touts it as "Natures Prozac".

Conclusion

When all is said and done, keep in mind there are no miracles in health care. Yes, herbs can offer a better and more natural approach to wellness, but they cannot override poor health habits. Exercise, quality sleep, good nutrition and a good attitude are still necessary to ever capture all that life has to offer. As I tell my kids, "The Dirt Road" is the only way. Pay now rather than later. Herbs do offer relief of symptoms and a more natural approach, but they need to be a complement rather than a cure.