Tri-Synergy Chiropractic - High Point Greensboro NC

New Year's Resolutions

2012-01-16T20:16:00.000-08:00

Did Santa leave extra weight under your tree?

How are your New Year's resolutions going? Did you make any? Nearly half of all Americans made a resolution this year--and two weeks in, about 70% of you are still going strong. The most popular resolution is losing weight, increasing exercise or changing eating habits. Let's look at the evidence to successfully make changes.

We need to soak in good information. We do need fats, carbs, and proteins to thrive, but we need them to accompany nutrients. This is why pop, sweet tea, and other simple carbs are "empty calories". When we take in calories without fiber, vitamins, & minerals, we miss the most important part. As Dr. Robert Lustig said, "Wherever there's fructose [sugar] in nature, there's way more fiber. The only exception is honey, and that's guarded by bees!"

Make a resolution that will last--make a lifestyle change. Most people require a change of food types, portion control, and exercise intensity. Make sure you include all three. Decide on specifically what you will eat, what you won't, and how much you're going to move in a day. Then tackle the biggest challenge of all: personal identity.

Evaluate your attitude. Are you fighting your desires? Are you leaning on your willpower, guilt, or shame to help you make new choices? Long term change requires a positive, curious view of one's self. You are encouraged to be creative about how you might succeed in the future, taking one step forward at a time.

Seek an identity shift. If you view yourself as a cookie lover, it's going to be very difficult to step away from cookies--but if you identify as a former-cookie lover, you will more easily avoid a less-healthful input. Perhaps you've experienced this with boxed mac & cheese, fish sticks, or other child-focused foods you no longer eat. If you identify as someone who loves a certain food, you will eventually breakdown and consume it. If you recognize that you are a new person--someone who is making new choices, you won't have to use willpower alone to overcome temptation.

I hope you are encouraged to make a healthy choice in this new year. If you wish you made a resolution weeks ago, tomorrow is a great day to start. Look for healthy, wise advice--and seek to be curious and positive about your new identity. You may discover that you've been hiding a love for bok choy, kale, or brussel sprouts beneath those carbs. Happy Belated New Year!

Fighting obesity...

2011-12-01T15:47:00.000-08:00

...of the Backpack

Our children are carrying too much weight, and I'm not just talking about their bodies. We have a problem we can solve immediately: the weight they carry in backpacks.

Some children are carrying 20, 30, or even 40% of their body weight on their backs. Imagine: a grown man carrying a 3rd grade child around on your back at work--it would look ridiculous, because it is ridiculous! Students should not be compromising their bodies for books and gear; we need to be smarter. Let's talk about solutions:

First: weigh your child--then weigh their backpack. It should be no heavier than 10% of their body weight. If they are 80 lbs, this means 8 lb pack; 120 lb child = 12 lb pack. Review every item and determine need. Their health is more important than any school supply and a duplicate book copy is much cheaper than a doctor's visit.

Second: check the fit of the pack. Select a small to medium sized pack to prevent over stuffing. Encourage utilizing both straps, resting on the middle of the collarbone, not the edge. Ensure the pack rests in the small of the child's back, not on their hips or glutes.

These encouragements apply to children of all ages. Poor bag ergonomics can create back, neck, shoulder pain. Yes, this goes for purses too. [Tiptoe carefully, Dr. Anthony :) ] If your child has symptoms which might relate to their backpack, a chiropractor, physical therapist or other trusted physician may offer great help with a return to good form. Don't let pain or dysfunction go unaddressed. It is not "growing pains" to have symptoms from carrying too much for our body.

Decisions, Decisions

2011-11-03T16:10:00.000-07:00

Do you remember what it was like to buy a bicycle...or a television--it was probably a little confusing. You might have started your research online then visited a local store to mosey up and down the aisle trying to figure out how much you had to spend to get what you wanted. Will it last? Is this the right size?

It can be difficult to purchase a durable good, and even more difficult to make a health care decision. You may start your research online by entering symptoms, only to find how many diseases you may have--most of which you've never dreamed of pronouncing. Osteochondral...who? Tenosynovitis...what?

Just as with durable goods, there's a lot of misinformation out there about your health. Wouldn't it be nice to have a helpful guide--an advocate--to sort through the decisions? "I wish my doctor had time for questions." The best physicians, doctors who have the most success in health improvement, are those that take time to understand their patients experience. They take time to answer questions and share knowledge so that an informed decision can be made.

Information and wisdom is important in buying the right refrigerator, and it's even more important when making decisions about your health. I encourage you to seek out doctors who have time for you, and who treat you with patience and empathy.

Scorn or Delight: Life as a Chiropractic Physician

2011-08-31T18:11:00.000-07:00

What does "chiropractor" bring to mind for you?

I enjoy when my title is brought up in social context, because folks are rarely shy about sharing their perspective about my field of doctorate. I imagine more pleasantries are offered for lawyers, real estate agents, pastors, and even customer service workers. Something about Chiropractic Medicine conjures the desire to share a story. The anecdote usually goes one of two ways: it's a love or concern kind of statement.

Often, I hear about how a chiropractor in some distant city was a savior to the family--resolving numerous and surprising ailments. This is the kind of doctor I would like to be: a physician who touches patients' lives, offering sound counsel and taking the time to empower people to live more fruitfully.

I also hear the "concerned" side--and too often. Sometimes it starts with: "Do you know [so-and-so]? He cracked my neck once even though I'd asked him again and again to not do it. It hurt my neck more. It was so jarring. I had to stop after 3 months of visits, and he was still arguing me to stay."

I can't share strongly enough how much this story upsets me. Both for the disappointing experience the patient had and also the future hesitancy for the patient to seek the best care possible (which may be a chiropractor). I have committed my practice--our entire office--to delivering chiropractic care that promises 3 things:

1) We will not advise treatments that aren't helping you or you don't want. We are not definied by our ability to adjust joints. There is so much more we can do including soft-tissue therapy, rehab exercises, and nerve entrapment release. Treatment should be comfortable.

2) We do not promote long term care. You should be seeing significant improvement every week. Patients understand that we don't use magic, but our average patient is finished in 3 visits. 30 visit averages and promotion of "maintenance packages" is unfortunate, manipulative, and not usually in the patient's best interest.

3) We will take the time required to solve the issue, including refer you to another specialist if that is what we think is best for your pain. We spend on average 30-45 minutes PER patient and reserve 90 minutes for our new patient visits. We put our actions where our heart is.

I hope the next time you bring up "a chiropractor I like" that you are able to talk about a different experience you've had a Tri-Synergy Chiropractic.

Tri-Synergy's New Intro Video

2011-08-02T13:30:00.000-07:00

We are very excited to share our introduction video. Tri-Synergy Chiropractic is Greensboro - High Point, NC's leading Chiropractic resource for gentle joint manipulation, Active Release Techniques (ART), and functional exercise rehabilitation.

Is it a pinched nerve? My neck is killing me!

2011-07-21T15:20:00.000-07:00

Have you been told your neck or back pain was caused by a pinched nerve? Have you heard a friend describe this issue or concerned you may be at risk? Fear not--this description is often not accurate and not likely.

A "pinched nerve" refers to the space just next to the spine, where spinal nerves exit from the spinal cord and travel towards fingers, toes, and all the organs of the body. If you've had pain anywhere from your neck to your fingertips, or low back down to your toes--you may have worried it could be a pinched nerve. The space provided in the low back is more than enough for the nerves to fit through. In fact, the space can often degenerate more than 50% and still have no symptoms! The space in the neck is sufficient for the nerves to travel through even with inflammation.

In the chiropractic world, a pinched nerve is often described as the "garden hose theory", similar to a hose losing water pressure when it is kinked or someone is stepping on it. This theory has no proper scientific evidence and should be disregarded as an explanation for treatment.

So if it's not likely a pinched nerve, what causes such pain?

The evidence points to irritation, adhesion, and perception. Yes, just as the brain is powerful enough to let a grandmother lift a car to save her child or a football star finish a game on a broken ankle--your brain is powerful enough to misinterpret irritating signals as significant pain. That means something can hurt really badly but not be very dangerous. Our brains have an imperfect ability to perceive the level of danger. As I remind my wife, the drive to skydiving is far more dangerous than actually jumping out of the plane. Yet our brains have decided that the skydiving is more intense than anything else, just as irritation to a nerve--not a pinched nerve--can be more intense than other insults.

Adhesions are like cob webbing around tissue and can create tension instead of smooth, easy gliding. Improper growth of connective tissue can create these stubborn changes, specific manual therapy can quickly eliminate these problems. This leads to a more fluid tissue motion, whether it's muscle, nerve, tendon, ligament, or fascia. Treating a "pinched nerve" should be focused on direct manual therapy and exercises that calm, release, and gently move the area. This is the best way to avoid surgery, speed healing, and return to feeling normal. Find a chiropractor, physical therapist, massage therapist, or physician who is focused on helping you move again, without relying on drugs to numb it or surgery to cut it.

Why does my back hurt so much?

2011-06-28T15:56:00.000-07:00

Why back pain and neck pain are different than arm or leg pain.

I hear from patients frequently: "I didn't do anything that I remember", "I lifted some things this weekend but nothing out of the ordinary", or "I'm worried that I'm about to break!"

Intense back or neck pain can be very startling--even scary. When pain appears without a specific incident or accident, it's hard to understand. Neck, upper back, and lower back pain can feel like you're headed towards paralysis and not able to return to the activities you want to do or even need to do. But why does neck pain or low back pain seem so much more challenging that wrist or ankle pain?

I suggest we remember that our neck and back muscles are most often controlled by the sub-conscious while our arms & legs are more often controlled by conscious decisions. You actively choose to move your arm to reach in the fridge, but you probably put little thought into all the back muscles you need to hold your body in front of the fridge. In that same way, our brains are able to discriminate more clearly what is happening to our elbow, while we have a greater challenge sensing where the pain is coming from in the back. I am often told: "it hurts everywhere in my neck". Which is another way of saying: "I can't tell where it's located."

If you're experiencing neck or back pain, visit a chiropractor or physical therapist whom you trust. Once a thorough exam has ruled out scary things (which would suggest more immediate or aggressive intervention), you can proceed toward conservative treatments knowing they are likely to help the most and have the least risk. Conservative manual therapy (including manipulation, soft-tissue treatments, Active Release Techniques, and exercise) works so well because it treats the source of the problem, which is often that muscles, nerves, and ligaments are irritated. The best way to calm them down is by providing calm, soothing input. The kind of input that is gentle on the body, feels good, and helps you return to the activities you want to accomplish.

Attitude for Success: Making long term body changes

2011-05-30T15:34:00.000-07:00

Last week, Jim came into my office finding it near impossible to walk. He was supposed to be golfing with family in three days. He had low back pain that had gotten worse over the past 2 months, a sharpness like a knife that prevented finding any comfortable position. Fortunately, we were able to show him the exercises that would help his back calm down, and he was able to play 72 holes within 72 hours. This is not the most amazing part...

...he came back from the trip and asked to learn what he could do to prevent that pain from ever returning.

Eliminating pain is exciting, and patients are--of course--glad to be out of pain. Preventing future incidents is additionally rewarding. Because I take much more time per patient than most physicians, I enjoy a unique opportunity to calm fears and educate for the future. There is often exercises in rehab or activity that will prevent pain from returning in the same way. I want to highlight the best start towards prevention which is a healthy mental attitude. In three steps:

1) Loving Curiosity: An attitude of curiosity and acceptance is crucial for lasting changes. You must view your problem as a experience you are having, not a fault or failure. Instead of thinking, "I have horrible posture" or "I am lazy and never exercise", you might ponder, "what get's in the way of me exercising?" or "what type of activity would I like to do?" Too often we close the door on change by attacking the one we're trying to help: ourselves.

2) Seeking a plan: Steps toward prevention most often include (a) optimal movement, (b) increased sleep, and (c) healthful diet. Is there an area you would like more information on? Do you think you could use an expert opinion on how to move, what to eat, or how to attain more rest? Ask your physician or friends if they know an expert in that area. Browse a few blogs and get some simple tips. You could even comment on this blog and we'll continue the dialogue. Be encouraged to take small steps, but keep stepping forward.

3) Following through: This is not about willpower. Repeat that to yourself. You will not continue activity which you do not truly enjoy. You cannot force yourself to participate in something you find miserable or undesirable. Dream of activity you would like to do, imagine how you might feel with appropriate rest, and how delicious healthful food might taste. By all means, if you find yourself slowing momentum or worse yet, quitting--stop and return to step 1) Loving Curiosity.

You can best help someone you love, equipped with fresh ideas, and continuing to take small steps forward. Best wishes on seeking the changes you desire!

Medicine at a Crossroads

2011-03-17T15:52:00.000-07:00

The dying art of patient care

When you last went to the doctor, did you feel they tried to listen and explain...or did it feel like he took a guess at which medicine was going to make you better? Did you feel more like a patient or a customer at a diner?

Our nation is engaged in a potent discussion over medicine, mostly over who is going to pay the bill. Who gets coverage? What coverage do we get? Important questions. More importantly, who's making these tough decisions? I believe we're missing a huge issue about what role a doctor plays in our care. It's like we're at the dealership haggling over price and financing without asking what car we get. If we end up without a listening expert who will help us make good health choices, what car are we driving? I believe now more than ever, we need an expert adviser who will help us negotiate questions of surgery, medications, and therapy options.

Psychiatrist Dr. Donald Levin offers an example of the compromises currently demanded by our health care decline. In a recent interview (http://nyti.ms/fWL7tS), he described how as a result of managed care pressure, he was no longer seeing patients 45 min, with time to listen and solve, but rather 15 min visits to adjust medications. Dr. Levin reveals, "I had to train myself no to get too interested in their problems." This change in psychiatry is one of many areas of medicine that have shifted dramatically away from a model of 'listen, diagnose, & teach' to one of 'interject, order tests, & prescribe'. Most upsetting, this shift is happening despite evidence that quality of care is greatly suffering.

Dr. Levin's son is pursuing his own career in psychiatry. Dr. Matthew Levin stated, "I’m concerned that I may be put in a position where I’d be forced to sacrifice patient care to make a living, and I’m hoping to avoid that." Hoping?! Well, I'm hoping our nation demands that quality patient care continue to be a ethical mandate for all physicians, not a secondary question to who else in lining their pockets.

The current drive of medicine to produce assembly line results offering an algorithmic response to human health denies value in our uniqueness as individual patients and the dynamic ways in which we respond to care. We would do well to demand health care that puts the patient first--instead of the insurance companies reimbursement rates or a physician's changing salary. We're trading a sit down family meal for a drive through hamburger...and paying more for it! The cost is the declining quality of patient care and higher costs for all.

Truth in Numbers - How risky is chiropractic care?

2011-02-09T13:08:00.000-08:00

What the cost of insurance says about the safety of Chiropractic Medicine

Just paid my malpractice insurance bill--whew! A whole $480 later, I and my patients are protected against any risks of practicing Chiropractic Medicine. Yes, you read that clearly: 480 dollars...for the whole year. Many of you pay more than that for car insurance--much, much more. The insurance company is basically saying that your drive to the grocery store is more risky than all the treatments I have so far provided. Kind of amazing.

Curious what your other doctors pay for their insurance? Why not ask one? In North Carolina, where our rates are often lower than the national average, MDs still pay significantly more than $400. General internists are often in the $10,000 - $40,000 / year range. Specialists like Ob/Gyn, cardiac, and surgeons can often range upwards of $250,000 per year. A quarter of a million dollars for a year's coverage! Why so expensive--because the insurance companies know that having back surgery is likely 500 times more risky for their bottom line than you choosing a chiropractor.

This is especially important to me to clarify the worries of risk. There are still some people, and unfortunately, some experts, who are concerned about the risks of seeing a chiropractor. I recently treated a student-athlete who's team staff warned him that seeing a chiropractor could be dangerous for his back. It's disappointing to have misinformation create fear. And that information couldn't be further from the truth. This patient was back on the field with no pain in 2 visits, treated with both joint manipulation and muscle re-education.

Chiropractors are trained to use neurologic and orthopedic testing as part of a full physical exam, in the same way that every physician should, to rule out patients who may be at risk from specific treatments. Manipulation is only one technique we use at our office. We use soft-tissue treatments, including functional rehabilitation and Active Release Techniques more frequently to get the fastest and best results with little risk. Next time you think of your car insurance, you might remember how safe and effective chiropractic care can be.

Numbness in the fingers: one patient's story

2011-01-12T20:52:00.000-08:00

Gail was in a bad car accident 8 weeks ago--thank goodness she's alright. She's almost back to normal except for the burning in her fingers on both hands and soreness in her forearms. Fortunately, a friend told her about our office--especially how we expect results within a few visits. I took over 40 minutes listening to her story, and it surprised me how clearly she described the moment of injury. She said that the airbag came out so fast, it ripped her hands from the wheel before she could let go. I pondered what I would ask my students about this case: "which muscle begins in the forearm, crosses the wrist, attaches to the fingers, and would explain burning in the fingers and pain in the forearm?" Any guesses?? ...

Flexor digitorum profundus/superficialis indeed! Sounds like a likely scenario for the symptoms she describes. What does this mean? It means Gail's story matches her continued symptoms, and it's likely something that can be treated and resolved quickly. It means that following a thorough exam (to make sure we're not jumping to conclusions but evaluating the facts), we can gently treat these muscles in the palm side of her forearm and look for quick relief and comfort.

Happier ever after? Yes. But could have been much smoother. Another chiropractor had told her that she had whiplash in her neck and that's what caused her pain. He adjusted her neck for 6 weeks without improvement to her pain. He told Gail she needed to stick with his program, and she would be better in a few months. Disappointing! She asked her primary care MD, and he prescribed her pain killers and told her to return if it didn't get better. I wish he had known about the care we could provide. I'm most glad that Gail is feeling better and able to use her hands without burning or pain.

Should I worry over my back x-ray? The diagnosis sounds scary!

2010-12-30T14:01:00.001-08:00

Patients often ask great questions with very personal feelings. What I mean is that history and math professors may get great questions but a student is less anxious over what the answer might be. One of the best parts of being a doctor is explaining something to a patient about their body. It can mean encouragement from great fear to relief or bringing comfort and illumination to a challenging outlook of injury. We care about what is happening to our body.

A patient recently told me: "I had a MRI last week and got the results today. I have a herniated disk, and arthritis. I am being referred to a specialist. I guess what is your take on both of those? I was in such shock when they told me the news I couldnt comprehend anything they were saying."

I've spoken about the value of xrays before (http://bit.ly/b0hhcX), and I would speak of MRI testing similarly. These tests are valuable tools when utilized to support an overall clinical picture. They are often misleading and unhelpful tools for pain. As the New York Times recently offered, "magnetic resonance imaging seldom sheds light -- indeed, in many studies the scans have picked up spinal abnormalities in many people who have never reported back pain" (http://nyti.ms/eENwWu). Unfortunately, many physicians will see an MRI report with degenerative changes and refer to a specialist for significant interventions (surgery, narcotic medications, injections) when prevention would be more productive to the patient.

Doctors are often driven to interventions while patients would more often benefit from preventions or restorative care. Our health care system does not incentivize preventative medicine nor is there a reward for saving patient's time and money. Our system promotes number and frequency of treatments, the costlier to the patient, the better for the industry. What would happen if a doctor was paid from the overall health of their patients or how much activity the patients were able to enjoy in a year? What a dream that might be!

When a patient hears "degenerative disc disease", "arthritis", "herniated discs", "misalignment", "subluxations", and other less helpful, common diagnoses, I would encourage a response of "what treatment is best for my body?". A patient needs to ask, "What is most likely to restore my ability to move and live?". The momentum of research indicates for low back pain: surgery, drugs, and bed rest are least likely to help while physical therapy, soft-tissue therapy, chiropractic techniques, and rehabilitative exercises are far more productive, safer, and less costly.

In meeting the reality of our system today, patients cannot change economic forces behind surgery and pharmaceutical medicine, but each can ask their physician, "what is the safest and most productive option for my body?"

Value of a physical exam

2010-10-17T20:18:00.000-07:00

The physical exam is a dying art in medicine. Patients know this; you may have waited longer in the waiting room or filling out forms than your doctor took to examine your condition. There is much evidence to the value of a doctor taking the time to fully examine your body and talk with you to discover what the best course of treatment might be.

A recent article: http://nyti.ms/aGv0m4, from the New York Times, which shares Dr. Verghese's work at Stanford medical school. As a professor, I encourage my students to spend time and effort with a thoughtful history--making a great effort to listen to a patient. A proper exam requires time not just for talking but also for inspection, palpation, range of motion, orthopedic, and neurologic testing. 'Time' is the key. It is not possible to consider most conditions in 20 minutes.

In practice, at Tri-Synergy Chiropractic, we reserve 90 minutes for new patient visits. We've found the best care we can offer takes between 60-90 minutes. We average 2-3 visits per patient with fully successful outcomes because we take the time to listen to a patient, ask key questions, and examine their body before we conclude how we might help.

The pressure other physicians feel to finish a pt visit in 15-20 minutes leads to higher use of MRI, xray, and other expensive testing, without improved healing outcomes. This also leads to a quick prescription mentality, that encourages patients to "take two of pills and call me in a week" instead of assessing the underlying problem. There is a great value in technology, but it will never replace the importance of a physician listening and touching their patient.

Nagging Injuries

2010-07-29T21:55:00.000-07:00

this is a blog I wrote for a great site: www.whywetri.net
the site has some great resources for amateur and professional triathletes

Return from Injury: the missing step

Injuries can be very frustrating. You’d like to train yet your body is letting you down. Diagnosis is the first step. Healing may include therapy, ice/heat, and medication. I hope you’re looking to rehab from the start to expedite your return to activity. We’re going to look at a missed step in return to activity that may be holding you back from racing your full potential.

Rehab is crucial for recovery. Even for surgical repair, studies have highlighted the value of not only rehab but pre-habilitation. For ACL repairs, up to 90% decrease in recovery time was shown with athletes who started rehabbing even before the surgery.

When rehabbing an injury, you want to remember a crucial order of events:
(1) Range of Motion
(2) Control
(3) Strength.

It’s important not to get ahead of yourself with rehab. Too often I hear suggestions from therapists and athletes that an injury would have been prevented if the area was stronger. Ankle or knee sprains are not usually caused by weakness but by the control of the joint. Hip injuries have less to do with weak muscles, but more often a need to resolve the timing and control the brain has over this complex joint. Even more surprising, significant injuries can occur within normal ranges of motion, even when a joint that is wrapped and braced.

In the case of injury, the joint or tissue should be assessed for structural integrity and range of motion first. Of course, you wouldn’t only rehab a detached biceps tendon. Once you have structural integrity and full, optimal movement of that joint, the next step is control not strengthening. The brain needs to be able to stabilize and move the area appropriately before adding additional force of muscle building. Gentle strength improvement is often a gift of chasing stability. Consider using an unstable surface post ankle sprain: this would encourage the brain to learn to control unexpected motions at the joint. Simply doing calf raises may strengthen the joint when the brain expects challenge, but does not focus on the cause of the injury: an unexpected change in forces.

For any injury you’re looking to move past, focus on full range of motion first. Treating scar tissue, adhesions, and painful trigger points is appropriate at this stage. Follow with a chase toward greater stability than you’ve had before, and finally, consider strengthening the area in a functional way.

How do your muscles get stronger?

2010-06-15T22:37:00.000-07:00

What happens to our muscles when we get stronger?

Highlights:

different ways your muscles get stronger
evidence for how exercise, nutrition, and activity change your muscles
learn what you can do today to increase strength, burn more calories and feel stronger

A friend, Samantha, recently asked me what the difference is between a weak and strong person's muscles. I think it's a neat question. Especially because of how dynamic the answer may be. An initial guess is that you add more muscle tissue--and this is correct, but there's so much more! When we discover the ways muscles strengthen, we can learn how to maximize our power and health.

Muscle action explained in 30 seconds...go!
Muscles on a functional level are made of overlapping protein fibers (eg actin & myosin). When a nerve signal fires, the muscle tissue is flooded with a watery bath of ions (kind of like gatorade :) which causes the protein fibers to play a game of tug-of-war. The winner is you--and your now contracted muscles. And scene!

An increase in the number of the protein filaments (myofibrillar hypertrophy) is not always shown in thickness or bulk of the individual. This is what I call "dad strength", where my father was always lean yet could battle 2 growing boys with ease. This is also encouraging to women who are looking to add strength or calorie-burning potential without adding significant bulk.

You can add strength, especially endurance without any physical change to the number or size of muscle fibers. Through good nutrition and exercise, you may increase the power plants in your cells that provide muscles with energy to work. The more often you work your muscles, the more you're telling your body to make little energy factories (mitochondria, for you biology buffs). This is like putting a bigger gas tank on your car. You also need calcium to fire muscles, which is a great reason to support healthy bones & muscles with a supplement.

The most significant part: Strength gains in the first 5 weeks of exercise is nerve based. Let me say that another way: if you change your exercise program, and start to notice strength gains, the physical physiology of your muscles has changed very little--it takes longer for your body to grow and repair those muscles--what is happening is your brain and nerves are learning how to better coordinate recruitment and firing of muscles. We could talk all day about this. This is where the fun of treatment really begins. When I treat the brain and nerves, I can often change the strength and function of muscles immediately!

Muscle growth, power plant improvement, neurologic development...we haven't even gotten to how we use biomechanical joint advantage (leverage) to add strength. How do your muscles get stronger? One part physiology (muscle fiber & mitochondria increase), 1 part neurology (brain and nerve control), and 1 part biomechanics (leverage & joint proprioception).

Now, If you're looking to strengthen your muscle, you have so many options!

begin with regular hydration and healthy protein sources (building blocks)
add activity based in real-life movements (functional training). eg. walking, swimming, playing with children, gardening
exercise regularly and with intensity to challenge your body to need more strength (5 x 40 min/week)
continue diet & exercise changes for more than 5 weeks to see physical changes
seek knowledgeable therapists and physicians who encourage you to move for enjoyment!

ADHD- Is food to blame for hyperactivity?

2010-05-19T13:57:00.000-07:00

"Hey did you hear ADHD is caused by eating pesticides?"
"No, I heard it was from BPA in canned foods...or artificial sweeteners!"

I enjoy observing the way mainstream media presents scientific data. Oversimplification, overstating, and flat out misrepresentation of the evidence is commonplace. However, I feel they mostly do the best they can. It is very difficult to grab reader's attention, sell copy, and remain objective and rational.

Example: Monday's AP article regarding evidence linking pesticides and ADHD (Attention Deficit Hyperactivity Disorder). http://www.usatoday.com/news/health/2010-05-17-pesticides-adhd_N.htm

A friend commented to this news, "of course", which is to point the wise idea "you are what you eat". ADHD is a complicated clinical diagnosis with likely complex triggers and causes. This article is encouraging news for parents who have felt helpless with their child's development. The evidence of research continues to point to the power of nuture in helping young minds focus. Healthy behavior role modeling, balance of freedom/structure, and yes, healthy diet are all contributing factors for optimal health. Organic food producers should feel especially encouraged with the research strongly suggesting a change to organic (non-pesticide) fruits and vegetables may reverse or halt this particular ADHD trigger.

What intrigues me is how readers will often take this information to an end point of assumption: "ADHD is caused by non organic food". I feel media is complicit in this dysfunction as they often use "prove" or elude to conclusion in presentation of evidence. Biologic science is a gathering of evidence. Proof in that arena is a majority agreement of interpreters. There is often confusion and dissenting viewpoints from reasonable people. We should be cautious anytime we're referencing an article to prove a recommendation for healthy living.

As far as food is concerned, the current government subsidy (im)balance is tilted sharply towards meat and grains, perhaps this will be one more straw for a public push to promoting healthy diet backed by healthier government policy--one that promotes fresh vegetables and fruits. Though when that happens, there will be so much more for the media to present incompletely.

How a Monk Solves Back Pain

2010-04-26T21:21:00.000-07:00

What can St Francis of Assisi teach us about alleviating back pain?

A highlight on Standing Desks--A new option for back pain sufferers

Standing desks are a new idea for some, and an old, old idea for others. Notice in Bellini's depiction of St. Francis of Assisi in the Desert (http://en.wikipedia.org/wiki/File:Giovanni_Bellini_St_Francis_in_Ecstasy.jpg).

Not only is St. Francis in an amazing extended position (we'll come back to that), but look in the lower right hand corner and you will find a standing desk! He is able to stand, move, write, read, and think without the tired stance of a chair. In your most energetic state, what position would you want to be in? Likely, it is standing. I've never had a patient tell me, "I was so excited, I had to sit down and slouch."

Speaking of slouching: did you notice St. Francis' excellent, extended posture. As infants, we adapt well to curling up, and we often return to this position as we age. Full extension (back, arms, hips, and shoulders) is rare, even for mature adults. Yet, our bodies were made for extension. Perhaps we could include more of this each day.

It would be valuable for us to consider a standing desk. We could read, write, email, and even blog from an energetic position--one that allows us to move and work.

Want to dig further?: http://www.nytimes.com/2010/04/22/technology/personaltech/22basics.html

Do I need x-rays to see a chiropractor?

2010-04-08T08:05:00.000-07:00

FAQ: Do I need x-rays to see a chiropractor?

Answer: No. For the great majority of our patients, x-rays are not needed.

At Tri-Synergy Chiropractic, we are focused on evidence-based medicine. We will recommend tests (eg xrays, CT, MRI) only when clinically necessary.

As a physician, I am interested in diagnosing the cause of your symptoms. I'm able to do this by providing a thorough physical exam, including appropriate neurologic and orthopedic testing. We look at muscles, bones, nerves--all of your anatomy. Not just your spinal alignment. Imaging--including x-ray, CT, MRI--may be helpful for your diagnosis, but for most of our patients, it is not needed. I may recommend treatment that I can provide or refer you to another specialist.

We do not depend solely on one form of testing to diagnose or predict treatment. We may not need any x-rays at all to help you feel better. We are more likely to recommend specific exercises for your back pain, rehab for an ankle sprain, or gentle muscle release for your neck pain.

If you are near the High Point - Greensboro, NC area and looking for a chiropractor who will solve your problem, without a lot of visits, find us: Tri-Synergy Chiropractic

If you have the keys, you're more likely to drive it

2010-04-04T14:05:00.000-07:00

Pitfalls of over use of testing in medicine

Continuing the discussion from the previous post:

Imaging and other tests can be a great help in diagnosis and measuring improvement. Testing also increases cost for a patient, risk of side-effects, and even harm patient outcome. It is surprising to learn the evidence behind multiple negative tests: even if a patient's tests show no direct problem, the more tests a patient has, the worse their health outcome. This means we (as patients and doctors) should be judicious in our use of all testing, regardless of whether the insurance company will cover the cost.

As a recent commentary on the NPR show "Marketplace" points out, doctors who own a testing device are more likely to use them--regardless of clinical need or benefit to the patient.

http://marketplace.publicradio.org/display/web/2010/03/30/am-cat-scans/

Patients should encourage informed consent from their doctors--information about the risks and benefits from any test or treatment recommended. Doctors who own an x-ray machine, CT scan, or access to an MRI machine are more likely to use it. Whether the increase is from a conscious drive to cover or justify machine expenses, or subconscious convenience of access--patients need to be encouraged to make informed decisions about their health care.

If you're looking for a chiropractic physician who will encourage you with informed options, check out:
www.TriSynergyChiro.com

Make it a double--if you're trying to fit into that black dress

2010-03-24T21:06:00.000-07:00

Intriguing article regarding a recent report in the Archives of Internal Medicine about moderate consumption of alcohol in women and weight gain. The study demonstrated a pattern of weight loss with alcohol consumption.

"Amount of alcohol consumed at baseline was inversely related to weight gain". Women who drank more--lost more weight!
http://www.medscape.com/viewarticle/718086?sssdmh=dm1.599113&src=nldne&uac=135056DN

Not only does this connect with physiologic support but multiple other studies. Individuals should always consider psychosocial effects of alcohol consumption, and the study identified subjects within a healthy beginning weight range, and without many of the common complicating factors (eg diabetes). I believe this information should serve as further encouragement that a great glass of wine, beer or a martini is To Your Health!

Carpal Tunnel - One patient's story

2010-03-21T14:21:00.000-07:00

Great question from a patient this week: "if it's my wrist and fingers that hurt, how come my elbow is the problem?"

I was encouraging this patient that her carpal tunnel symptoms can be caused by more than just tightness at the wrist. The carpal tunnel is located near the wrist:

The median nerve is commonly responsible for these symptoms--but surprisingly, the carpal tunnel is not usually the problem! The median nerve begins in the upper arm near the biceps and has multiple locations it can be irritated, inflamed, and entrapped. The most common location is as it crosses the elbow and weaves dives between multiple muscles that control the forearm and wrist.

Individuals who sit at a desk for multiple hours in a day or work with repeating motions in their hands and arms are particularly at risk for carpal tunnel symptoms. Athletes in tennis, golf, and throwing sports also experience irritation in the carpal tunnel.

For the patient this week, she types for 6 hours/day for work and likes to bowl twice/week. When examined, her symptoms all appeared when testing muscles that control her elbow. After 3 treatments, she no longer has the numbness, tingling, and swelling she had experienced in her hand/wrist.

At home, you can help prevent carpal tunnel irritation--especially if you have a job that requires repetitive motion or long-term holding of your hands at a computer:

take regular breaks--Stand up 3 times/hr, roll your shoulders back and let your arms fall back
do 3 snow angel movements, keeping your hands open and rolling your thumbs backward
extend your wrists, elbows, and arms while taking 3 slow deep breaths
gently move and lightly stretch your palms, wrists, and forearms

This should take 30 seconds and potentially save you from painful surgery and lengthy healing time. If you do have carpal tunnel symptoms, seek a physician who is able to properly diagnose the problem. Consider conservative treatment that looks at the entire median nerve, not just the Carpal Tunnel.

The more tests I get, the healthier I am. Right?

2010-03-10T20:57:00.000-08:00

Interesting commentary about the use/value of medical testing. I really enjoyed the wisdom shared about when and how tests should be used.

http://www.npr.org/templates/story/story.php?storyId=124279916

Joe Wright, M.D. is the author of the commentary; here is his blog-- http://hemodynamics.blogspot.com/

It's important for patients and physicians to think critically and constructively for each test taken. This applies most directly for chiropractic care regarding X-rays. Many chiropractors x-ray a majority and even every patient. This is not supported by research. I feel strongly that x-rays are a valuable tool to be used only when clinically prudent. At Tri-Synergy Chiropractic, we do not suggest an x-ray unless we feel it is in the best interest of the patient's outcomes.

The tarp goes down before the tent! --preparing a strong core

2010-03-03T19:58:00.000-08:00

A patient came to the office this week with pain in her right hip. After reviewing her experience--pain during running, pain walking up stairs, and soreness in her thigh--and a full examination, I recommended to her we begin some core rehab beginning with Transverse Abdominis (TA) recruitment.

We will refrain from a long academic tangent about the TA muscle. She felt my analogy was more helpful: one way of thinking of the TA is like the tarp on a camping trip. Just like the tarp, proper core control begins with the TA muscle. Optimally, our TA is like a firm belt--supporting the spine, pelvis, torso, and other abdominal muscles. Our TA is located about the same place a large belt buckle would be, firming and strengthening nearly every motion of the body.

When camping, you start with the tarp, and it will help prevent moisture from ruining a good night's sleep and protect your tent. A tarp is often an afterthought yet regretted when forgotten. Just like the TA--an afterthought until it's a problem.

As you are considering "core workouts" and resolution of back, hip, or knee pain. It is a great idea to investigate whether you are able to engage and utilize the Transverse Abdominis. It may be the answer to your symptoms.

At home test: touch the bony prominences in the front of your pelvis (6" to the side of a belly button and 3" down). Now move to the center 1" and down 1". While lying on your back, and holding 2 fingers at that spot, gently firm the muscle under your fingers. Did you feel it? Many of my patients have a tough time finding this, so do not dispair! It is important to be able to hold that muscle firmly while still able to breathe deeply, letting your belly rise and fall. Many patients bring their "six-pack" muscles into it, and this is not optimal. Continue to contract and relax these muscles in a gentle rhythm. You are now working the TA and helping your brain become more aware of this muscle! If you have difficulty performing this contraction, or draw other muscles into it, it may be a sign of TA dysfunction leading to other symptoms. Consider it as you seek to reach your pain-free goals!

Should we be concerned about plastic water bottles?

2010-02-17T21:31:00.000-08:00

BPA- the controversy.

There continues to be an interesting discussion regarding Bisphenol-A (BPA). Should we be concerned regarding plastic wrap, tupperware, and water bottles?

BPA is a chemical contained in some plastics--many of the food-grade plastics we use daily. I've found this discussion on NPR's science Friday to be extremely helpful in continuing the discussion. It's important to remember how challenging known toxic substances are to evaluate--unknown (like BPA) are likely to be a point of challenge for years to come.

http://www.sciencefriday.com/program/archives/201001223

My advice:

limit contact by using glass or metal bottles. Stainless steel bottles are available everywhere
avoid reheating food in plastic. It tastes better on a plate
use glass or BPA-free baby bottles for infant feeding

Should I use ice or heat?

2010-02-10T15:29:00.000-08:00

Benefits of hot vs cold for an injury.

Perhaps you've had a twisted ankle, sore elbows from another day at that desk, or stubbed your toe in the middle of the night. A bucket of ice is painful and it's just too difficult to sleep under a hot shower. What should you use to help calm symptoms of pain and swelling while increasing healing time? Let's look at the physiology of your body:

Ice

Advantages:

numbs skin sensations by slowing nerve conduction
overwhelms nocioceptive input from region (part of a pain signal) which limits sensation of pain
limits inflammation and swelling by constricting blood vessels thus reducing blood flow

Disadvantages:

limits inflammation--wait, what?--yes, inflammation is part of a healthy immune response to injury. The body will heal best with optimal amount/timing of inflammation, not a removal of it.
slows delivery of oxygen and nutrients by reducing superficial blood flow

Heat

Advantages:

promotes blood flow which increases delivery of oxygen and nutrients
blood flow to superficial nerves often relaxes and calms pain symptom

Disadvantages:

may increase inflammation in acute injury
may aggrivate and increase sensations of pain

Conclusion:

In general, injuries respond best to ice in the first 72 hours as the initial stages of inflammation are still taking place. After 3 days, do what feels best to you. Each persons body may respond differently to heat or ice.
Restrict either to 20 minute intervals with at least 20 minutes of rest between. You body needs time to restore normal temperature to superficial tissues. Avoid ice or heat if it adds great symptom increase.
Both ice and heat affect maybe 2 cm deep. They are used to help you feel better, not as a cure all. Hands and feet are the most affected tissues by ice/heat because they are thin enough to change temperature. The causes of low back pain are rarely altered by temperature change, though your symptoms may be helped.

All injuries should be evaluated by a medical professional. Feel confident that ice or heat may be a great part of helping you heal and feel better.

How do I choose a chiropractor?

2010-02-09T21:35:00.000-08:00

Finding a Chiropractor

This question was most recently posed to me while lecturing at Wake Forest School of Medicine. M.D.'s are asking; patients are as well. The following are guidelines that I feel are most important to consider.

Interview all physicians, especially your potential chiropractor. There are a wide variety of techniques and attitudes of D.C.'s (Doctors of Chiropractic) as how they approach patient care. Look for one who is:

Cooperative and competent
advises treatment based on a diagnosis
releases patients after improvement
engages you as a physician, not a technician. This means someone who looks at your experience as a human, not just a machine to work on.
treats with more than just manipulations or adjustments. Look for a chiropractor who also offers nutritional, soft-tissue, and exercise expertise.

Problem signs:

focused on "subluxations" or alignment only
talks about bones out of place
requires x-rays in order to treat you
encourages patients to sign a contract or suggests frequent maintenance care

I encourage my patients to have a goal when they visit (e.g. less neck pain, more shoulder motion, less tingling in their fingers). Patients are seeking progress and chiropractors should also. Some chiropractors are willing to treat a patient weekly to maintain health--this has limited and sinking support of scientific evidence. Find a chiropractor who is helping you reach your goals, not someone who is helping pay for their new boat.