January 5, 2016
THE MOVEMENT TIMES
Poor Diet Quality May Prolong Recovery Following Injury
By: Stacie Totsch
Special Interest
Articles:
• Poor Diet
Qulaity
• What is Nerve
Glide?
• Why You Can
Stop Doing SitUps
Important Dates &
Upcoming Events:
Balances Due- 1/5/16
Obesity is often the result of excess energy intake that is stored in adipose tissue
(fat). Obesity is a condition with significant social, economical and medical impact
worldwide. The risk of developing cardiovascular disease, stroke, Type 2 Diabetes
and chronic pain is raised by obesity. As such, it is imperative that we gain an
understanding of the relationship between the cause of obesity (diet) and the
negative health outcomes that accompany it.
Because the signals sent by excess adipose tissue (i.e. leptin) to the rest of the
body initiate an inflammatory response, obesity is considered a pro-inflammatory
state1,2. In addition, specific items in the diet can increase inflammation as well.
We, and others, have reported that foods containing high levels of saturated fats
or omega-6 fatty acids trigger an inflammatory response3-5. On the other hand,
foods high in omega-3 fatty acids and food additives that include ginger, ginseng
and turmeric have known anti-inflammatory effects5. Together, this information
suggests that both diet and fat tissue can have negative effects on health. Our
study in mice was designed to study these effects related to pain.
In the mid-2000s a large-scale study was completed in the US that investigated
the levels of micro- and macronutrients in a typical American diet: the National
Health and Nutrition Examination Survey (NHANES). Based on these findings, a
rodent diet was created that used the average values for all of the nutrients in the
NHANES. This diet is referred to as the Total Western Diet (TWD). In our study,
recently published in the Journal of Pain, we used this TWD to see what effects
the diet had on sensitivity to touch and heat as well as physiological effects of the
diet. Finally, we were interested in whether the animals on the TWD responded
differently to CFA-mediated (Complete Freund’s Adjuvant) chronic pain induction
compared to animals on a diet of standard laboratory animal food.
We found that the animals eating the TWD became less sensitive to heat and
touch. This was initially surprising, but it is similar to what is observed in obese
humans who show higher thresholds for peripheral pain6. While it may seem
plausible that fat deposits under the skin provide more insulation, we know that
nerve cells are actually closer to the surface than the adipose tissue deposits
making that explanation unlikely. In addition to the changes in sensitivity, the
mice showed significantly elevated levels of inflammatory cytokines in their
blood. This suggested that they were in an inflammatory state that is not unlike
that seen in obese humans. When we assessed the composition of their body
tissues after 12 weeks on the diet, the animals eating the TWD showed significant
elevations in body fat, without showing elevated body weight! That is to say, the
Page 2 of 8
Poor Diet Quality May Prolong Recovery Following Injury (CONT.)
poor quality TWD changed the animals’ body composition without making them
heavier or noticeably obese, suggesting that any effects were not due to the
animals being heavier.
Finally, we used a standard method to induce a recoverable pain condition and this
is where we really saw some startling effects. When animals were made
hypersensitive to touch and heat using CFA, control animals (n = 8) recovered in the
expected 5-8 days. However, animals that were eating the TWD (n = 10) took 11-14
days to fully recover. This diet effectively doubled their recovery time in a blinded
assessment of sensitivity. In addition, these animals showed more hypersensitivity
than control animals.
Taken together, we believe that our results suggest that poor diet and the
physiological changes that arise because of it could be an underlying mechanism
that contributes to chronic pain in humans. While we agree that increased weight
causes significant stress in weight-bearing joints (knees, back), obese humans
develop pain in other areas that are not weight-bearing (neck, fingers, shoulders)
suggesting other factors may also contribute7. Currently we are examining the
impact of poor diet on immune system activity and whether an anti-inflammatory
diet can reverse the negative effects of a poor diet. It is our hope that, in the near
future, diets can serve as a healthy alternative to pharmaceuticals when treating
chronic pain.
INSURANCE RENEWALS FOR 2016
2016 is here!!! Make sure you find time to reevaluate
your insurance coverage and find out the amount of your deductible! Check with your insurance company
to see when your plan renews and what your new benefits are for the year!
VISIT TRACKING REMINDER
We try our best at Mobility Plus to help patients understand their insurance benefits by providing insurance
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call the number on the back of your insurance card to find out how many visits are remaining and/or whether visits
are counting towards Chiropractic or Physical Therapy Services.
INSURANCE DISCLAIMER:
Your insurance company may consider some of the treatments and activities performed during your session as
physical therapy, and as such visits may be billed as both chiropractic and physical therapy. You are encouraged to
regularly check your total visit numbers with your insurance company.
Page 3 of 8
What Is A Nerve Glide?
Jay Armstrong
Have you ever thought about how extraordinary your nervous system is? The complexity of the brain is virtually
incomprehensible with its 100 billion neurons. Each of these neurons has an average of 1000 to 7000
connections to other neurons. The capacity of the human brain is out of this world!
But, here is something else amazing for you to think about. Our
nervous system, including the brain, is essentially all one giant,
interconnected nerve! The nerves in your left little finger continue
without interruption all the way up your arm, through the upper
spinal column to the brain. And, the brain is connected through the
spinal column all the way to your right big toe. This means that ALL
of the nerves in your entire body are connected together to form
essentially ONE HUGE network of nerve cells! And, when you turn
your head or bend your toes the nervous system’s network gets
twisted and pulled.
Nerves are pliable and can be bent without damage during our
normal movements. They are also able to change length or be
stretched. In fact, if the nerves do not stretch as they should the
brain (or central nervous system) will prevent us from moving at
our best. Peripheral nerves, the ones in our arms and legs, are
encased in a protective sheath called the epineurium. As we move
about, the nerve slides inside this protective sheathing. Part of good
health is supplying our bodies with the appropriate nutritional
intake to support the regeneration of these materials. Another part
of maintaining a healthy body is movement. Yes, this includes the
nerves along with the muscles, tendons, ligaments and joints.
Our nerves are designed to slide inside their protective sleeves and
the way to maintain this ability is through movement. Our bodies
are constantly adapting to the demands we place on them. If we do
not move, we will adapt so that we become better at not moving.
So, the clear lesson regarding our peripheral nerves is that we must
elongate them in order to maintain their health.
The human body is composed of a wide variety of different types of
tissues: bones, cartilage, skin, fascia, etc. All of these tissue types
must work together to support our movement. Bones provide
strength. Cartilage cushions and connects the bones at the joints.
And, as we move, the skin, fascia, and the nerve network must all
stretch to allow whatever movements we attempt. Whether we
are throwing a ball or bending over to pick something up, muscle,
skin, fascia and nerves are all stretching to allow the activity. If one
of the tissues will not stretch adequately, the central nervous
system will not allow us to perform the movement. This is a built-in
safety mechanism that helps prevent damage to the body.
Page 4 of 8
What Is A Nerve Glide? (CONT.)
Neurodynamics, neuromechanics, nerve stretching, or nerve glides all refer to the physical-mechanical process
of moving parts of the neural network. Muscle stretches will generally provide some stretching of the
peripheral nerves. Nerve glides are specifically designed stretches that allow the practitioner to elongate
segments of the peripheral nervous system. As a result, nerve glides may seem like very unusual stretches.
Maintaining the health of the peripheral nervous system will pay
big dividends. Improved signal conduction to the muscles,
increased sensory perception, and greater range of motion are
just some of the benefits that are likely from regularly practicing
nerve glides.
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Page 5 of 8
WHY YOU CAN STOP DOING SIT-UPS
Rachel Bachman
For anyone who has struggled on a gym mat, hands behind head, straining to touch
elbows to knees, there’s good news: The sit-up’s reign as a workout standard may be
ending.
People from high-profile exercise gurus to military experts are arguing that the sit -up,
that staple of fitness tests, presents too great a risk of back injury.
A recent editorial in Navy Times, an independent publication that covers the U.S.
Navy, called for banishing the sit-up from the physical-readiness test sailors must pass
twice each year. The editorial called it “an outdated exercise today viewed as a key
cause of lower back injuries.” The Canadian Armed Forces recently cut the sit-up from
its fitness test, citing concern over potential injury and its lack of connection to actual
military work.
Tony Horton, creator of the popular P90X video workout series, says he no longer do es
sit-ups or crunches, their truncated cousins. “I really believe that the traditional,
antiquated crunch has seen better days, and it’s time to make a change,” Mr. Horton
says.
Sit-ups can put hundreds of pounds of compressive force on the spine, says Stuart
McGill, a at Canada’s University of Waterloo. In dozens of published studies, Dr.
McGill has found that the forces, combined with the repeated flexing motion, in sit -ups
can squeeze the discs in the spine. That combination eventually can cause discs to
bulge, pressing on nerves and causing back pain, potentially leading to disc herniation.
For people who want to do abdominal exercises from the traditional sit -up start
position, Dr. McGill advocates a modified curl-up he developed, with the hands placed
underneath the low back and the shoulders barely leaving the floor.
Sit-ups can be done in many ways, including crunches and sit-ups on stability or Swiss
exercise balls. The injury risk with modified sit-ups depends on the exact motion and
on an individual’s physical limitations. But some fitness instructors have ditched even
modified sit-ups.
One move, called plank pose, has expanded beyond yoga classes and is used widely in
physical training in place of sit-ups. Plank resembles the upper position of a push-up,
with the body held straight from heel to shoulder. It is also often performed with
forearms on the ground. Plank uses muscles on the front, side and back of your
midsection or core, while a sit-up requires just a few muscles, experts say.
Cmdr. David Peterson, executive officer for the physical education department at the
U.S. Naval Academy, advocates replacing the curl-up in the Navy’s physical-readiness
test with plank if the Navy keeps a core-readiness exercise in the test. In a 2013 paper
in Strength and Conditioning Journal, he argued that plank was less likely to injure
people and more relevant to Navy operations.
When performing real-world tasks, Cmdr. Peterson says, “we typically stabilize the abs
so that we’re able to generate more power from the core so we can lift, pull, push,
carry. In that sense, sit-ups really don’t prepare us for what we typically use our core
for in daily life, or operationally on the battlefield.” He stressed that he was voicing his
opinion, not that of the entire Navy.
“Exercise gurus and military
experts are pushing for alternate
exercises, like plank pose, to
prevent back injuries”
Page 6 of 8
WHY YOU CAN STOP DOING SIT-UPS (CONT)
The Canadian Armed Forces’ overhaul of their longtime fitness test, phased in through last year, emphasizes
(CONT.)tasks such as lifting a 44-pound sandbag 30 times within 3 1/2 minutes.
functional
“We went away from just measuring core strength by doing sit -ups or push-ups,” saysPatrick Gagnon, senior
manager of human performance for the Canadian Armed Forces. He says the new test more accurately predicts how
well soldiers will perform their jobs.
One study of 1,500 U.S. Army soldiers found that 56% of the injuries related to the Army’s three -part physical
fitness test were attributed to sit-ups. The test’s two-mile run portion was associated with 32% of injuries and pushups with 11%. Overall, injuries affected nearly 8% of all soldiers studied.
Versions of the sit-up remain in the regularly required physical fitness tests for the U.S. Air Force, Army, Marines
and Navy, though three of those tests are under review. (The Coast Guard’s fitness test, which also includes sit -ups,
is required only for certain positions.)
The Army in recent years put 10,000 soldiers through a pilot of a revamped physical-fitness test that excluded situps. While the Army is studying the best methods to measure baseline soldier readiness, it’s sticking with its long standing three-event test: timed push-ups, sit-ups and a two-mile run, a spokesman says.
The Marines and Navy also are reviewing the elements of their tests. The Marines will collect recommendations
through July 1. The Navy has no deadline for possible changes to its test, says Lt. Joe Keiley, public affairs officer
for the Chief of Naval Personnel.
“We’re certainly looking at ways we can improve it,” Lt. Keiley says.
Page 7 of 8
WHY YOU CAN STOP DOING SIT-UPS (CONT)
Many Americans first did sit-ups as part of what is now known
as the Presidential Youth Fitness Program, the decades-old,
multi-discipline test given to millions of schoolchildren.
The FitnessGram, the health-related fitness assessment tool now
most commonly used in school fitness programs, in 1992
replaced the sit-up with a lower-rising curl-up.
“Experts believe it puts less stress on the lower spine and the
hip flexors than sit-ups do,” saysLaura Fink DeFina, president
and CEO of the Dallas-based Cooper Institute, which developed
and launched the FitnessGram in 1982.
The sit-up has remarkable staying power. Mark Langowski, a
New York-based personal trainer who founded the company
Body by Mark, says he hasn’t done a sit-up in 10 years and tells
his clients not to do them. Yet earlier this year he found himself
supervising the sit-ups of chief meteorologist Ginger Zee on
a “Good Morning America” segment about the FBI’s recently
adopted fitness test.
Schoolchildren demonstrate the curl-up as performed in the
FitnessGram health-related fitness assessment. The curl-up is
designed to minimize compression in the spine, according to
the group that operates the assessment. PHOTO: THE
COOPER INSTITUTE
“I’m holding her feet and I’m counting her reps and cringing
the entire time,” Mr. Langowski says. He says he didn’t speak
up because the segment was about whether Ms. Zee could pass
Mark Langowski, chief executive officer of Body By Mark
the new FBI test, not about the sit-up. An FBI spokesman
Wellness and author of ‘Eat This, Not That! for Abs,’ favors
declined to comment.
exercises
to thethe
sit-up,
including
the side
Anotheralternative
argument
against
sit-up:
Research
plank. PHOTO: SCOTT MCDERMOTT
suggests it is not the best exercise for strengthening
abdominal muscles. A 2010 study in the Journal of
Orthopaedic and Sports Physical Therapy found
that exercises using an inflatable Swiss exercise ball
activated more muscles than did bent-knee sit-ups or
crunches.
John Childs is CEO of Evidence in Motion, a
company that trains physical therapists. He says
generally available research shows that traditional
sit-ups do increase forces and loading on the back
but that “from our data, we can’t say that sit-ups
cause back pain.”
Mark Langowski, chief executive officer of Body By Mark
Wellness and author of ‘Eat This, Not That! for Abs,’ favors
alternative exercises to the sit-up, including the side
plank. PHOTO: SCOTT MCDERMOTT
The most important thing is for people to perform
exercises they enjoy so they’ll continue doing them,
Dr. Childs says. “Staying active and doing regular
exercise the old-fashioned way is far more
advantageous than doing nothing,” he says.
But Pete McCall, spokesman for the American
Council on Exercise, says he encourages alternative
exercises for abdominal muscles. He calls the sit-up
“an antiquity of exercise best left in the dustbin of
fitness history.”
Page 8 of 8
*Featured Patient of the Month*
Congrats to Kelly who has been selected as our featured
patient of the month! We asked Kelly a few questions about
the California International Marathon she participated in
this past December!
th
2200 6 Ave
Suite 832
Seattle, WA 98121
PHONE:
206-441-2505
E-MAIL:
[email protected]
Q: Tell us about the last event you participated in……
A: I ran the California International Marathon on December
6th. This race bills itself as “the fastest course in the west”,
as a lot of people run it to qualify for the Boston Marathon
or the Olympic Trials Marathon. This particular race has
been on my radar for a few years, and I was ready to go
chase a personal record, so I signed up.
Q: How did Dr. Li help you prepare for the event?
A: Dr. Li’s help has been long-term rather than for just one
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race. For my 2015 spring marathon, my goal was just to get
SCHEDULING:
to the start line healthy after recovering from an injury. This
training cycle, Dr. Li and I continued to improve my
www.mobilityplussportsrehab. running mechanics and efficiency, keeping a couple
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niggling tendencies at bay.
Even after a freak incident when I hurt my ribs (nothing to
do with running form), he knew how to make it better so I
could keep training.
Visit us online at:
www.mobilityplussportsrehab.com
Q: How did you feel after and what were your goals? Did
you meet those goals?
A: My goal was to run a personal best for the marathon
distance, which I accomplished with a 3:11:11 finishing
time. Except for the inevitable fatigue at the end of a
marathon, my body felt good throughout the race. I did not
experience any feeling of imbalance on my left or right
sides, which has happened before. As for afterward, I felt
tired and just wanted a cold Sprite!