Trying to change patient’s ways of doing body mechanics feels like a long hard road, so I decided to enlist Milou’ s help and favorite squeaky toy to illustrate how to safely bend forward with a flat back
https://www.youtube.com/shorts/SqsChsiKDTM
PASSIVE LORDOTIC TRACTION DEVICE FOR CERVICAL CURVE
https://www.youtube.com/watch?v=BibKL5FtPzc
Those who have been patients at our office for a while know that I'm not big into gizmos unless they have been found to have meaningful patient value in the long term. But there are a few staple items that have a high return on investment for home use, and the passive cervical lordotic traction devices (I know it's a mouthful, I used the abbreviation PCLTD) fall in that category.
The device is a rather simple molded plastic shape, that comes in a couple different sizes to accommodate different bodies, that is meant to apply a passive lordotic force in the cervical spine when applied in the supine position, to shape the ligaments of the cervical spine into a correct forward curve. The device are usually very easy and comfortable to use, and require about 3 to 5 minutes application time per day.
Patients were good candidate for the device are individuals with a reverse cervical curve without severe degenerative changes. Those patients will benefit the most from slow reshaping of the ligaments over time. Some patients are not good candidates for cervical traction device, including patients with severe osteoarthritis of the cervical spine, especially with stenosis that is aggravated by any extension position, or bony spurs encroaching in the posterior lateral spinal canal. Other contraindications include certain types of active vertigo, aggravated by posterior positioning of the head and neck.
We have a couple loners in different sizes that will send home with the patient for trial of 2 weeks of home use, to determine if the traction is beneficial and tolerable. PCL to the devices are readily available over the counter for under $20.
SOFT TISSUE HEALTH #7 : COMPLETE MOVEMENT
Last but not least in this soft tissue health series is a nutrient that's not often recognized as such, but when lacking, will have profound negative impact on soft tissue health even when number 1 through number 6 have been provided: complete movement.
Movement is nourishing to soft tissue in the sense that it's an essential signaling mechanism to the central nervous system to direct resources to the particular soft tissue area to deliver nutrients and provide signaling for repair, remodeling and growth. An immobile soft tissue will atrophy and degenerate regardless of how much oxygen,hydration and protein is available in the body.
There are several characteristics of movement that need to be present in order to ensure optimal soft tissue health:
– the quantity: there needs to be enough movement, frequently enough throughout the day ideally. Most patients seem to get that concept
– the range: tissues such as muscles and the tendinous junctions need to experience the entirety of their range from the most contracted state to the most lengthened state. That's often where things go wrong. There are several areas of our bodies that operate in a pretty small range of motion: our daily activities tend to have us hunched in postural stress without counterbalancing activities. Our modern lifestyle is depriving us of a lot of chores that our predecessors had to do to survive their day, and those chores had us moving in all planes. Not so anymore, so intentional full movement exercises like yoga and Pilates can fill the gap.
– The quality: the movement needs to place enough demands ( strength, speed, coordination) on a soft tissue to signal the brain to respond but not to the point of causing full blown injury
– The rest interval: the movement pattern needs to allow for the appropriate amount of rest to allow delivery of nutrients through restored blood flow, and enough time for the body to conduct the repair process from any micro damage associated with usage.
For that reason, it is important to look at your physical activity throughout a typical week, look at what your body is receiving in adequate amounts, and what it may be lacking that should be made up in formal exercise. It will be different for different individuals. Some people will have light cardio built into their day, but very little resistance activities, others will have a lot of strength requirements in their job but completely lacking in full range of motion/ flexibility of most of their joints. You will design your exercise routine to bridge the gap accordingly
SOFT TISSUE HEALTH # 6: ANTI-OXIDANTS AND ANTI-INFLAMMATORIES
SOFT TISSUE HEALTH #6: ANTI-OXIDANTS AND ANTI-INFLAMMATORIES
In this particular blog entry I will discuss some nutrient categories that can be very helpful for the overall management of soft tissue health and pathologies, and may be more recognizable "household names" to patients who have been keeping up with the popular literature regarding nutritional supplementation.
Some readers may wonder why we are only getting to discuss them in episode number 6 of the soft tissue health series, assuming they would be brought up much earlier. However the order in which each set of nutrients has been discussed is very intentional and reflects the hierarchy of needs and priorities when it comes to building soft tissues from the ground up. It's not so much that the anti-inflammatory and antioxidant compounds are not important for soft tissue health, but the fact that patients often try to incorporate them without 1st addressing some more basic metabolic nutrients such as oxygen and amino acids, thus putting the proverbial cart before the horses.
Our soft tissues, from muscles to ligaments to tendons, are in a constant state of turnover, the result of adaptation to our environment (both external and internal), and thus subject to episodes of stress, from such things as repetitive injuries, single traumatic injuries, or heavy training with the goal of causing some minor disruption of muscle to increase bulk. The normal repair mechanisms of the human body will best operate in a particular chemical environment with fewer free radicals and within the presence of inflammatory immune molecules that are supposed to be finally regulated to be released for short durations in controlled amounts, but will have a counterproductive effect if present in a chronic state and at higher levels. Unfortunately, most of the modern lifestyle in so-called 1st world countries predisposes people to chronic low-grade inflammation and depleted antioxidant status through the usual culprits: nutritional inadequacies, environmental toxicities, imbalanced stress rest ratio, etc. the problem with this scenario is that our soft tissues are constantly operating in a sort of chemical soup that's unfavorable to the normal repair and adaptation cycle.
Supplementing certain categories of antioxidants and nonpharmacological anti-inflammatory substances can make sense in that context, especially if the patient is experiencing more chronic or intense soft tissue demands. We have a lot of patients with heavy physical demanding jobs, 6 or more days a week for 8 months at a time, with suboptimal availability of rest for example, some patients with very chronic postural stress that is not easily altered with ergonomic modifications, or some athletes on intense training schedules. Under these types of circumstances, even when addressing the 1st 5 building blocks of soft tissue health, they still come come up short unless adding some botanical anti-inflammatory supplements for example.
Anti-inflammatory compounds fall along different categories, but primarily in the botanical family and in the fat-soluble family. Botanicals would include things such as high-grade curcumin extract, boswellia, white willow. Fat-soluble anti-inflammatories would be in the omega-3 family, vitamin A and D family. You could also make a case for categorizing CBD in the fat-soluble compounds.
Anti-inflammatory compounds also come in different families, the so-called "greens and reds" which are high concentrations of greens and berries primarily, bioflavonoids, as well as the glutathione family which is more of a direct red-ox system. The list is long and exhaustive in reality, with a lot of compounds that have both antioxidant/anti-inflammatory activity but also cross over into immune modulation and neurotransmitter/neurohormonal activity. While the basic nutrients outlined in blogs 1 through 5 are more straightforward for patients to self manage, supplementing antioxidants and anti-inflammatory compounds has a lot more nuances, and may be worth implementing with the support of a healthcare professional for maximum outcomes. It is also important to remember that the supplements will only ultimately be most effective when utilized as an additional strategy on top of a robust foundation of the previously discussed nutrients.
SOFT TISSUE HEALTH #4: HORMONES
SOFT TISSUE HEALTH #5: HORMONES
In this section we are trying to condense a very large subject into a blog size entry, meaning we will discuss general concepts without a lot of details.
In sections #1-4, we covered the nutrients needed to build high quality soft tissues, but now we to realize that nutrients are not automatically uploaded into the complex architecture of our soft tissues without some signaling to do so. Part of that signaling involves hormones.
A variety of hormones impact the growth, repair and remodeling of our soft tissues, and as such, hormone imbalances can be a source of low grade chronic poor soft tissue healing and susceptibility to chronic injuries. Below is a summary of the hormone systems that are more closely connected with soft tissue problems.
· Gender variable hormones, including estrogens, progesterone and testosterone. These hormones are involved in improving flexibility, quality and growth of soft tissues. Women suffer the bulk of gender variable hormone problems because they experience more hormonal fluctuations throughout their lifetime. Soft tissue injuries and pain can flare up at certain times of the menstrual cycle, post partum, and especially in the first few years of menopause when estrogens can drop pretty steeply. Women may be on long acting synthetic hormones that suppress endogenous production. Both men and women can be placed on hormone blocking therapies for years at a time for hormone positive cancers. Males often will go through the equivalent of menopause, or andropause, but more gradually starting around age 50, and while the sexual impact of andropause gets a fair amount of medical attention, the soft tissue symptoms of decreasing testosterone do not.
· Thyroid hormones: a huge driver of normal cellular metabolism, active thyroid hormones are crucial for soft tissue repair and resiliency. Ask anyone who has delt with hypothyroidism and they will tell you that every tissue in their body seems to hurt and be intolerant to normal activities. Thyroid disorders can be complex, more widespread than recognized with TSH testing alone, and in many instances, not fully balanced with straight T4 thyroid medications alone
· Anabolic hormones: there are quite a few hormones that have anabolic ( = tissue building) activity, but for the sake of this discussion I will highlight DHEA, pregnenolone and growth hormones. The first two are more closely related to the gender variable hormones through enzyme conversion. They are part of the system often called “ adrenal” in laymen terms. Their main role is to build up tissue. Chronic stress of all forms can shunt anabolic hormone precursors into the cortisol pathway and negatively affect tissue building: mental stress of course, but other forms of stress like sleep deprivation, chronic nutritional deficiencies, chronic infections, toxic exposure, significant thermal stress, chronic fasting etc . Medications, especially steroids which are widely used, can significantly depress normal soft tissue buildup by suppressing endogenous anabolic hormone production.
· Insulin: insulin is often overlooked in these discussions, since most people only associate insulin with blood sugar management and diabetes. Insulin is actually a very complex hormone that regulates anabolic activity in many tissues in response to perceived energy availability ( pancreas releases insulin in response to glucose sensors primarily, but also to fatty acid and amino acids, to determine if the body has enough energy on hand to perform a task, such a building up muscle or releasing a fertile egg). It needs to be present in a healthy normal amounts in order for other hormone systems to be active ( thyroid in particular). Soft tissue health will be affected if the body is in a state of insulin resistance and high BMI ( and can be aggravated by certain diabetic medications), or in a state of very low insulin production, such as excessive fasting, ketogenic diets etc
The bottom line: hormone imbalances can be part of chronic soft tissue disorders, but hormone imbalances are also delicate to work up and treat, and should be ideally addressed with the support of a health professional.
SOFT TISSUE HEALTH #4: AMINO ACIDS AND THE RIGHT KIND OF PROTEIN
The topic of protein adequacy should be a mainstay because it impacts every tissue in our bodies. Instead, it seems to experience episodic popularity in the area of weight loss and muscle mass building, overshadowing other important aspects of our health , such as soft tissue resilience and integrity.
All of our soft tissues are predominantly built on amino acids. What complicates matters is that collagen proteins require a higher percentage of some amino acids that are not well represented in our standard diet, even some protein rich diet: proline and glycine being the most important ones.
Proline and glycine are found in lower concentrations in vegetarian sources of protein, and in higher concentration in flesh protein. Thus vegetarian diets, even if supplemented with vegetarian protein powders like rice and peas, can be lacking the rate limiting amino acids to build strong tendons and ligaments. ( they will be usually adequate to build muscle mass however, but a bulkier muscle anchored by a weaker tendon can actually spell more soft tissue trouble). Moveover, not all animal protein is high in proline, which is not primarily found in muscle meat, but in the connective tissue of the animal you eat. Compared to even a generation ago, the standard American diet animal protein is very muscle based and contains little bone-in, skin, tendons, joints: chicken breast, steak, chops etc… All muscle meat. Contrary to their reputation for being lower quality, meat products such as sausages will often reclaim those “lower cuts” in ground form and give you a better amino acid mix for collagen building. Unless you eat your animal “nose to tail”, as humans have for most of their omnivore history, and continue to do so in many places in the world, you may need to consider a little proline/glycine and collagen support. Thankfully, collagen supplementation has been pretty readily available on the shelves and many patients have empirically found that their frame functions better when they take them, not just because collagen helps articular cartilage, but because proline ang glycine helps shore up tendons and ligaments
SOFT TISSUE HEALTH #3: HYDRATION ( WATER + ELECTROLYTES)
The topic of adequate hydration has already been debated to death, and the general public has a bit of fatigue in implementing the right hydration practices into their routine, much less listening to anything on the topic in the first place.
Getting enough water is obviously crucial yet in this part of the discussion, I want to talk about two lesser known, yet important aspects of hydration, when it comes to soft tissue health.
· Hydration is not equal to water alone. Hydration means maintaining the right amount of fluid in the right ionic concentration in tissues. This can only be achieved if water is anchored with the right minerals that can “hold” the water and prevent it from being flushed out. I have run into many patients over the years that tell me they are constantly drinking but never feel hydrated, because they seem to urinate right away any water ingest. This phenomenon is real and is corrected by ingesting the right balance of salts and minerals along with water. This becomes a problem for many reasons that can get complicated and well beyond the scope of this blog. The two main culprits are the standard American Diet lacking high quality sources of magnesium, potassium, calcium and other trace minerals, while being overloaded with refines salts ( which unlike naturally occurring salt in food, mined salt or sea salt, contains nothing beyond plain sodium). The second is the overmedication of most of the US population, both prescription and over the counter, with many of these pharmaceuticals altering mineral balance long term. Besides improving their diet, some patients with chronic soft tissue problems may need to speed up their recovery with mineral supplementation. The most common ones we tend to use are the C-M-K ( calcium, magnesium and potassium), as well as some of the homeopathic cell salts.
· Most patients understand that muscular function, especially cramp prevention, is affected by salt and mineral deficiency. Few seem to know that the quality and resiliency of collagen is affected by the excessively common magnesium deficiency, leading to greater susceptibility to chronic injury. Even fewer know that hydration keeps various adjacent layers of soft tissue from developing adhesions with each other during the normal friction of movement. The latter is probably one of the best kept secrets in the world of chronic myofascial dysfunction, where practitioners spend a lot of time releasing bound fascia to find it stubbornly rebounding to its original contractures and adhesions.
In summary, patients would be wise to keep adequate hydration by paying attention to the interventions mentioned above. When it comes to water alone, we should also all be wise in recognizing that the modern lifestyle is rife in stimuli that tend to suppress our natural thirst response, and that keeping a visual reminder of how much water we drink, such as pre-filling a few water bottles to be emptied out before retiring for the night, will go a long way to make up for it.
SOFT TISSUE HEALTH part 2: oxygen
The second item in the soft tissue health series is a nutrient that we often overlook, although we could not survive without it more than 3 minutes: oxygen.
Oxygen is important in many metabolic processes of our soft tissues, but I want to circle in on two specific functions: tissue flexibility and energy production. Soft tissues such as tendons can “fatigue” much more easily, manifesting as lowered endurance during activities and longer recovery time, when tissue oxygen concentration is reduced.
Perhaps the most significant manifestation of low tissue oxygen concentration however, is the inability of soft tissue to heal and repair with tissue of equal elasticity. The reason being that the type of collagen that is highly elastic can only be manufactured with a high oxygen saturation, while harder, less flexible types of collagen can be manufactured under much lower oxygen concentrations. The end result is post trauma changes in the soft tissue that feel firm, stiff, “string like”.
Oxygen is closely linked to the first topic of blood flow. While there is a lot of overlap between the two, there are still distinct situations when blood flow is adequate but oxygen concentration is not: chronic respiratory problems ( asthma, COPD), smoking, and chronic low grade anemia . Those are ongoing medical conditions that can really compound soft tissue problems from other sources.
There is a category of nutritional supplementation that helps improve oxygen delivery to peripheral tissues ( nitric oxide modulators), as well as some DME device ( PEMF), that can help make up for some of those issues, but ultimately addressing the underlying reason for low oxygen tissue concentration is the most effective way to resolve the problem.
Photo courtesy of Freepik