COLD AND NECK PAIN

I blogged about this more extensively a few years ago, but this polar vortex is worth at least a brief reminder of an overlooked fact: exposure to cold windy conditions can aggravate neck pain, especially for patients with underlying moderate degeneration and post traumatic scar tissue formation in the collagen of ligaments and muscle fascial layers.

Cold and wind exposure results in two phenomenons : vasoconstriction i.e. diminished blood flow to superficial tissues as the body tries to conserve energy for core organs, and protective posture of the neck and shoulders: hunched forward with trapezium muscles drawn up to your ears. Neither of which is helpful for chronic neck pain.

Remember to keep your cervical spine covered with an additional layer of warmth and insulation. A good neck gaiter, scarf, turtle neck or fully zipped up collar is all it takes.

Neck strain, Reading, & Periscope Glasses

https://www.amazon.com/Horizontal-Glasses-Definition-Periscope-Watch/dp/B00CY9RQ2K

I am not much of a gadget person but I have been paying closer attention to anything that can decrease the amount of flexion neck strain, since that is a gigantic problem of modern life that is hampering the progress of our patients dealing with neck pain. A couple patients reported using “periscope” glasses recently, to read books laying on their lap while on a recliner. It basically allows them to keep the neck upright and relaxed while reading the material on their lap at waist level. This is made possible by the reflecting mirror of the glasses angling the written text toward eye level. It apparently does take a little practice to correctly angle your head and keep it steady, but also well worth the rewards of not having to endlessly look down and loading up the junction between the neck and upper back.

New Year Resolutions and "Sugar Detox"

In the last installment of New Year resolutions to be healthy, I wanted to briefly address the concept of “sugar detox “.

Refined sugars are, for most people, almost as addictive as a drug. And while the idea of having a small, controlled amount of it sounds good in theory, many folks know full well that when you start, you really cannot stop. If it all or none.

Refined sugar consumption seems to escalate during the year end holiday splurging of endless treats and cookies, so many will start the new year feeling bloated, heavy, and on a blood sugar rollercoaster. And as such, wanting to get off the sugar wagon totally and cold turkey.

The unpleasant truth about “sugar detox “ (I prefer the term “ refined sugar fasting “), is that getting off the sugar train can be really hard and truly lead to initial sugar withdrawal symptoms.

A few years back I read Stephen Guyenet’s fantastic book “ The Hungry Brain”. As a prime researcher on brain based obesity pattern, he describes an interesting and unique feature of the brain’s response to fast acting refined sugar the sweet taste in general: unlike with other tastes, the brain has a very poor, practically non-existent negative feedback loop to the sweet taste the keeps you eating it ravenously long after your other brains feedback loops (such as those regulating energy balance and satiety), would have signaled you to stop. As such, the majority of humans are truly at a disadvantage when it comes to controlling sugar eating behaviors.

There is not miracle cure for the bad sweet tooth. Breaking the sugar addiction cycle requires some acceptance of that fact, and the reality that there will be unpleasant initial withdrawals and cravings, not much different than cutting out cigarettes, alcohol, drugs etc..

However, there are a few smart things you should do to make this a feasible endevour.

  • Don’t keep it at home. If you have it at home, you brain knows where it is and will send you hunting for it sooner or later. Splurge on it outside of the home , but let it stay there

  • The first 7 days will be the worst.

  • You need to be sure you are adequately nourished with protein, good fats, and fiber. People who cut out too much fat will find it more difficult to limit sugar cravings

  • There are a few supplements that can help mitigate the sugar cravings (they do NOT replace having a solid plan in place). These would include inositol, berberine, and gymnema. The latter can be used as lozenges you suck on , which arguably have a mild unpleasant herbal sweet taste and desensitize your taste bud for several hours to the pleasant sensation of sweets.

SWITCHING "RICE" TO "POLICE"

Switching RICE to POLICE

I have recently been working on completing some online courses in the efforts to obtain my Certified Chiropractic Sports Physician (CCSP) certificate and in these efforts I came across some research and material regarding the traditional Rest Ice Compress and Elevate (RICE) for injury. It really isn’t that recent research has been pointing away from this, but it still seems to be what the general population recalls and has been sticking to. So instead of  Rest Ice Compress and Elevate (RICE) we should be doing Protect Optimal Load Ice Compression Elevation (POLICE). 

I really want to talk about the “Optimal Load” portion.

Optimal Load- “Optimal loading means replacing rest with a balanced and incremental rehabilitation programme where early activity encourages early recovery” (CM Bleakley, P Glasgow, DC MacAuley).

EARLY ACTIVITY ENCOURAGES EARLY RECOVERY- YES! We want the injured area moving again and moving well. With the optimal load we are able to return quicker and more efficient. Optimal load can look like body weight, resistance bands, a book and/or weights, etc. The tricky part can be getting the load that it optimal based on the injury.

Don’t continue being a victim of the RICE mentality. Move often, move well.

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NEW YEAR RESOLUTIONS AND "DETOX": WHAT DOES THAT REALLY MEAN ?

As many folks head into the new year with the desire to reboot their health, there is a renewed interest in the concept and practice of “detoxification”.

The idea of periodic “cleansing”, “purging” to improve health is not a new one, however I would say there is a a lot of confusion about what it really means in sound biological terms, leaving a lot of folks reaching out for the wrong ineffective method at best , doing themselves some harm at worst.

The body’s mechanisms of detoxification are quite complex and varied, but for the sake of this blog entry, I am going to simplify them to try to give the average person a basic “one-size-fits-most” template. For some patients, however, a detoxification program will be individualized for emphasis on what toxic burden they are facing and what additional personal deficits they are trying to balance.

The toxic burden that our body has to keep up with on a daily basis includes both internal toxins (getting rid of old hormones for example) and external toxins (medication, environmental pollutants). Our body’s toxic burden is the balance between our toxic exposure and our toxic excretion.

For starters: If you want to “detoxify”, you need to include lessening your toxic load, otherwise trying to improve your toxic excretion is like scooping water out of the proverbial leaking boat. This include simple steps: cut out processed foods, alcohol, go organic when you can on your food items, body care products and household products.

The biochemistry of detoxification is complex, but here is the 10,000 foot view:

  • The first phase involves uploading toxins from the blood into the cytochrome enzymes, which are mostly found in the liver.

  • The second phase involves binding those toxins with another chemical group that allows it to be packaged into a form that can be excreted. (methylation, sulfonation etc.)

  • The third phase involves excretion of the packaged toxin through the bile salts into the stools, into the urine, and in smaller amounts through the skin and mucous membranes.

There are key nutrients that are necessary for the normal detoxification pathways to work:

  • The cytochrome enzymes are regulated by a lot of plant nutrients and some minerals. Hence many ingredients found in commercial “detox” supplementations (super greens, milk thistle, beet root etc).

  • The second phase requires a robust amount of high quality protein, including some sulfur amino acids.

  • The excretion in the intestines via bile salts requires clean fats (for bile salt production), a lot of fiber to capture bile salts and prevent reabsorption of toxins.

  • A healthy and diverse gut microbial flora is essential to capture toxins that enter our body through our mouth, as well as help discard of old bile salts.

  • Adequate hydration to ensure a normal filtration volume of urinary toxins.

  • Adequate levels of oxygen circulating in the blood. Much of our enzyme system is oxygen dependent.

  • While not technically a nutrient, adequate restful sleep. Many of the cytochrome enzymes are depressed with inadequate sleep no matter which supplements you take.

  • While not technically a nutrient either, there is lots of emerging evidence that exposure to natural light activates pathways in our subcutaneous tissues that may be really important for health, including detoxification (nitric oxide pathways).

  • The frequency of eating is also misunderstood. There is no benefit to grazing every two hours. Actually your GI does a better job at emptying out if you have 4-5 hours between meals, or if you practice various forms of intermittent fasting.

So if you are serious about “Detoxification” in 2021, you need to understand that your action plan needs to include more than just gulping down an expensive powder smoothie once a day. Look at all the elements above and include as many as possible in your action plan.

  • Clean eating 95% of the time. Eliminate toxins in your environment over which you have control.

  • A base of high quality plants with every meal. OK to supplement, but not replace with the appropriate nutritional support.

  • High quality diverse protein intake with most meals. This would include both animal and vegetarian sources. Try to stay with whole food sources whenever possible.

  • Enough food based fiber in your diet. Aim for 25 gr/day, no more than 10 in supplement form.

  • If you are at risk of probiotic deficit in your GI (medication side effect for example), consider adding probiotic foods, or supplements. Otherwise nourish your own gut bacteria with enough fiber every day.

  • Consider having three main meals and not plan on snacking unless you are hungry in between meals.

  • Stay hydrated with good filtered water, enough to keep your urine a pale yellow.

    Make sure you get enough sleep, oxygen, and sunshine.

Knee Proprioception Fatigue and Injury Risk

A few years ago as a student at an ACA Sports Council Annual Symposium, I presented on some original research regarding knee proprioception fatigue and injury risk. So basically we wanted to know if when an athlete gets tired, does their body positioning awareness in space change to a point that may put them at risk of injury. Unfortunately, our population size was too small to obtain any statistical significance making this a pilot study and statistically not seeing a correlation. However, what was really interesting is we did notice some of the participants did have difficulty recreating the test once the subject self reported fatigue. To view the poster- click on the button below.

New Year, Weight Management and Road Blocks

Lots of folks have made New Year resolutions that include aiming for a healthier weight, and a few have made it past the first weeks sticking to it… I was listening to an older episode from Chris Masterjohn’s podcast series where he recounts his weight loss journey in 2017-2018. One of the most interesting parts of the talk is the disclaimer in the first 5 minutes of his talk, when he talks about WHEN NOT to tackle weight loss. This is not to say that you should defer healthy weight management indefinitely, but that there are a couple of crucial non-dietary factors that will be a roadblock to not only effective, but SAFE weight reduction. The two main ones are:

  • uncontrolled stress

  • inadequate sleep quantity and quality

Chronic or acute unmitigated stress will lead to dysregulation of cortisol and lower your body’s ability to adapt to any new environmental demands. Weight reduction often requires increased energy expenditure in the form of increased physical activity, or decreased food intake, both of which are a mild form of stress which could overwhelm your body’s ability to cope if already in a high state of stress. If under high stress, at minimum you need to incorporate some stress reduction practices ALONG with weight reduction protocols to avoid a crash and burn situation.

Inadequate sleep is often the proverbial elephant in the room as well. The metabolic domino effect includes many biochemical and physiological disruptions that will also make weight reductions difficult if not harmful to the body: lowered insulin resistance, increased free radical state, decreased leptin sensitivity, decreased anabolic hormones, just to name a few. As a crude benchmark, you need to aim for at least 7 hours of actual sleep (which means closer to 7 1/2 to 8 hours of time in bed). Sleep quality is harder to quantify but for those of you with fitness apps, your sleep efficiency should remain above 90 most nights.

Bottom line: If you want to be safe and successful with a healthy BMI in 2021, pay close attention to the non-dietary factors that may otherwise sabotage the journey.

https://chrismasterjohnphd.com/podcast/2016/08/09/how-i-lost-30-pounds-in-four-months-and-how-i-knew-it-was-time