
	The Renkens Center Newsletter Volume 2; Issue 5 "Each body has its art."

"Things Happen For A Reason"

Whether you believe in this old saying or not is your own deal, but for some things it most DEFINITELY holds true. Last weekend I ran into a young athlete who previously had come to see me for medial knee pain. We resolved that issue quite easily and I had not seen him since. That was roughly eight months ago. After exchanging friendly "hellos" and "how have you beens", what he told me next was what left an impression on me. The young man (16 years old) told me his low back had been hurting him. When I asked him why he had not yet come to see me, he told me he had already gone to see his other doctor. His other doctor told him, "he has seen a lot of cases of this type and....he was having low back pain for no apparent reason."

"FOR NO APPARENT REASON?!!" C'mon folks. What is that? I can't blame the young man for this for he went to his doctor for help and this is what his doctor told him. On the other hand, how upset would you be if you went to a doctor looking for answers (and help) and you came away with some lame explanation such as that! And to put some icing on the cake, the doc tells him he has seen "a lot" of cases like his - low back pain FOR NO APPARENT REASON. This means there are several other people getting this same explanation. Believe me, there is always a reason one's back or any other part of their body is hurting. The pain we feel is nothing more than our body telling us something is wrong. It has crossed the threshold - it can no longer compensate - and is telling us to do something about it. It is my job to screen and assess, come up with clues and the reason / cause of the pain and treat accordingly.

Finding The Cause

Not a week goes by that I am not amazed by the human body. The paradox that exists is that while the body remains a mystery in many, many ways, there are several things that make a lot of sense. Furthermore, when assessed properly, issues can often be resolved very quickly. Oftentimes, individuals suffer far too long with dysfunction and resultant pains that arise from compensation. With a solid foundation of functional anatomy and biomechanics, the cause can be identified and appropriately addressed. The following is an example of an issue a patient and I worked through not too long ago.

Background: 28-year-old, first-time marathoner presents with medial lower leg pain of three + months duration. Before coming to my office, he had completed eight weeks of physical therapy after a "diagnosis of shin splints". During his time with the physical therapist, the medial leg received electric stimulation, ultrasound, ice massage, and calf stretching. The runner's leg pain decreased with rest, but as he attempted to run again, the pain returned unchanged. This approach illustrates a classic example of treating the symptoms while missing the cause and underlying dysfunctions. In this case, the symptoms were located in the lower leg while the dysfunctions higher up in the kinetic chain were missed.

Functional assessment revealed the following: Prone hip extension was poor on the symptomatic side - decreased by over 50 percent. Palpation revealed adhesions in the psoas and iliacus leading to shortening of these structures and further inhibiting the glute maximus (hip extensor). This inhibition was leading to overload on the posterior chain. While watching this individual run, I could see his running economy was greatly reduced. Ultimately, this means his body is working much harder than it needs to and will fatigue easier and quicker. The muscles comprising the calf - gastrocsoleous group, tibialis posterior, flexor digitorum longus, and flexor hallicus longus - were now being over-recruited (compensation) to propel the body forward. Further palpation revealed the tightness and adhesions in the posterior leg. This over-recruitment resulted in the tibialis posterior and flexor digitorum longus (FDL) eliciting overuse symptoms. The toes were actually seen to be clawing when he walked barefoot from the FDL over-recruitment. This resulted in limited ankle dorsiflexion. Furthermore, the tibialis anterior muscle on the front of the lower leg was found to be inhibited as was the peroneus tertius. Both of these muscles are dorsiflexors of the ankle. They were shut down as a result of straining to decelerate the strong plantarflexion action of the posterior chain muscles. This inhibition was further limiting ankle rocker motion which when taken a step further will further affect hip extension only adding to the problem at the top of the chain. Remember, if one part of the movement equation isn't doing its job, then other parts of the kinetic chain will be at an increased risk of injury.

Simply treating the site of symptoms was not enough. The symptom showing up is not the problem. Pain is only the presentation. We worked to release the adhesions and upregulate / restore the inhibited muscles which resulted in optimal muscle balance, less stress to the lower leg, and the body moving with greater efficiency. When the body moves efficiently, compensations no longer exist, energy leaks are eliminated, and symptoms go away.

Throw Out The Lucky Charms

Breakfast may be the most important meal of the day, but if you and / or your children are eating from a box that features cartoon characters or contains a prize, they might as well be eating Twinkies and Ho-Hoes. Researchers looked at the nutrition labels for 161 ready-to-eat cereals; about half are marketed to our children. Turns out that gram for gram, the kids' cereals contained 52% more sugar than the grown-ups' cereals and 15% more sodium (Journal of American Dietetic Association). And don't let that "whole grain" label fool you. Read the fine print and you will find one serving of some of those cereals has almost as much sugar as a Twinkie and only a single gram of fiber.

Time For Prevention

A recent survey of over 500 competitive runners, cyclists, and triathletes found that 90 percent had suffered an injury in the past year. About half of the athletes were sidelined for at least two weeks, and a quarter were out of competition for more than a month. Source: Active.com

Bummer! Being an athlete myself, I would be miserable if I missed even one week of training. Typically, we experience pain and injury due to an accumulation of stresses being placed on the body that the muscles and joints can no longer handle. Muscles control body movement. If the muscles are imbalanced, they can no longer function optimally. As a result, the body gets out of alignment as some muscles are short and overactive and others are long and underactive. My suggestion: Rather than falsely believe that injury is part of an active / competitive lifestyle, try taking a more proactive approach to staying healthy and injury free. There are several measures that can be taken to considerably reduce the likelihood of dysfunction and injury and at the same time enhance function and performance.

Consider another recent statistic taken from the British Journal of Sports Medicine: Researchers found that athletes who suffered an injury were 2.7 times more likely than uninjured athletes to suffer the same injury the following season. Those who had a hamstring, groin, or knee injury were most likely to suffer the identical injury again.

How could this be? Well, for starters, many try to "train through" pain and injury only to see it worsen or something else show up later further up or down the kinetic chain. Furthermore, our nervous system is plastic - oftentimes referred to as the plasticity of the nervous system. Our nervous system and the muscles it innervates will literally engrain patterns of compensation into its movements. Essentially, our body will take the path of least resistance, even if it means accelerated wear and tear. Until muscle balance is properly restored and proper movement patterns are relearned, injury is likely to reoccur.