How to Pevent Running Injuries

Running has become one of the most common forms of physical activity in today’s society. It can be a community building activity, a personal challenge and most importantly a great work out. It is a sport that everyone can participate in; all you need is a good pair of shoes and a little motivation. That being said running can be extremely hard on your body, especially when you are just starting.  We are finding that injuries among runners are very common. From shin splints to rolled ankles no one is immune from getting hurt; however, here are some tips to keep you healthy and on pace. 

Do not do too much, too fast

    When runners are just starting and begin to make progress, they tend to push their limits. Although this is a great way to challenge yourself, it is important that you understand your body has a threshold that when exceeded results in injury. Your mileage should be tracked on both a daily and weekly basis. If you have never done much long-distance running, then your weekly mileage should begin quite low. It is important that as you improve your mileage increases gradually. A consensus among the running community is the rule of 10%. Do not increase your mileage by any more than 10% on a week to week basis. For many runners and new runners specifically, 10% may even be too much of a jump. This is why when preparing for a distance race, whether it is a 10k, half marathon or a marathon it is recommended you start as early as possible. Could you train and complete a half marathon in 6 weeks? Maybe, but the toll it could take on your body and the injury risk you are exposing yourself to are likely not worth it. A recent study showed that runners who only increased their mileage by 3% a week had a much higher rate of success in their upcoming races than runners who ramped up their mileage quicker.

    So how do you know where to start? As a new runner, start with short runs and accumulate miles over the week. It is important to understand how far you have been running, so I recommend using an app on your phone such as “Map My Run” to help track each run. As you gradually increase your miles, you will have to begin to listen to your body. If you find that you are feeling fine after running 20 miles a week but when you increase it to 23 miles in a week you have no pains and discomfort, you may have to dial back to 20 miles/week before increasing more gradually. 

Do not run through significant pain

    As runners, we all understand some discomfort is a part of the sport. Your legs and feet will likely be sore after a long run; however, if you begin to notice significant pain or discomfort while running consider taking a break. Breaks are one of the hardest things to convince a runner of doing, but it could save you from more severe injury. Aside from the odd rolled ankle, very few running injuries are acute and traumatic. Far more commonly runners ignore the pain and “tough it out” when they begin to feel discomfort.

This can result in a cumulative injury cycle. What is that you might ask? It means if you continue to stress an injury by running, you will continue to make it worse and it can become a much more significant issue. Sometimes all it takes is an extra day off when symptoms are minor to allow your body to recover. This is important because if you have an injury, it is very common for your body to adapt by altering your gait (running pattern.) 

This may lead you to be less efficient, develop bad habits or in a worst-case scenario cause an injury elsewhere in your body. Remember, everything is connected, so if you are running with a limp the biomechanical stresses will be placed on a different part of your body. Give your body a chance to recover and if you think that an injury is nagging have a medical professional look at it. It is much more beneficial to have an injury taken care with a couple of sessions of treatment rather than letting it persist and having to deal with it when it is much more serious, and your recovery time is extended. 

Cadence (Stride Length)

The amateur runner may not put much thought into their running beyond putting one foot in front of the other, however, if you are finding yourself with consistent pain in your shins or recurring lower leg injuries the way you run may be playing a role. New research has demonstrated that when you take a longer stride as you run, the ground reaction force on your legs will be increased. This increased force can lead to more injuries and micro traumas that can lead to chronic injuries and discomfort. 

    If you think that this may be affecting your ability to run pain-free, try taking some shorter runs and actively think about taking shorter steps while running. Your legs will have to move faster to maintain the same pace as before, but you might find that you are injured less often. It will take some time to retrain your brain to alter your running pattern, but with some regular training, you should be able to make the transition. 

Warming up and Flexibility 

As with any other sport, it is essential that you warm up appropriately. A great way to warm up your muscles before a run is to perform a dynamic warm up. This means warming up while moving rather than a traditional static stretch. 

Some great dynamic exercises to perform before running are:

1. Forward Lunges

2. Side Lunges

3. Body Weight Squats

4. High Knee walking

5. Single leg deadlifts

These are simple exercises that will get blood flow to the muscles and help prepare you to start your work out. 

After your run, it will be important to perform some stretching and foam rolling to help your muscles recover.  You can use any of your favorite stretches but plan to spend at least 15-20 minutes stretching. Foam rolling does not require you to spend extensive time per region. Some people get carried away, but you only need to roll out the same spot for 1-2 minutes and move to the next. This is a great tool to help target knots and trigger points in your muscles that may have developed from your work out. If you have gone on an extended run (15 miles +), allow your body to cool down and recover before stretching. When you are running longer distances, your muscles will develop micro muscle tears which can be further injured if you stress the tissues (as with a stretch) immediately after the run. Give yourself a couple of hours and make sure you stretch before the end of the day. 

Quick Tips

• Don’t forget to stay hydrated. Water is always essential, but when training regularly your body requires even more water than you might think. 

• Fuel your body with nutrients: As you train you will be burning plenty of calories, remember to replace them with a healthy diet including healthy fats, fruits, vegetables and plenty of protein to aid in your recovery. 

• Consider strength training in your program. A diverse workout plan is essential to safe training, so just because you are training for a cardio event does not mean you can neglect the weight room. The stronger you are, the easier it is to prevent injuries. You may even use the weight room to target common weak muscles such as the glute medius, hamstrings, etc. which can help you prevent injuries

• REST. REST. REST. I discussed maintaining a gradual increase in your mileage but remember, your body needs time to recover. You can have an active rest day where you go for a walk or a casual swim but give your body a break while training so it can recover and help you perform to the best of your ability. 

There are plenty of things you can do prevent injuries while training and these are just a starting point. Implement as many of these strategies into your routine as you can, and you will be running pain-free in no time!

Is it Back Pain or a Herniated Disc?

If you are one of 31 million Americans experiencing back pain, neck pain, or low back pain, a "slipped" disc or herniated disc may be the cause.

But what exactly is a herniated disc, and how does it become injured?

The spine consists of 24 blocky bones (vertebra) stacked on top of each other in a flexible column that allows our body to move. Between each vertebra sits a soft, rubbery cushion made of cartilaginous fibers and hydrated proteins known as an intervertebral disc.

Intervertebral discs help act as shock absorbers for our spine. Discs absorb the impact of numerous physical activities: running, bending over, sitting, jumping on a trampoline, and more. Intervertebral discs also absorb physical forces sustained in stationary positions like sitting at a football game or in front of a computer for long periods.

Intervertebral discs are located along the spine in our neck, mid back, and lower back. They also bend and twist with movements of the spine, allowing our bodies to be flexible.

How do they accomplish this? Intervertebral discs are shaped like jelly donuts with a tough, fibrous outer portion known as the annulus fibrosis and a soft, gel-like inner portion called the nucleus pulposus. This combination of a more rigid exterior and softer interior allows it to distribute the forces we encounter with our everyday activities and physical exertion.

How does an injury occur to an intervertebral disc?  Imagine dropping a jelly doughnut onto the sidewalk and stepping on it.

The term "slipped disc," more accurately known as a bulging or herniated disc, refers to some damage that has occurred to either the annulus fibrosis, the nucleus pulposus, or both.

The damage can be minor – think of a small papercut that heals just fine on its own. Sometimes, the outer portion of the intervertebral disc tears, resulting in large bulges in the annulus fibrosis.  If the tearing and damage to the annulus fibrosis are extensive, the nucleus pulposus may leak out. 

Damage to this tough exterior of the intervertebral disc can also irritate the nerves on the outer third of the annulus fibrosis, causing pain and other issues to occur.

Compromise to the disc structure is commonly thought to occur from accidents or traumas, but this is not always the case. Although injuries from traumatic accidents like sporting injuries, vehicle collisions, or slips and falls can cause damage to the disc, degeneration, or accumulated wear and tear on the body, it can also cause discs to become more susceptible to injury and damage! Sometimes degeneration occurs from age, but it also can occur naturally. Thankfully, the rubbery discs in our spine are a lot stronger than a jelly doughnut!

Although intervertebral discs can be injured, there may not be any symptoms.  Having a disc injury may not always be painful or even result in pain or a loss of function. 

If there is a disc bulge or herniation, surgery is not always necessary to relieve the problem, either. Why is this? Disc bulges can occur naturally in the body without producing any signs or symptoms that they exist. It's when signs and symptoms, such as pain and a decreased ability to perform regular activities, may indicate the need for some intervention.

The mechanism of a disc herniation

The vertebrae and intervertebral discs of the spine surround and protect the spinal cord: the information highway connects the brain to the body's nerves.  The nerves exiting the spinal cord travel outward, innervating both the left and right sides of our bodies.

Injury to a disc can create a bulge that pinches one of the nerves exiting the spinal cord. This is known as nerve impingement. Signs and symptoms depend on where the disc is located and whether the disc bulge or injury is pressing on a nerve.

If this is the case, depending on where the pinched nerve is in the spine, it can result in pain, weakness, or odd sensations called paresthesia in an arm or leg!

Signs of a disc herniation causing nerve impingement include7:

• Arm or leg pain. If pain is left in the upper or lower extremities, it is usually only on one side. 

  • A disc herniation in the neck may cause pain and discomfort in the shoulder and arm. 

  • If the disc herniation is in the lower back, it may cause pain and discomfort along the beltline, thigh, and even into the foot. 

  • This pain can feel sharp or shooting when you cough, sneeze, or move into certain positions.

• Weakness. A disc herniation may pinch the nerve, resulting in muscles controlled by the nerve becoming weaker.

• Paresthesia. This may feel like tingling, numbness, strange sensations, or even ants crawling on the skin. The areas of the body that experience these symptoms are often supplied by the nerve being impinged.

Certain conditions increase the risk of developing disc herniations and disc injury. These are:

• Weight. Obesity and excess body weight places additional stress on the discs, primarily in the lower back.

• Occupation. People with labor-intensive jobs have a greater risk of developing back problems. This includes repetitive lifting, pulling, pushing, twisting, bending at the waist, and leaning from side to side.

• Genetics. Some people inherit a predisposition to developing a disc herniation.

• Smoking. Smoking decreases the oxygen supply to the disc, causing the cartilaginous fibers to break down more quickly.

Is your pain coming from a spinal disc injury?

What should you do if you suspect you have a disc herniation?  Because the nature of this injury is mechanical, which means it occurs in relation to the muscles, joints, and bones of the body, addressing the musculoskeletal components and making changes to overall bodily movement becomes a crucial part of an effective treatment plan.

Management of a disc herniation will depend on whether the condition is acute (sudden onset) or chronic (repeatedly occurring over time). It will also depend on the severity of symptoms and the size of the injury to the disc.

Thankfully, with the right interventions and tools, intervertebral discs can heal – although it can be slow!

What should you do if you suspect you have a disc herniation? To help prevent a herniated disc, you can:

• Exercise. Strengthen the trunk muscles (think core muscles: abs and back) as these muscles work together to stabilize and support the spine.

• Change your ergonomics. Lift heavy objects properly, making your legs and hips — not your back — do most of the work. Take breaks to change positions and move when sitting for long periods.

• Maintain a healthy weight. Excess weight puts more pressure on the spine and discs, making them more susceptible to herniation.

• Quit smoking. Avoid the use of any tobacco products.

Is a doctor's appointment necessary?

If you're having back pain, you may want to see your Doctor of Chiropractic to determine if you have a disc herniation.  A chiropractor is a trained doctor with the necessary educational background to analyze the physical movements of the body.  A chiropractor can be an asset in directing the course of care best for recovery if you have a disc injury or other musculoskeletal condition.  

Give our office a call if you feel you may have a disc injury or other condition causing your pain! Treating disc herniations and related conditions is right up our alley, and we have many methods to manage your care safely and effectively. In most herniated disc cases, a physical exam and a medical history are all that's needed for a diagnosis.  If you have another condition or extensive injury is suspected, you may be referred out for imaging.

Our office is well-equipped to assess, diagnose, and treat mechanical conditions — like disc herniations and pinched nerves — through gentle, conservative interventions that don't include injections or surgery.  Make your appointment today.  Living in pain is not an option if you have disc-related pain!

Low Back Pain and McKenzie Exercises

The visual that comes to mind when thinking of low back pain is a person half-bent over with a hand on the sore spot of their back.  Many of us have experienced low back pain, and you may recall feeling severely limited or even helpless during the acute phase of your last episode.   Feelings of pain and helplessness are some of the reasons why low back pain is of the most common causes for patients to seek emergency care!1

In fact, over 80% of people have experienced at least one episode of low back pain in their lives, and up to a quarter of adults have experienced low back pain in the last three months2,3!  That’s pretty... painful to think about, actually.

On top of this, chronic low back pain is considered the second most common form of disability worldwide,3 and one of the most common causes for adults to see a family physician.4

In the past, patients were told to “take it easy” during a flare-up of low back pain.  They may have been prescribed bed rest by their family physician, thinking that avoidance of movement would help relax muscle spasms and ease pain to more tolerable levels.

However, times have changed.  Treatment guidelines instead recommend specific exercise4, gentle stretches, and other ways of staying active during the recovery process.  Total bed rest is to be avoided.

Why the change?

Part of the reasoning is anatomical.  Two types of muscles exist in our backs: superficial muscles (or surface muscles) and deep muscles5.

Superficial muscles are used to perform motions like bending and twisting.  These muscles are strengthened by exercise that places stress on the muscles.  Think of the person at the gym lifting weights: they’re building and growing these superficial muscles.

Deep muscles, on the other hand, help stabilize the spine and maintain posture.  Physical activity such as yoga, walking, or specific exercises help keep them in shape. 

A common scenario is bending over to pick something off the floor.  You may hear a “pop” in your low back, followed by pain and muscle tightness.  You’re bent over, unable to fully stand upright, and your world suddenly hurts no matter what you do.  You go to bed – and stay there, unable to move because movement equals pain.  You call out of work because you can’t get out of bed.  You remain largely sedentary for a week, under the guise of “waiting it out.”

When a person goes on lengthy bed rest, the deep muscles in the back will weaken and begin to lose mass and strength.  This is a process known as atrophy.6

As the pain subsides and the person feels some improvement, activity is slowly resumed.  In order to do this, the body will recruit the bending, twisting, superficial muscles to help stabilize the back.  Although they can function in this capacity, superficial muscles are NOT well-adapted for this function!  These superficial muscles will tire more easily, resulting in impaired normal movement or motor control.

This can place abnormal stress on the structures in the spine such as joints and muscles, as well as joints and muscles in other areas of the body, increasing the risk for additional musculoskeletal injuries.7,8

There are specific exercises that help strengthen the stabilizing muscles that lie deep in our bodies, close to the spine.  Doctors of chiropractic regularly prescribe exercise to address an acute flare-up of low back pain and may suggest general activities, such as swimming or walking, to improve your overall fitness.8  

Some specific exercises, known as McKenzie exercises, are especially effective for patients who are suffering from an intervertebral disc injury.4 “McKenzie exercises” is a term you may not be familiar with. Yet. But hang with me. They have become a staple in the conservative management of low back pain. They entail simple exercises that have very profound impacts on a patient’s low back pain. They are named after Robin McKenzie, the physical therapist who first began using them.

McKenzie exercises are designed to be used after a thorough evaluation from your medical practitioner. In fact, McKenzie refers to a method of mechanical diagnosis and series of therapeutic exercises prescribed based on the determined diagnosis. The exercises I will be teaching here are simply one protocol of McKenzie exercises. It is the most commonly followed protocol; however, it will not help every low back pain patient. This is also not a substitute for a mechanical examination. Instead it is a tool for patients in acute pain seeking relief until obtaining professional care. 

In their most basic form, McKenzie exercises are most effective for patients suffering from intervertebral disc injuries. Disc injuries can cause a variety of low back symptoms from intense back pain to pain radiating into a lower extremity. These exercises may reduce the intensity of the pain and in some patients, eliminate it completely. 

When you are experiencing a disc bulge or herniation, the disc material will often protrude to the back side of the disc. While there are other kinds of disc injuries, these are the most common. Disc injuries are extremely prevalent in today’s population. Many who seek medical care for these injuries will be told their options are rest or surgery. Although in some severe cases surgery is necessary, the body has the ability resorb the disc naturally. McKenzie exercises are a mechanical tool that patients can use to help the body resorb this disc.

McKenzie extension exercises work because they force the spine to go into an extended, arched back, position. This arch will actually cause the two vertebrae to close down over the disc at the posterior aspect. This “closing” of the disc space can actually cause the protruding disc material to retract back into the spine and relieve many of the symptoms associated with a lumbar spine disc injury.

Before performing these exercises there are a few things you should pay attention to:

1. While performing the exercises it is common to experience pain throughout the exercise. Often after multiple repetitions the pain intensity will begin to decrease. If you perform the exercises and the pain gets worse and stays worse these exercises may not be right for you.

2. If you are experiencing symptoms into your lower extremity, these exercises may also help reduce those symptoms. As you perform repetitions, pay attention to the intensity of the pain in your leg. Has it been improving? Does the pain travel as far as it did when you began? If either of these occur continue with more sets and repetitions. These exercises may be right for you. It should be noted that even if symptoms in the lower extremity begin to trace back up the leg or decrease, it is not uncommon to simultaneously have increased pain in the low back. It sounds counterintuitive, but increased back pain is not always a bad sign when the pain in your leg is improving.  Typically, when there is radiating pain in the lower extremity, to get rid of the pain completely (from the leg AND back) the leg pain must be eliminated first. While performing these exercises, we often see the pain tracing up the leg towards the back becoming more intense, but over a smaller surface area. The smaller the area of pain, regardless of intensity, the closer you are to abolishing it completely.

How do we perform these exercises? 

You can begin these exercises in a standing or prone (on your stomach) position. When standing you will put your hands at the base of your spine and drive your hips forward. The goal is to push your hips over your toes or past them. Take the stretch to the point of pain or until you are unable to go any further and repeat.

If you are on your stomach, keep your hips on the floor and bring your hands up to your chest as if you are doing a push up. Push your chest up, going as far as you can without lifting your hips. If you are in a lot of pain, you may only move a couple inches. Do not force yourself through the pain. Let each repetition gradually improve your range through these exercises. 

A good place to start is with 3 sets of 10 repetitions. If the pain increases after three sets, it may not be the right exercise for your condition. If you experience no change or even mild improvement, perform more repetitions to see if you can create lasting improvement. For many patients these exercises may not only help decrease overall pain but also are useful for mitigating flare ups.

Remember these are just one of many different types of McKenzie exercises. You may require a different direction or progression of exercises. This is a great place to start if you are on your own but remember - it is highly recommended to get a proper evaluation from a McKenzie practitioner to determine exactly which exercises will treat your individual ailment.

References

1. Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.

2. “Back pain fact sheet.” (2014). National Institute of Neurological Disorders and Stroke. Retrieved March 2020 from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

3. Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. 

4. Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.

5.  Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.

6. Dirks, M.L., et al. (2016). One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65; (10):2862-75.

7. Belavy, D.L., et al. (2007). Superficial lumbopelvic muscle overactivity and decreased contraction after 8 weeks of bed rest. Spine 32(1), E23-E29.

8. “Low back pain.” (2020). American Academy of Family Physicians. Retrieved from https://familydoctor.org/condition/low-back-pain.

Carpal Tunnel Syndrome

Have you experienced wrist pain, hand pain, or numbness in your fingers?  Maybe you’ve felt this condition while sitting at the computer typing out work assessments, during a long session of playing video games, or swiping left or right on a phone or tablet screen repeatedly.  Perhaps you lift weights and experience it in the middle of an intense workout, or while holding heavy construction tools.  Whatever the cause may be, whether it’s from typing for long periods of time, holding a phone for a long time, or holding a jackhammer, the immediate conclusion people think of is a condition known as carpal tunnel syndrome. 

But what is this syndrome?  Is all wrist pain automatically carpal tunnel syndrome, or is it possibly something else?  

Carpal tunnel syndrome (CTS) is an entrapment neuropathy.1  Think of a pinch in a hose line caused by stepping on it, and you can visualize a similar compression of the nerve as it travels down through the wrist and into the hand.  The nerve, in particular, known as the median nerve, travels through a bony area in the wrist called – you guessed it – the carpal tunnel.  

The carpal tunnel itself is a narrow passageway inside your wrist surrounded by bones and ligaments.  Compression, or pinching, of the median nerve, can create symptoms including numbness, tingling, and weakness in the hand, wrist, and arm.2 

Carpal tunnel is the most common of neuropathies, or nerve conditions, with over 90% of neuropathic cases being from carpal tunnel compression.1

Carpal tunnel can be caused by a variety of circumstances and conditions as well.  CTS is more likely to occur in people who hold vibrating tools or work in an assembly line, engage in work that requires repetitive flexing of the wrist such as typing,  take certain medications, have inflammatory conditions, or have poor wrist and hand ergonomics.2  

The most common causes of carpal tunnel syndrome include genetic predisposition, history of repetitive wrist movements such as typing, or machine work as well as obesity, autoimmune disorders such as rheumatoid arthritis, and pregnancy.1  However, repetitive motions are a high-risk factor in developing carpal tunnel symptoms due to the repetitive activities inflaming the tendons that run through the carpal tunnel.  This inflammation can lead to compression of the median nerve.3

Symptoms usually start gradually, in one or both hands during the night, with frequent numbness or tingling in the fingers.4  Some people report their hands and fingers even feel useless, clumsy, and unresponsive or even feel swollen, although little or no swelling is apparent!

Unfortunately, many cases of the wrist and forearm pain are automatically diagnosed as CTS without truly examining all possible causes of the pain, or even confirming if the painful condition is truly CTS.

The million-dollar question: Is every hand and wrist issue created by an issue with the nerve inside the carpal tunnel?  The short answer: no!

Another condition, called Pronator Teres Syndrome (PTS), is very similar to CTS in the way it manifests.  PTS causes similar sensations to carpal tunnel syndrome, including weakness, tingling, pain, and numbness.  

However, Pronator Teres Syndrome is caused by a muscle in the forearm – it has nothing to do with the carpal tunnel in the wrist and hand!  

Pronator Teres Syndrome describes a condition where the median nerve is also compressed, but the cause is distinctly muscular.5  The Pronator Teres muscle in the forearm becomes over-used: think of excessive repetitive motions involved in our usual activities of daily living.  Maybe the repetitive motion is from an aspiring college tennis player perfecting her swing daily or someone who works in a kitchen, ladling soup, and washing dishes.  Maybe it’s the guy who wants to Do-It-Yourself a new kitchen in his home, and he’s swinging a hammer to break up old kitchen fixtures.  Whatever the repetitive cause, the same motions cause scar tissue, adhesions, or muscular restrictions to set up housekeeping inside the muscle and entrap the Median Nerve, causing forearm, wrist, and hand symptoms – much like CTS. 

Both syndromes cause similar pain but must be treated differently to achieve the desired results.  Imagine being treated for one condition with no change in pain and no results – when you actually have the other and need a different treatment altogether!  

Many cases of carpal tunnel can be treated conservatively or without surgical intervention.  Splinting, changing your daily routine, chiropractic care, soft tissue work, and other forms of treatment exist that safely improve and resolve a painful wrist condition.4

Keep in mind, there are other conditions that can affect the wrist, forearm, and elbow.  We only addressed two common causes here.  If you are dealing with any kind of discomfort in your wrist or hand, call today and get started on the road to recovery!

Sports Specialization: Yea or Nay?

Well-intentioned parents encourage children to pick up a sport or two to develop personal character: to learn the value of teamwork and collaboration, to develop grit and perseverance, engage and embody good sportsmanship, build self-esteem, and more. Sports activities not only provide children and students with a healthy activity to engage in for personal development but also creates an opportunity for fitness and energy. Adolescents who participate in sports activities may find them enjoyable as a healthy outlet for play.

Engaging in healthy physical exercise, such as organized sports, becomes an even more important endeavor from a health perspective. With the rise of obesity and lack of physical activity in school-aged students, particularly American high school students1, encouraging the youth to engage in at least one sport has become both underutilized and imperative.

The last decade has witnessed a steady decline in youth sport participation.1 With the increasing rarity of young persons actively engaging in athletic leadership, it is no wonder then that parents, coaches, and others tend to be encouraging when a young athlete shows talent and dedication in a particular sport.2

Sports specialization in youth is defined as engaging in a single sport for at least three seasons a year at the exclusion of other sports.2,3 Early sports specialization occurs in children under the age of 12.

Athletic specialization is inherently not a bad thing. Encouraging a student’s deep commitment to a sport can lead to several notable benefits such as recognition of college and professional coaches, the chance to attend prominent training academies, personal development of perseverance and time management, and an improvement in athletic skills and performance within a chosen sport.3

However, can there be too much sport for the individual? While it is important to foster a youth’s promising talent and dedication, doing so to an extreme can have detrimental effects on the long game. Intense focus on a single sport, largely driven by parents and coaches, can lead to a young athlete developing both injury and burnout. Almost 55% of parents encourage their children to specialize in a single sport.2

And if that wasn’t difficult enough, the number of hours of vigorous, repetitive, athletic activity are just as large a risk factor for injury as sport specialization, if not greater. This is especially true for female athletes who are more physically impacted by long repetitive hours devoted to sport than male athletes.2

That’s not accounting for additional factors that can contribute to overuse injuries. These include poor technique, inappropriate equipment, improper training methods, poor conditioning, prior injury, and more. It is true that any sports activity invites a chance of injury. However, the potential for injury increases as the intensity level and training volume increases.5  A series of studies in the Journal of Athletic Training were performed to evaluate the effects of being a specialized athlete at a young age.4 The results? Focusing on one sport increases the risk of major, career-threatening injury later in life.

And predictably, the type of injury accumulated from long periods of sustained, repetitive wear-and-tear on the body correlated with the sport. For example, in girl's basketball, soccer, and volleyball, specialization increased the risk of knee joint and hip injuries.5 In baseball, especially Little League, pitchers who specialized had a higher risk of elbow and shoulder injuries.5,6,8

The strongest argument against sports specialization is the idea of building overall athleticism before honing laser-sharp athletic focus; in essence, encouraging young athletes to foundationally move well before they move more and at higher intensities.4 The focus is to encourage overall movement until the young athlete is developmentally ready to learn sport-specific skills, and physical maturation will grant the required strength and speed to succeed at a specific sport.

Early sports specialization also creates a lack of cross-trained foundation, inhibiting the body’s natural capacity for adaptation and leaving young aspiring athletes more prone to injury. Multiple sports builds fundamental motor skill development, which should be trained to achieve success in sports activities such as running, jumping, kicking, and throwing.5

Repetition is an important part of athleticism, and one key factor that separates young athletes from mature athletes is that young athletes undergo numerous changes in a relatively small timeframe due to puberty and adolescence. Repetitive movements found in sport specialization can create microtrauma in areas that are still growing. Changes in body weight, height, and muscle mass provide additional stress to joints and connective tissue, and as young athletes grow, growth cartilage is vulnerable to the stress of repeated microtraumas. As muscle develops from repetition faster than bone, areas of musculotendinous attachment can be more susceptible to pathological injury. Such examples include Sever’s disease and Osgood-Schlatter disease, which are rarely found in adults.

Two-time NBA MVP Stephen Curry spoke on the topic of playing multiple sports at a sports panel with the junior NBA and the Positive Coaching Alliance. Curry advocates that children and adolescents should not specialize in a single sport too soon. “Because […] you might be better (than your peers) at any certain sport, you might feel comfortable in that space, and that zone. But you don’t really get to push yourself, you don’t really get to test yourself and how you deal with failure and success,” Curry said.8

It is important to vary training and avoid repetitive activities that place physical stress on an athlete’s body. Many options exist while resting from a specific sport; one such example is replacing overtraining with strength and conditioning. Not only can this enhance overall health, but also provide an opportunity for injury prevention and rehabilitation, improve body composition, and increase bone health. This can also lead to better outcomes with regards to athletic performance as it avoids staleness or unexpected long-term decreases in performance without evidence of injury.5

Sport diversification also enhances the mental health of a young athlete. Early specialization of one sport can lead to burnout6, which is defined as physical and emotional exhaustion from the athletic demands of a singular sport. With a decrease in performance from overtraining and the increase in the likelihood of being injured, burnout can ultimately lead to a promising athlete withdrawing or dropping out entirely.

Ultimately, sport diversification is what’s necessary to help prevent youth injuries. Playing as many sports as possible, as often as possible, creates an environment that is both physically and emotionally nurturing and productive. Sports specialization may be better utilized with structured practice once the foundations of proper movement have been placed in the aspiring young athlete.

Early involvement in sports should be encouraged. The development of gross motor skills is enhanced alongside the personal development that takes place with engaging in sports. A crossover between sports creates a positive physical, social, and mental experience that will springboard the young athlete into becoming a well-rounded elite — if he or she chooses.

References

1. Hainline, B. (2019) Early Sport Specialization: Shifting Societal Norms. Journal of Athletic Training: October, Vol. 54, No. 10, pp. 1011-1012.

2. “The growing trend of youth sports specialization.” Posted Mar 6, 2018. PR Newswire for the American Academy of Orthopedic Surgeons. Retrieved Feb 2020 from: https://www.prnewswire.com/news-releases/the-growing-trend-of-youth-sports-specialization-300608434.html

3. “The dangers of youth sport specialization and the benefits of diversification.” Posted May 20, 2019. Global Sports Development. Retrieved February 2020 from: http://globalsportsdevelopment.org/2019/05/20/specialization-vs-diversification

4. Newman, L. “Studies: Sports specialization at young age increases risk of career-threatening injury.” Posted Oct 22, 2019. USA Today High School Sports. Retrieved February 2020 from: https://usatodayhss.com/2019/jat-nata-sports-specialization-young-age-can-be-harmful

5. Caruso, T.H. (2013) Early sport specialization versus diversification in youth athletes. National Strength and Conditioning Association. December, Vol. 2, Issue 4. n.p.

6. Kutz, M, and Secrest, M. Contributing factors to overtraining in the adolescent multi-season/sport athlete. Strength and Conditioning Journal 31(3): 37-42, 2009.

7. Holt, J.B., et al. (2020) Progressive elbow magnetic resonance imaging abnormalities in Little League players are common: a 3-year longitudinal study. Am J Sports Med. 2020 Feb;48(2):466-472.

8. Interview with Stephen Curry with Stack. “Steph Curry says playing multiple sports gave him confidence to be an MVP.” Posted Feb 15, 2018. Retrieved Feb 2020 from: stack.com/a/steph-curry-says-playing-multiple-sports-gave-him-confidence-to-be-an-mvp

Sleep

Sleep is an important factor as it heavily influences our performance at work, our risk for chronic disease, and our overall quality of life. Sleep researchers, however, aren’t clear on the exact reason why humans even need to sleep. From an evolutionary perspective sleep would certainly have left primitive humans vulnerable to attack so it must offer some great advantage. Generally speaking, sleep is thought to allow our brains and our bodies to heal and repair from the damage of the day; synaptic plasticity is managed, brain pathways that are not being used are pruned, muscles are repaired, and energy stores are replenished

Short sleep duration (defined as less than 7 hours of sleep per night) is common. In the United States 24% – 48% of people report it. If you are obese, a smoker, consume excessive alcohol, or are physically inactive you are more likely to report short sleep duration.1 Sleep is an active process. In other words, you don’t fall asleep simply because your brain is tired. Sleep is actively maintained throughout the night. Disruption of this careful balance between arousal and sleep results in, what else, disrupted sleep.

Humans display a 24-hour circadian rhythm. This rhythm is endogenous, meaning it is maintained even in the absence of environmental cues. Human beings placed environments with no light, no time cues, no social cues, etc., will still display a 24-hour rhythm. However, external timing cues do modulate and adapt the rhythm to the environment. For example, sunlight, in humans, is a powerful cue to have the waking phase of our 24-hour cycle during the day. Other mammals, like rats and mice, have most of their waking phase at night. These rhythms were created through many years of evolutionary pressure. Light cues, which modulate our circadian rhythm, are extremely powerful. Circadian rhythm is endogenous so an internal pacemaker is necessary. The suprachiasmatic nucleus in the hypothalamus is a major part of the internal pacemaker of humans. This part of the brain is connected to the retina via the retinohypothalamic tract.2 This direct and powerful connection shows just how important light is for controlling circadian rhythm.

Sleep is divided into two forms – non-REM and REM. Non-REM sleep is further subdivided into 4 stages, each with its own properties. During non-REM sleep neuronal activity is low, metabolic rate and brain temperature are at their lowest, heart rate decreases, blood pressure lowers, and muscle tone and reflexes are intact. Contrast this with REM (rapid eye movement) sleep where brain activity is similar to that of the awake brain. For this reason, it is sometimes referred to as paradoxical sleep. In REM sleep brain temperature and metabolic rate rise and there is complete loss of muscle tone with the exception of the diaphragm (so you can breathe), the eye muscles, and some muscles within the inner ear.

A recent study of about 1,500 Americans found that 90% of adults use an electronic device within 1 hour of bedtime at least a few times per week. Devices may be an important contributor to insomnia because of the short-wavelength-enriched light that is emitted from them. Exposure to light in the evening and the early part of the night, even at low intensity, has several sleep-disturbing effects. First is suppresses melatonin, delaying the onset of sleep. It shifts the circadian clock to a later time making it harder to fall asleep at a regular hour. Finally, it increases alertness and arousal.3

In one interesting study, 12 adults were randomly assigned reading from a light-emitting eBook for 4 hours before bed or reading from a print book for 4 hours before bed for 5 consecutive evenings. They found that those reading an LE-ebook displayed decreased subjective sleepiness, decreased EEG delta/theta activity, suppressed melatonin secretion, lengthened sleep latency (increased time to fall asleep), delayed and reduced REM sleep, and impaired morning alertness.3 

Why does blue light have this effect? Human eyes have rods, cones, and intrinsically photosensitive retinal ganglion cells. Rods and cones are mostly responsible for image-forming vision. Intrinsically photosensitive retinal ganglion cells are responsible for regulating circadian rhythm and other biologic functions. Retinal ganglion cells form the beginning of the retinohypothalamic tract which transmits light data from the retina to the hypothalamus to regulate circadian rhythms throughout the body. Retinal ganglion cells respond powerfully short-wavelength light like the blue-colored light emitted from most devices and LED televisions. This blue light will cause a high rate of fire from the eyes to the hypothalamus, which will change hormonal and circadian rhythms.4 Blue light also has the ability to stimulate other areas of the brain which are responsible for producing norepinephrine, a neurotransmitter that has potent arousal properties.5

With the knowledge that the blue light emitted from almost all devices and LED TVs is disruptive to the foundational pathways for sleep, it’s important to take steps to remedy this if you’re having trouble sleeping. First and foremost, do not use your device in bed. At all. In fact, you should avoid using it at least an hour before you plan to go to bed. Do not watch TV in bed either. If your symptoms are severe, avoid TV for at least an hour before you plan to retire. If you have to use a device for some reason, avoid long exposure. You should also consider wearing red-colored lenses for about an hour before bed. The red-color of the lens blocks the blue light from reaching the retina. Blue-light blockers that are clear also exist. You could consider purchasing a pair of these and using them in the evening and while you’re using your device. I’ve recommended a pair from this website: www.blepeyewear.com. As devices age, they tend to emit more blue light. If possible, consider getting a newer device. Finally, many devices come with a night-shift mode. This mode shifts the hue of the screen to a warmer, redder tone. This has been studied to see if it offset the negative effects of the light from a device. Unfortunately, it did not. Melatonin levels were still reduced when using night shift mode.6

In the end, if you suffer from insomnia, reducing your device exposure is likely to have a measurable effect on your sleep. Our devices have become extensions of our lives so it may be difficult to completely eliminate exposure, however, your brain (and your boss) will thank you for the better sleep.

1https://www.cdc.gov/sleep/data_statistics.html

2Kandel, et al., editors. “Sleep and Dreaming .” Principles of Neural Science, 4th ed., McGraw-Hill, 2000, pp. 936–947.

3Proc Natl Acad Sci U S A. 2015 Jan 27;112(4):1232-7.

4Molecular Vision 2016; 22:61-72.

5Blue-Light Therapy following Mild Traumatic Brain Injury: Effects on White Matter Water Diffusion in the Brain. Front. Neurol. 8:616. 

6Sleep, Volume 40, Issue suppl_1, 28 April 2017, Pages A290.

5 Benefits of Chiropractic Care

1- Pain relief. Research has continually shown chiropractic care is a safe, effective way to relieve most causes of neck and back pain. From pulled muscles to herniated discs to arthritis, chiropractic treatment can help you conquer your pain.

2- Improved function. Pain and function are inversely related. The more pain you have, the less you can function. Chiropractic has been shown to not only help reduce your pain, but also increase your ability to function. Whether it is playing golf, running the trail, hitting the gym, or enjoying friends and family, chiropractic care can get you back to doing what you love.

3- Say goodbye to your headaches. Over 20 million people suffer every day with the pain, muscle tension, throbbing, nausea, and other issues caused by headaches. Chiropractic care is a proven way to reduce or eliminate your headaches so you can truly enjoy each day!

4- Reduce medication use. Nearly 200 people die every day from an opioid overdose. Many of these people were initially given these medications to help treat their pain. Even “safer” alternatives like NSAIDs are responsible for over 3,000 deaths per year.

Drugs should rarely be the first line of treatment for back or neck pain. Your body is designed to move and recover- so going to a doctor focused on movement and recovery seems like a good idea to not only reduce your medication use but to get the best results possible.

5- Improve athletic performance. All major sports teams employ chiropractors to help their athletes recover and get back in the game faster. Whether you are an office worker, weekend warrior, or professional athlete, a balance of strength and flexibility is one of the top keys to stay well long term.

Your Foundational Core

Your core is made up of the groups of muscles that provide stability in the abdominal and lower back regions. It includes your abs and the deep muscles that surround and support your spine. These muscles also coordinate the movement of your arms, legs, and spine. Ideally, your core and low back work together in a balance of strength and flexibility. A lack of flexibility or strength in your core can contribute to low back pain.

Strengthening your core muscles can help your endurance, improve your posture, and take the pressure off your low back. Having strong core muscles makes it less likely that you will suffer back pain and can give you better balance. Everything you do in daily life or during a workout will be easier if you have a strong and flexible core. It's the centerpiece of all body movement.

• A strong and flexible core can help improve your posture, balance, and reduce your risk of experiencing back pain.

• When your core muscles contract, they stabilize your spine, pelvis, and shoulder girdle to create a solid foundation for movement.

• Weak core muscles can alter your posture and spinal curves which often leads to back pain.

There are a million ways to work your core. So how can you decide what's best? Just ask us! We are happy to provide you with some of our favorite core strengthening exercises to fit your activity level and health goals. Some of the most efficient core exercises don't require any additional equipment, just the desire to improve your health with better strength and flexibility.

Fixing Low Back Pain

Restrictions and limited mobility of your lower back may be causing your pain. If your low back doesn't have a full range of motion, then you are setting it up for future injuries. Bending forward and back (flexion/extension), side bending (lateral bend), and turning side to side (rotation) are the three movements that make up a full range of motion. You have to use it, or you'll lose it. Neglecting your lower back and not actively improving and maintaining a full range of motion can cause restrictions, deconditioning and increase your chance of injury.

The care given in our practice is specifically designed to address both aspects of improving your range of motion, segmental, and global. That means our chiropractic adjustments work the specific joints of your spine that are "stuck" or restricted. This begins the process of improving your range of motion and often provides quick relief from pain. The next steps are to improve the overall, or global, range of motion. This is where we may recommend at-home stretches, specific exercise, or even periodic adjustments to help continue your progress and hopefully keep you pain-free in the future.

• Limited range of motion in your low back can lead to a combination of shortened and weakened muscles that increase your risk of injury.

• Chiropractic care provides relief by improving the motion of your facet joints and limiting the pain signals traveling through your central nervous system.

• At-home stretching, daily exercise, and even periodic chiropractic adjustments are all ways you can take a proactive approach to stay pain-free.

If your low back is de-conditioned and limited in its mobility, you likely have a combination of shortened and weakened core muscles that are over-stressed and causing pain. Our practice is focused on helping you decrease pain, improve your mobility, and live a healthier life. The first step is to give us a call and let us help you get back in motion.

What is Sciatica?

Nearly everyone will have back pain at some point in their life, but with sciatica, you'll know something is different right away. Pain that begins in your back travels down to your buttocks, and shoots down your leg is a classic sign of sciatica. The shooting pain down your leg is caused by compression on one of the nerves exiting your spine. Even a small amount of pressure can cause a tremendous amount of pain, so getting rid of the inflammation and opening up space, the nerve is essential to find relief.

Pinching, or compression on a spinal nerve can occur because of an injury to one of your spinal discs (such as disc herniation) or the development of a bone spur. Either way, it's likely to cause pain and discomfort until you can decrease the inflammation, open up space for the nerve, or improve the movement of your spinal joints.

• Sciatica occurs when a spinal nerve gets pinched by a disc, bone spur, or ligament and can cause pain that travels down the buttocks and leg.

• Research has discovered that 60% of people with sciatica benefited from chiropractic adjustments to the same degree as if they underwent surgical intervention (without any of the risks!).

• Exercise and rehab can help strengthen the muscles supporting your spine and reduce the likelihood of a relapse.

Pain, numbness, or weakness in the legs can be scary. If you experience any of these symptoms, it's best to consult with our office right away. Top research publications have shown that people struggling with sciatica can get fantastic results with chiropractic care. Reach out today to discover if the techniques we offer in our practice can help you get on the road to relief.