Sleeping Better

Morning Folks! We’re giving you a double-dose of YouTube channel goodness this week. This time we’re giving you the run-down on Sleep Remedy, the creation of former Navy Seal and MD Kirk Parsley. This all-natural supplement has been a life-saver for JC and I as we’ve endured 5+ years of intermittent sleep deprivation raising our 3 kids. If you struggle to get to sleep or stay asleep, we highly recommend you give Sleep Remedy a 30-day trial.

Shouldering-On

Morning, folks! We’re back for part 3 of our series on our YouTube channel to help folks build better shoulder health, mobility, and strength. Today we’re talking mobility. If you can’t reach behind your back and with your thumb reach the bottom edge of your opposite shoulder blade, you’ve got problems coming. If you can’t raise your arms fully overhead with your elbows straight and your thumbs pointed behind you, you’ve got work to do. We’ll show you how to solve both problems today. Enjoy!

More YouTube Goodness

Your warm-up and cool-down routines need an upgrade. It’s here.

Written YouTube Logo

Morning, Folks! We’ve got another video up on the Restore/Thrive YouTube Channel. This time, we’re tackling the concept of “stretching” and expanding your mind on what warming up and cooling down is all about. Enjoy!

Treating Concussions

Current treatment approaches for treating Post-Concussion Syndrome.

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This probably doesn’t sound like the post you’ve been waiting for. This is, however, a post I’ve been meaning to write for quite some time. As the only PT at my clinic who treats patients suffering from Post-Concussion Syndrome (PCS) I want to write about this topic for a few important reasons:

  1. The CDC (Centers for Disease Control) estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities every year. You probably know someone (or are someone) who has sustained a concussion.
  2. We spend, directly and indirectly, over $60 billion per-year treating concussions in the U.S. on a yearly basis.
  3. Many folks who sustain a concussion don’t seek immediate medical advice or treatment.

It’s that third point that I intend to address now. Reducing concussions is, to a certain extent, a fool’s errand. Accidents happen. People are going to play sports, run around and have fun, and occasionally slip/fall/run into something leading with their heads. The most important component in a traumatic brain injury situation is that the victim of the injury receives immediate treatment. Sitting in a dark room and waiting to feel better is a recipe for disaster. Seeking professional help and restoring your normal day to day functional abilities should be priority number one.

Let’s talk briefly, and as plainly as possible, about what happens when you sustain a concussion in terms of physiology. I’ll start with a diagramConcussion Pathophysiology

This is your brain when it becomes concussed. For those non-science majors, note point #3 in the diagram “Calcium in the cell impairs ATP production in the mitochondria, worsening energy crisis”. Put more simply, your brain is running out of energy to perform it’s normal functions. ATP, the energy produced by your body for everything from sprinting performance to recalling your daily chore list in your brain, isn’t produced at adequate levels when you have sustained a concussion.

To the left of the diagram you see a description of the depolarization and neurotransmitter release. Hang in there with me. In a nutshell, this means your brain gets really incompetent at using glucose (sugar) for energy.

And here’s where we start with our current methods for treating PCS. Lifestyle modification is key. If you are suffering from a concussion, start with these modifications:

  1. Avoid any screens with blue light (that means computers, tablets, TV’s, cell phones, and the like). Blue light heightens brain activity (read: energy consumption), something an injured brain can’t spare.
  2. Sleep in a pitch black room. We’ve discussed the ins and outs of the importance of sleep here. It’s doubly important when you’re trying to set the stage for your brain to heal that you optimize your sleep hygiene.
  3. Modify your diet. Reduce your carbohydrate intake. Carbohydrates are not the friend of an injured brain (carbohydrates are broken down into simple sugar in your body, and simple sugar are broken down into glucose-the fuel your brain can’t use when you’re concussed).
  4. There is considerable research demonstrating that an alternative fuel source can fuel the brain for all of the functions it requires energy for. That fuel source? Ketone bodies. Ketones are produced in the liver during bouts of intense exercise (not recommended if you are concussed), low carbohydrate intake, low calorie intake, or untreated Type 1 diabetes. Initially I recommended that my PCS patients consider a ketogenic (low carbohydrate, moderate protein, high fat) diet to supply the necessary fuel substrates (ketones) needed for their brains to heal. I still support that recommendation. Within the last year, though, there have been several companies that have started making exogenous (synthetic) ketones that you can mix as a drink to derive the same cognitive benefits that previously only came about when following a strict ketogenic diet. There are a host of brands if you do a simple search on Amazon, but I would recommend one of the following three brands in particular: Keto O/S, Kegenix, or KetoCaNa. These supplements are not cheap, but they are a small price to pay compared to the lost earnings from missed work time and myriad of medical expenses you will incur after a concussion if you decided not to take personal responsibility for optimizing the healing environment for your brain. (Side Note #1: Please contact my favorite dietician, Robyn Johnson, here, if you need help sorting out the nutrition component)

After you accounted for your light exposure, sleep, and nutrition, it’s time to get to work in restoring the normal function of your brain. This can be a multi-disciplinary process. I have been trained to administer vestibular rehab (restoring the normal function of reflexes that occur between the eyes, the brain, and the 5 canals in each of your ears that gives you sense of your body’s position in space). Sometimes vestibular rehab isn’t enough. If a concussed patient has a particular vision deficit, I refer them out to a neuro-optometrist to address the visual changes they have sustained. (Side Note #2: If you live in the Kansas City area, I highly recommend Dr. John C. Metzger at Kansas City Vision Performance Center if you have any visual deficits after a concussion).

Each concussion patient has a different experience. Though an estimated 80-90% of cases “resolve” in two weeks, if you’re part of the 10-20% of cases that don’t get better, you need to seek treatment ASAP. Even if you’re “recovered”, if you haven’t had a thorough vetibular-ocular exam, it is entirely possible, if not altogether likely, that you still have some deficits that are effecting your physical and mental capabilities.

Don’t wait to get the help you need. Find a qualified professional to help point you in the right direction to recovery.

One last side note (#3, for the record): if you have sustained a concussion, or even if you haven’t sustained a concussion and participate in a contact sport such as American football or ice hockey, you should seriously consider avoid the consumption or administration by injection of non-steroidal anti-inflammatory drugs (NDAIDS). This class of drugs has been shown to increase blood-brain barrier permeability. If you’re already concussed, receiving one of these drugs (Aleve and Toradol are two common forms) you’re making the problem worse. If you’re not yet concussed but taking these drugs, you’re opening the door for a more severe traumatic brain injury should you become concussed. Think long and hard about how much you enjoy your current mental capabilities before heading down the pharmaceutical pathway.


COMMENT RULES: If you are a real person, leave your real name. We are not a clearing house for solicitors so don’t do it here. Criticism and questioning is fine, that’s how we all learn and grow. Personal attacks, name calling, and the like ARE NOT COOL-if we catch you doing it you’re gone. Other than that, have at it folks! We love hearing from followers and newcomers alike and will try to reply to as many comments and questions as we can!

Are You Ready to Run? Part XII

The dietary staple your runs can’t do without

As we continue on in our series to make you the best version of your running self (we’ve put up enough posts on this topic that we’re rivaling the number of Air Jordan models that have been released), we’re going to talk about the simplest and most effective way to enhance your running performance.

Quickly, a review of the previous standards and some links for those of you who need to catch up:

The Standards

#1-Neutral Feet

#2-Flat Shoes

#3-A Supple Thoracic Spine

#4-An Efficient Squatting Technique

#5 Hip Flexion

#6 Hip Extension

#7 Ankle Range of Motion

#8 Warming Up and Cooling Down

#9 Compression

#10 No Hot Spots

#11 Hydration

A few questions for you:

Are you hydrated? Yes or no? It’s an easy but essential question to answer.

Are you drinking a minimum of 2 to 3 quarts of water each day?

Do you know how to check your hydration status?

How much performance are you leaving on the table by being dehydrated?

Some True Facts Related to Hydration

A 2 percent drop in your optimal hydration level can decrease your VO2 Max power output-the physical capacity that allows you to maintain your race pace from start to finish-by up to 11%!

You sweat out 3 cups of water through your feet every day. The average human loses 3 liters of water per day just perspiring, breathing, and peeing.

Water is the base of the aqueous environment inside of your body that allows a host of functions to occur: oxygen transport (fairly important if you want to breathe while you run), protein resynthesis (for muscle, tendon, cartilage, ligament and fascial repair), and hormone and antibody transport, to name a few. If you’ve got creaky knees from degenerative cartilage and you’re not on-point with your hydration game, you are accelerating the process of grinding your knee cartilage into a fine dust.

When you’re dehydrated while running, your body steals water from your muscles to keep your brain functioning-helpful in terms of keeping you from running into traffic, not so helpful in terms of keeping your muscles functioning properly. Chronic dehydration leads to muscle breakdown and a general loss of energy required to power that running motor of yours.

We’ve talked at length about tissue health and mobility. When you lack adequate hydration, those tissues get stiff, matted down, and stuck together. That quick roll of your ankle as you attempt to side-step a pothole in the sidewalk turns into an ankle ligament tear when those tissues aren’t properly hydrated and supple.

Application

A few simple practices will help you stay hydrated and optimized for running greatness.

First, a simple rule: you need electrolytes to absorb your water. Before you race out a buy the jumbo case of Gatorade at Costco, let me offer an easier, more cost-effective, and healthier approach. When you’re slamming back your Camelback water bottle throughout the day, add a pinch of salt. Otherwise that water will run right through your body instead of being absorbed by your tissues. I prefer Nuun hydration tablets, to add a little flavor to my water. If I don’t have any handy, a pinch of Himalayan Sea Salt (just about any brand) does the trick. When you’re eating food, salt your food and drink pure water.

Second, don’t count on the color of your urine to tell you if you’re hydrated. Spend $10 bfor a 100-count of Rapid Response Urine Dipsticks (RRUD). Dr. Stacy Sims has done in depth research into the hydration needs of male and female athletes, and has some specific markers to look for on your RRUD’s:

  • Look at the Specific Gravity (SG) marker:
    • Fully hydrated status is 1.005 to 1.015
    • When you approach 1.020 you’re 1 percent down from normal hydration status and approaching the threshold of a dramatic drop in performance
    • When you read 1.025, stop and drink up!
  • Leukocytes (LEU) indicate how well you have recovered from your previous training day. No change in color tells you no leukocytes are present. If leukocytes are present, the reagent strip will turn purple, the darker the more leukocytes are present. If this is you, hydrate, eat well, get some extra sleep, take some extra vitamins and minerals, and take note if your resting heart rate is higher than normal. It’s a good idea for you to take the day off from training if you find yourself in this situation.
  • Protein (PRO) will show up on the reagent strip in a tint of green. This is normal in the hours following training, but if the strip is green when you retest the next day, you need a lighter day of training or a day off all together.

The basics are the basics for a reason. If you don’t like drinking water, try the hydration tabs. If you refuse to drink water and think you’re immune to the effects of dehydration, we’re going to have to ask you to hand in your Adult Card. Handle yourself. Top-notch hydration practices are essential not just for running but to operate day to day like a normal human being. Drink up!


COMMENT RULES: If you are a real person, leave your real name. We are not a clearing house for solicitors so don’t do it here. Criticism and questioning is fine, that’s how we all learn and grow. Personal attacks, name calling, and the like ARE NOT COOL-if we catch you doing it you’re gone. Other than that, have at it folks! We love hearing from followers and newcomers alike and will try to reply to as many comments and questions as we can!

 

Are You Ready to Run? Part XI

What to do when it hurts to run.

You love to run. It’s a nearly overwhelming blast to the senses: the sun on your face, the wind rushing past your ears, your heart pounding, your breathing measured, your mind focused on willing your body to push farther, faster than before. Running is at once challenging and exhilarating. The process of training for your next race is a grind, but the grind of training is also your muse-that thing that keeps you pushing ahead.

There is a certain measure of honor and valor in being a dedicated runner. Suffering for your sport is baked into the whole deal. Pain, in a very real sense, is a part of you becoming better. Until it becomes too much.

And that’s why we’re here today, to deal with pain when it doesn’t make you a better runner. If you want to run your best, and run not just today, but for the rest of your days, these are the standards you need to be striving to meet as a part of your regular practice of training and running:

The Standards

#1-Neutral Feet

#2-Flat Shoes

#3-A Supple Thoracic Spine

#4-An Efficient Squatting Technique

#5 Hip Flexion

#6 Hip Extension

#7 Ankle Range of Motion

#8 Warming Up and Cooling Down

#9 Compression

#10 No Hot Spots

No hot spots is about being responsible for your body. It’s o.k. to push yourself but you have to be in tune with the signals your body is sending you. That gnawing pain in your Achilles, that stabbing pain under your kneecap, that deep ache you get in your hip joint, the throbbing in your low back you get after every run, those are smoke signals your body is sending up to your brain, telling you something is amiss. As we discussed earlier in this series: If you have pain while you are running or after you are done running, then what you were doing was not a functional activity.

Our key motivation here is simple: we want you to run for a long time. The ability to run well speaks highly of your body’s physical capacity to perform in a number of ways: postural stability, posterior chain power, foot and ankle strength, and aerobic/anaerobic capacity. There’s no shame in finding holes in your running game and addressing them. It’s in this way that we can ensure you’ll be able to run for years to come.

If you grab a foam roll or a lacrosse ball or any other sort of soft tissue massage tool, and upon compressing your tissues get a painful response, those tissues are not normal. Normal tissue doesn’t hurt under compression. Tissue that hurts to compress is tissue that doesn’t have the normal capacity to expand and contract as you run. We’ve covered the why, how, and when to do soft-tissue massage here.

Today we’re going to introduce a different way to deal with your hotspots: compression. This isn’t compression in the recovery sense that we talked about with standard #9, or even the foam rolling, ball-based soft tissue techniques previously mentioned. Instead we’re going to use high compression forces to create a dynamic restorative and healing response in those sticky tissues. How? Welcome to VooDoo Floss Band Compression.

The Voodoo Floss Band is so named because it works in a variety of ways to help your tissues feel better. You won’t know exactly why it worked, but after you’ve done it you’ll know you’re better.  Intermittent high compression does several things for hot tissues and joints:

  1. Restores sliding surface function. Your tissues are meant to glide over each other, not stick together. Compression of a point of sliding surface dysfunction creates a shearing effect that restores normal sliding surface function.
  2. Pushes swelling back into the lymphatic system. A swollen ankle or knee has a hard time getting that swelling out the area as those joint are in a dependent (against gravity position) that makes it nearly impossible to the lymphatic system to function properly. Flossing pushes that swelling back into the lymphatic system.
  3. Enhances normal joint mechanics. A joint that is blown out with swelling has a hard time operating efficiently when walking or running. Swelling presses on the peripheral nerves that give your brain a sense of where that joint is in relation to the rest of your body. This is what physical therapists refer to as “proprioception”. This ability is a significant determinant in your ability to stay injury-free. Also, compression of a joint creates a “gapping” effect that decreases the physical load in the joint.
  4. Accelerates healing times. Intermittently restricting then restoring blood flow to an injured area enhances circulation-the main way your body deals with injured tissues.

Here are a few different ways to use the VooDoo Floss Band. Always wrap towards the heart, applying 75 stretch over the problem area, 50 percent stretch in the rest of the band, and leave some slack at the top so you can anchor the band in place. Remember the upstream/downstream model of dealing with pain: if you knee hurts you need to compress and treat both your lower leg and your thigh.

Knee Pain

Start below your knee cap and wrap upwards, overlapping by half the width of the band with each pass.

Then:

Flex and extend your knee 30 to 50 times (princess mirror optional).

Achilles Pain

Start the band and the front of your ankle and wrap behind and over your Achilles, starting just above your heel bone and working upwards. Before the band covers your calf muscles, overlap it back down towards your heel.

Then:

Alternately push your foot down then pull it up towards your shin, for 30 to 50 repetitions.

IT Band Pain

Start the wrap below the area of your IT band that hurts, then wrap upwards.

Then:

Find something to hold onto and work in and out of the deep squat position for (you guessed it) 30 to 50 reps.

For any of these techniques, a few simple guidelines are important to follow:

  1. If it feels sketchy, it’s sketchy. Don’t try to work through weird pain.
  2. If you wrap a part of your body and it goes tingles, burns, or goes numb, take the band off.
  3. If you find it hard to breath and you feel anxious when you put the band on, take it off.
  4. It will usually take between 2 to 5 rounds of these techniques to affect a change that will last. A good general rule of thumb for the floss band is two minutes on, two minutes off.
  5. If you take the band off and you see stripes on your skin and it suddenly turns bright red-good job! This is the normal response of the body to compression. The flushing of the skin is a sign that you’ve increased local blood flow in the area you just compressed. The stripes and the redness will subside within a matter of minutes.

If you get a good result with the floss band techniques outlined above, stay after it! In some cases it may take several days in a row of using this technique to create the improvement you’re looking for. This technique is a great complement to other soft-tissue techniques like foam rolling in that it covers a host of factors that influence tissue mobility that simple rolling just doesn’t address.

Enjoy!


COMMENT RULES: If you are a real person, leave your real name. We are not a clearing house for solicitors so don’t do it here. Criticism and questioning is fine, that’s how we all learn and grow. Personal attacks, name calling, and the like ARE NOT COOL-if we catch you doing it you’re gone. Other than that, have at it folks! We love hearing from followers and newcomers alike and will try to reply to as many comments and questions as we can!

Are You Ready to Run? Part X

Kick-starting your post-run recovery.

68015_10151199176137739_1161845327_nA quick review to get everyone up to speed in our series:

The Standards

#1-Neutral Feet

#2-Flat Shoes

#3-A Supple Thoracic Spine

#4-An Efficient Squatting Technique

#5 Hip Flexion

#6 Hip Extension

#7 Ankle Range of Motion

#8 Warming Up and Cooling Down

There are a variety of methods involving ice, heat, and water that many people use religiously to treat their bodies after their runs. But what happens when you don’t have time or access to these modalities and you’re facing 8 to 10 hours of commuting and sitting at work? It’s unlikely your boss is going to sign off on that hot tub request you made. Or worse, what do you do after a morning run followed by a transcontinental airline flight to ensure you don’t feel like your legs are unfolding like an accordion when you arrive at your destination?

Enter the ninth standard for our runners and a secret weapon in the recovery game:

Compression

You’re no doubt familiar with the nearly ubiquitous use of compression shorts and shirts by athletes trying to keep their bodies warm and supported during their sporting activities. Lower extremity compression is often times forgotten or relegated to the realms of clinical use for lower extremity circulatory impairments. We’ve known for decades that compression of the feet, ankles, and lower legs allows the body to operate the circulatory and lymphatic systems more efficiently.

What we’ve found in our practice is that the same compression of the feet and lower legs is an incredibly simple and effective tool to help you bounce back faster from your runs.

Here’s the simple application process:

  1. Once you’ve finished your run, properly cooled down, cleaned up, and gotten fired up for the rest of your day, put your compression socks on.
  2. Go on about the rest of your day

That’s it. It’s a simple and cost effective standard to meet.  You can find a good pair of compression socks for $20-$30. Look for socks that provide compression at 20 mmMg for the optimum effect.

If you’re sitting for the majority of your day, the systems that deal with muscle recovery and tissue repair (your circulatory and lymphatic systems) just don’t work effectively enough on their own. Compression keeps blood and fluid from pooling in your lower legs as you sit. Better circulation equals faster recovery.

And compression socks are a lifesaver on a long plane flight. After finishing my most recent Spartan Race last fall, less than a day later I limped onto a plane from New York City to Kansas City (a 3 hour flight), compression socks on and my calves screaming at me after running up and down a mountain for four hours the day before. By the time we landed in KC I actually felt looser than when I walked on the plane in NYC. Despite only being able to get up and move around a handful of times, being intentional about my recovery made the process 10 times easier than it would have been if I had just waited for my body to try to recover from that torture I put it through on my own.

There’s mixed evidence as to whether or not wearing compression socks while you run has any performance benefits. But there’s no argument that compression after a run helps the recovery process along. Yes, the socks can look dorky. No, no one actually cares if you’re wearing them. But your body will notice the difference. Wearing them under your business casual attire will be your secret weapon to help fuel your next hard training run or race, without any extra effort on your part.


COMMENT RULES: If you are a real person, leave your real name. We are not a clearing house for solicitors so don’t do it here. Criticism and questioning is fine, that’s how we all learn and grow. Personal attacks, name calling, and the like ARE NOT COOL-if we catch you doing it you’re gone. Other than that, have at it folks! We love hearing from followers and newcomers alike and will try to reply to as many comments and questions as we can!