In the first part of my blog entries about pain, I wrote about pain and how much is too much versus how much is to be expected. Basically, laying out the guidelines to figure out if the pain you are experiencing is “normal” or if it requires treatment.
This part is about myofascial pain and stretching.
Stretching does Not Help Prevent Injuries:
The best way to avoid myofascial and/or musculoskeletal pain is to no injure yourself. At my Portland Brazilian jiu jitsu gym, Straight Blast Gym, I find many people stretching for various reasons and in various ways. Static stretching, dynamic stretching and even stretching with a buddy occurs in gyms everywhere. Why?
Often, when asked, people respond by stating that it keeps them from getting injured. Well, there is little to know research evidence that suggests this is the case; in fact, there is quite a bit of evidence suggesting that stretching (depending on the type of stretching), can actually pre-dispose you to GETTING INJURED.
Rather than writing a very opinionated post about stretching, I decided to grab some convincing research evidence to back my claims:
Effect of stretching on sport injury risk: a review: This review paper surveyed research from 1966 to 2002 and found no statistically-significant link between stretching and a reduction of injury risk.
Stretching before exercise does not reduce the risk of local muscle injury: a critical review of the clinical and basic science literature: This study (another literature review) did a more comprehensive search and still found no link between stretching and decreased injury risk.
A randomized trial of preexercise stretching for prevention of lower-limb injury: This was a very well-designed study that found no reduction of injury in study participants who performed a pre-exercise stretching routine.
There are so many research papers on this topic, none seem to clearly link stretching to decreased injury.
Stretching to Reduce Pain:
Another reason people often cite when asked why they stretch is because it reduces pain for them before and after exercise or activity. Well, this may be true is they are performing active “stretches” or what I like to call self-mobilizations (more on this in a bit, it has to do with joint motion, not muscle length), it probably has no real effect on pain at all.
Again, the evidence for this is overwhelming, I have picked out a few studies to illustrate my point:
Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review; this study showed no significant decrease in soreness with stretching before or after exercise.
The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise: This study also showed stretching has no effect on pain when performed before an activity.
Stretching to prevent or reduce muscle soreness after exercise: And yet another one that showed no reduction in soreness in those who stretched before and/or after activity.
Warm-up, Not Stretching:
OK, so many people stretch as part of a warm-up. The evidence is clear about stretching; skip it, but DO perform a warm up. Here is some evidence showing that warming up can help prevent injury although it probably still does not prevent soreness or pain.
Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial: Although the original premise that warming up would prevent lower extremity injuries was not proven; warming up does seem to reduce the risk of severe injuries and overall injuries.
Compliance with a comprehensive warm-up programme to prevent injuries in youth football: Here’s another study that showed a reduced risk of injury when young athletes perform a warm-up.
Again, skip the stretching but perform a warm-up; I’ll touch on my warm-up recommendation at the end.
Stretching and Trigger Points:
I have even heard that massage therapists, trainers and other health care providers are telling their clients/patients that stretching reduces the risk of developing myofascial trigger points. There really is no evidence for this idea; I think the idea came from (erroneously) the Travell and Simons trigger point books. I further believe it came from this part of the books; Simons et al. Myofascial Pain and Dysfunction, pp127–135.
Travell and Simons’ well-documented “spray and stretch” method seems to be promoting stretching for the treatment and eradication of myofascial trigger points. The point of the vapocoolant spray is to “distract” the nervous system from the pain of stretching a muscle that is both dysfunctional and painful because it is riddled with trigger points. These book go on to further suggest (possibly true) that myofascial trigger points have both small patches of hypercontracted muscle fibers (trigger points) and long stretches of fibers that are overextended. Without the spray, muscles in this predicament may contract defensively if stretched. Interestingly, Travell and Simons do not recommend stretching trigger points without the spray.
Stretching and Pain (Soreness):
So, does stretching help to reduce soreness from activity and exercise? No.
I have seen many patients with myofascial pain, trigger points and other musculoskeletal pain syndromes; stretching is rarely something I recommend. Here is some evidence supporting my stance on the matter; at the end of this post, I will write about my recommendations for warming up and self mobilizations:
Stretching to prevent or reduce muscle soreness after exercise: Stretching does not reduce muscle soreness after exercise…. sorry.
Warm-up and Self-Mobilizations:
The common thread here is that static stretching does not decrease activity-related pain. What does? Well, a good warm up and some mobility exercises. Here are areas of your body that really need optimal movement and mobility:
- Thoracic spine
If you tend to have joints that are mobile or hypermobile…. you don’t need to worry about mobilizations and PLEASE DON’T STRETCH. How do you know which of these areas you need to focus on? Well, if you have a history of low back or knee pain; you should focus on your thoracic spine (upper back), hips and ankles. If you’ve had a lot of shoulder injuries or neck pain, focus on your thoracic spine, shoulder and hips. Stay tuned to my new website:
In the months to come, I will be posting both free and paid lessons on this topic and more.
Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
In a recent article, Chronic Pain Fuels Boom in Opioids, the issue of opioid use for pain has sky-rocketed. It’s an interesting and VERY relevant topic; and it’s not just about people taking these medication illegally. Addiction to opioid pain medication is just as much an issue in those who get their medications legally as in those who get them on the black market. Feel free to read the article, it really is a great read on the topic; I am not going to write about these issues. What I want to write about is, what happens when we over-treat pain and how could it potentially create a reward system in which we are conditioning ourselves to be in pain.
Let me explain, I’ll use opioid medication as an example. Most opioids work by connecting with receptors in the brain to simulate or release chemicals that reduce pain, often, these chemicals “reward” s for their efforts. What does this mean?
This reward system produces a scenario where we tend to be attracted to the stimulus (cause) of the reward; in this case, a squirt of dopamine. This means that we are literally rewarding ourselves for being in pain. Does this occur naturally….. yes, but not to the extent that opioids do it.
How does this translate to everything else we do for pain? Possibly the same way! I know, you’re reading this thinking, “…are you saying that I shouldn’t get chiropractic care, massage therapy, myofascial work, dry needling, acupuncture, and other treatments for pain? Are you telling me that taking anti-inflammatory medications and natural products, stretching, soaking in a hot tub and other things I can do to relieve pain are bad?”
Well, no, that’s not what I am saying. What I am saying is that maybe we have created a scenario where, by paying attention to every ache and pain and giving ourselves rewards (in the form of nice and/or therapeutic treatments) for that ache and/or pain, we have created MORE pain. We may be literally producing pain in our nervous systems at a level that’s higher than needed. This is pure clinical speculation but here’s an interesting observation; the incidence of painful conditions has risen site a bit over the last 20 years, especially in the last 10. Is this because there is a lack or deficiency in treatments to alleviate pain? No, on the contrary, there are more.
How Much Pain is OK? How much is too much?
- Is below an intensity of about 4 on a 0-10 scale
- Disappears shortly after beginning activity
- This would imply that movement is good for it, this is great.
- The morning pain should be mild, if it’s more, you need to see a doctor about it
What is pain?
Pain is an interpretation of a signal by our brain. Under normal conditions, it often tells us that there is the potential for damage of a tissue or tissues. This is not ALWAYS the case though; our brains can interpret non-damaging signals as pain and it often does. This is one of the most promising theories about the cause of chronic pain…. that our central nervous systems are creating pain when it shouldn’t.
In conclusion, pain, like any other signal in the body is just that, a signal, but that signal may be going off for the wrong reason. It is my heart-felt opinion that we need to connect to our bodies better so that we can know when a certain pain is normal and not a signal that we are damaging anything versus when a certain pain is a signal that we need help.
I will be addressing this topic in future posts and will be talking about movements and movement patterns you can do to determine if pain you are feeling is a normal part of being active or if it is a sign that it’s going to cause long-term issues with movement and possibly be a sign that certain tissues are being damaged.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, just a short post about an article by Leon Chaitow entitled: Breathing Pattern Disorders and Lumbopelvic pain and Dysfunction: An Update.
Those of you who have seen me in my Portland Oregon Chiropractic and Functional Movement Clinic, Optimum Function, or at my NCNM teaching clinic shift, may have wondered why I recommended breathing exercises as the first line of low back pain treatments; well, Dr. Chaitow will help explain it in his article.
Enjoy….. and take a few deep, belly-breaths today to honor your core and exercise your diaphragm.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, I just finished another site www.OptimumHealthEducation.com
Optimum Health Education is your source for Health, nutrition and functional fitness online classes and resources. In the near future, I will be posting classes about vitamins and minerals, nutrition for MMA and other sports, daily mobility exercises, daily stability exercises, healthy eating and more. All classes will be college-level presentations; what this means is that I will be presenting them in the same quality as I do in the college and university classes that I teach. Anyone will be able to take these classes, no matter what your current educational level is; the only requirement is that you have a passion and desire to learn more about health, nutrition and functional fitness
Are you a health care provider? If so, Optimum Health Education will be for you too! May of 2012, I will be launching a class about internet marketing for health care providers. For more information, click here: Blog Post || Optimum Health Education; Internet Marketing ClassYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
OK, for the last 12 years, I have been learning and applying fascial techniques, myofascial release, Fascial Manipulation©, trigger point dry needling, chiropractic adjusting and mobilization, instrument-assisted soft tissue techniques (like Graston© therapy) and more in unique ways to restore movement, stability and dynamic physical health.
This year (2012), I am dedicating my clinical practice to further develop a system to use these myofascial techniques and more and will work on developing a curriculum to teach this system so no matter what fascial technique you use, you can use them more efficiently and effectively. I have decided to call it Fascial-Applied Soft-Tissue TherapySM or F.A.S.T. TherapySM.
In fact, I am in the process of developing an adjunct tool to be utilized for various fascial therapies. I have been developing this tool for a while and it is going to blow the doors off of everything else out there….. stay tuned for F.A.S.T. TherapySM and the F.A.S.T. Therapy ToolSMYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
OK, I have been busy in my SE Portland chiropractic, nutrition and function movement clinic, Optimum Function, in addition, we have recently added a puppy into our already animal-full family and I have taken up Unicycling (click for more info). I have been wanting to create some videos showing how some of you out there can do some simple tests to see if your low back, hip, knee, or ankle/foot pain is coming from a mobility issue (things aren’t moving correctly), a stability issue (the right muscles aren’t firing at the right time) or tissue damage (something is injured and needs to heal).
Here is part 1 of my lower quadrant assessment video:
Here’s part 2:
After that, I decided to post a video for those of you who had primary stability issues, not mobility issues or tissue damage (you’ll have to see someone for those…. hint… come on in and I’ll help). These lower quadrant stability exercises are designed to get your glute muscles firing and increase their endurance so you can move on to more dynamic stability exercises that get you ready to do what you want to do pain free.
Here’s part 1 of that series:
Here’s Part 2:
And finally, Part 3:
Remember, if you have any questions or are not sure if these exercises are for you, contact me, I can help.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Here is a 2 part YouTube series that I recorded about low back stability and mobility. This first set of videos talks about 3 exercises to determine the nature or your lower quadrant problems. As a Portland chiropractor, I often see patients with low back pain, hip pain, knee pain and ankle pain; often, this pain is ongoing in part, due to a functional problem in their lower quadrant. To figure out how best to help these patients, I must first determine if the problem is coming from:
- Damaged tissue
- Mobility problems (muscles and joints aren’t moving the way they should)
- Stability problems (the muscles that are supposed to be firing at certain times are not)
This is VERY important because the treatment for each potential problem is pretty different. Check out the videos here are feel free to contact me if you have any questions.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, a few of my patients, especially the athletes in my practice have asked quite a few questions about barefoot running or barefoot shoes. In general, barefoot technology as far as footwear is concerned, is just not as prolific as the non-barefoot shoes. What is a barefoot shoe? I know, the term is contradictory. As a Portland chiropractor and nutritionist, my goal is to help my patients’ bodies to be as pain-free and efficient as possible. I often see feet that are dysfunctional causing low back pain, back pain in general, knee and hip pain and even….. headaches! How is this possible? Well, forces are transmitted through our body through various structures. If those forces are transmitted properly, we can handle them, if not, tissues break down and we may notice symptoms anywhere along the road.
When we are barefoot, and our foot structure has not been malformed by more modern, stylish shoes, every time we take a step, the long bones leading to our toes spread apart, the big toe is aloud to extend freely; this tightens-up your plantar fascia and various ligaments related to your long arch creating a spring mechanism. In addition, your heel is at the same level as the rest of your foot which allows your various arches to do what their supposed to do (support and transfer motion). This means a feet that are allowed to work the way they are supposed to will support you, stabilize you and help to properly transmit forces through your body. This results in less pain and more efficient running and walking, jumping etc.
As I have talked about before….
- On my video updates: Portland Chiropractor and Nutritionist, Dr. Tim Irving on YouTube
- My articles: Portland Chiropractic and Nutrition Articles
- Various other blog entries: Portland Chiropractic and Nutrition Blog
For there to be functional movement in the body, there must be a balance between mobility and stability (stability = the right muscles are contracting at the right time and motion is controlled). Without proper foot mobility and stability, you are setting yourself up for ankle, knee, hip, low back and neck problems and pain. The foot is THE FIRST structure to begin transmitting force through your body when you are walking, running, jumping or even just standing there, in awe at what you’re reading
Here are a few resources that reinforce my commitment to get everyone of my chiropractic patients to utilize barefoot technology.
If you have any more questions or want to come in to have me examine your foot structure, help you regain mobility and then help you develop supreme stability, comment on this blog entry or contact me through the info on my website (www.OptFunction.com)Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Although chiropractors care for more than just back pain, many patients visit their chiropractor looking for relief from back pain. In fact, 31 million Americans experience low-back pain at any given time. (1) In my chiropractic, nutrition, functional medicine and hypnosis clinic in Portland, Oregon, more than half of my patients initially come in to find relief from back pain.
A few interesting facts about back pain:
- One-half of all working Americans admit to having back pain symptoms each year. (2)
- Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.
- Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions or diseases.
- Americans spend at least $50 billion each year on back pain—and that’s not including time lost from work or the “cost” of being in pain. (3)
- Experts estimate that as many as 80% of the population will experience a back problem at some time in our lives. (4)
What Causes Back Pain?
Your back is a complicated structure of bones, joints, ligaments and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.
Manipulation as a Treatment for Back Problems
Used primarily by Doctors of Chiropractic (DCs) for the last century, manipulation has been largely ignored by most others in the health care community until recently. Now, with today’s growing emphasis on treatment and cost effectiveness, manipulation is receiving more widespread attention.
Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest. (5)
In fact, after an extensive study of all currently available care for low back problems, the Agency for Health Care Policy and Research—a federal government research organization—recommended that low back pain sufferers choose the most conservative care first. And it recommended spinal manipulation as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.6
Tips to Prevent Back Pain
- Maintain a healthy diet and weight.
- Remain active—I can help you restore mobility first then I will help you contract the muscles needed to support and stabilize your back; after that, I will help to design a full-body, functional program to keep you stable, strong and healthy.
- Avoid prolonged inactivity or bed rest.
- Prepare you body for various activities….. even things like gardening! I can help you figure this out
- Maintain proper posture. This will be much easier if your joints and muscles are working correctly
- Wear comfortable, low-heeled shoes. Shoes like crocs, sanuks, and my favorite, Vivo barefoot shoes (I can order these for you, call me)
- Sleep on a mattress of medium firmness to minimize any curve in your spine. Sleep on your side or back, not stomach.
- Lift with your knees, keep the object close to your body, and do not twist when lifting.
- Quit smoking! Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues. I can help with this through clinical hypnosis in Portland
- Work with me to help you make sure your daily activities are performed with good ergonomics.
Once your back pain is gone, I can work with you nutritionally as well to ensure that you reach all of your health and wellness goals. In addition to chiropractic adjustments, Graston Therapy, Kinesiotape, Cold Laser, mobilization and active muscle release are wonderful treatments for back pain that do not involve high velocity movements.
- Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.
- Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
- This total represents only the more readily identifiable costs for medical care, workers compensation payments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.
- In Vallfors B, previously cited.
- Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today 2003 Feb; 23(2):14-15.
- Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No.14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.
This is a question I receive quite often when potential patients in Portland, Oregon and other places in the U.S. and Canada call me, email me or contact me through the Optimum Function Website.
At Optimum Function, patients not only have access to various chiropractic and soft tissue techniques, they also have access to functional rehabilitation and training that includes kettlebells, TRX suspension systems and body weight exercises. My patients have access to nutritional interventions to decrease pain and inflammation that include diet and lifestyle counseling, body composition analysis, anti-inflammatory supplements, and blood work or other lab work if necessary.
In fact, there are not many chiropractic, nutrition, functional medicine and hypnosis clinics in Portland, Oregon; and even fewer that treat patients from all over the U.S. and Canada. As a doctor, I decided to pursue treatments that allowed me to help my patients from a few different avenues.
- Chiropractic, soft tissue therapies and manual medicine allow me to restore motion in joints and balance tension throughout your body. Techniques used include; Graston Therapy, Kinesiotape, Cold Laser, Electrostimulation, Arthrostim, Vibracussor, Adjusting, Active Muscle Release, and more!
- Functional rehab. and training allows me to “turn-on” the muscles that are your prime movers. After this is done, I can give you full-body functional workouts to help solidify your body’s stability and reduce your risk of re-injury.
- Nutrition and functional medicine allows me to look at and treat your particular chemical and physiological processes. Often, diet, exercise and lifestyle changes are the first line of defense against diseases like type II diabetes, cardiovascular disease, hypertension and obesity
- Hypnosis helped me round-out my treatment paradigm by allowing me to help my patients on a subconscious level, dealing with habits, issues and problems on a level deeper than the conscious mind for long-lasting, effectiveness.
Well, there you have it, at Optimum Function in Portland, Oregon, you get one-on-one treatments that address many of your health concerns. Escape pain and live the life of your dreams!Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health