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
As a Chiropractor and educator in Portland, Oregon, I see patients with pain of all types and intensities; I also lecture on myofascial pain and mechanical pain (low back, shoulder, neck, etc.). A subject that recently came up with both my students, interns and colleagues is, how much pain is OK?
Can you answer this? How about your medical doctor, naturopath, chiropractor, physical therapist? I was playing devil’s advocate with some interns in my teaching shift at NCNM and I asked them,
“Should we be treating every little ache and pain our patients have and if so, is this teaching them to be hypersensitive?”
In addition, what impact does this have on their pain coping mechanisms, both internal and external? I believe it gives the message that any and all pain is bad and makes patients much more likely to overuse pain medications. There has been some speculation amongst researchers and clinicians (doctors and therapists) alike that we are conditioning ourselves to be in pain. By taking pain medication and other remedies every time we feel, even the slightest pain, we may be conditioning our nervous system to SENSE PAIN ALL THE TIME.
Now most know that in my Portland chiropractic, nutrition, myofascial therapies and functional movement clinic, Optimum Function, I often treat patients to improve function instead of treating pain. The simple fact is, we have to help patients with their pain because often, that is why they are coming in; the unanswered question is, how much is OK?
I have been training in Brazilian Jiu Jitsu (BJJ) in Portland at Straight Blast Gym for almost a year now and recently, been training harder . We have some fighters going to the worlds at the end of this month and our competition team has been going at it in practice. This past Friday, my back just couldn’t take the pace and today, it’s hard for me to move around, in fact, writing this is painful as sitting seems to be the offending position. Is this OK? Well, in my opinion, it is…. let me explain.
I overdid it, I kept playing in people’s guards and they kept trying to break down my posture, the is the game of BJJ. I should have known better, my back has been feeling tired after practices for 2 weeks, I should have modified my game. Now I am in pain, I didn’t damage anything, just some minor strains and sprains but in an area that is fairly crucial to functional movement and one that is affected by just about any position I put myself in. I have no doubt, that in 2-3 days, I will be back to 100%
Why am I writing this? Because I am planning on doing a more in-depth article series on the topic and will use this information to help educate my patients and students on this topic so we don’t over focus on normal, physiologically-beneficial pain.
Stay Tuned…. feel free to leave a comment, maybe I’ll use it in the articles to come on this topic.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Having just come back from Casper, Wyoming after taking the first of four Trigger Point Dry Needling Seminars taught by Jan Dommerholt, (who, in my opinion is one of the world’s foremost experts on trigger point dry needling), I have realized that I made a mistake in other posts.
Is dry needling acupuncture?
Yes, I believe it is…..
It is also chiropractic care and physical therapy; in fact, dry needling is ANY profession that diagnoses and treats myofascial trigger points. The needle is just a tool, many clinicians also use our hands, instruments, lasers and injectables to treat myofascial trigger points.
Dry needling is not exclusive to any one profession; let’s move on, patients need us! There is so much chronic pain out there that can be attributable (completely or in part) to myofascial trigger points that everyone who treats them and has the skills to do so with a needle SHOULD…. now!
I had a patient Wednesday of this week who has chronic TMJ pain that absolutely needs dry needling for myofascial trigger points in her lateral pterygoid. I did what I can with my hands but my hands cannot get to 90% of this muscle. What I did do knocked her pain back to the point where she is “hopeful” and does not feel like she has to live with her daily pain and headaches but because of the infighting between the chiropractic board and a few acupuncturists in Oregon, she cannot get this therapy. She had gone to orthodontists, TMJ specialists, massage therapists and yes, acupuncturists and has not had any appreciable gains with her chronic pain.
Shame on the powers that be for withholding this beneficial and valid therapy from patients who need it by not allowing providers who are qualified and trained to do it.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 published in the Journal of Manual and Manipulative Therapy by Jan Dommerholt entitled, Dry Needling: Peripheral and Central Considerations, Dr. Dommerholt discusses some updated theories and ideas as to the mechanism behind the benefits of dry needling (DN) and other related topics. Dr. Dommerholt has his doctorate in physical therapy and is one of the world-experts in the field of DN with regards to myofascial pain.
Over the last 10-20 years, DN has grown in popularity among chiropractors, physical therapists, naturopaths, acupuncturists and medical doctors. The indications for the use of DN vary by profession but most include some sort of myofascial disturbance. These myofascial disturbances or lesions often lead to aberrant biomechanical forces being transmitted through the neuromusculoskeletal system which can lead to further damage and injury. In addition to treating these structural lesions, DN also works on pain mechanisms mediated by the central and/or peripheral nervous systems.
In his paper, Dommerholt addresses the various models used to explain how myofascial lesions affect the entire neuromusculoskeletal system. One model, the pain-spasm-pain cycle, often referred to as “the vicious cycle” has not stood the test of time and research, as such, other models have since surpassed it. The pain-adaptation model is another model that suggests muscle pain from trigger points and other myofascial lesions lead to a cascade of antagonist activation which leads to an overall decrease in motor function. Neither of these models explains the role of myofascial lesions in neuromusculoskeletal pain and dysfunction. Later in the paper, Dommerholt discusses Hodges and Tucker recently proposed a new motor adaptation theory. This theory, although not specifically referring to myofascial trigger points or lesions, best represents what occurs when muscle pain causes a redistribution of activity within and between muscles leading to overall biomechanical dysfunction.
Dommerholt discusses the various schools of approach for DN, including, Yun Tao Ma’s approach, Gunn’s approach and Dommerholt and Huijbregts’ approach, this discussion is an interesting one and helps to explain why there may be some confusion as to exactly what Dry needling is and what it treats. The next couple of pages are devoted to an excellent and clinically-relevant discussion on the physiology behind active and latent trigger points. For a more comprehensive discussion on this topic, I suggest getting Dommerholt and Huijbregts’ book entitled, Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management (Contemporary Issues in Physical Therapy and Rehabilitation Medicine)
The section on muscle pain is quite interesting and what I would refer to as a concise summary of information pioneered by Mense and Gerwin in their books Muscle Pain: Understanding the Mechanisms and Muscle Pain: Diagnosis and Treatment . The section on central sensitization as a result of myofascial trigger points is another wonderful summary on this topic. The neurophysiology behind central sensitization, while complex, is clinically-relevant and a topic that all clinicians dealing with pain should understand. DN can disrupt this process, presumably through disrupting the neurochemical links developed during sensitization, effectively breaking the cycle.
The concept that Dommerholt seems to challenge is that trigger points are solely a peripheral problem. In this paper, he does an excellent job of presenting research to the contrary and how DN not only works to treat the peripheral neuromusculoskeletal system but acts on the central nervous system too. The implications of this evidence is broad and may explain why those with peripheral (local) myofascial lesions like trigger points receive both local and system wide benefits from the application of DN. This may help to explain why there is a good deal of variability in the DN approaches as discussed in the beginning of the paper.
In addition to all this great information, Dommerholt tackles the subject of Acupuncture and Dry Needling. This is a topic that is germane to current discussions and legal feuds here in Oregon. DN is a technique that should be in the scope of practice for physical therapists and chiropractors who diagnose and/or treat myofascial trigger point on a daily basis. The acupuncture community and chiropractic community are at odds right now in the Oregon legislature about this topic. Dommerholt tackles this task with ease and grace, presenting a cogent discussion that concludes with the idea that DN is yet another tool to treat myofascial trigger points and should be within the scope of practice for physical therapists, chiropractors and acupuncturists.
In the summary section, Dommerholt pulls it all together in a way that my writings would not do it justice; here are quotes from his summary:
“Dry needling or trigger point inactivation rarely is a stand-alone kind of intervention and is just one aspect of a comprehensive manual physical therapy approach.”
“Dry needling is not solely in the scope of any one particular discipline. Overlap in scope of practice is not only inevitable; it may even be desirable to best meet the needs of patients. Dry needling is an easy to learn technique in the hands of qualified health care providers.”
“In this review, we have postulated that dry needling is a potent therapeutic measure to remove a constant source of peripheral nociceptive input originating from myofascial trigger points. As such, dry needling does not replace other manual physical therapy technique, but may be useful in facilitating a rapid reduction of pain and a return to function. A thorough understanding of the role of trigger points in peripheral and central sensitization is important in manual physical therapy practice. Trigger points can be inactivated with manual techniques and joint manipulations, but dry needling may be a more efficient and quicker method.”
Reference: Dommerholt, Jan, PT, DPT, MPS, DAAPM; Dry Needling: Peripheral and Central Considerations; Journal of Manual and Manipulative Therapy 2011, Vol.19 No.4; pgs 223-237Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, the Oregon Dry Needling debate shuffles forward……
Of course, as a Portland Chiropractor who wants to use dry needling in my practice for the treatment of myofasacial trigger points, I am biased. I recently read an excellent blog by an Oregon acupuncturist (click for link) on the community acupuncture network. In this blog, the author states why she does not consider the dry needling issue here in Oregon to be one that the acupuncture community should be concerned with. In this blog post, the author dispels many of the myths about dry needling and refutes the arguments against physical therapists and chiropractors performing this technique. The only point I disagree with her on (and it’s a minor point) is her conviction that Dry needling IS acupuncture. To this, and to acupuncturists reading this post, I ask this:
How many hours have you spent learning trigger point theory? Can you explain the etiology behind trigger points? Can you state what the research has shown regarding the use of solid-filament, small-gauge needles and the eradication of trigger points? Have you been taught (in acupuncture school) how trigger points form, what biomechanical effects they have, how to rehab them and teach your patients what to do so they don’t come back? Have you been taught the fine details of locating them?
Trigger point therapy is not adequately taught in acupuncture school. Acupuncturists have mastered the use of solid-filament, small-gauge needles but have not mastered trigger point theory, assessment and treatment. Don’t get me wrong, I know a few acupuncturists who have gone through post-graduate training and are excellent clinicians regarding trigger points but Dry Needling is not acupuncture. Can acupuncturists perform Dry Needling…. yes, of course, they have already mastered the needling aspect of it, most would just need to pursue training on trigger point theory, assessment, rehab and treatment.
In contrast, a video on Vimeo from The Oregon College of Oriental Medicine posted this video (Click Here). In it, they really show their ignorance as to what we, as chiropractors in Oregon are trained to do. The panel consists of various teachers and acupuncturists in Oregon. They even have the nerve to claim that they are the Dry Needling experts in Oregon and they should teach PTs and chiropractors how to perform it….. really?
I wish I was at that meeting, I would have asked this question:
“Please, explain to me, the etiological, biochemical and neurochemical aspects of myofascial trigger points and how Dry Needling takes care of them. Compare and contrast this with other trigger point treatments and explain to me (us) how core acupuncture programs make their graduates experts in this treatment modality.”
I have emailed various individuals in the OCOM and NCNM acupuncture programs about where in the core curriculum is trigger point Dry Needling taught and have received one response that it is the same thing as “ashi points”. Nowhere do they learn the finer details of trigger point theory……. why would they consider themselves experts on this topic then? How insulting….
And so it goes, misinformed individuals guiding and teaching their profession to believe half-truths….
For those of you (no matter what your profession) who want to learn more about modern trigger point theory and therapy, Jan Dommerholt has co-authored an excellent book on the topic: Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management
In addition, the Simons and Travell 2 volume set has been dubbed “the trigger point bible”: Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual
Lastly, there is a ton of great research, mostly coming from the PT profession on trigger points and Dry Needling, all you need to do is search for it on PubMed.
That’s all for today; I am reading a pre-published version of an article that Jan Dommerholt has written with a colleague on how trigger point Dry Needling affects the peripheral and central nervous systems to do more than disrupt the excess achetylcholine secretion and decreased acetylcholine esterase production often seen as one of the causes of trigger points….. stay tuned for my report on this article.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
OK, since my last blog post, I have received several email regarding the chiropractic dry needling issue that is currently being discussed in Oregon.
In a nutshell: The insertion of a filament-gauged, solid needle into fascia and myofascial trigger points can produce many physical effects. Most are similar to what a skilled manual medicine practitioner can do (massage therapists, physical therapists, chiropractors etc.). It has been determined that chiropractors can utilize these types of needles as instruments to treat trigger points and myofascial lesions that we currently diagnose and treat. This apparently has some acupuncturists scared that their profession is in danger.
First, it’s not, look at one of the other 16 states where chiropractors are allowed to perform dry needling; if licensed, acupuncturists have continued to grow in number in these states.
Some of the other concerns that have been emailed to me:
Pneumothorax, AKA collapsed lung, this happens as a result of a needle piercing the chest wall and can occur pretty much anywhere in the thorax if the needle is not carefully placed. The only time I have heard of this happening has been in acupuncturists’ offices. In the 16 states where chiropractors are allowed to perform dry needling, I am sure at least a couple of them have produced pneumothorax but I doubt the number is higher (percentage-wise) than with the acupuncture population.
“Chiropractors are minimally trained…” OK, this is just downright offensive! We have over 4000 hours of training; our programs are clinical doctorates…. we are NOT minimally trained. We take classes in diagnosis (western diagnosis; meaning, we have within our scope, the ability to render a diagnosis of myofascial trigger points), physical examinations including, heart and lung, classes on phlebotomy and in Oregon, minor surgery.
“If chiropractors want to do acupuncture, they should become acupuncturists…”
I actually agree with this but is dry needling acupuncture? I am not an acupuncturist so I am not an expert as to what ans what is not acupuncture but I thought using a needle to treat myofascial trigger points and other myofascial lesions is not acupuncture per say…..according to some acupuncturists, I am wrong.
Here’s an analogy, is adjusting a vertebral motion segment the entirety of chiropractic? I hope not, I can’t see why laboratory diagnosis and phlebotomy classes prepared me to do that (tongue-in-cheek ). I know there are a few chiropractors out there who would vehemently disagree with me, that’s fine. I don’t think adjusting is all we do as chiropractors and as such, I have no problem with physical therapists mobilizing joint or even doing high velocity adjusting is they have been trained.
If I am wrong about dry needling not being the entirety of what acupuncturists do, then I am mistaken,; although I don’t think so. Why would the acupuncture community want to sully their art, their craft by distilling it down to be defined as the placement of a needle into a trigger point? Why would anyone spend all the time and money becoming an acupuncturist if that’s all is was?
Can acupuncturists do dry needling? Again, I am not the expert here but I think so….. here’s a question though? Can they diagnose myofascial trigger points (ICD-9 codes: 728.89, 729.1 etc)? If so, what is the standard of care for acupuncturists and trigger points? Can they diagnose joint adhesions and fibrosis to be treated with the insertion of a needle to promote fibroblast activity? If so, what ICD codes would they use?
My point is this, acupuncturists can perform dry needling just as naturopaths and physical therapists can perform high velocity adjusting, dry needling is to acupuncture what high velocity adjusting is to chiropractic….. a tool.
Another argument: “24 hours of training is not enough to perform dry needling…”. See the above retort, we have over 4000 hours of training on the human body; the extra 24 is to tie some of that information into the context of dry needling. Most of it is about safe needle selection and placement and adequate hands on time. This is plenty of time to teach doctors, who have an excellent working knowledge of the body, including precise placement of nerves, vessels, bones, muscles and depth of chest-wall cavity. In addition, we know when to use one of the other tools in our toolbox if an area is dangerous or prone to pneumothorax…. it’s really kind of simple. Answer this question, how long did it take until you (acupuncturists) were able to insert a needle into someone’s musculoskeletal system? Not long, huh? Most of the time you spent was on point location and other aspects of oriental medicine….. right?
In conclusion, let’s be fair and honest with what this is all about….. MONEY; and actually it’s only the perceived effects that chiropractors performing dry needling will have on the money in Oregonian acupuncturists’ pockets. I think we will all find out, it’s not going to have much of an effect, the rate of pneumothoraxs will not increase, patients will have access to another helpful, effective tool to treat myofascial lesions….. period.
What Oregon has the unique opportunity to do is makes sure the health care world knows that chiropractors cannot perform acupuncture without going through an approved acupuncture program but they CAN perform dry needling with some training on how to utilize needles in an effective and safe way. By doing this, the barrier to care perceived by the public regarding needling of any kind will be diminished and the acupuncture community in Oregon will actually benefit from this; the problem is, a few of them are just to short-sighted to see thisYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, while preparing to teach Nutrition III at National College of Natural Medicine (NCNM) in Portland, OR; I have been compiling information about blood sugar regulation and…. naturally, insulin. Insulin is a hormone that many of you have heard/read about in relation to diabetes and blood sugar regulation. Those who are in the body-building and/or weight lifting industry have heard about it because of some of insulin’s anabolic (muscle building) properties. What does insulin do?
Click on the following link for an article that addresses the function of insulin and relates those functions to body composition (body fat, lean muscle mas and more): Insulin and Body CompositionYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
I’ve been working on a new project and came across an interesting research paper. Here’s another great reason to be lean (like you needed one); a 2009 article in the New England Journal of Medicine studied lean and obese men and the effects cold has on activating their brown adipose tissue. Brown adipose tissue, or brown fat, gets its color from the increased number of mitochondria compared to regular (yellow) adipose tissue. Mitochondria are the powerhouses inside our cells and can utilize fat for energy. With more of them, brown adipose cells can actually burn fat as it “spills” out of the adipose cells. Regular adipose cells need other cells’ mitochondria to burn fat that is liberated from them.
Classical thought was that brown adipose tissue serves an important role in infants but disappears in adults. Modern research is showing that adult men (especially non-obese adult men) still have brown fat and exposure to cold can activate it, allowing it to burn fat and produce heat. Interestingly, cold exposure can also activate the hypothalamic-pituitary-thyroid axis; this can help to bring a sluggish thyroid gland “back online”.
Here’s the reference: Cold-Activated Brown Adipose Tissue in Healthy MenYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
OK, lately, I have been obsessed with “The Dog Whisperer” on Animal Planet
Now, stay with me for the next paragraph, I will tie this all into the title of this post and a simple and effective way to set your body up for the efficient utilization of the calories you eat….
Early in 2010, we adopted a 5 week old lab/Shepard/pit bull mix. I have always been an animal lover and with both my dog and cat dying of cancer in the past 4 years, I have decided that we must investigate how best to keep our pets healthy; much in the same way I investigate ways to keep myself and my patients healthy. The first thing I did was to dive into the vast amounts of information on dog training. Huck (the lab/shepard/pit mix) is incredibly sweet, healthy and is fun to go off-road unicycling with; this is in part due to the principle laid out by Cesar Millan:
Providing these things in that order helps to set rules, limitations and boundaries for dogs but also helps to support them physiologically as this is how their body is meant to work. This is where my dog training research started to parallel my human health and wellness research. Regarding dogs, it has been amazingly helpful and healthful with our dogs to take them for a walk, play Frisbee with them, go unicycling with them or rough-house with them before they eat; it’s what they would do (or technically, their ancestors would do) in the wild, they chase their food down and eat it.
Well, for the better part of human history, this is what we would do too. Research is telling us that this is the way our physiology is set-up too; metabolic and lifestyle diseases have been on the rise for the better part of the last 60-100 years and food has become easier to get and eat every day. So, regarding food, we should consider food as the affection, it’s how our internal environment communicates with the external environment and how we nourish (READ: love) ourselves. I know; what about the discipline part?
Well, that could be built into our “how to eat equation” by stating this; we should eat until we are 75% full and have the discipline to choose a diet that is plant-based or mostly plant-based and not processed. OK, it’s a little bit of a stretch but it works well for my agenda
Here’s more, in fact, I’ll cut to the chase with my recommendation regarding exercise and meals:
Do some quick muscle contractions a few minutes before you eat to make sure you maintain a healthy relationship with sugar, insulin and fat deposition.
Now, I’ll get to the “how” and “what to do” in a little bit; first the “why”.
I’ll start off by saying this idea is not necessarily new ; it’s fairly well-established in research to one extent on another (see my references) and the idea has permeated a few resources for the every day individual; most notably, in a book called, 4 Hour Body by Timothy Ferriss (click for link to book). In this book the idea is discussed under the premise that this technique and other explained in the book will help you look and feel better. I want to expand upon this idea and state that it can help you regulate the sugar in your body.
Why would you want to do this?
It’s scientifically-solid and well understood that after an intense work out, food calories are less likely to be stored as unwanted fat. When our muscles perform work (especially intense work and even in VERY short bouts), they use sugar. Most of the sugar used is supplied by glycogen; this is a storage unit of sugar in muscles and the liver. As such, exercise depletes muscle glycogen and therefore many of the calories you take in after contracting muscles intensely serves to replenish this glycogen so it’s there the next time your muscles contract for more than a few seconds. In fact, it appears that this process occurs with as little as 60-90 secs of muscle contractions.
The appropriate exercise carried out a few minutes before eating may encourage glycogen restoration and not favor fat deposition, this is a GOOD thing.
In addition, this “habit” seems to be a good recipe to improve insulin sensitivity and improve your blood sugar regulation long term. Exercise before eating does this by increasing a substance in your body named GLUT-4 (glucose transporter type 4). By contracting muscles before insulin is secreted after a meal, it appears we can make sure that the calories we eat are used to replenish glycogen and not be stored inside our fat cells.
What type of exercises should you do? Here is a list of things you can do but the main principle is, 90 seconds of intense muscle contractions:
- Go through each big muscle group and squeeze them as hard as you can for 10-30 seconds until you accumulate 90 seconds of muscle contractions. (the bigger the muscle group, the better
- Do 90 seconds of kettlebell swings
- Do 90 seconds of jumping jacks or jumping rope
- Do 90 seconds of squatting up and down
The list goes on; NOTE: if the activity you choose causes pain, stop and talk to your chiropractor or trainer.
So, be good to yourself; regarding food, use this formula:
- Exercise first (60-90 seconds),
- Discipline next (make the right food choices; real, unprocessed foods, eat mostly vegetables)
- Affection last (EAT )
I should also note that those of you who regularly workout should eat readily-available carbohydrates within 60-90 minutes after your workouts. This is the window of opportunity to maximally replenish your glycogen after a longer workout.
Questions? Ask away…..
- Terada S, Yokozeki T, Kawanaka K, Ogawa K, Higuchi M, Ezaki O, Tabata I.Effects of high-intensity swimming training on GLUT-4 and glucose transport activity in rat skeletal muscle.J Appl Physiol. 2001 Jun;90(6):2019-24.
- Barnard RJ, Youngren JF. Regulation of glucose transport in skeletal muscle. FASEB J. 1992 Nov;6(14):3238-44.
- Youngren JF, Barnard RJ.Effects of acute and chronic exercise on skeletal muscle glucose transport in aged rats.J Appl Physiol. 1995 May;78(5):1750-6.
- Richter EA, Kristiansen S, Wojtaszewski J, Daugaard JR, Asp S, Hespel P, Kiens B.Training effects on muscle glucose transport during exercise.Adv Exp Med Biol. 1998;441:107-16.
- Kawanaka K, Tabata I, Katsuta S, Higuchi M. Changes in insulin-stimulated glucose transport and GLUT-4 protein in rat skeletal muscle after training. J Appl Physiol. 1997 Dec;83(6):2043-7.
- Terada S, Tabata I, Higuchi M. Effect of high-intensity intermittent swimming training on fatty acid oxidation enzyme activity in rat skeletal muscle. Jpn J Physiol. 2004 Feb;54(1):47-52.
- Fujimoto E, Machida S, Higuchi M, Tabata I.Effects of nonexhaustive bouts of high-intensity intermittent swimming training on GLUT-4 expression in rat skeletal muscle. J Physiol Sci. 2010 Mar;60(2):95-101. Epub 2009 Dec 19.
- Hiltunen JK, Qin Y.beta-oxidation – strategies for the metabolism of a wide variety of acyl-CoA esters. Biochim Biophys Acta. 2000 Apr 12;1484(2-3):117-28.
OK, I am perpetually asked about my opinion on High Fructose Corn Syrup (HFCS). There is an ever-growing spectrum of opinions to HFCS is the root of all evil to HFCS is harmless (conveniently, this stance has been taken by the Corn Growers Association). For those patients and clinicians that know me, I am sure you know my stance; for those that don’t let me write about it here. As an evidence-based nutritionist and chiropractor who focuses on real food, not consuming too many calories and eating a large variety of locally-grown vegetables, meats and other food products…. here’s my opinion on HFCS
- No one NEEDS HFCS
- No one will be harmed by NOT consuming it
- Some people may be harmed by consuming it (even though the evidence is still in the preliminary stages)
- The consumption rates of HFCS (an other processed substances) and various liver and metabolic issues have risen together
My Conclusion: I don’t recommend anyone consume it; the research community would have to prove that it’s actually GOOD for people to consume HFCS for me to recommend it. There are just too many yummy sugars out there in nature and processed foods really shouldn’t have much of a place in our diets; come on people, it’s 2010….. nobody should be smoking and almost no one should consume processed foods!
Natural sugars in non-processed foods are going to win every time in my book. Nature put sucrose in whole foods and interestingly, research has suggested that (regarding IBS at least) consuming glucose and fructose together is better for us. Just about all of the food and nutrition evidence suggests that non-processed foods are healthier than processed. We need to eat “real” food; this kind of food does not have HFCS in it….. period. Most of my opinion is based on research, especially a recent paper from Duke this May suggesting a link between HFCS and non-alcoholic steatohepatitis (NASH) AKA “fatty liver”or the multiple papers on fructose and irritable bowel syndrome (IBS). Glucose and fructose are absorbed and metabolized differently, that’s a physiological fact….
Suggesting or even proving that a substance is not harmful does not prove that it’s good for us. The problem with HFCS is that there IS some evidence suggesting that it’s harmful; that’s good enough for me.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health