When the Doctor Says, "Don't Do That"

Here's another golden nugget from Dr. Kathy Dooley. The golden rule when it comes to degenerating joints and restricted motion is "if you don't use it, you lose it." 

- Dr. P

Dooley Noted: 4/21/15

An old joke persists: If you tell your doctor it hurts when you do something, the doctor will likely tell you, "Don't do that."

I truly believe this has pervaded our culture so much that certain movements and exercises have been avoided out of injury fears.

People hurt some knees when squatting, so squatting became bad for the knees.

Basketball and soccer had high incidents of ACL injury, therefore one shouldn't play those sports.

Running is probably the most bastardized activity of them all. If it hurts when running, then running must not be for you, right?

What bull.

I'm a doctor, and yes - I have placed patients on restriction from certain activities.

But it's only temporary until they do something important.

It's not that they shouldn't squat or run.

They must learn to squat or run the way that protects them from injuries.

It's not, "Don't do that."

It's more like, "Don't do that the way you did it when you got hurt."

With movement re-education, you can return patients safely to many activities.

But I give these patients fair warning.

If they want to safely do what they love, they may have to do some things they don't love.

If they lose stability in a squat below parallel, they may have to come above parallel for a little while to build some strength there.

(Don't gasp. Earn the right to go below parallel.)

If they lose stability or mobility in their runs at 2 miles, then they may have to be restricted to 1.5 miles with a stopping point for correctives.

(Running isn't bad for you. The way you run may not be right for you.)

Gait re-training may be necessary for someone with pain with walking or with running.

I would never tell someone who loves their activity that the activity is to blame. If the activity were at fault, everyone would have the same injuries.

They don't.

Educate, don't eliminate.

As always, it's your call.

- Dr. Kathy Dooley

On The Run From... Running?

Written by Dr. Prathap Addageethala

It's getting warmer out there, and people are starting to stretch their legs by getting out and putting in a few kms on the road. As North America thaws out from an exceedingly frigid winter, it's rolling into the hottest part of the year here in Southern India, where temperatures can soar past 37C with regularity.

I am planning to run a 10K for the very first time in May of this year. There. I said it. You know what they say, "speak your dreams into existence." And I'll be honest with you, I'm a bit nervous. That seems fairly normal considerig the longest race I have ever run was while I competed for my elementary school's cross country team. I can't even be sure that it was more than 5km back then, so if it wasn't, then 5km was my all time longest run. EXACTLY HALF OF HOW FAR I NEED TO GO.

In high school I was a decent athlete. During our mandatory timed mile run in Phys.Ed I posted a  respectable 6 minutes and change; during our 12 minute timed run, I chugged out 7 laps. A lot has changed since then! Two degrees, multiple injuries, and two moves across international borders later, I'm a slightly overweight and under-active healthcare practitioner. Doctors are human too!

I have had a longer hiatus from training and regular exercise than I'm proud to admit. So, naturally, my worries in running this middle distance race stem from that; will I be able to finish? will I injure myself? After doing some light reading about starting a running regimen, I noticed a few things. It seems that all fledgling runners go through a period of uncertainty. Everything that I read indicate that they are all normal concerns that engaging in a new physical form of rigorous training elicits. And rightfully so!

Common injuries that occur to novice runners (fairly common in experienced runners as well!) include shin splints, IT Band syndrome, cramping, sprains, and other strain based injuries. By and large, these injuries happen due to poor warm up/cool down strategies, and a case of "too much, too soon." As with any other form of exercise, it is best to build up to a challenging routine to give your body a chance for success. Feeling DOMS (delayed onset muscle soreness) is normal if you are just starting out, or just getting back into working out. Try to challenge yourself in each successive workout, keep an eye on your form (there is a proper way to run, believe it or not), and listen to your body.

Here are some tips and tricks on navigating the road, the trail, or the treadmill as you prepare yourself for your next athletic achievement! Incidentally, since I'll be on a major training kick in the weeks approaching the big race, I'll be blogging more about running as I come across valuable information to share. Keep an eye out for the "Running" folder in the coming weeks.

Make a run for it with these training tips:

• Stay hydrated! A common recommendation is to drink 8 cups of fluids a day. This is just a general guideline and not a hard and fast rule. Obviously if you are sweating profusely from an uptempo workout, you should be replacing the fluid lost with an extra cup or two of water, and it is recommended to replace electrolytes (salts) with a sports drink. This is a huge topic, and will be covered in a later blog entry. YOUR GOAL: 3L (12 cups) spread through the day. Here's a life hack on how to stay evenly hydrated through the day.

• Warm up dynamically (actively). Doing sport specific movements will aid you further in achieving athletic performance than your average hold-that-position (static) stretch. A healthy warm up for running may include a light jog for 5-10 minutes, followed by 1-2 sets of lunges, prisoner squats, leg swings, windmills, jogging butt kicks, walking knee raises, and walking mummy kicks. YOUR GOAL: Improve your flexbility and endurance of the muscles you engage most during your sport activity.

• Keep records but don't let it discourage you. Set some goals and work your way towards them. Your best bet to know if you're improving or subconsciously slacking off is to keep an accurate record of your running activities. Some people use heart rate monitors and other gadgets to keep electronic or digital logs of their runs, which is a solid idea. I personally use an app on my smartphone called MapMyRun, which features a simple and easy interface, and excellent in-run guidance. Only drawbacks to this app are that it doesn't do much for a treadmill workout (other than keep time), and you have to keep a clunky smartphone on your person during your run. YOUR GOAL: Record each workout, and challenge yourself to improve your times on a week to week basis.

• Get rest. I can't emphasize this one enough. Your body grows and repairs itself largely while asleep, so make sure you are doing what you can to get adequate amounts. In addition to the typical grogginess, mind fog, and irritability that one feels when not well rested, we also become more susceptible to injury and cramping. A growing body of evidence also shows that using an electronic device with a screen (smartphone, laptop, tablet, etc) just before sleeping can lead to a decreased quality of sleep. YOUR GOAL: 6-7 hours of quality sleep each night, turn off your electronics at least 30 mins before bed.

• Wear proper footwear. Unfortuately those 5 year old sneakers that you wear during any and all athletic undertakings will not suffice when it comes to a renewed dedication to running. Seeking out a running professional at a running specific sporting goods store is a great way to get a shoe that is tailor made to your body type and needs. It is easy to pick the wrong shoe from myriad choices on the shoe rack, so in this sense, a little research goes a long way. I really benefited a ton from Runner's World's "shoe advisor." And I really liked their tool for determining your own arch height and foot type. With moderate usage (around 25-30 km a week) it is recommended to get new shoes every 6-8 months. Even though the shoe might remain in good shape from the outside, the heel pad and cushions for the sole of your foot might be too thin to effectively absorb the repeated pounding of the pavement. Barefoot running is a completely different animal, so stay tuned for an article about that. For average height arches, and neutral foot roll, I can't think of a better shoe than Asics Gel Nimbus series. YOUR GOAL: Assess your footwear situation, and pony up for a decent pair of running shoes that are used exclusively for running. Runner's World has an excellent assortment that can fit every budget.

• Supplement intelligently. As I mentioned above, each of these tips and tricks can be their own blog entry or fill many pages in a text book. According to Examine.com (a trusted source for accurate and succinct health information backed by scientific research) the three supplements that absolutely work include fish oils, vitamin D, and creatine. Fish oils are excellent for joint pain reduction (at higher dosages) and decreasing free floating fats in the bloodstream which is fantastic for heart health. Vitamin D is essential for bone health, and is necessary in order to absorb Calcium, the bone-building staple. Creatine was a much-maligned supplement about 10 years ago, when claims that it created a higher incidence of kidney stones surfaced. The reality is that any protein-dense diet (with or without creatine) can create kidney stones and gout if proper measures aren't taken to hydrate responsibly. Creatine supplementation provides extra energy for your cellular processes, and has been shown to improve physical performance, and boost muscle growth. YOUR GOAL: Regular supplementation with a recommended multivitamin, fish oils, and creatine can help you surpass performance obstacles. Keep in mind, these are supplements, you know, in addition to a balanced diet rich in green leafy veggies, lean protein, and healthy fats.

It is always better to check with your MD regarding your current blood chemistry and physical fitness before engaging in a new, vigorous exercise regimen. Your chiropractor can help you manage your performance by decreasing joint pain and stiffness, improving your range of motion and flexibility, and by keeping your nervous system in optimal shape. 

See you out there!

- Dr. P

Top 10 Hip Hop Tracks For Chiropractors

Written by Dr. Prathap Addageethala

Okay, so this post doesn't have much to do with health tips, improving your health, or anything health related, really. It is a kind of awesome list though. Hip hop has long been fascinated with Chiropractic and its references to the back, having one's back (rapper E-40 uses exactly this reference on three different songs), or just referring to the backside (glutes) in general. Some of the biggest names in hip hop have referenced our profession with subject matter ranging from:

• blatant violence
•  ex. Notorious B.I.G on Dangerous MC's - "Ac-tor needs chiro-prac-tor for cracked jaw"
• lyrical genius 
• ex. Canibus on Collecting Taxes - "I lean you back like your spine just cracked/Rhyme chiropractor, get paid to adjust raps"
• sexual innuendo 
• ex. Nicki Minaj on Turn Me On - "I just want you to be my docta/we can get it crackin', chiropracta" 
• extra syllable filler 
• ex. Nas on Hero - "Exotic lady eye-catcha/holla atcha/call me the chiropracta"

Given the nature of our scope of practice, and being embraced by the hip hop community, here are the Top 10 Hip Hop Tracks for Chiropractors.

Disclaimer of sorts *Be forewarned! Although all of the videos are of the "edited" or "clean" variety, some of the language and images may not be suitable for all environments or audiences. Enjoy responsibly.

10. Push It - Salt-N-Pepa

The Chiropractic adjustment is the cornerstone of Chiropractic. In fact, many would suggest that it is the element that makes our profession separate and distinct from any others. Other practitioners do perform spinal manipulation, but the training a Doctor of Chiropractic is extremely unique. In other words, it's more than just pushing on a bone or a joint. Prior to graduation, it is common for most Chiropractic students to have participated in more than 1000 hours of adjusting practice. Palpate, contact, set, and p-p-push it real good!


9. Walk This Way - Run DMC

A little gait analysis goes a long way. Getting adjusted can help you functionally correct any disparities in leg length and pelvic level. We connect to the earth through our feet. Every motion our feet make in connection with a surface sends a flurry of forces through our legs, into our hips and pelvis, and finally into our spine. Having a solid base and improving your gait could be your gateway to pain relief. And I'm not even talking about orthotics yet!


8. Stronger - Kanye West 

Just ask anyone involved in any sport at a high level, seeing a Chiropractor could be just be the edge you need to set your next personal record, or achieve what you previously could not. Ask Michael Jordan, Tom Brady, or Usain Bolt, just a handful of world class athletes who got to the top of their game with the help of their Chiropractor. Harder, better, faster, stronger, indeed.


7. Protect Ya Neck - Wu Tang Clan

There was absolutely no way I could curate a hip hop list and leave the Wu-Tang Clan off.
Let's say you never brushed your teeth. Ever. Your teeth would probably turn yellow, rot and decay, and you'd develop serious gum disease (not to mention the worst case of the dragon). Luckily for you, these issues can be quickly resolved by visiting a dentist. The damaged teeth can be replaced, capped, drilled, and filled. Unfortunately, you can't do the same thing with your spine, and especially not your neck. You only get one neck, so getting checked regularly by your Chiropractor can protect against early degenerative changes. You best protect ya neck!


6. Back That Thang Up - Juvenile

The curve of the low back or lumbar spine is called a "lordosis," Some people, more commonly in women, are genetically predisposed to having a more pronounced curve in that region, called a "hyperlordosis," (historically called a "sway back") which can create pain and discomfort in the low back, as well as distortions in posture. While some remain asymptomatic, it's best to be evaluated by a Chiropractor before returning to the dance floor.


5. Baby Got Back - Sir Mix-A-Lot

Yup! It's true. Babies CAN be adjusted by Chiropractors (they have backs too). Actually, the birthing process can be quite traumatic for a newborn, involving a lot of torquing, turning, and pulling, which results in a lot of stress on a little spine. Many Chiropractors have an advanced training in pediatrics, and their specialized, safe, and super gentle techniques are wonderful for infants who are suffering from digestive issues, colic, and other ailments. Also, Chiropractic care for infants gives your child the best possible start to their lives by optimizing their nervous system and improving their immune system. And if you ask nicely, some Chiropractors might even be able to sing this song to your kid like Ross and Rachel on Friends.


4. I Need A Doctor - Dr. D.R.E.

I would argue that we all need a doctor! Medical Doctors are critical to community health and well being. While medicines and surgeries are sometimes necessary to save a life, they can be irreversibly damaging or toxic when they are prescribed as "optional" treatments. The best cure is prevention, and that's where Doctors of Chiropractic excel. In fact, even if you are not in pain, you should at least have your Chiropractor check your spine to achieve and maintain maximum wellness. Health is not just the absence of disease, according to the World Health Organization, and peer-reviewed research supports the notion of being adjusted regularly for maintenance of your spine.


3. New Workout Plan - Kanye West

 -
Yeezy made it to the list for a second time! This goes along with my post about sitting too much - health in the modern world is actually harder to attain than we think, especially with the barrage of information that we get blasted with on a day to day basis, care of the mystical Interweb. Having ANY workout plan is a great start. Having the same workout plan for the entire year? Not so much. Change your workout plan from time to time to keep your muscles and joints challenged. Chiropractors can help you attain your goals in the following ways:

• physically by improving your range of motion and decreasing joint restriction
• nutritionally by coaching you on your dietary choices; many will even sit and organize a meal plan that will best suit your needs and goals
• mentally by optimizing your nervous activity and decreasing stress

That's a plan that can work.

2. You Can Do It - Ice Cube (NSFW)

You can do it... Put your back into it... Two statements that have so many connotations. Truth is, you really can do it! Many successful people point to their positive mental attitude as their go to weapon in their arsenal to combat adversity. It's not as easy as it looks, especially if there is some history of stress, anxiety and depression in your life. That being said, putting your back into it, or putting in some effort towards achieving something is one way to overcome negativity. Sometimes stress can manifest in the body as physical pain, something doctors refer to as "psychosomatic" pain. Chiropractic care has been proven to decrease stress, leading to more feelings of positivity and increased energy.


10. Let Your Backbone Slide - Maestro Fresh Wes

Having a flexible and unrestricted spine can improve your quality of life, can decrease future issues like arthritis and spondylosis, and help you achieve your goals. How many people do you know who can't play with their kids because their back hurts too much? How many of your friends suffer from constant headaches that prevent them from accomplishing much work? Which of your family members still has chronic pain despite trying everything? Sliding in to see a Chiropractor could make a huge difference in your life, and those around you.


Honorable Mentions
* Kick, Push - Lupe Fiasco - For those lazy side posture adjusters.
* Lean Back - Fat Joe - Just... not too far. Unless you're in yoga class, of course.
* By Your Side  - Jadakiss - Chiropractors. They got your back. Now, please lay on your side.
* My Neck, My Back - Khia - Intentionally left off because I'd never hear the end of it. Ever.
* Lose Yourself - Eminem - For the ultra intense, block booking, high volume clinic rockstars, who need to get in the zone when they adjust.

- Dr. P