Ski season is in full swing in Colorado and we are currently having one of the best snowfall years in the last decade. Many of the resorts are well above seasonal averages for snowpack depth. As of today, Vail is at 124% of seasonal average, Aspen Snowmass is at 140%, and Steamboat Springs is at a whooping 154% of average (via OpenSnow and based on averages over the last 20-40 years). The opportunities for skiing and snowboarding fresh Colorado powder are ample this season, and many individuals are flocking to the mountains to hit the slopes. Skiing and snowboarding are incredibly exhilarating, but they are also extremely dangerous. So what are the most common injuries for skiers and snowboarders, and how do you minimize these risks?
Injury Prevalence in Skiers vs. Snowboarders
Skiers and snowboarders are more susceptible to different types of injury. The reason for this has to do with the stiffness of bindings and boots, the use of poles in skiing, the ability to use two edges at once when skiing, and the differing techniques used in sliding downhill sideways versus straight forward. Research suggests snowboarders are most likely to injure their wrists, shoulders, and ankles, while skiers are more likely to injure one of the ligaments in their knee such as the ACL, MCL, or LCL1. The same study reports wrist injuries were the most prevalent in snowboarders (27.6% of all snowboard injuries), while anterior cruciate ligament (ACL) tears were most prevalent in skiers (17.2% of all skiing injuries). Specifically, the injury profile for snowboarders includes wrist fractures and wrist ligament sprains, shoulder labrum tears, ankle fractures and sprains, concussion, and clavicle fractures. Among skiers, the injury profile includes ACL sprains and tears, MCL and LCL sprains and tears, tibial plateau fractures, and concussion as well. After 4 years of treating ski and snowboard injuries as a chiropractor in Colorado, the results of this study are all too common at our practice.
Improving Control on the Mountain
The best way to minimize injury on the mountain is to learn how to control your speed in all types of terrain. Many beginner skiers and snowboarders simply ride too fast, putting themselves and other riders at risk. The best skier in the group isn’t always the one who gets to the bottom of the run the fastest, rather it’s the rider who stays in control, always on their edges, and adjusts their speed effectively based on upcoming obstacles.
In skiing and snowboarding, the ‘fall line’ refers to the line down a mountain that is most directly downhill. If you are on a steep slope, it’s important to periodically deviate from the fall line and move laterally on the slope to slow down. If you constantly face down the fall line, you will gain too much speed and lose control. Alternate between turning down the fall line to gain speed, then checking your speed by moving laterally when you feel like you are going too fast. Other ways to control your speed include turn shape, skidding, and checking. Check out this excellent article on speed control.
Understand When to Call it a Day
According to Utah based sports medicine expert Dr. Travis Maak, MD, a former ski patrol volunteer and current head physician for the Utah Jazz, the majority of ski and snowboard injuries happen at the end of the day, around 3:30 pm. Lifts typically close at 4 pm meaning most ski injuries happen in the final 30 minutes of the riding day. The reasons for this are multifactorial. Firstly, temperatures start cooling off at the end of the day causing the snow to be harder and icier. The softer snow is more skied off, exposing icy snow with rocks and branches. Additionally, riders are more fatigued at the end of the day, especially in the active stabilizers of the lower leg such as the muscular quads, hamstrings, and calves. When these muscles become fatigued, the rider relies more on the passive stabilizers of the lower leg such as the ligaments of the knee and ankle, the meniscus, and the hip labrum. This is a recipe for disaster since the passive stabilizers of the lower leg are less reactive to quick, ballistic forces that might be imparted with an unexpected fall on the mountain. Advanced skiers know when to call it a day and when it is time for their last run.
Avoid Alcohol or Drugs while Skiing or Snowboarding
Skiing and snowboarding are activities in which many people treat alcohol and drugs as the norm. Alcohol decreases cerebellar function which results in decreased balance, motor control, coordination, and cognition – all athletic attributes required for a safe day on the mountain. If an individual is drinking or doing drugs, they are treating skiing and snowboarding as a leisurely pastime rather than a sport, and could be putting themselves and others in danger. If you want to avoid injuries, save the drinking for after you have called it quits for the day.
Take a Lesson
Take a lesson from a trained instructor. Ski school instructors are specifically trained in the progressions for learning how to ski and snowboard. Progressions refer to the gradual acquisition of new skills within a given sport, and are an integral piece to safely learning a new sport. Progressions are particularly important in extreme sports like skiing and snowboarding where risk of injury is high if a stepwise fashion to learning is not followed. For an example of a beginner progression for skiing, check out this excellent YouTube video for some helpful tips.
Be on the lookout for Part 2 of Ski Safe in 2023, where I will teach you training techniques to reduce injury risk and to improve your performance on the mountain!
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Build Resilient Immunity in 2023
Last month, Dr. Ryan and I had the pleasure of attending a seminar taught by Dr. Dan Murphy, DC. Dr. Murphy is one of the foremost experts on nutrition and functional medicine in the chiropractic profession. He lectured on topics such as brain injury and concussion, nutrition for cognitive and immune system health, the beneficial effects of red laser therapy, and the prevention of dementia and Alzheimer’s disease using nutrition and lifestyle modification.
Perhaps the most impactful topic for me was Dr. Murphy’s lecture on ‘host immunity.’ Host immunity refers to the strength, resiliency, and adaptability of a given patient’s immune system. The better the patient’s immune system, the more effectively that patient can combat all forms of disease and illness affecting the body. Dietary and lifestyle modifications such as exercise, proper sun exposure, and evolutionarily consistent eating are examples of techniques patients can use to improve their host immunity.
In my opinion, mainstream media does not focus enough on host immunity. Instead, we are told strategies such as staying up to date with the latest vaccine or booster, avoiding close contact with sick individuals, wearing masks in public, or taking medication for any physical or mental stress your body is subjected to. When did we become so weak we had to start relying on all of these external, synthetic inputs to keep us healthy? Since when did being around other people endanger us, rather than strengthen our immune system by presenting our immune system with a wide array of pathogens and creating a more robust immune system? I recall when ‘chicken-pox’ parties were the norm. Each individual has the opportunity to have an extremely strong, smart, and resilient immune system.
Dr. Murphy suggests a number of vital supplements for optimizing host immunity. First and foremost are omega-3’s and vitamin D. Aim for around three grams of omega 3’s each day. For many, this means supplementing with a high quality fish oil supplement. Omega 3’s help with the inflammatory balance in the body and foster an environment where immune cells can combat external infections and diseases. Next up is vitamin D. Your goal should be around 5,000 mg per day. Getting vitamin D from natural sunlight is the best option, however, during the winter months supplementation is often necessary. Nearly every cell in the body, including our immune cells, possess a vitamin D receptor and is positively activated when this hormone is at proper levels. Vitamin D is also great for bone mineral density, memory, and mental health.
No lecture on immune health is complete without mentioning vitamin C. Did you know the benefits of vitamin C were first discovered among sailors with scurvy? Scurvy is a connective tissue disease causing gum disease, hair loss, excessive bleeding, and poor healing from wounds and infection. When the sailors were given oranges, which are high in vitamin C, the symptoms of scurvy all but disappeared. Alas, the immune benefits of vitamin C were front page news! Vitamin C has a host of health benefits including reducing the duration of the common cold, helping with the synthesis of collagen so you can have healthy skin, hair, and nails, and acts as a strong antioxidant with some research suggesting anti-cancer and anti-Alzheimer’s benefits. Vitamin C is found in the highest quantity in citrus fruits. If supplementation is deemed necessary, liposomal vitamin C is your best option. Liposomal vitamin C is encapsulated with a fat or lipid coating improving absorption and decreasing gastrointestinal distress.
The final three nutrients are magnesium, zinc, and vitamin A. Magnesium is a mineral acting as a cofactor in over 600 reactions in the body, and is important for normal immune function, energy production, blood pressure regulation, and blood sugar control. Magnesium deficiency is common in developed countries. Aim for about 300-600 mg per day of magnesium from a whole food source or supplement. If supplementing, I recommend taking either magnesium threonate or magnesium glycinate, since these have the best absorption in the body and brain. Zinc is an essential mineral associated with proper wound healing and immune system function. It is an antioxidant and important for maintaining proper testosterone levels. I recommend 15-30 mg of zinc daily. Vitamin A refers to a group of chemical compounds composed of retinol and its metabolites. Vitamin A is essential for optimal immune function, and is also important for our skin and vision. Take around 5,000 IU of vitamin A each day.
Coming up soon, I will take a deep dive into the importance of exercise and sleep for healthy host immunity. At the surface level, a balanced combination of aerobic (endurance) and anaerobic (strength) training will help develop a robust individual with a strong immune system. Consistent, quality sleep each night is essential for immune health because melatonin benefits the immune system by decreasing inflammatory reactions in the body, notably the ‘cytokine storm’ seen with covid-19. Supplementing with 3-10 mg of melatonin while symptomatic may provide some benefit, however, I do not recommend long term supplementation of melatonin. Melatonin is a hormone produced by the body, and long term supplementation may decrease our body’s capacity for producing the hormone on its own.
Make 2023 the year for improving host immunity. With covid-19 in the rearview mirror, prepare yourself now for any future health crises that may affect our society. If we all commit to focusing more on healthy host immunity, the need for societal wide shutdowns and vaccination may not be necessary!
Post written by Dr. Riley Kulm, DC. Check out his bio here:
Anemia may be the root cause of many chronic conditions such as headache, migraine, mood disorders, and fatigue. Getting assessed by a functional medicine provider trained in the diagnosis and treatment of anemia may be the missing link towards optimal health. In this blog post I will be focusing on iron deficiency anemia as it is the most prevalent in our clinical practice. While both males and females can be affected by anemia, females are affected at a much higher rate.
What is anemia?
Anemia is defined as a low red blood cell count (RBC), low hemoglobin (Hgb), and a low hematocrit (red blood cell concentration in whole blood). Iron deficiency anemia, or IDA, is defined as a microcytic, hypochromic anemia, where the red blood cells are small in size and pale in color due to poor hemoglobin concentration. These red blood cells do not carry oxygen as efficiently, and your tissues can become hypoxic or starved of oxygen. As a result, your heart pumps faster to try and bring more oxygen to the tissues. Additionally, your brain gets less oxygen which causes headaches and mental fatigue. Symptoms of anemia include fatigue, cold hands/feet, rapid or irregular heart rate, headaches, dizziness and lightheadedness, pale or yellow skin, and shortness of breath. When iron status is addressed, we have seen issues like anxiety, depression, and insomnia improve drastically in our patients.
There are many types of anemias that can affect the body. For instance, Vitamin B12 (cobalamin) and Vitamin B9 (folate) deficiencies can cause anemia. These anemias will present as a ‘macrocytic’ anemia where red blood count is low and the red blood cells actually become larger as part of the deficiency. When assessing your bloodwork for anemia and any other condition, make sure to consult with a physician trained in functional medicine.
How do you measure it?
To assess iron status, we order a simple test called plasma ferritin. Ferritin is your body’s storage form of iron and is in largest concentration in your liver, spleen, and bone marrow. Small amounts of ferritin circulate in your bloodstream in direct proportion to the amount of ferritin stored in tissues. Normal values for ferritin vary with age and sex, and good laboratories will provide age and sex specific reference ranges. The lab reference ranges for ferritin are typically quite large, e.g. 16-154 ng/ mL for a 40 year old female, meaning stricter ‘functional ranges’ need to be used for clinical decision making. Using functional medicine standards, we prefer to see ferritin levels above 100 ng/ mL. It’s important to note too much iron is also a problem, and can cause conditions such as iron overload or hemochromatosis.
What to do:
If your ferritin levels are low, look to optimize digestion of iron by taking a hydrochloric acid supplement which will help increase the acidity of your gut. Having an appropriately low stomach pH (more acidic) is necessary for the proper digestion of iron, vitamin B12, calcium, and magnesium among other vital nutrients. For more information, refer to my blog post on stomach acid and digestion here.
To improve iron status it’s important to consume foods high in iron. Animal protein is one of the best ways to get iron. Red meat, organ meats, shellfish, and turkey are excellent ways to increase iron status when paired with optimal digestion. Cooking daily with a cast iron skillet is another easy way to improve iron status. One of my favorite iron and vitamin B12 rich meals is a grass fed ribeye steak cooked with butter or coconut oil in a cast iron skillet. Another option is to use an ‘iron fish’ which can be dropped into warm beverages and will safely release iron into your drink. Consider using an iron fish in hot water with honey and apple cider vinegar. The apple cider vinegar will help increase gut acidity and improve iron absorption.
If you can relate to the symptoms described above, make sure to get a ferritin and complete blood count (CBC) test as soon as possible from your doctor. It’s always better to ‘test rather than guess’ because too much iron can also be problematic. The tests are simple and inexpensive so don’t hesitate to ask your doctor to order it for you. Having healthy red blood cells is essential for optimal health, and a CBC test looking at iron levels will help determine what steps you may need to take to improve your overall well-being.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Last weekend I had the pleasure of attending the annual Colorado Chiropractic Association (CCA) Conference. Each year chiropractors from across Colorado gather to enjoy a weekend of educational speakers, networking, and discussion of the future of the chiropractic profession in Colorado. The CCA conference offers a unique opportunity for doctors of differing experience levels, techniques, and chiropractic universities to connect with a common goal – the advancement of the chiropractic profession in Colorado.
Since there has been a scarcity of in-person continuing education opportunities over the last two years, the phenomenal speakers at this year’s conference were a breath of fresh air for the doctors in attendance. As a clinician, it’s important to regularly learn new treatments and methodologies, staying up to date with the most current research available. I truly love continuing education courses because you come back to work with a renewed sense of vigor, and are eager to try new treatments and methods to help your patients. There were many fantastic speakers at this year’s conference, including Dr. Mike Hall, DC, Dr. Alicia Yochum DC, and Del Bigtree.
Dr. Hall spoke extensively on the importance of maintaining a healthy cervical lordosis. The cervical lordosis is the natural C-shaped curvature your neck should display. Many patients present with a flattened cervical spine which may be due to prior motor vehicle accident (MVA), prolonged poor posture, or genetic predisposition. Dr. Hall spoke about how the cervical lordosis acts as an indicator of the orthopedic health and fitness of the rest of the body. Patients with good strength in their hips and legs, shoulders and arms, often present with a healthy cervical lordosis. Conversely, individuals with poor strength in the lower body and who sit at a computer all day, often have a flattening of the cervical curve. Patients dealing with chronic stress and anxiety often present with head tilts and a poor cervical curve, indicating that the emotional and physical health of the brain is represented in the health of the cervical curve. The cervical curve is a window into the neurologic and orthopedic health of the entire body.
Dr. Alicia Yochum, daughter of Terry Yochum, who is co-author of Essentials of Skeletal Radiology, a textbook universally used in chiropractic and medical radiology programs, spoke about clinical radiology cases. For each case, she asked the audience to identify the pathology and then decide the appropriate course of action in terms of treatment or external referral. Dr. Yochum also spoke extensively on the benefits of musculoskeletal (MSK) ultrasound which is a cost effective diagnostic tool for soft tissue injuries. She provided an excellent review of how to distinguish T1, T2, and STIR sequence MRI’s. As a talented presenter, she made her radiology course engaging for all attendees.
To round out an exceptional group of speakers was Del Bigtree, former Hollywood producer of ABC’s The Doctors, who now uses his production skills to educate the public on the danger of vaccines, medical misinformation, and the pursuit of health care freedom in the US. His highly acclaimed internet show, The Highwire, is watched by millions of Americans who seek unbiased information when it comes to health related topics in the US. Bigtree spoke at length on the dangers of global vaccination for Sars-cov-2, which has a 0.26% mortality rate worldwide. Noting Dr. Robert Malone, inventor of mRNA vaccines, has even publicly spoken out about the dangers of global vaccination and has urged the medical community to stop. The mRNA vaccines use a new form of technology where vaccine adjuvants can turn off the ‘toll like receptors (TLR’s) of the patient’s innate immune system. Turning off the TLR’s allow the mRNA gene therapy to quickly bypass the innate immune system and enter the patient’s cells with the goal of stimulating an immune response and subsequent antibody formation. The overlooked issue is TLR’s are an extremely vital component of our immune system and shutting them off may have deleterious effects. Bigtree noted many oncologists have contacted him saying they’ve never seen new cancer rates this high in the US, and one plausible explanation is widespread vaccination with the mRNA gene therapies. Bigtree is a prominent advocate for the health freedoms of all Americans and I am grateful to have heard him speak on such a divisive and important topic.
The 2021 conference was my second CCA conference and I left feeling refreshed, excited about chiropractic, and with a wealth of new information to share with my patients. Whether you’ve been in practice for 3 years or 30, chiropractors share a kinship with each other and treat each other with respect. I enjoyed getting to know other Colorado chiropractors such as Dr. Roman, Dr. Pearson, Dr. Starling, and Dr. Birdsall just to name a few. My deepest thanks goes out to the staff of the CCA and all those involved in orchestrating a truly fantastic weekend.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
When I am performing needling on a patient for the first time, I am regularly asked what the difference is between acupuncture and dry needling. For many, these two treatments are one and the same, but despite their similarities, they also have their differences.
Acupuncture is one branch of Traditional Chinese Medicine (TCM), the others being herbal medicine, nutrition, movement (Qi gong), and manual therapy (cupping, tui na massage, and gua sha). Acupuncture involves inserting needles at specific points and utilizes the ‘meridian theory’ as its basis for treatment. On an acupuncture chart you will notice lines, or meridians, drawn throughout a person’s body. A meridian may travel from the hand to the head, the foot to the abdomen, or from one end of the spine to the other. Meridians connect different parts of the body to each other. Each meridian is linked to an internal organ, such as your liver, lung, or heart. There are 12 primary meridians, one for each organ, along with 2 ‘extraordinary’ meridians, which are commonly used in practice.
Based on the theories of TCM there is an energy force called ‘Qi’ flowing along the meridians. Qi is responsible for keeping our tissues healthy, youthful, and disease free. The smooth flow of Qi along the meridians is imperative for optimal health. When Qi does not flow well or is stagnate, pain, injury, and disease can arise. When a needle is used to stimulate an acupuncture point in clinical practice, the goal is to restore the flow of Qi along the meridian. When Qi is flowing freely throughout your body, you will feel vital and energized.
The origins of dry needling and trigger point theory are closely related. Trigger point theory refers to the idea that pressing on a tight, tender band of muscle tissue will often refer pain to a different area of the body. For instance, stimulating a trigger point in the upper trapezius muscle of the shoulder may cause pain in the temporal region of the skull. Researchers began mapping these ‘referral patterns,’ which appeared to be consistent from person to person. Janet Travell and David Simons are arguably the two most influential contributors to trigger point theory and their pain referral charts are still widely used today. Early researchers of the trigger point theory used needle injections of local anesthetics to map the associated referral areas for each trigger point. Interestingly, the treatment benefit would often outlast the anesthetics known treatment time. It was at this point researchers realized it was actually the needle insertion into the trigger point, rather than the anesthetic itself, providing the therapeutic effect. Dry needling is referred to as ‘dry’ because there is no anesthetic or saline injection used during the needling treatment.
Similarities Between the Two
In general, the local effect of the needle is the same whether you are performing acupuncture or dry needling. At a microscopic level, the needle is causing a local micro-trauma or small injury to the tissues, which stimulates the body to send blood and healing products to the area. Needling is a viable treatment for areas receiving poor blood flow, such as tendons, ligaments, and the periosteum of bone. By stimulating blood flow to these traditionally ‘avascular’ or low blood flow areas, the patient’s recovery from tendinous and ligamentous injuries can be accelerated.
In my practice I use a combination of acupuncture and dry needling. I often do dry needling at the site of pain, and then utilize local, adjacent, and distant Chinese medicine acupuncture points to help move Qi and blood throughout the body. As a chiropractor, I utilize many spinal points to help with painful conditions of the neck and low back. Combining a spinal chiropractic adjustment with needling in the same area is extremely helpful for patients. Acupuncture and chiropractic care complement each other wonderfully. Chiropractic care helps the neurologic and orthopedic systems function better, while acupuncture helps with systemic health by improving the flow of Qi and blood throughout the body. Combining a Western orthopedic approach with an Eastern Chinese medicine approach is an excellent way to help patients achieve optimal health.
Post Written by Dr. Riley Kulm DC. Check out his bio here.
People are often told in order to meet their weight loss goals they need to eat clean, work out consistently, and limit the number of calories in versus calories out. Unfortunately, despite working these modifications into their daily lives, they still find their weight loss goals unachieved. I’ve worked with numerous frustrated patients who work out strenuously 5 to 6 times per week, yet are not seeing the results they would like. The overlooked missing piece to weight loss is hormonal imbalances. These imbalances may be preventing you from reaching your weight loss goals.
The two hormones I will focus on for weight loss are cortisol and melatonin. Please note, hormones such as grehlin and leptin (hunger and satiety), testosterone and estrogen (male and female sex hormones), and insulin and glucagon (energy storage and utilization hormones), are all intimately involved in weight loss, but cortisol and melatonin are a simple and effective place to start.
Cortisol often gets a bad rep as our body’s ‘stress hormone’. Cortisol is a primary hormone involved in the body’s stress response, however, cortisol is more appropriately defined as our ‘awake’ hormone. Cortisol is released in the morning and helps us get out of bed, use the bathroom, and provide us with the stimulation to start our day. In a normal functioning endocrine system, cortisol release is high in the morning and then tapers off in the afternoon to allow our sleep hormone, melatonin, the chance to take over.
Melatonin is our ‘sleep’ or ‘darkness’ hormone and it’s release is inhibited with exposure to light. Melatonin helps us wind down in the evening and prepare the mind and body for sleep. Melatonin and cortisol work in opposition to each other. Having one with high levels means the other is not fully expressed. With this in mind, if cortisol levels are abnormally elevated in the afternoon and evening, the normal release of melatonin around lunch time is inhibited, therefore impairing our ability to fall asleep. The entire system is regulated by our circadian rhythm which responds directly to light exposure on the eyeballs. Bright light in the morning stimulates cortisol release, the dimming of light in the evening stimulates melatonin release.
Cortisol becomes a stress hormone when levels remain elevated in the afternoon and early evening. When cortisol release is improperly timed and is still high in the afternoon, we feel anxious and crave sugary, fried, and fatty foods. If our ‘awake’ hormone is elevated in the evening when we are trying to prepare for sleep, we will feel uneasy and distressed. The combination of excess calories from sugary, fried, fatty foods and poor sleep due to excess cortisol and deficient melatonin is what leads to weight gain and the inability to lose weight. Even if you eat a clean diet excess cortisol in the evening will create a stress response causing systemic inflammation. Systemic inflammation and insulin resistance each make weight loss more difficult to achieve and maintain.
The best way to normalize your cortisol/melatonin system is with direct sunlight exposure within 30 minutes of waking. Dr. Andrew Huberman, neurobiologist from Stanford, was recently interviewed on The Tim Ferriss Show Podcast where he suggests everyone get 2-10 minutes of direct sunlight exposure on their eyes first thing in the morning. By stimulating photoreceptors in the eyes, cortisol release is amplified. Going outside for an additional 2-10 minutes in the evening, when the sun is at a low angle, will help to stimulate melatonin and prepare us for sleep. Start your weight loss journey by normalizing your circadian rhythm using direct sunlight exposure in the morning and again in the evening.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
The standard lipid panel consists of four different numbers – total cholesterol, LDL, HDL, and triglycerides. LDL and HDL refer to ‘low density lipoprotein’ and ‘high density lipoprotein’ respectively. LDL and HDL are the carrier proteins for cholesterol in the body and help to make sure the fat from our diets ends up in the cells needing the energy. Triglycerides are fat molecules circulating in the bloodstream. When triglycerides in the bloodstream are abnormally elevated due to poor diet, obesity, or type 2 diabetes, there is more deposition of fat in the tissues leading to weight gain. Total cholesterol is the sum of LDL, HDL and 20% of your triglyceride level. Looking at the values of these different numbers can give valuable clues into heart disease risk and overall metabolic health.
When assessing a lipid panel, I like to use the numbers offered by functional medicine practitioner, Dr. Catherine Shanahan, M.D. in her excellent book, Deep Nutrition: Why Your Genes Need Traditional Foods. She suggests the following optimal lab values for the standard lipid panel:
-Triglycerides less than 150.
-HDL greater than 45 in men and greater than 50 in women.
-LDL: HDL ratio less than 3 to 1.
A high total cholesterol is not concerning if the ratio of LDL to HDL is maintained below 3. Likewise, a high LDL number does not necessarily indicate an increased risk of heart disease if the ratio is maintained. It’s important to remember the gold standard test to determine the health of your lipid cycle is the LDL particle size count. The test assesses for damage to LDL particles – a damaged LDL particle is a smaller one. Damaged LDL particles are more likely to cause inflammatory reactions in the arterial walls leading to plaque formation and atherosclerosis. The LDL particle size count is rarely ordered by physicians due to the cost, however it remains the best test for assessing heart disease risk.
Many physicians put their patients on a class of drugs called a statin which decreases the body’s natural production of cholesterol, especially the type of cholesterol bound to LDL particles. The problem with this is cholesterol is an important building block for many cells in the body including our steroid hormones which include testosterone, estrogen, and cortisol among others. Additionally, the brain contains the highest amount of cholesterol on the body, meaning lowering cholesterol with a statin drug may impair brain function and induce cognitive decline. Statins come with a host of side effects including muscle aches and pains, altered liver enzymes due to liver damage, and increased risk of developing type 2 diabetes. This is why it is so important to match your most recent lipid panel up with the numbers I give above before agreeing to start taking a statin drug. In future posts I will explain some of the diet and lifestyle factors you can adopt to help normalize the levels in your lipid panel without having to take a statin drug.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Sleep is the most important cornerstone for optimal health. Without the foundation of a healthy night of sleep, all other health interventions, such as nutrition and exercise, will fall short. Our memory, cognition, and ability to learn new tasks all depend on healthy sleep. ‘Sleep hygiene’ refers to the quality and quantity of sleep you are getting each night. I recommend my patients get 7 to 9 hours of sleep each night, depending on activity level, as well as season. During the winter months, you should opt for close to 9 hours of sleep. During the summer months, 7 hours of sleep may be adequate since days are longer and the nights are shorter. Additionally, more sleep is needed the more active you are as it is important to allow your body adequate time to recover after difficult workouts. When helping patients improve their sleep hygiene, there are three interventions I use most frequently, outlined below.
First morning sunshine
Going outside first thing in the morning with as much skin exposed as possible stimulates the body’s release of the hormone cortisol. Cortisol is known as our ‘awake hormone’ and gives us the energy to start our day. Cortisol naturally starts to decline around lunch time, and by the evening levels should be low as it starts to get dark and we prepare for sleep. Cortisol becomes problematic when levels remain high in the afternoon. When cortisol levels remain elevated, it becomes a stress hormone and causes us to crave sugary and fatty foods. Additionally, high levels of our ‘awake hormone’ in the evening work against us falling and staying asleep. The best way to ensure cortisol levels are low in the evening is to secrete as much as possible in the morning. Sunshine stimulates cortisol secretion, meaning it is optimal to get plenty of sunshine in the first half of the day.
Turn off electronics at least 90 minutes before bed
Blue light exposure tricks your brain into thinking it is still light outside, decreasing the release of your sleep hormone, melatonin. I recommend turning off all electronics 90 minutes before bedtime. Not only does blue light manipulate our brain into thinking it’s light outside, but often the things we are looking at on our screens, such as social media feeds or work emails, stimulate our brain in a way making sleep difficult. Scrolling through your social media feed causes a release of the neurotransmitter, dopamine, which plays a role in the brain’s reward system. When dopamine is released, the brain is stimulated and there are feelings of pleasure. While satisfying at the moment, excessive release of dopamine prior to sleeping will make it harder to fall asleep and stay asleep. Therefore, put those phones away before bed time!
Read fiction before bed
Reading before bed is one of the best ways to prepare our brains for sleep. Giving the brain a singular point of focus, such as a captivating fictional story, will allow you to stop thinking about the stresses of work and life and prepare your brain for sleep. With this in mind, reading materials related to work or checking emails will continue to stimulate our minds and keep us thinking about the day. Consequently, I recommend reading fiction. It is a better way to take your mind away from the pressures of the day. If you are a fan of historical fiction like myself, check out Ken Follet’s new novel, Pillars of the Earth.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Many people experience popping in their hips. Most patients come to the clinic complaining of back or knee pain, and a popping hip may be a secondary complaint. Although typically not a significant pain generator, popping in the hip is a sign of an underlying dysfunction in the hip needing to be addressed. If the popping in the hip is not attended to, more serious orthopedic issues may arise down the road.
There are three main causes of a popping hip – external, internal, and intra-articular. External is most frequent and refers to the iliotibial (IT) band snapping over the greater trochanter of the femur. Internal is also common and refers to the iliopsoas (hip flexor) tendon snapping over a bony prominence on the pelvis or at the lesser trochanter of the femur. Intra-articular is least common and refers to a floating loose body within the joint such as a torn labrum. External and internal variations are often due to gradual onset, whereas an intra-articular loose body is often due to trauma. There is a higher incidence of hip popping in females, especially those who perform sports requiring repetitive flexion and extension of the hip such as gymnastics, dance, soccer, and running.
How to fix it
Popping in the hip is often related to a stability issue in the hip or the core. To address this, work to improve your hip stability in all three planes of motion. Train slowly, controlling the motion to avoid the pop. Train only through ranges of motion where you can avoid the pop, and gradually increase the range of motion as your stability improves. The external hip pop (ITB over greater trochanter) is often related to poor hip stability in the frontal plane (abduction/adduction), and increasing strength of muscles such as the gluteus medius will be helpful in decreasing the external hip pop. The internal hip pop relates to the iliopsoas muscle. The iliopsoas muscle has shared attachments with the diaphragm. If the diaphragm is not providing a solid anchor point for the iliopsoas muscle, function of the hip flexor will be impaired increasing the likelihood of an internal hip pop. For this, focus working on diaphragmatic breathing to create better stability patterns in your core. Intra-articular hip popping requires an in-depth examination to determine which structures may be injured and to determine the best course of care.
To know exactly which exercises and treatments are best for you, it is important to seek out a therapist who understands hip biomechanics and can help you address the specific stability limitations causing the pop. Whatever the cause, popping in the hip should not be ignored. Even if caused by mild muscle imbalance, a popping hip can worsen over time if not addressed early.
Post written by Dr. Riley Kulm. Check out his bio here.
Goal setting has been touted as the most effective way to achieve success in life. We’ve been told to write them down, stick them to our refrigerator door and even to write them on our bathroom mirror. You’ve heard that goals should be SMART – specific, measurable, attainable, realistic, and time oriented. I even wrote a blog post on effective goal setting. Recently, I’ve moved away from goal setting with both myself and my patients, focusing instead on daily habit formation and the implementation of routines that set you up for success now and in the future. The inspiration for this change came after listening to the Atomic Habits audiobook by James Clear. Clear argues that goals are easily procrastinated upon, and can often be too daunting to even get started in the right direction. By focusing on daily habits and routines, you will improve yourself each day, setting yourself up to achieve success and ultimately to conquer even the loftiest of goals.
The problem with goal setting
One of the main problems I see with goal setting is that time oriented goals are susceptible to procrastination. If my goal is to lose 20 lbs. by the end of the year, it’s very easy to let myself wait until 6 or even 3 months are left in the year to start working towards the goal. Why start now when I have an entire year to accomplish my goal? A goal that is set out over a year may lose steam after a couple of months, which is what I commonly see with patients looking to make health changes at the beginning of the New Year. Everyone knows that you will see more people out walking in your neighborhood or exercising at the gym in January, February and March only for it to taper off as the year progresses. Rather than setting a time oriented goal, instead pick daily habits that will incrementally help you achieve whatever you envision for yourself.
Define your ideal self
Before completely throwing away your list of goals, make sure you have a clear idea in your mind of what you want for yourself. Envision your ideal job, body composition, and skill set. Where do you see yourself in 5 or 10 years? Where do you want to be financially? How do you define your ideal self? Once you’ve established these parameters, you are better suited to implementing daily habits that align with this vision. If you envision yourself as having a fit and healthy body, implementing a daily habit that helps you save money or be more organized doesn’t necessarily bring you closer to your vision. Instead, for weight loss, pick habits such as a consistent gym routine, a healthy breakfast at the same time each morning, or reading a book before bed to help promote optimal sleep and recovery.
Do this instead
As stated previously, the alternative to goal setting is the implementation of daily habits and routines. Habit formation is beneficial because it focuses on daily growth. If we aim to grow and improve ourselves little by little each day, the culmination of consistent work will be incredible in the long term. We may not notice the improvements on a day to day, micro level, however, if we step back after a year and look at the macro improvement the results are substantial. True growth and change does not come with drastic lifestyle changes such as an extreme 10 day fast or juice cleanse but rather with small steps each day in the right direction.
Next, I show you how to reframe your goals into daily habit formation.
Goal #1: ‘I want to lose 20 lbs. before summer’
Habit: I will work to implement a habit where I do 3 sets x 15 push-ups in the morning followed by drinking a 16 ounce glass of water.
Habit: Weather permitting, I will go outside in the morning for a 10 minute walk in the sunshine before work.
(First morning exercise and sunshine stimulates cortisol release and helps to regulate our circadian rhythm. Sufficient cortisol release in the AM will decrease cravings for fried and sugary foods in the evening which occurs if cortisol levels remain high.)
Habit: I will place a pan, plate, and eating utensils out in my kitchen before I go to bed each night. Already having the pan on the stove increases the likelihood that I will cook a homemade breakfast and adopt a more consistent eating schedule that includes breakfast each day.
Goal #2: ‘I want to increase my sales at work by 15% this year’
Habit: I will wake up at the same time every day to ensure a consistent sleep schedule and to increase my productivity at work.
Habit: I will call 2 potential new clients each day prior to leaving for lunch.
Habit: I will send a thank you card to 2 existing clients each week thanking them for their business.
For work related goals, consider setting up a daily, weekly, and monthly checklist in a binder or whiteboard to track progress of tasks to be completed. Make these tasks part of your habits at work and you will see your productivity increase.
Goal #3: ‘I want to improve my relationship with my parents’
Habit: Each morning I will practice gratitude by writing down 3 things in my life that I am grateful as part of a journaling routine.
Habit: I will call one of my parents every Friday after work to check in.
Goal #4: ‘I want to be more organized’
Habit: Each morning I will make my bed as the first task to be completed in my day. Making your bed each morning sets yourself up for success throughout the rest of your day and helps you to establish a task completion mindset.
Habit: Each morning when my coffee is brewing I will take 5 minutes to tidy up my living room so I leave for work with an organized living space.
Goal #5: ‘I want to get better sleep this year’
Habit: I will develop a habit where I turn off all electronics at least 1 hour before bed time. Blue light exposure stimulates cortisol release at the wrong time of day and will make falling and staying asleep more difficult.
Habit: Prior to going to bed I will write out tomorrow’s ‘To Do’ list in a journal that I keep by my night stand. Getting tomorrow’s tasks written down will give you peace of mind and allow your brain to turn off before going to sleep.
Habit: I will read for 20 minutes before bed. Reading, especially fiction, gives your brain a singular point of focus, and helps you get your mind off of the day’s stresses.
I hope this article gives you valuable insight into daily habit formation and the power it can have. I finish with a quote from W.H. Auden – ‘Routine, in an intelligent man (or woman), is a sign of ambition.’
Post written by Dr. Riley Kulm, DC. Check out his bio here.