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.
For years it was thought the cause of indigestion, stomach ulcers, and gastric reflux was the presence of too much acid in the stomach. However, research shows the cause of these issues is actually too little stomach acid. Stomach acid, or hydrochloric acid (HCL), is necessary to ensure the proper digestion of your food, protect you from pathogenic bacteria, and prevent the backflow of food into your esophagus and throat. If our stomach is not acidic enough, our gastro-esophageal sphincter will not close and we can get back flow of acid into our throat (esophagus) which causes heartburn (gerd). Without adequate stomach acid, vitamins and minerals such as calcium, magnesium, iron, and vitamin B12, are not fully absorbed into the body. For example, if you are supplementing with calcium and magnesium in an effort to improve the strength of your bones but do not have enough stomach acid, the supplements will not be effective.
To determine whether you have adequate stomach acid, your doctor will have you perform one of the two tests below:
- First thing in the morning, before eating or drinking anything, mix ¼ tsp baking soda in 4 to 6 ounces of cold water. Drink the baking soda solution and set a timer for 5 minutes. Record and note the time anything happens over the next five minutes and bring the results to your doctor at your next visit.
- The betaine HCL test requires some trial and error, but you will finish the test with an exact dosage for how much HCL you need supplementally. For this test you will start by taking one betaine HCL pill right before eat. If you do not feel a “burn”, you will then take two pills right before your next meal. You will continue to up the pills one by one for each meal until you feel a burning sensation. Once you feel a burn, you will take one pill off and this will become your dosage. Once you begin to feel a burn at this dosage, you will again drop by one pill. This is not a long-term solution for lack of stomach acid, but it is a good way to kick start your digestion. It will also aid in vitamin and mineral adsorption so you have the energy and motivation to improve stomach acid naturally through weight-bearing exercise, improved posture, and stress management strategies. When dosing the supplement if you have an uncomfortable burn you can drink some baking soda in water to neutralize the acid. Make sure to lower the dosage at the next meal.
If your doctor determines your stomach acid levels are too low, here are some natural ways to boost HCL production in the stomach and ensure healthier digestion:
- Consume apple cider vinegar. Put ½ tablespoon up to 2 tablespoons in 8-12 ounces of water. Drink this solution first thing in the morning and before bed. If apple cider vinegar makes you nauseous, start with ½ tbsp and slowly build up to 2 tbsp.
- If you don’t struggle with heartburn add fresh squeezed lemon or lime juice to your water and drink throughout the day.
- Eat grapefruit and fermented foods (sauerkraut, kombucha, pickled foods (pickled beets, etc) to help stimulate HCL production. Eat pineapple and papaya to increase digestive enzymes.
- Use vinegars (red wine, white wine, balsamic, etc.) as a salad dressing or marinade.
- Drink celery or cabbage juice.
- Chew on celery, pumpkin seeds, or beeswax throughout the day. In addition to stimulating HCL production, this will also help heal your stomach lining, and boost metabolism for fat loss.
- Mindfully chew your food. The physical act of chewing will stimulate HCL production and help digest your food via adequate release of salivary enzymes triggered in the mouth by chewing.
- Limit fluid intake with meals as it dilutes your stomach acid. Drink your fluids in between meals.
- ONE glass of wine with a meal can help add some acidity to your stomach to aid with digestion
- To improve digestion after meals limit sitting and laying down, go for light walks, perform light chores, stand, etc.
Finally, make sure you are in a calm and relaxed state before eating your meals. When you are in a stressed state (sympathetics), your body does not produce stomach acid or digest your food. Take 4 deep, slow breaths prior to eating, reflecting on how lucky you are to have an abundance of healthy food to fuel your body. Gratitude is excellent for your brain and digestive health!
If you have sensitivities or allergies to any of the suggested foods on the list please continue to avoid them and consume the ones you can tolerate. Food allergies and sensitivities start because of increased sympathetics and therefore decreased stomach acid. As we repair your gut, increase stomach acid, and decrease sympathetics you will begin to tolerate foods you couldn’t tolerate prior.
If you struggle with heartburn (GERD) it is best to avoid citrus, caffeine, alcohol, spicy foods, peppermint, and eating after 7pm as we repair your stomach. These foods and activities can cause relaxation of your stomach valve which can cause regurgitation of acid into your throat/chest.
Post Written by Dr. Riley Kulm, DC, and Dr. Ryan Dunn, DC.
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.
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.
After a car accident your ‘to do list’ may be long – get your car fixed, find an attorney, file a claim with your insurance agent, find a rental car to get to and from work, etc. For most, the damages to your body are less of a concern in the initial stages following an accident. Unfortunately, many do not know where and how to find treatment for their injuries. Without the guidance of someone who understands the system, it’s possible to get taken advantage of as there are extensive legal businesses built around profiting from MVAs. In this post I’ll describe some of the most common injuries sustained during MVAs, as well as give you insight into the medico-legal process and how to make sure you get the care you deserve.
Opt into MedPay
In Colorado it is state law every insurance company provides their drivers with a minimum $5,000 Medical Payments Coverage (MedPay) policy in addition to their automobile liability policy¹. MedPay should be included on any insurance policy by default and is against state law for an insurance company to deny a customer MedPay. The $5,000 policy provides coverage for the driver, as well as the passengers in the insured driver’s car, regardless of which party is at fault. MedPay even covers you when you’re in a car that isn’t your own. Unlike other medical insurance, MedPay never carries a deductible or co-pay in the policy and is available immediately following the accident². Colorado MedPay covers payments related to bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of the motor vehicle. Colorado MedPay can be used to cover accident related expenses such as emergency or trauma care, ambulance rides, emergency room care, imaging services (X-rays, CT scans, or MRI’s), and conservative care treatments from chiropractors, massage therapists, and physical therapists.
Despite being mandated by Colorado state law, some insurance companies find ways to avoid providing their customers with the required $5,000 MedPay coverage. I’ve had numerous patients tell me they unknowingly opted out of their MedPay coverage before being told what the payment meant or included. Insurance companies in Colorado are required to include MedPay by default into any new policy, however, if you’ve opted out in the past, the insurance company is not required to remind you of MedPay or to ask if you want to opt in. If you use MedPay for an accident where you were not at fault your insurance company cannot raise your premium following the accident. I highly recommend calling your insurance agent today and making sure you have not opted out of MedPay. MedPay should be of little or no extra cost to your policy, and will provide you with much needed, immediately available funds following an accident.
Common injury patterns with MVAs
The injuries sustained in even minor MVAs can be severe. Many patients I’ve treated for a MVA report little to no pain the day of the accident, with symptoms hitting them hard the following morning. The shock involved with being in an accident is one explanation for the latency of symptoms, and oftentimes the brain is focused less on pain in the body and more on the financial and legal implications of the accident. Pain typically starts in the spine, with symptoms radiating down the extremities as the full effects of the injury are realized. I recommend waiting 2-3 days following a MVA to receive treatment. Waiting will ensure the treating physician gets the full picture of your injuries and can determine the appropriate treatment approach.
The most common type of injury sustained during a MVA is a whiplash type injury. Whiplash involves a sudden acceleration – deceleration force on the spine and muscles. Cervical acceleration – deceleration injuries are very common in MVAs and the whiplash injury causes tearing of muscle and ligament fibers. The muscles damaged in a cervical acceleration – deceleration injury are typically the cervical deep neck flexors which include the longus colli, longus capitis, and also the sternocleidomastoid. These muscles are extremely important for normal biomechanical function of the cervical spine. Weakness and inhibition of these muscles due to injury can lead to instability in the cervical spine and poor healing outcomes. Exercises targeting the function of these muscles are critical following a MVA and the guidance of a trained therapist is recommended to determine which exercises will be most beneficial.
Concussions are another possibility after a MVA and are most often associated with a blunt force trauma to the head against the steering wheel, dash, side window, or even an airbag. If the patient lost consciousness due to head trauma and post concussive symptoms are severe, a CT is recommended to rule out a more serious pathology such as an internal hemorrhage inside the brain. Any concussion, no matter how severe, deserves attention. Less severe cases warrant a neurologic examination by a trained therapist to assess for damage to the brain, spinal cord, or peripheral nerves. Some of the assessments used include a cranial nerve examination, ocular examination, and a high index neurologic exam that includes skin sensation, muscle testing, and deep tendon reflexes. The patient should also be taken through a verbal Sport Concussion Assessment Tool (SCAT 5) which helps determine severity of concussion and also to track treatment progress. Treatment of concussions often requires a nutritional component and an anti-inflammatory diet free of refined sugar and highly processed vegetable oils. High dose EPA/DHA from fish oil and vitamin D is also recommended to help heal brain tissue. Finally, our clinic uses a class 2 therapeutic infrared laser that can safely penetrate the skull and help to heal brain tissue via mitochondrial upregulation.
How long will it take to get better?
Tissue healing times are different for every patient and depend on age, injury history, genetics, nutrition, and lifestyle status. The severity of the accident and associated discrepancies in physical forces placed on the body are also a factor. As a general rule, the below gives the healing times for different tissue in the body which may be injured in a MVA³:
Muscle Strain (Grade 1): 0-2 wk
Muscle Strain (Grade 2): 4d-3mo
Muscle Strain (Grade 3): 3wk-6mo
Ligament Sprain (Grade 1): 0-3d
Ligament Sprain (Grade 2): 3wk-6mo
Ligament Sprain (Grade 3): 5wk-1yr
Many insurance companies try to fit every client into the same recovery timeline which is not realistic. If you are still in pain and someone handling your case says you need to be finished with care, advocate for yourself and demand the care you need.
At our clinic we use passive therapies such as acupuncture/dry needling, active release technique, therapeutic laser, cupping, and instrument assisted soft tissue manipulation among others to help you heal faster. We also use a wide variety of physical rehabilitation exercises to treat the specific deficits caused by the MVA. The focus of care after a MVA is to build strength, stability, and resilience in the cervical and lumbar spine and other body regions affected by the accident. Our goal is to make the patient stronger and more functional than they were before the accident.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Sources and References
The recent snowstorms in Denver are a reminder ski season is right around the corner. Skiing is an incredibly demanding sport requiring high levels of fitness and athleticism. As with any athletic endeavor, it is important to prepare your body for the forces and demands of the sport. A skier must have strong legs and hips so they can turn sharply on their edges, brace for impacts, and hike at high altitudes to reach the best terrain. Off season preparation drastically decreases your risk of injury and subsequent time away from the mountain, and is an integral part of every successful athlete’s program. I will provide 5 simple exercises you can do from home which will prepare your body to hit the slopes come winter.
The SAID Principle
Well accepted in the strength and conditioning world, the SAID Principle (Specific Adaptation to Imposed Demands) states training should be specific to the type of sport the athlete is preparing for. The intensity, volume, and duration of training should be tailored to the specific sport. Skiing requires a diverse mix of strength, balance, and endurance that is unparalleled in other sports. The athlete must be strong enough to dig their edges into the snow at high speeds, have the endurance to hike at altitudes above 10,000 feet, and have the balance and stability to correct body position when uneven surfaces are encountered or landing from a jump. The skier must build strong quads, hamstrings, and glutes to effectively and safely navigate the mountain. The program I outline below addresses each of these muscle groups with functional exercises specific to skiing.
Off-Season Ski Workout – perform the following sequence of exercises for 3 rounds.
Body Weight Reverse Lunge – 3 sets x 20 reps (10 each leg)
Body Weight Squat – 3 sets x 10 reps
Rear Foot Elevated Split Squat – 3 sets x 10 reps
Wall-Sit – 3 sets x 45 second hold
DNS 7 Month Side Lying Hip Get Up – 3 sets x 10 reps
I recommend performing this exercise routine 3-4 times per week. You can increase the number of rounds as you gain strength and endurance and as ski season gets closer.
Post written by Dr. Riley Kulm, DC. Check out his bio here.