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.
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.
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.
My Least Favorite Exercise Part 2 – The Quadricep Knee Extension
Continuing with the theme of our last blog post My Least Favorite Exercise – The Clamshell, I’d like to highlight another popular exercise that should be avoided at all costs. This week, my least favorite exercise is the quadricep knee extension exercise. I regularly see people at the gym using the quadricep knee extension machine, and I truly worry about their orthopedic health when I’m watching them. To perform the machine based knee extension exercise, people sit in a chair with a pad on their shins. Next, they kick their legs straight against the resistance of the machine, contracting the quadriceps muscle. People perform this exercise because they want to improve the strength and size of their quadriceps muscle – some may even think it’s healthy for their knees; however, the biomechanical consequences of this exercise can be highly detrimental to the health of your knees.
Open vs. closed chain exercises
The machine based knee extension is a single joint, open chain exercise. Open chain exercises refer to movements where the distal extremity (hand or foot) is not fixed and is freely moving in space with or without external resistance. Examples of open chain exercises include a bicep curl, hamstring leg curl, and shoulder fly. Open chain exercises cause an isolated muscle contraction over a single joint of movement, which some believe to be beneficial in the early stages of an injury rehabilitation program. Open chain exercises are in contrast to ‘closed chain exercises’ where the hand or foot is fixed to the floor. Examples of closed chain exercises include the squat, deadlift, or push up. Closed chain exercises involve multiple muscle groups and require coordinated muscle contractions to complete the compound (multi-joint) movement.
The forces imparted on the joints differ between open and closed chain exercises. For open chain exercises (quadricep knee extension) the force imparted by the weighted resistance is transmitted back up the leg and into the knee joint. This force can cause compression in the knee joint, putting increased pressure on the meniscus, ACL, PCL, and patella-femoral joint. In contrast, with closed chain exercises (deadlift) the force imparted by the external resistance is transmitted into the ground. For instance, in a deadlift, the force from the load is pressed through the feet into the ground rather than up the body into the knees and hips.
The second problem with the exercise is that it is a repetitive concentric exercise. Remember from my last post, concentric muscle contractions occur when the muscle is shortening and repetitive contractions over time can cause a shortening and tightening of the muscle fibers even while at rest. Ignoring the eccentric (muscle lengthening) component of a muscle’s function can be detrimental to movement patterns and ultimately put you at an increased risk of injury. Additionally, a short and tight quadriceps muscle can pull upwards on the patella, altering the mechanics of the patella-femoral joint and cause conditions such as patellar tendinitis which is also known as Jumper’s knee.
What to do instead – deadlifts, squats, single leg squats, reverse lunges
If you want to strengthen your quads and the rest of the muscles in your leg, the best exercises are closed chain, compound movements that integrate the feet, hips, and core to create a functional and stable lower body. My favorites are deadlifts and lunges because you can add a lot of weight without placing much force on the knee joint (when performed properly).
As I said previously, closed chain exercises like the squat and lunge transmit force down into the ground, which is why they are popular for building speed and explosiveness in strength and conditioning programs.
Post written by Dr. Riley Kulm, DC.
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
With the recent passing of Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020), the cost of using tobacco products in the state of Colorado is higher than ever. For smokers in Colorado, the estimated increase in taxes will be $222 in the state budget year 2021-22, increasing to $291 by state budget year 2027-28¹. The minimum price for a pack of cigarettes will be $7 in 2021, and will increase to $7.50 by 2024². Tobacco products will see the current 40% tax rate increase to 62% by 2027, and the new nicotine tax aimed at e-cigarettes will be applied at 30% starting in 2021 and go up to 56% starting in July 2024. These taxes are mainly incurred on Coloradans in lower income brackets. Of the 14 percent of Coloradans who use tobacco products, 80% of those individuals make less than $40,000 per year. Financial incentives aside, smoking is the leading cause of preventable death in the US, accounting for 1 out of every 5 deaths in the US each year or 480,000 deaths³. For context, the covid-19 pandemic has taken the lives of 269,763 Americans in approximately the last year⁴, many of whom were significantly immunocompromised and suffering from two or more comorbidities. These statistics beg an important question – why is smoking cessation not a greater public health concern?
Why you should quit smoking
Smoking is strongly linked to chronic diseases such as cancer, heart disease, and stroke. Smoking damages your hair, skin, and nails leading to premature aging on the inside and out. Smoking eats away at the cartilaginous cushioning between our joints and promotes arthritis and joint pain. Smoking promotes a chronic chest and neck dominant breathing pattern leading to headaches and muscle tightness in the upper shoulders and neck. Second hand smoke exposure can create these problems for family members and friends.
The detrimental effects of smoking are related to oxidative stress, which occurs when the delicate balance between pro-oxidant and antioxidant systems in our bodies can no longer be maintained. Regular smoking increases the amount of reactive oxygen species (free radicals) in the body, overwhelming the antioxidant defense systems in the body. Free radicals are circulating molecules that have an unpaired electron. In an attempt to bind the unpaired electron, free radicals steal electrons from normal, healthy cells in the body and alter their structure and function. Damaged cells do not function properly and are flagged by the immune system for destruction resulting in widespread inflammation. Damaged cells can also become cancerous as normal cell replication processes are disrupted. The cell walls of our arteries and veins are damaged by smoking, increasing the likelihood of artheroscletoric plaque formation and subsequent heart disease and stroke. The good news? Your body starts healing within one day of quitting smoking.
How does acupuncture help you stop smoking?
Acupuncture helps you quit smoking by decreasing the mental and physical stress involved with quitting, as well as helping to diminish cravings. The most powerful detox points for alcohol abuse, drug addiction, and nicotine are located on the ear. The treatment of these areas is referred to as auricular acupuncture, and the protocol I use is based on the National Acupuncture Detoxification Association (NADA) nicotine cessation protocol. I also incorporate specific body points which help improve blood flow, decrease stress, and increase the likelihood of successfully quitting. Additionally, we use semi permanent acupuncture needles (seeds) which are implanted into the ear like a small piercing and stay there for 3-5 days providing constant stimulation of the acupuncture point. I use seeds at the designated nicotine point which is located on the lower tragus and can be manually stimulated by the patient when a craving is felt.
Combining acupuncture with patient education seems to be more effective than acupuncture or education alone⁵. I encourage my patients to adopt some of the strategies found on state sponsored quitting websites, like Colorado QuitLine. Beneficial strategies I’ve used with patients include telling loved ones when and why you are going to quit, making a list of all of the items or experiences you can buy with the money normally spent on tobacco, disposing of all tobacco or tobacco related products at the house or in the car, setting a strict quit date instead of trying to slowly wean yourself off, and to write out a daily health journal to track improvements in energy, mood, and pain levels.
I recently treated a patient at the clinic for smoking cessation. For this case study, we will refer to the patient as Laura. Laura is a middle aged female who has been a pack a day smoker for 20 years. She was spending upwards of $1,000 per month on tobacco products. Laura came to me wanting more than anything to quit smoking. She had tried everything from nicorette to patches, and had even tried hypnosis. However, nothing seemed to work and the nicorette made her nauseous. She was open to the idea of acupuncture because it had been a helpful treatment for a low back injury I was seeing her for. We settled on a treatment plan of 8, 30 minute visits over a 4 week period. Laura set her quit date in conjunction with her first day of acupuncture.
Within a week, the immediate improvements in her health were palpable. Her skin was clearer and was less red and inflamed. Her stiff and leathery muscles felt relaxed and pliable. Her breathing was slower, deeper, and less labored. She seemed less stressed, and had a calm nature about her. The acupuncture helped her deal with the day to day stress of quitting, and also mitigated cravings and withdrawal symptoms. On top of this, the chronic low back pain she was experiencing dramatically improved as her body’s internal healing mechanisms were better allowed to do their job. Overall, her transformation was inspirational. It motivated me to want to help more people struggling with nicotine addiction create lasting change in their lives. I’m happy to report it is now 3 months since her quit date and she has not had a cigarette since.
If you or someone you know smokes and wants to quit but doesn’t know where to start, please direct them to this article or me personally. It would be a privilege to assist you or a loved one quit for good and to help you realize the immense financial and health benefits of quitting today.
Post Written by Dr. Riley Kulm, DC. Check out his bio here.
Sources and References
- Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020)
- Proposition EE: Taxes On Nicotine Products, Explained
- Centers for Disease Control and Prevention, Current Cigarette Smoking Among Adults in the United States.
- CDC COVID Data Tracker
- Auricular Acupuncture, Education, and Smoking Cessation: A Randomized, Sham-Controlled Trial