The most common hip exercise I see prescribed to patients for hip pain is the ‘clamshell’. The clamshell exercise, shown in the picture below, is commonly used to increase the strength of the gluteus medius muscle with the goal of improving hip stability. The clamshell is prescribed for conditions such as hip impingement, low back pain, or knee pain, and is commonly used to strengthen the glutes during post surgical knee rehabilitation programs. While the clamshell targets the gluteus medius muscle, one of our main stabilizers of the hip, there are functional limitations to the exercise which can cause adverse effects on a patient’s movement patterns and overall function of the lower extremity.
The issue with the clamshell exercise is it is a repetitive concentric exercise. A band is used around the knees to create resistance of the top leg moving into abduction (leg moves away from body). The gluteus medius is a primary hip abductor, and is thus contracted when the patient separates the top knee away from the bottom against the band’s resistance. A ‘concentric’ muscle contraction refers to a contraction where the muscle shortens as it contracts. This is in contrast to an ‘isometric’ contraction where muscle length does not change during contraction, and also an ‘eccentric’ contraction where the muscle contracts while lengthening. The problem with only training the concentric phase of muscle contraction is over time the muscle fibers will become short and tight. Remember, muscle fibers are shortening during a concentric contraction, and doing so repeatedly will cause a gradual tightening of the muscle. A short and tight muscle often equals a weak muscle and weakness in the gluteus medius muscle puts your low back, hips, and knees at risk for injury. Muscle function should be a coordinated blend of isometric, concentric, and eccentric contraction to maintain proper muscle function and physiology.
To determine if you have a short and tight gluteus medius not functioning properly, look for a ‘gluteal hollow’ – a concavity easily visualized on the outside portion of the glute complex. While some believe hollow hips to be aesthetic, they indicate poor function and stability of the hip. Ideally, the glute complex should be full and round with no hollowing. Notice the hollowing in the hips of the bodybuilder below. The athlete is overdeveloped in the gluteus maximus muscle and underdeveloped in the gluteus medius and gluteus minimus muscle. Despite having an impressive muscular build, the function and stability of this athlete’s hips are suspect. Contrast the bodybuilder’s hips with the athlete on the right. The football player on the right has a round and full shape throughout the entirety of the glute with little to no hollowing in the outer aspect of the hip. The football player has strong and stable hips in all planes of motion allowing him to jump, change direction, and accelerate effectively.
What to do instead – the DNS 7 month hip lift exercise
If your goal is to strengthen the gluteus medius muscle and improve hip stability in all planes of motion, the Dynamic Neuromuscular Stabilization (DNS) 7 month hip exercise is your go to movement. The DNS 7 month hip exercise linked here, is a movement pattern based on the 7 month developmental pattern as outlined by the Prague School of Rehabilitation. The 7 month hip lift is a transitional movement from a side sitting position into a quadruped position, and it incorporates all 3 phases of muscle contraction for the gluteus medius muscle.
To perform, lay on one side with your hip flexed to just below 90 degrees. Initiate the movement by rotating your pelvis forward on top of the bottom leg. Doing so will lengthen the gluteus medius on the bottom side and you may even feel a stretch in the hip. Once the pelvis is fully closed down on top of the bottom leg, load weight into the bottom knee and use your strength to lift your hip off of the ground. You should feel the muscle contract on the outer portion of the bottom hip (gluteus medius). Hold at the top for 2-3 seconds and then slowly lower down to the ground. Focus on slow and controlled raising and lowering of the hip, which forces your body to coordinate isometric, concentric and eccentric contractions – closely replicating the demands placed on the gluteus medius muscle during sport and everyday life. Start with 3 sets of 6 reps for this exercise. Expect to be sore in the outer hip as this exercise is challenging and forces the gluteus medius to function in ways it may not have for a while.
Post written by Dr. Riley Kulm, DC.
Check out his bio here.
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.
Core Exercises – Do’s and Don’ts
Many patients understand they need to strengthen their core in order to live functional and pain free lives. However, most do not know where to start. The popular opinion is exercises such as sit-ups, crunches, bicycle crunches, and Russian twists are the primary exercises to improve core strength. Unfortunately, these commonly performed exercises are not the best choice when looking to add strength and functionality to your core.
The Problem with Sit-ups and Crunches
Sit-ups and crunches are perhaps the most regularly performed core exercises. These exercises are effective at increasing the tone of the six-pack or rectus abdominis muscle group. While great for aesthetics, a tight and toned six-pack is not essential for a functional core and may even be detrimental. The issue with sit-ups and crunches are the forces placed on the spine during these exercises. Both involve repetitive flexion of the lumbar spine and most of modern society already gets too much ‘lumbar flexion.’ Lumbar flexion means rounding forward of the low back. The low back is in flexion when we are sitting in our car, at work, or on the toilet. The low back is flexed when we pick items up from the floor with improper form. The net result of so much lumbar flexion is placing undue stress on the discs, muscles, ligaments, and nerves of the low back. Sit-ups and crunches involve repetitive flexion of the low back and thus add fuel to the ‘flexion fire’ we get all throughout the day.
The Problem with Rotational Core Exercises and Stretching
The Russian twist and bicycle crunches are other commonly performed core exercises that are not ideal for the function of the core or spine. The Russian twist is performed by balancing on your pelvis with legs suspended in the air and knees bent while the upper body is held at roughly a 45 degree angle. Next, the athlete uses their hands or a medicine ball to twist back and forth in an attempt to work the abdominal obliques. Bicycle crunches are similar except the individual is on their back and the rotational crunch is combined with a straightening of the opposite leg and hip. The first problem with the Russian twist is it is extremely difficult to keep the spine in a neutral position and many individuals round their backs due to a lack of core strength and balance. Once again, many people are developing a detrimental position of lumbar flexion during this exercise.
Another issue with the Russian twist and bicycle crunch is the forced rotational load it places on the spine. Functional movement specialists now agree the main purpose of the core is to resist forces placed against the spine rather than actually creating movement. The lumbar spine only rotates 2-3 degrees per segment and thus requires more stability in the rotational (transverse) plane compared to mobility. I’ll explain exercises such as the Pallof Press and Cross Press in a future blog post, as both are excellent exercises for improving core stability in the rotational plane.
Basics of Effectively Performing a Core Exercise
Before we get into the specific exercises I teach my patients, I’ll explain why form is important for any core exercise you perform. First, the spine needs to be in a neutral position. A neutral spine may look different for each person, but the spine should be straight and may have a slight extension curvature. Extension is the opposite of a flexed and rounded position of the spine. The two variables that affect proper neutral spine positioning are your rib positioning and your pelvic posture. Many patients have what is called ‘flared ribs’. This means your ribs are protruding upwards and forwards and may even be visible. When the ribs are in this position the diaphragm muscle cannot function properly and core strength will suffer. Use an exhale breath to push your ribs downwards towards the floor to place them in a more ideal position.
Secondly, you need to be aware of the position of your pelvis. Think about your pelvis as a fish bowl filled with water. If you have what we call an ‘anterior pelvic tilt’ your pelvis is dumped forward and water will be spilling out of the metaphorical fish bowl. Less commonly, patients may adopt a ‘posterior pelvic tilt’ where the water will be spilling backwards. Both of these pelvic postures are detrimental to neutral spine positioning, as well as core strength. Always think about keeping your pelvis tucked under you so water cannot spill out of the fish bowl. By making sure your ribs and pelvis work together to maintain a neutral spine, you will safely perform core exercises.
Practice these Core Exercises:
3 Position Plank
The 3 position plank is a sequential exercise involving a front plank, right side plank, and left side plank. Each position is held for 10 seconds before switching positions. Do your best to avoid dropping to the ground when switching positions. Switching positions every 10 seconds forces the brain and nervous system to react to a new stability pattern frequently and is thus more typical of how we move in life and sports. Additionally, by switching positions every 10 seconds we better guarantee perfectly executed reps.
The dead bug is another excellent option for building your core strength. Lay on your back with your hips, legs, and arms raised. Simply holding this position is a difficult exercise in itself and is an effective way to exercise your core. Make the movement more dynamic by reaching one arm over your head and slowly lowering the opposite heel towards the ground. Alternate sides, and perform in succession while making sure to keep your ribs down, low back glued to the ground, and head supported and slightly elevated to protect your neck.
The bird dog exercise teaches you to move your extremities while maintaining a neutral spine. The exercise does an excellent job of mimicking real athletic activities you will face in daily life. Get in a tabletop position with your hands stacked under your shoulders and your knees stacked under your hips. Your chin should be tucked and the back of your neck long with no creasing of the skin. Slowly move one of your arms forward while simultaneously extending the opposite leg backwards. The back leg only needs to be about 2 inches off of the ground to avoid hyper-extending your low back. Hold the completely extended position for a count of 2 and then return to neutral. Alternate sides while keeping a neutral spine and make sure to not let your pelvis rotate and shift excessively. Imagine there is a glass of water resting on the base of your low back and you do not want to let it spill!
My goal with this blog post is to provide you with safe and effective exercises for improving the strength and function of your core. Enjoy!
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Do you struggle with neck or shoulder pain, headaches, poor sleep, snoring, rib pain, shortness of breath during exercise, pelvic floor dysfunctions, or persistent dental issues and bad breath? The issue may be simpler than you think. Each of these conditions can be caused or worsened by poor breathing patterns, i.e. taking short, shallow breaths through your mouth instead of breathing through your nose. One of the quickest and easiest ways to improve overall health is to adopt more efficient breathing patterns!
Developmentally, the mouth is connected to the digestive system, while the nose is connected to the respiratory system. Food enters the mouth and passes through the back of the throat, down the esophagus, and into the stomach. Air enters the nose, passes through the pharynx, down the trachea, and into the lungs via a series of tubes called bronchi. These passageways are distinct in the ways they prepare food and air for use in the body. An anatomical structure called the epiglottis, which acts like a folding door, ensures that food does not pass down the trachea, and that air does not pass down the esophagus. For normal health, it is important we keep these two pathways separate. You would never consider eating through your nose, so why do so many people breathe through their mouths? Unless we are performing intense exercise, our mouths should be shut and we should be breathing through the nose. There are numerous health benefits associated with nasal breathing, as well as numerous health issues caused by mouth breathing.
The benefits of nasal breathing.
Breathing through the nose prepares the air for use in the body in three ways. First, the bony passageways and mucus lining of the inside of the nose act like a natural air filter, cleaning the air before it reaches your lungs. This function is extremely important if you live in a city or are exposed to inhalants in your line of work. Secondly, the air is humidified as it passes through the inside of the nose, moistening the air, allowing better absorption of oxygen at the lungs. Third, the air is warmed as it passes through the nose, further allowing a smooth diffusion of oxygen into the lungs. None of these vital preparatory functions occur when breathing through the mouth.
Nasal breathing forces you to use your diaphragm, the body’s main muscle of respiration. The diaphragm is also an important postural and core stabilization muscle. When you breathe through your nose using your diaphragm, the belly should expand on the inhale and come back to a neutral position on the exhale. I never let my patients suck in their stomachs! Sucking in your stomach drastically decreases the stability of your core and causes a shortening and tightening of the muscles in the abdomen. We want the muscles in the abdomen to be relaxed when we are at rest, gradually expanding on the inhale and returning to neutral on the exhale. If you want a perfect example, watch a baby breathe while they are sleeping!
Diaphragmatic breathing is beneficial for patients with conditions related to pelvic floor dysfunction (reproductive organ prolapse, incontinence, sexual dysfunction, etc.). All of these conditions are characterized by weakness in the muscles lining the pelvic floor which are important for stabilizing the organs in the area. When we inhale and the diaphragm contracts downwards, pressure is directed against the pelvic floor muscles, which lay in parallel alignment with the diaphragm. The pelvic floor muscles are activated in response to the increased pressure exerted against them during breathing. The pelvic floor muscles are difficult for many to isolate, and learning to breathe into these areas is the first step in recovering muscular function.
Another interesting benefit to nasal breathing is the increased nitric oxide (NO) production associated with nasal breathing. Nitric oxide is important for the health of your blood vessels and heart. Nitric oxide ‘vasodilates’ or expands your blood vessels, ensuring blood can flow easily to all parts of the body. A reservoir of nitric oxide producing cells is located at the back of the nose, so make sure to breathe all the way into the back of the nose. Actively flaring the nostrils when practicing breathing will help the air reach the furthest reaches at the back of the nose.
Issues with mouth breathing.
The main issue with mouth breathing is the muscle recruitment patterns that develop. When people breathe through their mouths, it’s very hard for the body to use the diaphragm for breathing. Instead, the body recruits other muscles to help with breathing which we call ‘accessory muscles of respiration.’ These muscles are located in the neck and top of the shoulder, and normally kick on only when the body is performing intense bouts of exercise. However, with chronic mouth breathing, these muscles kick on even while we are at rest. When the muscles in the neck and top of the shoulder are used for respiration all throughout the day, they become short, tight, and overused. Strained muscles in the neck place increased stress on the joints in the neck, causing issues such as headaches and neck pain. Receiving treatment for pain in these areas can be very effective, however if the root cause of the issue is improper mouth breathing habits, the main goal of therapy must be to correct breathing patterns.
Chronic dental issues and bad breath are also related to poor breathing habits. If we constantly breathe through the mouth, pathogenic bacteria in the mouth are given a ready supply of oxygen to grow and duplicate. Additionally, these bacteria thrive off of a dry environment, and the mouth becomes very dry with chronic mouth breathing. When the mouth stays closed, saliva is able to flush out the oral disease causing bacteria from the mouth and into the digestive tract where they can be expelled. Amazingly, many indigenous tribes, who breathe primarily through their noses and speak less frequently, have very low levels of dental issues.
Rib pain is another common condition caused by a mouth and chest dominant breathing pattern. If we breathe through our chest during the day even when at rest, the ribs are placed under constant stress. You’ll notice minimal rib movement when you breathe strictly in the belly using your diaphragm. Patients that constantly need to see the chiropractor to have their ribs adjusted can benefit greatly from switching to a diaphragm driven belly breath.
Decrease stress with nasal breathing.
Breathing slowly and deeply through the nose activates a state of relaxation in the body. The hormonal state related to relaxation is governed by the parasympathetic, ‘rest and digest’ system. Unless we are hunting, competing in athletics, or performing manual labor, the body should be in a state of parasympathetic relaxation. Focusing on slow, deep, nasal breaths is an excellent way to make sure we are in a state of relaxation when we should be. To ensure full recovery between exercise sessions or competitions, it’s vitally important the body is in the ‘rest and digest’ hormonal state. Since nasal breathing is our best way to induce the ‘rest and digest’ system, nasal breathing is an excellent tool for athletic recovery!
Where do I start?
Lay on your back with your legs elevated and supported with the hips, knees, and ankles all at 90 degrees. Place one hand on your chest and one hand on your belly. Take a large inhale breath, then exhale forcefully like you are trying to blow a candle out on the ceiling. As you exhale, think about sending your ribs downwards and into the table. Taking the ribs out of a flared position and downwards toward the table will put the diaphragm in the optimal position to be recruited for breathing. With the ribs in a down position, breathe through your belly. Do your best to only let the hand resting on your belly move, while the hand on your chest stays stationery. Take long, slow breaths through the nose, allowing the belly to rise on the inhale and to return to neutral on the exhale. Stay relaxed through your abdominal muscles. Focus on breathing into the front and sides of your belly and even into your low back as well.
As stated previously, correcting your breathing patterns is one of the fastest ways to improve overall health. Follow the steps in this post and you will notice the immense benefits right away. If you’d like to learn more: check out the excellent novel The Oxygen Advantage by Patrick Mckeown.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Brief History of Yoga
Yoga originated in ancient India circa 3,000 BC and offers an excellent blend of meditation, respiratory training, and movement. Practitioners of yoga enjoy the relaxing benefits of a class, most commonly performed in a heated room. Anyone who has taken a yoga class understands the mental focus and physical resiliency required to successfully complete a practice. In fact, the breathing practice utilized in yoga called ‘pranayama’ is very similar to the diaphragmatic breathing exercises we teach our patients in the clinic.
Should I be doing yoga?
Yoga has gained immense popularity in this country over the last decade. As a result, many patients ask for advice on whether or not they should be practicing yoga. My overwhelming answer is yes! Any physical practice that promotes movement, whether it is yoga, pilates, weightlifting, or running – is beneficial to the human body and should always be encouraged. However, the main caveat I give my patients when it comes to yoga is they need to understand which movements are healthy for their body’s and which movements are potentially damaging. Certain injuries or movement deficiencies can put the body at risk if you don’t know when to modify the yoga pose or to avoid it all together.
Low back pain and yoga
Let’s look at some examples. Chiropractors treat many patients with low back pain. Many patients experience increased back pain with sitting, picking items up off the floor, and bending forward to tie their shoes. The common theme is rounding postures of the low back, termed ‘flexion’ is provocative for these patient’s low backs. We term this type of back pain ‘flexion intolerant low back pain’. A patient with flexion intolerant low back pain should avoid flexion based activities while their low back is in the healing stages. Very often, these patients respond well to exercises or static positions that place the low back in extension – adhering to the natural lordotic curve of the lumbar spine.
If after assessment in the clinic the Chiropractor decides the patient will benefit from extension based exercises or static positions, the patient will be counseled to avoid all flexion based activities or postures for the low back (bending forward, prolonged sitting, etc.) during the initial stages of rehabilitation. If you have taken a yoga class, you are familiar with the numerous forward folds and sustained toe touches that are done during the class to stretch out the calves and hamstrings. If a patient is experiencing flexion intolerant low back pain, performing 20-30 forward folds in an hour practice is harmful to the body. In a patient prone to back pain, persistent forward bending places stress on the discs, nerves, ligaments, and muscles of the low back. Even Child’s pose position places the low back in end ranges of flexion and should be avoided for most acute back pain patients. Instead of forward folding, perform the downward dog position which will give similar benefits of stretching the calves and hamstrings while keeping a neutral spine.
Shoulder/ neck pain and yoga
Another example is a patient with shoulder and/or neck pain. Handstands, headstands, and other inversion based poses are very popular in yoga. Teachers cite the benefit of reversing the gravitational flow of blood in the body for improvements in circulation. While I agree with this notion, patients with shoulder and neck pain should not be putting this amount of stress on their muscles and joints. Performing a proper head or hand stand requires extreme levels of shoulder and scapular stability – something many beginning yogis do not possess. If you have shoulder or neck pain and are new to yoga, do not try and impress the rest of the class by forcing yourself into an inversion pose. Instead, ask your teacher to show you a regressed version that does not place as much stress on your neck and shoulders.
Knee pain and yoga
Last, the athlete with knee pain needs to be careful with certain yoga postures. Patient’s with current knee pain or a history of knee pain and surgery need to be cautious with certain yoga poses. Popular poses that impose large amounts of stress on the knee joint include the full squat (frog pose), hero pose (sitting on heels and laying backwards), pigeon pose (lying body weight on top of figure 4 pose), and standing tree pose. The common theme with these positions is they add load to the knee joint in extreme ranges of flexion and rotation. When the knee is forced into end ranges of flexion and rotation, the muscles and ligaments of the knee are placed under stress, which is amplified if previous or current injury exists. Instead of fighting through the pain to complete the class, work on poses like the lunge, warrior 1 and 2, bridge pose, and chair pose. These poses will strengthen the muscles and ligaments of the knee in less extreme ranges of motion.
Your Yoga Practice
Practicing yoga should be challenging but pain free and relaxing at the same time. If you are constantly fighting through pain in yoga, you are missing out on the many benefits of a successful practice. Do not feel bad about modifying your practice to work around injuries. Always remember it is YOUR practice, and not everyone else in the room. Make sure to communicate all injuries to teachers before the class starts so they can help you with modifications to make sure you get the same benefits as everyone else. As always, if you have a lingering injury that does not seem to be getting better, make sure to consult a health care professional who can diagnose and correct your specific issue.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Treat Yourself Like a Professional Athlete Part 4: Utilize Conservative Health Care
Elite athletes are utilizing complementary and alternative health care providers more than ever. They understand the key to career longevity is receiving preventative treatments before injuries and sickness occur. Practitioners of complementary and alternative, or ‘conservative’ health care pride themselves on treating the root cause of injury and illness, rather than just treating symptoms. Conservative health care providers aim to use surgery and drugs as a last resort, and only when the athlete has failed to respond to all conservative care treatments.
Who are the complementary and alternative health care providers?
Professional athletes are regularly receiving treatments from Doctors of Chiropractic (DC), Doctors of Physical Therapy (DPT), Licensed Acupuncturists (Lac), Doctors of Oriental Medicine (DOM), Registered Dietitians (RD), Medical Doctors with a focus in functional medicine (MD), and Doctors of Naturopathic Medicine (NDs). Many professional teams employ or subcontract with these various practitioners. Most of these practitioners receive 4+ years of additional education after their undergraduate studies to learn the skills of their given professions and often take similar courses as Medical Doctors (MDs). For example, a Doctor of Chiropractic (DC) or Doctor of Naturopathic Medicine (ND) take many of the same science, pathology, and radiology courses as MDs.
What treatments do complementary and alternative health care providers provide?
Doctors of Chiropractic (DC) and Doctors of Physical Therapy (DPT) are best known for hands on treatments, such as joint manipulations, soft tissue treatments on muscles, tendons, and ligaments, and prescribing exercise therapies to correct faulty movement patterns. Licensed Acupuncturists (Lac) and Doctors of Oriental Medicine (DOM) utilize principles of Traditional Chinese Medicine (TCM) to treat a wide variety of pain syndromes, metabolic and hormonal issues, and other inflammatory conditions that may be hampering athletic performance. These doctors use treatments such as cupping, herbs, ‘Tui Na’ Chinese massage, movement therapies like Tai Chi and Qi Gong, diet and lifestyle modification, and acupuncture. Acupuncture is the application of small needles at areas on the body along specific ‘meridians’ that correspond to areas of pain.
For those athletes seeking more of a Western medicine approach, a Registered Dietitian (RD) or Medical Doctor (MD) focusing on functional medicine, are both great options. The RD will create customized dietary and supplement plans for athletes based on the unique metabolic needs of their sport. The MD focusing on functional medicine will order comprehensive blood, stool, urinary, food sensitivity, micronutrient, and environmental toxicity tests to look for specific underlying causes of metabolic, digestive, and hormonal issues.
How many athletes utilize complementary and alternative health care providers?
Focusing on chiropractic in professional and olympic sports, today all 32 NFL teams and 93% of MLB teams have a chiropractor on staff, and 72% of PGA golfers receive regular chiropractic care. Globally, 90% of all world-class athletes utilize chiropractic care to enhance performance 2.
Dr. Michael Reed, DC was the first chiropractor to act as Medical Director for Team USA at the 2010 Winter Games in Vancouver 1. At the 2012 Summer Olympics, Dr. William Moreau, DC served as Medical Director for Team USA, and an additional 40 chiropractors were on site to treat the US team and athletes from other countries 3. Similar statistics for other alternative health care providers show the mainstream inclusion of their professions into elite level sports.
Which provider should I see?
For athletic injury recovery and functional movement analysis, Chiropractors (DC) and Physical Therapists (DPT) are your best choice. These practitioners are experts at human movement and can identify which movement deficiencies you may have that are predisposing you to injury. Look for practitioners who have the following certifications or coursework: Dynamic Neuromuscular Stabilization (DNS), Functional Movement Systems (FMS), Selective Functional Movement Assessment (SFMA), Global Rehabilitation and Injury Prevention (GRIP), or any practitioner who holds a Certified Strength and Conditioning Specialist (CSCS) certification. As movement experts, chiropractors and PTs identify limitations in joint ranges of motion, stability, and muscle firing patterns that are currently causing or may eventually lead to injury.
For sports nutrition, Registered Dietitians (RD) with a focus in sports nutrition and Doctors of Naturopathic Medicine (ND) will be your best option. These practitioners understand there are unique energy requirements for each athlete and can help you find out what works best for you. Nutrition is key for both recovery and performance, so finding a practitioner well versed in nutrition is imperative.
For digestive issues impairing sports performance and overall health and well-being seek out Doctors of Naturopathic Medicine (ND), Doctors of Oriental Medicine (DOM), or Medical Doctors (MD) with a focus in functional medicine. The MD focusing on functional medicine will order comprehensive tests to assess the health of your gut microbiome, determine if parasites are present and effecting your gastrointestinal tract, and assess how well your body is metabolizing the foods you consume. Functional medicine embodies the idea of treating the root cause of a patient’s problem, rather than just treating symptoms.
When it comes to pain syndromes and injury your best choices are Doctors of Chiropractic (DC), Doctors of Physical Therapy (DPT), and Licensed Acupuncturists (Lac). As stated previously, acupuncturists use needle point stimulation to decrease pain along meridian lines throughout the body. DC’s and DPT’s utilize a variety of manual therapy and joint manipulation techniques to decrease pain and inflammation, accelerating the healing process.
Post written by Dr. Riley Kulm, DC MS. Check out his bio here.
- Mike Reed. 27 April, 2014. In Wikichiro. Retrieved October 24, 2018 from, http://wikichiro.org/en/index.php?title=Mike_Reed.
- Sports Chiropractic: A Winning Solution For Athletes. Infographic (2016). Palmer College of Chiropractic. Retrieved from: https://www.palmer.edu/uploadedFiles/_Resource_Center/Infographics/infographic-sports-chiropractic-.pdf. On October 2, 2018
- William Moreau. 16 June, 2014. In Wikichiro. Retrieved October 15, 2018 from, http://wikichiro.org/en/index.php?title=William_Moreau
We’re going to take a quick break from our ‘Treat Yourself like a Professional Athlete’ blog series to address commonly asked questions in our clinic – how much should I be stretching, how should I be stretching, and why do improvements in flexibility from stretching seem to happen so slowly?
Do you feel like you are constantly stretching and foam rolling yet are not improving flexibility? Patients regularly ask me how to become more flexible and mobile. They stretch their hips, hamstrings, and lower backs constantly, yet see little improvement in function, range of motion, or pain. For many patients, the issue is not the extensibility of their tissues, it is poor or inadequate stabilization patterns.
Create a Stable Base of Support
For the brain to allow movement and lengthening of a muscle, there must be a stable base of support. If a stable base of support is not present, the brain will perceive the movement as threatening and unsafe, and will put the brakes on. The brain does this by preventing muscles from expressing their full ranges of motion. This phenomena may show up as tight hamstrings, hip flexors, and lower back muscles.
Muscles most commonly attach to joints or on bony landmarks next to joints. With this in mind, the stable base of support required for movement is most often a joint, which includes the vertebrae in the spine. Poor stability at a joint is perceived as a ‘red light’ to movement. We call this ‘neurologic tension’ which refers to muscular tightness caused by the brain putting brakes on a movement. If all we do is stretch the tight muscle, we are not addressing the root cause of the problem – an inadequate base of support. The feet, hips, shoulders, and vertebrae in the lower back and neck are common areas where patients need to improve stability because many muscles attach to these areas.
Breathing to Release Your Hip Flexors
Many of our patients stretch their hip flexors constantly but do not see any improvement. The main muscle for hip flexion is the psoas major muscle. The psoas muscle attaches to the vertebrae in the spine, crosses the hip joint, and eventually attaches to the top of the leg near the head of the femur. If the psoas muscle does not have a stable base of support at the spine, the brain will not allow this muscle to fully lengthen, leading to tighter hips. Proper breathing patterns utilizing a diaphragm-driven belly breath and 360-degree cylindrical core stability are essential to create a stable base of support at the spine. At our clinic we teach patients how to breathe deeply into their abdomen. This is important because you must be able to breathe into an area if you want to activate the muscles in the area. Once they can breathe into the front, sides, and back of their abdomen, we teach them how to stabilize the muscles of the core using progressively more difficult exercises. Many patients notice improved hip flexor mobility simply by achieving better breathing and core stabilization patterns.
Stabilize Instead of Stretch
You should now understand how poor stabilization at joints can lead to an inflexibility of the muscles that attach at or near the joint. The focus of exercise therapies at our clinic teach patients to have better stabilization at their joints. Patients are amazed when they see active and passive ranges of motion dramatically improve once a stable base of support is created. We rarely give clients traditional stretching exercises because for the vast majority of patients, the root cause of stiffness is neurologic tension due to poor stabilization patterns.
As today’s blog post is more technical than previous posts, please feel free to reach out if you have any questions!
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Train like a pro
Elite athletes understand they need to build durable and resilient muscles, joints, ligaments, and tendons. The best way to do this, aside from a healthy diet (nutrition blog post) and adequate recovery practices (sleep blog post), is resistance weight training. When we lift weights, we place an external load on the body, mimicking the forces encountered in sports. Forces placed against the body are present in both contact and non-contact sports. When participating in non-contact sports such as running, throwing, and golf, forces are still exerted from contact with the ground or from internal forces the body places on itself during movement. This week we will dive into the key principles of strength and conditioning that will help you train like a pro.
Keep it simple
Most people would be surprised by the simplistic workouts of the world’s top athletes. There is a misconception professional athletes are using state of the art equipment unavailable to the average person. While elite athletes do have access to incredible facilities and equipment, most pros are still using simple squat racks, barbells, dumbbells, pull-up bars, and kettlebells – equipment we almost all have access to.
Traditional bodybuilding training focuses on single joint, single muscle group exercises. While effective for improving aesthetics, these movements do not increase functionality in the athlete or mimic the demands encountered in sports. The key is to focus on compound, multi-joint exercises like the deadlift, squat, pull-up, bench press, and weighted rows. These exercises will stress multiple muscle groups, requiring they work together to move the load.
Focus on closed chain exercises
Closed chain exercises are when the body part being moved is anchored to the ground or an immovable object, like a pull-up bar. The direction of muscle pull is towards the ground or immovable object. Force is being transmitted through the ground, not through the air when you perform exercises such as deadlifts, squats, push-ups, pull-ups, or lunges. These exercises recruit larger muscle groups and require they work together to move the load. Closed chain exercises also require greater stabilization of the spine, which is essential for protecting the lower back during sports.
Contrarily, open chain exercises are when the arm or foot is free to move and is not anchored to the ground or an immovable object. The direction of muscle pull is inwards toward the body when you perform exercises such as bicep curls, bench press, hamstring leg curls, or quad knee extensions. The muscle is mainly recruited in the concentric (shortening) phase of muscle action. As such, open chain exercises are less functional to the athlete and should not be the focus of a strength and conditioning program.
Control the eccentric portion of the lift
Many injuries in sports occur when the muscle is asked to contract while it is in the process of lengthening. Bicep tendon tears, hamstring tears, and achilles ruptures are common injuries that often occur in the eccentric phase of muscle action. This type of contraction causes the most tearing of muscle fibers, whether injury occurs or not. A simple example of eccentric muscle action is during the bicep curl. As the weight is lifted, the bicep is acting concentrically, meaning it is shortening while it is contracting. As you slowly lower the weight, the bicep is eccentrically contracting, meaning you are putting it under load as the muscle lengthens.
By focusing on slow lowering in movements like the squat (descent), deadlift (lowering the bar to the ground), and pull-up, you can target the eccentric muscle actions, making your body more durable and resilient to injury. As an added bonus, muscle growth is stimulated most by eccentric exercises.
Adopt a pull to push ratio of 2:1 or 3:1
This ratio will maintain the balance of your posterior (back) and anterior (front) muscle chains. Proper balance and upright posture depends on balance between these two chains of muscles. Most people are insufficient in their posterior chain (calves, hamstrings, glutes, triceps, upper back muscles) and overly sufficient in their anterior chain (quads, upper abdominals, pecs, and biceps). A reason for this pattern is the anterior chain muscles are the ones typically associated with an aesthetic body and are trained more often than the posterior chain muscles. When it comes to function, a strong posterior chain in balance with the anterior chain is key. A strong posterior chain will help you develop more force in your running stride, take and receive hits in contact sports, and stick a landing after a vault in gymnastics.
Pulling exercises include pull-ups, deadlifts, seated rows, dumbbell rows, and lat-pull downs.
Pushing exercises include push-ups, bench press, incline DB press, landmine press, and strict press.
Finally, it is important your gym training closely mimics demands encountered by your sport. The Specific Adaptation to Imposed Demands (SAID) principle states the biomechanical and neural adaptations your body makes to training will be specific to the movements being trained. For example, if you want to get better at running, you should not bench press every time you go to the gym. Conversely, if you are an offensive lineman in football, obtaining a strong bench press will be essential to success in your sport. Choosing exercises that either recruit the muscle groups you plan to use or movements that look similar to the ones you perform in your sport is crucial to training like a pro.
Have questions? feel free to reach out to Dr. Riley at [email protected]
Post written by Dr. Riley Kulm, DC. Check out his bio here.
More so than ever, professional athletes are paying closer attention to the foods they are putting into their bodies. Elite competitors understand the quality of food they consume directly correlates to their athletic performance. Athletes look to nutrition for a competitive edge, as well as a way to extend the longevity of their career. In this week’s post, we will focus on ways you can maximize your athletic performance and overall health using proper nutrition.
All foods are composed of three macronutrients – proteins, carbohydrates, and fats. Fad diets, such as the ketogenic (high fat) and Atkins (high protein), claim that eating one macronutrient is the best for human health. However, for an athlete to perform at their highest potential they need to find a macronutrient ratio that best suits their sport and maximizes the amount of micronutrients they are consuming. Micronutrients refer to the vitamins and minerals found in food and are essential to human health and athletic recovery. Foods highest in micronutrients include organic fruits and vegetables, nuts, seeds, grass-fed meat, and wild caught fish and shellfish. In general, the best diet for athletes is one rich in diverse vitamins and minerals and has a balanced macronutrient distribution suited to a particular sport.
Different macros for different sports
Based on your activity level, there is a certain balance of carbohydrates, fats, and proteins that will suit you best and enhance your performance.
The power sport athlete – sprinting, weightlifting, discus, football – will function best on a diet high in carbohydrates and protein. These athletes need quick burning fuel, and carbohydrates are the best source of energy for the body to metabolize in high intensity exercises. Power sport athletes will also require adequate post-exercise protein to repair the damage done to muscle tissues.
The endurance athlete – long distance running, swimming, rock climbing, cycling – will function best on a diet high in fats and carbohydrates. Dietary fat is the most energy dense macronutrient, but it is also the slowest to metabolize, making it ideal for endurance athletes who need to fuel their bodies for longer periods of time. Carbohydrates and protein are also important for these athletes as they need to restore muscle glycogen (carbohydrate) stores and repair damaged tissues following exercise.
Following these general guidelines, athletes from each subset should maintain a balanced macronutrient distribution. The endurance runner needs dietary protein to repair their damaged tissues following a long, grueling race, while the power sport athlete needs dietary fats to maintain the health of their cell membranes, brain, and nerves.
Adopt a lifestyle, not a diet
When we exercise and metabolize foods for fuel, metabolic waste products are created causing inflammation in the body. However, post-workout inflammation is not inherently bad and is beneficial to stimulating growth. Nevertheless, if an athlete is eating a pro-inflammatory diet, the compounding effect of exercise, plus poor nutrition, can create a state of chronic inflammation in the body. As a result of athletes continually breaking down their bodies and causing normal post-exercise inflammation, they need to ensure their diets do not cause more inflammation. The goal of an anti-inflammatory lifestyle is to increase the amount of anti-inflammatory omega-3 fatty acids, while decreasing the amount of pro-inflammatory omega-6 fatty acids.
Foods that are high in anti-inflammatory omega-3 fatty acids and lower inflammation levels include grass-fed meat, wild caught fish and shellfish, organic vegetables, fruits, stem tubers and roots (yams and sweet potatoes), nuts, omega-3 seeds (hemp, chia, and flax), and dark chocolate with a cocoa content greater than 85%. These foods are also the richest in micronutrients and should be the focus of any athlete’s diet.
Foods that are high in pro-inflammatory omega-6 fatty acids and cause chronic inflammation in the body include refined sugars and grains, grain flour products, trans fats, alcohol, and refined omega-6 seed oils (corn, safflower, sunflower, and other vegetable oils). Dairy products and nightshade vegetables (white potatoes, eggplants, bell peppers, and tomatoes) may be pro-inflammatory for some athletes, and a food sensitivity test will help to determine if the athlete should be consuming these foods or not. Athletes who decrease their consumption of pro-inflammatory foods, while increasing their amount of anti-inflammatory omega-3 containing foods, will notice an improvement in athletic performance, mental focus, and muscle resiliency.
An excellent resource for anti-inflammatory lifestyle information is Dr. David Seaman’s ‘de-flame diet’.
We hope you enjoyed this week’s blog post on nutrition for athletes. Please reach out if you have any questions!
Post written by Dr. Riley Kulm, DC. Check out his bio here.
1. Use Magnesium, Not Melatonin
For a supplement option, utilize magnesium to promote healthier sleep. Magnesium can act as an inducer of GABA, the major inhibitory neurotransmitter of the body. GABA helps the body slow down internal processes, especially in the nervous system. By decreasing facilitation of nerves, we help the nerves and the muscles they supply recover, which is extremely important for successful repeat athletic performances. Magnesium comes in many different forms or ‘chelates’, and research suggests that magnesium threonate is the best inducer of GABA in the body, and will ultimately be the best choice for athletic recovery during sleep. Other supplements supported by the research include chamomile, kava kava, and Valerian root.
However, be careful about the popular sleep supplement, melatonin. While very effective for some people, it’s important to remember that melatonin is a hormone that is naturally produced by the body. This means that if you are taking the hormone externally, you run the risk of turning off your body’s natural production of the hormone, so reserve this supplement as a last ditch effort.
2. Avoid Late Night Workouts and Meals
Your late night workout or large meal close to bedtime may be disrupting your sleep. Working out late at night can increase levels of our ‘awake’ hormone, cortisol, and decrease the body’s natural release of our ‘sleep’ hormone, melatonin. Additionally, we induce a “fight or flight” sympathetic state when working out, which will make falling asleep more difficult. Shoot to finish your workout before 7pm to ensure that you give your body adequate time to calm down and relax before you go to sleep. If your schedule absolutely requires that you workout late at night, make sure to utilize effective down regulation strategies after your workout to turn off your sympathetic system and activate your “rest and digest” parasympathetic system. Excellent down regulation strategies include post workout foam rolling, static stretching, and deep breathing exercises.
Choosing to eat dinner late at night may also disrupt your sleep. Embedded in the lining of the digestive tract is the enteric nervous system, a complex web of neurons that has been called the ‘second brain.’ The enteric nervous system is important for the muscular contractions that move food through the digestive tract, the secretion of digestive enzymes, and communication with the brain via the vagus nerve. The importance of the connection between the gut and the brain via the vagus nerve cannot be understated, especially when one considers that 90% of the nerve communication moves from the gut to the brain. In regards to healthy sleep, it makes sense that an active digestive system will send stimulatory signals from the digestive tract to the brain, keeping us awake at night. Keeping this in mind, I like to finish eating at least 90 minutes before bedtime.
3. Foam Rolling for the Nervous System
Many professional athletes utilize massage therapy as a post-performance or before bed treatment. Massage has been shown to decrease cortisol levels (which are naturally high after exercise), while increasing serotonin and oxytocin, two hormones associated with relaxation and our parasympathetic ‘rest and digest’ state. While most of us do not have access to a nightly massage, a 10-minute foam rolling session before bed can have a similar down-regulating effect on the nervous system and promote healthy sleep. Focus on the calves, quadriceps, hamstrings, and glutes, as these areas may be prone to tightness after a full day of exercise or after a long day of sitting at work.
4. Consistency is Key
As with any health and fitness related goal you are looking to achieve in life, consistency and adherence to a predetermined plan is essential. Make it a point to wake up, as well as go to sleep, within the same 60 to 90 minute time frame every morning and evening, even on the weekends. Do your best to schedule social activities during the day and evening so that you don’t feel like you missed out on anything by not staying up late on the weekends. Sporting events, outdoor activities like skiing and hiking, or a trip to the botanical gardens are excellent ways to have fun on the weekends without sacrificing your sleep schedule.
Want to learn more? Check out Sleep Smarter by Shawn Stevenson. Many of the ideas mentioned above are draw on methods from this book.
Post Written by Dr. Riley Kulm, DC. Check out his bio here.