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
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.
Dry Needling
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.
Many patients come to me with the goal of losing weight. They have seemingly tried everything from complex dieting, hiring personal trainers and life coaches, to intense calorie restriction and juice cleanses, yet nothing seems to work. Many methods work for a month or two and then the patient reverts back to their previous way of eating, often consuming more of the unhealthiest foods as a means of compensation for months of dieting. This cycle is repeated many times until the patient is discouraged and feels like lasting change will never happen. However, with proper education and dedication towards taking small steps in the right direction, lasting change is possible. In the following blog post, I’ll outline simple ways to take steps toward losing weight and keeping it off for years to come.
What is metabolism?
Metabolism refers to the caloric cost of all biochemical processes in the body: digestion of food, maintenance of blood pressure, regulation of body temperature, protection from pathogenic diseases, production of ATP for energy, etc. As metabolic rate increases, the amount of calories burned each day increases as well. Basal metabolic rate or BMR refers to the amount of calories burned while at rest. If you were to lie in bed all day your body would still be using calories to perform it’s essential needs, and the amount of calories you’d burn would be your BMR. A main goal of weight loss is to increase the patient’s BMR (metabolism at rest), that way they are using more calories during the day, even when not exercising. One of the best ways to increase BMR is through resistance (weight training) exercise.
When we perform resistance exercise of appropriate intensity, we increase the amount of lean muscle mass in the body. An increase in lean muscle mass is important because the metabolic rate is directly determined by the amount of lean muscle mass in the body. As the percent of lean body mass increases, the metabolic rate also increases, resulting in more calories used throughout the day.
An important point to remember is that lean muscle mass weighs more than fat. This means that when you start performing resistance exercise, your body weight may initially increase. It is important to not get discouraged. Even though you are gaining weight, your metabolic rate is increasing and your percentage of lean muscle mass is increasing. As metabolic rate continues to increase due to a higher percentage of lean body mass, you will eventually start to lean out and lose weight. I’ve seen too many patients get discouraged from an initial increase in weight and they end up missing out on the true benefits of resistance exercise.
As an added bonus, one of the best ways to maintain the structure and function of your bones is through resistance exercise. Bones grow and remodel in response to external force. You need to utilize barbells, dumbbells, kettlebells, and machine weight training to stimulate growth and repair in your bones.
‘The Fat Burning Zone’:
There is a common misconception that the best way to lose weight is through long duration cardio at a slow pace, such as taking long walks, slow jogging, or low level cycling on a stationary bike. Most people have seen the charts on the treadmill or bike that highlight the ‘fat burning zone’ which supposedly gives the desired percentage of heart rate (HR) max that burns the most amount of fat. The target zone is typically around 60% of the individual’s estimated heart rate max. While there is truth to the fact that our body’s burn more fat at lower intensities of exercise, the total amount of calories burned is much less when staying within the ‘fat burning zone’. The amount of calories burned is more important than the percentage of fat being utilized for exercise. Higher intensity exercise such as sprints, repetitive jumping, resistance weight training, and plyometrics, burn more calories in less time and thus are more beneficial for weight loss.
I prefer patients to perform short duration, high intensity bouts of exercise. I’m not suggesting they completely give up taking long walks, or other forms of lower intensity exercise, but rather know the importance of getting their heart rate up and muscles firing in order to achieve a successful fat loss workout regimen. Commonly known as high intensity interval training (HIIT), this training model uses short bouts of high intensity exercise, interspersed with brief periods of rest to reset cellular energy levels. The purpose of HIIT is to utilize and grow the body’s fast-twitch skeletal muscle fibers (type II fibers). These fibers are responsible for sprinting, jumping, and heavy lifting, and are highly active metabolically (meaning they burn lots of calories). HIIT can be performed with running, biking, or with body weight exercises.
A popular form of HIIT training is a Tabata workout. The classic Tabata protocol is 20 seconds of max effort high intensity exercise followed by 10 seconds of rest. Complete this cycle 8 times for a total workout time of 4 minutes. Exercises include squat jumps, burpees, lunges, push-ups, or any movement that can be performed repetitively and explosively. If you are new to HIIT training, instead of jumping right into a Tabata, consider performing interval training starting at 30-45 seconds of a moderately fast pace, followed by 20 seconds of rest, for 6-8 cycles.
Decrease inflammation to lose fat
A growing body of research is linking inflammation and obesity. Obesity leads to inflammation in the body, and inflammation makes weight loss more difficult. Inflammation is the body’s response to injury or infection and is characterized by redness, swelling, heat, pain and loss of tissue function. Inflammation can be looked at as the body’s alarm system. While an important and essential response to injury or infection, the body can kick on the inflammatory process in the absence of injury or infection. When our body’s alarm system is in a constant state of activation, damage to tissues can occur. The most likely culprits of increased inflammation are diet, poor or absent exercise patterns, physical and mental stress, lack of sleep, and lifestyle diseases such as obesity, type 2 diabetes, and heart disease.
The common belief in human physiology for years was that after puberty, you are essentially stuck with the number of existing fat or ‘adipose’ cells in your body. After puberty, the fat cells would only be able to shrink or grow, but the total number would stay the same your entire life. New research suggests this is not the case and that fat cells can die and even transform into other cell types such as muscle or neural tissue. This information should be very encouraging to an individual trying to lose weight. Even more interesting is the same research suggests that chronic low grade inflammation in the body makes fat cells more resistant to dying or transforming. If the patient is seemingly doing everything, yet they are still not losing weight, look to inflammation as the culprit. Decrease inflammation in your diet by cutting out refined sugars and grains, corn, soy, pasteurized dairy, grain fed meat, and commonly used vegetable oils such as corn, peanut, safflower, and sunflower oil. Instead eat a diet rich in vegetables, fruits, grass fed meats, pasture raised eggs, sustainably caught wild fish, coconut oil, olive oil, grass fed butter, and a wide variety of spices (garlic, turmeric, cumin, cayenne, etc.).
Morning sunshine exposure
For each of my patients I recommend 10 minutes of sunshine first thing in the morning with as much skin exposure as possible. There are numerous health benefits to morning sunshine exposure, with the most important being the regulation of your circadian rhythm. Think of your circadian rhythm as a giant clock, and at specific points in the day, certain hormones are released on a timed schedule. Cortisol, our ‘awake’ hormone, is released in the morning and is stimulated by UV light exposure from the sun on our eyes and skin. It’s important to get an adequate cortisol release in the morning to avoid elevated afternoon and night time cortisol levels. Cortisol is often wrongly referred to as our ‘stress’ hormone. Cortisol release only causes stress when released in the afternoon and evening, when our body should naturally be shutting down and preparing for sleep. When cortisol levels are high in the afternoon, our body’s naturally crave refined sugars and unhealthy processed fats. You’ve probably noticed how you gravitate towards sweets and fast food when you are most stressed. You can avoid these cravings by making sure cortisol release in the morning is adequate.
Leptin and ghrelin are two important hormones that also depend on an intact circadian rhythm to function properly. These hormones regulate appetite and need to be in balance if weight loss is going to be successful. Leptin is an appetite suppressor and ghrelin is an appetite stimulator. Leptin is released when our body has consumed enough energy from food and we no longer need to eat. Leptin is our satiety hormone, and tells our brain when we are full. As you can imagine, if leptin release does not occur, we will not have the signal to stop eating and we will over consume calories and increase weight gain. Ghrelin does the opposite, stimulating appetite when our stomachs are empty. These two hormones work in alternate relationship to each other and both rely on a healthy Circadian rhythm to function. An excellent health initiative would be to visibly watch (no sunglasses/ no windows) the sunrise and sunset every day. Balanced hormones, better sleep, improved energy, and better appetite regulation are some of the many benefits you’d get.
In summary, three excellent ways to trigger weight loss are: 1) start performing a high intensity interval training (HIIT) program, 2) decrease inflammation through diet and exercise, and 3) regular sunshine exposure to optimize your circadian rhythm and hormonal balance.
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.
Nutritional Basics
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.
