Ski season is in full swing in Colorado and we are currently having one of the best snowfall years in the last decade. Many of the resorts are well above seasonal averages for snowpack depth. As of today, Vail is at 124% of seasonal average, Aspen Snowmass is at 140%, and Steamboat Springs is at a whooping 154% of average (via OpenSnow and based on averages over the last 20-40 years). The opportunities for skiing and snowboarding fresh Colorado powder are ample this season, and many individuals are flocking to the mountains to hit the slopes. Skiing and snowboarding are incredibly exhilarating, but they are also extremely dangerous. So what are the most common injuries for skiers and snowboarders, and how do you minimize these risks?
Injury Prevalence in Skiers vs. Snowboarders
Skiers and snowboarders are more susceptible to different types of injury. The reason for this has to do with the stiffness of bindings and boots, the use of poles in skiing, the ability to use two edges at once when skiing, and the differing techniques used in sliding downhill sideways versus straight forward. Research suggests snowboarders are most likely to injure their wrists, shoulders, and ankles, while skiers are more likely to injure one of the ligaments in their knee such as the ACL, MCL, or LCL1. The same study reports wrist injuries were the most prevalent in snowboarders (27.6% of all snowboard injuries), while anterior cruciate ligament (ACL) tears were most prevalent in skiers (17.2% of all skiing injuries). Specifically, the injury profile for snowboarders includes wrist fractures and wrist ligament sprains, shoulder labrum tears, ankle fractures and sprains, concussion, and clavicle fractures. Among skiers, the injury profile includes ACL sprains and tears, MCL and LCL sprains and tears, tibial plateau fractures, and concussion as well. After 4 years of treating ski and snowboard injuries as a chiropractor in Colorado, the results of this study are all too common at our practice.
Improving Control on the Mountain
The best way to minimize injury on the mountain is to learn how to control your speed in all types of terrain. Many beginner skiers and snowboarders simply ride too fast, putting themselves and other riders at risk. The best skier in the group isn’t always the one who gets to the bottom of the run the fastest, rather it’s the rider who stays in control, always on their edges, and adjusts their speed effectively based on upcoming obstacles.
In skiing and snowboarding, the ‘fall line’ refers to the line down a mountain that is most directly downhill. If you are on a steep slope, it’s important to periodically deviate from the fall line and move laterally on the slope to slow down. If you constantly face down the fall line, you will gain too much speed and lose control. Alternate between turning down the fall line to gain speed, then checking your speed by moving laterally when you feel like you are going too fast. Other ways to control your speed include turn shape, skidding, and checking. Check out this excellent article on speed control.
Understand When to Call it a Day
According to Utah based sports medicine expert Dr. Travis Maak, MD, a former ski patrol volunteer and current head physician for the Utah Jazz, the majority of ski and snowboard injuries happen at the end of the day, around 3:30 pm. Lifts typically close at 4 pm meaning most ski injuries happen in the final 30 minutes of the riding day. The reasons for this are multifactorial. Firstly, temperatures start cooling off at the end of the day causing the snow to be harder and icier. The softer snow is more skied off, exposing icy snow with rocks and branches. Additionally, riders are more fatigued at the end of the day, especially in the active stabilizers of the lower leg such as the muscular quads, hamstrings, and calves. When these muscles become fatigued, the rider relies more on the passive stabilizers of the lower leg such as the ligaments of the knee and ankle, the meniscus, and the hip labrum. This is a recipe for disaster since the passive stabilizers of the lower leg are less reactive to quick, ballistic forces that might be imparted with an unexpected fall on the mountain. Advanced skiers know when to call it a day and when it is time for their last run.
Avoid Alcohol or Drugs while Skiing or Snowboarding
Skiing and snowboarding are activities in which many people treat alcohol and drugs as the norm. Alcohol decreases cerebellar function which results in decreased balance, motor control, coordination, and cognition – all athletic attributes required for a safe day on the mountain. If an individual is drinking or doing drugs, they are treating skiing and snowboarding as a leisurely pastime rather than a sport, and could be putting themselves and others in danger. If you want to avoid injuries, save the drinking for after you have called it quits for the day.
Take a Lesson
Take a lesson from a trained instructor. Ski school instructors are specifically trained in the progressions for learning how to ski and snowboard. Progressions refer to the gradual acquisition of new skills within a given sport, and are an integral piece to safely learning a new sport. Progressions are particularly important in extreme sports like skiing and snowboarding where risk of injury is high if a stepwise fashion to learning is not followed. For an example of a beginner progression for skiing, check out this excellent YouTube video for some helpful tips.
Be on the lookout for Part 2 of Ski Safe in 2023, where I will teach you training techniques to reduce injury risk and to improve your performance on the mountain!
Post written by Dr. Riley Kulm, DC. Check out his bio here.
References
https://pubmed.ncbi.nlm.nih.gov/22268231/.
https://healthcare.utah.edu/the-scope/shows.php?shows=0_7m18zo0t
https://www.youtube.com/watch?v=MMeJsyiiifM
Build Resilient Immunity in 2023
Last month, Dr. Ryan and I had the pleasure of attending a seminar taught by Dr. Dan Murphy, DC. Dr. Murphy is one of the foremost experts on nutrition and functional medicine in the chiropractic profession. He lectured on topics such as brain injury and concussion, nutrition for cognitive and immune system health, the beneficial effects of red laser therapy, and the prevention of dementia and Alzheimer’s disease using nutrition and lifestyle modification.
Perhaps the most impactful topic for me was Dr. Murphy’s lecture on ‘host immunity.’ Host immunity refers to the strength, resiliency, and adaptability of a given patient’s immune system. The better the patient’s immune system, the more effectively that patient can combat all forms of disease and illness affecting the body. Dietary and lifestyle modifications such as exercise, proper sun exposure, and evolutionarily consistent eating are examples of techniques patients can use to improve their host immunity.
In my opinion, mainstream media does not focus enough on host immunity. Instead, we are told strategies such as staying up to date with the latest vaccine or booster, avoiding close contact with sick individuals, wearing masks in public, or taking medication for any physical or mental stress your body is subjected to. When did we become so weak we had to start relying on all of these external, synthetic inputs to keep us healthy? Since when did being around other people endanger us, rather than strengthen our immune system by presenting our immune system with a wide array of pathogens and creating a more robust immune system? I recall when ‘chicken-pox’ parties were the norm. Each individual has the opportunity to have an extremely strong, smart, and resilient immune system.
Dr. Murphy suggests a number of vital supplements for optimizing host immunity. First and foremost are omega-3’s and vitamin D. Aim for around three grams of omega 3’s each day. For many, this means supplementing with a high quality fish oil supplement. Omega 3’s help with the inflammatory balance in the body and foster an environment where immune cells can combat external infections and diseases. Next up is vitamin D. Your goal should be around 5,000 mg per day. Getting vitamin D from natural sunlight is the best option, however, during the winter months supplementation is often necessary. Nearly every cell in the body, including our immune cells, possess a vitamin D receptor and is positively activated when this hormone is at proper levels. Vitamin D is also great for bone mineral density, memory, and mental health.
No lecture on immune health is complete without mentioning vitamin C. Did you know the benefits of vitamin C were first discovered among sailors with scurvy? Scurvy is a connective tissue disease causing gum disease, hair loss, excessive bleeding, and poor healing from wounds and infection. When the sailors were given oranges, which are high in vitamin C, the symptoms of scurvy all but disappeared. Alas, the immune benefits of vitamin C were front page news! Vitamin C has a host of health benefits including reducing the duration of the common cold, helping with the synthesis of collagen so you can have healthy skin, hair, and nails, and acts as a strong antioxidant with some research suggesting anti-cancer and anti-Alzheimer’s benefits. Vitamin C is found in the highest quantity in citrus fruits. If supplementation is deemed necessary, liposomal vitamin C is your best option. Liposomal vitamin C is encapsulated with a fat or lipid coating improving absorption and decreasing gastrointestinal distress.
The final three nutrients are magnesium, zinc, and vitamin A. Magnesium is a mineral acting as a cofactor in over 600 reactions in the body, and is important for normal immune function, energy production, blood pressure regulation, and blood sugar control. Magnesium deficiency is common in developed countries. Aim for about 300-600 mg per day of magnesium from a whole food source or supplement. If supplementing, I recommend taking either magnesium threonate or magnesium glycinate, since these have the best absorption in the body and brain. Zinc is an essential mineral associated with proper wound healing and immune system function. It is an antioxidant and important for maintaining proper testosterone levels. I recommend 15-30 mg of zinc daily. Vitamin A refers to a group of chemical compounds composed of retinol and its metabolites. Vitamin A is essential for optimal immune function, and is also important for our skin and vision. Take around 5,000 IU of vitamin A each day.
Coming up soon, I will take a deep dive into the importance of exercise and sleep for healthy host immunity. At the surface level, a balanced combination of aerobic (endurance) and anaerobic (strength) training will help develop a robust individual with a strong immune system. Consistent, quality sleep each night is essential for immune health because melatonin benefits the immune system by decreasing inflammatory reactions in the body, notably the ‘cytokine storm’ seen with covid-19. Supplementing with 3-10 mg of melatonin while symptomatic may provide some benefit, however, I do not recommend long term supplementation of melatonin. Melatonin is a hormone produced by the body, and long term supplementation may decrease our body’s capacity for producing the hormone on its own.
Make 2023 the year for improving host immunity. With covid-19 in the rearview mirror, prepare yourself now for any future health crises that may affect our society. If we all commit to focusing more on healthy host immunity, the need for societal wide shutdowns and vaccination may not be necessary!
Post written by Dr. Riley Kulm, DC. Check out his bio here:
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.
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.
The Importance of a Morning Routine
If I were to pick one lifestyle intervention for anyone looking to enhance their energy levels, increase productivity, and improve relationships with friends and family, a consistent morning routine would be my top choice. An effective morning routine will set you up for success throughout the rest of your day. If you start the day by completing small, productive tasks you will establish a feeling of accomplishment immediately after waking up. By finishing these tasks at the beginning of the day, other, more daunting projects related to your work or personal life will seem less intimidating. You will establish a task completion mindset first thing in the morning which will increase productivity throughout the day. Lastly, you will practice gratitude in your morning routine, which will help you appreciate your life and the people in it.
The five tasks you should complete every morning are:
- Make your bed
- Drink a glass of cold water
- Five minutes of light exercise
- Meditate
- Journal
Next, let’s talk about the specifics of each task in your morning routine.
1. Make your bed
I recommend watching this link of a speech by US Navy Seal Admiral William McRaven titled, ‘If You Want to Change the World, Start Off by Making Your Bed.’ McRaven stresses the importance of completing one small task (making your bed) in the morning, to set you up for success in completing other, more difficult tasks throughout your day. He also discusses how learning to do the small things in life correctly allows you to complete the big things in life correctly. Making your bed does not need to be a lengthy ordeal of tucking in 3 layers of sheets and organizing 12 throw pillows, but rather make your bed presentable enough to give you peace of mind that you completed your first task of the day successfully.
2. Drink a glass of cold water
You are dehydrated when you wake up and your body is thirsty. Do not drink coffee right away as coffee is a diuretic and will cause you to expel out more fluids than you are taking in. Instead of coffee, start your day with 16-24 ounces of cold water immediately after waking up. By giving your body the hydration it needs first thing in the morning you will notice more stable and consistent energy levels throughout the day.
3. Perform 5 minutes of light exercise
To assist in waking your body up, perform 5 minutes of light exercise first thing in the morning. Your movement flow may include stretching, body weight strength exercises, breathing, or yoga. This is not meant to exhaust you, but rather to stimulate your body’s awake hormone, cortisol. Cortisol gets a bad rap as the body’s stress hormone, but this is not entirely true. Cortisol is normally elevated in the morning and helps to wake up the body and mind for the day ahead. Cortisol becomes problematic when it remains high into the afternoon and evening due to chronic stress, poor nutrition, and excessive exposure to blue light emitting screens. Two of the strongest stimulants for proper cortisol release in the morning are direct sunlight exposure and exercise. By performing light exercise in the morning, you are ensuring an adequate cortisol release in the morning. My 5 minutes of light exercise includes 3 sets each of push-ups and bodyweight squats. In the past I’ve incorporated other movements such as planks, wall-sits, hip stretching, and kettlebell deadlifts. I find that these movements are enough to get my blood and heart pumping without tiring myself out for workouts I have planned later in the day.
4. Meditate
Perhaps the most important yet difficult task in a successful morning routine is meditation. Meditation is a mindfulness technique that teaches the individual how to be present in the current moment. Headspace defines meditation as the “intention to be present in the here and now, fully engaged in whatever is happening, free from distraction or judgement, with a soft and open mind.” Guided meditations on apps such as Headspace or Calm use a form of meditation called ‘Vipassana’ which aims to help the individual gain self awareness of body and mind.
Guided meditations often start with deep breathing exercises utilizing slow, controlled, nasal breaths. Next, the guided meditation will ask you to mentally scan different parts of your body, noticing areas that are relaxed as well as areas that are tense. Finally, the guided meditation may ask you to count your breaths, with the ultimate goal of focusing on nothing besides the breath. Guided meditations typically end by completely letting go of your focus, allowing your mind to run wild, before bringing your intention back to the breath for a final 2-3 focused breaths. Many people notice an immediate change in their day to day lives when starting a daily meditation practice. People who meditate are more calm throughout the day, their interpersonal communication is improved, their breathing patterns are better, and they are less agitated by the stress of daily life. Taking just 5-10 minutes to perform a guided meditation first thing in the morning may be the best way to set yourself up for success throughout the rest of the day.
5. Journal
Another beneficial task to complete every morning is a short journal entry. You can get creative with this one, but there are two key pieces that are essential. First, use your journaling as a way to reconnect with your ‘why’. If you read my last blog post Effective Goal Setting 2020, you know the first step towards creating your goals is to establish your why. Your why is your purpose, cause or belief – it is the reason you get out of bed in the morning. Reconnecting with your why using journaling may include writing a quote everyday that reminds you of your passion in life, physically writing out your most important goal, or listing out positive qualities about yourself and the person you want to become. Second, develop a practice of gratitude in your morning journaling. For me, I list three things I’m grateful for every morning. Some days it reads ‘a loving and supportive family,’ or ‘a career that challenges me mentally and physically,’ and some days it’s as simple as ‘a healthy breakfast to fuel my body and mind throughout the day.’ Writing out what you are grateful for first thing in the morning will remind you how good your life truly is and place you in a positive, optimistic mindset.
The Outcome
The goal is to complete all five of these tasks every morning. You will be busy some mornings and may only have time to complete two or three of these tasks. For me, I notice that the quality of my day directly correlates to how many of the morning tasks I complete. The more I successfully complete, the better my day tends to be. When you establish a consistent morning routine you will notice improvements in your energy levels, productivity, interactions with other people, sleep quality, and overall happiness with your life. Attached is the template for the morning routine I use every day. Enjoy!
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Over the past weekend, Dr. Ryan and I had the pleasure of attending the annual Colorado Chiropractic Association (CCA) convention. Speakers from all around the country discussed the benefits of receiving chiropractic, specifically the hormonal benefits of receiving regular chiropractic adjustments. Chiropractic adjustments have a beneficial effect on your endocrine (hormonal) system, resulting in far reaching health benefits you may not previously have associated with the chiropractic adjustment.
The topics covered in this blog post are inspired by two lectures given at the 2019 Colorado Chiropractic Association (CCA) convention. The first is a lecture given by Dr. John Minardi, DC on 10/26/2019 and was titled ‘The Power of Chiropractic.’ The second is a lecture given by Dr. Monique Andrews, MS, DC, DNM on 10/25/2019 and was titled ‘A Potential Role for Chiropractic in the Neurobiology of Autism.’
How chiropractic adjustments affect your brain.
First, it’s important to explain that the chiropractic adjustment does not only affect the joints of the spine and extremities, but also the brain. When a joint is adjusted, special nerve receptors embedded in the joint capsule called mechanoreceptors are activated and fire signals to the brain. These signals are received and integrated by the brain, and the brain’s activity is noticeably changed in response to the sensory input from the adjustment. Studies have shown increased glucose uptake (a marker for metabolic brain tissue activity) in the frontal lobe of the brain following an adjustment (Inima et al, 2017). The frontal lobe of the brain is responsible for executive functions such as decision making, personality and emotional expression, problem solving, and also controls our ability to communicate and connect with others. This may explain why chiropractic is an excellent, yet underutilized, adjunct therapy for children dealing with autism.
When an adjustment is performed and mechanics in the spine improve, signals are sent to the brain conveying the new, corrected position and/ or motion of the vertebrae in the spine. The brain accepts and integrates these signals, producing an output signal that will have far reaching effects in the body. When joints are aligned and moving properly in the spine, the brain produces signals to the body that promote health and decrease inflammation. When joints are not aligned and are not moving properly, the brain produces signals that decrease health and increase inflammation.
How the brain functions after an adjustment.
Now that we know adjustments affect the brain, let’s talk about the positive changes that occur in the brain after an adjustment. The hypothalamus is a small region located at the base of the brain near the pituitary gland. The hypothalamus is important for the regulation of body temperature and other homeostatic systems such as hunger, thirst, sleep, and circadian rhythm. The most important role of the hypothalamus is the linkage of the neurologic system to the hormonal or ‘endocrine’ system via the pituitary gland. The hypothalamus receives sensory information from the body, and produces ‘neurohormones’ that activate or inhibit the release of hormones from the pituitary gland. When we adjust the spine we improve the quality of sensory information that is sent to the hypothalamus. Here is where the magic happens. As I previously described, when you are adjusted, small nerve endings in the joints called mechanoreceptors are activated and send signals to the brain. These signals provide your brain with valuable information about where the body lies in space, the structure and integrity of your spinal column, and can even block or mask pain signals being sent to the brain by other sensory nerve endings! Adjustments positively affect the brain and nervous system, improving the quality of sensory information sent to the hypothalamus. The end result is an improvement in the quality of hormonal release that is governed by the hypothalamus.
How the brain functions when things are off-balance.
Spinal malposition and/ or decreased joint range of motion is perceived as a stressor by the brain. The brain sits on top of the spine and thus relies on the spine for its structural stability. Imagine you were trying to replace a light bulb, but did not have a ladder. You need to get the job done, so you decide to stack boxes on each other for you to climb until you can reach the light bulb. After stacking the boxes, imagine that one of these boxes is rotated and has slid out of alignment compared to the other boxes. How confident do you feel about climbing the boxes to change the light bulb now? I’m guessing you’d be a little more nervous and stressed standing at the top of the boxes. In this metaphor, the boxes are your spinal vertebrae and the person standing on top of the boxes is your brain! If the boxes are not in proper alignment, you will perceive standing on top of the boxes as danger and your stress hormones will dominate. The body acts in the same way. When the brain does not sense healthy alignment of your spine, poor information is sent to the brain and stress hormones are released.
When the brain is stressed, hormones such as cortisol and norepinephrine dominate. These are the hormones released in the body’s ‘fight or flight’ response and are very useful in situations where the body needs to respond to a threat to survival. These hormones increase heart rate and breathing, shunt blood to the heart and skeletal muscles and away from the digestive and reproductive organs, dilate the pupils, and cause metabolic changes that increase energy delivery to skeletal muscles. The problem is that in modern society many individuals are in a chronic state of stress, and thus their ‘fight or flight’ system is always on. Hormones such as cortisol and norepinephrine are essential to life, however the constant presence of them in our bloodstream due to a stressed state is highly damaging. Improper cortisol release timing is one of the main implications for weight gain and an inability to control cravings for sugar and highly processed foods.
Testosterone and Estrogen.
By decreasing the stress response to the brain, adjustments decrease the amount of cortisol released by the adrenal cortex via the pituitary gland. Inappropriate cortisol release wreaks havoc on the endocrine system. Hormones such as testosterone, estrogen, dopamine, and serotonin are all measured at lower levels when cortisol is too high. Testosterone is often singled out as important for male sex drive and energy, and while this is true, research also suggests that men with higher levels of testosterone show more compassion and are more loving to their partners. When cortisol levels are high, testosterone levels plummet. Estrogen is highly important for bone formation in women and also for achieving and maintaining pregnancy. Cortisol kills off estrogen and progesterone, another important hormone for maintaining pregnancy.
Dopamine and Serotonin.
Dopamine is our anticipation hormone. It governs the motivational component of reward-motivated behavior. Dopamine fuels the anticipation of a future reward. Dopamine is released when we are particularly excited for an upcoming event, i.e. seeing a loved one, going on a long anticipated vacation, etc. Dopamine is also released when we are particularly anxious for an upcoming event. Proper cortisol and norepinephrine levels are necessary to maintain balance in the dopamine system. When cortisol and norepinephrine are high, due to stress on the brain, dopamine release goes awry and can cause depression, thrill seeking, unhappiness, decreased immune function, excessive worrying and bickering.
Serotonin is the body’s satisfaction hormone. It governs happiness, satisfaction, and fulfillment in life. Serotonin is even boosted when in the presence of a particularly friendly or happy person. Excessive cortisol decreases the amount of serotonin and can contribute to depression and chronic pain syndromes such as fibromyalgia.
Excessive cortisol and norepinephrine throw the entire endocrine system out of whack. Cortisol will decrease sex defining hormones such as testosterone and estrogen, dampen the effect of dopamine, our motivation-reward hormone, and serotonin, our happiness hormone. The good news? Chiropractic adjustments and other forms of manual therapies decrease the amount of cortisol and epinephrine released by the adrenal cortex and medulla via the brain and thus increases the levels of all these highly necessary and beneficial hormones. As a result, many of my patients report improvements in breathing, energy, digestion, and sleep following a chiropractic adjustment. Even if you are not in pain, regular chiropractic adjustments are highly beneficial for your health and should be received at least once monthly. By getting assessed at least once a month you are ensuring the health of the joints in your spine and extremities, and drastically decrease the risk of future injuries, and the need for costly orthopedic surgeries.
Post written by Dr. Riley Kulm, DC MS. Check out his bio here.
Citations: Evid Based Complement Alternat Med. 2017;2017:4345703. doi: 10.1155/2017/4345703. Epub 2017 Jan 12.
So you’ve recently scheduled your first chiropractic visit. Having never been to a chiropractor before, you aren’t sure what to expect. You’ve seen the YouTube videos, heard many stories, both good and bad, with everyone seemingly having a unique experience with a chiropractor. In this post I’ll outline what you can expect on your first chiropractic appointment.
The following article outlines a typical new patient exam at Mile High Spine & Sport. Most evidence based chiropractic clinics will follow a similar plan for a new patient visit.
History (10-15 minutes)
Once in the treatment room, the doctor will ask you a series of questions related to your area of complaint. Questions asked will include the location of pain and if there are any referred symptoms. Referred symptoms refer to pain, numbness, tingling, and/ or weakness that may be stemming from the main area of pain. The doctor will ask for a detailed description of how the pain came on, whether it happened in a single traumatic incident, or if it came on more gradually over time. The doctor will ask which activities specifically make the pain worse (i.e. sitting vs. standing, bending forward, turning, lifting an object off the floor, etc.) and also if there’s anything specific that makes the pain better (heat vs. ice, Advil, relieving postures or positions, etc.). The doctor will ask about your treatment history – any past injuries or surgeries, and whether any imaging (X-ray, MRI, CT) have been taken recently, so be prepared with this information if necessary.
A doctor who treats the entire body and not just the site of pain will ask you a variety of other questions regarding your overall health and lifestyle choices. The doctor will ask about your diet because the foods we eat can affect the way the body experiences pain and recovers from injury. They will ask about any medications or supplements you are currently taking, as well as what you like to do for exercise because activity modifications may be necessary while you recover from your pain. The doctor will ask about your sleep quality as sleep is the most fundamental human function necessary to heal. Additional questions will be asked regarding any drug/ alcohol/ or tobacco use, as abuse of any of these can magnify the inflammatory pain response and slow healing. Interview over! Now the doctor has a clear picture of your current chief complaint, your past medical history, and knows the kind of lifestyle you are living.
Exam (15-20 minutes)
Vladimir Janda, a renowned Czech physician, always taught that ‘Time spent in assessment, will save time in treatment.’ With this in mind, chiropractors like to perform detailed, in depth exams to determine what specifically is causing your pain or dysfunction. It’s important to assess the entire body and not just the site of pain, because dysfunctions elsewhere in the body may be contributing to the site of pain. For instance, a shoulder problem may be related to poor function of the hip on the opposite side of the body, a chronic knee issue may be stemming from poor ankle mobility on that side, or low back pain may be related to diminished mobility and/or stability in the hips.
The doctor will start by taking your vitals, which includes blood pressure, heart rate, respiratory rate and body temperature. More specific exams such as an eye exam, cranial nerve exam, ear exam, lung exam, cardiac auscultation, abdominal exam, and nasal exam will performed on an as needed basis.
Next, the doctor will perform a comprehensive neurologic exam. They will test your deep tendon reflexes (think patellar knee jerk as a little kid), muscle testing, and sensation testing of your skin. These tests are meant to test the integrity of your nervous system. Other neurologic tests include single leg balance testing, your ability to stand with the eyes closed, the ability to sense vibration in your fingers and toes, and even your ability to distinguish smells such as coffee and cinnamon. The purpose of these tests are to screen for any pathology that is damaging your central nervous system and may include a disc herniation, spinal or brain tumor, or disease process. The vast majority of neurologic exams come up as normal, and the vast majority of positive findings in a neurologic exam are related to non-pathologic processes that can be corrected in the chiropractic office.
The next portion of the exam is the orthopedic exam. These tests help the doctor figure out exactly which tissues are injured, i.e. is it the meniscus, ACL, PCL, joint, or muscle? Orthopedic exams are meant to elicit pain and will most likely recreate your pain. Do not be worried about these tests damaging your tissues, they are only performed once and will help the doctor figure out the best course of treatment for you.
The final portion of the exam will be the functional movement exam. The doctor will take you through a series of functional tests such as a SL squat, SL balance, lunge, push-up, active range of motion, passive range of motion, and muscle testing among many others. These tests are meant to recreate the demands of daily living and the basic requirements for healthy human movement. When a dysfunction is found in the functional movement exam, the doctor is given valuable insight into which specific exercises will be beneficial for you.
Will X-rays be taken as part of the exam?
At our clinic, we do not take X-rays on the majority of our patients. Most presenting problems can be diagnosed and treated without the use of X-rays. While radiation exposure during an X-ray is minimal, we still opt to only order X-rays or advanced imaging when absolutely necessary. Minor anomalies and asymmetries will be found on the majority of X-rays, but these issues rarely correlate to pain and can often confuse the patient into thinking they should have pain because of what the image shows
Review of findings (5 minutes)
After completing the exam, the doctor will have a solid idea of what is driving the pain and the best course of treatment. The doctor will suggest which tissues are damaged and what other contributing factors are adding to the pain or dysfunction. Additionally, the doctor will explain the different treatments they want to use, including potential adverse side effects such as soreness or mild bruising for 1-2 days after treatment.
Treatment (20-25 minutes)
With the history, exam, and review of findings complete, the doctor can start the treatment. Treatments will address the joints, nerves, muscles, tendons, ligaments, and any movement compensations you may have. The most commonly utilized treatments used at our clinic include:
Active Release Technique (ART) – considered the gold standard in soft tissue therapies.
Dynamic Neuromsucular Stabilization (DNS) – functional movement protocol based on principles of neuro developmental kinesiology.
Instrument Assisted Soft Tissue Manipulation (IASTM) – the use of metal tools to decrease tone of tight and tender muscles.
Acupuncture – needling technique used for thousands of years to treat pain and organ dysfunction. Acupuncture is based on needling along specific ‘meridian’ pathways that have specific uses for healing in the body.
Kinesiology taping – special type of tape that provides support to joints and muscles without causing disuse atrophy of the muscles as is the case with traditional orthopedic braces.
Cupping – effective decompressive technique which lifts the skin away from the muscles allowing increased blood flow and lymphatic drainage at the site of treatment.
Internal medicine blood testing – functional medicine blood testing to assess for specific nutrient deficiencies, digestive irregularities, and hormonal imbalances that can be an underlying cause of pain and chronic disease.
A typical treatment plan at our clinic is 2x/ week for two weeks, 1x/ week for two to four weeks, once every other week for 2-4 weeks, then once a month for maintenance care if the chief complaint pain is resolved. Most patients feel significant relief after 6-8 visits. Additionally, most patients feel even stronger and more flexible compared to their first visit because of the exercises they’ve been given at our clinic.
Now you know what to expect in your first chiropractic visit, hope to see you soon!
Post written by Dr. Riley Kulm, DC MS. 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!
Basic anatomy.
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.
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.
SAID principle
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.
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.