The Bodywise Blog

Thoracic Outlet Syndrome (TOS) is a condition whereby blood vessels and/or nerves are impinged at the area around the base of the neck and/or the top of the shoulder. Symptoms include pain, numbness, tingling or coldness in the arm, hand or fingers. Frequently the symptoms are similar to Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome (CTS) is impingement of the median nerve at the wrist. TOS can present with identical symptoms and is often mistaken for CTS. With TOS, blockage can occur an numerous locations other than the wrist, though primarily between the scalene muscles of the neck and/or between the collarbone and first rib. Other areas that can cause similar symptoms but aren’t technically TOS are spinal nerve impingement in the neck, and nerve impingements at the elbow and forearm. One of the most common complaints with TOS is waking up with numbness in the arm or hand.

Thoracic Outlet Syndrome is usually easily corrected by addressing muscle imbalances of the neck, shoulder, and arm, addressing repetitive stresses and improving rib/spine mobility. However, it is common practice in the allopathic medical community to address TOS surgically by removing the first rib. You read that right… removing a rib.

If any of the above symptoms sound familiar to you or you’ve received a diagnosis of TOS or Carpal Tunnel Syndrome and would like a free evalutation, give me a call.

Stress headaches. Sinus headaches. Tension headaches. Migraines. We’ve all heard the terms before, but what’s the difference? In short… nothing. All of these common ailments are really the same thing… migraines. That is to say they are all caused by what’s known as the migraine mechanism. The difference is in their symptoms.

In the migraine mechanism, blood vessels in the brain become inflamed and dilated, causing decreased blood pressure to the brain. This can cause myriad symptoms, ranging from your stereotypical throbbing migraine to visual artifacts or something as innocuous as “cloudy” thinking. It’s all migraine.

The causes of migraine are many… far too many for a simple article such as this. There exist what are known as migraine “triggers.” These are substances, foods, or even actions which increase the likelihood of having a migraine. Each of us has our own trigger threshold and we all respond differently to our own unique triggers. As long as the aggregate of our trigger exposures remains below our threshold, we have no migraines. Once our trigger load goes above threshold…. bam! Migraine. Some triggers have an immediate effect, others can take days or even a week to have their effect. While we may all have our own unique migraine triggers, some are more common than others.

Among the most common triggers, and those over which we have the most control, are the dietary triggers. There are hundreds of potential dietary triggers, but among the most potent are caffeine, alcohol and monosodium glutamate. Any alcoholic beverage is a potential trigger, but red wines are the most notorious, as they contain high levels of sulfites, a notorious migraine trigger. Caffeine is perhaps the most potent of the migraine triggers and one of the most commonly consumed. The irony here is that caffeine is a staple ingredient in over-the-counter migraine/headache remedies. The caffeine causes constriction of those dilated blood vessels in the brain, affording temporary relief. Unfortunately, caffeine, in addition to being a migraine trigger, is a rebound drug… that is to say while it make relieve the headache you have NOW, it makes you more likely to have a WORSE headache LATER. It’s a vicious cycle. Monosodium glutamate, or MSG, is a common food additive. It’s an effective flavor enhancer and is thought it some culinary circles to be the sole way of acheiving what’s known as “umami”. There are five cardinal flavors: sweet, salty, sour, bitter and umami, or savory. MSG is also thought to be the most potent dietary migraine trigger of all. It’s also a known carcinogen among other things. Restaurants and food manufactures must clearly state if they add MSG to your food. So if you receive no such warning, your safe, right? Not so fast. They have to advise you if they’ve added MSG… they don’t have to tell you if MSG naturally occurs in whatever they’re serving you. Soy sauce contains MSG, as does any other fermented soy product. In fact, the entire family of so called glutamates are migraine triggers. MSG also is a naturally biproduct in hydrolyzed proteins, a common food additive. It’s harder to avoid than you may think.

So what do we do about it? Well, it’s a process… a highly effective, if not lengthy, process. It involves elimination of triggers with their gradual reintroduction so as to be able to identify your own most potent triggers, then eliminating those permanently. Also involved is raising your trigger threshold, making migraines harder to get. The techniques behind all of that are beyond the scope of this article, but can be found in an awesome book called Heal Your Headache, by Dr. David Bucholz. I can’t recommend it enough. Happy reading.

Every exercise exists a sliding scale. On one side, you have safety. On the other, effectiveness. The goal in implementing an exercise regimen is to find exercises which strike the perfect balance between the two. Let’s review some common, poorly-executed resistance exercises and how to modify them so as to strike that ideal balance.

THE BENCH PRESS

An oldie, but a goody…. or is it? The ubiquitous bench press (for the uninitiated, that’s laying on your back pressing a barbell off your chest) is a staple of most strength routines, though predominately for men. There’s nothing inherently wrong with this exercise… it’s the traditional execution that is of concern. This exercise is traditionally performed by lowering the bar until it contacts the chest, then pressing it back up until the arms are fully extended. This places intense stress on both the rotator cuff and the ligaments in front of and below the head of the humerus, leaving you at risk for an anterior/inferior subluxation (read: dislocation) of the shoulder. To make this exercise safer while not significantly sacrificing effectiveness, only lower the bar until your upper arm is parallel to the floor. This usually works out to about one fist’s distance from the chest with the bar.

ABDOMINAL CRUNCHES

There are 1,001 different crunches out there and I lack the time to address all of the ones that aren’t especially great for you. However, there’s one variation I feel needs particular attention. There’s ongoing debate among the fitness lay-community as to what to do with the head during a basic floor crunch. I frequently encounter individuals who have been instructed to perform crunches with their chin up in the air… presumably to “isolate” the abs better. Unfortunately, this is terrible for the neck. This places a great deal of compressive stress on the upper cervical vertebrae and intervertebral discs and can over-stretch the muscles and ligaments at the base of the neck. This is not to mention the fact that the neck flexors and trunk flexors (abs) are meant to work together as a force-couple as part of normal body mechanics. This exercise is not functional and potentially injurious. Instead, BEGIN the crunch from the neck, tucking your chin into your chest and then following through by curling up with the rest of the trunk. Reverse that sequence on the way down.

PUSHING OR PULLING BEHIND THE NECK

Lat pulldowns (seated, pulling a bar down against resistance) are a perfectly good exercise. Unfortunately, they’re frequently fouled up by pulling the bar behind the head. This is old-school bodybuilding technique and has long been deemed a no-no…. and yet, they’re still done… and TAUGHT! Behind the neck shoulder presses fall under the same category. These exercises place tremendous stress on the rotator cuff and can lead to such conditions as rotator cuff tendinitis, rotator cuff tears and adhesive capsulitis. It is argued by the old guard that these exercises are more effective than their in-front-of-the-head counterparts. This is in some regards true. However, they tip the sliding scale so far away from safety and toward effectiveness that any gain in effectiveness simply isn’t worth the risk. Simple fix? Do them in front of the head. They work the relevant muscles nearly as well with little or no risk.

There are 100 more such exercises out there, but there’s only so much time in the day to cover them. When determining where a given exercise falls on the aforementioned scale, don’t ask the buffed-out dude in the parachute pants at the gym who routinely and happily sacrifices safety for a better “pump”. Ask a pro.

Sciatica: Pain in the lower back, buttock, and/or various parts of the leg or foot. Sometimes, there may be numbness, muscular weakness, pins and needles or tingling and difficulty moving or controlling the leg. Any of this sound familiar?

The sciatic nerve is a large nerve about the diameter of a dime which runs down the back of the leg, branching to supply most of the muscles of the posterior leg. Sciatica is a collection of symptoms associated with irritation or compression of the sciatic nerve or its associated nerve roots… and it’s extremely commonplace. There are a number of potential causes of sciatica. I’ll outline some of them.

The most frequent cause of sciatica is intervertebral disc herniation. In such a case, a herniated or bulging disc presses on one of the 5 nerve roots which form the sciatic nerve. Activities featuring heavy impact or repeated impacts will exacerbate such cases. Often, depending on severity, these herniations can heal themselves.

Spinal stenosis is a conditon where the spinal canal narrows and compresses parts of the spinal cord; and in some cases the roots of the sciatic nerve. The narrowing can come from a number of sources, such as bone spurs or disc herniations. Poor posture is a frequent contributing factor.

Above were conditions which cause true sciatica. There is also what is known as pseudo-sciatica. With pseudo-sciatica, the symptoms can be the same or similar to true sciatica, but the causes are less severe and non-discogenic (not disc-related). I’ll mention a few frequent causes of pseudo-sciatica.

Referred pain from surrounding muscles can also give sciatica-like symptoms. Trigger points in muscles such as the gluteals, quadratus lumborum, psoas (hip flexor) and deep hip rotators can causes pain referral patterns similar to sciatica.

Compression, degeneration or irritation of the facet joints of the low back (joints along the spine) can cause pain referral patterns  in the low back and upper legs.

One of the most common causes of pseudo-sciatica symptoms is compression of the sciatic nerve by the piriformis muscle, a deep rotator of the hip. In some cases, there is what’s known as piriformis entrapment. In such cases, the nerve actually perforates the piriformis, a congenital defect present in roughly 15% of the population.

Last, but not least, is constipation. Yes… constipation. Pressure from the bowel can press on the sciatic nerve roots.

Most of the conditions I’ve listed above can be treated non-surgically. Through improved posture, correction of muscle imbalances and, in the case of bulging or herniated discs, spinal decompression (whether via traction tables or decompression equipment such as the DRX-9000), as well as such interventions as weight-loss, physical therapy and acupuncture, symptoms can be reduced or eliminated all together. In the case of disc herniation, as many as 90% of cases heal without intervention, though there are often residual imbalances that require correction.

There are also numerous surgeries designed to eliminate the underlying causes of sciatica. Just be aware that numerous studies show that two years after surgery, surgical and non-surgical treatments offer about the same results. Food for thought.

Womens’ bones begin demineralizing and becoming less dense steadily from young adulthood on. This process accelerates after menopause. Men lose bone density as well, only usually much slower. Other than diet and drugs, what can we do about it?

You may have heard that resistance training is good for improving bone density, or at least stopping bone loss. What you may not have heard is that it’s not quite that simple. Not all resistance training methods and exercises are created equally for the purpose of bone-building. More often than not (at least as I have found in my years as a fitness trainer), women who are new to resistance training and looking to strengthen their bones look to strength-training machines, as they are frequently simple to use and offer helpful instructions on the placard. If not machines, they will try simple, single-joint, muscle-isolating free-weight exercises. Usually they will use low resistance for fear of getting “bulky.” They’ll target primarily only the areas in which they wish to affect cosmetic change. While this can causes some changes in mineralization, they will be minimal. To understand why this approach doesn’t work so well, I’ll explain a little about how bone-remodeling and building work.

From a resistance-training standpoint, there are two primary methods for stimulated bone-building: stressing the muscles and stressing the bones. First I’ll discuss the muscle-stress method. When we use our muscles, tension is increased at the muscles’ attachments to the bones via their tendons. The tension on the bone stimulates a piezo-electric response, whereby a small electric current is created along the line of pull stimulating the osteoblasts (bone-building cells) to go to work at the attachment site. Unfortunately, this effect is limited to the tendon attachements, so any increased bone-density is isolated and minimal.

The other, and much more effective method of bone-building is the bone-stress method. This method calls for, believe it or not, the “bending” of the bones. Our bones are hollow and flexible which makes them light and resistant to fracture. When a substantial compressive force is applied to the long-axis of a bone, the bone bows slightly creating a compressive stress inside the bend and a tensile stress outside the bend. These compressive and tensile stresses create the same piezo-electric response previously mentioned, only along the entire length of the bone, increasing osteoblast activity throughout the entire bone and affecting a far greater increase to overall bone-density.

What does this mean for your workouts? Instead of those simple, light, isolated, single-joint exercises such as bicep curls and leg extensions, go the other way with it. Do complex movements with heavier loads, working many joints and muscles simultaneously, such as squats or military presses. Such exercises offer mineralization benefits to not only the attachments of all the involved muscles (which are many), but also to the entirety of all the bones loaded longitudinally (in the case squats, that’s the upper and lower legs and arms and the thoracic and lumbar vertebrae).

So, ladies, if you want to use weight-training as part of your bone-health regimen, you’ll have to redefine what you may think of as a “woman’s workout.” That means big movements, few or no machines, and heavier loads… a workout traditionally though of as more of a “man’s workout.” But hey, what’s good for the goose is good for the gander.