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Miscellaneous

What is the purpose of the navel in the human body, beyond birth?

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As Lou Davis says, there is no function of the navel for autonomic function past birth. But it can be argued that there is a musculoskeletal / myofascial function to the navel as it relates to deeper muscular and connective tissue structures in relation to anatomical development and subsequent physiological functional capacity.

The navel is a connective tissue (fascia) locus[1] that is centered around our physical center of gravity, which is why physiotherapists make such a fuss about “core” strengthening. The abdominal muscles and associated connective tissue (including in the area of the navel) constitute a center of support for the viscera and the musculoskeletal (including Lumbar) structures surrounding and supporting it.

This becomes important, in physiotherapy, when the “core abdominal support” has been anatomically or physiologically / functionally compromised. The navel itself doesn’t have muscular components, such as contractive sarcomeres, but it affects the sarcomeres of the surrounding myofascia, including rectus abdominus and external obliques,etc. The navel itself is not the issue, but its location at our center of gravity and the functionality that extends from that center of gravity is the issue.

[1] Fascia: The Tensional Network Of the Human Body; 2012, Elsevier; Robert Schleip, Thomas Findley, Leon Chaitow, Peter Huijing; pgs. 50-52

What do you do to stay productive all day?

What do you do to stay productive all day?

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The answers to this will be a bit subjective, due to the demands and personal makeup of our different lives. As a 46yo woman, wife, mother, business owner, muscle therapist, etc., here are some things that help keep me on track.

  1. Good sleep. This cannot be overstated, and I am fierce about not only the quantity (min. 6 hours, 8 best), but the quality. I spend an hour with a hot bath and soothing music and meditation to calm my body and mind down before going to bed. I have a great bed and pillow, and I make sure that I am warm and comfortable during sleep. Consequently, I fall deeply asleep about 2 minutes after hitting the pillow, and I wake up when the alarm goes off, refreshed and ready for the day. Well, after one cup of coffee.
  2. Morning exercise. I have a pretty rigid schedule, but I find that 30 minutes of morning exercise (minimum) in a natural setting, such as a walk on the beach (or somewhere similarly enjoyable) clears away the “cobwebs” physically and mentally, and I feel like it gives me a jump-start on increased energy for the rest of the day. It clears my mind of clutter and makes me feel ready to face the day’s challenges calmly. It works better for me first thing in the morning, because I tend to be too busy or tired later in the day, when it’s easier to blow off.
  3. Good nutrition. I have high physical and mental demands on me during my workday, and I am sensitive to drops in blood glucose levels (runs in my family). I try to get good quality food (nutritious, moderate fat/sugar/salt intake) at even 2-4 hour intervals throughout the day. Low-fat protein sources, such as soy milk or miso, tend to help me stay awake and alert.
  4. Productive use of downtime. I have been trying to make a habit of meditating for up to 15-minute intervals through the day during “waiting” periods. These can include the time between appointments, end of the workday, during a bath, etc. Allowing myself to try to “drain of thought” is like a deep breath of refreshing air for my whole self. Which leads me to:
  5. Take notes. I have always found it difficult to give myself permission to jot down a note (on paper, Post-its, Evernote, my wrist, etc.) to remember something trivial (calling a friend, picking up something at the store, etc). I do not remember these things well while working. When I’ve written the note, I no longer feel the weight of trying to remember, and I can concentrate better on the moment at hand.
  6. Regular time with family and friends. We make a family habit of eating together and watching a movie together every night. Yes, every night. This requires a fair bit of compromise on all our parts. We have never regretted it, and you don’t ever get the time with your kids back to do over. It makes for a grateful, peaceful evening. As regularly as possible, we try to get together with friends about whom we care deeply.  Scheduling ahead helps. Again, we’re never sorry we did, and good times and lasting friendships are shared by all.

Rinse, repeat.

How do sports medicine physicians (MD or DO) and physiotherapists view chiropractic?

How do sports medicine physicians (MD or DO) and physiotherapists view chiropractic?

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My perspective on chiropractic, outlined below in 3 parts, is that of an advanced muscle therapy practitioner who has worked with many wonderful DCs in the Bay Area. We’re lucky to have them and their services.

1. How do sports medicine physicians (MD or DO) and physiotherapists view chiropractic?

This will depend heavily on which MD/DO you ask, their professional training, and the focus of their practice. Those that specialize in pain medicine are often acquainted with experienced DCs that are very skilled in helping people get out of pain very quickly. Chiropractors have a very in-depth training in musculoskeletal anatomy and physiology that enables them to understand and enlist effective therapeutic techniques that can achieve speedy relief from symptoms. The proof is in the result: does the patient feel better, or not? Although no technique is a panacea, a DC’s techniques often yield an answer of “yes.”

In my 24 years of experience, I’ve found that sometimes you need someone skilled to cavitate a joint (therapeutically manipulate the alignment of the bony tissue), or series of joints, if they are “stuck.” You have to take into account the tension and function of soft tissue as well (perhaps even primarily), but if the joint is “stuck,” it needs to be mobilized, softly and mindfully. It won’t be functional otherwise, and therapeutically, that’s the bottom line.

2. Has chiropractic managed to shake itself loose from the old Palmerian dogma of “subluxations” and the notion that “adjustments” can cure all manner of illnesses?

As far as I know, DC curriculum still includes such dogma. However, any responsible practitioner knows that no technique is a panacea, and answering on behalf of those DCs who no longer subscribe to such notions, and whom I respect, the answer is “Yes.”

Good DCs have many therapeutic techniques besides “adjustments.” When used well, they get great results in pain management.

There are many symptoms and conditions where cavitation can help provide comfort. See also this entry on Quora.com: Human Physiology: Is it okay to pop/crack your joints (knuckles/back/neck/etc.) daily?

3. How prevalent are chiropractors in sports medicine?

Again, this will depend on the area of practice and training standards. If someone is good at what they do (getting people out of pain and back to functional levels), they could be an MD, DO, PT, DC, or MT. “Therapy” is a very divergent and fluctuating field, one that has only one goal: Get Someone Better, ASAP. The trick is, the modality must be consistently effective and reproducible. As in any therapeutic field, great DCs are well-educated healers. They will most probably be at the forefront of challenging cases, providing pretty astonishing results. I’m honored to be working with some of the best of them. They continually, delightfully, surprise me and my patients with results that we can’t get from soft-tissue therapy or medications alone.

When you’re injured and something is swollen, why is it good to ice it?

When you’re injured and something is swollen, why is it good to ice it?

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Your body’s soft tissue includes muscle, fascia (connective tissue), nerves, blood vessels, and lymph vessels, predominantly. When this soft tissue is injured (via bruise, tear, sprain, etc.), it is like a bunch of broken fluid pipes that require the “pressure” to be turned off until the pipe can heal enough to resume stable and reliable function. To reduce this pressure, short, local applications of cold are called for.

The effects this has on the injured joints, bursae, or fascia include:

  • vasoconstriction of blood and lymph vessels, which squeezes out excess plasma and lymph from the site of damage and helps control hemorrhage and hyper-edema (excessive swelling), and
  • brief analgesia, or relief from pain, which may help moderate the inflammatory response from excessive to helpful.

What we’re going for here is modulation of the inflammatory response from over-reactive to measured. This allows the tissue to begin healing in the most helpful bio-environment possible. When applied properly, cold will accelerate the healing rate via beneficial tissue metabolic activity and enhanced return to comfortable function.

1. Hydrotherapy; Theory and Technique, 3d Edition; Patrick Barron; Pine Island Publishers, 2003; pg 72

If one had a probable hernia that has gone undiagnosed by a doctor, and which is negatively impacting one’s quality of life, what should one do?

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First, it’s good that one see a doctor, even if that doctor is unable diagnose the problem. If there is no diagnosis of hernia, however, below is some information concerning the muscle-strain aspect of this issue.

This presentation of symptoms is consistent with a strain of the external oblique muscle of the abdominals (shown in red, below):

Lateral abdominals

The strain can result in a trigger point, which is a hyperirritable locus, or “knot,” within a taut muscle band that refers (sends) pain to a location distant to it (pictured as circles in the above picture). The trigger point we’re concerned with is located in the bands of external oblique about 1-2″ above the inguinal ligament (groin line). This is the lower circle in the picture. If you lean forward a bit, to relax this muscle, you can feel the fibers of this muscle going in a diagonal line:

Anterior view of the abdominal muscles

You can palpate (feel) this muscle quite easily, as it is very near the surface of the body:

Abdomen: Iliocecal Junction

After you’ve found the taut, guitar-string-like band of external oblique, do the following:

  1. Apply heat to the area first. This will help relax the muscle fibers and flush pain chemicals from the tissue. This also dilates the blood/lymph vessels and brings fresh blood to the area, making it easier to “dissolve” the trigger point (#3, below).

  2. Run your fingers up and down the band (guitar-string) of the external oblique muscle to find a “knot” (trigger point) or point of “exquisite tenderness.”

  3. Push on the trigger point for up to 1-2 minutes. It should feel as if it is “dissolving,” softening, or simply becoming less sensitive. Keep the pressure on until it feels done “dissolving.”

You can also use ice packs along the lower ribs to decrease motor nerve over-activation to this muscle.

(For more information on the Abdominal external oblique muscle, please click on the highlighted text.)

Next, It is important to take the external oblique muscle through its full range of motion following trigger point release. The following stretches are helpful:

  • A full (careful, non-painful) lunge:

A full (careful, non-painful) lunge

Please be careful not to take the front knee more forward than that side’s foot (which can strain that side’s knee). Observe the upright calf angle here on the forward leg.

  • A good side-stretch:

A good side-stretch

Observe that the person reaches up and back over the side being stretched, which directly stretches external oblique

If there is pain during these stretches, fall back to a position where there is no pain, just a sensation of “pull/stretch.” Then relax/breathe until you don’t feel the pain anymore.

If there is sharp pain at any point during these exercises, STOP immediately and ice the area of sharp pain. Wait until all pain or tension in the area has passed. Then try again, going much slower and easier.  

If these techniques do not work within one week of daily practice, more interventional techniques (trigger point injection or nerve block) may be in order, which a pain management specialist can determine.

In my practice, I have found that roughly half of the cases respond quickly and well to these simple techniques. More severe strains (most often sports injuries, and minus hernia diagnoses) require the deeper interventional techniques mentioned above.

How would you go about finding an experienced RSI therapist?

How would you go about finding an experienced RSI therapist?

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The most important first step in finding a well-trained and experienced RSI therapist is to find a great physician who is a specialist in occupational injuries (such as RSI). This doctor must be committed to referring to a good hand, physical, or manual (massage) therapist who has the training, experience and track record of success in treating RSI and associated dysfunctions.

I have had great success in working with occupational physicians at the major hospitals in San Francisco (where my practice is located). No one knows how hard these gentleman and ladies work; they are a credit to their profession. My current favorites are Jules Steimnitz, MD (at St. Luke’s), and Elliott Krames, MD, and Robert Markison, MD (UCSF). They have been exemplary physicians to their patients over several decades, and I am proud to work with them. They don’t monkey about in deciding the best and most comprehensive course of action for RSI cases, and they are willing to go to bat with insurance companies that drag their feet or are blatantly obstructive.

I believe the very best Hand Therapist in SF is Pam Silverman, LHT at Hand Therapy of San Francisco. If I had RSI, and I didn’t know which doctor to choose, or even with whom to consult, Pam would be my first stop. She has worked with, and on, the best.

Yelp is a good resource for finding good therapists, but the quality of the reviews are spotty sometimes, as they are written by patients. Use with caution when vetting medical talent.

The last resource (or perhaps the first) is your gut. Check out a therapist’s website. Talk to them. Check out their CV/resume. Check out their reviews. If you give them a “try-out” session, be ruthless: do you feel relief or not?  Have they helped you with tension reduction and helpful advice, or not?

In the end, medicine is a service, one that serves the patient. The US is a free market, and each patient is beholden only to themselves and their recovery. Find your best medical “servant” who will help you recover the fastest. Settle for nothing; life is too short.

 

How do I know whether or not a stretching exercise could actually hurt my body?

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Very simply. The best way to ascertain if a stretching exercise is hurting you is … wait for it … if it hurts to do it.

Your body is actually quite adept at letting you know if it is being hurt. It is “wired” with sensors that send your brain pain signals if damage is occurring. If a stretch you are doing results in a sharp twinge or an “uh-oh” kind of sensation, it is best to STOP that stretch, and to also leave off similar stretches to that muscle and its myotatic group (associated muscles).

Rest is to follow, as well as ice applied to those muscles (to reduce swelling and inflammation). An anti-inflammatory medication such as ibuprofen (Tylenol) may also be called for. If symptoms are severe, naproxen (Alleve) can be especially helpful in the short-term. Please consult a physician if you are not sure what to take or are concerned about drug interactions or side effects, or if you have other significant health issues.

What is the “dark side” of Silicon Valley?

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Workers’ health and physical limits are often disregarded in the tech industry. This results in repetitive strain and other physical injuries, as well as psychological damage and disability from excessive stress and destructive self-criticism. From the 90s until the present day, every tech boom has resulted in a large increase in RSI cases, Fibromyalgia and other myofascial and systemic syndromes, as well as hypertension and associated illnesses. Whether by their employers or themselves (in the case of entrepreneurial start-ups), people are placed in situations with inhuman stress levels and unsustainable, unrealistic expectations. While we all may want to be Superman, our bodies and our minds are only capable of so much. To exceed our capabilities often results in injuries that can take months, or even years, to heal. Some never heal at all. Careers are lost, along with self-worth. The stress of this and further depression take increased tolls, and suicide rates rise.

I worry about the future for current tech workers. When someone feels they have no recourse other than to “work until they drop,” they do just that. Serious injury is often the result, and the prognosis for recovery becomes darker and more complicated. We now live in an era of the ”disposable worker” – a Very Slippery Slope, indeed.

My colleagues and I feel there must be more stringent protections for tech workers. Management must be held accountable for the basic safety of their workforce. It’s just good business to retain talented, skilled people, and thus the investment the company has made in them. It also just happens to be, IMHO, the most moral decision.

Ultimately, however, it’s up to each and every one of us to take care of ourselves. What use are fame and fortune if your health and functionality are too “blown out” to enjoy them?