Thursday, May 12, 2011

Obesity...its not just for breakfast!

As a chiropractor, "rehab guy", "soft tissue guy", "neurology guy", trainer, and even referred to as "kind of a mixture of a bunch of things"...the biggest problem I see in the world of rehabilitation and physical fitness is THE MAJORITY OF THE PATIENTS I SEE ARE TOO DAMN FAT!

No, not very political of me but then again most of you who know me can attest to that.

FAT is not a bad word, however there are good fats and bad fats. Confusing but off the target a bit.

How did the US get so FAT? I think I remember the one fat girl and one fat boy in grade school (I will not mention their names for fear of bringing back bad memories for them), and the rest were the skinny, wiry little types of that generation (the 1970's). Longish hair, and Toughskins jeans falling off until we started to outgrow them then the constant harassing about waiting for the flood waters. One pair of pants (usually plaid, blecht!) for church, and one pair of Toughskins for everything else. We used patches in those days, and when the patches on the patches wore out then they were made into cut off jorts! We didn't need much and since that was the norm, didn't want much.

A 12 oz can of Coke was a treat, and walking to Tom's (variety store, non-existent now) for a Hostess cupcake was a real luxury.

Did I say walking? Oh yeah we did that back then. We walked, and we played, and we walked to go play, and then we walked again...sprinkle in the random fisticuffs for good measure since boys will be boys...oh yeah, then we walked home with our scraped knees, and bloody noses, washed off and took a drink from the hose, went in and ate something which was made just prior to our eating it...

OK, here is your objection and usual gripe and wine. "I don't have time to make dinner because in today's world both parents have to work". Here is my answer. Quit F---ING whining! My parents both worked, long hours...longer than I am sure the majority of people work today. But as adults they cared more about their children then themselves. Wait, that's it! I know why everyone is so fat!

When a parent looks at their child and sees an obesity problem, they must not really care enough for that child! When a spouse looks at their spouse and sees an obesity problem, they must really care for their spouse. When a friend looks at a friend and sees an obesity problem, they are not really friends after all...unless they are trying to help them.

The reason that there are so many FAT people in the US is because people care about themselves more than they care about others. Sure we can blame the food companies, but we eat the shit they put out there. We can blame the government, but we still elect the same assholes looking for easy work and benefits over and over again. We can blame everyone we want, but until our blatant lack of caring for one another in this world changes, we will still see rising rates of cancer, diabetes, heart disease, metabolic disorders, learning and behavioral disorders, etc., etc., etc...

Start today. Get a good friend out for a workout. Force your child to be physically active. Yes, I said force them. After all you are the parent, not their "freakin' buddy"! Tell your spouse you love them enough not to let them die a horrible, drawn out, demeaning death from one of the many cancers we dump trillions of dollars into just to have them win! If you are a medical practitioner, grow some balls and tell your patients they are TOO DAMN FAT and they have to do something about it now...not "the beginning of next month I'm really gonna start that new diet" bull pucky!

I took my friend for a work out today, don't want to see him die from (fill in the blank). I will encourage and give guidance to all my patients today regarding diet and exercise because I don't want to see them die from (fill in the blank). I will encourage all of my loved ones to do the same, because I care for them and I want them to stay alive so I can continue to build memories with all of them and not have them die unnecessarily from (fill in the blank).

Please try to do the same

Saturday, February 19, 2011

What a Combo-Platter...
Chiropractic and Strength and Conditioning

Let me qualify the above title...our brand of chiropractic at Marchese Sports Therapy...not the blind gorilla manipulators.
That said, why do the two go together?
In the recent past a large emphasis in strength and conditioning has been focussing on what is termed CNS fatigue. What's disturbing is that the majority of coaches using this mystical term have no idea what components of the human nervous system make up the CNS. Briefly put it is comprised of the brain and spinal cord.
With that said, how do we evaluate for CNS fatigue? Why is chiropractic care an essential part of strength and conditioning, yet may be the only subspecialty kept off a professional teams health care staff (that part still puzzles me to this day). I cannot go into the testing, that would be akin to giving a loaded gun to a mass murderer. "I had them close their eyes and they fell over and busted their wrist...his post didn't say anything about that". What I can talk briefly about is why chiropractic is actually very good for athletes who value the most important "muscle" they have...their brain!

A former patient of mine who has been in the NBA for several years once said "it is only a matter of time before this s--t is in every locker room in the NBA". he went on to say "if I ever become a GM or something, my players will be getting this kind of work". Me being the eternal pessimist replied "not likely".

What he was referring to was a systematic stimulation of the nervous system utilizing multiple bone and joint, as well as soft tissue, and therapeutic exercise/neurological re-education techniques. You are probably asking yourself what is special about this?
Why should we be impressed by this? The simple answer is that we as chiropractors have the ability to perform an extensive orthopedic, neurological, and biomechanical evaluation and then have the ability to interpret the findings in a way that no other therapeutic profession is doing now, to come up with a set of tools to put to work restoring the lost function as indicated by the examination. The most important to the athlete concerned with the state of his or her CNS "fatigue" is the neurological aspect.

The human body after all is a system of neurochemical exchanges which pass for communication. Chiropractors can affect the communication utilizing input into the central nervous system (adjustments, soft tissue manipulation, therapeutic exercise/neuro re-ed, ems, etc) for the soul purpose of changing the central integrated state (level of functioning of the central nervous system) of the CNS.

If the central integrated state (CIS) of the athlete is improved, and monitored before and after the implemented therapeutic intervention, the athlete should be able to respond to the stressors they face during their competition in a competent and effective manner. This seems like a no-brainer eh'?
Devils advocate here. There is no all encompassing term to describe the function of the central nervous system. Let's just use the term central integrated state to mean a compilation of the neurological findings accumulated by the chiropractor during the evaluation. It is merely the sum of all the excitatory and inhibitory potentials occurring in the nervous system. Too much inhibition in the system and the CIS is low and far from threshold (achieving its task). this has been referred to as "global dampenning" by Thomas Culleton DC, DACNB. Too much excitation and the CIS is too close to threshold, possibly allowing for an escape of function. does the CIS get affected by the various techniques and interventions put forth by the treating chiropractor? One example would be to increase the sensitivity of a muscle found to be difficult to bring to threshold (contract/activate), compared to others which may lead to muscular imbalances, and potential injury. How is this achieved? First identify the muscle(s) via evaluation procedures. Next pick the appropriate intervention to increase the ability of the muscle to fire, then implement it. An example could be, if a muscle is too close to firing (maybe described as "tight" or "cramping") then the appropriate intervention would be to "relax" the muscle and decrease the activity of the muscle spindle, using a "fast stretch technique". The common response would be to statically stretch the muscle, but unfortunately that would lead to increased muscle spindle activity, and potential for injury to the athlete.
A simple neurological approach towards keeping athletes on the field. Not mysticism, which is what the non-self-informed majority believe goes on during chiropractic treatment sessions.

For the sake of the athletes health, chiropractic (remember the caveat, and find and support the good ones) is an essential part of a whole health care team. Not just adjunctive fringe!

Saturday, March 13, 2010

Baseball, Hot Dogs, Apple Pie, and 17 Million a Year

As the 2010 campaign for the World Series begins in the MLB world, millions of children are beginning a quest of their own to master everything from the dig at first base, the defense of the hot corner, and slapping the ball to the opposite field on a pitch down and away. The irony is that these kids are not being paid to do this, they are in fact paying to play a game they love and hope in many cases to continue loving for many years.
Baseball is a game which enlists very fond memories in my brain, and most assuredly in the minds of other 40 somethings. The different colored tee shirts to symbolize the team we played for now replaced by cutting edge uniforms, sliding pads and cleats where Chucks once were. The beaten and battered glove, reeking of vasoline, and the underside of your mattress where it stayed in hibernation all winter bound up with twine and housing a similarly beaten and battered baseball with a few stitches replaced by the latest and greatest "position specific" glove, a must in the age 7-10 brackets eh'? A volunteer coach, occasionally a father of one of the kids on the team trying to show you how to swing and get some contact with the ball, replaced by batting coaches at 75 clams an hour at indoor facilities.
The past time has changed for the youth of America, and the habits, like everything children learn, are passed down from the adults.
What got me thinking about baseball has been the talk this week in Boston about Nomah' retiring as a member of the Bosox. Why? What I can recall about that Friday night at a certain drinking establishment in Charlestown is hunkering down with a couple of compadres to watch the hometown 9 take on the dreaded pin stripers. Guess who walks in and takes a table in the corner with his buddy. You guessed it.
So with the kids spending bundles of dough on the "American Pastime" this spring to emulate their heroes in the big leagues and maybe one day be like them and "get paid" like them (becoming a catchy tattoo in professional sports), try to keep them on the path and don't get caught up in the major league hype. Stay rooted in what baseball is all about...colored tee shirts, plaid pants, Chuck Taylors and runny noses on the kids who are smiling and enjoying baseball for "the love of the game". Stay Gold.

Saturday, February 20, 2010

Pearls for the Chiropractor, Trainer, and Weekend Warrior...

Chiropractor: When treating a patient with a primary subluxation, and a secondary muscle length discrepancy remember these tips for assessment...
1. Isolate the muscle to be tested by positioning the joints the muscle crosses in an alignment to maximally stretch the fibers in the direction they anatomically align.
2. If the muscle crosses two joints, affix either end of the muscle while you move the other attachment away in a super slow manner not to allow for any jerking movements to affect your assessment.
3. Try to get as much feedback from the patient during the muscle length assessment. They are your sensory input.
4. Muscle length restriction can be mistaken for neural tension, and vice versa. Know the difference!
(Thank You Dr. Janda, rest in peace)

Trainer: You cannot warm up your client too much! Especially during the cold winter months.
This includes conditioning apparatus, movement series (dynamic warm up), joint mobility, calisthenics, agility, etc. Take it from an "old bull" who loves to jump into the heavy stuff right off the bat, take the time to warm up the tissues. Use an extended warm up on the next visit, or have the client come in early and post their warm up to be done on their own until you are scheduled to take them. Safety and efficiency. Better than sliced bed!

Weekend Warrior: Don't ignore pain. It is a warning sign that something you are doing is wrong. Get it checked right away by a chiropractic sports physician, before it becomes an every day occurrence. Trust me, little aches are easier to get rid of than 6 years of big aches! To save time for your chiropractor, write down your workouts and the symptoms you had during the specific exercises. This can help determine not only what is wrong with you but also how to fix it and prevent it from coming back again.

Stay Healthy, Listen to Your Body!

Wednesday, April 1, 2009

Today's Workout...
Joint mobility, strength stretch, LTI holds
Arm bars 2x15 ea. 16kg
partial TGU w/bridge up 2x5 grind ea. 16kg
stagger swing ipsi. 25 sets, 20 sec. on 20 sec. off, 16kg
stagger snatch ipsi. 6x20 ea., 16kg
MP to windmill 3x12 ea., grind, 16kg
Warrior I
Up/down Dog

Decreased lbp, increased energy, ready for long day!
The Massachusetts Chiropractic Society meeting was a great motivator to stay in good condition to better instruct and serve our patient base. A lesson the majority of physicians at the meeting had obviously forgotten about. Walk the walk to talk the talk!

Saturday, August 16, 2008

Cynnical Hour

"Hello all, my name is John..."
response from the crowded room..."Hi John"
"...and I'm a chiropractor."
a cautious yet somehow friendly grumbling arises from the room
"It's been 12 years and 6 months since I officially entered the chiropractic profession."
the crowd cries out its supportive Sundays best..."at a boy John...good for you day at a time kiddo!"
the lights dim on this dream and on the other side of the id-ego-super ego border arises the morning traffic report as the alarm clock spews forth it's 4:45 am rooster imitation.

I figured that my first article/expounding in the world of blogging could be used to address one of my favorite newly developed pastimes from the past year. Cynical Hour!
First let me present you the reader with some background. In our multidisciplinary clinical setting the space is shared amicably between chiropractors (mixers of course), personal trainers, physical therapists,acupuncturists, massage therapists, and traditional Chinese medicine practitioners. Strangely enough we all get along. From the outside it may resemble a meeting of Israelis, and Palestinians, with a smattering of Buddha and Vishnu...but on the inside we get on like "peas and carrots". Multiple practitioners from varied backgrounds working hand in hand towards a common goal...outstanding patient care!
We start early and end late. Similar to many other professions in the highly stressful and, lets face it, expensive northeast. So we work a lot. So what you say, everyone does. You are correct, everyone does. Doesn't make it right. Kind of like paying $3.94 a gallon for gas and thinking "gosh that's low". conditioned response. Insanity warmed over.
So we have the 5 pm hour to look forward to, to become cynical regarding the "topic of the day". 8 am to 4:59 pm, good times and good vibes. 5 pm to 5:59 pm cynical. 6 pm to close, sailboats and puppy dogs all over again.
Topics range from conspiracy theories regarding pro athletes retiring and un-retiring at the last moment to avoid drug testing scrutiny, to blaming children for their childhood obesity (shame-shame parents!).
So why bring this whole cynical hour (CH) thing up in an article. Good question. As a chiropractor and especially as a chiropractor who is over and over again embarrassed by his own profession (hence the dream regarding CA, chiropractors anonymous) one topic of CH came up which particularly ruffled my bloomers and transitioned my cynicism into mild anger.
Enter the players...Dr. Tim Morgan (outstanding chiropractor, cyclist, and center ice man), Patient A (cyclist, avid gym bull, salt of the earth guy), Dr. Melrose Neurologist (even though he is a jackass he deserves his privacy respected).
Patient A suffered a cycling palsy as diagnosed by Dr. Morgan. Even though the majority of these syndromes are self resolving with conservative care, Dr. Morgan still felt Patient A should be further evaluated by a neurologist to utilize further testing should the need arise. Chiropractors in Massachusetts have great difficulty ordering specialized tests (impossible actually) and the patient should not suffer due to our biased image. Patient A went to his appointment with Dr.M Neurologist and was met coldly and suspiciously. Dr. M Neurologist then asked the patient "you look like a smart guy, why are you going to a chiropractor?". This line of questioning went on for 30 minutes without Dr. M Neurologist even evaluating the patient for his presenting complaint. The patient was infuriated with the doctor and voiced his disdain to Dr. Morgan on his next visit. In our therapeutic setting the room is open with curtains if privacy is needed as well as multiple private rooms if further privacy is needed. Patient A entered the therapy suite after 5 pm. Good timing. Our discussion went on for the majority of the hour and involved shock, anger, disdain, sadness, and eventual acceptance that "it's just the way things are". Gas prices too high, pro athletes in trouble, "I just can't keep my 5 year old from eating junk"...just the way it is I suppose. You can get used to just about anything I suppose...insanity warmed over.
Well, at the end of the cynical hour I wasn't able to let it go. I kept thinking about it and thinking about it. The chiropractic profession is over 100 years old and it is still looked upon as borderline quackery.
Can we place the blame on the medical profession? Can we place the blame on the pharmaceutical profession? How about the media, they defecate on everyone! We have to blame someone don't we? It can't be our fault!
One of my favorite movies is "The Shawshank Redemption". In it was the phrase "get busy living or get busy dying". Pretty soon chiropractors will be sitting on the park bench next to Spuds McKenzie, Jim Thorpe, John Adams, and Leonardo DaVinci feeding the bleeping pigeons and listening to Jim talking about winning the decathlon again, or John reminding us that kicking out the British was HIS idea.
This writing is primarily meant for chiropractors as a wake up call. It is our fault! No one else's. Our fault. Dr. M Neurologist was the extreme case, but nonetheless I get tired of hearing from the supposed approving MD's "well, if you feel it helps you, then you can keep going, but I cannot medically justify the care. Just don't throw away your wheelchair" (true quote from very well known MS specialist in Boston).
So Dr. Know It All, what do you suggest? Any pearls of wisdom?
All journeys begin with a first step.
What may this first step be you ask?
In my first month, in my first year of practice I encountered a patient who was evaluated by my boss at the time, and re-evaluated by me for a specific extremity issue (another straight numbers game DC in the area called me "that extremity guy" because his 3x/wk patient for 6 months had knee pain that didn't go away after being "adjusted" the same way on every visit..."I guess if you feel it helps you..."). After his evaluations he went to the front desk to schedule his report of findings visit, did so, and came back in for his flip-chart presentation (10 minutes) on chiropractic and rust on the bones, stalagmites in a cave (or were they stalactites?), etc., etc., 3x/wk for 6-8 weeks...initial intensive phase of care...OK lie face down. He got his first treatment (about 1 minute of contact time with the doctor) then I went in to do "that extremity guy thing". The patient was an old timer from the neighborhood I grew up in, a hardened Italian American laborer, who in his hay day may have been able to palm a Volkswagen Beetle. Before I could get to the business at hand (or in this case foot) he got one of his swollen, leathery meat hooks on my wrist and grabbed me, pulled me over to him and said "that guys full of s--t, you hear me, that guys full of s--t. Don't you be full of s--t." Never saw him again. But never forgot him or the words he spoke to me. Also I still cannot feel my fifth digit on my left hand.
Every journey begins with a first step.
I propose that the first step for the chiropractic profession going forward in the future is "don't be full of s--t"
So next time you as a chiropractor are telling a patient a canned treatment plan, spending 1 minute "adjusting" the same segments over and over again not knowing why except that those are the easy ones to get when employing the "flying seven techniques". Stop and think what you are doing to your profession. You DON'T have to see 1500 people a week. As a matter of fact you shouldn't.
And especially don't brag about it in the multiple "full of s--t" publications that pass for our professions societal magazines and newspapers. Just stop, think, and change.
Get busy living or get busy dying. Besides, Spuds keeps scaring the pigeons away!

Wednesday, April 16, 2008

Article coming soon!
Marchese Sports Therapy