ChiroMasterMind

At your core, there’s an incredible athlete. Lean and powerful. Strong, but still flexible. Use your core to transform your body—and your life, turn back the clock, speed up your metabolism, trim your waistline, build muscle, permanently rid yourself of nagging back pain and gain unlimited energy.  Sound good?  It can become a reality for your patient’s with a ” Core Regeneration Program!” 

So what is the core you say?  Good question. Lets start learning. 

The major muscles of your core include:

• Transverse Abdominis (TVA)-The deepest of the abdominal muscles, this lies under the obliques (muscles of your waist). It acts like a weight belt, wrapping around your spine for protection and stability.

• External Obliques-These muscles are on the side and front of the abdomen, around your waist

• Internal Obliques-These muscles lie under the external obliques, running in the opposite direction.

• Pelvic Floor- These muscles are responsible for support of your internal organs and abdominal contents.

• Multifidus-Responsible for stabilizing the spine and pelvis directly prior to limb and trunk movement.

Why should you care about the core?
Core strength enhances your overall fitness level. Your body moves more efficiently and gracefully. You gain more power in athletic moves and other exertion. And you’re less prone to injury and muscle pain. When your core muscles are weak, other muscles compensate by doing work they’re not intended to, and you’re more likely to wind up with chronic debilitating back problems and injuries to the knee joint.

Weak core muscles contribute to all kinds of problems in the body, the most prevalent of which is lower back pain. By strengthening the muscles that help support the spine and improve posture, you can dramatically decrease the symptoms of lower back pain. Picture your spine as a column of soda cans stacked one on top of the other. If you wanted to keep that column standing up under stress, what do you think would work better: a “tenser” bandage (as is used for wrapping injured ankles) or Scotch tape? Sure the tape would keep the cans together but the cans wouldn’t receive a whole lot of support, would they?

When you strengthen the muscles of the core, you are in effect turning that Scotch tape into a nice, tight “tenser” bandage, increasing the amount of support that your spine gets. Core training also has the potential to greatly improve sports performance. The core is the one area of the body that will always give you a great return on your investment.

So how do I train my core muscles?
Exercises that work the abdominals and the lower back are the staples of core training. Also, exercises that target the stabilization and power-transfer duties of the core muscles are very effective.  Here is brief exposure to the beginning of core training.  (A personalized one-on-one program is designed for patients.)

The exercise is known as the Abdominal Sit-Up. It uses a sit-up-like movement but focuses directly on the abdominal muscles rather than the hip flexors (which a regular sit-up does). It is also very safe for your lower back. Another advantage it has over the standard crunch is that it targets the stretched (arched back) range of motion of the abs, which is totally missed in standard floor crunch.

How To Do It:

Lie on your back on the floor. Roll up a towel or mat and slip it underneath your lower back, just above the waistband (the size of the towel affects your body position during this movement - use a fairly large towel). Your knees should be bent about 90 degrees. Keep your feet close together and knees fairly wide apart. This prevents the hip flexors from having a direct line of pull, helping to minimize their involvement. Do not anchor your feet or have someone hold them down. This automatically activates the hip flexors. You will get the most out of this exercise by minimizing their involvement.The difficulty of this exercise depends on where you hold your hands. The hardest position is above your head at arms-length, then beside your head, then across your chest, then straight down between your legs or at your sides. You are now ready to begin. (Do 3 sets of 12-15 reps)

• Keeping your torso straight and stiff, start the sit-up by tightening your lower abs then lifting your upper body off the floor.

• As you continue up, imagine trying to push your face up against the ceiling (think up, not around).

• When you reach about 25 to 30 degrees above horizontal, hold there for a second or two and squeeze your abs hard.

• Keep your lower back in contact with the towel at all times and always maintain tension in the abs.

• Lower yourself down slowly and under control. Do not just drop back to the ground. The negative portion of this exercise is extremely effective. Take at least 3 seconds to lower down!

• Remember to adjust your arm position depending on the strength of your abs

If you were to ask me which muscle group in your entire body you could work to get the greatest benefits in the shortest amount of time, I would tell you without hesitation, “the core.” Strengthening the core can realize tremendous benefits to anyone regardless of his or her training experience and can do so very quickly.  Have fun with the exercise above.

Dr. Perry Nickelston, DC VP of Practice Development for K-laserUSA.www.painlasercenter.comwww.-k-laserusa.com

1-866-595-7749 Ext. 102

Tags: Integrative Treatment Strategies, General by Dr. Perry
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What do you do for a living? What is your profession? Most people will answer with the name of their job title; “I am a Chiropractor, I am an Accountant, I am a Painter.” Wrong! Wrong! Wrong!. You are a MARKETER first. You can’t BE a chiropractor unless you have a patient to care for. They have to be in your office for you to do that, get it? So stop trying to become a better doctor, that’s easy. Become a better marketing professional. That takes time, commitment and LOTS of failures. Here is a list of some of the marketing essentials you need to know and implement for lifeling practice and business success. So do it already…

 Create Your Marketing Plan:

You cannot reach a destination you’ve never been to before without a map. Your marketing plan is your map. It is a PROVEN principle that those who take the time to think, strategize, set goals and plan – in writing – are immensely more successful than those who do not. If you fail to plan, you plan to fail.

Goal Achievement:

Use a DO-DOING-DONE storyboard divided into three vertical sections. New marketing  projects go in the DO section with approximate completion date. When you begin the project, move it to the DOING section and attach a hard deadline. When it’s completed, move to the DONE section and leave it up for 1-3 months to reinforce the positive feeling. This gives you visual accountability of your projects.

Unique Selling Proposition (USP):

Your USP answers the question, “why should I do business with you versus any or all of your competitors, or doing nothing at all?” A classic USP for you to consider is Domino’s “Fresh, hot pizza in 30 minutes of less, guaranteed.”  Your USP is the central theme of all your marketing.

Sampling:

Have you heard of the puppy dog close? That’s when you give the prospect the puppy to take home for a week and fall in love with it. After the week you go and collect payment. Nine times out of ten, the prospect will not be willing to part with the puppy. Providing a sample of a free chiropractic session or my favorite (laser therapy tx) is a variation of the puppy dog close. As long as you deliver value, it will work 90% of the time.

Back End:

As your business and marketing mature, you will find that your biggest windfall profits will come from your back end: the additional products and services you sell to your existing clients. You MUST have a back end if you want to grow a thriving business and stop being at the mercy of your clients. In most cases, your chiropractic services will be your primary back-end, but they should not be your only back-end.  Your goal is to continually locate or create additional products and services you can sell to your existing clients. Your market’s ability to consume far exceeds your ab ility to create, so look for Joint Venture products/services you can offer (e.g. nutritional consulting, massage therapy, rehab supplies/equipment, information products, etc.).

Think outside the box. Have fun and enjoy.

Dr. Perry Nickelston, DC

1-866-595-7749 Ext. #102

www.k-laserusa.com

www.painlasercenter.com

 

Tags: Integrative Treatment Strategies, Practice Tips of the Day, General by Dr. Perry
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“I can’t close my bra in the back.” “The pain in my shoulder is terrible when I turn on it in bed at night. “It hurts like hell when I try to put on my T-shirt.” “The pain starts in my shoulder and goes down my arm to the elbow.” “The pain is so bad, that I can’t workout without pain.”  “Just thinking about exercise makes my shoulder hurt Doc!”

These are typical of the things I hear from patients consulting me about shoulder pain. Most ailments afflicting the shoulder have a gradual, often imperceptible onset. We keep thinking it’s going to get better, but our range of motion decreases progressively because of our natural avoidance of moving into pain. Muscles and tendons shorten, joints tighten and movements are more limited, until daily activities become so difficult we finally have to scream for help.

The shoulder is not a biomechanically efficient joint, nor is it one single joint. The head of the upper arm bone (humerus) sits rather insecurely in an extremely shallow cup at the outer upper angle of the shoulder blade (scapula) called the glenoid fossa. Essentially, it is held in place by the muscles and ligaments attached to it. Extreme movements in any direction, but particularly overhead and/or to the back, subject those tethers to stretching which eventually results in slight tearing of ligaments and tendons. The body attempts to protect these structures and sets up a reaction called inflammation. The inflammatory response is associated with swelling due to increased blood flow, further restricting motion and increasing pain.

MOST COMMON INJURIES FOR PEOPLE WHO EXERCISE

Rotator Cuff Injury. Tears in the rotator cuff can result from the progressive worsening of tendonitis, repetitive strain through overuse, or trauma- especially as a result of athletics. The gradual tearing of the rotator cuff is a process similar to a shirt wearing out- it gets more and more threadbare until the edges fray or a hole appears. This sort of rotator cuff injury can be difficult to repair surgically, and conservative treatment under the direction of a professional is often the best course of action.  A “clean” tear to the rotator cuff (due to trauma) can often be repaired surgically. Whether or not surgery is indicated, Sports Medicine treatment will almost certainly be involved in all stages of recovery.

Bursitis/Tendonitis go hand-in-hand. Inflamed bursa sacs and muscle tendons may become thickened and reduce the “free” space in the joint, thus restricting movement. In extreme cases some of the bursa sacs can be removed surgically; otherwise, the therapeutic approach to treating bursitis and tendonitis is similar.

Impingement refers to a condition, sometimes painful, in which the shoulder joint lacks enough room to function properly. Structural impingement is a “built-in” organic condition, e.g., a bone spur in the shoulder joint. This situation is usually the result of years of tendonitis, rotator cuff injuries, and wear-and-tear. It is important to note that structural impingement usually requires surgical intervention.Functional impingements often result from repetitive motion situations (such as pressing movements overhead with weight training). Stretching and rotator cuff exercises, along with proper CORE muscle balance training, can help prevent and alleviate functional impingement.

Trigger Points are “knotted” up muscles in the shoulder that cause significant debilitating pain and restricted movement.  The most effective treatment for these points is aggressive Orthopedic Sports Massage.      

               

TRAINING SECRETS   ********    TRAINING SECRETS

Balance your upper body workouts

A good way to avoid shoulder injuries is to make sure your upper body strength sessions are balanced. This means that every push or press exercise must be balanced with a pull or row exercise. Too many athletes and weight trainers focus on developing the ‘mirror muscles’, the upper trapezius, anterior deltoid and pectorals. As a consequence, the ‘non-mirror muscles’, lower trapezius, rhomboids, latissimus dorsi and rear deltoid, are underdeveloped. This leads to a muscular imbalance about the shoulder, which results in poor scapular stabilization. since the non-mirror muscles are the ones that work to stabilize the scapula. In addition, over-developed mirror muscles can lead to a round-shouldered posture, which incorrectly places the scapula up and forward. Redressing this imbalance is very important for the prevention and rehabilitation of shoulder impingement injuries

Limit your range of movement, and take it easy

Often this means avoiding certain ranges of motion where the shoulder joint sub-acromial space is compressed the most. The impingement zone to avoid is between 70 and 120 degrees of shoulder abduction (when you move the arm laterally away from the side of the body). To start training the non-mirror muscles, begin with the seated row, because the shoulder joint is not abducted in this exercise. Once the pain is completely gone, then introduce the overhead exercises such as pull ups and lat pull downs. You should be even more careful when it comes to the mirror-muscle exercises. I would avoid lateral raises, upright rows and shoulder presses completely for a while. However, incline bench press with arm abducted to 45 degrees would be a good choice to start again. Slowly build up to the normal bench-press range as strength improves.

Correct scapula positioning when performing exercises

The correct position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a good ‘military posture’, with shoulders back and chest out. A round-shouldered or hunched posture is to be avoided at all times. To achieve the correct position, you need to use your rhomboids, mid and lower trapezius muscles to retract the shoulder and pull the scapula down.

When you perform any upper body weight training exercise, always get into the habit of starting with good upper body posture and pinching the shoulder blades together. You should feel that the scapula is a solid platform which keeps the shoulder correctly positioned while you perform the exercise. As mentioned last issue, a good way to learn the correct position is during the seated row exercise by keeping your scapula back and down while you move your arms. During the exercise, you should feel that the rhomboids and trapezius muscles are statically contracting to hold the scapula in place, and the latissimus is working to perform the movement. Once you have the feel for maintained scapula stability during the seated row, try to achieve it during all upper-body exercises. What you might find is that exercises such as the press up or front raise, where the shoulder may become impinged, will not be painful if you stabilise your scapula correctly. In effect, by using the scapular muscles you can achieve better shoulder mechanics and avoid injury.

Correct scapular stability is difficult to learn and demands a great deal of practice and concentration during your training sessions. You first need to understand what the correct position is, and often this requires a professional to guide you. Instruction and observation can help you achieve and maintain the correct shoulder position.

Avoid too many consecutive training days

The more consecutive training days you have, the higher your chances of getting hurt.  Consecutive days are counted as follows: if you train on Monday, Tuesday, Wednesday, and Friday, you are training on three consecutive days each week (Friday doesn’t count because it has a rest day before and after it). Studies show that reducing the number of consecutive days lowers the risk of injury. This means that if you train for one hour every day from Monday through Friday (five consecutive days), you could reduce your risk by completing 75- minute workouts on four days per week (Monday, Wednesday, Friday, and Saturday, for example). Your total training time (and gain in fitness) would be the same in each case, but the second strategy would reduce your consecutive days from five to two, giving you much more average recovery time between sessions and a lower risk of injury.

PROPER Stretching

Stretching to increase flexibility should never be done prior to training or competition, but instead done during ‘down’ times in the week. This is because of the suppression of the ‘stretch reflex’ that takes place during sustained passive stretching of muscle tissue (i.e., repeated holds of 20-30 seconds). If one were to do rapid forceful movements such as lifting weights straight after such passive stretching, there would be an increased chance of muscle and tendon tears. For flexibility every muscle needs to be stretched three to four times at 20-30 seconds each, and repeated three to four times per week. The best way to learn how to stretch the above areas is to be taught by a sports physiotherapist, sports conditionist or personal trainer. It is important not to stretch the ligaments of the shoulder, which in due time can cause laxity of the joint and potential instability.

If you have a shoulder injury and would like to try to treat yourself, please remember:

It would be wise to visit a Sports Medicine Specialist to rule out structural damage first, via X-rays, CT-Scan, US Scan or MRI, particularly if your shoulder joint experiences sharp catching pains, locking sensations, clunks, pins and needles or numbness, looseness or laxity, or the history of the injury was in any way traumatic, involving body contact or a fall.  The length of time it took to develop your problem will give you some indicator of how long you will need to persist with correcting the faults before the results will be felt. Don’t forget, that the pain is often only the tip of the iceberg, directing you to the real issue.

Dr. Perry Nickelston, DC VP of Practice Development for K-laserUSA.

www.painlasercenter.com

www.-k-laserusa.com

1-866-595-7749 Ext. 102

Tags: Integrative Treatment Strategies, General by Dr. Perry
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Patient Education! It can mean the difference between practice success and failure. Making money or starving. Before your patient leaves the office after your Report of Findings and during their care plan, they MUST know and understand the following 12 points. These are in no paticular order, but each one is an integral part of the success formula. Practice. Practice. Practice. Everyday.

1. Chiropractic care is SAFE!

2. The condition they have

3. They should get rid of the problem

4. Condition is caused or related to ’subluxation’

5. Chiropractic CAN HELP!

6. As treated, symptoms will disappear

7. Symptoms gone-Still have an underlying condition

8. Drop out of care too soon-Symtoms WILL return

9. Differnce between Relief Care vs. Corrective Care. (Which do THEY want?)

10. Status of Progress Reported during care. They need objective feedback

11. Treatment Plan-They need a roadmap and a plan to follow. Commitment required.

12. Insurance and Financial responsibilties-No surprises!

If you fail to educate you fail to retain! You have failed to deliver value for the patient’s investment. No one turns down a ‘Good Investment!” You never get a second chance to make a first impression.  Keep your attitude in check. An attitude can be more important than facts. It can make or break a doctor. You can’t change many things in life, but you can always change your attitude! Invest your time and effort into learning more about education and communication. Have a plan and follow it! Until next time…

Dr. Perry Nickelston, DC

VP of PRactice Development for K-laser, USA and Clinical Director of The Pain Laser Center, LLC in Ramsey, NJ.

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. 102

Tags: Integrative Treatment Strategies, Practice Tips of the Day, General by Dr. Perry
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Depends on the success rates you want to obtain in laser therapy. Higher power allows for a greater range of clinical applications, leading to patient satisfaction. Not to mention, your financial satisfaction. Next to an accurate diagnosis and proper clinical training in laser therapy application, dosage is the single most important parameter for a successful outcome in laser therapy. Too little energy produces no effect. The primary factor in lasers that determine dosage is power. 

DOSAGE = Power x Time 

While power is the amount of energy measured at the source of the beam, dosage is the amount of energy delivered to the skin. Dosage may also be referred to as energy density or fluence. Its unit of measure is the Joule. Higher power gives a higher power density, which very often is beneficial.  Insufficient power cannot be compensated with more treatment time!  Positive results require more than increasing time. By itself dosage cannot adequately describe laser treatment. One must ask several questions. What is the depth of the target tissue? Is the laser power strong enough to reach this target? 65% of laser energy is absorbed by the subcutaneous tissues, so you must take this into account when determining the laser power options. 

Example:

Given enough time a 500mW laser could administer a dosage equal to that given by a 2 watt instrument. Yet results will be very different. The higher power density of the 2 watt laser will penetrate far more deeply and with greater effect. 

Dosages and power at higher ends typically provide better results, as long as treatment intervals are not too close together. 

I often meet doctors who do not know what type of laser they should purchase. When asked, it is not unusual for them to respond 3B. Make sure to investigate the option of Class 4 lasers too. Trust the science, not the sales brochures!

Perry Nickelston, DC

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. 102

Tags: Integrative Treatment Strategies, Class 4 Laser Therapy, General by Dr. Perry
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COMMON KINETIC DYSFUNCTIONS

There are three common kinetic chain dysfunctions you must be aware of to treat a patient effectively. These include the Lower Crossed Syndrome, Upper Crossed Syndrome, Pronation Distortion Syndrome.

LOWER CROSSED SYNDROME

A patient with lower crossed syndrome shows increased lumbar lordosis and an anterior pelvic tilt. There are muscles that are too tight and others that are too weak. The muscles that are too tight include gastrocnemius, soleus, hamstring complex, adductor complex, hip flexor complex (psoas, rectus femoris, tensor fascia latae), and the erector spinae. The muscles that are commonly weak or inhibited include posterior tibialis, anterior tibialis, gluteus maximus, gluteus medius, transverse abdominus, internal oblique, multifidus, and deep erector spinae. This pattern of tightness and weakness causes predictable patterns of joint dysfunctions, movement imbalances, and injury patterns.

Joint dysfunctions include:

• Subtalar joint • Proximal tibio-fibular joint

• Tibio-femoral joint • Iliofemoral joint

• Iliosacral joint • Sacroiliac joint

• Lumbar facet joint

Common movement dysfunctions include decreased stabilization of the lumbar spine characterized by excessive lumbar lordosis. This is caused by tightness in the hip flexors and lumbar extensors as well as weakness in the lower abdominals and lumbar stabilizers. Common injuries include hamstring strains, anterior knee pain, low back pain, sacroiliac pain, and hip pain.

Dr. Perry Nickelston, DC

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. 102

 

Tags: Integrative Treatment Strategies, Practice Tips of the Day, General by Dr. Perry
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 Whys is this topic on my chiro blog? Because most people with chronic back pain are overweight and clinically obese. Duh! That’s why. You need to offer them advice and guidance to a positive end result. If you don’t a more successful doctor will. How is that for a reality kick in the pants? Here a 6 ways to begin.

1. Eat Five or Six Small Meals.
Despite compelling information arguing to the contrary, many people still consume most of their food in two or three large meals every day, often going for hours at a time eating nothing in between. Sure, you can lose weight and fat on a reduced-calorie trio of meals, but you can’t train your body to burn fat efficiently, which is key to maintaining weight loss.  A nutritious meal or snack every three hours or so provides a number of metabolism-enhancing benefits, stabilizes your blood-sugar levels, ensures adequate nutrients are constantly on hand, and helps control hunger-induced cravings for sweets and fats. It also leads to more effective glycogen storage in the liver and muscle tissues; thus, your body won’t cannibalize muscle as an energy source during training.

2. Drink The Right Amount Of Water

Did you know that being dehydrated makes you fatter?  Why?  Muscle Glycogen (stored sugar energy created from ingested carbohydrates) is stored along with water.  For every gram of Glycogen in the muscle there should be three of water.  Dehydration forces Glucose to remain in the bloodstream instead of muscle until it reaches the liver for overflow storage.  When the liver is full, the Glycogen (sugar) has no place to go but your FAT cells.  Not good!!  So how much should you drink? (.55 x your bodyweight in pounds = # ounces day                                                                                                                                    

3. Never Skip Breakfast

I guarantee if you skip breakfast you will NEVER get a lean, toned sexy physique!  Let me repeat, NEVER!  Why? Just like Mom used to say, breakfast is the most important meal of the day.  Gotta love Mom!  Breakfast sets the tone for your metabolic rate the entire day.  Skipping this meal sets your metabolism low and Insulin will spike with the first large meal you ingest.  Then get ready for the sugar high crash and burn feeling.  Your largest carbohydrate meal should be eaten at breakfast.  Load up on the complex carbs and remember to combine them with protein.

4. Cheat On Your Diet
Once in a while you should let loose and give yourself a break from the rigors of dieting and scale watching. In fact, it’s helpful in losing weight. That’s because continual dieting eventually leads to roadblocks where the body responds by slowing its metabolic rate. Strict dieting also takes its toll on you mentally, and can leave you feeling deprived. That’s a bad combination! Taking in a couple of high calorie meals once every 7-10 days not only provides a mental break from dieting, but helps you side-step roadblocks by preventing the body from entering a starvation state where the metabolic rate slows.

5. Do Smart Cardio
What happens to someone who performs 1-2 hours of cardio a day? (We know you’re out there!) They send their body into a tailspin, a state where the “starvation hormones” secreted by the body skyrocket (it’s your body’s survival mechanism, a response to too much exercise!) causing fat cells to try to hoard their energy! Moderate cardio is the way to go. Four to five 20-30 minutes sessions per week is all that it takes. Any more than that and you run the risk of losing precious muscle tissue, which negatively affects your metabolic rate and your ability to burn fat.

6. Start Weight Training

Some people avoid weight training because they don’t want to bulk up. However, strength training is a critical element to maintain a healthy weight and strengthen your body.  The average person who strength trains two to three times a week for eight weeks gains 2.75 pounds of lean weight…and loses 10.5 pounds of fat.  Muscle is a metabolically active tissue that requires calories for support.  Meaning, the more muscle you have the more body fat you burn at rest. Always do cardio work AFTER weights, NEVER before!  Why? You burn about 300% more body fat. 

BONUS TIP:

COCONUT OIL Start with one tablespoon per day and work up to three tablespoons per day. Coconut oil raises your metabolism, which helps detoxify your body. It stabilizes the blood sugar levels which decreases physical cravings. It also protects the heart cells from damage. Next to mother’s milk, it is nature’s highest source of medium chain fatty acids (MTC’s), which raise the body’s metabolism, leading to weight loss. It has fatty acids such as lauric acid and monoglycerides. When lauric acid is consumed in the body, it enhances the immune system to help the body fight infections, bad bacteria and underlying yeast invasions. Lauric acid is known to be anti-viral, anti-fungal and anti-bacterial.

Here are two athletes I took care of with laser therapy at the Arnold Scwarzenneger Bodybuilding Expo. Specializing in treating athletes and fitness competitors is my niche market. Get one too and you will always be successful. Why? You are delivering value to a specified marketplace. Mine is laser. What is yours?

Dr. Perry Nickelston, DC VP Practice Devlopment for K-Laser USA and Director of The Pain Laser Center in Ramsey, NJ. 1-866-595-7749 Ext 102

www.k-laserusa.com

www.painlasercenter.com

Tags: Integrative Treatment Strategies, General by Dr. Perry
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“You miss 100% of the shots you never take.”

If you see overweight people in your office, and most of you probably do since they usually have back pain, it is important to evaluate the adrenal glands. They can be a primary cause of chronic pain due to elevated levels of the catabolic hormone Cortisol. Ignore them at your own peril. I have found Ionic Footbaths to be a great way to help detoxify the body and improve hormone function. Worth invbestigating!

Hormones and Weight Loss

Adrenal Fatigue and the Cortisol Connection

Adrenal Fatigue is a syndrome that results when the adrenal glands function below the necessary level, usually because of intense, prolonged or repeated stress. Its severity can range from a general sense of tiredness and the inability to lose weight, to difficulty getting out of bed for more than a few hours. Every organ and system in the body is more profoundly affected if left untreated.  Changes occur in carbohydrate, protein and fat metabolism (leading to weight gain); fluid and electrolyte balance; nervous system function and even libido. Although it affects millions of people in the U.S., conventional medicine does not yet recognize it as a distinct, treatable condition. Most doctors are not aware of adrenal fatigue. They only recognize Addison’s Disease, which is the most extreme end of low adrenal function. Astute doctors who are familiar with the degrees of adrenal fatigue usually test the adrenal hormone levels in the saliva.

What are the adrenal glands?

The adrenal glands are two small glands, each about the size of a large grape. They are situated on top of the kidneys. Their purpose is to help the body to cope with stress and help it to survive. Each adrenal gland has two compartments. The inner or medulla controls the sympathetic nervous system through secretion and regulation of two hormones called epinephrine and nor epinephrine that are responsible for the fight or flight response. The outer adrenal cortex comprises 80 percent of the adrenal gland and is responsible for producing over 50 different types of hormones.

 Is too much Cortisol bad for you?

Chronically elevated cortisol levels may have a variety of negative effects. Cortisol is catabolic, and elevated cortisol levels can cause the loss of muscle tissue by facilitating the process of converting lean tissue into glucose. An excess of cortisol can also lead to a decrease in insulin sensitivity, increased insulin resistance, reduced growth hormone levels, and reduced connective tissue strength. Chronically elevated levels of cortisol can also decrease strength and performance in athletes.

 Should I take Cortisol supplements?

In my opinion, no, absolutely not. Cortisol suppressing supplements are not a valid solution for losing weight. No pill can replace a healthy program of diet and exercise. Pills do not make you lose fat. Body fat is lost by creating a caloric deficit through exercise and nutrition.

 What can I do naturally?Avoid very low calorie diets, especially for prolonged periods of time. Low calorie dieting is a major stress to the body. Low calorie diets increase cortisol while decreasing testosterone. Avoid overtraining by keeping workouts intense, but brief (cortisol rises sharply after 45-60 min of strength training) Suppress cortisol and maximize recovery after workouts with proper nutrition: Consume a carb-protein meal or drink immediately after your workout. Get plenty of quality sleep (sleep deprivation, as a stressor, can raise cortisol). Avoid or minimize use of stimulants; caffeine, ephedrine, synephrine, etc.  

Dr. Perry Nickelston, Vice President of Practice Development for K-laserUSA and clinic director of the Pain Laser Center in Ramsy, NJ.

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext #2

Tags: Integrative Treatment Strategies, General by Dr. Perry
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One of the most effective ways to help the #1 cause of pain is laser therapy. What is the number one cause of pain? Trigger points! Treating a trigger point with 180-250 joules of laser light combined with manual therapy is a fantastic way to relieve chronic pain. As long as you are trained in how to diagnose primary trigger points, have an accurate diagnosis, and are proficient in laser therapy clinical applications. The main reason laser therapy is not successful as a treatment protocol is lack of proper/sufficient dosage to the ‘intended target tissue.’ You can’t heal it if you can’t reach it.

Ever wonder what can be done to help headaches, neck stiffness, carpal tunnel type symptoms, tennis elbow, bursitis, frozen shoulder, back pain, low back stiffness, sciatica, shin splints?  Find a Doctor that is skilled with finding and treating trigger points and you just might find immediate relief for pain that has been afflicting you for years. 

Trigger points are accumulations of waste products around a nerve receptor. Often times they feel like nodules or taut bands of fibers within the soft tissues. Trigger points form in muscles that have been overused, injured due to an accident or surgery. Common characteristics are increased muscle tension and muscle shortening. Increased muscle tension is the primary side effect of trigger points and pain is the most common secondary effect.  

Trigger points can present themselves as referred patterns of sensation (pain that travels away from the trigger points) such as sharp pain, dull ache, tingling, pins and needles, hot or cold, as well as can create symptoms such as nausea, ear ache, equilibrium disturbance, or blurred vision. Trigger points can exist in two states, either active or latent. Active trigger points are those that cause discomfort. Latent trigger points wait silently in the muscle for a future stress to activate them. Aches and pains which began in the past become more frequent and severe in intensity as we age. It is common to attribute this discomfort to arthritis instead of our tight muscles which harbor trigger points.
 

Trigger points are not visible with traditional medical testing such as MRI or X-ray and are frequently over looked by most healthcare practitioners as the cause of your pain.
 

80% of the trigger point locations are common with acupuncture treatment locations. When trigger points are not treated, they will create satellite trigger points in the affected area. For instance, a trigger point in the trapezius muscle may cause a trigger point to appear in the shoulder blade muscle. The trigger point in the shoulder blade is the most common cause of shoulder pain, especially when exercising. And, voilà! - a case of shoulder Rotator Cuff Syndrome.  (Not good) 

To break-up a trigger point, static compression (pressure) is applied for 10 seconds, released, then pressure applied for 10 more seconds in a pumping action while the client breathes deeply. This action flushes the toxins and calms the nerves. Releasing trigger points releases endorphins so the result is elimination of discomfort as well as being energized.

Determining which “one” is causing the pain is where the specialty comes into play.  Not all knots cause pain.  That’s why traditional massages usually DO NOT work.

Trigger point massage is not a relaxing, “fluff and buff” technique. It requires the participation of the client to communicate the presence and intensity of pain and discomfort. The doctor and patient work together as a team to maximize the effectiveness of the treatment to ensure long-term relief.  It is common to find great improvement after one treatment. Repeated treatment may be necessary for those with chronic trigger points. Stretching should be done as “home work” to encourage the muscles that have been treated to stay in a lengthened position.  One reason why people may not have improved with traditional medicine, physical therapy or chiropractic is because these trigger points were never released before treatment began.  You cannot stretch, exercise, or rest away a trigger point.  It must be actively removed by specialized treatment before any other type of therapy will help.

Research lists nutritional deficiencies or inadequacies as “perpetuating factors.” A good multi-vitamin supplement that is high in anti-oxidants and is in an encapsulated form can help ensure that once treated, trigger points do not reform.

Dr. Perry Nickelston, DC

www.k-laserusa.com 1-866-595-7749 Ext. #2

www.painlasercenter.com

Tags: Integrative Treatment Strategies, Class 4 Laser Therapy, General by Dr. Perry
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TMJ Syndrome: An Integrative Treatment Approach

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By Perry Nickelston, DCTemporomandibular joint (TMJ) syndrome can be one of the most difficult and elusive conditions to treat.

Patients can suffer with symptoms, despite years of traditional medical therapy. In order to effectively alleviate the symptoms associated with TMJ, one must use an integrated treatment approach combining various therapeutic modalities.

One of the primary reasons for a poor outcome in TMJ treatment is a lack of clinical understanding of the relationship between articular, muscular and neurological causes of the condition. If any of these potential causative factors are missing in the treatment approach, poor results can occur. The doctor who diagnoses and treats all factors will notice an increase in positive results and patient satisfaction.

TMJ Anatomy

The temporomandibular joint is the articulation between the condyle of the mandible and the squamous portion of the temporal bone. An internal disk known as the meniscus is a fibrous, saddle-shaped structure that separates the condyle and the temporal bone. The meniscus and its attachments divide the joint into superior and inferior spaces.¹ These disks not only act to separate the hard bones, but also to absorb and cushion vibrations and impact transmitted through the joint.

The TMJ is controlled by muscles. The muscles controlling the TMJ are predominantly the masticatory muscles including the temporalis, masseter, lateral pterygoid, medial pterygoid and buccinator. However, other muscles may have an effect on the functioning of the TMJ such as the neck, shoulder and back muscles.² This is the key area overlooked by physicians when treating TMJ syndrome. Primary muscles include the scalene, sternocleidomastoid, trapezius, levator scapulae, supraspinatus, infraspinatus, rhomboids and latissimus dorsi. There has even been a case in which the soleus muscle affected the TMJ via kinetic-chain dysfunction.

Causes: Arthritis is one cause of TMJ symptoms. It can result from an injury or from grinding the teeth at night. Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk may produce clicking or popping sounds, limit jaw movement and cause pain when opening and closing the mouth.

The disk also can develop a hole or perforation, which can produce a grating sound with joint movement.³ Bruxism (teeth grinding) causes micro-trauma to the joint capsule, ligaments and soft tissue, leading to symptoms from active trigger points and adhesions.

Common symptoms: Clicking or popping, bruxism, headaches, earaches, dizziness, eye pain and neck/shoulder pain.

Integrative Treatment

One must take into consideration all of the physiological and anatomical structures listed above. Starting with a three-day-a-week program, the following therapy approach has proven to be successful in alleviating symptoms associated with TMJ dysfunction.

Laser Therapy

The bio-stimulation, anti-inflammation, and pain-alleviating effects of laser light are what makes this therapy so special and of prime importance. Laser dosages of between 600 and 700 joules per side are recommended. Be sure to aim the laser inside the joint capsule with the jaw open and cover all the trigger points found on palpation. You may also laser the pterygoid muscles from inside the mouth.

If TMJ symptoms are due to arthritis, laser therapy may be the only therapeutic modality to offer lasting pain relief. Due to treatment time constraints and penetration capabilities of low-level cold lasers, higher-power class-4 therapy lasers may be the preferred instrument of choice.

Trigger Points

Check all of the muscles previously listed. You may use ART, MRT, TPT or MFR depending on your skill level. Primary trigger points include the pterygoids, sternocleidomastoid, scalene and temporalis. These points can be excruciatingly painful when treated, so make sure to prepare the patient. Active trigger points may take six to 10 therapy sessions for resolution. If you feel comfortable, do trigger-point therapy with a gloved finger to the pterygoids inside the mouth.

Check the infraspinatus carefully. These points are typically latent and only present pain on palpation. A knotted infraspinatus causes internal rotation of the glenohumeral joint and external rotation of the scapulae, leading to over-recruitment of the rhomboids and trapezius, resulting in forward-head carriage. This abnormal posture over-stimulates the scalene and sternocleidomastoid muscles, causing faulty TMJ mechanics and an elevated first rib.

Check the latissimus dorsi attachment at the thoracolumbar junction. Myofascial adhesions here can restrict normal scapular motion during glenohumeral abduction, resulting in cervical kyphosis and altered righting mechanisms via kinetic-chain dysfunction. MFR and ART can be very successful in this region. A high dose of laser therapy along the entire thoracolumbar region with a dosage of 1,000 joules can break up chronic adhesions that have been lying dormant for years. This can be the “magic bullet” area for unresolved shoulder and neck disorders, too. Don’t overlook it!

Articular

Check for a hypomobile occiput and atlas articulation. I have found occiput is the primary culprit, usually subluxated posterior. An elevated first rib may cause a kinetic-chain alteration with the sternoclavicular joint, resulting in overactive neck flexors. Normalizing a subluxated first rib can have an immediate pain-relieving effect on TMJ pain and chronic trapezius muscle spasm. Speed is of utmost importance when adjusting a first rib.

I only recommend manually adjusting a TMJ if you have specialized training in TMJ disorders or if you work directly with a TMJ specialist. Adjusting the wrong side, an incorrect line of drive or a hypermobile joint can have severe pain-inducing consequences.

Cranial

Using a gloved finger/thumb, put superior pressure for five seconds on the center of the hard palate and then bilaterally on the horizontal plate by the back molars. Repeat three times while the patient inhales slowly, releasing pressure as the patient exhales. This technique normalizes function of the sphenoid bone, which can improve TMJ mechanics.

As you can see, success in TMJ treatment involves looking way outside of the proverbial box. The word integrate means “to make something part of a larger whole, or be joined or made part of a larger whole.” Remember to look at the whole patient and don’t get caught up in the vicious cycle of targeted symptomatic care. This integrated treatment protocol can give profound improvement to your patients’ quality of life. Take the time to implement them; your patients will be glad you did, and so will you.

References

1. Basmajian J. Muscles Alive. Baltimore: Williams and Wilkins, 1974.
2. III Gillespie T. TMJ Anatomy. Accessed Oct. 12, 2007 from University of Washington: www.rad.washington.edu/anatomy/modules/ TMJ/TMJAnatomy.html.
3. NYU Medical Center. Accessed Oct. 11, 2007, from www.med.nyu.edu/surgery/oral/patients/ article.html.

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Dr. Perry Nickelston is a 1997 graduate from Palmer College of Chiropractic. He practices in Ramsey, N.J., and is vice president of practice development for K-Laser, USA. He can be reached for clinical questions or discussion at www.k-laserusa.com.

Tags: Integrative Treatment Strategies, General by Dr. Perry
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