To Run Barefoot or Not?

If you suffer from foot pain, knee pain, or lower back pain of unknown origin, then it might be related to your shoes:  Scientists recently held a conference in England to debate shoe running vs. barefoot running.   Over the last five years, the barefoot movement has gained a lot of recognition among runners and experts in human biomechanics.    I wrote about the merits of going barefoot last year.   The movement was apparently started by the book “Born to Run” by Christopher McDougall.  In it, he tells of time spent with members of Mexico’s indigent Tarahumara tribe, who routinely run long distances barefoot, often very fast, apparently without suffering the injuries that plague many avid runners in the developed world.

The issue is whether or not putting on a pair of running shoes implicitly causes the person to run in an unnatural way; a way that goes against nature’s design, due to a “false sense of security” offered by the thick cushioning of the shoes, especially in the heel and arch.

In a study published in the scientific journal Nature last year, Daniel Lieberman, an evolutionary biology professor at Harvard University, sought to find out how our ancestors, who ran and hunted for millions of years in bare feet or simple moccasins, coped with the impact of the foot hitting the ground.

Lieberman and colleagues from Britain and Kenya studied runners who had always run barefoot, those who had always worn shoes, and runners who had abandoned shoes.

They found that barefoot endurance runners often land on the fore-foot (the ball of the foot) before bringing down the heel, while shoe runners mostly rear-foot (heel) strike, prompted by the raised and cushioned heels of modern running shoes.

The study further discovered that barefoot runners incur less collision forces on their feet compared to shoe runners, despite the heel cushioning of the shoe, and that they use their calf muscles more efficiently.

As of this date, there isn’t a large scale study that gives definitive data on what is better for the human body, going barefoot or wearing shoes.  People are taking sides based on their beliefs, biases and experiences.  Major athletic shoe companies generally are against the barefoot running idea, for obvious reasons; but some are experimenting with “minimalist” shoes to capture this growing market.  These are shoes that offer protection to the feet but with the least amount of restriction.

My take on this:  it makes a lot of sense to walk and run barefoot.  It is a natural act, and it’s tough to argue against nature because it has its ways of cancelling out bad traits.  Our human ancestors walked and ran barefoot for millions of years, and were fine.   I believe that walking barefoot exercises the muscles and small joints of the foot and takes more of the load off the knees, hips and pelvis in doing so.  On the contrary, wearing shoes binds the feet, prevents the foot joints from doing their job of distributing the body weight and cushioning the shock, and makes the leg and back muscles work in a less efficient manner.    It is easy to see how this can result in lower back problems.  So, walk barefoot more than you currently do– not just in the house, but on pavement, hilly terrain, and the nearest park.  Then, when you feel that your feet have acclimated to the new sensations, give barefoot running a try!

 

 

 

Laser Therapy for Chronic and Acute Musculoskeletal Pain

tendlightLow level laser therapy, or LLLT is the application of low-powered lasers or light emitting diodes for the purpose of pain relief and/or injury repair.  The therapy is typically done transdermal; meaning through the skin into the target tissue, such as a sore shoulder joint (no surgical incisions).  While some research studies show that LLLT can result in immediate pain reduction in rheumatoid arthritis, osteoarthritis, tendinopathies, acute and chronic neck pain, temporomandibular joint (TMJ) pain and other joint disorders there is currently a lack of consensus on the best parameters to use; i.e. power, dosage, time, pulsing, and type of laser.  The therapeutic wavelength appears to be between 800-1,000 nm; and dose to be around 6-10 joules/cm2.

LLLT may reduce pain related to inflammation by lowering levels of COX-2 and tumor necrosis factor-alpha (enzymes associated with inflammation);  oxidative stress, edema, and bleeding.  It is also believed to cause cellular mitochondria to produce more ATP– a cell’s basic energy unit, resulting in increased metabolic activity.

Low level laser therapy is offered by some chiropractors, sports physicians, and acupuncturists.   Lasers are classified according to how much damage they can do to the eye, which basically means how powerful they are in terms of wattage.  The wattage rating of a laser determines how long it takes to deliver a dose, and how deep the light penetrates tissue (important if you are treating thick areas of the body such as the hip or knee joint).  At 10 watts max output, the LiteCure and K-Laser are two of the strongest lasers in the market for this purpose.  Lasers with output of 500mW or less will not penetrate as deeply, and will require a longer treatment time to administer a therapeutic dose.

A typical treatment regimen will be 10-15 minutes of laser; six to eight sessions.  Sometimes that is all it takes to take care of an acute or chronic problem.  Many practitioners including myself incorporate soft tissue therapy, joint mobilization and rehab exercises to fully deal with the painful condition.

So if you are experiencing a recent injury such as a sports injury; or have chronic pain such as tendinitis, sciatica,  plantar fascitis, rotator cuff tear, or knee pain, consider trying low level laser therapy.  It is generally safe, and faster-acting than manual therapies alone (chiropractic, PT, occupational therapy).  Be cautious and tell your practitioner if you are taking photosensitive medications, or have light sensitive skin, as the treatment can be uncomfortable and may even cause pigmentation.

UPDATE ON THIS TOPIC: Can Red Light Heal Injuries and Lessen Pain?

 

Dr. Dan

 

Chronic Pain Affects Approximately 116 Million Americans

Woman with hip pain

Woman with hip pain

The Institute of Medicine (the medical branch of the US National Academies of Science) released a report brief on June 29, 2011 on the state of chronic pain in America, entitled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.  The purpose was to assess how pain affects people of different socioeconomic backgrounds, and what can be done on the national level to improve awareness and treatment.

Chronic pain affects at least 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.   It is  a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

The toll documented in the report is staggering. Childbirth, for example, is a common source of chronic pain.  The institute found that 18 per cent of women who have Caesarean deliveries and ten per cent who have vaginal deliveries report still being in pain a year later.

Ten per cent to 50 per cent of surgical patients who have pain after surgery go on to develop chronic pain, depending on the procedure, and for as many as ten per cent of those patients, the chronic postoperative pain is severe.

The risk of suicide is high among chronic pain patients. Two studies found that about 5 per cent of those with musculoskeletal pain had tried to kill themselves; among patients with chronic abdominal pain, the number was 14 per cent.

For patients, acknowledgement of the problem from the prestigious Institute of Medicine is a seminal event. Chronic pain often goes untreated because most doctors haven’t been trained to understand it. And it is isolating: family members and friends may lose patience with the constant complaints of pain sufferers. Doctors tend to throw up their hands, referring patients for psychotherapy or dismissing them as drug seekers trying to get opioids. “Most people with chronic pain are still being treated as if pain is a symptom of an underlying problem,” said Melanie Thernstrom, a chronic pain sufferer from Vancouver, Washington, who wrote The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering (Farrar, Straus & Giroux, 2010) and was a patient representative on the committee. “If the doctor can’t figure out what the underlying problem is,” she went on, “then the pain is not treated, it’s dismissed and the patient falls down the rabbit hole.”Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.

“Having pain that is not treated is like having diabetes that’s not treated,” said Ms. Thernstrom, who suffers from spinal stenosis and a form of arthritis in the neck. “It gets worse over time.”

Ms. Thernstrom compared the effect of chronic pain on the body to the rushing waters of a river carving out a new tributary. Pain, she says, also changes the body’s landscape.

“My pain is at the level where it’s manageable,” she said. “I do wish I had gotten aggressive treatment in the first year. There is a window of time to intervene, because pain changes your nervous system and pain pathways develop.”

“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,:” Mackey said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.” The pain report is only a first step for the community of medical professionals who treat pain. It will be up to medical schools to begin better education of doctors in the treatment of pain, and the National Institutes of Health to decide whether to promote research into chronic pain.

——

My comments:

This report is an important milestone in creating a national awareness of the “epidemic of pain” in this country.   Chronic pain is a very difficult problem to treat, because in most cases, there is nothing left for the doctor to do.  It truly frustrates doctors to see patients not getting any better over time.  Many primary care doctors dread having to see their chronic pain patients come in, because of the reasons stated in the article– suspicions of exaggerated symptoms, assumptions of pain reliever drug addiction, psychological problems, etc.

More attention is needed in formulating a strategy to prevent chronic pain from happening, and ways to better manage it.  This study is a good first step towards that direction.

If you have chronic pain, it still is a good idea to do the things that make the body healthier overall:  give it the building blocks to regenerate and repair tissue (high nutrient density foods); avoid ingesting toxins such as smoke, alcohol, preservatives, and pesticides; drink pure, clean water; get a good dose of Vitamin D every day by going outside in the sun; do short workouts that engage all body parts in unison every day, avoid negative people, negative media, and negative thoughts as best you can; engage in activities that require concentration; socialize with positive people; laugh to your heart’s desire, and get enough rest each and every day.  These activities may not cure chronic pain, but can make it more manageable.

 

References:

The New York Times, Giving Chronic Pain a Platform of Its Own

The Institute of Medicine, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

Article on Laser Spine Institute

For many individuals searching the internet for solutions to their lower back pain, Laser Spine Institute, or LSI is a familiar name. This is a network of physician-owned spinal surgery centers that rely heavily on Google and other internet search engines to obtain their clients. Their chosen niche is minimally invasive laser surgery, where the physician makes a tiny incision in the patients back and inserts a fiber optic laser and tiny camera to ablate, or burn off nerve endings around an offending spinal disc. Then, they may burn off part of the disc that is compressing nerve tissue. Through their marketing, LSI suggests that patients can be back on their feet within hours of the surgery.

However, the center is attracting a lot of attention in the malpractice arena.  And, respected spinal surgeons not affiliated with LSI say that such a methodology is already available through standard medical care for spinal disc problems and cost much less; although instead of lasers, radiofrequency devices are used.

According to an article in the May 2011 edition of Bloomberg magazine, author David Armstrong reports:

Laser Spine and its competitors, part of a boom in outpatient clinics operated by entrepreneurial physicians, sell a high-tech version of procedures that have been around for years — despite a lack of independent research to show that their variations lead to better outcomes. The company commands higher prices than laser-less rivals, driving up the cost of health care. Its number of malpractice claims per 1,000 surgeries is several times the rate for all U.S. outpatient surgery centers, based on insurance industry data.

…There’s little government oversight regarding which doctors can do spine surgery — all they need is a medical license, whether their training is in orthopedics, foot surgery or pediatrics…

…Doctor-investors may lower their standards for deciding when to operate, according to researchers from the University of Michigan in a study in the journal Health Affairs last year. Looking at five common procedures at Florida surgery centers, they found that once doctors became investors, the number of surgeries they performed increased by 87 percent.

So, if you are considering spinal surgery and run across LSI, make sure to do your due diligence.  Being in acute pain can make one vulnerable to lofty marketing, as there is an urgency to make a fast decision.   Based on this article, it seems that there are three main problems with Laser Spine Institute:

1.  There is a conflict of interest, as some doctors are investors in the parent company.  Thus, there is an incentive for performing unnecessary procedures.

2.  There is little if any respected research that suggests that laser surgery is superior to traditional spinal surgery methods.

3.  The centers use a high volume model and rely heavily on advertising instead of professional referral.  Not a good indicator for quality of service.

Whiplash Injuries and How to Treat One

Whiplash is the colloquial term for a neck sprain strain injury that comes about from the head and neck being “whipped” back and forth as the result of a short-lived acceleration and deceleration of the body. Perhaps the most common event that can create this is a car collision; specifically a rear end car collision. Other things that can cause it are roller coaster rides and other amusement park rides; bungee jumping; horsing around and similar types of accidents.

Let’s discuss whiplash from a car accident. You’re sitting in traffic, and all of a sudden you hear a loud screech and feel something powerful crash into the back of your car. You hear crunching metal, and maybe even shattered glass. Your back sinks into your car seat as your car is thrust forward from the impact, and your body suddenly stops and reverses direction. You instinctively grip your steering wheel and stiffen your arms to protect yourself, which braces your torso somewhat but because of the flexibility of your neck and the weight of your head, your neck bends back sharply and recoils violently forward, then back again until it rests. In that split second, your neck muscles, not having enough time to react do not protect your cervical (neck) spine and suffer microtears.  Swelling sets in; then soon after, neck stiffness. Depending on the force of the impact and other factors such as the speed and mass of the car that struck you; the amount of denting/deformation of your car, and your body type other areas can experience injury as well. This includes the upper shoulders, mid and lower back, jaw, wrists, knees and ankles. Most pain in a whiplash, however, is centered in the neck, upper shoulders and upper back.

I made a video on what to do for whiplash that illustrates a good home care procedure to alleviate the pain and rehab the neck.   If you’ve suffered a whiplash injury to your neck, and were cleared by the emergency room of any red flags, the goals will be:

  1. Reduce pain and swelling
  2. Reduce scar tissue build up by doing gentle, active stretches, even during the pain period
  3. Restore joint (verbebral) biomechanics and neck range of motion
  4. Strengthen surrounding muscles in the neck
  5. Restore proper neck curvature

You’ll also want to get enough protein (whey protein is the best, followed by eggs and fish), foods high in anti oxidants, and drink enough fluids during your injury rehabilitation.  Taking 2000 mg Vitamin C is also a good idea, as it has shown to be helpful in wound regeneration.  Lastly, get out in the sun and expose your neck and back for about 20 minutes.  Sunlight stimulates Vitamin D synthesis and may have other beneficial effects on the cellular level.

If you were in a car accident and want extra reassurance,  find a chiropractor who has experience treating soft tissue injuries.  Don’t just go with the office that has the loudest advertising– make sure you are comfortable with the office and the doctor first after asking a lot of questions.  I have treated whiplash injuries in San Francisco for over 15 years and have had great success.  One of my most useful pieces of equipment for treating acute sprains and strains such as whiplash is the Solaris phototherapy unit, which uses therapeutic light between 660-800 nm wavelength.  Light at this frequency actually speeds up wound healing at the cellular level by increasing ATP production (basically, increasing cellular metabolism, which includes waste removal).  Once the pain and swelling is down, I initiate manual therapies to restore joint biomechanics and to rehabilitate the surrounding soft tissues to reduce the risk of chronic pain.

If you happen to live or work near San Francisco and were injured in a car accident, you can contact my office at (415) 627-9077.

You can find more information on whiplash on my website.

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