Should children run marathons - something every runner should consider reading

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Jack La Lane was a chiropractor. I didn't know that and more...

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USA Track and Field NJ y Open & Masters Indoor Track & Field Championships

Today, 2-20-11 I was on the medical staff for the USATF open and masters indoor track and field championships at the John Bennett Indoor Athletic Complex in Toms River.  As many of my patients already know, I have been their medical director since 1992 and also do my best to make sure that their events have medical staffing which is typically all volunteer.  


This particular event features athletes who are at lease 18 years of age and some are in the 80's.  Pictured above was the start of the 50 yard dash.  Below to the left is one of our patients, Jane Vaneewan who got into track and field when her doctor told her she had some health issues.  Rather than take pills, she found track and field and on a given weekend, is a national competitor, often doing at least one if not more events,  To the right was an older high jumper. I was watching his jumps which were quite good for his age group.  Lastly, the bottom photo was of a high jumper.  


I was quite busy today, since we had one runner who I suspect fractured his ankle and another who severely pulled his hamstring.  Stuff happens but I was also able to help quite a few runners.  When I was packing up and leaving, one of the runners I worked on came over to thank me.  I turned out that he had some problems that continually were occurring and he had been through all sorts of therapies which did not work.  He ran after I taped his feet and worked on him free of pain for the first time in years. He is planning to visit and bring members of his team he trains with to the office from Pennsylvania because he believes he finally found someone who understands running problems. 

 It is nice to receive that type of endorsement.  I also met a number of coaches who brought over their team members because the liked the way I helped their athletes.I love working with runners and seeing them improve with my treatment.  It is quite rewarding which is why I will work for pizza and soda and the occasional T Shirt I receive at an event.

How to stay running injury free this spring

The weather is finally warming from this deplorable winter and many runners are testing out the roads during some of our warmer February days.  As many of our patients who run know, injuries tend to happen when you load up poorly functioning bodies with exercise.

Simple tests to screen yourself and see if your body may require some help before hitting the road.
1. Balance on one leg - This simple test where you balance on each leg, for 30 seconds will tell you if you are likely to have running problems.  Lift the leg until your thigh is perpendicular to your body (90 degrees).  If you lose your balance on one or both sides, you should visit your chiropractor or muscle therapist to have them find the muscular imbalance and correct it.  Often, problems in the back of the calf by the posterior knee are part of the problem as well as the gluteal muscles and the oblique muscles in the abdomen.  An imbalance of tension in these muscles will cause you to over and under stride with the net result being pain.  Get it checked out by a professional and then hit the road.
2. Crouch down slowly.  If you lose your balance or have a hard time getting up from this position unassisted, you are having problems and should have them checked out.  Imbalances such as the ones I spoke about in the first test will make it difficult to do this correctly.  What will likely happen if you run like this - pain in the hips, shins and the legs will tighten.  See a professional before running.

Great warm up exercises before your run
1. Hip Extensions - get on all fours and lift the right leg bent at 90 degrees 10 -20 times.  This will help warm up the gluts.
2. Lateral leg raises - While on your side, with the bottom leg bent, lift the top leg straight up for 10 - 20 repetitions.
3. Calf raises - Stand on the stoop on one foot with the ball of the foot on the edge.  Let the calf stretch out all the way and then slowly push off and lift your body.  Do these 10 -20 times.  These are great for warming up the front and the back of the lower leg.
4.  Balancing for 30 seconds on each leg - Essentially, this is the same as the test mentioned above.  This will help warm up the muscles and prepare them for exercises.

Avoid stretching - little evidence to support this unless we have a young growing child. Exercises is what you should do even if you grew up with the notion that you should stretch before the run.  Trust me, you will run stronger with exercises instead.

Other things that may help
1. Foam rollers - especially if the gluts and lateral legs are tight, this will perform a crude form of myofascial release and improve the way you feel during your run. Never do this after exercise, only before
2. Mild stretching after the run to ensure the muscles heal with more flexibility.  Gentle, not vigorous.

I hope you find this useful.  If you have any questions, or opinions, please forward them to backfixer@aol.com

Fewer scans recommended for lower back pain says a recent NY Times article

The other day I read about the American College of Physicians recent updated recommendations concerning ordering routine scans such as x rays and MRI for back pain (http://www.nytimes.com/2011/02/15/health/research/15screening.html). 


The study states "Routinely ordering X-rays and CT orM.R.I. scans drives up health care costs, and does not help resolve the problem, the college’s “best practice advice” guidelines say. On the contrary, the guidelines suggest, the scans may pick up unrelated abnormalities, leading to additional tests or procedures that are of no benefit, and some scans expose patients to high levels of radiation. The recommendations are the first in a series of papers aimed at helping doctors and patients identify misused medical treatments."


On one hand, I totally agree because many physicians who do not have good evaluation skills for lower back problems will rely on scans that can be expensive in the case of an MRI or CT scan, and the tests either come back negative or show a lesion that may have nothing to do at all with why the person is in pain.  A proper evaluation is essential, and requires more than just feeling the muscles, checking reflexes and doing a straight leg raise test, which we are taught in school to do.  Many of the newer doctors who specialize in physical medicine such as chiropractors are now using active evaluation methods which tell us much more about what is going on functionally. We can then use a standing lumbar xray to deduce the overall condition of the structures.  Unlike many doctors who order lower back films taken on a table, standing films yield more useful information because it shows posture (a component of lower back pain in many cases), alignment as well as other useful information such as the quality of the hip sockets (which can be problematic in older patients).


The big question of course is when is it appropriate.  In our office, we typically do not taken plain films in children under 18, unless trauma was involved.  Over 18, if I deduce there was trauma or recurrent injuries, films are indicated to determine where the injuries occured and to what extent.  Most people over the mid 30's on will likely be candidates for x rays films with trauma or if the problem is recurrent.  While we do not perform blanket screenings, the use of plain films is quite helpful, especially in the chiropractic office since we are performing manual work and the films also alert us to anomalies.  Recently, an older patient we took films on looked to have a slight curvature in his back.  The films showed the curve to be over 30 degrees which is quite significant and alters the way we would treat him.  Obviously, this gives us medical necessity.


The article continues by saying "Most lower back pain is caused by strain on bones, muscles and ligaments. It can be treated with over-the-counter painkillers and usually abates within a few days, said an author of the practice guidelines, Dr. Amir Qaseem, director of clinical policy in medical education at the American College of Physicians." Personally, I think this shows the typical lack of true knowledge of what back pain is and why most people are not helped.  Pain killers may hide the pain, however, they never fix the body mechanics that create the problem. When you teach legions of primary care doctors that this is what back pain is, which is what typically happens, you get poor patient satisfaction, mediocre outcomes and people developing chronic back problems.


Lower back pain, especially chronic problems, most commonly start at the feet.  The more asymmetrical or inefficient your body is designed, the more you tend to suffer from back problems. Our patients know this because they see the results we get, and the way we are able to demonstrate to them where the problems are coming from and how quickly we often can turn these problems around.  To dismiss this as strain on bones, muscles and ligaments ignores that all structures against gravity experience this.  Not all structures have pain.  It is when these structures are overloaded by asymmetrical forces that the back breaks down and joints are damaged.  This is why we rarely perform tests such as MRI because 
1. most people improve from our care and not only feel better but function better too.
2. Those who do not improve after a reasonable course of care (2-3 weeks) are then referred for MRI or other advanced scans.  Since most people improve, few scans are ordered.


This is my opinion based on many years of experience.  Of course, I value your opinion too.  You can email any questions to backfixer@aol.com

Defying Medical Convention - Dr. Charschan's New Book arriving soon

Many of our patients know that a few years ago, I decided to write a book on chronic pain for consumers.  Like Syms, the clothing chain, they always say " An Educated Consumer is our Best Customer."

In the current american health care system, an educated consumer is their worst customer.  This is because the system for many years thrived on people who just took orders from their doctors, took their cholesterol meds because their numbers were not favorable and went for unproven and often ineffective therapies and treatments at great cost that were unreliable, and often dangerous.  In many other countries during the healthcare debate that had universal healthcare, where the systems were about the patients and their needs, rather than the systems themselves, they looked at us like we were nuts to not consider universal healthcare.  We heard about the horror stories of waits to see specialists, with little mention of the fact that in the end, people who live in these countries will still defend their often imperfect but affordable and cost effective healthcare delivery systems.

One of my biggest frustrations is the way the insurance companies have perverted health care delivery in our country.  The American Medical Association has maintained their monopoly on medical practice, owning the coding systems doctors use, making sure care stayed expensive.  Doctors were specialized and taught to believe that organs just went bad and that we must find the disease and treat it with the appropriate drug.  Tests took the place over the years of good manual (by hand) diagnostic skills and many of these tests come back negative, at a great cost to the system.

In my world or rehabilitation, insurance companies raised the co payments everyone pays, so they essentially pay less and we pay more.  In rehab, where people need multiple visits, this makes sense, setting up a financial barrier for the truly needy.  With a periodic office visit, a $50 co pay makes sense.  With rehabilitation 2-3 times weekly, this quickly creates an economic burden, something insurance was designed to take care of and has now been perverted by the insurance industry so they can make more money for their shareholders.  Just recently, Aetna had a great quarter, while they reduced our reimbursements for the umpteenth time and raised your insurance rates.

The healthcare paradigm in the United States is very broken indeed, and more than ever, cost effective solutions are essential. This is why I wrote this book.  I often see inappropriate rehab on a wing and a prayer without consistent results.  This is largely because the public does not understand chronic pain or why they experience it.  This groundbreaking book explains body mechanics in simple terms, why most people suffer from chronic pain and what you as the public can do to get better and more consistent results.  It makes you a smarter patient which the health care abhors and helps you find the practitioners who are about the patient, rather than the system. It also offers some self help advice, and some exercises and helps people understand the health care system better.

I plan to get the book in Amazon.com as an e book within the following month,

The cost of managing chronic pain, are there better options?

I recently came across an article on the NY times regarding Treating chronic pain and its associated costs (http://www.nytimes.com/2011/02/05/health/05patient.html?_r=1&ref=health).

There are many causes of chronic pain as discussed in this article.  Most of them are afford-ably treated in our office but many of them never quite get to us. Whether from a bad lower back disc, or from a bad auto accident, or from functional mechanical pain, many of the patients who have visited us have already seen the neurologist, the orthopedist, the rehab therapist, the rhumatologist, all at great cost from the care, the injections, the medications and other types of interventions, many of which have little worth because quite simply, they are expensive and have little effectiveness.

The big problem for most people is that most doctors know little about body mechanics, believe the pain is a disease process and treat problems that they quite frankly, do not understand.  This leads to treatments for the pain, rather than the cause of the pain which more often than not can be explained and proved to be mechanical in nature.  Mechanical problems require a mechanical based evaluation to understand the problem and finally, require a mechanically based solution.  This is why many medically based treatments simply can't work.  They do not find the source of the problem and many doctors recommend muscle relaxants believing inflammation just happens which is just ridiculous.

The benefit of seeing a chiropractor is all their solutions are mechanically based and chiropractic has a long history of helping people with chronic pain.  In our office, you have the added advantage of myofascial release treatment and Graston techniques, two methods that address the myofascial system, commonly part of the cause of chronic pain syndromes.  Secondly, we check out posture and your feet, often at the root of chronic pain.  The best part is that care is based on functional improvements that will become more pronounced from visit to visit, resulting in a marked reduction of pain. The other major benefit that as compared to many of the medical rehab and drug based regimens, chiropractic uses no drugs and the rehab is closely tied to manipulative therapy, improved joint function your body will age better because it functions better. Chiropractic should be on the top of the list of treatments people should explore before doing less conservative methods of medical care because quite simply, its more appropriate in most cases.

Big breakfasts don't help you lose weight, study says.

A recent study published by the NY times suggests having a large breakfast does not decrease the need for or the desire for food for the rest of the day (http://www.nytimes.com/2011/02/01/health/research/01diet.html?_r=1). The recent German study found that a large breakfast only adds to the amount of foot consumed by someone during the day adding to calories consumed .

The bottom line of the study suggests that to decrease overall calories during the day, either eliminate or markedly reduce the size of the breakfast. This should reduce overall caloric intake.

Personally, I love a big breakfast.  Often, when I have a large breakfast, I have no problem skipping lunch and because I view food as fuel (being a chiropractor is a physical job and I need the right type of fuel), I avoid the urge to eat lunch and may or may not have a snack.  During the normal work week, when I go to the office, my breakfast consists of coffee with milk and 1/2 regular bagel with creamed cheese.  This is sufficient because the creamed cheese has the protein I need and the bagel gives me some carbs to get the day started.

After the holidays, many of us want to shed that unneeded weight and myself included, have decided it was time to shrink myself.  Successful diets work or don't work depending on what you eat and how you apply the diet to your lifestyle.

Many diets suggest you should limit portions.  My current diet has a reduction of carbohydrates such as breads (cut the usual portion of bread in half, eat half a bagel, use pita bread or have a wrap instead of a hero), making it a practice to leave some food on the plate because we are typically full before our body tells us we are.  In other words, leave 1/3 of the food over that you would usually eat. Many of our portions are super sized compared to the rest of the world anyway.

You can also fool yourself into doing this by using a smaller plate and then avoiding second portions.  If this sounds like calorie limitation, it is.  This is much easier than attempting to measure out four oz of meat.

My result, I have lost 10 pounds since New Years and plan to lose another 8-10.  Why starve yourself?  Just eat more appropriately, less carbs, more protein.

One last thing... Exercise.  Cardio classes are great to burn off weight along with swimming and running.  Too much of this will increase your appetite so be careful to mix it up with some other type of exercise such as weight lifting.

Big breakfast - not a problem if you are in control IMHO.

What to you think?  As always, I value your opinion.