Coastal Health and Fitness

Nuts!!!

2010-05-18T13:29:00.000-07:00

I'm back to one of my favorite subjects: walnuts.

What is there NOT to like about walnuts? Unless you're allergic to them, they are high in protein, good fats and they taste great. Best of all, they are extraordinarily good for you. Here are a few points that I've hit on in the past (click on the links to read the source):

Walnut consumption lowers several markers of heart disease.

Walnut consumption helps to keep bones strong.

Walnut consumption lowers the risk of developing Alzheimer's.

And most recently:

Walnut consumption prevents and slows the growth of breast cancer tumors AND

Walnut consumption slows the growth of prostate cancer tumors.

So sprinkle a handful on your cereal in the morning, your salad at lunch or your pasta at dinner. Maybe together we can change the saying to:

Several walnuts a day keep the doctor away!

It Be the ITB

2010-05-13T11:05:00.000-07:00

I see a lot of runners in my practice. Make that a LOT of runners...and cyclists...and walkers...and paddlers...et al. As such, I spend at least half of my time working on the lower portion of the body. One of my favorite "portions" is: the iliotibial band.

Oh, so misunderstood and maligned.

Say the word "iliotibial" or "ITB" to a cyclist or a runner and you'll see a combination of fear, disgust and sorrow. When an ITB is angry, soooo many weeks and miles of training are lost to it.

I will not claim to have complete mastery of ITB problems, but it is typically a pretty simple part of the body to treat.

The ITB is a tract of fascia (connective tissue) that runs from Gerdy's Tubercle on the lateral side of the proximal tibia to the Tensor Fascia Latae and Gluteus Maximus muscles. Along the way, it sends little fibers anteriorly and posteriorly to Vastus Lateralis and Biceps Femoris, respectively.

Huh, you ask? Unlike the muscles I just named, the ITB--being wholly of connective tissue--is not a contractile tissue. Sure, connective tissues can and do contract (shorten) if allowed, with a Dupuytren's Contracture of the palmar fascia being the best example. But only muscle tissue has the ability to repeatedly and quickly contract and relax.

So, in my view, pain along the ITB is merely a symptom. The real culprits are the muscles pulling it too much and/or too little. The first places to look are the guys that attach to the ITB: glutes, quads and hamstrings. And the best way to do this is a gait evaluation.

As a lifelong runner, USATF running coach and biomechanics junkie, this is where I excel. I love to watch people move--swim, walk, run, ride. It is amazing how much a thorough gait evaluation can help in determining the "true" culprit of a person's pain.

If your foam roller, yoga class and stretching strap haven't helped to alleviate your pain, it may be time to focus on a few muscles surrounding the ITB. And if that doesn't help you, find a health care provider that is as crazy about your sport as you are.

Spring has Sprung!

2010-03-14T13:44:00.000-07:00

Well, it's not quite spring yet. But today does mark the beginning of daylight savings time. I'll admit that I do not understand why we push our clocks forward---explanations of saving fuel during the Second World War, allowing farmers more time to bring their crops to market, etc., just don't make sense to me. Though I will gladly enjoy another hour of daylight tonight!

Over the past 17 years I have celebrated the beginning of daylight savings with a late afternoon run or ride. There is something so great about be 40 minutes into a 90 minute session so late in the day. I guess I see it as my own pagan ritual, celebrating the gods of endorphins and sunlight. This afternoon winter will be crushed under the weight of the sun. Let summer and warm weather training begin!

As the mercury does begin to climb, I'd like to share a couple bits of advice for your spring and summer workouts.

1) Always wear sunscreen. I am very good about doing this now in my old age, but rarely applied any sunblock while in my 20s. At the very least, wear a hat while running and---of course---wear a helmet while riding.

If you're shopping around for a sunscreen, look for one that is both UVA and UVB protective and has both organic (chemical) and inorganic (metal) sun block components. My own personal favorite is Watermans SPF 55. While it costs more than a bargain brand sunblock, it is a full spectrum sunscreen and stays on throughout a 6 hour paddle, an 8 hour mountain bike and a 3 hour trail run. Truly amazing stuff.

2) Hydrate, hydrate, hydrate. If you're out for a short workout, water will usually suffice. But anything longer than 60 minutes may require a sports drink; longer than 90 minutes definitely requires a sports drink. There are so many out there, endorsed by everyone from basketball players to NASCAR drivers to ultra runners.

How do you choose? There are 3 components you should seek in a sports drink.

First, water. Duh!!

Second, electrolytes. All major brands differ slightly on ratios of potassium to sodium to magnesium. While there is an abundance of research, there is still much debate as to how much and in what ratios. My own view is that the ratio is in large part dependent upon the rest of the athlete's diet. If you are like most Americans, you consume far more sodium than potassium, so your sports drink should be biased towards potassium.

Third and finally, you need easily digestible carbohydrates. This can be difficult to find. Take a stroll down the aisles of the local 7-11 and read the labels of all of the sports drinks--every one of them contains fructose as the primary or only sugar. For an athlete, fructose is a terrible choice mid-workout. It cannot be absorbed into the cells without first being processed by the liver. This additional step delays how quickly and how well it works.

My own choice is powdered Gatorade. I can mix it with water to my own desired consistency, it has a great sodium:potassium ratio, and unlike its bottled cousin, fructose is not the primary ingredient. And better still, it's cheap!

3) Recovery drinks. I was a little sad a few years ago when researchers let my secret recovery drink "out of the bag". For over 15 years I have used chocolate milk as a recovery drink. Powered chocolate with nonfat milk has a nearly perfect profile of carbohydrate and protein (4:1 ratio) for rapid absorption into depleted and exhausted muscle cells. You can skip buying those expensive and (often) ineffective recovery drinks, and get a tin of Nesquik instead.

Enjoy tonight's run/ride/swim/paddle/walk/workout. Hopefully your weather is as perfect as it is here in Orange County. Our penance for this great day: your alarm will be ringing an hour earlier tomorrow morning. Enjoy tomorrow's cup of coffee...hopefully it will help.

He said, NSAID

2010-03-01T18:09:00.000-08:00

I am absolutely NOT "anti pharmaceutical". I firmly believe that all drugs have their place. In fact, my own view as both a doctor and an occasional patient is that people are and should be free to do to their body whatever they'd like. Our role as healthcare providers is both to treat AND to inform.

So when I see a study like this one it does make me happy. Afterall, I recently wrote about the problems associated with the prophylactic use of NSAIDS.

The point of the Indiana University article is that regular use of NSAIDs potentially--and very regularly--leads to delayed healing, gastro-intestinal disease and cardiovascular disease. They also point out that training with an anti-inflammatory/analgesic masking an injury leads to delayed healing and even increased injury.

I will add what I have stated before---that NSAIDs block the chemical/physiological pathway that both leads to inflammation and to healing/repair. Unfortunately you cannot stop one without stopping the other.

You can, however, limit the former without limiting the latter. RICE: Rest, Ice, Compression and Elevation. This time tested method limits the accumulation of edema/swelling without inhibiting the healing process.

But there are certainly times when a more aggressive approach is needed. Hopefully your healthcare provider will give you all of the options (as well as the likely outcomes) for your problem.

Gotta go...I have a sore hip to ice.

Hi, Acai!

2010-02-24T14:04:00.000-08:00

Time to weigh in on something that seems to be discussed everywhere lately: the acai berry.

Well, it is a dark blue/purple berry from the acai palm of Central and South America. For a fruit, they are fairly high in protein (though still not a complete source like poulty/beef/fish/game or quinoa). Acai berries are known to be extremely high in resveratrol and anthocyanins. These are probably the chemicals responsible for the purported health benefits of the acai.

Those compounds may or may not sound familiar to you. Resveratrol is the much discussed compound present in grape seeds and grape skins. It is likely responsible for the cardioprotective abilities of red wine.

Anthocyanins are a class of compounds that are, well, blue. From the greek for blue flower or plant, fruits known to be high in anthocyanins are cherries, blueberries, acai, blackberries, and currants. Anthocyanins are thought to be a highly active class of antioxidants.

What's my point here? I cannot say whether or not Acai is "THE ANSWER" to health. But I do know that the berry's use as a nutraceutical is still relatively new and, therefore, expensive. Just as CoQ10 and high EPA Fish Oil were outlandishly expensive when they were new and in limited supply, you may want to wait out the acai rush if money is a little tight.

Again, nothing against the acai berry. But considering it costs dozens of times more than the seemingly comparable blueberry, blackberry, red grape, dark red cherry, et al, I cannot justify telling my patients that it belongs on their "must eat" list.

So if you just got your Goldman Sachs bonus and you don't know where to spend the money, buy some acai berries and live forever!

Otherwise, have a glass of red wine tonight and sprinkle some blueberries on your yogurt tomorrow morning. And remember me if your bonus shows up in the mail.

Got Fish?

2010-02-24T11:22:00.001-08:00

I know, I must seem like a broken record when it comes to omega-3 supplementation (specifically EPA and DHA). Here are a few more reasons to consider adding it to your daily diet:

In this study of patients already suffering from stable coronary artery disease, those with the highest levels of EPA/DHA in their blood had the lowest degree of telomere shortening (a marker for identifying a cell's lifespan). In other words, their cells were "younger" than those of people with lower levels of EPA/DHA.

This study shows the relationship between low levels of EPA/DHA and a higher incidence of nervous system diseases (i.e. schizophrenia, bipolar, obsessive-compulsive, and attention-deficit hyperactivity disorders, Huntington's disease, etc.).

And finally, this study delves into the relationship between a diet high in EPA/DHA and lower incidence of colorectal cancer.

And these are just three recent studies over the past few months. Were I to dig, I could probably come up with 100 other examples. At the least, have some salmon for dinner tonight. This is my favorite way to eat it: Salmon Fillet en Papillote with Julienne Veggies. Bon apetit!

A Forum For 'Em

2010-02-17T03:08:00.000-08:00

As both a doctor and a small business owner, I love Google. It's great. It promotes my practice for free, provides me with maps, abilities to create coupons, hosts blogs, hosts my calendar page and a lot more. Best of all, it's fast. When I need to look up the potential side effects and cross reactions of an obscure medication, I can do so more quickly through Google than I can flipping through the Physicians Desk Reference.

So what's not to like about it? Sure, I occasionally have to convince a patient that their self diagnosis via Google was incorrect. But sometimes it is correct. And my guess is that 30 years ago those same patients would have walked into my office with their Encyclopedia Britannica or Readers Digest in hand.

But Google really just indexes a lot of information. It's your job to read through it. Even blogs dispense info and advice (hopefully you find this one useful?), but they, too, simply put their info "out there" for you to process.

Forums. Now this is where health care advice becomes interesting. I have a guilty pleasure. I am willing to admit it. About once per week I read through the injury sections of a few of my favorite endurance sports forums (letsrun.com, slowtwitch.com, beginnertriathlete.com, paddleboard.com, standuppaddlezone.com, etc.).

As I peruse these sites, I get to read the sort of advice that some of my current and future patients receive. About 10% of it is good and useful, 40% is relatively harmless and 50% is awful and potentially harmful.

As an example, last autumn I examined a new patient, a runner with calf pain. He'd been dealing with pain and tightness for a while. His coach told him to stretch more, his wife told him to see a doctor, and the people on the other end of his web forums told him to stretch, buy a hot tub, join a Crossfit gym, don't see a physical therapist, don't see a chiropractor, don't see a medical doctor, soak in epsom salts, run barefoot, take Advil, blah, blah, blah.

He should have listened to his wife. By the time he got to me, nerve damage from two ruptured/herniated lumbar discs had caused significant (and probably irreparable) motor nerve damage to his lower leg. He was in surgery 2 days after I examined him, and last I heard, is progressing at a moderate pace.

I don't like to post on those forums. It's not helpful for me nor the "patient". But sometimes I'll see a person similar to that previous patient getting some terrible advice, and I have to jump in and say "Hello? You're soliciting advice from people with no training whatsoever?" Hopefully they get the message.

No, you do not have to spend an arm and a leg to get a diagnosis for your leg or your arm, but this is the only body you'll ever have. Take care of it, please.

So long, Sodium!

2010-01-26T07:55:00.000-08:00

This article, printed in the New England Journal of Medicine, makes yet ANOTHER strong case for lowering your sodium intake (for a more easily read version, try this one).

The amount of salt that researchers determined should be eliminated from our diets is 3 grams of sodium, or about 1/2 a teaspoon of table salt. Here's the first few paragraphs of the article. Enjoy.

Health care reform is front and center on the U.S. politicalagenda. Actively debated are fundamental changes to the healthcare delivery system, which largely focuses on the diagnosisand treatment of existing disease. Prevention of disease, commonlyaccomplished through public health interventions, appears tobe an afterthought, perhaps because the benefits are mistakenlyperceived as small and the cost savings delayed.

In this issue of the Journal, Bibbins-Domingo and colleagues¹ document a public health intervention designed to reduce dietarysalt intake that can have huge benefits. In brief, the authorsproject that a national effort to reduce daily salt intake by3 g (1200 mg of sodium) could reduce the annual number of newcases of coronary heart disease (CHD) by 60,000 to 120,000,stroke by 32,000 to 66,000, and myocardial infarction by 54,000to 99,000 and reduce the annual number of deaths from any causeby 44,000 to 92,000.

This intervention could also save 194,000to 392,000 quality-adjusted life-years and $10 billion to $24billion in health care costs annually. Even if the interventionreduced salt intake by just 1 g per day, the benefits wouldstill be substantial and would warrant implementation.

Magnesium Cum Laude

2010-01-21T11:06:00.000-08:00

I'd like to write today about a really boring mineral: magnesium. It's not too often discussed probably because it isn't exotic like acai berries or expensive like krill oil or etc. Its deficiency, however, is a cause and effect of numerous conditions.

But first, I'll start with a disclaimer:

If you are currently experiencing any type of kidney condition or disease, do not use magnesium supplements without the full knowledge and approval of your physician. Magnesium is necessary for life and can protect the kidney from disease but if kidney damage has already occurred magnesium supplementation could be harmful, even life threatening.

And now for the more interesting stuff. Magnesium is the fourth most abundant mineral in the body, with approximately 50% of total body magnesium found in bone. The remainder is found predominantly inside cells of body tissues and organs. Only 1% of magnesium is found in blood, but the body works very hard to keep blood levels of magnesium constant.

Magnesium is needed for more than 300 biochemical reactions in the body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong.

Deficiency (from low dietary intake or excess loss) is clinically associated with:

ADD/ADHD
Alcoholism
Alzheimer's
Angina
Anxiety disorders
Arrhythmia
Arthritis- Rheumatoid and Osteoarthritis
Asthma
Autism
Auto immune disorders- all types
Cavities
Cerebral Palsy- in children from magnesium deficient mothers
Chronic Fatigue Syndrome
Coffee Consumption
Congestive Heart Disease
Constipation
Crooked teeth- narrow jaw- in children from magnesium deficient mothers
Depression
Diabetes- Type I and II
Eating disorders- Bulimia, Anorexia
Fibromyalgia
Gut disorders- including peptic ulcer, Crohn's disease, colitis, food allergy
Heart Disease- Arteriosclerosis, high cholesterol, high triglycerides
Heart Disease- in infants born to magnesium deficient mothers
High Blood Pressure
Hypoglycemia
Impaired athletic performance
Infantile Seizure- in children from magnesium deficient mothers
Insomnia
Kidney Stones
Lou Gehrig's Disease
Migraines- including cluster type
Mitral Valve Prolapse
Multiple Sclerosis
Muscle cramps
Muscle weakness, fatigue
Myopia- in children from magnesium deficient mothers
Obesity- especially obesity associated with high carbohydrate diets
Osteoporosis- just adding magnesium reversed bone loss
Parkinson's Disease
PMS- including menstrual pain and irregularities
PPH- Primary Pulmonary Hypertension
Raynaud's
SIDS- Sudden Infant Death Syndrome
Stroke
Syndrome X- insulin resistance
Thyroid disorders- low, high and auto-immune; low magnesium reduces T₄

Recommended Dietary Allowances for magnesium for children and adults

Age (years)	Male (mg/day)	Female (mg/day)	Pregnancy (mg/day)	Lactation (mg/day)
1-3	80	80	N/A	N/A
4-8	130	130	N/A	N/A
9-13	240	240	N/A	N/A
14-18	410	360	400	360
19-30	400	310	350	310
31+	420	320	360	320

The best dietary sources of magnesium include green leafy vegetables, nuts, peas, beans, and cereal grains in which the germ or outer layers have not been removed. Hard water has been found to contain more magnesium than soft water.

Children's Tylenol, Benadryl, etc. Recall!

2010-01-15T14:00:00.000-08:00

As both a father and a doctor, I have a responsibility to help get this "out there" ASAP. The following is from WebMD:

Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids Recall

Containers' Moldy Odor to Blame for Recall of 60 Million Over-the-Counter Products

Jan. 15, 2010 -- Because of a sickening smell in some containers, 54 million packages of 27 different over-the-counter remedies now are being recalled.

Products include various types of child and/or adult Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids, and Simply Sleep. This adds to the 6 million packages of Tylenol recalled late last year, bringing the total number of recalled products to 60 million.

Click HERE to read the rest of the article

Warts happening?

2010-01-14T21:33:00.001-08:00

I will admit it. This may seem like an odd topic for discussion: plantar warts. I mention them today for several reasons. First, they are likely to be encountered in public gyms/showers/restrooms. Second, with the new year and New Year's resolutions in full swing, people will unfortunately have to deal with them. Third and finally, I have experience with them.

Plantar warts are benign (noncancerous) growths that occur on the sole (plantar surface), heel, or ball of the foot. Pressure from standing and walking often causes them to grow into deep layers of the skin. The human papillomavirus (HPV) causes several different types of warts, which are the most common type of skin infection.

Anyone can contract the virus that causes plantar warts. According to the American Podiatric Medical Association (APMA), plantar warts occur most often in children and young adults between the ages of 12 and 16. Incidence is highest in people who share common bathing areas (e.g., dormitory students, military recruits, gym members).

So, what to do about them? The standard treatment for years has been one of two methods: cryotherapy (freezing them off) and topical salicylic acid (chemically burning them off). Several studies (numbers one and two) point towards and alternative method----duct tape.

That's right, duct tape to kill your plantar wart. Sure, it's not as aggressive as salicylic acid, or as painful as liquid nitrogen or as "techie" as laser therapy, but it works.

The research shows quite well that duct tape applied and worn constantly over the affected area (read: wart) is as or more effective than any other form of therapy in killing the virus (HPV) responsible for plantar warts.

And speaking from experience, it works quite well. I caught mine after swimming at UCLA's pool a few years ago. Laser and salicylic therapies failed. Then a podiatrist friend recommended 3 weeks of duct tape therapy.....and....problem solved.

So, it's an ugly problem with an even uglier name, but it should be addressed. If you or someone you know is fighting this problem, head on down to the local hardware store for your treatment. It's cheap, effective, and will stick to darned-near-anything.

Happy New Year?

2010-01-12T18:10:00.001-08:00

Well, this post is a bit of a bummer to write. After running about 1000 miles in preparation for this weekend's Avalon 50 mile race, I'm officially dropping out. :(

Since I promised to keep the "web" up to date on any issues I encountered during training, here it is:

On Christmas Eve-Eve (that's the 23rd), while surfing my favorite spot (south of Newport and north of San Diego....that's all I'll say!) I jumped off of my board in what I thought was 4-5 feet of water. Problem is, it was about 1 foot of water. What resulted? A hyperextended left knee.

The good news is that the major ligaments of the knee are intact. I believe that I sprained a minor ligament--the antero-medial menisco-femoral ligament. This ligament helps to hold the horns of the menisci to the femur.

A sprain is never good news, but in my case it is. The sort of injury I suffered could have and probably should have resulted in an ACL and medial meniscus tear.

So what does this all mean? Well, no 50 for me this winter. Today I managed to run 8 miles pain free, so I am healing well. I guess the rest of the winter and spring will have a few 10k races for me.

People often ask me if I'm afraid that all of the "things" (meaning sports) I do will wear-out my body. As I've established previously, exercise makes the body stronger--all parts of it. Furthermore, significantly more people die on the sofa than in the water or on the trail.

My advice to you: if you fall off of that horse, get back on it and ride the heck out of it!

More-on OA: Bone Spurs

2009-12-09T15:58:00.000-08:00

As long as I’ve delved into the world of osteoarthritis, I might as well tackle another issue that regularly presents itself in my clinic: bone spurs.

At least one patient per week walks into my office with x-rays in hand showing bone spurs. Yes, they can be very problematic. But my experience is that--far more often than not--the cause of the patient’s pain is not the bone spur. The pain generator may be related to the spur (as with bursitis resulting from the compression of a bursa against the spur) or completely unrelated.

My view on health care is to treat as conservatively as possible and move to more aggressive types of therapy when the conservative ones fail. Because of this philosophy, I am (unfortunately) often at odds with another physician who may have recommended surgery to grind down the spur and, hence, do away with the patient’s pain.

To quote the Mayo Clinic (because they wrote this as succinctly and correctly as could be):

Most bone spurs cause no signs or symptoms. Often you don't even realize you have bone spurs until an X-ray for another condition reveals the growths.

While the presence of bone spurs does not equate to pain, it does mean that something abnormal is occurring in the bone/joint/tendon in question.

When I am able to rule out the scary causes of bone spurs (i.e. DISH, CPPD) I look for aberrant causes of stress: far too much or too little motion in a joint, strength imbalances, movement pattern deficiencies, etc.).

If you ever do find yourself with an x-ray of a bone spur, my advice is to find a health care provider that will determine WHY the spur is there. If you can figure out why the calcium deposited in the first place, you can work on treating the CAUSE rather than the SYMPTOM.

Osteoarthritis: Surgery versus Therapy

2009-12-05T07:32:00.000-08:00

A great aspect of treating patients is never becoming bored. I see nearly every condition on a fairly regular basis. What is odd is the patterns of conditions that develop. I might not treat a case of tennis elbow for a month, then 6 new cases of it in a day.

That's been the case over the past week with osteoarthritis of the knee. It's a very common condition, related to use (actually to misuse rather than overuse), body weight, lifestyle (smoking!) and genetic factors.

It is very common for a patient to tell me--in a depressed and resigned tone--that he/she had an x-ray of the knee and has been diagnosed with arthritis of the knee. I usually reply, "Okay. Big deal. "

What I mean is that x-rays and MRIs and CT scans only tell a tiny portion of what is going on in your body. Some people with hideously awful x-ray findings have no pain whatsoever. While others with nearly normal x-ray findings have truly debilitating pain.

My opinion is that the over-reliance on these imaging modalities is the reason that surgery for osteoarthritis is no more effective than exercise therapy. I think that often both patient and doctor see the scariness of the x-ray results rather than the treatable patient and condition.

There are times when surgery is necessary, but many of the post-operative patients I see could have and should have undergone a thorough strength, flexibility and endurance regime before opting for surgery.

What does all of this mean? As I tell all of my patients: you're the boss. You pay me and other practitioners for a service. Ultimately it is your decision, your motivation and your consequences. Don't rely on just one x-ray or just one opinion or just one course of therapy. In today's health care system, you need to take the lead on all decisions regarding your health.

Exercise for......smarties

2009-12-01T17:11:00.000-08:00

I've had a goal for at least the past year---to post the one hundred (or so) exercises that I most commonly prescribe so my patients may have access to them at any time. After a lot of wasted time and effort, I have finally made some head way.

If you proceed to http://www.coastalhealthandfitness.com/page25.php you can see the first few dozen exercises that I've uploaded. Please keep in mind that this is still a work in progress.

Last week, over Thanksgiving, I reviewed almost 100 patient charts and found 245 different exercises that I had prescribed. SOOOOoooooo, I hope Youtube can afford a little space on their server. Eventually, we will have every exercise that I would offer to a patient available on our site.

Feel free to send me any comments or critiques! Thanks.

Fishy, fishy, fishy

2009-11-03T03:57:00.000-08:00

So we've already established in a previous post that fish oil consumption is generally a great thing. And as shown in this article, consuming actual fish (as opposed to fish oil supplementation) is likely the best way to absorb the omega 3 fats that are so necessary and desired. But if you don't like Fish Chowder, what do you do?

Well, first lets take a step back. Fish versus supplements. Who wins? I am a "whole food" guy----if and whenever possible I prefer that I (and my patients) get their nutrients from actual foods rather than in a pill form. Fish oil, however, may be a little different.

Oily fish--albacore, herring, mackerel, salmon, tuna, et al.--are also predatory fish, meaning they consume smaller fish. Those smaller fish consume smaller organisms which consume even smaller oceanic flora. A drawback to being a "big" fish is every time you eat, you're not just eating the fish in your mouth, but you're eating every fish that it ever consumed (sorry for the flashback to high school health class!).

In ocean-going fish, this means a lot of mercury accumulates in the predatory, oily fish varieties. In farm-raised fish, the problem is more often one of PCBs, dioxin and chlordane. In either case, overconsumption can lead to a lot of health problems for people hoping to improve their health.

In California, Prop 65 does offer some safeguards to the consumer. And supplement industry tradegroups, both the Council for Responsible Nutrition and The United States Pharmacopeia, set voluntary standards that are actually more stringent than Prop 65 or the EPA. So then, for starters, see if the manufacturer/distributor of your fish oil supplement is listed here, here, or adheres to the European Pharmacopoeia Standard.

Once your supplement has passed those standards, time for your nose to do some work. Smell the capsule and container in which it was sold. A lightly "fishy" smell is acceptable. But a powerful fish smell (think being along a bay near murky, mucky water) is a good indicator of rancidity. And rancidity means that the oil has begun to oxidize and is now actually MORE harmful than taking nothing at all. Color is a good indicator of rancidity, too. Your supplement should be translucent and very light colored. Orange and brown are bad, bad, bad!

Finally, what to do for the vegan in search of omega 3 fats. There are sources of non-animal omega-3 fats, namely in the form of alpha linolenic acid. This fat is found largely in flax, walnuts and canola oil. An 18 carbon, essential fatty acid, alpha linolenic acid can be converted in the body to EPA and DHA, but this conversion appears to be around 10% efficacy. Another choice is stearidonic acid, found largely in hemp seed oil. This fat has a nearly 50% conversion rate to EPA and DHA in the body, but is a very difficult fat to find in foodstuffs.

There are currently several companies working on increasing the levels of stearidonic acid in more easily grown crops. Hopefully this will someday become a viable option for the omega 3 consumer. Until then, enjoy your fish oil!

Swelling isn't too swell!

2009-10-20T13:02:00.000-07:00

If you've ever twisted an ankle badly enough to sprain or strain it, you know the routine: RICE: Rest, Ice, Compression, Elevation. The goal is to reduce swelling as quickly as possible in order to help the healing process and reduce pain.

So, inflammation is bad, right? Umm, well, sort of. The discovery of aspirin in the late 1800s, followed by ibuprofen in the 1960s led us all to believe that inflammation, and with it pain, could be easily managed. Over 100 years later (and probably thousands of studies) the medical world is thinking a bit differently about inflammation.

Immediately following an injury, damaged cells produce large quantities of COX enzymes (cylooxygenase-1 and cylooxygenase-2). These enzymes, in turn, produces a type of chemical called prostaglandins, which send a message to the brain signaling that a specific part of the body is in pain. Prostaglandins also cause cells in the injured area to release fluids, leading to swelling and inflammation. Non steroidal antiinflammatory drugs (NSAIDs) irreversibly halt the enzymatic activity of Cox-1 and latch onto Cox-2, preventing them from producing prostaglandins. As a result, less inflammation occurs and fewer pain-signals are produced.

This is all good, right? If the goal is simply to limit inflammation, then yes. But if the goal is healing and recovery from the injury, then no.

Prostaglandins not only lead to the signs and symptoms of inflammation, but they also play a role in healing (actually, Cox-1 and Cox-2 play a role in healing as well). There are countless sites and articles on the web which explain the role of NSAIDS. A great read is this Phd dissertation (read just the first few pages unless you have a degree in bio sciences).

So then, it's pretty well established that using NSAIDs adversely effects the healing process (both via delayed repair and increased scar tissue formation). I absolutely will not tell you NOT to use it: that's a decision for you and your health care provider.

If you opt to avoid NSAIDs during your injury, there are other options. First, back to RICE. Rest: well, duh! Ice: the application of ice over an injury causes a vasoconstriction in that area---literally squeezing accumulated swelling from the area (though be careful here: too much icing actually causes inflammation). Compression: doesn't allow edema/swelling to accumulate in the first place. Elevation: whenever possible, keep the injured area at or above the level of your heart, otherwise gravity will keep the swelling in your body.

And lastly, omega-3 fatty acids (mainly EPA and DHA). Prostaglandins are synthesized from 2 fats: omega-6 and omega-3. A specifice type of prostaglindin from omega-6 fats (largely grains and peanuts) is PRO-inflammatory. Prostaglandins from omega-3 fats (flax, salmon, cod) are ANTI-inflammatory. Our western diets are very high in omega-6 fats and very low in omega-3 fats.

If you are currently injured, increase your omega-3 fat consumption (you should probably do it even if you're not injured). It's thought that omega-3s may be better absorbed if you consume them in REAL food rather than in pill form. If you take your omega-3 in pill form, just be sure it's mercury-free. The issue of how to choose an omega-3 supplement, how much to take and when to take it is complex enough that I intend a follow-up article to this one.

Vitamin D

2009-10-07T15:53:00.000-07:00

I haven't written too much on nutrition lately, so here's a little info on one of my favorite vitamins!

Vitamin D is found in significant levels in numerous dietary sources such as fish, eggs, fortified milk, and cod liver oil (yum!). Daily sun exposure also contributes significantly to the daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies. In fact, it is believed that the general fear of sun exposure and its accompanying skin cancer risk has led to an increasing rate of Vitamin D deficiency.

The major biologic function of Vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. Recently, research also suggests Vitamin D may provide protection from osteoporosis, hypertension, cancer, and several autoimmune diseases.

There are so many potential benefits to the consumption of Vitamin D, and so many risks associated with a deficiency of it, that I could write pages and pages on the subject. Hmmm, I may have a new idea for a book!

Vitamin D is included in most multivitamins, usually in strengths from 50 International Units (IU) to 1,000 IU as softgels, capsules, tablets, and liquids. The Adequate Intake (AI) levels have been established by the U.S. Institute of Medicine of the National Academy of Sciences.

Recommendations are:

5 micrograms (200 IU) daily for all individuals--males, female, pregnant/lactating women--under the age of 50 years-old.
For all individuals from 50-70 years-old, 10 micrograms daily (400 IU) is recommended.
For those who are over 70 years-old, 15 micrograms daily (600 IU) is suggested.

Some authors have questioned whether the current recommended adequate levels are sufficient to meet physiological needs, especially given our society's general lack of fitness and "outdoorsmanship".

The upper limit (UL) for Vitamin D has been recommended as 2,000 IU daily due to toxicities that can occur when taken in higher doses.

Whenever possible, I opt to consume any nutrients, vitamins, et al from whole foods. For a list of foods highest in Vitamin D, click HERE.

Now, if it isn't too late, go get in that swim you've been avoiding all day. Hopefully there's still a little sunlight left. If not, enjoy your cod liver oil tonight!

To heel, or not to heel...

2009-09-22T16:32:00.000-07:00

I started running almost 40,000 miles ago (actually, I should hit 40k sometime late 2010). Fortunately, I was once in "the industry" and received dozens (if not hundreds) of pairs of shoes either free or close to it. While I don't know how many pairs I've worn, I can recall every brand and model in which I've logged miles.

As my body adapted, my ideal shoe type changed. In the earliest days (before I learned about running biomechanics and before I discovered some great running shops), I wore cheap, poorly cushioned and non-stability shoes. I actually ran a half marathon in Guadalajara in Nike crosstrainers. Needless to say, I blistered badly and could barely walk for a week.

Soon after that, a local running shop fitted me in a moderate stability shoe. I logged a couple thousand miles over the next 2-3 years in shoes like the Asics GT 2001, Nike Structure Triax and Brooks Adrenaline. With all of those miles, my body adapted (the daily stretching and strength training helped, too). Soon, I was running in neutral trainers like the Adidas SL96, Brooks Cheetah, Adidas Ozweego and Saucony Jazz.

A couple of years ago, I took up barefoot running 1-3 times per month. Thanks to the adaptations in my gait, my current trainers of choice are cross country flats. Yep, went from no stability to moderate stability to no stability/no cushioning. Funny thing is, my body feels better now with these basic shoes than it ever did with "cushioned" shoes.

You could spend hours online reading about the benefits of barefoot running or minimalistic running. For a more brief and basic read, check out this article by podiatrist William Rossi.

If you're interested in shedding a few ounces from your feet, please do it gradually. Take your time in the journey towards minimalism or barefoot running. I took around 30,000 miles to make the change that maybe could have been accomplished in half the time. Still, that would have been 15,000 miles, or 5-6 years of running.

Now, get out there and run!

Run, don't trot

2009-09-08T13:41:00.000-07:00

None of us was born a runner. At some point, all runners experience that moment of being a runner. With running comes a universe of great side effects: increased endurance, lower body weight, stronger bones, decreased joint problems, etc. With running also comes a host of problems: sprain/strain injuries, chafing, sunburns, over-training, etc.

For the most part, we were all aware of the typical problems that runners endure (chafing being a possible exception to that list). One issue with which MANY runners contend is gastro-intestinal related. Sure, we all have to use the restroom before a race, but some people really struggle with what has become known as runner’s trots.

Patients don’t typically seek out my services to help them with this. Gastro-intestinal problems are not very often discussed by patients with any health care provider. It’s believed that is why colon cancer is so deadly---the stigma associated with the bowels is so strong that patients would rather ignore gravely serious problems than have to discuss them with a healthcare provider. Often, patients come to me with an aching achilles or a sore low back. At some point during the course of treatment, he or she will mention having the symptoms runner’s trots.

There’s no set group of symptoms that defines runner’s trots. Typically, it’s defined as cramping, flatulence, diarrhea and/or nausea during or immediately following a run. If you google the problem enough, you’re sure to find countless recommendations on how to deal with this, including not eating or drinking before or during a run, using Immodium before every run, increasing water intake, decreasing water intake, eliminating wheat from your diet, and many, many others.

My advice is this: first, talk to your healthcare provider so he/she can help to determine that nothing more serious is occurring. And second, change your eating and running routines until you find one that works for you. I have a friend who cannot run before 8 a.m. without suffering diarrhea during a run, and another one that must run after 3 p.m. for the same reason. Some patients have found eliminating caffeine was the key, while others found no change. As similar as we all are, we are also very unique (see, your mom was right!). Don’t be discouraged if you have not yet found the solution. It’s probably out there, waiting for you to discover it.

The next step you might take is to research irritable bowel syndrome. The symptoms of IBS are essentially the symptoms of runner’s trots. Some of the dietary restrictions of IBS are on the extreme end of the spectrum (good-bye pepperoni pizza and Guinness), but they may be the solution to an uncomfortable problem.

If all else fails, live with it. Find an area where you like to run that has numerous restrooms. Maybe over time your body will adapt and the problem will lessen. If it doesn’t at least you can still run.

An Ultra Cool Ultra Marathon

2009-08-31T13:27:00.000-07:00

I used to run a LOT of miles. Sometimes those miles fit nicely into the training plan that a coach had devised for me, and sometimes those miles just seemed like a fun way to pass a few spare hours on a given day.

Because I so rarely race long distances any more, I rarely run long distances (wow, how profound!). It's time for me to re-enter the world of long distance running. And by making my goal public, hopefully it will help motivate me to put in the miles on days where I'd rather sleep or rest or surf or etc.

On January 16, 2010 I will be running the Avalon 50 Mile Run. I do not want this blog to become about me, my training and injuries, but if I suffer any unique problems over the next 20 weeks, I'll be sure to let the web know about it.

If any of my regular readers have advice for me (other than "don't do it"), please let me hear it. This will be 19 miles further than I've run before. As a side note, I'll be doing my long runs at El Moro and Aliso Woods. So, for any of you nuts who want to run 15-30 miles on a given Sunday, drop me a line. It'd be nice to have some company on those big days.

As long as I'm throwing myself to the lions, I also intend to race the Catalina Classic Paddleboard race next August---a 32 mile race from the isthmus of Catalina to Manhattan Beach. Training for that begins as soon as recovery from the run ends. See y'all on the trails....or water.....or hospital!

Nonagenarians for Dummies

2009-08-26T05:29:00.000-07:00

When I was a 20-something runner, I remember looking at the 50 year-olds and thinking, “Wow, I hope that I can still walk when I’m that age.” With 40 fast approaching, those 50 year-olds seem pretty young.

My wife is an amazing person who, among other things, hails from a family that seemingly has no problem living well into their 90s. Whereas in my family, the men tend to drop off around 25 years earlier, usually to cancer. As such, I made it a goal a few years ago to live to 100.

The changes in my life are pretty simple ones. To maintain my already “normal” level blood pressure, I supplement beet juice several times per week. To help combat risk factors of prostate cancer (the #1 cancer in my family), daily I consume flax, saw palmetto and a few servings of red veggies. No more returning from the market with a bag of tortilla chips and pretzels. If it’s a processed grain, I don’t eat it. I ride my road bike less (I’ve been bumped and hit by cars too many times) and spend more time in the serenity of the ocean, surfing and paddling.

A study published around a year and a half ago looked at the lifestyles of men who live into their 90s. Researchers tracked a group of several thousand men over 20+ years. From the results of their study, they estimate that a 70-year-old man who did not smoke and had normal blood pressure and weight, no diabetes and exercised 2-4x per week had a 54% probability of living to age 90. However, if he had adverse factors, his probability of living to age 90 was reduced to the following amount:

Sedentary lifestyle, 44%
Hypertension, 36%
Obesity, 26%
Diabetes, 30%
Smoking, 22%
Combination of any 3 factors, 14%
Combination of all 5 factors, 4%

The study does not tell the whole story (family life, work history, etc) but it does give a pretty good picture of how to live long and well. And note that according to the study, the 90 year-olds did not just live longer than those who died younger, but they seemed to live “better”. I know, that’s a terribly subjective term. But the nonagenarians in this study lived longer, were stricken by disease at a later date, were more active and were more mentally acute than their counterparts.

For myself, it would seem that those 5 risk factors are a non-issue. Woohoo! Assuming I make it to 70, I have a 54% chance of living as long as my wife. If you’re dealing with any of those 5 risk factors, make the change today. It’s truly is never too late to change.

HELP SAVE UC IRVINE'S SWIMMING AND DIVING PROGRAMS!

2009-08-13T13:56:00.000-07:00

Due to our state's current economic crisis, on August 1^st UC Irvine Intercollegiate Athletics discontinued five sports teams. The Men's and Women's Swimming and Diving teams, along with Men's and Women's Rowing and Sailing were eliminated.

Both the swimming and diving teams are not going down without a fight, however. A nonprofit organization, Anteater Swimming and Diving Foundation (ASDF), has been formed by the swimmers, concerned alumni and the community to help raise funds to reinstate the programs. Click HERE to visit the Anteater Swimming and Diving Foundation. Also, you can visit them on

As an Anteater alumnus who endured the cancellation of our baseball program in the early 90s, I am trying to do my part to help these student-athletes continue in their program and their university.

On Thursday, August 20, we are offering a >50% discount of our usual rate....actually, I am offering my services free-of-charge to any person bringing a cash or check donation of $60 or more to the Anteater Swimming and Diving Foundation.

If you have been thinking about seeing a doctor for an ache or pain or stiffness or even just a checkup, now is the time to do it! As a not-for-profit organization (a 501c3), your donation is tax deductible. Checks should be made out to "Anteater Swimming and Diving Foundation."

Services available (depending on your diagnosis and condition) include complete neuro-musculo-skeletal examination, chiropractic adjustments, Active Release Technique^®, KinesioTaping^®, and rehabilitative exercises.

This offer is by-appointment only. Call our office at (949) 951-1160 to schedule an appointment with Dr. Scott on August 20^th. Call now while we still have appointments available. You can also visit us on the web at: www.coastalhealthandfitness.com

My goal is to raise $1000 on August 20. If you are unable to make it to our office, credit card donations can be made through the ASDF Paypal site and checks can be mailed to:

Anteater Swimming and Diving Foundation
P.O. Box 5295
Irvine, CA 92616-5295

Pier to Pier Quest

2009-08-10T18:02:00.000-07:00

Okay, so today's post isn't too informational. I guess the "take home" message might be: go have fun!!!!

Below is an excerpt from the Orange County Register about an event that occurs every August. This year I was lucky/foolish/naive enough to take part in it.

Scott Neubauer, a Laguna Hills chiropractor and a former triathlete, thought he knew the Orange County coast pretty well from having paddled up and down it.

On Tuesday, minus paddleboard, he discovered some rocky features he hadn't known existed.

For the full story, click here!

Train smarter, not harder

2009-07-28T19:41:00.000-07:00

Anyone who has been in the fitness/health industry for more than a couple of years can attest to the fads that permeate the industry. After obtaining my undergrad degree from UC Irvine, I worked for several running and cycling retailers and manufacturers. From the inside I was able to witness some crazy inventions that were marketed as the "next great" thing. Some of the highlights were the Quintana Roo Redstone, Cannondale Headshok, Z Coil, Nike Shox, Reebok Pump, and Adidas Feet You Wear (though, in fairness, the Feet You Wear was a brilliant concept for running and tennis shoes that retailers and customers failed to understand...too bad).

Then several years ago I became a CSCS through the National Strength and Conditioning Association. The CSCS exam is known as the most difficult in the fitness industry (I have been told that the pass rate is only around 40% of test-takers). The exam called on a great breadth of knowledge from endurance sports to skill sports to strength sports to geriatric activities to powerlifting to periodization. It is difficult to find a collegiate or professional sports team strength coach who does not have a CSCS certificate. Similarly, a large number of sports medicine doctors and therapists have obtained the certificate. Just as it is a great way for a doctor to differentiate his/herself from less athletic peers, personal trainers can use the CSCS to demonstrate their superior knowledge over their peers. Seeking a trainer or coach with a CSCS is a great way of screening the potentially good from the probably bad.

Some of the workout fads I have witnessed are Bikram yoga, Pilates, Curves and pole dancing. A current "fad" in exercise is CrossFit. I don't mean to be demeaning--I actually am a fan of the types of exercises that CrossFit incorporates. What I like about it is the emphasis on closed-chain exercises and the embargo of machines. I think it is fantastic for general fitness, though it is not the sort of program I would recommend for a competitive athlete.

What is my point? Well, before you embark on your fitness journey, set a fitness goal. Define what you hope to achieve and why. A jogger has different needs than a surfer who has different needs thant a Cat 1 cyclist who has different needs than a rock climber. For most of America, simply beginning a fitness routine, any fitness routine, would be a great step in the right direction. But an athlete needs a workout routine specific to his/her sport. In my opinion, no one needs to perform Olympic weight lifting exercises other than Olympic weight lifters. A person's exercises should mimic his/her daily or athletic activities.

What if you don't want to hire a coach or a trainer? Read, a lot! Regardless of your sport or level of activity, start with the "father of periodization", Tudor Bompa. All runners should read Jack Daniels and Timothy Noakes. Cyclists and triathletes should try Joel Friel. Swimmers should.....well, swimmers should join a masters swim group.

One piece of advice I can give to all athletes and fitness enthusiasts is to "mix it up". Do not do the same workout two days in a row, two weeks in a row or two months in a row. Many weight lifters think it is adequate to break lifting into chest, back and leg exercises. Try occasionally splitting exercises into flexion days and extension days; internal rotation and external rotation days. Sometimes lift weights before you swim, sometimes after. Sometimes swim-bike-run, sometimes bike-swim-run. Whatever you do, constantly change it up. Variety really is the spice of life.

Open Water Swimming for Triathletes

2009-07-19T13:39:00.000-07:00

I am very fortunate. I learned to swim around 2 years of age, began swimming competitively at age 4 and started spending time in the surf around age 6. This means that I am a good (not great, just good) pool swimmer and a very good ocean swimmer. My older sisters are both excellent swimmers and are more than competent in the open water. Similarly, my younger brother is absolutely fearless on a board regardless of the size of the swell.

What is my point? Well, my workout this morning was a continuous swim-run just down the road at El Moro in Crystal Cove State Park. When the water is warm, as it is right now, I love to swim out past the breakline, head down the beach a couple hundred meters, swim back in to shore, run a mile and then do it all over again, ad nauseum. With next weekend’s Pacific Coast Triathlon occurring in the park, there were a LOT of triathletes getting into the water.

After my hour and a half of swim-run-swim-run-etc was finished, I sat and watched the triathletes head into and out of the water. I noted that the top 10% were fantastic swimmers—probably faster than myself. The next 50% were capable—neither fast nor slow, but competent enough to handle the open water. The remaining 40% (or so) probably should not have been in the ocean….at least not a few hundred yards out from shore, away from the eyes of the lifeguards.

Every year there are a few drownings in triathlons across the country. Some of the time there is an underlying health condition (i.e. heart attack) that leads to the drowning. But much of the time it is competitors not familiar with lake or river or ocean swims who fall victim.

Watching that slowest 40% today, I observed them get into the water (very slowly), stop and rest constantly, and leave the beach as soon as their swim was over. There was no time spent "playing" in the water—no riding swells, diving under the crashing surf, etc. Despite paying $10 to park at that beach, they left the beach as quickly as possible to run or ride.

My assumption is that the 40% have not had the luxury of time in the ocean that myself and the other 60% have. I would guess that some of that 40% are actually fair pool swimmers. And some of the 40% are probably incapable of swimming more than a few hundred meters at a time.

My recommendation is: if you plan on putting yourself in an inherently risky situation (and I have seen enough big “animals” in coastal waters to know how risky it is out there!), then you must become familiar with that environment. No, that does not mean that you have to become the next Laird Hamilton or Craig Hummer in order to compete in a triathlon. But preparing for a triathlon—especially one with a surf swim—by pool swimming exclusively is a lot like using a stairmaster to prepare to climb Mount McKinley.

US Open Water Swimming is a good place to start, as is US Masters Swimming. Whatever you do, don’t go solo. I may paddleboard alone all of the time, but I never open water swim without another swimmer nearby. And with 8-10 foot swells forecast for the end of this week, I wish all competitors good luck out there—be safe, be smart and have a great race.

There's no screen like sunscreen

2009-07-13T15:49:00.000-07:00

I had a late start at the office today, leaving me with a chance to get in a nice, long run before seeing my first patient. I don't very often run during late morning hours---and today it was HOT! And bright. Sure, we've passed the solstice, but the sun is still very high and very bright in the sky.

Now that I'm an "old" man, I have become very good about wearing a hat and coating my body with sunscreen when running, paddling, hiking, surfing, etc. I was not always so diligent. At Ironman Hawaii in 2000, I decided not to wear sunscreen at all. I didn't want it dripping into and burning my eyes, and the greasiness of so many sunscreens has always been a problem with sunglasses. So, I (foolishly) raced sans screen. The result? Oddly, no burn. I was VERY lucky and pretty stupid (though the absence of a burn does not mean that my skin/body was free of any damage from that day).

Skin cancer is the most prevalent cancer in the United States. Cumulative sun exposure is thought to be the cause of squamous cell and basal skin cancers (the "less" serious cancers) while episodes of serious sunburns (click here if have a strong stomach) early in life are thought to lead to melanoma. Melanoma is by far the rarest of the 3 types, but is responsible for approximately 75% of deaths related to skin cancer.

Sunscreens have changed a lot since my childhood. In the old days, we looked at the SPF number and slathered it on. Now, you need to read the label well enough to know which UV spectrums will be "screened". And don't count on that running shirt or rash guard to offer protection. Most dry t-shirts offer SPF around 10, and once wet drop to less than half that number.

And now that I'm a dad, I had to research all over again to know not only what would protect my son, but what would not irritate his skin. I am neither a pediatrician nor a dermatologist, so I'll leave that research up to you.

For my body, I go to Costco or Target and buy (in bulk) a broad spectrum, high SPF "water-proof" sunscreen. I don't care too much about the brand, just the ingredients. For my face, I recently discovered Watermans sunscreen (note: I have no affiliation with the company). It's pretty expensive (hence, I just use it on my face) but it is the first and only sunscreen that I have ever used that does not drip into and burn my eyes. I have paddled, surfed, run and mountain biked using this stuff. It works well enough that I no longer paint my face, ears and scalp white with zinc oxide before heading out on the water---like this.

Need an excuse to exercise?

2009-07-09T10:04:00.000-07:00

There was an interesting article in the Wall Street Journal a few days ago. It cited several sources that show running participation—in races—has grown significantly AND finish times have improved. The article blames (or credits) current “economic doldrums” for the newfound training time that runners are enjoying. And more time to train equals faster times at races.

It is an interesting thought, that running enjoys a boom when the economy goes bust. This would help to explain running’s boom years of the late 70s, when it seemed half of the field of any given marathon would run sub 3 hours. Even the early 90s, when I started in triathlons, seemed much more competitive than the past few years.

I have noted several times that Orange County in the early 90s was awash in runners and cyclists and triathletes. There certainly are a lot of us now, but not as many as “back then.” My theory was as real estate became more and more expensive (have you looked at housing in Newport Coast or Corona del Mar lately???), the middle class weekend warriors were priced out of the area. While that may be true, the article postulates that many of us simply became too busy to train and race at our previous levels.

There is a pretty well-known study, now about 10 years old, that looked at the affect of aerobic exercise on patients suffering from major depressive disorder. After 16 weeks of medication, aerobic exercise or a combination of the two, all groups had similar outcomes, improving by statistically similar amounts.

Another study looked at the possible mechanisms for this reduction in depression. The verdict? It’s difficult to know how or why regular exercise helps with the “mood” of people. All that is known is exercise does help with people’s mood.

Maybe it’s the formation of a habit, the sense of belonging to a group, the regular exposure to endorphins, the sense of accomplishment, the learned resistance to stress, or something else. Speaking personally, I have a tough time getting through the day if I go 2 days in a row without some sort of workout.

I’m not saying that running or cycling or paddling will solve life’s problems. But I will advocate that our bodies are meant to move. From our huge Achilles tendons to our long femurs to our broad nuchal ligaments, we are built to walk and run over very long distances. Be it God or Darwinian, someone or something intended for us to be in motion on a daily basis. It would seem our brains and psyches crave the same movement.

If you’re a runner, make sure to get a few miles in today. If you surf, go get in the water (despite how cold it’s been here lately). If you’re not currently active, try something new: a walk around the block, a jog around the high school track, a few laps in the community pool, even mowing your lawn! Get your body in shape, and hopefully your mental state will follow.

Happy Independence Day!!!

2009-07-02T15:50:00.000-07:00

If you're on the roads or on the water, be careful out there!

And if you see a serviceman, thank him/her for their service.

Better yet, visit the Wounded Warrior Project.

Have a great weekend!!!

And now, for something completely different...

2009-06-29T13:31:00.000-07:00

Or maybe just a little different today.

I want to take you back in time to the 8th or 9th grade. You go to bed having forgotten to study for a test the next day. Morning arrives, you ride your skateboard to school and then it hits you: a TEST! Instead of admitting the error of your ways and rededicating your academic intentions, you hope and pray to anyone who will listen for the teacher to be absent…or a fire drill…or an earthquake…anything! Please let the test not be on this day!!!!!

The Waterman Challenge was that sort of race for me. Sure, it’s only 15 miles and sure, the conditions were calm and overcast. But I didn’t “study” for this race at all. Apparently changing the diapers of a 9 week-old is not the quality cross-training that I had hoped it to be.

My lack of fitness showed up around 8 miles into the race in the form of dead and exhausted arms. My prayers for a water spout…or a hurricane…or a shark lasted for the next 7 miles. I needed something, no...anything...that would give me an excuse to turn to shore. Just like in the 8th grade, my wishes went unanswered and I had to finish my “test”.

With 2009 being the 14th running of the event, the Waterman Challenge is an open water paddleboard race from Swamis beach in Encinitas to Windansea beach. The event is open to traditional (prone) paddleboards and stand up paddleboards with separate divisions for differing lengths of boards.

This year’s overall winners were Rob Rojas on a SUP in 2:06:33 and George Plsek on an unlimited in 2:09:14. My under-prepared body floated across the finish line a half an hour later like a dead whale carcass carried by the currents.

The lessons to be learned from this race? Firstly: if you want to do well on your “test”, you have to “study” for it regularly and often. I know I could have spent less time over the past month watching the French Open, the Penn Relays, etc. and more time swimming and on my board. And secondly: there’s never a shark around when you need one.

SUP is 'sup

2009-06-25T17:32:00.000-07:00

What do golfers and stand up paddlers have in common? Not very much. And no, I’m not trying to make a joke at the expense of SUP-ers. The answer is: elbow pain.

I have been seeing an explosion in the number of medial elbow pain cases over the past few months. All of these patients are stand up paddlers and nearly every one of them is new to the sport. There are a lot of areas I would expect to be the “weakest link” in a SUP-er. What surprises me is that, as of yet, the ONLY SUP-related injury I am treating is medial epicondylitis, or “golfer’s elbow”.

There is some debate about the etiology of golfer’s elbow: is it the repeated and high velocity concentric contraction of the forearm flexor group during the mid phase of the swing or the ever so slight but real eccentric contraction of the forearm flexors as the club head strikes the ball? I’ll let the researchers sort that one out. I have tough enough a time getting the ball to go through the windmill, under the mushroom and come out of the waterfall to land next to the hole! :P

With SUP, the flexion motion of the forearm muscles (the extrinsic flexor muscles of the hand/wrist plus the pronator teres and quadratus) is much more powerful than in golf, but much slower as well. This probably removes the eccentric model. This is important because eccentric-type contraction injuries (in my experience) are much more acute and cause significantly more inflammation (think soccer player rupturing a hamstring as her knee extends beneath her) when compared to concentric-type injuries (think cyclist NOT stretching his hamstrings over thousands of miles of training). This puts the typical SUP-er in an overuse category of muscle injury (cumulative trauma disorder) rather than a one-time traumatic injury.

So what, you ask? I went through the hundreds of hours of post-graduate courses to learn Active Release Technique®, which is intended to treat exactly this type of injury. While ART® works fantastically well, the best course of action is to avoid the injury in the first place.

Well, how do you avoid CTD problems? Deal with them before they become a problem (duh!!). If you’re a SUP-er and you are asymptomatic (no pain, no numbness, no weakness) start stretching the forearm ASAP. Even though we’re discussing a flexor problem, I would recommend stretching the wrist and elbow extensors, as well. As for strength exercises, the act of paddling gives the flexors enough of a workout already. So focus on strengthening the wrist extensors, supinator and elbow extensors (triceps and anconeus).

There’s no guarantee that you won’t become injured, but at least no one will mistake you for a golfer.

Happy Father's Day!

2009-06-21T14:47:00.000-07:00

In honor of Father’s Day (and my first one as a Dad) is a quick look back at a study from about 6 years ago.

In a STUDY at the University of Wisconsin, researchers showed that dark beer significantly reduced markers for platelet aggregation, which can lead to clotting that causes heart attacks in patients with atherosclerosis. The Wisconsin researchers compared the effects of light and dark beers on dogs with narrowed arteries, similar to those in humans with heart disease.

Measurements of platelet markers for various cellular processes involved in platelet aggregation were taken before and after the administration of the light and dark beers. Afterwards the dogs were given epinephrine, a stress/fight-or-flight hormone previously shown to reverse the anti-clotting effects of drugs like aspirin. Only the dogs administered dark beer were protected against the reversal of its antithrombotic effect.

Researchers theorize that certain polyphenolic compounds are responsible for the cardio-protective effect of beer. As such, they continue to seek that key ingredient that protected the dogs from clotting. I believe we have already found the key ingredient……it’s called Guinness stout! "Administer" one or two today at the barbeque!

Another Way to View Piriformis Problems

2009-06-12T16:46:00.000-07:00

I work with a LOT of runners. I am very accustomed to the typical tight hamstring and/or tight external hip rotators (piriformis, superior gemellus, obturator internus, inferior gemellus, quadratus femoris and gluteus maximus). When I work on any of those muscles, I often follow the anatomy train (for a FANTASTIC anatomy read, check out Anatomy Trains by Myers) across the pelvis to the opposite side quadratus lumborum (QL).

This month’s moment of epiphany occurred thanks to working on a few dozen athletes at a regional USA Track and Field meet two weeks ago. So many of the athletes exhibited the typical tight external hip rotators and tight opposite side QL that I began to wonder: “How many hip patients have I seen over the years who had this same combination of hip and opposite side low back issues?”

Each one of those runners at the meet was shocked when, after performing ART on the symptomatic hip, I would then work on an equally tender QL on the opposing side. They would ask “Why does that hurt, too?” They were even more surprised to find that they could not hold a side bridge plank with that QL for more than a few moments.

My theory is that upward pull of the tight QL changes the orientation of the opposite femur relative to the pelvis. This altered positioning in turn leads to a tighter external rotator of the hip. The tightness eventually leads to pain that diminishes with therapy, but returns with activities.

Fast forward to today. While hanging out at a local bike shop between patient appointments, I watched a Retul road bike fitting taking place. With every stroke of the pedal, the customer’s left knee swung outward at the top of the pedal stroke. When the cyclist would rest in between computer measurements, I observed his right iliac crest (hip) approximately 1” higher than the left regardless of his position on the bike. And finally, the Retul system “detected” his LEFT leg as longer than his RIGHT leg---meaning my observation of a higher right iliac crest correct. Unfortunately, the “Retul” solution to this problem is to shim the “short” leg. The system isn’t intelligent enough to recognize the interconnectivity of muscle groups and anatomical regions.

Even though there is a supposed relationship between the glute medius and the opposite side QL (see Trendelenberg exam), I constantly find that hip external rotator problems travel with the opposite side QL. What this means is if you have a piriformis problem that never completely goes away, add a routine of QL stretching---especially on the opposite side.

The other take-home message is be careful when someone offers shims or orthotics to account for a “short” leg. If the leg actually is shorter, then an orthotic device is a great and necessary approach. But too much of the time there is a tight group of muscles pulling the pelvis and causing the “short” leg. Find a knowledgeable health care provider to give a thorough evaluation of the entire body before sticking devices beneath your feet.

Listen to your patients!

2009-06-11T08:35:00.001-07:00

Here’s a lesson for patients and health care providers. I recently evaluated a patient who was suffering from carpal tunnel syndrome. He had lived with pain and numbness in one hand that began a little over a year ago.

These symptoms were treated with cortisone injections, which temporarily relieved the symptoms. After a few rounds of cortisone, he finally relented and underwent a carpal ligament release. And: problem solved. No more pain in that hand.

Then a few months ago he felt the same symptoms of pain and numbness in the OTHER hand. Not wanting to go through injections and surgery, he sought more conservative care first. Twelve visits to a physical therapist did not help. Six more visits to a chiropractor who is an Active Release Technique provider also did not help.

So in front of me sat a man who was running out of patience and hope. Carpal tunnel syndrome does tend to be a “mechanical” problem---something occupies the space of the tunnel and presses on the median nerve. If you remove or reduce that occupying “mass”, the symptoms go away. Very often, the “mass” is somewhere else along the path of the median nerve (pronator teres, antecubital fossa, medial intermuscular septum, etc.).

What was odd was the success, albeit temporary, of the cortisone injection coupled with the absolute failure of the other approaches (which included ART, stretching, strength training, ultrasound, electrical stimulation and ice).

Chiropractors are not experts in pharmacology. That stated, most chiropractors (and physical therapists) become very familiar with the 40 or 50 most commonly prescribed medications. This patient was taking a heart medication that was NOT familiar to me. A quick search through the PDR (Physician’s Desk Reference) followed by a phone call to my favorite pharmacist (thanks for taking my call so quickly, Dave) confirmed my suspicions.

This patient seemed to be suffering from a side-effect of a medication he was taking. When I asked the patient if he had spoken to this cardiologist (who prescribed the drug) about his carpal tunnel syndrome symptoms, he said “no”. He did not think a heart doctor would know or care about hand problems. Similarly, his general practitioner was unaware of his heart medication (same logic employed here, too). And finally, on his initial patient paper work, he failed to include this drug as something he currently takes. I had to ask him in order to learn about it. I made him phone his cardiologist from my office to set up an appointment for later that day.

When I spoke to the patient recently, his cardiologist had altered the medication about a month earlier. His pain and numbness were completely gone. I wish I could say it is because I treated him so well—all I did was talk to and examine him!

The lesson—patients: tell your health care provider EVERYTHING. Let him/her decide if it is germane to your condition. And doctors: if you’re not helping within the first 2 weeks, you’re not going to help. At that point, change your course of treatment or find someone with a different perspective.

How to and how NOT to breathe

2009-06-04T10:25:00.000-07:00

I was at a local 5K/10K last weekend watching a few hundred finishers on the course. When I watch runners I can't help but to pick apart their gait issues (or, in some cases, their blessed gait). For whatever reason, what I saw was a LOT of breathing issues.

I don't mean asthma or COPD, but people who--despite running at or near their top speed--were not moving their abdomen at all. As an example of how to do it right, think about video you've seen of Lance Armstrong during any of his Tour de France wins. As he climbs up some awful grade, his belly moves in and out so much with each breath that he appears.....overweight. But during those races I doubt his body fat percentage is greater than 5%. He is doing an amazing job of letting the primary muscles of respiration (diaphragm, internal and external costals) do the job of inspiration. Granted, he is a professional athlete and genetically blessed, etc.

I made similar observations during the finish of the 5k/10k. The top 10% of runners came through with their chests relaxed, shoulders (upper traps) down and relaxed and their stomachs moving nicely in and out with each breath. A strong majority of the remaining 90%, however, looked like their shoulders were glued to their ears.

Diaphragmatic breathing (aka belly breathing) is a breathing technique historically practiced by yogis and more recently in the treatment of symptoms of asthma and COPD.

In the past, I haven't considered counseling athletes and weekend warriors on diaphragmatic breathing. And the fastest among us don't seem to need the advice. In fact, the patients to whom I usually recommend diaphragmatic breathing have been patients with neck complaints. During times of stress, whether physical or emotional, we seem to "turn on" the accessory muscles of inspiration---upper trapezius, sternocleidomastoids, scalenes, serratus posterior superior, et al. A lesson in belly breathing could help all of us.

No matter what your "sport" is---running, engineering, weights, accounting, paddling, typing, golf, parenting, cycling, etc---practice the techniques of diaphragmatic breathing and relaxation. Unless, of course, you WANT to become a "neck patient".

2009-05-31T12:26:00.000-07:00

Running is perhaps the greatest form of exercise. It costs little more to be a "runner" than a pair of shoes. No other special equipment is needed. No special fields or stadiums are required. Running is...simple! And contrary to popular belief, runners are 60% LESS likely to be injured than non runners! (Anderson, O, 'What's the Truth about Running and Bad Knees?' Running Research News, Vol. 11(8), pp. 10-12, October 1995). Even as simple and basic as running is, I see numerous running related injuries on a weekly basis that could have been avoided with a few easy steps.

1) Buy a good pair of shoes. Good doesn't mean expensive. Good shoes don't have to be endorsed by a celebrity athlete. "Good" means shoes that fit your feet and fit your body's biomechanics. Shoes are designed with wide toeboxes or narrow toeboxes, higher heels or lower heels, high arches or low arches, to support an orthotic or to be extremely flexible. Generally, a shoe should not flex in the middle of the arch. It should be well-cushioned without being thick like a platform shoe. Be sure to try on several pairs of shoes before you choose your model. You can get a lot of help with finding the right shoes at a specialty running store. And when all else fails, give custom orthotics a shot.

2) Replace a good pair of shoes. Depending on your weight and distance you run, you can expect 300-500 miles from a typical pair of shoes. Any more than this amount and the midsole is probably not offering you much cushioning or support. The midsole, that soft foam material sandwiched between the shoe's upper and the outsole, wears out long before the rubber bottom does. So if you see a lot of wear on the outsole, either turn those running shoes into gardening shoes, or donate them to a charity.

3) Warm-up, run, then stretch. You warm-up your car before you drive it, your barbeque before you grill in it and your shower before you bathe in it. Your running body deserves the same treatment. Some runners like to integrate a specific warm-up routine into every run, while others simply start the first 5-10 minutes at a slower pace than the rest of the run. Whichever you choose, be sure to ease into your running pace.

Stretching, probably the best way to avoid running related injuries, should be done at the end of the run. By stretching after the run, your muscles will be warmer and more pliable. Adding flexibility not only will help you to avoid some injuries, but it can improve your running by improving your gait.

4)When all else fails, treat the injury as soon as you can. We all have a tendency to hope and wish our aches and pains away. The sooner you seek treatment, the sooner you can be back out on the roads again. Treating an injury early on can reduce the treatment time by more than half.

Swimmers' and Paddlers' Shoulder

2009-05-18T08:22:00.000-07:00

I went for a paddle this morning with a friend. I was on my 14 foot Bark paddleboard (which I love!) and he was on his 19 foot Eaton (which I also love!!!). We paddled a tough 14 miler from Newport to mid-Laguna and back. Well, it was tough for me, pretty typical for him. Anyways, about 10 miles into the paddle, I started thinking about the shoulder girdle, which is, by the way, my favorite girdle…..and joint.

Whether knee paddling or prone paddling, the shoulder acts in a very similar manner. Recovery (sweeping your hand forward while out of the water), like with swimming, is flexion and external rotation of the glenohumeral joint. The “pull”, again as with freestyle and butterfly, is primarily extension and internal rotation of the GH joint. Obviously, there is a LOT more going on (at the scapulothoracic, acromioclavicular and sternoclavicular articulations), but these are the basic shoulder motions for swimming and paddleboarding.

We strengthen the “pull” phase with the resistance of each pull. The recovery phase receives little to no resistance and gains little to no strength. The fast and smart among us stretch the “pull” muscles (lats, pecs, subscapularis, teres major, rhomboids, rear delts), but few of us spend any time strengthening the “recovery” muscles. This is important because the muscles that move the GH through recovery are also the antagonist muscles of the pull. They serve not just to move the arm through recovery, but they also help to stabilize the shoulder girdle.

For a healthy, non-injured paddler, I recommend large and global strength exercises for the “recovery” muscles (teres minor, infraspinatus, mid and upper trapezius). Try adding 2 days per week of exercises (the web is full of great ones!!) during season and maybe 3 days per week off-season. For the injured and suffering among us, you can start with the exercises nearly every “shoulder patient” has been prescribed: empty cans, external rotations, and Ts Ys and Ws.

For any activity you do this can hold true. Spend time strengthening the muscles that you DON’T use, and it can greatly improve the performance of the ones you DO use.

Common Cycling Aches and Pains

2009-04-29T16:15:00.000-07:00

Do you remember the day the training wheels came off of your bike? Can you still feel the excitement and exhilaration? Now is a great time to pull the bike out of the garage, tune it up and take it for a ride. And now that we live in an era where a gallon of gasoline costs more than a grande nonfat latte, you can think about cycling your way to work a few times a week to help save a few dollars as you get your daily exercise. As with any other activity, I see more than my fair share of cycling injuries in my clinic. Below are a few precautions you can take to hopefully avoid any aches and pains.

Raise your seat! Most people ride with their bike seats too low and too far back. Low seats are generally responsible for achy knees, usually in the form of Patellofemoral pain syndrome.

If the seat is at the correct height, your knee should be almost straight when the pedal is at the bottom of the pedal stroke. A quick way to get your seat to the correct height is to raise the seat until your heel can barely touch the pedal at the bottom of the pedal stroke. While riding, the ball of your foot should be directly over the axle of the pedal. Any further back and your foot may slip off. Any further forward and you lose a lot of power production.

Slide your seat forward on the rails! Most of those low seats are also forward seats. By having your seat so far back it forces you to rotate your pelvis forward, placing more pressure on your perineum and lower back. The increased pressure on the perineum is the cause of numbness and discomfort that so many men experience with cycling. Part of the answer to this problem is a good seat, and the other part is proper positioning of that seat. The forward rotation of the pelvis also can place too much pressure on the lumbar facets. Known as facet syndrome, any prolonged extension can aggravate this condition.

With your cranks horizontal, a plumb line dropped from the bottom of the forward kneecap should run directly through the axle of the pedal. Time trial and triathlon bikes may be a little further forward than this and cruisers may be a little further back that this. You can adjust this measurement up to 2 centimeters based on your riding style.

Raise your handlebars! Well, maybe. If you ride a hybrid, city bike or a cruiser, then your bars can be several inches higher than your seat. With mountain bikes, the bars may be higher or lower depending on your flexibility and riding style. On road bikes and time trial bikes, the bar is very low, up to 5 inches lower than the top of the seat. Do not attempt this position unless you are physically ready for it. Handlebars that are too low force you to extend your neck, placing far too much pressure on the muscles that move and support your neck and head. One study of cyclists showed that the most common overuse injury report was to the neck, with almost half of the subjects reporting neck pain.

Get a good pair of gloves! Not only will they save you a lot of skin if you happen to crash, but they’ll protect a very delicate nerve that passes through your palm. Cyclist’s palsy, a condition where the ulnar nerve is impinged as it passes through the tunnel of Guyon, is often avoided by simply wearing well-padded gloves.

"Other" Approaches to Hypertension

2009-04-20T15:50:00.001-07:00

It may seem strange that a column devoted to avoiding and treating musculoskeletal injuries would kick-off with a subject like hypertension. I am fascinated by hypertension (and diabetes) because they have become endemic to our society. Let's face it, while a quad strain may be a bummer because you can't run for a few weeks, at least it won't kill you. We are surrounded by people suffering from high blood pressure. With heart disease as this country's leading cause of death as of 2007, I hope this little bit of information will empower even a few people to take control of their life and body.

The National Institute of Health estimates ¼ of adults have high blood pressure, defined as pressure greater than 140/90mmHg. Because symptoms of high blood pressure may take decades to manifest, many of these people likely have no idea of the internal damage occurring in their bodies. For those interested in addressing high blood pressure through methods other than popping a pill every day, recent studies have found some simple and amazing methods to lower blood pressure.

There’s an old saying among dieticians and nutritionists: avoid anything white. That includes refined sugars, saturated fats, refined flour, white rice and white potatoes. Anyone who has ever washed and peeled a beet knows that beets are anything but white. The Journal of Hypertension helps to support that axiom. They found a daily serving of 500mL (that’s slightly over 2 cups) of beet juice lowered, on average, systolic pressure by 10.4mmHg and diastolic pressure by 8.1mmHg. Researchers theorize that beets’ high concentration of dietary nitrate (no, that is NOT the same evil substance that you find in hot dogs and processed meats) are responsible for the reduction in pressure. Maybe it’s time you dig that Jack LaLanne juicer out of the cabinet? To read the journal article in full, click HERE.

The DASH (Dietary Approach to Stop Hypertension) diet was created in conjunction with the US Department of Health and Human Services, the National Institutes of Health and the National Heart, Lung and Blood Institute to avoid developing and to treat high blood pressure. It is a fairly simple diet, characterized by low sodium and low dietary fat intake. The DASH diet now has two versions: the standard DASH diet and the lower sodium DASH diet. Both DASH diets aim to reduce the amount of sodium in your diet, but the lower sodium DASH diet encourages an even further reduction in the amount of sodium you eat. When followed, studies have shown a decrease of diastolic pressure by up to 14mmHg. To read more, click HERE.

Even chiropractic manipulation has been shown to reduce blood pressure. The results of a clinical trial showed a high level of efficacy with a chiropractic adjustment of the upper cervical spine. Compared to the control group who received a “sham” adjustment, those who received the “real” procedure saw an average 14mmHg greater drop in systolic blood pressure, and an average 8mmHg greater drop in diastolic blood pressure. To read more about this study, click HERE.

This Blog's Purpose

2009-04-20T14:19:00.000-07:00

I chose to become a chiropractor because I am fascinated by biomechanics (my first love!), enjoy working one-on-one with patients to help them improve, and I have been treated by a lot of great chiropractors whom enabled me to continue training and racing despite my own obsessive training regime.

It was a visit to my brother-in-law, Dr Daniel Jacobsen, back in the early '90s that opened my eyes to what a chiropractor could do. At that time, I was running 80-90 mile weeks training for a marathon. My hip had been hurting so badly for a few weeks that, while I could still run, I could no longer stand without intense pain. It was my sister who convinced me to see Dr Dan (after I had already sought relief from my general practitioner, my running coach and a massage therapist). Prior to this, I had no idea what a chiropractor could or would do. After treating me twice that first day and teaching me a dozen stretches and exercises, I was able to run that evening pain-free! "WOW", I said.

So, my own journey to this profession took me to working for a major running shoe manufacturer (where I honed my observations on running biomechanics) to becoming a strength coach for professional athletes and weekend warriors alike.

Because of my history of athletics as well as the specialized knowledge that I've amassed, on a weekly basis I receive numerous requests for help from injured people all over the world. Despite the obvious limitations of email and telephone, I help however I can.

With this column, I hope to preemptively "attack" some of those requests for help. This blog is a combination of what's new in health and fitness, case reports (of both the mundane and not-so mundane type) and injury/illness avoidance advice. Please, if you have an injury or problem that you are concerned about, find a health care practitioner that can diagnose you.

I firmly believe that the type of provider is not important---whether he or she is a chiropractor, medical doctor, physical therapist, osteopath, nurse practitioner, acupuncturist, et al, the most important attribute is that the practitioner listen to you. Secondly, find a provider who "does" what you "do". Only a runner truly understands running injuries, and surfers best understand surfing injuries, etc.

I hope you find this helpful. I also hope to see you out there on the water, trails or roads sometime soon!
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