Spine Wellness, Physio-Style (Part 2)

Continued from my last post, Spine Wellness, Physio-Style (Part 1):

We’ve all felt it before... tight upper neck and shoulders, tender rhomboids between the shoulder blades, a sore & stiff low back… these can be normal signs of physical wear and tear from life in general. However, if the body begins to crumble under the physical stressors placed upon it, we come to a familiar experience of the "straw that broke the camels back."  When the last straw lands... our body is truly in trouble.  These warning signs, especially those feelings of TENSION and FATIGUE, are the body’s way of letting us know that something is not quite right. While it is likely that nothing is pathologically or medically emergent with your spine or associated tissues, however, they are not in the best of health.  Most of us are keenly aware of these warning signs, however, many of us delay... ignore… and eventually regret.

Choosing tissue tension as an initial point of focus for spine wellness was reinforced as people perceive tension as a widely common early expression of declining spine health.  Be the cause a variation, combination, or permutation of neurophysiological, biochemical, biomechanical, and/or psychosocial factors – many individuals agree that their concern of decline in their own spine health is made more aware when the uncomfortable sensation of tissue tension is experienced.

This is when the Physio-Style wellness approach shines in comparison to the “Sick Care” interventive approach. Reflecting on the current “Sick Care” reactionary interventive health approach versus a wellness approach of prevention and proactive pursuit of optimal health, I realized that there is a need and a large public demand for “Physio-Style” wellness services to improve spine health. The public at large is quickly growing impatient with a reactionary, nearly spastic approach of putting out fires as they happen.  Rather, the favor is trending toward the prudent foresight, regular health screenings, wellness treatments, and injury prevention.

Spinal Tension Release Therapy aims to alleviate the compounding and repetitive stress & strain which commonly expresses itself as uncomfortable tissue tension BEFORE the stress becomes damaging.  As these physical stressors pile up, tender trigger points, pain, headaches, muscular stiffness/tightness, decreased physical capacity, poor biomechanics, etc. become the next tier of the worsening signs and symptoms of poor spine health.

The composed systematic approach of Spinal Tension Release Therapy are as follows in the below components:

• Spinal Mobilization/Manipulation: acts as a catalyst in the process of normalizing tissue to normal resting state. This is important as repetitive physical stress causes tissues to be in a chronic state of irritation. Spinal mobilization/manipulation also manually releases joint & tissue tension and allows for an endorphin release which interrupts pain-spasm-pain cycle. Additionally, it is noteworthy to point out that this technique also causes a “down-regulation of inflammatory-type responses” (Teodorczyk-lnjeyan et al 2006) which aides the body in combating irritation to quickly restore a normal resting state.  The evidence for spinal mobilization supported by: Cross et al 2011, Puentedura et al 2011, Bishop et al 2011, Cochrane Review 2010, and much more.

• Soft Tissue Therapy, Massage, Manipulation:  relaxes tissues to a natural resting state (versus the chronically irritated and tense tissue state). Soft tissue techniques also allows for optimal circulatory flow which is crucial for cellular replenishment and tissue restoration. This technique can also modulate/manage painful areas and allow for encourages normal movement and tissue function (Poitras et al 2007, Furlan et al 2002, Cherkin et al 2003.)  One of my favorite applications of soft tissue therapy is with the use of instruments (IASTM), particularly, the EDGE Tool.

• Therapeutic Stretching: releases and lengthens tightened tissue (Sihawong et al 2011, Poitras et al 2007, Vladimir Janda, MD approach) which can allow for unrestricted tissue movement. Additionally, stretching optimizes the Length-Tension relationship of muscle & connective tissue for optimal function from a biomechanical perspective. Stretching can also reflexively enable weak counterparts to create muscular balance during static and dynamic states.

• Neuromuscular Corrective Exercise: strengthens and controls weak tissue which are not operating in ideal biomechanics during function.  This can creates muscular balance between antagonistic and synergistic muscle groups to create optimal postures, mechanics, and health (Janda approach, McGill & Karpowicz 2009, McGill et al 2009, Smith et al 2008) and retrains habitual patterns of movement for ideal function which naturally yields prevention (an example: the Functional Wall Squat).

• Preventive Ergonomic Body Awareness: the training of mind-body awareness to the static and dynamic orientation and position over time for the purpose of minimizing internal and external stress forces from the environment. Developing health habits of ergonomics and good biomechanics during movement & function naturally decreases the physical stress & strain in our daily life preventing the over-competition of stress forces to our body’s natural restorative processes.

In most scenarios, our body responds to excessive stress with natural and fairly expedient healing.  However, sometimes we simply need the therapeutic catalyst to avert the vicious cycle of overwhelming stress & strain. The therapy to our bodies allows for the natural process of daily restoration to win-out instead of waiting for the “last straw” to cause damage.

I want to reiterate that the concept of Spinal Tension Release Therapy was simply a way for me to personally and systematically organize therapeutic theory, scientific research, and clinical application for the benefit of my patients, clients, and public at large.  The above concepts are shared by many clinicians of various disciplines (though the perspectives and preferences may differ).  I have been able to utilize this particular method to help many individuals with complaints of chronic trigger points, muscular pain, head aches, sinus pressure, low back pain/soreness after work, etc.  Many of these individuals consulted physicians who did not feel that their experiences were at a medically pathological state necessitating intervention.  However, each individual was keen to express the need for something to be done from a perspective of prevention and wellness prior to an impending critical incident.

Health and Wellness is still a developing concept as our society and our healthcare system as a whole has yet to determine and agree upon a standard operational understanding of the two. Nevertheless, I would venture to surmise that all Physical Therapists/Physiotherapists aim to better the health & wellness of the public at large through our combined clinical expertise, public influence, and personal examples.

However, whenever the lines get hazy, I refocus myself with the combined wisdom in the quotes drawn in my previous post (Spine Wellness, Physio-Style Part 1):

Health is: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity…” achieved through “a proactive, preventive approach designed to achieve optimum levels of health, social and emotional functioning.”

To our best health!

   -Dr. Ben Fung, PT, DPT
    PhysioTherapist
    Doctor of Physical Therapy

Spine Wellness, Physio-Style (Part 1)

Recently, I gave a public service lecture on spine health at the Cushman Wellness Center located in the Outpatient Pavilion at Sharp Memorial Hospital in San Diego.  My topic: Spinal Tension Release Therapy – A Physiotherapy Wellness Approach to Spine Health.  There was a great turn out, but, I know many of you wanted to attend and were unable to. Thus, I am posting the content over the next several posts.  Enjoy!

The World Health Organization defines health as: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."  However, using “well-being” to define “health”, one must define “well-being” or “wellness".

Searching throughout the all powerful INTERNET, I conveniently found a nice compact definition from DefinitionOfWellness.com which I happen to agree with: “Wellness is not the mere absence of disease. It is a proactive, preventive approach designed to achieve optimum levels of health, social and emotional functioning.”

Combining the two definitions in its application to the spine, I came up with the following:  “Spine Health is the optimal state of physical, mental, and social well-being as affected by the spine achieved through proactive, preventive measures.”

This is distinctly different from the reactionary and interventive approach of most healthcare systems.  While most healthcare systems align with taking action only after physiological and/or pathological insult to the body, the approach of wellness not only prevents decline, it actively pursues measures which brings one’s health to the farthest point from illness and dysfunction to optimal health and functional performance.

Spine health & wellness generally revolves around postural awareness, core strength, muscle control, biomechanics, tissue integrity, tissue recovery, nutrition, lifestyle, and global life stressors. However, achieving and maintaining a Well-Spine isn’t always easy.  Normally, our body experiences wear & tear and responds to this daily damage with precise systems of function to repair, replenish, recuperate, and recover. This process of tissue restoration is active at the molecular level, the biochemical level, the tissue level, and ultimately the body and mind as a whole. However, there are times when the proverbial “straw breaks the camel’s back.”  Just about everyone has experienced that one “time” when compounding stress & strain add up to a critical point beyond the capacity of our body.  This is when the trouble starts. When physical stressors out-compete & overwhelm the body’s natural process of restoration, this over-competition of stress, strain, & tension can create a chronically impaired system of function. For those of you who have suffered through or currently experience chronic pain, you know that the impairment is both mental and physical.

A decline in the health & wellness of the spine can present in and is not limited to variations and combinations of the following manners:

• Joint and muscle stiffness/restriction in movement
• Joint and muscle soreness/pain/aches (even headaches!)
• Muscular tenderness and trigger points
• Impaired movement patterns
• Impaired functional capacity
• Decreased tolerance to activities
• Weight gain due to decreased activity
• Painful and limiting postural deviations
• Decreased tissue integrity, fracture, strain, sprain
• Inefficient and dangerous biomechanics which lead to a high risk of injury

So how do we achieve a well-spine and maintain that high level of health?  My suggestion is to explore approaching spine wellness from a physiotherapeutic perspective.   Physiotherapy is an ideal modality to achieving optimal spine health as many of the symptoms of poor spine health are rooted in the neuromusculoskeletal impairments.  These impairments tend to be a combination of pain, poor movement, and decline in function of which Physiotherapists are expert in correcting and resolving.

As the body is comprised of living tissues, we know that everything that moves within the body must have circulation (the movement of fluid, proteins, particles, cells, etc.)  Circulation allows for tissues to heal and regenerate; therefore, it can be said that physiological health is founded in MOVEMENT. "Moving Well Is Living Well."

But to truly understand Spine Wellness, "Physio Style", we must discuss the major practice patterns of which Physiotherapists are "practitioner of choice", and, how it relates to the wellness of the human body.  Physiotherapy address four interrelated practice patterns which are integrated to rehabilitate, promote, and maintain physiological health and well-being:

• The Musculoskeletal system: The muscles, bones, and connective tissue which are responsible for gross body movement by use of mechanical levers throughout the joints of our body.
• The Neuromuscular system: The brain, nerves, and connections which are responsible for activating, terminating, and controlling the movement of the musculoskeletal system.
• The Cardiopulmonary system: The heart, lungs, and blood vessels which supply oxygen, energy, and nutrients to the neuromuscular system which controls the musculoskeletal system.
• The Integumentary system: The skin - the largest organ of our body - which acts as a barrier and protective armor for the cardiopulmonary system; protecting it from injury, insult, and infection. However, the integumentary system yet is still controlled & limited by the architecture and physical structure of the musculoskeletal system.

In essence, Physiotherapy approaches wellness from a comprehensive and integrated consideration of the physiological tissues of the whole body as it applies to movement, function, health and wellness. Well... this is all good but how exactly we achieve a Well Spine, "Physio-Style"?  After contemplating on the concepts above as well as some of the scientific literature regarding therapeutic treatment of the spine, I wanted to systematize for my own edification - a reliable order of operations of which I personally could address the spine from a perspective of wellness. Eventually, this systematic approach became what I composed as Spinal Tension Release Therapy.

Coming Up: Spine Wellness, Physio-Style (Part 2). In my next post, I will continue to highlight key points of my lecture on spine health and expand on how I came to the idea of Spinal Tension Release Therapy.

A Christmas Case Report

About 6 months back, I had a co-worker of mine (Female, 50's, generally sedentary, office work) approach me regarding intense headaches stretching from the base of her skull to the sides of her upper scalp. This was accompanied by the usual office space muscle tenderness, stiffness, soreness, and discomfort of the body as a whole.  Additionally, she had noted pain in her upper thoracic spine which she noticed were associated with her headaches. At the time, she was very stressed with work and expressed she carries all of her stress in her upper shoulders and neck.

I made time to evaluate her. In the end we decided to go a manual route along with postural awareness and corrective exercise.  Since we work on opposite sides of campus, we were only able to meet up once for a single treatment after hours.  We went with approach of Spinal Tension Release Therapy.

After treatment, she felt immediate relief of thoracic pain, cervical neck stiffness, elimination of trigger points, and finally - NO HEADACHES!

I've kept up with my co-worker every couple of weeks just to see how she is and to remind her of her Home Exercise Program.  She has proudly reported each time that since treatment 6 months ago, she has been pain free, headache free, moving with ease, and much more aware of her ergonomics during stress.

As Dr. Erson Religioso states in a related topic, thoracic pain should be properly resolved in just a couple visits. This is a similar case that demonstrates that the patient, the science, and the clinician can achieve that ideal result when it all comes together in an integrated and properly applied fashion.

Have a Very Merry Christmas & Happy Holidays!

Sincerely,

-Dr. Fung

Coming Up in the New Year: Optimizing the Fung Protocol. Metabolically optimize the Fung protocol for maximal physiological effectiveness. Learn the science behind how Dr. Fung personally lost 2 inches of waist in less than 6 weeks!