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Boulder Climbing Chiropractor Q and A

 

A lot has happened already in 2014! Let’s talk about it:

 

 

Q. I hear your athletes are doing quite well this year, and you appear in an American Ninja Warrior video and possibly an upcoming Outside Magazine article! What does this entail?

 

A. Heck ya! I have two athletes competing in the American Ninja Warrior this season, which is a competition involving ballistic motions, climbing, and full body challenges. One of these athletes, Dan Entmacher, put me into his entry video for the competition and it will soon be available for the world to see…the competing athlete came in with injuries and prevention woes and we are working hard to get him to competition level before things kick off. I am really excited about this season!

 

How honored am I to be able to say that I am affiliated with these hard working and adventurous souls?!! Sitting in my office all day, I imagine I live vicariously through them and ask them the nitty gritty of their training while they prepare for this fun adventure. It is fun to have these athletes in my office for sure, and being asked to be in Entmacher’s video was such an honor as he sees another acupuncturist on the side but chose me to be in his final video. Hah!

 

 

Q. What’s up with Daniel Woods mentioning you in his upcoming article in Outside Magazine?

 

A. That was a shock! Daniel Woods is almost always healthy and we truthfully see him rarely…a phone call or seeing him on the schedule instantly makes me worried that he is injured (as with my other high end athletes). The athletes that grace our office achieve their success with hard training, attention to detail with diet and sleep, and possess the drive to get them to places that only you and I can imagine. With that said, their success is impacted greatly with self-care and prevention.

 

Daniel Woods was nice enough to answer the question about his care with mentioning he gets acupuncture and chiropractic at our office. Truth be told, he is as flexible and nimble as a cheetah and is less prone to injuries because of that in conjunction with his sheer strength. He has the best health out of any athlete I have had in my office that trains and competes at his level. I am honored that he mentioned me even though he didn’t need to.

 

 

Q. When is this article coming out?


A: That’s a good question! We aren’t sure but will put a link on the website and announce it when it does!

 

 

Q. Didn’t he and his wife, Courtney Woods get you into the climbing scene in the first place?

 

A. Yes. I began treating Courtney (Sanders) before I ever met her husband or knew that they were climbers. At the time I was merely a runner and her injuries intrigued me. I began spending a LOT of time reading articles and research to understand what forces they put on their bodies. In the end, Courtney also brought her husband in and along the way, ended up giving me my first pair of climbing shoes… The addiction escalated quickly as I began hitting the wall, checking out loading, types of forces, and body positioning to understand how to re-create these athletes injuries (to the best I could). Now I work on the athletes that I respect and learn from and I love every step of the way…Life is good!

 

 

Q. So, back to the office…What is the most common cause of injuries seen in your office?

 

A: Yes, traumatic injuries happen and I see them daily, but most likely, patients are suffering from one of two issues, mobility issues where they are too tight to make motions without bio-mechanic faults (such as they get low back injuries because their pelvis musculature is too tight and they arch repetitively in the low back to compensate..thus leading to injuries.

 

The second most common injuries that I see are from bio-mechanic faults, such as loading their joints or musculature abnormally from weakness, fatigue, or just plain slouching at work. These injuries add up, as I call them daily repetitive stress injuries, and they end up in our office looking for help and solutions.

 

 

Q.  I hear you aren’t running anymore, whats up with that and what type of training are you doing now?”

 

A.  I’m still running but not nearly as much. As you might know, I ran a series last summer that ended with a 100 mile bike on Saturday (the Leadville 100 Mountainbike Ride), a 10k the next day, and then the 100mile run that next Saturday. While running/riding, I spent quite a bit of time cultivating what I am up to next on the cerebral plane and decided I’d spend a little more time in putting out some knowledge about injuries and solutions to the world… Namely, I’m coming out with a book on training and injuries (in the climber namely as they are my main source of patients these days), and am dilly dallying in the idea of a nonprofit for injury prevention and education in climbers.

 

 

Q. What are your main points of education for those who wish to visit you at your office?

 

A: My most important goal in practice is to teach patients how to heal themselves, and how to avoid injuries. Every patient deserves to know how their body works and they should have a basic understanding of what it takes to prevent and heal their own injuries. With each patient, I spend time focusing on where their injury came from, discussing solutions to desk, posture, and motion issues, and finally correcting these faults.



chiropractors in boulder can treat carpal tunnel symptoms

All types of professions are susceptible to carpal tunnel...Are you?

 

 

What are the Symptoms of Carpal Tunnel Syndrome?


Common Carpal Tunnel Symptoms include wrist pain on the front and back of the wrist by up to two inches above the carpal tunnel itself. Additional symptoms include decreased grip strength in addition to pain, numbness and weakness of the muscles in the hand and wrist. Pain may also radiate or travel up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment syndromes of nerves.

 

Why Does this Occur?

 

Lets get into the nitty gritty of the wrist!

Sometimes, due to repetitive stress injuries from writing, typing, repeated hand motions, and a variety of other causes there can be an increase in the thickening of these tendons…Perhaps not just in the size of the tendon (due to the amount of load on it from a tight muscle) but also in the amount of inflammation around the tendon which also take up space and clog the region that your important structures run through!

 

This result of tension on these tendons causes constant irritation and attracts swelling  due to friction and narrows the tunnel that these structures travel through (the carpal tunnel, which is named after the carpal bones of the hand). This tiny space only has so much room.

 

With a decrease in room in the carpal tunnel itself, the patient begins to notice numbness and pain and in this case, it causes the nerve that also travels through this same tunnel (the median nerve) to be compressed.

 

This is carpal tunnel in a nutshell. Most wrist isuses seen in our office come from just not enough space due to tight muscles, locked up joints, and a whole lot of swelling in the region. With widespread pain and possibly numbness and had numbness, we classically call this “Carpal Tunnel Syndrome” though the symptoms may be close to or far from the actual carpal tunnel itself.

 

Who is at Risk?


-Receptionists

 

-Dentists and Hygenists

 

-Surgeons

 

-Texters/Videogame addicts

 

-Accountants

 

-Hand and Forearm intensive athletes

 

Why are these people at risk you ask? They do repetitive motions with little rest. To generalize, we see common traits among them. A day off can occur from their habits of choice if an injury arises but they are usually back again and again using the tissues in a way that doesn’t allow them to heal and sets them up for further injury.

 


How Do We Fix It?


Not to worry, we have great results with these patients. Un-weighting the “tunnel” begins with making space and decreasing tension. But how do we do this?

 

-Make sure carpals are moving correctly and in correct place. Decreasing joint pressure causes a reflex in which all muscles attaching on or near the joint will simultaneously relax.

 

-Decrease load on tendons thereby allowing them to decrease in inflammation and size. Massaging and stretching upstream of the joint will decrease the friction and tensile load of the tendons as they travel through the region and decrease the overall symptoms.

 

-Decreasing friction and heat by ensuring normal fluid motion in the region

 

-Unweighting the nerves traveling through the wrist farther up the kinetic chain

 

Care:

 

Working on all these fronts during your care, we can use conservative care and progress this patient before surgery becomes an option. Usually 12-24 visits (just like normal physiotherapy) gives this patient the best chance of keeping pain free and returning to their normal hobbies without risks of re-injury.

 

Work Modifications Programs:

 

We also need to get going modifying the habits that have caused your injuries. If you are a desk jockey, check out the ergonomic software called Squid Melon on YouTube. Using this will remind you to take breaks during working at the computer to ensure you don’t develop an overuse injury. This program is for Mac but there is also one out there for Microsoft. SmartBreak reminds you during long hours nad monitors your use to give you break intervals at the appropriate times or even stop you to rest when needed. Of course, correcting your work station if possible is very helpful in keeping the injury from returning and speeding your recovery.

 

Ergonomic Suggestions for the Desk:

 

Important Ergonomic Changes:


-Desk Height

-Chair Height

-Keyboard Shape

-Distance to Keyboard

-Distance to phone/printer/etc

-Proper chair support

-Removal of sharp objects and aggravating angles to wrist and forearm

 

Below is a great photo of measured “normals” that adjusting your desk to assure decreased risks of injury and exhaustion.

 

 

Borrowed from LifeHacker’s W. Gordon


There are many ergonomic changes you can make to decrease your symptoms. First off, keeping an upright posture protects your whole body and protecting your hands and forearms will decrease your symptoms.

 

Pulling your chair closer to your desk (and taking the arms off of it so it fits under your desk) is the first major change. If your elbows can be bent at 90 degrees while typing, good for you! If not, it’s time ot get in there and get the modifications going.  Also, is your forearm or wrist resting on a sharp edge? Time to pad it or put a cushion under your wrist such as this one to decrease your wrist extention and pad the area from friction.  Also, if it’s on the side of that mouse, making sure you keep your elbow by your side and having a laser mouse will make all the difference in the world.

 

Here is a great link to learn how to ergonomically set up your desk and the proper orientation of each part of your work station, proper typing technique,  and a great program for Macs to remind you to take breaks and stretch (and a microsoft version as well)



Boulder Chiropractic USAClimbing Courtney Sanders

Courtney climbing Unshackled, v10 -- Mt Evans, CO

 

 

The ABS and SCS Climbing Nationals are coming up and athletes are mentioning periodization and wanting to do continuous 30 min of climbing on rest days and wondering how that plays into care and their health (and if it is a good idea). My answer is yes.

 

 

Part 1 of Periodization is endurance. On the wall endurance entails 25-30 min of continuous climbing (climb up and then down climb) at your favorite gym. Understanding that this is related to overtraining is super super important as it might take a week or three to finally realize you feel exhausted and you are overtraining. Ok, here’s the plan. If you climb normally at a 5.12 let’s say, perhaps do continuous climbing on a 5.8 for starters to check your endurance. It might be super easy for 3-4 climbs and then whoa, you are getting super tired, you are sweating and huffing and puffing and counting the time. I’d rather start you on something super easy just incase so you don’t thrash a rest day than to have you go to a harder level and realize that you have overdone it and that much needed rest day has been lost.

 

How to Know if You Are Overtraining.

 

Write these in a daily journal:

 


1. Check your heart rate.

 

Keep tabs on it. If it’s normally 46-48 and it’s 65 today, you are either on a super hard back to back day, you are stressed out of your mind, or you are about to be on the edge of getting sick. If it’s high, it better be high for a reason. If it’s super low, you’ve been doing lots of endurance (or genetically you are better than everyone else, jk) and that’s ok. If it’s high, if it dips down the day after a rest day, we need to think on your diet, off-time, and your general training. You might be pushing your body too hard and setting yourself up for exhaustion before your big comp, not a good plan.

 

2. Check your diet.

 

Are you not hungry even though you should be? That’s a sign of being overtrained. If you feel like you are sludging along but you are eating fast food (or not eating raw fruit/veges) this might be the culprit. Keep a log and try to make it as healthy as possible. As little man-added sugar as possible unless it’s the 30min immediately following a hard workout sesh. A candy bar is ok after really pushing yourself in the gym, but before or near breakfast and you are setting your training back and setting those good climbers even farther in front of you without meaning to.

 

 

3. Check your mood.

 

Do you feel like crap, are you moody for no reason, do you get really extreme about needing food when you finally feel hungry? These are all symptoms of overtraining. It’s ok to feel this way on the second day of a back to back suffer-fest, but if it’s a normal training or climbing week, it either means you are eating food that isn’t healthy (as in too much sugar/carbs and not enough quality fat/complex carbs). My male training buddy used to become a little pain in the ass on hard training weeks and I wanted to give him a tampon. Don’t be that friend.

 

4. Check your sleep.

 

Training hard means you need recovery. Day after day of training means you need excellent recovery. Sleeping well, going to bed early, not interfering with sleep by skipping it, chopping it up, or shortening it. Studies show for every hour you go to bed earlier it is the equivalent of 2 in regards to sleeping in. So just going to bed 30 minutes early can be a lifesaver.

 

 

What have we learned?

 

Overtraining can be demonstrated by lack of sleep, moodiness, lack of appetite, or fatigue. Get on top of it and put yourself higher on the podium.



boulder chiropractor understands ultrarunners and leadwoman/leadman participants.

 

It’s started! The first race of Dr. Lisa’s Leadwoman experience has passed and the rest is full steam ahead Sharing this with patients helps people to understand (or possibly realize how crazy she is) what this entails and to share learning experiences so you don’t reinvent the wheel if you are crazy enough to try it…

 

 

Brief Synopsis:

 

 

Leadman and woman is a collection of 5 races over 8 weeks. The races get longer and the rest periods between them get shorter with a final culmination of 206.2 miles in just 7 days. The finishing times are added up and may the best (Lead)man and woman win.

 

This race report is on the first race of the series, the Leadville Marathon. Raced in one of the highest towns in the nation, it courses up to the highpoint at Mosquito Pass at 13,185ft.

 

Toeing the line it became apparent to me that all the training is over and not only do I have no idea what they did to fuel them through the season, these Leadwoman have no idea what I have done myself (notice I’ve been quiet about it?!). One can only wish that it gets me to the finish line of the last race in just as good form as the Leadville Marathon!

 

How it Went- (Leadville Marathon 2013)- Ripped it up!

 

 

Race Prep:

 

 

It’s an interesting conundrum preparing for a race series when you know what you have to do to finish but have no idea what the others are doing to equally prepare. With that said, I shocked myself with an excellent race and had my best Leadville experience to date. In 2011, during my first time attempting the race, I hit the wall so hard after running the first 5 miles at “race speed” that I nearly lost myself to high altitude symptoms. Vision decreased and fuzzy, headache, wobbly body parts, I kept contemplating dropping out but hung in there and finished with a 7:04 marathon…not exactly something to be proud of but I mention this because it brought me respect for the course and educated me that an athlete is made, they don’t pop off the sofa and decide to go run a marathon on the toughest course in the area.

 

When people think of marathons they think running, but if the race is straight up, I learned that patience, listening to your body, and good old fashioned hiking just might get you to the top faster than the girl in the flashy sports bra next to you.

 

 

Changes for This Year:

 


For the Leadwoman experience I decided to get a coach and to also make some drastic changes. With focused training, emphasis on a healthy diet (I have chosen to be mostly hypoallergenic in my food choices), and avoidance of the social scenes that we all spend our time on instead of training, I’m hoping this helps me to jump again to the next level. So far, this has panned out quite well. I finished in the top 3 in my age group, top 10 overall for women, and 3rd in the Leadwoman standings…Quite the other side of the coin.

 

 

The differences are this, it takes many years to get your body into to racing shape and one must have patience. I was in shape in college but during my medical studies, I lost all of it in trade for a better education. Finally, it has come back, and better than before. Secondly, balancing work and training is tough. One cannot run just on the weekends and hope to have any healthy type of result in the long run. Somehow I thought i was different and my young years would get me through, but with these results, this was entirely egotistical thinking on my part I fear.

 

Additionally, I had the positive addition of my charming counterpart who showed up unbeknownst to myself to cheer me on every step of the way with a cowbell. He made the life of the party right up there on the hillside where I could hear and see him most of the race. Who can’t run faster with a charming man cowbelling you along? I think he had more fun than we did. After the race we still saw people that thanked him for his excited and positive hoots and hollers.

 

 

Learning Points:

 

 

I was shocked to say the least that my descending skills (which I thought were excellent) lost me 4 minutes on the downhill to the other top contenders. I’m impressed at their skills as I all but flew down that mountain. In order to win this thing, I might have to take more chances and work to improve my skills and technique better to not only keep my placing but move up in the standings. There is a place and a time for speed and I’m hoping I can hang in there until the last and final race and keep them within striking distance and then have the health and the gumption to push this little body to the finish line of the 100 with a faster overall time.

 

 

Foodstuffs in Retrospect:

 

Nutrition wise, I got a little over excited while I was slowly sauntering along in the beginning and was following my predesignated goal of focusing on nutrition. I did all right and calculated that I ate over 630 calories in the first hour and a half, this was probably too many obviously but I was preparing to not be eating as much up Mosquito Pass and it could have been the reason why I climbed so well up Mosquito Pass (and then bonked afterwards for not continuing to eat as much as I should up the pass). Nutrition is a definite focus but the varying course always makes it entirely impossible to rely on timing methods as uphills and downhills require different food strategies.

 

 

Finish Line:

 


During the race you are in the moment and at mile 24, I still had so much energy left. I let go of the reins and absorbed the energy my co-racer threw off as we bolted onto the pavement from the old mining roads into town. Summoning what little speed and energy we had to lay on the line was the final acknowledgment that yes, the series is indeed on and we are here in rare form (He left me in the dust but was my ticket to feeling solid and helping me to find my top gear).

 

Well, now that I know my competitors and they know me, the training has already been laid down and let the best wow-man win. Ha Ha.



Boulder Chiropractic USAClimbing Courtney Sanders

Courtney climbing Unshackled, v10 -- Mt Evans, CO (Photo: Brandon Amos)

 

 

We have decided to make a short compilation of learnings from working at our clinic and at the climbing competitions with which we have been blessed to be involved. As we see a lot of injuries in great climbers, here’s what you might be missing from your teachings on the playground-

 

  1. Pulley Tendon Taping:

 

 

There are many different tape jobs in climbing with different uses. Taping the sides of the fingers is done for joint capsule injury and is not for pulley tendon stability. We also see lots of figure 8 taping with pressure across the joint line and not across the pulley tendon itself. Figure 8 taping is fine but with pressure over the joint and not over the pulley tendon cuts off blood flow, causes more inflammation in the finger, and doesn’t support your tendons as it could (however it does allow one to use less effort as the tape supplies a “sling” which holds your hand onto the wall easier). A nice medium is to tape this way with light pressure if desired and then also in addition to release pressure on the pulley itself and maintain it’s lifespan, tape each finger between the joints (not over the joints).  Pulleys are best supported in the region that is the “flesh” of your finger. Taping in this area gives the most support to your pulleys and keeps the tendons firmly supported against your bone as they should be and not bulging out into space (as with a missing pulley tendon). There might still be inflammation and pain with pulley taping but at least they won’t blow out on you while you continue to climb.

 

 

  1. Pushing Multiple Days of Climbing Increases your Risks Exponentially.

 

 

Most patients examined in our office for a climbing injury were injured on that last day of an epic trip. If you’re still fighting that Crux, and its been a few days of hard climbing, chances are you should get those pulley’s taped and stretch out the triceps, hamstrings, and dig into the wrist flexors just to make sure you don’t rip something in these exhausted regions. Friction has been building each day, inflammation has been growing in overused areas, and your muscles are tighter than they have been the whole trip (meaning tendons can fail because they now have the greatest amount of load on them than they have in a long long time). This is now a high-risk time. These areas listed above are the most common “unusual” climbing-specific muscle injuries that we see in our clinic.

 

 

  1. Use compressive tape between climbing sessions.

 

 

Kinesiotape, KTape, Vetwrap, etc can be used to keep the swelling out of that painful joint or pulley tendon between play sessions.

 

If you work all day or sit all day, that inflammation is pooling and can delay your healing (or your fun). Cut a 5 inch piece into 3 strips, use it to tape any angry, stiff, or painful joints. The tape can last a few days if you are not training. If you are, tear it off if it interferes with your grip or to use the white supportive tape. Hints: Place the loose ends on the top of your hand so it doesn’t come untaped with finger motion or friction. Getting it wet is not a problem and you can compress the water out of it with a towel and let it air dry.

 

 

  1. Climbing Preparation/Prevention.

 

 

The only way to prep for being a good climber is really to climb. The trick is to keep in mind that what you do during the hours you are not climbing has a direct effect on your injury rate and your strength. Desk and Sleep modifications help our climbers reach the top with less injury. Look at modifying your computer’s mouse/desk setup if you work a lot or your sleep posture if you sleep with your wrists all balled up. This makes a huge effect on the health of your structures. If you look down all day or slouch, you are setup for injury of the shoulder, mid-back and neck.

 

 

  1. Tendons are slower to bulk up than muscles.

 

Therefore, if you are picking up climbing as an adult (20+ years old), your muscles grow faster than your tendons strengthen. This means you have greater susceptibility to injury to these tendons. What happens with rapidly increasing muscle size in comparison to tendon strength is that as the muscles place a larger load on the tendons (which are not reinforced or as thick as they would be if you had been training since childhood), these tendons begin to fail and in the best case scenario, pain and swelling result. In the worst, they rupture or fail completely. To do a self-test, press on the tendon attachments near your joints, if they hurt that means there is swelling in there. If there is pain there is swelling, even if you can’t see it…it’s just not extreme enough to see with the naked eye. If inflamed, they need ice and compression to get the swelling and inflammation out of that region so they can heal. To unload these tendons, they need the corresponding muscle that attaches to them to relax (this can be done with stretching, acupuncture, foam roller, tennis-ball, joint manipulation or adjustments, self-care tasks, etc).

 

 

  1. Injury Management. Rest isn’t the answer.

 

This is where our help comes in. In some cases rest makes things better on a local level (like if you smack your hand on the wall or inflame that pulley tendon by climbing on large indoor slopers. If (most likely) that inflammation is coming from upstream or downstream of the injury (as in the pain is secondary to a bigger issue that you don’t know about), rest will not make it better and as soon as you are back on the wall your injury is in full bloom again even after a few months off. If this is the case, this is where a professional can correctly evaluate your issue and help you to make strides in correcting the problem from it’s cause, be it joint immobility, a build up of scar tissue, or improper home-care techniques.

 


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3775 Iris Ave. Ste. 2A&B
Boulder, CO 80301
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