February 2012: Expert Interview with Dr. Ryan Smithby John Meadows on February 23, 2012
JOHN: Good day everyone. This month we are fortunate to have Dr. Ryan Smith share his insights with us. Ryan, thank you and let’s get started by talking a little bit about you and your business? What are you doing these days?
RYAN: Well, first and foremost, I am a chiropractor and I have a special interest in sports injury and rehab. My office, Synergy Chiropractic Wellness Clinic, is located in Columbus, Ohio. It is inside the Columbus Sports Connection fitness center, so I have access to an entire gym when working with patients on rehab exercises or educating them on proper lifting form/technique to help them avoid or recover from injury. Additionally, I am a member of the EliteFTS Q and A Team, where I try to provide information and guidance to readers who are dealing with weight-training injuries and/or are having trouble with their training programs. If any of your readers would like more information on my background or clinic, they can go to my website www.synergycwc.com or “like” my Facebook fanpage, www.facebook.com/SynergyChiroColumbus.
JOHN: Let’s also talk about being a chiropractor. It’s an interesting field, and very science based, but some think it is voodoo health…haha. What’s the real truth here?
RYAN: I love what I do and it definitely is an interesting field. Chiropractic is firmly rooted in science. Most of its principles are based on the function of the nervous system and how it controls and coordinates all of our body’s functions. While chiropractic is most often thought of as spinal adjustments for treating neck pain, back pain and headaches, that is only a small fraction of what it entails. Chiropractors treat all types of neuromusculoskeletal conditions and most provide other treatments in addition to spinal adjusting. For instance, at my office, I am able to perform electric muscle stimulation, ultrasound, cold laser, ART, stretching, rehab exercises, cervical/lumbar traction/decompression, and nutritional counseling in addition to spinal adjustments.
What I also like is that chiropractic has been stressing the importance of wellness and prevention since its inception. One of the fundamental principles is that the human body has an innate intelligence to it. This allows it to sense, respond and adapt to its environment and, that intelligence is expressed through the nervous system.
If your readers are interested, we could get in to the whole topic of homeostasis and the types of stress, and how the body adapts.
JOHN: Absolutely, talk to us about stress and bodily adaptation.
RYAN: In order for us to stay healthy, with health being defined as an optimal state of physical, mental and social well-being and not just the absence of disease, our bodies must strive to maintain a relatively constant internal environment. This process is known as homeostasis. Since our bodies are constantly being exposed to stressors, it needs to be able to sense the stress, assess the physiologic effect and then form and execute an adaptive response. The nervous system is what allows us to do this and it must function properly in order for our bodies to maintain homeostasis. Therefore, we must have a little background on the nervous system to fully understand this concept. Our nervous system is made up of the central nervous system (CNS) which consists of the brain and spinal cord, the peripheral nervous system which consists of the spinal and cranial nerves, and the autonomic nervous system which is broken into two components, sympathetic and parasympathetic. The autonomic portion really plays a major role in homeostatic processes. The sympathetic branch is responsible for managing functions that are part of our fight or flight response and the parasympathetic branch handles more of the rest and digest functions. If we get excessive or insufficient stimulation of either of these branches, problems with our adaptive processes can develop and our health will suffer. One of the most common problems in today’s society is chronic stimulation of the sympathetic portion of nervous system. Since the sympathetic branch handles fight or flight responses, it will raise blood pressure, increase heart rate, increase blood sugar, increase cholesterol, and suppress immune and digestive function. All of these things are normal physiologic responses that we want to happen, when needed, but are not something we want to be chronically stimulated.
Stressors must be managed to avoid this problem. Everything we do in the course of a day, are stressors, they can either have a positive influence or negative influence on our health. Stressors fall into three main categories: physical/mechanical, chemical and mental/emotional. All of these stressors, while they may have different effects on our physiology, all influence our adaptive response. What is important to understand, is that our bodies do not differentiate between them. Our bodies only have so much adaptive reserve and if we overdraw that account, some sort of problem will manifest. To illustrate, let’s say your body has 100 units of stress handling capacity and your activities for the day use 50 units of physical stress, 30 units of chemical stress and 30 units of mental stress, now you are 10 units over, your body can no longer adapt to the demands.
So, this will be the day that something goes wrong. For instance, maybe you bend over to pick up your socks and your back goes out or you start to get a sore throat or you feel depressed/anxious etc. The take home message is that you need to be aware of the different stressors you are exposed to and try to manage them accordingly. If you are going through a really busy and mentally stressful period at work/school, it would be wise not to do your most intense workouts at the same time. If there is any interest, maybe we can do a follow-up article that details the different stressors that fall into each category and then present some ideas to manage them.
JOHN: Absolutely! I think chronic low grade stress is one of the biggest challenges we face today in this fast paced, keep up with everybody else society that we live in. As you say, too much if this can manifest itself in so many different ways.
I know that you also practice ART. I have always been a big believer in ART (active release therapy). In 1999 my elbows hurt so bad I couldn’t flat press a 20 lb dumbell, and ART fixed it remarkably fast. I have also had numerous rotator cuff strains over the years, and again, ART always seemed to bail me out. Talk to us about ART, what it is, what it does, and who it’s good for.
RYAN: Glad to hear that you have had excellent results with ART. ART or active release techniques is a soft tissue diagnosis and treatment system that was developed by Dr. P. Michael Leahy. While the system itself is quite complex to learn and develop proficiency at, the principles it is based on are relatively easy to understand. Everyone is repeatedly subjected to repetitive stress and postural strain throughout normal daily activities. For readers of your site, their training programs are going to create a certain pattern of stress and microscopic trauma to the muscles/tendons/fascia and peripheral nerves. Overtime, this can create inflammation, fibrosis/adhesions, muscle tightness/weakness and possible nerve entrapment. Once these problems develop, they can lead to a cumulative trauma cycle which can perpetuate pain/dysfunction and loss of performance.
An ART practitioner attempts to locate the involved tissues and provide a treatment to restore it to proper function. Often this treatment will involve palpating a muscle, finding a tender and taut band, placing the muscle in a shortened position and then drawing tension along the muscle fibers and having the patient elongate the muscle while the tension is held. This helps to break up adhesions, restore muscle length, and freedom of movement relative to the other muscle fibers.
ART treatments are good for most anyone just due to the repetitive nature of daily tasks and the postural strain placed on them throughout the day. However, people who participate in weight-training, running, cycling and other sports benefit greatly from treatments because they tend to place the most stress on their bodies.
JOHN: What are some of the most common injuries you treat with ART?
RYAN: I would say the most common injuries or I see are: rotator cuff impingement/tendinitis, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow), carpal tunnel syndrome, thoracic outlet syndrome, gluteal tendinitis/hip bursitis, patellofemoral pain, IT band syndrome, quad/patellar tendinitis, ankle sprain/strain and plantar fasciitis.
JOHN: What are some of the injuries that ART has NOT seemed to help with. I wouldn’t want to give the impression it’s the cure to every issue known to mankind, despite the fact that it is my favorite treatment.
RYAN: ART seems to work best on cumulative trauma conditions like the ones I mentioned above. These are injuries that tend to develop over time and with the accumulation of stress and strain on the tissues. In situations where there is a major trauma to the tissue, ART wouldn’t be as effective in the initial management, but could be utilized later in the healing process to effect the remodeling of scar tissue. For example, if you partially tore your pec bench pressing, doing ART on the pec right away will not “fix” the problem. However, once the initial healing phase sets in and scar tissue forms, ART can be used to help remodel the scar tissue, to prevent it from healing in a shortened/contracted position.
Also, ART is less effective for treating joint problems and disc injuries although it can be used to treat some of the muscle/soft tissue problems that these joint/disc problems create. For instance, if you were to sustain a disc bulge/herniation or facet joint injury in your low back when squatting, ART is not going to be an effective stand alone treatment, but it can be used to help release some of the muscle contracture/spasm that develops. By doing so, it can relieve pressure on the joint/disc that develops due to the muscle spasm, which will help to reduce pain and further irritation of the tissue.
JOHN: One of the things we see in bodybuilding, especially in older guys, is that they seem to shrink on one side of their body. For example, Ronnie Coleman’s lats, Jay Cutler’s legs, etc…one is significantly bigger than the other, and the disparity gets worse each year. Do you think this is due to some kind of nerve impingement? I know we are speculating here, but if there is a way to sort of prevent this, I would love to pass it along to my readers.
RYAN: That is an interesting observation and one that could stimulate a lot of discussion regarding cause/effect. It would be interesting to know Ronnie and Jay’s injury history to see if there is any straight-forward correlation. In addition, I would want to know how much difference there is side-to-side and whether there is any strength discrepancy. Nerve impingement is a definite possibility, the question would be, where are the nerves being impinged on? Are they being compressed around the spine where they exit from the vertebrae, or peripherally, somewhere along their course. To try to discern where they could be impinged, you would have to determine what muscle group(s) are involved, what nerves innervate those muscles and is there a common pathway that could explain what you have observed. In addition to direct nerve impingement, the muscles could be neurologically inhibited from firing for a variety of reasons:
- The muscles and tendons have spindles and golgi tendon organs that monitor tension and stress, and if there has been a previous injury, they could be giving feedback to shut the muscles down to avoid further injury.
- The muscles could be reciprocally inhibited from contracting as hard if the antagonist muscle groups are tight/restricted. Joint dysfunction can also reflexively inhibit the muscle from firing efficiently.
JOHN: Got it. You mentioned an imbalance, one muscle is tight and it’s antagonist is impacted. Can you talk about this at a high level. What comes to my mind is people who always press (like for chest), and rarely do back. Or at a smaller level, maybe you always work on your gripping and squeezing, but don’t work on opening your hands. Those little expand your hand bands seem to help with this, and creating better balance. I think they actually helped my elbows too. Anyways, these imbalances, are they to underlying causes to injury?
RYAN: The examples you gave are correct, with the chest/back being one of the most common. There is a chronic musculoskeletal pain cycle, in which muscle imbalance (tightness/weakness) plays a major role. Muscle imbalance can result in impaired movement patterns and postural changes, which leads to faulty motor program/motor learning, which then can result in altered joint forces and altered proprioception. This can then lead to joint degeneration and postural changes which can cause pain/inflammation, which leads back to muscle imbalance. Muscle tightness can result from limbic system activation (stress, fatigue,pain, emotions), myofascial trigger points, and muscle spasms. Increased muscle tension can then result in an adaptive shortening which effects both strength and pain threshold. Muscle weakness can result from reciprocal inhibition, arthrogenic weakness, deafferentation (decreased information from neuromuscular receptors usually as a result of joint or ligament injury), myofascial trigger points, pseudoparesis and fatigue. There are a couple common patterns of imbalance, upper-crossed and lower-crossed syndrome. Upper-crossed syndrome is characterized by tight suboccipitals, and upper trapezius/levator scapulae and pecs, with weak cervical flexors, rhomboids and lower traps. Lower-crossed syndrome is characterized by tight thoracolumbar extensors and hip flexors and weak abdominals and gluteus maximus. Much of the reasearch into this topic was performed by Janda and he further described tonic (postural) muscles being prone to tightness and phasic (dynamic) muscles being prone to weakness.
JOHN: Switching gears here, there seems to be a ton of conflicting information out there on stretching. Is it valuable, when do you do it, or is it actually harmful? I would love to get an educated perspective on this. What do you think?
RYAN: I think some of the conflicting information came from a study that showed that there was a reduction in maximal force production in exercising muscles when static stretching was done immediately before lifting. So, if you were going to do a max effort attempt, you may not want to stretch the prime mover right before performing the attempt. Most coaches and trainers that I have talked to recommend doing dynamic mobility drills as a warm-up prior to lifting. Combining the dynamic exercises with some light full-range reps of the exercise you are going to do, should reduce injury risk. Static stretching should be done at the end of the workout as part of your cool-down. It is usually more beneficial at that time. Overall, I would say that stretching is valuable, especially when performed on the muscle groups that are prone to tightness. I do not feel that excessive stretching is necessary, being overly flexible can result in decreased stability. When training, it is important to have enough flexibility to allow you to perform all exercises through a full range-of-motion, using proper form. If you can do that, then injuries will be minimized.
JOHN: Ok, it’s gadget time. What are your three favorite gadgets you use? There are some I love, such as a rumble roller from Elitefts.
RYAN: I think the Rumble Roller is great, it is excellent for self-myofascial therapy. Some people may find it a bit hard to get used to compared to a smooth roller. I usually recommend the Rumble Roller for more deep tissue and trigger point work and a smooth roller for general rolling and warm-up exercises. I also like the Stick, it is good for myofascial work. I am fortunate to train at the EliteFTS compound, so there are quite a few things I use frequently. The bands are great and really have a lot of diverse uses. You can use them to provide accomodating resistance on exercises and also use them for stretching and traction. I am also a fan of the trap bar for deadlifting and also the yoke bar. As someone who treats back injuries and has also had a couple himself, I find that those allow me to lift heavy, while also reducing stress on my low back. Recently, we have been doing straight-bar deadlifts with chains and I have found that those are excellent. The weight is less off the floor, where the stress on the low back is greatest, and as you pull, the weight increases, so you really overload the top half of the lift where your leverages are better.