Low back pain can emanate from many anatomical locations (as well as a combination of locations), which always makes it interesting when a patient asks, “…doc, where in my back is my pain coming from?”  In context of an office visit, we take an accurate history and perform our physical exam to try to reproduce symptoms to give us clues as to what tissue(s) may be the primary pain generators. In spite of our strong intent to be accurate, did you know, regardless of the doctor type, there is only about a 45% accuracy rate when making a low back pain diagnosis?  This is partially because there are many tissues that can be damaged or injured that are innervated by the same nerve fibers and hence, clinically they look very similar to each other. In order to improve this rather sad statistic, in 1995 the Quebec Task Force published research reporting that accuracy could be improved to over 90% if we utilize a classification approach where low back conditions are divided into 1 of 3 broad categories:

1.    Red flags – These include dangerous conditions such as cancer, infection, fracture, cauda equina syndrome (which is a severe neurological condition where bowel and bladder function is impaired). These conditions generally require emergency care due to the life threatening and/or surgical potential.
2.    Mechanical back pain – These diagnoses include facet syndromes, ligament and joint capsule sprains, muscle strains, degenerative joint disease (also called osteoarthritis), and spondylolisthesis.
3.    Nerve Root compression – These conditions include pinching of the nerve roots, most frequently from herniated disks. This category can include spinal stenosis (SS) or, combinations of both, but if severe enough where the spinal cord is compromised (more commonly in the neck), SS might then be placed in the 1st of the 3 categories described above.

The most common category is mechanical back pain of which “facet syndrome” is the most common condition. This is the classic patient who over did it (“The Weekend Warrior”) and can hardly get out of bed the next day. These conditions can include tearing or stretching of the capsule surrounding the facet joint due to performing too many bending, lifting, or twisting related activities. The back pain is usually localized to the area of injury but can radiate down into the buttocks or back of the thigh and can be mild to very severe.

If this should happen, ice the area for a few days and avoid further stress to the lower back, especially heavy lifting and bending at the waist.  Laser treatment can help accelerate healing of the facet capsules and microtears in surrounding muscle, and chiropractic adjustments can help ensure the range of motion is not degraded during healing.

Till next time,

Dr. Perez, San Francisco Chiropractor
(415) 627-9077
Online Appointment Scheduling

When you woke up today, you thought this was like any other Friday. You’re on your way to work, and traffic is flowing smoother than normal.  Suddenly, someone crashes into the back end of your car and you feel your head extend back over the headrest and then rebound forwards, almost hitting the steering with your forehead. It all happened so fast. After a few minutes, you notice your neck and head starting to hurt in a way you’ve not previously felt.   When the police arrive and start asking questions about what had happened, you try to piece together what happened but you’re not quite sure of the sequence of events.  Your memory just isn’t that clear. Within the first few days, in addition to significant neck and headache pain, you notice your memory seems fuzzy, and you easily lose your train of thought. Everything seems like an effort and you notice you’re quite irritable. When your chiropractor asks you if you’ve felt any of these symptoms, you look at them and say, “…how did you know? I just thought I was having a bad day – I didn’t know whiplash could cause these symptoms!”

            Because these symptoms are often subtle and non-specific, it’s quite normal for patients not to complain about them. In fact, we almost always have to describe the symptoms and ask if any of these symptoms “sound familiar” to the patient.

As pointed out above, patients with Mild Traumatic Brain Injury (MTBI) don’t mention any of the previously described symptoms and in fact, may be embarrassed to discuss these symptoms with their chiropractor or physician when they first present after a car crash.  This is because the symptoms are vague and hard to describe and, many feel the symptoms are caused by simply being tired or perhaps upset about the accident.  When directly asked if any of these symptoms exist, the patient is often surprised there is an actual reason for feeling this way.

The cause of MTBI is due to the brain actually bouncing or rebounding off the inner walls of the bony skull during the “whiplash” process, when the head is forced back and forth after the impact. During that process, the brain which is suspended inside our skull, is forced forwards and literally ricochets off the skull and damages some of the nerve cells most commonly of either the brain stem (the part connected to the spinal cord), the frontal lobe (the part behind the forehead) and/or the temporal lobe (the part of the brain located on the side of the head). Depending on the direction and degree of force generated by the collision (front end, side impact or rear end collision), the area of the brain that may be damaged varies as it could be the area closest to initial impact or, the area on the opposite side, due to the rebound effect. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions.

The good news is that most of these injuries will recover within 3-12 months but unfortunately, not all do and in these cases, the term, “post-concussive syndrome” is sometimes used.

In my practice, once the auto accident patient has been cleared of all red flags and it is determined that the injury is limited to soft tissue with possible vertebral misalignment, the initial focus of care is to reduce pain and reduce inflammation.  As the pain subsides, passive stretching is utilized with some gentle adjustments to the neck vertebrae.  The LiteCure laser is sometimes used to accelerate soft tissue healing.  Towards the end of care, strengthening exercises are prescribed to bring the neck and spine to pre-injury status.

More information on whiplash can be found on our clinic website.

Dan Perez, D.C.

(415) 627-9077

Online Scheduling

Exercise for the neck is very important since weak muscles are related to many painful conditions of the neck and can contribute to fatigue, irritability, headaches, sleep loss, and more.  When done correctly (perform slowly, staying within “reasonable” pain boundaries), they can increase your range of motion, reduce stiffness/tightness, and strengthen your neck muscles.

The exercises below combine range of motion (ROM) against light/partial resistance in 4 directions (forwards, backwards, and L/R side bending).  To do these correctly:   similar to an arm wrestling contest,: 1. Push your head into your hand while moving the head to the end of the range, “…letting the head win” (See A, C, E, G).  2. Repeat this going back in the opposite direction by “letting the hand win” (see B, D, F, H), again, moving through the entire range of motion.  ALWAYS push the head into the hands, Make sure you move the head against resistance in BOTH directions, 3 times each (A-B then B-A x3; C-D then D-C x3) then, (E-F then F-E x3, and lastly, G-H then H-G, x3 reps). The trick is doing this VERY slowly (to build motor control and coordination) and to move through the entire “comfortable” range of motion.  Repeat 3x slowly.  If pain worsens, lighten up on the amount of pressure used or, stop the movement just prior to the sharp pain onset. If you can’t make it to the end of the movement due to pain, make a note of how many reps it took before the onset or increase of pain and how far you could move your head. Do 3 slow reps and then move to the next exercise direction.

These exercises can be performed 1 to 3x/day, according to tolerance, and will increase ROM, increase strength, and build coordination, all at the same time.  Remember, the key is consistency and proper form.

Dr. Perez

(415) 627-9077

 Carpal tunnel syndrome or, CTS, is a common condition that drives many patients to chiropractic clinics asking, “…what can chiropractic do for CTS?”  As an overview, the following is a list of what you might expect when you visit a Doctor of Chiropractic for a condition like Carpal Tunnel Syndrome:

1.    A thorough history is VITALLY important as your doctor can ask about job related stressors, hobby related causes (such as carpentry or playing musical instruments), telephone work, or factory work – especially if it’s fast and repetitive.  Your doctor will also need to learn about your “co-morbidities” or, other conditions that can directly or indirectly cause CTS such as diabetes, thyroid disease, certain types of arthritis, certain medication side effects, and others.
2.    A Physical Exam to determine the area(s) of nerve compression degree of severity. This may include ordering special tests such as EMG/NCV, if necessary.
3.    Treatment can include manipulation, soft tissue release, PT modalities (eg., electric stim., ultrasound).
4.    Home Therapies are the main topic for this Health Update. What can YOU do for CTS?

Here are some of the things that you, the CTS sufferer can self-manage:

A Carpal tunnel splint  is primarily worn at night, keeping your wrist in a neutral or straight position. This position places the least amount of stretch on the nerves and muscle tendons that travel through the carpal tunnel at the wrist.  The idea here is that the immobilization gives the median nerve a better chance to heal.

Exercises (Dose: 5-10 second holds, 5-10 repetitions, multiple times / day) such as:

A. The “Bear claw” (keep the big knuckles of the hand straight but bend the 2 smaller joints of the fingers and thumb and alternate with opening wide the hand)

B. Tight Fist / open hand (fully open – spread and extend the fingers and then make a fist, with the hand).

C. The upside down palm on wall wrist and forearm stretch (stand facing a wall; with the elbow straight, place the palm of your hand on the wall, fingers pointing down towards the floor. Try to bend the wrist to 90 degrees keeping the palm flat on the wall. Feel the stretch in the forearm – hold for 5-10 seconds. Reach across with the other hand and gently pull back on the thumb for an added stretch!

D. Wrist range of motion (dorsiflexion/palmar flexion) – Place forearm on a table with wrist off the edge, palm down. Bend hand downward as far as possible, then upward. Repeat 5 or 10 times.

E. Wrist range of motion (pronation/supination) – Place forearm and whole hand on table– elbow bent 90°, palm flat on tabletop. Rotate the wrist and forearm so the back of hand is now flat on tabletop. Repeat 5 or 10 times.

F. Neck Stretch. Sit or stand with head facing forward. Side bend as far to the right as possible (approximate the right ear to right shoulder) and hold for 5 seconds. Reach over with the right hand to the left side of the head and gently pull further to the right to increase the stretch. Reverse instructions for the other side. Repeat 3 to 5 times. Consider other neck exercises if needed.

G. Shoulder shrug and rotation. Stand with arms at the sides. Shrug the shoulders up toward the ears, then squeeze the shoulder blades back, then downwards and then roll them forward. Do the whole rotation slowly and reverse the direction. Repeat 3 to 5 times. If you cannot comfortably do the whole rotation, just shrug the shoulders up and down. H. Pectoral stretch. Stand in a doorway (or a corner of a room). Rest your forearms, including your elbows, on the doorframe, keeping your shoulders at a 90-degree angle. Lean forward until a stretch is felt in the chest muscles. Do not arch your back. Hold 20 seconds; repeat 5 times.

Job modifications are also VERY important but unfortunately, a topic for another time! In short, rotate job tasks (if possible), take mini-breaks, and use tools with handles that fit easily into the hands. Have a job station analysis completed if the above are not enough.

Make sure to visit our website for more information on the nature of carpal tunnel syndrome.

Till next time,

Dr. Perez

(415) 627-9077

www.hand.genbook.com

Headaches can be caused by a number of factors.  The two most common forms are tension headaches and migraines.

Tension headaches, as the name implies, are associated with muscle tension around the head and sometimes back of the neck and upper shoulders.  Sufferers describe it as a “tight band” around the head.  They can be triggered by prolonged exposure to computer monitors, TV or other video display monitors; and for some people, hard concentration.  Tension headaches can last for a few minutes to several hours.

Another common culprit of tension headaches is neck vertebrae that are not aligned properly, due to a previous trauma event such as a whiplash car accident.  There are seven bones that comprise the neck, and any one of them can displace slightly as a result of trauma, relative to the others, leading to abnormal joint movement and muscle strain.  In some cases, these displaced vertebra can affect the nerve tissue within.   If the nerves that control muscle contraction around the head and neck are affected, the pressure from displaced vertebrae can cause them to misfire resulting in hypertonic musculature (increased tone/contraction).

Migraine headaches are more complex and less understood.  They are usually associated with hormonal changes and abnormal response to environmental stimuli.  Migraines can be preceded by an aura, which can be visual in nature, where the sufferer knows the migraine headache is about to arrive.  They are usually one-sided and can last for several days.

If you experience headaches in a regular pattern, it would be a good idea to get checked for possible neck involvement; especially if you have a history of significant whiplash car accidents or other accident, or if you played in a contact sport such as football, boxing and martial arts.  Chiropractic adjustments to restore proper alignment can usually help reduce or eliminate the headaches.

For either type, the following can be done to ease the headache pain:

• Avoid your computer monitor and TV for six hours minimum, and avoid caffeine and alcohol for a while.
• Drink a tall glass of water, and get some fresh outdoor air.
• Roll up a towel so that it is about a 5″ diameter cylinder.   Lie on your back and place the rolled towel under your neck (not back of head) so that your neck arches upwards.  This decompresses the discs and ligaments in the neck.  Try putting a cool (not frozen) gel pack on top of the roll, under your neck.   Lie down in a darkened room for about 20 minutes in this position; knees bent 45 degrees.  Close your eyes, and breath deeply through your nose and out your mouth.
• Consider applying pure peppermint oil to your temples and forehead.  This herb relaxes smooth muscles, which is what blood vessels are made of.
• Do gentle stretches for your neck:  let your head drop forward, and circle it five times, using the weight of the head to stretch the neck muscles.  Reverse directions.
• There are two maneuvers that may help:  using the tips of your index fingers, gently press the small bumps just above the eye, toward the nose bridge under the orbit bones.  Hold for about 30 seconds.  Secondly, you can try pressing the acupuncture point for the head structures in the same way, which is the webbing of the thumb.

There are also some “red flag” conditions that can cause headaches, so make sure to see your doctor if your headaches are especially strong, recurrent, and don’t respond well to medications or self help techniques.  The main ones are a developing cerebral aneurysm and a brain tumor.

Till next time,

Dr. Perez

The Body Doctors Chiropractic & Massage

(415) 627-9077

Appointments:  www.hand.genbook.com

Just about every adult alive has at one point experienced a lower back strain.  This can happen from lifting something heavy, or even by seemingly harmless movements like bending at the waist to pick something off the floor.  In both cases, soft tissue fibers of the muscles, tendons, ligaments and fascia (muscle covering) can experience tiny tears resulting in inflammation, pain and stiffness.  It usually happens when the person is not cognizant of her movements; i.e. not careful; and more frequently affects those whose back muscles are weak in some way.

At the onset of injury, you will feel a sharp pain in the lower part of your back, and sometimes as low as the gluteal (buttocks) region.  A couple of things are happening:  inflammtion and localized swelling begin.  This is your body’s way of healing injuries, but unfortunately swelling triggers pain (in fact, most over the counter pain meds work by blocking the formation of inflammation).  Your muscles may spasm causing you to have a crooked posture– leaning to one side, or forward.  And, you will have muscle stiffness resulting in loss of spinal flexibility.  These things, if severe enough, can put you out of commission for a day or two, as it is extremely difficult to do any kind of work in this condition.

Here is what to do if you strain your back:

1.  Ice the area for 15-20 minutes, every two hours throughout the day, for the first 2-3 days.   When applied properly, ice will constrict blood vessels and reduce the inflammatory response.  It will also slow down the nerve impulses of pain.   Don’t attempt to stretch on the first day.  It’s best to get a large, frozen gel pack that covers the area and place it under your back as you lie down face up on the floor; bend your knees and put a pillow under your knees and neck.  You’ll need to put a thin layer of tissue paper between the ice and your back (get clothing out the way) to prevent ice burn.

2.  On day two, continue the icing.  This time, do very slow and controlled stretches to your lower back:  knees to chest and hold; repeat; gentle side bending, forward bending, and extension.    A small amount of discomfort is OK, but if the movements cause the pain to increase significantly, it means you are not ready for stretches.

3.  On day three, alternate ice and heat:  Ice for 10 minutes; apply a hot pack for ten minutes.  A hot water bottle should do, but heat the water on your stove to 150 degrees and use a moist face towel between your skin and the bottle.  This will dilate and constrict blood vessels, which can pump out the inflammatory products being generated.

If the pain isn’t entirely gone by 3-4 days, and if you still have a crooked posture (muscle spasm and/or vertebra misalignments remain), consider getting chiropractic adjustments to accelerate recovery.   At my clinic, I also incorporate exercise rehabilitiation and somatic exercises to strengthen the muscles and regain better neurological control of them to reduce the chances of re-injury.

In my next post, I will discuss one of the main risk factors for lower back pain, so stay tuned…

Dan Perez, DC

San Francisco Chiropractor, Union Square

447 Sutter Street, Ste. 414

(415) 627-9077

Online Appointment Scheduling:  http://hand.genbook.com

Posture is the alignment of the body when standing, and is evaluated from the front and the side.  Posture is very important to health because it can affect movement, breathing and energy expenditure.  Poor posture may not cause sharp, noticeable pain but it can cause problems in a more subtle manner.  This is actually more dangerous because the person fails to make the connection between her bad posture and her symptoms; does not take corrective measures and continues to suffer the consequences.  Bad posture can cause fatigue, muscle aches, headaches, poor sleep, loss of energy, digestive disturbances, and may even contribute to injuries.

When viewed from the front, the head and neck should align exactly in the middle of both shoulders.  The tops of the shoulders should be even.  The torso should be evenly divided by a straight line perpendicular to the ground.  The hips (tops of pelvic bones), like the shoulders, should be even. 

When viewed from the side, a straight line perpendicular to the ground should be able to pass through the ear, shoulder, hip, and knee joint.

One of the most common types of postural deviation is forward leaning of the head relative to the neck and shoulders; also called foreward head posture (FHP).  It is usually caused by years of desktop work, which forces the head to gravitate forward to see the work area (desktop papers, computer terminal).  This puts the center of gravity of the head, which is essentially a weight, forward of the spine, the foundation of the body.  In physics, this creates what is called a moment force, which increases in pull the further the center of gravity of the head moves away from the spine.

Here is a good illustration of how moment forces work:  find something about the weight of the head, about 8-10 pounds.  If you have an exercise dumbbell, this works well.  Now, grab the dumbbell, sit at your kitchen table, and put your elbow on the table so that your forearm is perpendicular to the table surface (straight up).  In this analogy, the weight in your hand is your head, your wrist is your neck, and your forearm is your spine.  When the weight (head) is directly over the forearm (spine), your wrist (neck) and forearm (spine) experience minimal energy expenditure.  The bend of your wrist is like an ideal, concave curvature of the neck, which acts like a spring that absorbs some of the weight. 

Now, straighten your wrist and slightly bend in down so that the weight is a few inches in front of your forearm.  All of a sudden, you feel strain on your wrist and forearm.  The muscles of your arm have to contract to balance the weight.  This is precisely what happens when you have  forward head posture—it places a lot of stress to the neck, shoulders, and upper back muscles.  The result is neck pain, stiffness, and sometimes headaches.

Studies show that poor posture also taxes the brain (saps its resources; i.e. energy), as the brain constantly works to maintain proper tone to keep the body in an upright posture when standing.  Poor posture can also make it more difficult for the ribcage to expand, affecting breathing and oxygen intake.  Combined, it is not surprising that persons with poor posture often feel tired.

 So what does one do if he/she has poor posture?  A regimen of chiropractic adjustments, stretches, specific posture correction exercises, and certain home traction devices can improve posture in a matter of weeks.  The main thing to understand if you have sub-optimal posture is that it will require some time and consistent effort to normalize your posture, but the end result is most definitely worth it.

To get a free posture evaluaton and recommendations, call our center at (415) 627-9077.

If your doctor informed you after your last blood test that you have “high cholesterol” you were probably given a prescription of statin drugs, or cholesterol lowering drugs.  These drugs block the metabolic pathway of cholesterol formation in the liver – the “bad” cholesterol, or LDL cholesterol, and the “good” cholesterol or HDL.  Cholesterol is an important molecule that comprises the structure of cell walls, among other things.  It keeps cells hydrated and helps maintain proper nutrient and waste exchange in all cells of the body.  It is also a key component of the myelin sheath of nerves.  The myelin sheath of a nerve is analogous to the rubber coating of an electrical cord—it keeps the electrical flow within the nerve and prevents cross communication with other nerves.

Studies show that long term use of statin drugs can lead to symptoms such as muscle pain, weakness, and involuntary muscle contractions or fasciculation.  Some researchers believe it may be tied to Alzheimer’s disease and other forms of dementia, as the drugs erode the protective covering of the brain and spinal cord.

If you are experiencing any strange symptoms involving your muscles after taking statin drugs such as difficulty walking up stairs, riding a bike, or balancing on one leg, don’t assume that you need a massage or rest—it may be side affects of the drug.  Go to your doctor and express your concerns.

The other thing worth mentioning is that you can be a vegetarian and have high cholesterol.  Remember, cholesterol is manufactured in the liver and intestines and doesn’t change much in response to cholesterol consumption.   Since cholesterol is found only in animals, people with high cholesterol tend to avoid meat.  This may not be the best strategy, because it forces one to default to carbohydrates to obtain the necessary calories the body needs.  Excessive carbohydrate consumption (grain foods, starches, refined sugars) will increase blood sugar and triglyceride levels, and over time, insulin insensitivity.  This can lead to increased fat stores and weight gain.

A healthier approach to lower your cholesterol is to exercise regularly—cardiovascular, strength, and functional (all body parts simultaneously) and eat a diet centered on protein and plants.  Limit all grain based foods to about 150 grams per day, and totally eliminate refined sugar, fructose, and corn syrup.  Once your cholesterol drops to normal levels, you can increase your carbohydrate intake to 300 grams per day.  But as a rule, keep carbohydrate intake relatively low.

To summarize, if you frequently have weak, sore muscles; or worse, nerve-related symptoms such as involuntary contractions and sensory dysfunction and happen  to be taking cholesterol-lowering drugs, there is a high likelihood that the two are related.  Report to your doctor your symptoms, and express your concerns about the side effects of these drugs.

Dan Perez, DC

Chiropractor, San Francisco

(415) 627-9077

Trying to figure out exactly what your health insurance covers can be a tricky ordeal.    Patients often inquire if their health insurance will “cover” chiropractic or massage therapy.   The answer is not so simple, because there are things that one must first understand about health insurance coverage.  This post will help clarify how health insurance works, as it relates to chiropractic coverage.

Many insurance plans have deductibles and co-pays that require out of pocket expenses from the patient.  It is rare to have a plan that covers 100% of your medical care.  Some plans have reimbursement amounts to the provider that frankly are so low it would be a business loss if the doctor accepted the plan, depending on the provider’s overhead expenses to deliver care (rent, payroll, equipment leases, and so on).  And, some plans have caps on the number of chiropractic visits a patient can get in a calendar year, or caps on the annual benefit (limit on dollar amount coverage).  These factors all play into the answer to the question about whether chiropractic services are “covered.”

A chiropractor can choose to be in-network or out-of-network for a particular health plan.  In-network benefits appear attractive to patients because usually the deductible is low, or there is no deductible (the amount the patient has to pay out of pocket before coverage starts).   Being in network for an insurance plan is attractive to chiropractors because it enables them to be listed in the in-network provider directory of the plan, which many people check when choosing a chiropractor.  However, in exchange for being in-network, the provider accepts a reimbursement that is much lower than his usual and customary fees, and cannot bill the patient for the balance.  The lower reimbursement usually prohibits the provider for employing ancillary procedures such as massage therapy, exercise rehabilitation, and modalities such as laser, traction, and ultrasound which could be instrumental in resolving the patient’s condition in a shorter time frame.  An out-of-network doctor usually gets reimbursed at the usual and customary level (the regional market average) after the deductible is met, but is not listed on the provider list of the plan.

So, what patients should realize is that having an insurance plan that claims that it “covers” chiropractic services does not mean you can go to any chiropractor and have your treatment covered 100% by your plan.  Choosing an in-network doctor will get you the lower out of pocket expenses, but you may not receive effective procedures outside of chiropractic adjustments which could help resolve your condition faster.  Also, plans may have in-network or out-of-network deductibles of upwards to $2,000 or more before chiropractic coverage starts, effectively making chiropractic a non-covered benefit.  I’ve seen some plans have a limit of 12 visits per year with a $500 deductible, and visits during the deductible period are counted toward the 12 visits, leaving just a few visits with some coverage after the deductible is met.

Basically and fundamentally, insurance coverage should not dictate a patient’s treatment plan.  If for example a patient has an acute lumbar disc injury that needs comprehensive acute care followed by a rehabilitation phase and has a minimal coverage plan of 12 visits, discontinuing care after 12 visits could jeopardize the outcome.  Most chiropractors in cases like this will assist the patient in using her benefits to the max, combining it with a cash plan that fits within the patient’s budget.  After all, the primary goal should  be to get well; not to have to stress out over insurance coverage.

Dan Perez, D.C.

(415) 627-9077

If you experience general, chronic lower back pain and stiffness, and you sit for long hours each day at work or have a history of repetitive trauma to your back, it may be due to abnormal muscle contraction along your spine.

You see,  the muscular system is controlled by your brain and nervous system.  Your brain sends electrical impulses down your spinal cord, through your peripheral nerves and into your muscles, causing them to contract and relax.  There is the voluntary nervous system, where you have conscious control of your muscles (example:  using your muscles to lift something heavy) and the autonomic nervous system, where the brain and cerebellum manage muscle contraction via a highly complex system, independent of conscious thought (example: using your muscles to stand upright).   But what if your brain sent excessive nerve impulses to your muscles, even during rest due to a malfunction?  Wouldn’t it result in a constant state of involuntary muscle contraction; i.e. spasms and stiffness?

This is the basis of somatics, a bodywork discipline that deals with the connection between the brain and musculoskeletal system.  It is theorized that trauma to the body, whether it be physical, emotional, or chemical can cause the brain to constantly over-stimulate muscles, making them feel stiff and fatigued.   If this abnormal nerve stimulation cycle can be broken, then the muscles can return to normal.

If your muscle stiffness, fatigue or pain does not respond to massage therapy, rest, stretches, yoga, or even chiropractic; or if it keeps returning, then you might have abnormal nerve stimulation to your muscles originating in your central nervous system.  In this case, a technique centered on not so much the muscles, but the nervous system, may be able to break the cycle.

A basic somatic exercise to help restore proper muscle tone to the muscles, particularly the spinal and core muscles is as follows:

Find a dark, quiet room.  Lie down on a mat, face up.  Place your hands under the back of your head, fingers interlaced.  Bend both knees about 45 degrees; keep them close together.  In order for this exercise to work, you must concentrate and use visualization.  There should be no noise or other distractions.

Close your eyes, and breathe deeply, smoothly and slowly in through your nose.  As you breathe in, arch your lower back and push your tailbone into the floor while visualizing the back muscles in that area contracting.  At the same time, gently push your head downward into your hands and squeeze your shoulder blades together.  Visualize these muscles contracting as well.  The third thing to do is contract the psoas muscles, which will lift the feet off the floor while your knees are bent.  However, do not let your feet leave the floor; just maintain the isometric contraction of the psoas muscles during inhalation.

Next, exhale through your mouth and gently release the contraction of your muscles, but flatten your lower back so that the arch is gone.  Visualize the muscles flattening out your lower back.  Repeat twenty times; do daily for a week.

Remember, this exercise is not for strengthening, and it is not a stretch.  The goal here is to consciously reconnect the brain with the postural muscles of the back.  So, the keys are relaxation, proper breathing, concentration and visualization, and repetition.

Somatic therapy is often integrated into the chiropractic office visit at our center.  For more information, call (925) 627-9077.

Dan Perez, DC

San Francisco Chiropractor