Chronic Pain & Z-Health

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I find chronic pain to be a tremendously fascinating topic.  It’s all around us and it’s mysterious.  Even though it’s 2010 and we’re the beneficiaries of thousands of years of medical advances, we still have trouble fixing various lingering aches and pains.

Reconceptualizing Pain According to Modern Pain Science comes from the wise Australians at Body in Mind.  Much of the world’s population is wracked with chronic pain.  It seems anyone near the age of 30 has at least a little bit of mysterious lingering pain.  Many a neck, shoulder, knee and/or low back has been treated over and over again yet the pain stays.  Why?  Further, chronic pain is typically very different from acute pain.  There’s no blood, perhaps no swelling, and the pain often comes on gradually and for no apparent reason.  Chronic pain is very different from the pain of a sprained ankle or dislocated shoulder.  So what are we dealing with? The article makes four key points:

  1. Pain does not provide a measure of the state of the tissues.  (i.e. Pain doesn’t necessarily = injury.)
  2. Pain is modulated by many factors from across somatic, psychological and social domains.
  3. The relationship between pain and the state of the tissues becomes less predictable as pain persists.
  4. Pain can be conceptualized as a conscious correlate of the implicit perception that tissue is in danger.  (The PERCEPTION of a threat may generate more pain than the actual threat itself.)

Many Z-Health methods are based on these factors.  We recognize that pain may be rooted in any number of sources including emotions and stress.  We also recognize that the nervous system is in charge of pain, and that the site of the pain is often not the site of the problem.  We may be wasting our time if we spend time at or around the painful area.

For example, Z-Health practitioners may make use of opposing joint motion to address pain.  If someone has left knee pain then we might go to the right elbow and ask the client to perform elbow circles.  To take it a step further, we may ask the client in what position does he or she experience pain?  Does the left knee hurt when the hip is extended (leg behind the torso) or flexed (leg in front of the torso)?  If the left knee hurts in hip flexion then we may put the client’s right arm into extension (arm behind the torso) and then call for elbow circles. Many times I’ve seen a client’s pain reduce in moments as a result of these types of drills.

I’ve seen big-toe pain reduced through opposite thumb mobility.  I’ve seen shoulder pain reduced through opposite hip mobility.  Low-back pain may be eliminated through neck mobility drills.  (This stuff is wild!)

Further, if either our visual or vestibular reflexes are faulty then the result may be joint pain.  The nervous system is sending a message: Change something.  Our eyes and inner-ear structures are the seats of very powerful forces.  If these two mechanisms aren’t working together then the nervous system will perceive a threat.  The nervous system can use pain to alert us to that threat.  Addressing the visual and vestibular systems is vital if we’re combating chronic pain.

None of this obviates the need for other diagnostics.  MRIs and X-Rays may indeed show structural problems contributing to pain.  Various drugs may cause pain in some regions of the body.  Some cholesterol meds may cause low-back and leg pain for instance.  The main point here though is that pain is often a very complex issue, the causes of which may not be obvious.  You can have power over your pain if you recognize how it works.

Please go to the link above and read the article to learn more about how chronic pain works.  For further reading on Z-Health, Todd Hargrove’s Better Movement is an excellent source.

Goodbye Plantar Fasciitis???

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This is a quick update to my recent plantar fasciitis posts (Part I and Part II.)  I met recently with Denver-area Z-Health movement specialist Brain Copeland and it seems he may have helped me find a titanic breakthrough in my PF!  Briefly, he assessed whether or not my arms and legs were coordinated properly during gait.  He used muscle testing as part of this assessment.  Turns out I had really only been cheating at walking and chewing gum.  My gait looked normal enough but I was weak in certain positions where I should’ve been strong, and I was strong in some positions where I should’ve been weak.  He then introduced cross-crawl patterns to me.  Since then, my PF pain has decreased significantly and it has stayed that way.  (I saw him on Saturday and this is Wednesday.) In some circles, this is known as a “WTF?” moment.

“Imagine you hire three people to work at a company to perform three separate jobs. But two of the employees are trying to do the same job and the third job is getting neglected. This is how I envision neurological disorganization.” Brian Copeland, Z-Health Movement Specialist

Goofy? Yes. Effective? Also yes!

The Cross-Crawl

Cross-crawl patterns are, as the name implies, movement patterns that resemble crawling.  That is, the right arm and left leg converge and vice versa for the left arm and right leg.  These are remarkably easy patterns and they can be created while standing, seated, prone or supine.  Some of this stuff resembles some goofy old-school “aerobics” class movements (‘Knee to elbow everyone!!”)  The supine cross-crawl looks like the “dead bug” ab exercise while the prone cross-crawl is essentially the same as the “bird-dog” low-back rehab exercise.  Still another version looks like some sort of Irish jig.  Fun stuff right?!  (The good news is these moves are really easy and at least in my case, very powerful.)  I’ll post video of cross-crawls soon.

What’s at Work Here?

I asked Brian Copleand several questions:

Q: Who might benefit from cross-crawl patterns?

A: “Everyone can benefit from cross-crawling patterns as the movement helps strengthen certain neural pathways in the brain that are beneficial. For instance, when you run, jog or walk and you step forward with your right leg which arm swings forward? It better be your left or you are a toy soldier. This cross lateral pattern of movement is key in both athletes and non-athletes. If you ever see a martial artist throw a very powerful kick with their right leg you will see their right arm go back and left arm come forward. This has to do both with rotational force and rotary stability in the trunk to maintain balance. So cross crawling movements are basically a part of our everyday lives. When the movement patterns become switched then we see all number of strange neurological issues arising such as unexplained pain that has no pathological explanation, clumsiness, troubles with memory and other cognitive issues depending on the severity of the neurological switching.”

Q: How do we identify those who may have this neurological switching?

A: “There are some specific tests that a Level 4 Z-Health Exercise Therapist can give to ascertain if someone has neurological disorganization and no one should self diagnose, but having said that people can get an idea if they have this by looking for the following things. Typically someone will have had some head trauma at one point in their life, even if it was as a child. People might be socially awkward and not know why. People may have a hard time remembering things and have to be shown something over and over again. People will often say things like, ‘things always work different for me than other people,’ and they don’t know why. Frequent clumsiness is a possible indicator as well.”

Q: What do cross-crawls achieve?  Can you describe what these patterns do for our brains?

A: “Well that is the $64,000 question. Researchers are still discovering the how and why but for now we know that it does work. As I’ve been told before, science is the observation of repeatable phenomenon. So even if we don’t have the full picture yet we know that it works. But if I may hypothesize just a little… It is classically understood that the left hemisphere of the brain controls the right side of the body and vice versa, there is some variance in there but as a general rule it is true. We also know that many of the natural movement patterns that we have are cross-lateral in nature, in other words right leg, left arm and vice versa. These patterns help to stabilize our torso and provide balance and efficiency of movement.  Now imagine if all of a sudden the right hemisphere of your brain decided that it would control the left side of your body, except it would also control the right thumb but not the fingers. Now the left side of the brain is having signal feedbacks or misfires as it tries to control your right thumb. Now the pre-cognitive brain (the automatic part that controls the behind the scenes stuff) encounters confusion and we reach what Z-Health founder Dr. Eric Cobb, D.C. calls a threat response. I can already tell that I am about to open a whole can of worms so I’ll digress a little. Imagine you hire three people to work at a company to perform three separate jobs. But two of the employees are trying to do the same job and the third job is getting neglected. This is how I envision neurological disorganization.”

Q: What else should we know about cross-crawl patterns?

A: “Well there is always more to know but it can become quite complex. I would just say make them a part of your daily warm up for your exercise routine, 20 or so should suffice as preventative medicine. If you have neurological disorganization you may need to do more reps than that. And ultimately each person will respond uniquely different, the amazing and frustrating thing about the human body.”

“Folks can learn a little more about Z-Health and how the human nervous system has an impact on both the pain we feel and our potential for athletic ability by checking out these articles: What is Z-Health and Why It Works and How to Eliminate Pain, Stiffness and Weakness Forever.”

So that’s a fairly thorough discussion on cross-crawling and why it may work.  I don’t want to promote cross-crawling as a magic cure-all panacea for everyone.  That said, these are very easy movements to execute and they may very much be worth a try.  If you have lingering pain that isn’t responding very well to treatment, give cross-crawling a shot.  In my case I’ve had tremendous results.  (Now of course the challenge is to remain conservative as I add back in running, biking, etc.  The temptation is to ramp up to 1000 mph.  Not a good idea.)

Further information on cross-crawl patterns can be found at the following sites: Head Back to Health, Natural Health Techniques.

Three-Week Kettlebell Workout: Power Endurance/Strength

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In case anyone’s interested in a medium-term workout, here’s the one I’m doing.  I’ve spent a good bit of the past several months deadlifting and side pressing.  To a large degree I’ve followed one of the programs out of Pavel Tsatsouline’s Power to the People.  So now I want to convert some of that strength into power–and I want to generate power repeatedly–i.e. power endurance.  So here’s what I’ve designed.  Follow along if you’d like and please let me know your results.

Pre-Workout:

All workouts are preceded by a combination of Z-Health Neural Warm-up Levels I and II.  I mobilize various joints such as feet and hands, knees and elbows, hip, shoulders, pelvis and spine.  I want to wake them up fully before I start to generate a lot of force.  I want to make sure each individual joint is read to go before they start working together.  Next comes the warm-up and workout prep.

The warm-up involves body weight movements that resemble the workout movements.  The workout prep consists of the main lifts I’ll use for the day but with a light load.  Here’s how the workout might go:

Body weight goblet squat: 6 reps

Lateral lunges: 6 reps

Crossing lunges: 6 reps

Rotating T: 6 reps

Cross-crawl patterns: 20-40 reps

Get ups, light swings, snatches, presses, high pulls

The Workout, Week 1:

– Monday
1) One-arm snatches: 5 each arm followed immediately by
Swings: 20 two- or- one-hand
Repeat 3x as fast as possible.  You track my heart rate and the time it takes to complete this circuit.  This will show your progress.

2) Clean & press + pull-up ladders: 1, 2, 3 x 3 sets
Here’s how this works. Clean and press a kettlebell for one rep on each arm then do one pull-up.  Next, clean and press for two reps each arm followed by two pull-ups.  Then perform three cleans and presses each arm followed by three pull-ups.  Perform this process three times.  Rest between sets as needed.  This isn’t a race like the previous circuit.  Use perfect form!  No hunched struggling pull-ups.  Use an assisted pull-up machine or a partner if you need help.

– Wednesday
1) Double kettlebell snatches: 5 reps followed immediately by
Swings: 20 reps
Do this circuit once only.

2) Repeat Monday’s clean & press + pull-up ladders x 3 sets

– Friday
1) Repeat Monday’s snatch and swing circuit twice.

2) Repeat the clean & press + pull-up ladders x 3 sets.

Week 2:

Perform the same snatch and swing circuits but move up in weight if the circuits become easy.  As for the clean & press + pull-up circuit, you’ll add one set.  This means that you’ll do 4 x 1, 2, and 3 reps.  (You did three sets of 1, 2, and 3 reps in week 1.)

Continue to use perfect form.  Stop early if you need to.  Don’t go to out-and-out failure.  The work should be challenging but not impossible.

Week 3:

Week three is essentially the same.  You may need to move up in weight on the snatches and swings.  Stay with three sets on Monday, one set on Wednesday and two sets on Friday.  Experiment with one- and two-hand snatches and swings.

Add another set to the clean & press + pull-up ladders.  So that’s 5 x 1, 2, 3, reps.

Simple right?  Shouldn’t necessarily be easy though.  Following this workout I plan to return to deadlifts, various overhead and side presses, and the overhead squat–and who knows what else?!

Hello Plantar Fasciitis :-( Part II

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Part I of this post ended mid-way through my explanation of various strategies to combat plantar fasciitis (PF).  Here are more treatment methods.

Taping

Various taping strategies may be used to help alleviate PF symptoms.  Tape should help support the arch of the foot and help shoulder some of the burden borne by the plantar fascia.  There are two options.  First is the traditional white athletic tape.  This stuff can be rigid and uncomfortable but possibly effective.  Here’s a video on how to apply athletic tape in order to relieve PF.  And here is a slightly different method.

The other taping option is elastic therapeutic tape, (aka Kinesio tape.)  Elastic therapeutic tape became popular during the 2008 Beijing Olympics where many athletes were seen wearing the strange, multi-colored blotchy looking stuff on their legs, shoulders and other body parts.  Kinesio tape supposedly goes beyond simply providing support to injured areas but also may influence the healing process.  Here’s resource on how to apply this stuff.

Night Splints & Socks

For anyone interested in a more medieval approach to PF, you may enjoy the night splint.  Similar to the night splint is this specialized sock.  Both items are designed to provide a prolonged stretch to the plantar fascia and Achilles tendon while you sleep.  I recently spoke to an employee at a local running shoe store and she said these things are fairly uncomfortable.  Still, several posts I’ve read on various forums proclaim these things as useful.

Other methods

This guy swears by walking on gravel in his sock feet.  I think it must be the same principle as using a golf ball to break up the scar tissue associated with PF.  Other sources suggest freezing a can of coke and rolling it underneath the foot.  Here’s an example of a specific plantar fascia stretch from which some folks have had success.

I would suggest staying away from cortisone injections.  Cortisone is a powerful steroid that can provide very quick relief from PF pain.  The big drawbacks are 1) it’s a symptom treatment; it doesn’t fix anything, and 2) too much cortisone weakens connective tissue thus creating a risk of a rupture.

Nor can I see much benefit to plantar fascia release surgery.  This again doesn’t solve a problem but may create more problems.  Part of this surgery includes cutting the plantar fascia in order to release tension.  Problem is the plantar fascia is a major shock absorbing part of the body.  Altering that structure doesn’t seem wise to me.

My Strategy:

As I’ve thought about my own PF, I realize a couple of things: 1) I changed my gait and therefore changed how my tissues were being stressed.  2) I simply didn’t give myself enough time to adapt to this change.  3) I believe my PF is part of a larger puzzle involving faulty movement patterns.  Here’s my plan.

Rest

The one common theme I’ve seen and heard from those who’ve overcome PF is that rest is necessary.  Damaged tissues must be allowed to heal.  Therefore, I’ve greatly reduced my running and biking.  There seems to be no way around it.

Joint Mobility

If, as I believe, I have faulty biomechanics (i.e. I don’t move well) then no matter how much I rest and treat my injury, I can expect it and/or other similar symptoms to return once I start running again.  Thus I must search out those resources that will help correct my movement problems.  Z-Health is my chosen rehab system.  Why Z-Health?  Because the Z-Health methodology recognizes that there is probably more to my PF than simply heel pain.  My whole body–especially my nervous system–must be addressed in order to move better.

Z-Health has helped tremendously with my back and shoulder pain, and I’ve seen numerous others improve their performance through Z-Health.  I’m a certified Z-Health trainer but I recognize that I can’t solve all my problems on my own.  Twice recently I’ve visited with certified Z-Health practitioner Brian Copeland of Core Fitness in Aurora, CO.  I’ve been very impressed with my results thus far–especially after yesterday.  We did further testing on my neurological system and found that certain fundamental aspects of my movement coordination aren’t functioning quite correctly.  Among several exercises, we recently implemented cross-crawl patterns into my process.  All I can say is I’m stunned at how much better my heel feels!  In 24 hours the pain has subsided very significantly.  I believe correcting my movement patterns is the most significant and most complex part of my plan.

Structural Integration

I haven’t experimented much with massage though I’m aware of its role in many athletes’ lives.  Structural integration (Rolfing is a type of SI) involves manipulating connective tissue including the fascia.  In this way, my body should interact better with gravity.  Posture should improve, pain should diminish and I should move better.  Donielle Saxton is the Denver-area massage therapist with whom I’ll be working.  The details and principles behind this process is really fascinating.  For further information check out Anatomy Trains and KMI (Kinesis Myofascial Integration).

Cold Laser

Finally, I’m getting a bit of cold laser therapy at Mederi Health in Denver.  This is pure symptom treatment–and I’m OK with that.  Reducing the pain should help calm my nervous system and speed my return to normal function.

Shoe Insert and Taping

I recognize that my arch may need some help.  Therefore I’m going to bolster the area by way of a grocery store-bought arch support and Kinesio tape.

We shall see what happens.

Hello Plantar Fasciitis….:-( Part I

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Ouch...

Here is a major drag in my life.  I’ve run into injuries off an on over the past few years.  Just as I get healthy a new one seems to crop up: back pain, shoulder pain, Achilles tendon pain…  The latest and greatest issue is heel pain aka plantar fasciitis.  (I’m going to call it PF.)

Minor symptoms showed up a few months ago but they sort of came and went.  Pain on the outside of my heel wasn’t severe and it faded out rapidly.  (I associated plantar fasciitis with pain along the inside of the arch of the foot.)  I’d been running some and biking a lot.  I’d changed my gait and I was running a good bit in my Vibrams–and I was feeling really good!!  (Interestingly, my new gait pattern had helped my Achilles tendon pain.  Seems I shifted the stress elsewhere.)

I’ve read up on the issue.  What have I found?  It seems that one person’s PF is very different from another’s PF.  Some runners insist that once they went barefoot, their PF went away.  Other runners swear by the opposite end of the spectrum and that orthotics were the cure.  Still many many other runners have tried many different treatments but with limited success.  Some people suffer with PF for a few weeks or months.  Others deal with it for a decade.  Much of PF is a big mystery.  What’s important here?

Causes of plantar fasciitis:

This is hard to figure out.  Like most things involving bodily pain,  there’s likely more than one cause.  “Improper footwear” is one culprit.  Biomechanical glitches such as leg-length discrepancy or tight calves also get blamed, as do high arches, low arches, leg length discrepancy, poor glute firing patterns, tight illiotibital bands.  Some sources suggest that PF is due to trigger points, or knots in the muscles.  There are many potential culprits for this crime, and most likely some of them are working together.

(I’ll go a little further and suggest that all these issues have causes.  If we’re not asking WHY the arches/glutes/IT bands/trigger points are tight/slack/dysfunctional then we’re definitely not getting to the true cause(s) of PF.)

Improper footwear is an interesting issue.  Much of the conventional wisdom says we should run in well cushioned shoes that fit our foot type, support our arches and guide our feet properly.  Funny thing is military studies such as those discussed in the previous post show that footwear matched to foot type does nothing to decrease running related injuries.  Ask barefoot runners and they’ll tell you that any footwear is improper footwear.  So what is improper footwear?  Seems it’s dependent on the eye of the beholder.

Treatment of Plantar Fasciitis:

Conventional treatment includes rest, ice, anti-inflamatory medication.  Orthotics are often prescribed as are calf and foot stretches.  Further pharmacological treatment may include a steroid shot.  That’s the conventional stuff.  What else is there?  Well, there are a multitude of therapies and strategies.  As I mentioned, it seems that every case of PF is different from every other case.  Therefore there are many variations on treatments.

Massage

Rolling a golf ball, lacrosse ball or similar ball along the bottom of the foot helps many PF victims.  This is supposed to help break up scar tissue and keep the plantar fascia supple.  A similar strategy involves using a foam roller to massage the calf, hamstring, illiotibial (IT) band, glutes, etc.  These are forms of self-massage.  More formalized massage methods may proove beneficial.  Myofascial release, Active Release Therapy (ART), deep tissue massage, trigger point therapy, Structural Integration (aka Rolfing) are examples of massage-type techniques that may prove beneficial in addressing PF.

Shoes

Lots of options here!  From barefoot to orthotics and all points in between, what you put on your feet (or possibly take off of your feet) may strongly influence PF.  This series of posts on the Runner’s World Forum encapsulates the issue very well.  One poster emphasizes wearing orthotics ALL THE TIME, while another poster says, “I think the thing that finally was a breakthrough for me was walking barefoot in the sand.”  I’ve found very similar statements throughout my reading.  So while there doesn’t seem to be any one shoe-based solution for everyone, consider the idea of changing footwear.

Orthotics are usually expensive.  Cheaper options include grocery-store bought arch supports and heel cups.  Superfeet and Sole Supports are similar to orthotics but also less expensive.

Joint Mobility/Strengthening

Weakness of the foot muscles may be causing your PF.  Therefore, strengthening the foot and lower leg and improving mobility/stability is vital.  We may not spend much time thinking about strong feet but hey, we only have to use them all the time every single day right?  Maybe it’s actually important!   I look to Z-Health R-Phase and I-Phase drills to enhance neural communication and awareness in feet and lower legs.  I’ll give some examples.

Start by simply moving the foot and ankle in all available directions.  Make circles with your feet.  Turn the sole in and out.  Flex and extend the toes along with the rest of the foot (make foot waves).  Ball-of-foot circles, toe pulls, and knee circles may help as well.  You must concentrate and try to make the movements as smooth and refined as possible.  Stay relaxed and breathe.  Single-leg balance drills may be beneficial too.

My personal opinion is that at some point, barefoot or minimal shoe work should improve foot strength.  (Again, some people insist this is the key to their overcoming PF.)  It may be too much though if your foot is injured.  The plantar fascia may be further damaged if you overload the region.  So it may be a progression similar to adding weight to a strength program or mileage to a running program.  Start with a small amount of barefoot balance work while still wearing whatever supportive footwear you’ve got.  You may gradually add in more barefoot work if the pain decreases.  Back off if the pain increases.

Ultrasound, Cold Laser, Shockwave Therapies

Physical therapists and chiropractors often use ultrasound therapy on soft-tissue injuries.  The idea is to bring heat to the area and facilitate healing. Research is mixed on effectiveness.

Cold laser therapy is a somewhat new therapy that may aid healing of PF.  The evidence is unclear though.  Research continues as to what wattage laser is ideal, what wavelength should be used, and how often one should receive treatment.  A Runner’s World article profiles one runner’s positive experience with laser therapy.

Extracorporeal shockwave is yet another electromagnetic method of addressing soft-tissue injuries.  Similar to ultrasound and cold laser, research is mixed, which shouldn’t be surprising.  If we’re dealing with a problem that may have multiple and varied causes it makes sense that one or another type of therapy may or may not be effective.  Further, ultrasound, laser and shockwave therapies deal with focused energy.  That energy can vary in terms of power and wavelength.  An injury may be exposed to varying amounts of energy for varying amounts of time.  Thus there are numerous factors that may or may not lead to healing of PF.  Lots of choices….

I’ll continue this post with a look at night splints, walking on gravel, magical ceremonies and everything else used to drive out the evil spirit that is Plantar Fasciitis (plus my own strategy in overcoming this issue.)