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11 Jan 2017
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The Major Reason Why Your Knee Hurts and What You Can Do About It

The Major Reason Why Your Knee Hurts and What You Can Do About It

January 11, 2017 | 0 Comments | , , , , , , , , , , , , , ,

As a sports rehabilitation doctor, I get the benefit of seeing all types of sports injuries.  One of more common injuries I see is a ‘knee tracking’ issue.  I’ll go as far as saying about 75% of all people presenting with knee pain have this condition as either a primary issue or issue that is causing a more serious situation.  So, what exactly is this funny sounding condition?

As humans, we are the ONLY animal to be upright and on two legs as a primary means of ambulation.  Although our evolution has allowed us to do this, it is not without issues.  It just so happens that the muscles on the outside of the thigh tend to get stronger/tighter than the muscles on the inside.  Now, it’s a bit more complex than this but this should help give us a general idea of what is occurring. Continue Reading →

09 Jan 2017
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Dr. Manison is now Selective Functional Movement Assessment (SFMA) Certified

Dr. Manison is now Selective Functional Movement Assessment (SFMA) Certified

January 9, 2017 | 1 Comment | , , , , , , , , , , , , , ,

Doctors learn how to assess and treat based on their specialization. Chiropractors are taught how to diagnose neuromusculoskeletal problems and how to properly treat them.  If a patient presents with a condition that a chiropractor cannot handle, then an appropriate referral should be made.

Dr. Manison has acquired skills in most of the highest level treatment approaches in his field.  In fact, he now teaches part of the Certified Chiropractic Extremity Practitioner (CCEP) program nationally.  This program, developed by Dr. Kevin Hearon, is regarded in the field as the highest level program on the assessment and treatment of extremity injuries. Continue Reading →

08 Jul 2016
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Dr. Manison now TPI (Titleist Performance Institute) Medical Level 3 Certified Provider

Dr. Manison now TPI (Titleist Performance Institute) Medical Level 3 Certified Provider

July 8, 2016 | 0 Comments | , , , , , , , , , , , , ,

Golf is a sport that many consider to be an addiction: players will go through great lengths to improve their swings, ball distance, fitness, conditioning, etc… all in the name of lowering that handicap.  Along with the need to have a good teaching golf professional to work with, players at all levels need a proper assessment to see if their bodies are even capable of doing what they are asking it to do and proper personnel to help them ‘move’ as they should.  Fixing a golf swing is not as easy as simply saying ‘you need to rotate more.’  The body is quite complex and the golf swing relies on so many joints and muscles that even a slight bio-mechanical issue can cost the golfer many strokes! Continue Reading →

24 Jun 2016
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Introducing The InBody 570 Body Composition Analyzer Part 1

Introducing The InBody 570 Body Composition Analyzer Part 1

June 24, 2016 | 1 Comment | , , , , , , , , , , , , , , , , , , , , , , ,

We are excited to be introducing our patients to the FDA approved  InBody 570 Body Composition Analyzer.

So, what does this incredible machine do?  Well, it does a LOT.  Simply put, it provides information about what you are made up of…do you have enough muscle, too much fat, are you more likely to have serious health issues due to too much visceral fat, too much systemic inflammation, etc…?  Did I mention this unit has cleared FDA testing?

It is now considered to be one of the gold standards for body composition assessment.  This might seem like an odd piece of equipment for a sports medicine chiropractic office, but in reality, all sports chiropractors should all have one.  It is vital to have a quality body composition analyzer as so many patients need to improve their muscle:fat ratio as an imbalance in this plays a direct role in a patient’s ability to recover.   In addition, we can determine the intracellular water weight vs. the extracellular water weight in the body.  This helps us in a unique and validated fashion to determine whether a patient has systemic inflammation. This is very important to be able to assess.  On the topic of visceral fat, the major contributor to vascular health and an indicator that most have probably never had checked, yes, the 570 has you covered (it’s validity has been compared to abdominal CT scans). Continue Reading →

20 May 2016
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Slouching Population Part 2 of 3: Good Posture and Children

Slouching Population Part 2 of 3: Good Posture and Children

May 20, 2016 | 0 Comments | , , , , , , , , , , , , , , , ,

Have you recently witnessed a child sitting hunched over with their head down staring at a smartphone, ipad, or tablet on a table or on their lap? I would venture to guess that you see this picture multiple times per day if you have, or are around, children.  I would also go as far as to assume that most, if not all, children have been told multiple times to “sit up straight” by teachers, parents, and/or grandparents. However, even with the constant reminders, it seems that kids have been slumping more and more with the passing of each decade. One of the worst postures I have seen to date is a preteen who developed a point in his mid-back where there should be a smooth curve.

What is causing our youth to have worsening poor posture? Are they having an undeclared slouching contest with the previous generation, are they trying to be cool, or are they just a product of their environment with the vast surge in the use of technology? I get it. Even we adults need to be told to sit-up properly, especially when we are working at a computer, texting, or using a tablet. And you know what? Children hate being corrected as much as we do. With that said, it is hard enough to get adults to follow instructions, so how do we get children to change their habits, and understand the lifelong repercussions of sitting and standing in bad posture? Continue Reading →

15 Dec 2015
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‘Leaner and Meaner’: How Much Protein Do You Need?

‘Leaner and Meaner’: How Much Protein Do You Need?

December 15, 2015 | 2 Comments | , , , , , , , , , , , , , , , , , , , , ,

There has always been a debate about how much protein an athlete needs.  ‘You need one gram per kilogram of weight’ or you need ‘one gram per pound of weight’ and some other somewhat random numbers are usually used to determine how much protein resistance training athletes need.  As a healthcare provider who works with athletes, I need to make sure my athletes have enough protein to ensure healthy soft tissue function and reduce the likelihood of injury. Without proper protein consumption, an athlete will not achieve his/her fitness goals, and if there’s an injury, the athlete will certainly need extra protein during the recovery phase to get better.  I won’t discuss the subject of sarcopenia in this blog but this topic too is a major crisis in our country.  So, how do we know where to really start?

A literature review study from 2014 in the International Journal of Sports Nutrition and Exercise Metabolism along with its follow-up study 3 years later gives us a good formula for determining the range of protein needed for caloric restricted, resistance trained athletes. Before we go any further, we should define who these athletes are…. they are…you and me.  Even if you are not utilizing caloric restriction, the protein needs remain the same.  If you work out, want to look good, and want a high level of lean muscle mass (highly desirable for good health), then this formula applies to you.  In fact, if you just work out and wish to have healthy muscle, this formula will help you achieve your goals.

The bottom line is that athletes tend to ingest less protein than they need and this is a major concern.  Not only that, but they also are unlikely getting the best quality protein they can. Oh, this study also mentions that total fat consumption should not go below 20% of total calorie intake.  So what are we looking at?  A sensible caloric restricted diet with adequate micronutrient ingestion and the proper ratio of macronutrients.  So, you want to be ‘lean and mean’?…here’s how to achieve it… Continue Reading →

06 Jul 2015
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Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

July 6, 2015 | 0 Comments | , , , , , , , , , , , , , , , , , ,

We have covered a lot of information about Dry Needling in our last 3 blogs.  We discussed the Radiculopathy Model, the Trigger Point Model, and the Spinal Segemental Sensitization and Pentad Model.  Already, we can clearly see how Dry Needling can help to break down myofascial trigger points (MTrPs) and reduce pain.  The fourth model will discuss another reason as to why Dry Needling can help you.

Central Model

Our final model, the Central Model, covers information about how Dry Needling and other physical interventions (including manipulation, massage, mobilization, etc…)  affect the spinal cord and brain.  This is a rather basic but powerful model.  The premise is that input stimuli will affect tracks in the spinal cord that will carry that information up to the brain.  The deeper the treatment, the more information that will be conveyed.  The hypothalamus will then take the stimuli and  communicate with the pituitary gland and affect other endocrine functions.

In regards to the hypothalamus, it has three primary functions:  1.  It supplies input to the brainstem, thus affecting autonomic regulation, 2.  It controls endocrine function, and 3.  It exerts influence on posture and locomotion.

With the Central Model, MTrPs along the spine will likely cause more autonomic issues (please click to read more about autonomic issues on the Trigger Point Blog).   Dry Needling causes an anti-inflammatory response that emanates from the hypothalamic-pituitary-adrenal axis.  This is deep stuff!

If we assume that the hypothalamus is directly or indirectly adversely affected by MTrPs, then we can conclude that such MTrPs create autonomic and endocrine problems in addition to postural and movement issues (this means it affects the way you work inside and outside).  Certainly, we would want to rid our bodies of such noxious stimuli, and since Dry Needling can eliminate such MTrPs, then this makes it a great option for restoring proper function of not only the musculoskeletal system, but also the autonomic and endocrine functions that are affected by an improperly functioning musculoskeletal system.

Any way you slice it, Dry Needling can help you to function better.  From simple pain and dysfunction to autonomic concomitants, Dry Needling offers a viable option for the treatment of trigger points and pain due to musculoskeletal causes.

Let’s take a look at some studies supporting the application of Dry Needling…there are a few here but many more in print:

We will start with the grand-daddy of them all…the landmark study performed by Karl Lewit, MD published in 1979.  This study broke down the effects of trigger point injections to determine if the analgesic/steroid that was the agent that helped the patient, or was it the needle alone that contained all the magic!  Please read study, and if you would like the full study (versus just the abstract), please let us know.

The Needle Effect In The Relief of Myofascial Pain

And the other studies…

Dry Needling Having Anti-Nociceptive (anti-pain) Effects

Probable Mechanisms of Needling Therapies for Myofascial Pain Control

The Influence of Dry Needling of The Trapezius Muscle on Muscle Blood Flow and Oxygenation

Dry Needling at Myofascial Trigger Spots of Rabbit Skeletal Muscles Modulates the Biochemicals Associated with Pain, Inflammation, and Hypoxia

The Effect of Dry Needling in the Treatment of Myofascial Pain Syndrome: A Randomized, Double-Blinded Placebo-controlled Trial

Dry Needling and Exercise for Chronic Whiplash – A Randomized Controlled Trial

Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players

04 Jun 2015
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Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

June 4, 2015 | 1 Comment | , , , , , , , , , , , , , ,

In our last two blogs, we went over models that help explain how Dry Needling works.  These two were the Radiculopathy and the Trigger Point Models.  The topic of this blog will involve the third model, or the Spinal Segmental Sensitization and Pentad Model.  As we have with the last two discussions, we will try to explain any difficult terminology or ideas.

Spinal Segmental Sensitization and Pentad Model

The Spinal Segmental Sensitization (SSS) and Pentad Model was proposed by the late Andrew Fischer, M.D. (Physiatrist…pain management and rehabilitation medical doctor).  This is a good time to discuss this model as it really incorporates both of the first two models.  Dr. Fischer proposed that the SSS is a ‘hyperactive’ state of the dorsal horn of the spinal cord that is caused by damaged tissue sending nociceptive (pain) input into the spinal cord.  This information then causes the over-sensitivity of the associated spinal level dermatome (skin), pain sensitivity of the associated spinal level sclerotome (bone, ligaments, joints), and Myofascial Trigger Points (MTrPs) in the associated spinal level muscles.  All this occurs because the nerve coming from the spine is over sensitized, and by being in this pathological state, it stimulates these changes listed above.  In effect, we have a pretty vicious cycle of pain and dysfunction. Continue Reading →

14 May 2015
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Dry Needling Support Models (2 of 4): The Trigger Point Model

Dry Needling Support Models (2 of 4): The Trigger Point Model

May 14, 2015 | 2 Comments | , , , , , , , , , , , , , , , , , , ,

In the last blog, we discussed the first model (The Radiculopathy Model) that helps explain why Dry Needling works.  Now we will continue with the second of four models.   This one is probably the most well-known one and there is a plethora of medical literature supporting it.  Again, we will try to explain any concepts that are a little difficult to understand.  These models really shed light into how our bodies work and they are great to learn about.

The Trigger Point Model

Myofascial Trigger Points (MTrPs, or TrPs for Trigger Points) are defined as ‘hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band’ (Travell and Simons).  The resultant pain/discomfort that one gets due to such points is referred to as myofascial pain syndrome (MPS).  Simply put, MPS is defined as ‘sensory, motor, and autonomic symptoms caused by myofascial trigger points’ (Travell and Simons).  Sensory symptoms refer to what you feel, motor symptoms refer to how the muscles work, and autonomic symptoms refer to the things that you do not realize.  This seems a little odd, but consider what happens when you bang your arm really hard.  You will feel the pain (sensory), the muscle might be painful and not contract properly (motor), and your heart rate goes up as does your respiration due to the ‘adrenaline rush’ (autonomic) of the injury. Continue Reading →

11 Nov 2014
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Hyperbaric…This Is What You Want To Breathe!

Hyperbaric…This Is What You Want To Breathe!

November 11, 2014 | 0 Comments | , , , ,

I recently wrote a letter to the Maryland Board of Chiropractic Examiners on the topic of allowing us to use mild Hyperbaric Oxygen Therapy (mHBOT)  in-office. I had been exposed to patients/doctors utilizing it with great results over the years when I worked at various sporting events and I wanted to add this amazing technology to my office to help my patients.  I am happy to say that at the June 2014 meeting, the Board determined that Hyperbaric Oxygen Therapy can be included under the scope of practice for chiropractors in the state of Maryland. I’m so excited my patients can now benefit from it and you should be excited too!

Continue Reading →

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