The Core Defined

Written by: Jeffrey Sergent, DC

This is a debated topic. A fun nerd-fight if you will? I find the difficult part is really defining the core. Many different groups and clinicians have different muscle groups associated with their definition of the core. But I suppose I will define my own opinion of the groups of muscles that define core and why.

Outer core muscle examples

I like to divide the core into 2 parts: the outer core and inner/deep core. The outer core is what most people typically think of the core as: Rectus abdominis (6 pack muscles), obliques (inner and outer), transverse abdominis, quadratus lumborum (QL), latissimus dorsi and erector spinae. This creates the outer shell. For example, if you think of a can of soda, they would be the outer aluminum shell.

The deeper or inner core muscles create the top and bottom of that can. This would be the diaphragm, pelvic floor, multifidus, longus colli and longus capitis (deep neck flexors). I do include neck muscles, dnf, in the core. My reason for this is basically that the spine works as a unit. If the neck is too far out of alignment, then the lower back will be too. To see what I mean try to do this easy exhale technique on yourself: Place your hands on your low back and now protrude, or jut your neck and chin forward.  Feel how the lower back follows, resulting in increased muscle activation down there.

        

Deeper/Inner core muscles

Deeper/Inner core muscles in the neck.

The reason for the distinction of inner and outer core is in the development of performance and rehab. The goal is to be able to create a brace and muscle stiffness that don’t allow the spine to move. This stiffness protects the spine from mechanical stress during lifting, bending, sitting, standing... pretty much everything. If there is inefficiency in the core, then the energy will be displaced from the muscle and stiffness to the only still structure: the spine.

Really the purpose of the core is to create intra abdominal pressure and stiffness. Let's go back to the can analogy. If you had only the outer shell, no top or bottom, you would be able to deform it without much effort. Now add a lid and bottom, the inner core. This creates more rigidity and stiffness, making you put in a little more effort to crush that can. Now imagine increasing the pressure within by carbonating and shaking up the can. This creates an even greater stiffness. At this point that can would be pretty difficult to deform, and unless someone gets thirsty would last quite a bit longer than any of the individual parts of the can on their own.

Photo sources: www.slamdunk.ru, mikescottdpt.com, www.cityedgephysio.com.au

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.

Rants From a Chiropractor: Part 2

Written by: Jeffrey Sergent, DC


Low Back Pain and my Personal Struggle

Let's start at the beginning.  The lower back vertebrae, cartilage, ligaments and muscles are beautifully constructed architecture.  My favorite thoughts on the architecture come from one of my favorite researchers, Stu McGill, PhD.  Professor McGill asks a simple question: If you were an engineer how would you create a structure that needs to resist shear, bending and compression? The common sense answer would describe a stiff bonded pole like structure, think cement cylinders that hold up highways and bridges. Well now, that same structure needs to bend and rotate slightly. Engineering would create multi sections that allow for limited motion and say that this concept is crazy to make possible. Our bodies, our low backs in particular, are designed to take compression, resist shear forces, and allow for bending and rotating. This is possible due to the core systems. See my 'Core Defined' article for my definition of the core.

Disc Bulge of 15/s1 centrally.

Now let's go into my personal story of my struggle with low back pain and sciatica (leg pain). How did I manage to do this to myself with my knowledge of the spine and mechanics? The short answer… I got cocky. The thing with intervertebral discs is that we know they fail. They fail from repetitive movement, most notably flexion and rotation. Day in and day out I was showing people what they were doing wrong at home or with their movement. I would stupidly then do my Core exercises and lifting with good form, thinking that would fix the damage I was doing all day. Like I said… cocky. So cocky I thought somehow my discs won't fail like my patients, because I have great trunk stability, good hip mobility and balance. I was wrong and that wrong caused my disc to not only bulge but fragment in.


In the pictures to the left, the top shows a disc bulge of l5/s1 centrally. You can see the nerve, the line coming down from the bulge is the s1.  The bottom is just to the right of center and reveals a fragment, the cloudy part off the 

A fragment.

disc bulge. This fragment is surrounding the nerve root. Due to the bulge and fragmentation I had right leg pain, numbness and weakness without lower back pain.

Disc injuries come in a variety of shapes and sizes. The size and shape do not correlate to the amount of pain or symptoms. This is a great area of discussion in the pain community (a great nerd fest).  The amount of tissue damage does not equal pain. Actually with disc injuries the more significant the bulge the quicker recovery. Sometimes a small bulge can cause severe symptoms, while a large bulge causes less pain and less direct quality of life issues.  This again is a newer concept within spine literature. The hypothesis is that the larger bulges send more signals of immune mediators to start the re-absorption process. 

Going back to my case, I had a moderate bulge with large fragments; this caused severe stenosis, or narrowing of the opening for my nerve. Due to the size and compression being done to my nerve you would think I would have severe back and leg pain. In reality, I had calf pain, cramping in my foot and calf, weakness in the calf and numbness in the lateral (outer) foot.

Below is a good representation of disc herniations and the type of pain they most likely would create.

 

www.necksolutions.com

Citations:

1.J Craniovertebr Junction Spine. 2013 Jan;4(1):16-20. doi: 10.4103/0974-8237.121619.

Clinical correlation of magnetic resonance imaging with symptom complex in prolapsed intervertebral discdisease: A cross-sectional double blind analysis.

Bajpai J, Saini S, Singh R.

2. J Neurosurg Spine. 2013 Dec;19(6):678-87. doi: 10.3171/2013.9.SPINE13349. Epub 2013 Oct 18.

Predictive value of MRI in decision making for disc surgery for sciatica.

el Barzouhi A¹, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-Hague Spine Intervention Prognostic Study Group.

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.

Naturopathic Medicine: The Medicine of the Future

Here in the United States, our medical system is changing. Since the 1960s the focus of healthcare has been progressively shifting from curing diseases to disease prevention. One reason for this is the recent push toward healthier lifestyles, such as eating less fast food, stopping tobacco use and getting regular exercise. In addition, prevention of disease is critical to lowering healthcare costs, as people will spend less time in the hospital and will spend less money on never ending treatments and medications. For example, despite the fact that purchasing a treadmill or a gym membership is not always cheap, and healthy food always seems to be more expensive than processed food, these costs are nothing compared to what it might cost you if you develop Heart Disease or Diabetes later in life. Not only would the financial burden of treatment be difficult, but you could end up paying with time as well.

For years practices like Chiropractic, Acupuncture, Naturopathy and other preventative medicines were labeled as non-credible or fake. This was in large part thanks to John D. Rockefeller's consolidation and monopolization of medical schools and medical practice in the early 20th century. (Further explained in this interesting podcast by James Corbett).

John D. Rockefeller, Sr., seen here in 1930, died at the ripe old age of 97.

Proof that having an abundance of leafy greens in your daily life does wonders for your health.

However, I won't throw all the blame in one place, there have also been countless instances where people claiming to be well versed in trades like Traditional Chinese Medicine and herbal medicines in fact had no idea what they were talking about and made many of the professionals in these fields look bogus. Luckily, today holistic, or non-evasive, practices are once again on the rise as viable options for healthcare seekers. One such practice that many people have never heard of, or have misunderstood, is Naturopathic Medicine.

What is Naturopathy?

Bastyr University, one of the leading natural medicine universities in the United States, describes Naturopathic medicine, sometimes call Naturopathy, as, "a distinct system of primary health care that emphasizes prevention and the self-healing process through the use of natural therapies." Naturopathy is holistic and is based on a combination of traditional herbal home remedies that were passed on through the generations, as well as current research on a wide variety of medicinal sciences and practices, including conventional medicine, homeopathy, clinical nutrition, psychology and more. A Naturopathic Doctor (ND) is trained in primary care and receives education in the same fundamental sciences as a Medical Doctor (MD). In order to become a licensed doctor in a jurisdiction, just like MDs, NDs must pass difficult board exams and complete a lengthy internship in a licensed clinical setting.

According to Dr. Robert Coleman, Goodyear Health Center's Nationally Board Certified Licensed Naturopathic Physician, Naturopathic Medicine is the healthcare of the past and the healthcare of the future. At the core of his Naturopathic beliefs lay the ideals NDs follow: do no harm, stimulate nature's healing powers, address the causes of disease, work to heal the whole person and to teach the fundamentals of a healthy lifestyle. Utilizing this framework, Dr. Coleman specializes in Detoxification, Vitamin & Nutrient therapy, Physical Medicine, Therapeutic Bodywork, Homeopathy & Herbal Supplements and Energy Balancing & Mind-Body Medicine.

Now, I know what this sounds like. It sounds like an episode of Portlandia where all the flower children are trying to sell you their home grown herbs, and convince you that you should take up yoga, change your wardrobe to tie-dye and replace your music collection with The Rolling Sones discography. However, Naturopathic Medicine is based on years of treatment trials, observation and scientific research. But is Naturopathy right for you? Well, for one thing, Naturopathy is a good idea for someone who has seen a Medical Doctor to no avail. For example, if a patient came to Dr. Coleman complaining of acid reflux, rather than hand him a bottle of Tums and a prescription for an acid reducer, he would advise adding an acid found in food to the patient's diet instead (combining homeopathy and nutrition). So basically, Naturopathic Medicine is more than just a prescription to make symptoms better, it is a lifestyle change to make symptoms disappear, whether you suffer from headaches, stomach problems, anxiety, physical pain, insomnia, or more serious issues. It is best for people looking to find long-term solutions to their problems with a minimum amount of medication and a commitment to making the necessary changes. A Naturopathic Doctor will listen to you, will never judge you, and will set you on the right course for treatment based on your lifestyle.

Thomas Edison was not only a fantastic inventor and businessman,

he could also see into the future...

Finally, despite the fact that Naturopathy has come a long way since the reign of Mr. Rockefeller, NDs are still not recognized as licensed doctors in a number of states, including Wisconsin. However, progress is being made, and hopefully the state's legislation will change in 2014.

For more information on Naturopathy visit here: www.naturopathic.org, or contact us here at Goodyear Health Center and we can set up an appointment for you to talk to Dr. Coleman in person.

Acupuncture Phobia?

One of the major excuses people use to explain away trying Acupuncture is that they are afraid of needles.  I have also heard “It is out of date” and “All it’s good for is pain relief, just like Tylenol.”

The truth is most people are just scared to try Acupuncture, and are not sure how it actually works.

Originally a traditional Chinese medicine, Acupuncture is based on the belief that what happens in one part of the body affects the entire body. It works by reestablishing a healthy energy flow (or Qi – pronounced chee) throughout a person’s body. A person’s Qi travels along meridians throughout the body that come in contact with the skin at over 300 different acupuncture points. When these points are obstructed it can cause an imbalance in a person’s body, leading to pain, sleepless nights, stomach problems and more. An Acupuncturist stimulates or directs these blocked points in order to restore the balance. This is done by inserting about 2 - 8 incredibly thin needles into certain points on the body. They are then left in for about 20 to 30 minutes. This is the part that makes everyone so nervous, but don’t worry, these needles are so thin that most people feel nothing at all, if only a slight prick.  They are also sterile and disposable, and have been approved by the FDA. On another note, if you come into the appointment complaining of back pain, don’t be surprised if the Acupuncturist puts a needle in your ankle or somewhere else seemingly unrelated.  As I mentioned, what happens in one part of the body affects the whole body, and the place where pain is being felt might not be the culprit.

Acupuncture is most commonly used for pain relief. People suffering from arthritis, sciatica, fibromyalgia, tennis elbow, knee pain, neck pain, etc., could benefit greatly from this type of therapy. It can also help people who suffer from migraines, digestive issues, insomnia, depression and can help with weight loss. Acupuncture helps these conditions by stimulating the circulatory and the immune system. This then releases endorphins into the body helping to stop the pain and correct chemical imbalances.

Finally, as is the case with all therapy, each person is different and will require a different treatment. This could mean needing acupuncture once or twice a week for a month or two for the best outcome.  Acupuncture is not a replacement for medications, but rather it is a fantastic compliment to your physician’s already prescribed treatments, and can greatly help those little ailments you are sick of dealing with on a daily basis. Our expert Acupuncturist Jaret Sahr will also offer advice on vitamins and supplements that could help restore you and your body to a healthy balance.

Still have questions or don’t know if you can get over your Acupuncture phobia? Visit our website http://www.goodyearhealth.com/health/acupuncture.aspx or feel free to arrange a time to drop by and chat with Jaret! 

Top 5 Crazy Chiropractic Myths

Over the years chances are you have known someone who regularly visited a Chiropractor for their back problems. Maybe you have even gone to see one yourself. On the other hand, you have also probably heard a lot about Chiropractors through the grape vine, often placing them in a not so credible light. The truth is, many people actually have no idea what Chiropractors really do. However, for decades now Chiropractors have fought the good fight to gain the credibility that they deserve.

That being said, today I’m going to help shed some light on the truth behind Chiropractic care, beginning with my list of the Top 5 Chiropractic Myths:

1. Chiropractors aren’t real doctors

• To become a certified Chiropractor a person must earn a Doctorate (8 or more years of study) from an accredited university. They also must pass both national and local licensing exams, not to mention the hundreds of required clinical hours in a clinical setting.

Dr. Corey Schneider

Don't let his lack of white lab coat fool you, he's a real doctor.

2. Chiropractic care is not Scientific

• Just because Chiropractors do not prescribe medication, does not mean it is not a scientific practice.  Maybe this is a good comparison: while Medical Doctors study methods to delay death, Chiropractors study methods to enhance life. The profession assesses the spine and other joints (i.e. knee, shoulder, elbows, etc.) and the supportive soft tissues adjoining the area in order to establish proper body mechanics and movement. Chiropractors then evaluate if pain and dysfunction are due to degenerative changes, arthritis, weakness, nerve entrapments, disk hernias and more. In order to do this, Chiropractic Doctors must have a firm understanding of the human body and scientifically proven healing methods.

3. Chiropractic adjustments are painful and potentially harmful

• Occasionally you might feel a little discomfort during an adjustment, especially if you have never had one before, however, usually these will not hurt at all. In fact, quite often the patient experiences a great sense of relief afterwards. Furthermore, when performed by a licensed Doctor adjustments are incredibly safe! 

On the other hand, I wouldn't recommend the at home approach...

4. Once you start going you can’t stop

• Of course this is not true. It’s a free country after all. Returning to a Chiropractor is just like going to the gym to keep fit or visiting the dentist to avoid cavities. Patients who return often do because they liked the results (i.e. better sleep patterns or a wider range of movement), and would like to continue seeing these positive results.

5. Chiropractic care is too expensive

• According to a study done in 1996, 87% of Chiropractic patients who had been seeing a Chiropractor for a longer period of time not only considered their health to be exceptional, but also experienced fewer chronic conditions linked with aging and took less medications. This ultimately saved them a lot of money on health related costs. In addition, depending on your insurance provider, Chiropractic care is often included.

102-year-old French Cyclist Robert Marchand

I'd say an outcome like this would be a pretty good ROI.

(Image source: bicyclinghub.blogspot.com)

Sooo… Have I convinced you yet? If not, Goodyear Chiropractic Health Center always has its doors open, and Dr. Corey Schneider would be happy to sit down with you and tell you more about all of the benefits of Chiropractic Health!

(Sources: Coulter et al TopClinChiro, www.goodyearhealth.com

www.acatoday.org, www.connerlychiropracticcenter.com, 1023blakefm.com)

Welcome!

This is the blog associated with Goodyear Chiropractic, Integrated Pain and Health Center and Fusion Gym, three sister companies all based at 5261 N. Port Washington Rd in Glendale, Wisconsin. Together these companies are on a mission to restore and maintain exceptional, pain free movement and health for people from all walks of life all over the world… or at least in the greater Milwaukee, Wisconsin area.

So if you are looking for information, news, advice or ramblings on health make sure to check back often. We will have posts covering everything from exercise, nutrition, chiropractic, pain management, acupuncture, naturopathy, massage therapy, and much more. Or if you just cannot wait to get moving again feel free to email us at info@goodyearhealth.com or drop by our office.

But for now, we hope you all have a Happy Thanksgiving!