diaphragm

Feeling the reflux burn?

Are you feeling the burn? 4 reasons why you have acid reflux (or just reflux). I don’t know how many clients I saw last year who came to me with reflux. You know that burning sensation in the windpipe. It’s not that nice to have it and I have experienced it myself and got rid of it too. Not with the oh so many proton pump inhibitors ( PPI’s are acid lowering drugs, that don’t address why there is a specific reflux type symptom) that Dr’s seem to prescribe in a vague attempt to get rid of the unwanted symptom. This is a brief synopsis of why you may get reflux type symptoms and not discussed at  great length.

In my experience there are four specific reasons why individuals get GERD or Gastro-Esophegeal Reflux Disease and in pretty much most cases do not warrant the use of PPI’s such as Nexium or Omeprazole which have many side effects including digestive dysfunction. Here they are:

  1. Identified Helicobacter Pylori infection.
  2. Dysfunctional diaphragm
  3. Food irritant of digestive tract
  4. Stress

Helicobacter Pylori infection-

H pylori infection is one of the most common digestive tract infections that I have seen (probably second to a parasite called Blastocystis). It is prevalent in both developed and developing countries and responsible for gastric ulcers. This pesky helix shaped bacteria burrows deep into the gastric mucosa and has the ability to shut down the production of hydrochloric acid. Hey but hang on, I though that I had been prescribed medication to stop me producing more stomach acid? Yep! Go figure, in some cases reflux type symptoms may even be alkaline refluxing through the pyloric sphincter.

Below the pyloric sphincter it should be a case of the acidic stomach contents triggering the digestive enzymes but that doesn’t happen in cases such as H-pylori and others and therefore digestion is compromised. Ok, I am getting side tracked so back with the H-pylori. The medical approach is to treat with triple therapy, which is two rounds of antibiotics and PPI’s and there are even quadruple rounds of treatment now. Guess what? H-pylori is becoming resistant to antibiotic use! Don’t get me wrong I think antibiotics have their place and  should be used accordingly but to keep increasing doses is a recipe for disaster.

In 99% of H-pylori infections I have seen this resistant critter eradicated with a few different types of natural supplements and I have seen this in scores of clients with this infection. Much more effective than antibiotics and PPI’s which have unwanted side effects to the digestive system. I had this just last year and it was gone pretty quickly with the right approach. Given that it can be passed by hand to hand contact, kissing, zoonosis or contact with pets, drinking water and food are just some of the ways that you can contract it.

Diaphragm dysfunction.                                                 Diaphragm

I have written many times on the need for optimal respiratory mechanics for management of pain and movement dysfunction but the diaphragm has another key role in the management of the pressure of the esophageal sphincter which can control reflux..

There have been several studies on the use of diaphragm modulation and its effect on GERD. http://www.rehabps.com/REHABILITATION/Poster_GR.html

In a nutshell get someone who can help to improve diaphragm function and improve its effect on management of the digestion system. If it doesn’t work, try any of these four points and I am almost certain that you will eradicate reflux without the need for courses of medication. That said, you should always discuss medication cessation with your Doctor first. If you mentioned any of these approaches you will either be greeted with raised eyebrows or a satisfactory nod depending on how your Dr views this type of treatment.

Foods as an irritant to the digestive tract.

This is an anecdotal tale initially and then feeds into other factors. For me personally if I eat bread daily then I get back bending reflux symptoms. I can’t tell you whether it is a reaction to gluten or yeast but I know that when I cut it out it goes within two days. Some clients have found that when they do the same with coffee, wine or any other number of different foods they too have a cessation of symptoms, if the food as an irritant is the potential source.

Some people can argue that certain foods are quite acid and you should attempt an ‘alkalanising’ diet. In my opinion this is hog wash as alkaline and acid environments within the body are managed by complex systems involving respiration, kidneys and the digestive system. Being too alkaline poses similar problems to being too acidic. Its true that eating lots and lots of meat can produce ammonia and you may notice that in the urine but anybody who spouts alkalinity is the way to health should be viewed with scepticism.  Cutting down on high protein diets may just be your best bet.

The simple approach to this is, if you eat a food on a regular basis and you notice that you get reflux….cut it out! Does it go? No then it’s not the issue.

Stress

Stress is a killer, we all know that one don’t we? Well then it wouldn’t be that far fetched to say that stress decimates the digestive system. If you are one of those people who races your food down, rushing to work, eating at your desk, eyeing the figures and not truly eating your food then your digestive system is going to become ill fast and so are you.

Digestion starts….in the brain! It was shown nearly a century ago that failure to think about eating fails to produce gastric juices responsible for breaking down nutrients. The work of Walter Cannon demonstrated the failure of the digestive system when constantly exposed to stress both acute and chronic.

An easy place to start is to think about what you are eating and enjoy it. That’s pretty easy right?  Remember that both too much and too little acid in the stomach can pave the way for reflux type symptoms. Slow down. Give the body and mind a chance to digest your food, not only will you enjoy it, it is key in dealing with digestive dysfunction and reflux type symptoms.

If you know anybody suffering with reflux that mention these four points to them. They might just help to get rid of the problem for good.

References:

Cannon, W.B. Bodily Changes in Pain: Hunger, Fear, and Rage: An Account of Recent Researches Into the Function of Emotional Excitement. D Appleton and Company. 1920

Online references:

http://www.rehabps.com/DATA/Bitnar.pdf

http://harborfm.pbworks.com/w/file/fetch/65647098/PPIs%20and%20hip%20fracture.pdf

Proton Pump Inhibitor–Associated Hypomagnesemia: What Do FDA Data Tell Us?

Getting to the core and why you have back pain despite rock hard abs!

The concept of ‘core’ conditioning has evolved significantly since the millennium and there have often been some common misunderstandings of the mechanisms, which can increase the prevalence of back pain. I know because I taught them in an inappropriate way, that’s the way that I was taught. But times change and increased knowledge and application go a long way for someone to determine what works and what doesn’t. Many people still have back pain despite participation in core conditioning regimes, pilates and other types of 'core' workouts. Many lay peoples understanding of the core is that a strong set of abdominal and back muscles prevents back pain. This statement is false and I have seen hundreds of people with strong trunk muscles all still prevent with back pain. Overtraining of the core is responsible for increasing back pain in many individuals. Many focus on strength, skipping key elements such as flexibility and stability paving the way for muscular dysfunction. Neuromuscular retraining should often be the focus for optimal core function but for many throwing big weights around, worrying about weight loss or how many spin classes they can get to takes precedence over dysfunctional movement and pain .

Then there is the concept of the inner unit which was touted by Richardson, Jull and Hodges, a good book and one that was part of the curriculum at the CHEK Institute (where I learnt a lot about rehabilitation) and no doubt many other institutions and how, by isolation of the Transversus Abdominus or TrA created an increase in Intra-Abdominal Pressure (IAP) co contracted with the multifidus and worked intrinsically with the pelvic floor.

Training the TrA in isolation fails to offer the complete picture and treatment for segmental stability. The diaphragm working in co-contraction with the TrA, pelvic floor and lumbar multifidus present a more appropriate method for stabilising not only the lumbar spine but provide a foundation for a more efficient methodology of rehabilitation which covers stability.

The Rehabilitation School of Prague’s model of Dynamic Neuromuscular Stabilisation offers a compelling model of stabilisation via developmental kinesiology. How the developing child moves and integrates stability is an effective method for re-integration of the intrinsic stabilisation system which comprises of the diaphragm, pelvic floor, TrA and spine flexors and extensors. The image below of the open scissors position of the rib cage and pelvis details the oblique angle that can occur when poor stability is mediated by poor diaphragmatic action.

why you get back pain, DNS

With DNS technique the flare of the rib cage and optimal contraction of the diaphragm can be corrected in the space of minutes to provide an optimal pathway for diaphragmatic breathing.

This concept is an effective method for rehabilitation but in my opinion there remain questions when utilising the concept of stability from the trunk. The diaphragm has the capacity to work segmentally too much or too little based upon a client’s injury history. Here are just some of many scenarios where the intrinsic stabilising system could become dysfunctional.

• TMJ or jaw dysfunction • C section or other significant scars on the body • Pelvic floor dysfunction • Any other muscles has the capacity to affect any other muscle in the body. • Local inhibition of synergistic, functional opposites or stabilising muscles • Emotional distress • Broken bones • Functional slings such as the posterior oblique sling, lateral sling and others • Why you get neck pain

Use of a joint by joint approach to testing such as Neuro Kinetic Therapy ™ helps to establish a baseline for dysfunctional patterns of facilitation (overworked muscles) and inhibition (underworking muscles). Decisions should be made as whether a mobility or a motor control issue exist. Motor control or the ability of the muscles to be efficiently recruited by the nervous system can be rectified by understanding patterns of inhibition and rewiring the nervous system for optimal control. Integration between both NKT and DNS techniques allows for a progression from pain and dysfunction to integrated movement patterns that can be hard wired with practice of developmental kinesiology exercises.

Many traditional and rehabilitation conditioning exercises often serve to increase dysfunction. Extension and even neutral load training based exercises such as deadlifts, bird dogs and horse stances can increase activation of the thoracolumbar fascia which serves as a conduit for force transfer especially for the posterior oblique sling. index

A release of the thorocolumbar fascia and integration of the posterior oblique sling through proprioception via taping or exercises remains an efficient method of neuro muscular activation rather than just increasing motor activity via strength and conditioning exercises. tape Posterior oblique sling and reducing back pain

Integration of techniques allows for a much more efficient treatment for clients who suffer from pain and movement dysfunction and can truly get to the core of both acute and chronic conditions. Isolated approaches yield isolated results.

To find out more about how to get out of pain and improve movement and energy please get in touch.

References:

Frank, C Kobesova, A and Kolar, P.Dynamic Neuromuscular Stabilisation and Sports Therapy.Int J Sports Phys Ther. 2013 February; 8(1): 62–73. Myers, T. Anatomy Trains. Churchill Livingstone Elsevier. 2001. Richardson C, Hodges P and Hides, J. Therapeutic Lumbo Pelvic Stabilisation. Churchill Livingstone. 1999 Weinstock, D. Nuero Kinetic Therapy. An Innovative Approach to Muscle Testing. North Atlantic Books.

Is your functional training making you dysfunctional?

Buzz words of the last decade in the health and fitness industry were terms such as functional, core, ground reaction, Paleo, intermittent fasting etc etc. It is an easy approach for people to throw around these types of phrases, impressing clients without having a true understanding of what they really mean. Like many it took me some time to realise that to get people strong you need a combination of good therapy, improved movement patterns and ultimately lifting well.  The emphasis on functional training has contributed to increased facilitation patterns which contribute to musculo-skeletal issues, much in the same way that the circuit training phase of the 90’s did. Now there are increased loads and patterns of dysfunction by methodologies such as Boot Camps, Cross Fit, TRX classes, Endurance events and the like and more than ever, I (and my peers) am seeing the incidence of overuse injuries created by inhibition and facilitation from poorly constructed exercise programming.

Let’s take this guy below. His exercise using the TRX must be functional , it must be making him strong right? Well no and here’s why? This gym dude like millions of others makes the mistake of utilising balance with strength as an exercise. The net effect of this type of exercise is facilitation when there is instability without the ability to stabilise.

trxjpg

You can clearly note here a rounding of the upper back   and cranial extension caused by inability to stabilise using the cervical flexors, mid and lower trapezius.

Facilitated                                                                          Inhibited

Upper traps/Scalenes                                                     Cervical flexors

Levator Scapula                                                              Middle and lower trapezius

Pec minor and probably major in this case                    Latissimus dorsi

Sternocleidomastoid                                                      Subscapularis and other structures

The cervical extensors, upper traps and pec minor amongst other structures have the ability to disrupt breathing patterns, gait and decrease strength in patterns such as the squat and dead lift. Those who teach these type of exercises should be skilled in spotting movement dysfunction, inhibition and facilitation and understand strategies of how to correct these issues or at least understand that if you keep exercising in this way you will lead to breakdown of key stabilising structures.

Is it a ‘core’ problem?

The core is really the interaction of all the muscles in the body but specific attention has been paid areas such as the ‘inner unit’ which comprises of the Tranversus Abdominus (TrA), multifidus, diaphragm and pelvic floor and the outer unit which comprises of the abdominals and internal and external obliques which interlink with many larger muscles.  In reality these muscles work in tandem with other muscles to create structural balance.  Many people think that to train their core they have to blitz their abdominals, obliques and back muscles with intensity which creates dysfunction.

This is where common misconceptions occur. The core more often than not, needs to be recruited appropriately and that should occur with proper movement development and determining what other structures beyond the core (such as previous injuries) are prevalent. Many of these problems can occur as a result of many factors. Children who don’t develop crawling patterns, who are either rushed into walking or put into baby crawlers can be at risk in later life of poor breathing patterns and core dysfunction. The seated position is not great for the spine and muscles can develop inhibition as other muscles get overworked and the nervous system will always take the least path of resistance when it comes to movement and muscle activation. Additionally the seated position also helps to create inverted breathing patterns, which disrupts the stabilising capacity of core muscles.

Many people make the mistake of activating the TrA in all the time (or drawing the belly in), even when walking. This is a disaster as it creates facilitation of the accessory muscles of breathing, creating a forward head posture, rounded back and weak links in the chain from head to the toe. In fact in some schools of thought letting your belly out and pushing outwards  also increases abdominal pressure and stabilising mechanisms that are just as good if not better for ‘core’ recruitment. Sometimes we are so fixated about our weight that we constantly walk around with our belly drawn in…let it hang out I say.

References:

  1. DNS technique according to Kolar. Training Manual Rehabilitation School of Prague
  2. Hodges, P. W. Is there a role for Transversus Abdominis in Lumbo-Pelvic  Stability? Manual Therapy (1999) 4(2), 74±86
  3. Kolá, P. Importance of Developmental Kinesiology for Manual Medicine.1996
  4. Weinstock, D. Neuro Kinetic Therapy. North Atlantic Books 2010