Saturday, June 20, 2009

Colavita Moves into the Number one spot on the NRC rankings!

It was the day before Christmas Eve and I just found out that the director for the original team I was going to work with this year was not going to be with the team. After a few choice words and a bit of complaining. I started to call around to different teams looking to find a new team to work with and the Tour of California was coming up quick. I called team Colavita and was able to work something out and get out to California to start the season at the largest event of the year. Having Lance back in action made this ToC even wilder. I must say that I was a bit nervous meeting the team for the first time because that's always the strangest part and not being with them at training camp made it even worse but hey I can blend with the best of them. I was picked up by the two massage therapist Balee Holt and Susan Somye. We exchanged info about ourselves and had a few laughes and I felt comfortable already and that was important because these ladies would be sending the guys for me to work on and without their approval as "mother Hens" for the team I would be hard pressed to build confidence. I then settled in my room and panicked for a few moments that they would not come into my room ........they did of course and soon I had met all of the American and Italian guys on the team and began to do some work. I finally met Seba Alexander the D.S. of the team and he sat me down with the rest of the team and explained that he had no clue how I would help with the team.....I instantly liked him. I went over how I would contribute and by the middle of the tour I was working on the whole team and most of the staff it was an very difficult week but I grew to respect the team and Athlete's. So Congrat's Team Colavita now hold onto it.

Friday, June 19, 2009

Cycling and Hot Foot or Metatarsalgia

The foot forms one of the three primary contact points between the body and bike, so it’s no surprise that it can be one of the main sources of discomfort and/or injury. “Hot foot” is something that most of us have likely experienced, but is spraying water on the foot or loosening the straps on the shoe all we can do? By Rick Rosa, D.C.,D.A.A.P.M.

With the temperature soon to be reaching 100° in the Washington DC area, I was asked by a reader of this blog, who who had been experiencing foot pain, which he soon came to learn, was a condition known as “Hot Foot.” He asked me about it and wanted my help to “cool off” the situation. “Hot Foot” or Metatarslgia is caused by the compression and inflammation of nerves and joint tissue in the metarsal heads, which is the area right above a well placed pedal spindle. It is characterized by pain and a sensation of burning as well as numbness. Many cyclists believe that splashing water on the feet will help with the symptoms, but that is a symptomatic treatment that is not getting to the root of the problem, namely an inflammation in the nerve and surrounding tissues. The

Joys of New Stuff

Recently, I had a case of a young man who had classic symptoms of metatarsalgia that began after putting in some long miles on his bike on a hot day shortly after buying new shoes and pedals. He claimed that the pain kept returning when he climbed hills or during a long ride. In taking his history, I noted that the new shoes and pedals were made up of much stiffer carbon fiber. In addition, he was in the habit of using regular short socks that he would wear with his regular running shoes. There was no evidence that organic diseases, such as diabetes or degenerative joint disease, was present in his history. Exam DetailsUpon physical examination, I found that he had significant restricted movement in the joint tissue of the foot and ankle. He had an obvious fallen medial arch (foot was flat) and was pronating. In addition, he had very tight gastroc/soleus (calf), as well as Achilles tendon. His foot would swell up from the heat and this would only add to the pressure on the forefoot, excacerbated by the thicker socks he wore.


The treatment in his case worked out well. We began using ultrasound, Low level laser and manipulation of the foot and ankle as well as ice baths in order to restore proper biomechanics and reduce inflammation. I placed a small pad that was inserted into his shoes under the metatarsal heads in order to spread them out and reduce pressure in hopes that this would help him without the need to be fitted for orthotics. I also suggested that he get thin socks and asked him to loosen the lowest strap over the metatarsal heads to decrease the pressure that was building up during the long rides. He was very diligent about performing the stretches I gave him for his calf muscles and Achilles’ tendon, which added to his recovery. In this case he was able to acclimate well with these minor adjustments, primarily because most of the injury was due to the sudden change in stiffness of the carbon pedals and shoes.

In one study done by Jarboe and Quesada on the effects of shoe stiffness on the forefoot, they found that carbon shoes can be 42% to 550% stiffer, which translated to an average increase in the pressure of 18% over more traditional plastic shoes. (1)Other Things to ConsiderIn other cases, casting for an orthotic that will support the metatarsal heads as well as the medial arch is needed. Orthotics correct and support proper biomechanics, which evenly distribute the pressure on the metarsal heads. In cases of extreme events like RAAM they place the cleat way back or cut open the toe box to help alleviate pressure on the forefoot but this is not ever necessary for the amateur cyclist. Lastly, moving the seat down 1 cm and shifting the cleat back 1 cm can also take some pressure off the metatarsal heads. However, I am not a big fan of this because I believe this can force other biomechanical issues to other joints, such as the knees to come about unless of course I personaly fit you to that position myself. Also using pedals with a large platform is better for distribution of the pressure over the forefoot and will not pinpoint all your weight and force into a small area. Using cortisone injections and surgery is rare and is usually related to other issues, such as neuroma’s, seasamoid issues, or acute trauma to the foot.As always remember to work with a qualified professional.

References1. Jarboe NE, Quesada PM. “The effects of cycling shoe stiffness on forefoot pressure.” Foot Ankle Int. 2003 Oct;24(10): 784-8.2. Cailliet R. Soft Tissue Pain and Disability. Philadelphia: F.A. Davis Company 1996 pg 442-445

THIS WEB SITE IS NOT DESIGNED TO, AND DOES NOT, PROVIDE MEDICAL ADVICE. All content ("Content"), including text, graphics, images and information available on or through this Web site are for general informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis or treatment. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY IN SEEKING IT, BECAUSE OF SOMETHING YOU HAVE READ ON THIS WEB SITE. NEVER RELY ON INFORMATION ON THIS WEB SITE IN PLACE OF SEEKING PROFESSIONAL MEDICAL ADVICE. • PezCycling/ Dr. Rosa Not Liable: PezCycling or Dr. Rosa IS NOT RESPONSIBLE OR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS SITE.

Friday, June 5, 2009

Nutrition For Sports Injuries

A great article from ACA Today regarding proper nutrition.

Nutrition Advice for a Healthy New You
There is no better way to rejuvenate your health than by eating more nutritiously. In fact, even a few simple changes in your diet and lifestyle can have a positive impact on your health-and can also prevent a variety of health problems in the future.

The traditional coffee and doughnuts for breakfast; a hamburger for lunch-or no lunch; candy, cookies, and a soft drink for a snack; followed by a huge dinner with more protein than a person needs-are unhealthy dietary choices.

As a result, younger people are starting to suffer from heart disease-not only because of poor diet, but also because of an epidemic of inactivity.

To reverse the alarming trend, many doctors of chiropractic urge patients to stop smoking, eat a balanced diet, drink plenty of water, exercise regularly, and augment their balanced diet with appropriate nutritional supplements.

What Can You Do?
The ACA offers the following prevention and wellness advice:

Lifestyle Changes
-Exercise at least 20 to 30 minutes three or four days a week.
-Eat out more sparingly.
-Food preparation methods in restaurants often involve high amounts-and the wrong types-of fat and sugar.
-Brown-bag your lunch to control your fat and sugar content while adding nutritious fruits, vegetables, and grains.
-Limit your intake of alcohol and quit smoking. Drinking alcohol excessively and/or smoking hinder your body's ability to absorb nutrients from your food.

Dietary Changes
-Eat more raw foods. Cooking and canning destroys much of the nutrition in foods. With the exception of canned tomatoes, which can help prevent prostate cancer,1 fresh or frozen fruits and vegetables always have more natural vitamins and minerals.
-Select organically grown foods when possible, because they have lower amounts of toxic elements, such as pesticides and heavy metals.
-Consume 25 to 30 grams of fiber a day. Whole-grain breads and cereals, beans, nuts, and some fruits and vegetables are good sources of fiber. High-fiber diets can help prevent digestive disorders, heart disease, and colon cancer.
-Drink eight to ten 8-ounce glasses of water a day. Coffee, tea, soft drinks, and alcohol are dehydrators. Don't substitute them for water.

Vegetarian Diets
Research shows that a good vegetarian diet as part of a comprehensive health program can help prevent heart disease, cancer, and other diseases.2,3 However, fried foods, hydrogenated fats, and commercial meat substitutes may contain more sugar and fat than a meat-eater would consume.

If you are considering a vegetarian diet, keep the following tips in mind:

-Don't rely on fruits and vegetables at the expense of grains and legumes. Eat a variety of fruits and vegetables to consume a wide range of nutrients.
-Tiredness, malaise, and anemia can be signs of deficiencies. Have your B12 and iron levels checked at least once a year.
-Consume fortified foods or take supplements to obtain the nutrients you no longer get from animal-based products, such as vitamin B12.
-Before eliminating animal products from the diet, learn to do it right. Children, pregnant and breast-feeding women, and people recovering from illness should consult their health care practitioners.

According to the U.S. Food and Drug Administration, dietary supplements are not substitutes for foods, nor can a person sustain good health by just taking vitamin and mineral supplements.4 When taken properly, however, supplements can play an important role in achieving maximum health. If you are considering nutritional supplements, keep the following tips in mind:

Remember to consume dark green vegetables, oils, nuts, and seeds, which are sources of magnesium, fatty acids, and many other vitamins and minerals.

Don't "self-prescribe." Consult a health care practitioner, such as a doctor of chiropractic, to determine what supplements are best for you. If you have symptoms such as headaches, chronic fatigue, or cardiac problems, seek professional advice from a health care provider who specializes in nutrition.

Running and Plantar Fasciitis

Plantar fasciitis occurs when the long, flat ligament on the bottom of the foot (plantar fascia) stretches irregularly and develops small tears that may cause the ligament to become inflamed. It causes heel pain, which can become long-lasting.

Plantar fasciitis is the result of repeated stress on the foot that may be caused by normal aging or being overweight. Other causes of plantar fasciitis include:

-Activities such as running and jumping, which increase weight and stress on the foot.

-Foot conditions, such as having high arches, flat feet, tight calf muscles, heel tendons, or walking with an inward twist or roll of the foot (pronation).

The most common symptom of plantar fasciitis is sharp or knifelike heel pain that usually occurs when a person gets up in the morning and takes the first few steps. The pain also may occur when the person stands up after sitting for a period of time.

Here at Rosa Family Chiropractic, we address Plantar Fasciitis with a variety of treatments including:

-Heat and electric muscle stimulation
-Therapeutic Ultrasound
Graston Technique for the soft tissue on the sole of the foot.
-Cold Laser Therapy to controll inflammation
-Exercises includinge toe curls, calf raises, marble pick-ups, etc...
-Kinesio Tape over the plantar fascia to support and re-educate the musculature

Monday, June 1, 2009

Cycling and Back Pain Part III

How can something so good for you as cycling be so bad for you? In exploring the various potential causes for back pain while cycling, it’s time to face up to the problems caused by improper bike fit or the act of cycling itself…

By Rick Rosa, D.C.,D.A.A.P.M.Get Fit(ted)We’ve plugged it here on RecoveryDoc before, but the best thing you can do for yourself is to get a proper bike fit to make sure you and your bike are a pair of happy amigos throughout your long and passionate relationship. Much of the way we set up of bikes often has more to do with style and what we think the pros do, rather than what type of riding we actually do and the way our body works. With bike fit we have several areas to consider when it comes to influences on pain. Please note that the below are just general principles to consider along with recent trends, and that your exact needs are individual and can only be discerned by professional bike fitters.

• First off, improper position of the saddle will increase the load on the lumbar spine, and we definitely don’t want to do that. In fact, a study done at Chaim Sheba medical center in Tel Hashomer Israel examined saddle position and found that if they changed the seat height from a horizontal to 10 to 15 degrees rise, it decreased symptoms in 70% of the study population.

• Next, chances are that with proper saddle height you avoid the rocking back and forth motion in an effort to reach the pedals as well as the change in lumbar muscle recruitment patterns by having the seat too low. • An overly long reach to the bars may also stretch your back an increase spine loading, and two recent studies found benefit from moving the seat forward. Next, you can use a handle bar with less drop, especially if the problem occurs while racing. Remember to train in the drops as well as on the tops to allow your body to be adapted to both positions. Another quick fix is a shorter stem and/or raising the stem as this will help with the position of your spine and create less stress. Bad Bike Bad!Apart from the way we fit ourselves to our bikes, the very act of biking itself, with its restricted and repetitive range of motion, can conspire to magnify any existing problems with physiology or bike fit. Some things to consider about the act of cycling itself, and more importantly what we can do to minimize the stress:

• Road vibration on the road or the trails can really pound on your back, especially as it’s in a stretched out position horizontal to the vibration itself. So what can you do to decrease this road vibration? Change hand positions, don’t lock your elbows, and use padded gloves and handle bars. Consider some of the elastomer inserts that are appearing on the road market in forks and handle bars and tape, and seat tubes. Lastly, wider tires can also help decrease road vibration.

• Most of us are aware that leg length discrepancies can be problematic with cycling. However, most people do not realize that many changes in leg length can be functional in origin, meaning that the muscle and joint tissue on one side is causing the decrease in leg length as opposed to say a shorter femur on one side. Functional changes can be treated by a professional only and can basically even out the legs. Structural changes need to be evaluated as well. You may have either a custom orthotic measured or you can use some of the shims that are used at the pedal. This will correct the biomechanics and thus correct the problem.

• The riding position also creates strength differences between your back and abdominal muscles. You are flexed over the bike for extended periods of time and this not only stresses the lumbar spine, but over activates it. This means that the signal that is sent to the brain and back kinda keeps ringing while the abdominals get less and less signal so that over time you develop comparatively weak abdominals. In addition, riding a big gear and climbing up hills changes the recruitment pattern and utilizes the muscles of the lumbar erector group as well as gluteals to a higher degree. So what can you do to correct this problem? Core training does not just mean abs and back. It also involves the hips and shoulders.

• Active stretching, along with other workouts including pilates, yoga, and resistance training, results in flexibility of the back and hips. This will increase the length of the muscle and will decrease the pull on the pelvis and low back marinating normal biomechanics. One quick fix while on the road is to stretch back first (assuming you do not have a disc herniation or facet syndrome) and contract those back muscle while holding that position make sure your knees are bent slightly. Then flex forward trying to touch you toes. Lastly, turn your feet in and then out and repeat. This will target the inner hamstring fibers and adductors as well as gluteal muscles and hip rotators. You’ve heard it since you were a wee lad/lass in gym class, but these off-bike flexibility and core based workouts really pay off in decreased injury risk in both the short and long-term.
• One other problem I see with athletes, especially during the off-season, is that they will miss a few workouts and then proceed with a super hard work out in the trainer with the front wheel elevated. Needless to say, the next day their ass and back are screaming. Well that’s because they just overloaded the muscle group with little rest. Don’t make up for lost pedaling by going nuts when you get back on the bike. It never, ever, works out and you will end up injured, I promise.

References1. Fanucci E, Masala S, Fasoli F,Cammarata R, Squillaci E, Simonetti G. Cineradiographic study of spine during cycling: effects of chaning the pedal unit position on the dorso-lumbar spine angle. Radiol Med (torino) 2002 Nov-Dec;104(5-6):472-62. M Salai, T Brosh, A Blankstein, A Oran and A Chechik Effects of changing the saddle angle on the incidence of low back pain in recreational bicyclists. Br. J. Sports Med. 1999;33;398-4003. Ganzit GP, Chisotti L, Albertini G, Martore M, Gribaudo CG. Isokinetic testing of flexor and extensor muscles in athletes suffering from low back pain. J sports med phys fitness 1998 Dec;38(4):330-6.4. Bressel E, Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort Med Sci Sports Exerc. 2003 Feb;35(2):327-325. Green BN, Johnson CD, Maloney A. Effects of altering cycling technique on gluteus medius syndrome. J Manipulative Physical Ther. 1999feb;22(2):108-136. Callaghan MJ Jarvis C. Evaluation of elite British cyclists: the role of the squad medical. Br J Sports Med. 1996 Dec:30(4):349-537. Mellion MB Common Cycling Injuries. Management and prevention. Sports Med.1991 Jan;11(1) 52:-708. Angus F. Burnett, Mary W. Cornelius, Wim Dankaerts and Peter B. O’Sullivan. Spinal Kinematics and trunk muscle activity in cyclist: a comparison between healthy controls and non-specific Chronic low back pain Subjects-a pilot investigation.9. Salai M, Brosh T, Blankstein A, Oran A, Chechik A. Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. Br J Sports Med 1999;6;398-40010. Usabiaga J Crespo R, Iza I, Aramendi J, Terrados N, Poza J. Adaptation of the lumbar spine to different positions in bicycle racing. Spine 1997;17:1965-911. Mellion M. Neck and back pain in bicycling. Clin Sports Med 1994;1:137-64
About Rick:Rick Rosa, DC, DAAPM, is a practising chiropractor based in Maryland. He is the owner of Rosa Rehab in the Washington, DC area, and has worked as a team doctor for a wide variety of champion boxers and cycling teams.
Medical Disclaimer/ Dr. Rosa Is Not a Substitute for Medical Advice: THIS WEB SITE IS NOT DESIGNED TO, AND DOES NOT, PROVIDE MEDICAL ADVICE. All content ("Content"), including text, graphics, images and information available on or through this Web site are for general informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis or treatment. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY IN SEEKING IT, BECAUSE OF SOMETHING YOU HAVE READ ON THIS WEB SITE. NEVER RELY ON INFORMATION ON THIS WEB SITE IN PLACE OF SEEKING PROFESSIONAL MEDICAL ADVICE. PezCycling/ Dr. Rosa Not Liable: PezCycling or Dr. Rosa IS NOT RESPONSIBLE OR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS SITE