When it comes to trigger point needling in the shoulder one of the major muscles we have to address is subscapularis. It plays a unique role as the only rotator cuff muscle to perform internal rotation. It is also notoriously uncomfortable to access. In my days as a massage therapist, I found it was in a similar class to the psoas in the fact that even in seemingly healthy muscle, it is very sensitive. When it comes to needling, it takes significant skill to safely needle. Please see this video for how I like to needle subscapularis!

sub scap needling

In our advanced shoulder course, we teach how to treat subscapularis and the first aspect we discuss is risk to reward. The risk of needling any trigger point should not exceed the reward of it being released. With confident palpation, accurate needling skills and proper training, the risk of needling subscapularis decreases and the reward increases. If these skills are not present, the risks can include pneumothorax, nerve damage or artery puncture. If someone is untrained or uncomfortable with needling subscapularis, we encourage using manual therapy to treat the local trigger points. If you are interested in some of our favourite manual therapy techniques, check out last week’s blog!

Palpation

In my opinion the most important tool to confidently needling subscapularis is

Palpating subscapularis

Palpate where subscap is believed to be and resist internal rotation

manual muscle testing. As mentioned above, the subscapularis performs internal rotation. When palpating what is believed to be suscapularis, resisting internal rotation can help confidently identify the muscle. I like to ask the patient to push their wrist to belly button as a cue (check this out in my video). Another tip is to identify other easy to find landmarks such as intercostals, latissimus dorsi, and the lateral border of the scapula. Once the lateral border of the scapula is located it is simple to find the way to the subscapular fossa. If you know all your surroundings structures, it becomes much easier to find any muscle you attempting to palpate.

Trigger points

As shown in the picture below, the trigger points in subscapularis refer to the posterior shoulder and arm as well as the anterior and posterior wrist. Under palpation is often easy to illicit a clear referral pattern.

Subscap trp

When to treat

Deciding when to treat subscapularis is not always as straightforward as other trigger points acupuncturists treat. With a muscle like the upper trapezius, a trigger point can be palpated and safely released on a patient. In the case of subscapularis, many factors can get in the way. Frozen shoulder is a great example. It can be a major relieving factor to needle these trigger points for decreased range of motion, but the patient needs to have the range of motion to allow access. Manual therapy can help achieve access to this area. The axilla is also a common area for patient’s to be ticklish. This is usually easily overcome by the use of a glove and quick firm pressure. I would say comfortable patient placement with safe access is an absolute must. For me, I prefer to needle subscapularis in supine position with the patient in abduction as seen in the video.

Some common indications for needling the subscapularis can be:

  • Frozen shoulder
  • Decreased internal rotation
  • Posterior shoulder pain
  • Difficulty with putting a bra on (don’t forget Lats and Teres Major!)

Homecare for subscapularis

Homecare for subscapularis is dependent on movement and orthopedic assessment. Sometimes internal rotation with a resistance band is appropriate, but often there is more to it then that. For example, in the case of SICK Scapula, focusing on corrective exercises for the tipping of the scapula and it’s accompanying dyskinesis may prove more useful then direct strengthening to the subscapularis. Some of the most basic shoulder exercises I like can be found in the Trigger Point Acupuncture facebook group or in this video. Another great tool that can be incorporated is kinesiotape. To see an easy and effective taping method, check this video out! Just because we are using homecare to treat other muscles doesn’t mean that Subscapularis won’t be indicated for needling. It is simply that we have to treat the whole pattern, versus just a single muscle….however, that is nothing new to an acupuncturist, we always treat the pattern!

If you enjoyed this post please subscribe! And remember the above is for educational purposes only. Online reading and videos are not a substitute for in person training by a qualified professional. The author is not responsible for your actions should you use anything in the above article.

 

 

One of the most under-utilized techniques in the acupuncturist’s tool belt is manual therapy (Tui Na). This modality can be an extremely effective tool to decrease pain and increase range of motion immediately for a patient. Manual therapy is a modality every acupuncture practitioner spent a fair amount of time learning in school. Of course, like any other technique learned, it takes practice and clinical use to stay consistent with.

Often, we do not think there is time in a treatment for manual therapy, so this video shows how you can spend just a few minutes to get fast results. A few minutes before or after treatment can make a world of difference in patient outcome. Remember patients want the fastest results they can get!

When to use manual therapy

                Every practitioner will have their preference. I used to always perform manual therapy before needling, but have shifted into using the techniques more post treatment. The major exception to this is the needle sensitive patient or acute muscle spasm (i.e. torticollis). Using manual therapy before needling can decrease the discomfort of needling for a needle sensitive patient.IMG-0355 The reasoning is simple; manual therapy to MTrP will decrease the active response of the trigger point. If a patient is hypersensitive to needling, 30 seconds of manual therapy to oversensitive trigger points makes all the difference in the world.  After treatment it can quickly make a difference in pain and range of motion on top of what acupuncture had already achieved. This manual therapy can really be the icing on the cake of a great treatment.

Get immediate relief of symptoms

When performing manual therapy post treatment, it is pivotal that it provides immediate relief and increase ROM. When utilized on top of acupuncture it can accelerate the treatment effect. As discussed in this short video a combination of passive flexion and active flexion with compression on a MTrP can help to decrease the pain quickly. If the patient is sensitive to pressure passive flexion performed correctly should decrease pain in the point by approximately 60%. Hold pressure in the decreased pain state at least 30 seconds and up to 2 minutes then retest and the pain point should be less sensitive. This technique is often called positional release or strain counter-strain. If the patient is less sensitive to deeper techniques applying pressure through flexion of the muscle can create a quick decrease in trigger points. A combination of the two can be beneficial and quickly attained.

For quickly increasing ROM I add PNF (Proprioceptive Neuromuscular Facilitation) or Muscle Energy techniques along with the above techniques. My personal favourite version of these is a method of Contract-Relax technique which works through reciprocal inhibition. For example, when a patient has decreased lateral flexion in the cervical spine they are placed in passive flexion. Once a range where the muscle restricts movement is attained the patient restricts lateral flexion in the opposing direction for several seconds. After a few seconds the patient relaxes and passive range of motion increases. The results are instant and are phenomenal for increasing range of motion.

Create a well-rounded treatment

As acupuncturists we often fall into the trap of thinking our needles are a hammer and every problem is a nail. We have a complete scope of practice to treat a variety of conditions and should use the tools in our tool bag as efficiently as possible and to the best of our ability. When treating pain combining just a few minutes of manual techniques can be an excellent way to create a well-rounded approach to the patient’s symptoms. Please comment with your favourite manual therapy techniques to use on patients!

Information in the above contains statements related to the below:
Bron, Carel et al. “Treatment of Myofascial Trigger Points in Patients with Chronic Shoulder Pain: A Randomized, Controlled Trial.” BMC Medicine 9 (2011): 8. PMC. Web. 29 Mar. 2018.
https://www.jiscs.com/Article.aspx?a=11
Hindle, Kayla B. et al. “Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function.” Journal of Human Kinetics 31 (2012): 105–113. PMC. Web. 13 Apr. 2018.

 

 

When patients receive trigger point needling for the first time it is often a significantly different experience then acupuncture treatments they have had in the past. The world of acupuncture is quite diverse with those practicing and favoring a variety of techniques based on their own clinical experience. Many patients that have experience with acupuncture are only familiar with distal needling practices so when they first experience local needling it can require adequate patient communication.

With distal needling, depending on style, the needling method may be pain free or focus on attaining “De Qi”. This can be very different than a twitch response elicited when a trigger point is directly needled. When I first see a patient, I always ask about previous needling experience. If they have had acupuncture before, I am sure to ask about the experience and whether they felt a twitch response. Often patients have also experienced needling from physical therapists, chiropractors, or physicians, which I also inquire more about as these providers treatment approaches can vary greatly as well.

I personally feel that the experience of Trigger Point Needling is separate enough from Distal or Constitutional styles that it even can have different home care recommendations and expectations. Not every practitioner may agree with this, but here is what I find most effective for my patients:

Move the day you are treated

This doesn’t mean have your most intense training session or compete right after needling. What this does mean however, is do not get a treatment and go rest all day. Taking a walk, going for a swim, doing a light work out or performing recommended exercises can all be beneficial movements. When we treat trigger points, we are increasing blood flow with needling and if the patient gets the blood moving it is even more beneficial.

Avoid NSAIDs

                This is a tricky one. I encourage patients to avoid NSAIDs as long as it does not counteract direct advice from their Physician. When we needle trigger points, we are somewhat reliant on micro trauma to create a positive healing cascade and NSAIDs are not going to help this process. In my opinion, if the patient can avoid anything that interferes with the healing cascade I recommend it. Movement, heat, and self massage can help instead. Ice is a topic onto its own. Qualified practitioners should be well educated on the topic to apply their knowledge to their patient’s specific needs.

Self massage is good in small doses

                Foam rolling, lacrosse balls and other methods of self massage are very common among well-informed patients these days. While I encourage my patients to utilize these techniques, I also give some time restrictions and try to limit overdoing it. A little bit can go a long way with these techniques. Use of these self care techniques for too long or too frequently can exacerbate symptoms and in my experience prolong the healing process.

Common occurrences

The other point I note to patients post treatment is common “side effects” and what to watch for. Obviously, the most common post treatment occurrences are bruising and temporary soreness. I think it is important to note that the bruises are not usually tender and the soreness should be brief but paid attention to (see the needle intensity blog for more). Fatigue can occur in some patients as well, but is not something I see often. Temporary exacerbation of symptoms also occurs occasionally enough to be called common, so being informative about this point can be very helpful to patients.

Want more tips and tricks for Trigger Point Acupuncture? Check out the Trigger Point Acupuncture facebook group!

 

When we think of treating shoulder, elbow, and hand pain, many practitioners do not often consider Brachialis, however it can be a very effective trigger point to treat. Considered a prime mover for elbow flexion, brachialis lays under the more commonly thought of biceps brachii. Brachialis originates from the lower half of the humerus (anterior aspect) and travels over the cubital fossa to attach to the coranoid process of the ulna and the ulnar tuberosity.  The trigger points in brachialis can be easily palpated and well accessed with acupuncture needles.

The common trigger points of brachialis are palpated when the patient is supine

Brachialis Trigger Pointd

with passive elbow flexion and the forearm is pronated. Palpate the bicep tendon and then travel superior and lateral to the bicep (essentially underneath) to note the taut bands of brachialis. When learning to find these trigger points, it is important to differentiate the biceps from brachialis. This can be easily done by manual muscle testing. While both muscles perform elbow flexion, the biceps also perform supination and shoulder flexion. If resisted supination is performed, the brachialis will not contract but the biceps will. This simple maneuver can help assure muscle identification between the two.

Once the practitioner has palpated the trigger points, needling the brachialis can be performed. My preferred method is to isolate the muscle between two fingers (compressing muscle and spreading skin), then insert the needle as shown in our YouTube video. The depth of insertion varies based on patient body habitus. To consider how much twitch may be needed see last week’s post!

Looking at the trigger point patterns, brachialis has referrals to the shoulder, elbow and hand, similar to that of biceps. The taut bands of brachialis can often be even more pronounced than biceps trigger points. More interesting is to consider what kind of patients may have certain active trigger points vs those that are present in others. For example, the athlete that performs a great deal of pulling motions (crossfit, gymnasts, grappling) is a definite candidate for the brachialis trigger points, as is the body builder. Occupational hazards may be landscapers or mail carriers as they both often work with prolonged elbow flexion. The only function of Brachialis is elbow flexion, so any activity that is reliant on sustained elbow flexion can create these trigger points.

Simple home care methods can include self massage and stretching. One of the most efficient methods  to perform self massage on brachialis is with a lacrosse ball (or I very much love “Rock Balls”). The patient can place the ball between the wall and their brachialis and apply tolerable pressure to the trigger point. When instructing patients on how to do this, I recommend demonstration and observation to make sure it can be performed correctly in a pain free manner. There are also several ways to stretch the brachilias (see photo below for two ways) depending on the mobility level of the patient. A combination of home care and Trigger Point Acupuncture can be very effective at dealing with Brachialis trigger points.

 

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The preceding is for educational purposes only and is not intended to treat or diagnose any disease. Trigger point needling should only be performed by those with adequate training and license to do so. The author is not responsible for your actions.

 

 

 

 

 

 

When we teach our courses one of the most common questions is about intensity of needling. Specifically, how much mechanical irritation is needed to relieve a trigger point. This is, of course, a loaded question. There is a great deal of research that is done to try to answer this. Research will also examine whether or not a twitch response is necessary for pain relief. However, in practice the amount of twitch response varies quite a bit not only from patient to patient, but often from location of the body.

The upper trapezius is an very common area to illicit a large twitch response multiple times. Depending on the severity of the patient’s pain level and their comfort Upper Trap Needlingwith trigger point needling, the amount of stimulation can greatly differ. If the patient is coming in after an MVA for example, less may very well be more. If the patient is a high-level athlete they may do better with a higher level of stimulation. This can only be assessed after building a relationship with the patient.

So how much stimulation should I use?

If it is the first time a patient is receiving trigger point acupuncture, I highly recommend starting with low to moderate levels of stimulation. It is very easy to increase the treatment intensity the second visit, but it is impossible to take back treatment intensity after the fact. Proper communication the patient can really help determine the treatment intensity. This does differ from the TCM tonification/sedation methods. We always have patients report back on how they felt afterwards and there are two questions that are key:

1.How long were you sore?

2.How long did you have a decrease in pain?

How long were you sore?

                Soreness is common after trigger point needling. Soreness is not pain! The soreness associated with trigger point needling should be likened to that of post work out. If a patient notes an increase in pain or lasting pain, then decreasing mechanical stimulation or utilizing more superficial fascial needling may be indicated. Manual therapy can also greatly help patients that have an increase in pain from needling.

How long did you have a decrease in pain?

                This question serves two purposes, and one of those is to see if an increase in stimulation is indicated. If the patient noted little to no soreness and only a brief or no relief, increasing stimulation can be indicated. This question can also can indicate treatment frequency for the patient. It is very common to have trigger point needling patients come in for shorter intervals at the beginning such as twice a week for two to four weeks depending on condition or whether or not they are seeking care with other providers.

One of the other major concepts to get across to patients is that less can be more. While we are going for a twitch response we don’t want the patient to be in pain. More often than not, a twitch response isn’t particularly painful, it is just a new sensation. If the patient is associating pain with a particular trigger point being needled it shouldn’t necessarily be a grin and bare it situation. That is why communication is key. In my opinion, communication during the needling process of trigger points is more interactive than that of needling acupuncture points with therapeutic properties. If we can communicate goals of needling with the patient, then needling intensity can be better attained creating more positive treatment outcomes.

Type “paleo diet” into google and you’ll find countless threads talking about it and most have a very strong opinion towards it. Some of these sites quite literally say it is the “healthiest way to eat,” while others talk as if it poison for every ounce of your being. Very few of these sites present pro’s and con’s and an informational approach. Hence my approach, an attempt at an unbiased review pointing out pros and cons so that the reader can decide and not be told the answer. Of course to do this, we have to first decide what the paleo diet is.

The concept of paleo from a branding standpoint is to mimic the diet of the caveman. Now of course, there is heavy branding going on and getting caught up in the specifics of this is missing the point. Essentially the diet is based on eliminating processed foods, grains, and dairy. It is a high protein, low carb diet attaining protein mostly from animal sources. Veggies, oils, nuts and some fruits are included in the diet. For the purpose of this article, we will leave it at that as getting too in depth with specifics will only cause arguments. Based off this definition, let us look further at some of the pros and cons.

Essentially the diet is based on eliminating processed foods, grains, and dairy.

Essentially the diet is based on eliminating processed foods, grains, and dairy.

Pros:

  1. Focusing on food- this diet gets you to pay attention to what you are putting in your body on a daily basis. It provides accountability and a map for eating. It encourages the avoidance of processed foods and aims for whole, organic foods. This is definitely a step up from the SAD (Standard American Diet) that is prevalent today. If everyone in the country took this step we would be a much healthier country.
  2. High Protein Low Carb- Want to cut weight? High protein low carbohydrate is the way to do it fast and effectively. Most athletes will follow that simple concept in sports nutrition at some point and be successful in certain ratios.
  3. Great Option for certain health conditions- Lactose intolerant? Celiac’s Disease? Gluten Sensitivity? Paleo has you covered as you are not eating Dairy or Gluten.
  4. Not your standard diet- I love that there is no calorie counting and Paleo is a sustainable dietary lifestyle versus a “diet”. It is something a person can embrace without having the likelihood of huge ebbs and flows due to difficulty of food choice availability.
  5. Group Mentality- The CrossFit community has really embraced Paleo. It practically comes packaged in some Boxes (CrossFit Gyms). Have a community supporting diet and lifestyle can be a very good thing and making it easier to stay on track.

Cons:

  1. Inflammation- High animal protein equals elevated inflammation in the body, period. There is no way around it, no arguing it. If you eat a diet that is high in animal protein you will increase inflammation via arachadonic acid pathways.
  2. Dehydration- With a high protein diet you will need more water. Drinking lots and lots of water can help with this, but more often than not, markers will show up on a blood panel such as an elevated ESR (inflammatory marker).
  3. Global Impact- High animal protein equals a heavy impact on the planet. It is estimated that about 18% of human caused green house gases come from live stock production. That is a huge global aspect to think about when you are considering eating meat with every meal.
  4. Not for everyone- There is the obvious, Vegans and Vegetarians will not be on board with this diet. There are also health conditions that would not benefit from a Paleo diet. People with inflammatory conditions such as arthritis, rheumatoid arthritis, lupus, ect or those with heart conditions. There are much better options for these individuals. This directly counteracts number 3 of the pros so I would say it is pretty balanced in this case.
  5. Excuse to indulge on meat- As a health care practitioner I have seen many patients that operate under the theory that Paleo means eat bacon all day, every day. They will look at paleo as a solid reason to offset any hope for a balanced diet. This can be argued for other diets as well (in fact I made a similar argument in a vegan diet blog). Balance is key with food.
  6. Elevated Cholesterol- Eating a diet where often every meal contains animal protein can have a negative effect on cholesterol. Many Paleo eaters find themselves on a high protein, high fat, low carb diet which can lead to an increase in LDL, decrease in HDL and increase in total cholesterol. In the event that an annual blood panel shows a negative increase in cholesterol, perhaps the Paleo diet should be reconsidered, especially in those with a genetic predisposition to elevated cholesterol. Interestingly, there are some studies performed that show people that switch to the Paleo diet actually have an improvement in Cholesterol levels. One study showed a decrease in LDL of up to 22%. The reason this is in the “con” section is it also shows the inconsistency of the diet standards. The Paleo diet can vary so much as to what is eaten, therefore sometimes having a positive effect and sometimes having a negative one. As mentioned in number 5, if the Paleo Diet is not well balanced, then is can be hazardous (as is the case with many other diets).

There is a brief synopsis of Paleo pros and cons. Part 2 coming soon will be a look at the Paleo diet from an East Asian Medical perspective. Don’t forget to subscribe if you want to check it out! What are your thoughts regarding the Paleo diet? Sound off below!

1)      Make a habit of not taking the easy route: Most people will wait for someone to pull out of that front spot in a a parking lot so they can take it and get into the store as quick as possible. Don’t be that person. Park further away and get a quick walk into your location. Same thing goes with elevators. There is no good reason (assuming capability) that you should take an elevator up one floor. Take the stairs! Another idea is, if you can use a hand basket instead of a cart while shopping, go for it!

The mind set of training over working out is highly beneficial.

The mind set of training over working out is highly beneficial.

2)     Don’t think exercise, think training: Mindset is extremely important. When someone asks me, “how often do you work out”, I say rarely, if ever. However, I do “train” about 6 days a week. Of course it is just a play on words, but there is some meaning behind it. People often think of “working out” as an activity done specifically to lose weight or get six pack abs and personally I never do that. I set goals and work daily to achieve them. The healthy management of weight and gain of lean muscle mass is just a cool side effect. For example, the goal I achieved to the right took a really long time to reach! Setting goals gives you something to focus on and create “work outs” around. Maybe you want to run a 5k? Or maybe you want to achieve a specific movement like a strict pull up? If you build your training schedule to achieve these specific goals, you will increase fitness levels while achieving these new skills.

3)      Get a partner or join a group: Some people love fitness groups to get motivated. For example, CrossFit or Yoga are large group fitness classes. Classes usually have around 10-40 people and this can create a great environment to encourage fitness.  A group or partner setting can easily be applied to any fitness situation. Training partners not only encourage you to reach fitness goals, but also can hold you responsible on those days where sleeping in or hitting the couch instead of training sounds good.

Go For a Hike4)      Find active activities you enjoy:  It’s no big surprise that not everyone enjoys the daily grind on a treadmill or hitting the weight room. In fact I’m that guy too! That is completely okay, but find something active you can enjoy. Don’t like a treadmill? What about hiking? Or golfing (walk the course!). Finding hobbies that are active will provide you exercise outside of hitting the gym. Who knows you may even find an activity that lets you look at gym time as training.

 

 

5)      Avoid negative reinforcements:  Becoming healthy is all about lifestyle changes and not temporary fitness and diet trends. Part of that can be making changes to habits that reinforce behaviors that won’t help you reach your goals. One example is “happy hour”.  Red wine in low amounts can be good for the heart and have antioxidant value, but more often than not, happy hour means cheap beer or high sugar beverages along with calorie laden appetizers. Hate to break it to you but they aren’t helping your heart or your fitness goals! Skip happy hour and grab a friend for a walk, run, or dance class instead!

6)      Don’t be afraid to get your hands dirty: Not many of us like chores but, they can be a good way to stay active. Mowing the lawn, tending the garden, and even doing laundry can play a part in your fitness. Yard work is hard work!

7)      Don’t sit all day: It is all too easy to get stuck at the desk staring at a computer for hours on end. We are all guilty of it. It is important to take time once an hour to get up and walk around. It is the perfect time to go to refill that water bottle you have been using to stay hydrated (see what I did there?). Another great idea is don’t have lunch at your desk. Take 30-60 minutes and go for a short walk. Eat outside if the weather allows. Getting that extra movement will also help recharge you for the second half of the work day without needing a pick me up.

8)      Create a routine: And stick to it! This can be huge for developing great fitness. You don’t have to go Type A about it, a broad routine is okay. For example, I make a point of going hiking at least once a week. Sometimes it is a whole day, sometimes it is just an hour or two but, I get out there for a good hike.  Even if I only have one day off that week, I carve the time out of that day to do this activity and make it a priority. You can do the same. You can also be more specific with a training plan and come up with an agenda that you want to go to the gym 5 days a week, three days cardio and two days strength training.  The routine is up to you, but make sure you can commit to it. Start with a realistic and attainable plan. It will feel better to be able to commit to your routine and even be able to surpass it rather than feel like you are falling short because it is too much.  Remember the importance of mind set!

9)      Cook at home: When you make meals at home you have total control about what is in them. When you eat out all the time you don’t always know what is snuck in there to get that rich flavor. Ever wonder why when you attempt to recreate a meal it doesn’t turn out the same as the restaurant? To be honest you may not want to know. Limit eating out and you may find success in the kitchen!

10)   Have your health team in line: Those who are really fit usually have a health team in order. Look at a professional athlete. These individuals have athletic trainers, coaches, physical therapists, acupuncturists, massage therapists, nutritionists, and chiropractors depending on what they find most useful. They do not just go to the doctor when something goes wrong, they see health care practitioners to prevent something from going wrong and to stay their best!

What kind of things do you do to keep active and fit? Leave a comment below! And don’t forget to subscribe to our blog and follow us on Facebook for lots of other great tips!

Getting an extra boost is always desirable for a workout. Whether you are looking for an edge on a big day or just dragging a bit and need a pick me up, energy drinks have become a quick grab for both the athlete and those trying to get through the work day. As always, it comes down to what is in the energy drink that should be considered. Obviously, the number one “pick me up” ingredient is caffeine. Now there isn’t anything wrong with utilizing some caffeine, but overuse will decrease its usefulness and have a negative impact on your body.

                Caffeine is a stimulant. That means it will give you energy, but it does not mean it does not come with side effects. For example, caffeine may cause an increase in heart rate, blood pressure, and body temperature. In that effect it is similar to a basic warm up before exercise; it will get our body temperature up, get the blood flowing, and prepare body for the actual workout. From that stand point, it isn’t the worst thing. Personally, when I climb mountains, I will have Cliff Blocks with caffeine handy because the extra energy and calories work great when I am at an altitude where the last thing I want to do is eat. These would not be as useful if I used them all the time though, as tolerance to caffeine also occurs. Unfortunately so does addiction.

                It is one thing to use caffeine for an occasional workout, but it is completely different thing to use caffeine all day. The more one uses caffeine, the less effective, more addictive and worse the side effects become. I mentioned some of the side effects and can reason how they would be good for exercise, but let’s think of those effects during times of rest or at least physical rest.  An example is 2 cups of coffee sitting in rush hour traffic. The caffeine can cause restlessness and perhaps anxiety. Coffee with breakfast, energy drink for your morning workout, mid afternoon iced coffee to get through the day, and then a soda with dinner now you’re in trouble!  Another fun side effect of caffeine is the increased excretion of calcium. Now that useful occasional drug has the potential to cause lasting side effects to the body including decreased bone health. So what do we do for energy instead?

                I don’t necessarily recommend stopping a single daily cup of tea or coffee. The increased antioxidants are a great benefit and the amount of caffeine isn’t going to send you on a downward spiral. I do encourage people to consider the thought behind the extra pick me up. Do you need a boost or do you need more rest? Caffeine can stay in the system for 6 hours, so that night cap is affecting your sleep whether you want to admit it or not. Realistically, you want caffeine, but you need water and electrolytes. Dehydration has a profound effect on energy levels. We recommend drinking half of your bodyweight in ounces of clear filtered water per day.  To gain electrolytes you can be sure to eat a balanced diet. What about energy for the everyday workout?

                If you are dropping back to a max one cup a day of tea/coffee and you are a multiple cup drinker per day, the first week will be tough. Nervousness, irritability, and headaches are not uncommon. Once that is done what are options for energy? A pre-workout energy shot can be useful and does not have to contain enough caffeine to turn a slug into a cheetah. My personal favorite is Elevate Shots by Thorne. It contains minimal caffeine (2mg per serving), which means the pick up is more gradual and thankfully the crash is non-existent. It works off a proprietary herbal blend to give adaptogenic support (think balancing more than stimulating). Using Elevate before longer workouts is awesome and you will experience great stamina. They are portable, single dose and even tasty. If you want to learn more about these, come into the clinic and check them out.  The other amazing and simple way to help maintain natural energy without overloading on caffeine is a homemade sports drink. Below is a great and simple recipe for one that I got from my colleague at Source Naturopathic Dr. Robert McElroy.

Home Made Sports Drink

An amazing and simple way to help maintain natural energy without overloading on caffeine is a homemade sports drink.

 

                This is just one of many options for creating a homemade sports drink. It is also significantly lower in cost than picking up a Gatorade (with way too much sugar) or an energy drink (with way too much caffeine) at your local store. It also allows you to pay closer attention to what your body actually requires in regards to nutrients. With adequate hydration (water and electrolytes) and the occasional use of adaptogenic herbs (see your natural health care provider first!), a high caffeine intake will no longer be as appealing. If it is, seeing a health care practitioner for a screening would be a great idea. Have questions? Please feel free to comment below or contact us directly. If you liked it please remember to share this with your friends! Thanks for reading.

False Grip Gymnastics Rings

I work with CrossFit enthusiasts regularly to help them improve specific gymnastic skills

 

As a hand balancing instructor, I work with CrossFit enthusiasts regularly to help them improve specific gymnastic skills. As a Bellevue acupuncturist, I see CrossFit enthusiasts with injuries some avoidable, some not.   Regardless of my relationship with the athlete, I’ve learned they enjoy taking their health and fitness seriously and want to reach their full potential. To help do that, I have compiled my top 3 tips for the Crossfit athlete.

Prehab– CrossFit can be very hard on the shoulders. In order to continue to train injury and pain free, consider a prehab routine. In the case of Crossfit, strengthening the core, rotator cuff and periscapular muscles should be considered.  Check out the video to see some great exercises that can help keep shoulders healthy and prepared for the stress that a good WOD can put on them.

Periodization– Creating a cycle of intensity in your exercise program helps achieve goals and improve the overall quality of said program. This is especially true if you compete in any CrossFit competitions, but works great for every CrossFit enthusiast. If you look at any professional athlete’s training program you will clearly see periodization.  It is an annual plan to layout goals, how to achieve them, and how to do so without getting avoidably injured. It is not written in stone and can be modified to meet an athlete’s individual needs. If you take baseball as an example, these athletes have a clear off season. This does not mean they sit on the couch and eat chips though. The professional athlete will utilize the off season to work on specific skills and to maintain overall health. During spring training season, they take sport specific time to get ready for serious competition. As spring training comes to the end, official season begins. This is when there is constant training and a high level competition occurring. This shows a clear annual training plan for these athletes and it keeps them at their best.  So how would this look for a CrossFit competitor?

If we break down skills of CrossFit into three aspects; gymnastics skills, weight lifting, and high intensity cardio, then periodization will be easier to implement. Most CrossFitters I work with tend to have a preference for a specific area, which from a competitors stand point can come back to bite them. Having a planned approach can all skills will be addressed to be well rounded. A good plan can also prepare the athlete for a competition. For example, take a certain competition, say the CrossFit Open, and make it the main event of the year. Planning that time to be a physical peak would be great to focus on. Divide the rest of the year into cycles where skills are focused on in divided sections. An example is to focus on gymnastic skills such as muscle ups and handstand walks for a few weeks, then switch to a focus on weight lifting for a few weeks followed by cardio skills (i.e. double unders). When working on specific skills, it doesn’t mean that is the only thing you do during this time, just that these skills will be the focus. Continue to rotate these during your off season. Perhaps two months before the Open, enter your own “spring training” where you begin to combine the skills you work on in a way that directly mimics how the Open competition will be. This is a good time to even check out other local competitions or encourage your gym to have an in-house competition. As the Open gets closer (about a week before,) taper the workouts down and take some rest days. The skills have been trained, mimicking of real life challenge has been performed, so taking some time to ease off will be very beneficial. Rest, prevent injuries, and prepare mentally. This will allow you to enter the Open fresh, trained and ready to PR!

Recovery– I could probably write an entire book on recovery, but some important aspects to ensuring an adequate recovery are:

Stretch– All too often people want to get in and get out with a workout. They will slam out a new personal record on the WOD, then get out of the gym to get on with their day. Taking just a few minutes to work on flexibility will not only help with recovery, but improve one’s overall skill level.

Sleep– Something people often neglect is rest. The body needs adequate sleep to work on recovery. When we sleep, we enter a parasympathetic state (rest and digest). The body gets a chance to relax and focus on repairing the day’s work. Personally, before sleeping is when I like to take my herbs and supplements tailored to recovery. I tend to think of sleep as my time to prepare so that tomorrow’s work out can be even better than today’s.

Nutrition– The best way to ensure the body recovers, is to make sure it is adequately nourished. This can be accomplished with a combination of good whole foods and quality supplementation. If you look back at our blog about supplements for athletes, it will give you a small intro into recovery supplementation. As far as diet goes, one simple tip is to be sure to get protein within 30 minutes after a workout. Protein is the building block for muscles. Feed the body protein and it will get to work on healing everything that is torn down during a workout.

Health Team– There is a reason they are called health care professionals. Take the time to have a team that is familiar with your health goals. This can be a Naturopath focusing in the nutritional aspects, an acupuncturist that focuses on sports (like the one’s at Pins and Needles!) helping manage pain and keeping muscles healthy, and a massage therapist to keep the kinks out.

 

Implementing these three tips into your life can really help improve athletic ability within CrossFit. Be sure to take the time to speak with professionals (health care and coaches) to reach your specific goals. If you have specific questions please feel free to leave a comment or contact us! And don’t forget to subscribe to our blog for more great tips!

                Sports nutrition is often designed without the vegan lifestyle in mind. To be honest, many sports nutrition diets are designed without long term health in mind. That is the difference between a diet and a lifestyle, the latter is sustainable while the former is a temporary approach. That doesn’t mean temporary dieting is bad, done with periodization of training, it is very effective for competitive athletes. The lifestyle approach to food is what is done the rest of the time. For a vegan athlete, there are some concerns when attempting to maintain a high level of activity with a healthy diet. Some are more common misconceptions, while others are valid concerns. The following are 5 of the most common issues a vegan athlete may come across.

Vegetarian Trap- The dietary issue with the vegan lifestyle I come across as a health care practitioner is, what I refer to as, the vegetarian trap. It is similar to that of the omnivore’s great failing… too much processed high sodium foods. Many vegans ‘go vegan’ and think that means frozen readymade meals and pasta at every meal. This equates to excess salt, hydrogenated fats and way too many carbohydrates. It will undoubtedly offset the vegan athlete’s dietary goals. Vegans turn vegan for different reasons. Sometimes the reason is about animal rights or a personal belief and other times it is to become “healthier”. The best way to be a vegan athlete is to truly embrace a plant based diet. This should mean fresh, organic, unprocessed foods.

 B12 Deficiency– This is definitely a valid concern. The highest sources of B12 come in the form of meat products. If a person chooses to not eat meat they can usually be health conscious enough to get adequate B12 via fortified foods and not become ill from a deficiency. Just because you are achieving the bare minimum, does not mean you are achieving enough. As an athlete you are striving to be at your best, not to scrape by. This means the Vegan athlete will most likely need to supplement B12 to become as efficient as possible. There are many products on the market that claim to provide B12. If oral B12 is being taken it is often best absorbed in a sublingual form rather than a pressed pill. More often than not we would recommend an intramuscular injection of B12 to maintain a high performance level for an athlete. B12 shots are inexpensive, sustainable and easily put the vegan athlete on par with if not above the omnivore athlete in regards to B12. Intramuscular B12 injections are the number one method of absorbing this vitamin. To learn about B12 shots, contact your friendly neighborhood Naturopath (like the one at Pins and Needles!)

Vegan Athlete

The best way to be a vegan athlete is to truly embrace a plant based diet.

Protein Insufficiency– I personally believe this is more of a mythical threat as long as you don’t fall into the Vegetarian trap. There is more than enough protein available in a plant based diet to achieve optimal amounts. The trick is to not rely on one source of protein. As discussed in our last blog (check it out here), protein powders are wonderful for athletes. The problem with protein powders and the Vegan Athlete is finding a source that provides a balances complete protein. Our tip is to mix up the sources of protein in protein powders. This is the same tip we have for gaining protein through foods, be sure to mix it up! Examples of high protein vegan foods are tofu, seitan, tempeh, dark leafy greens (kale, spinach), almonds, and beans.

Calcium– We are more or less bred in North America to think dairy is how we get calcium. In fact I would give major kudos to the dairy marketing industry for having the capability to practically brainwash an entire population into thinking this is a legitimate fact. It isn’t true. The next big lie marketing campaigns came up with was, you need to get extra calcium via “calcium chews”. Again amazing campaign with a heavy impact to create desire for a product, that is usually junk. In fact, many Calcium products use Calcium Carbonate which has potential for worsening bone health by creating osteophytes. Attaining calcium without calcium chews or a cows milk product is actually pretty easy!  While we often recommend a calcium/magnesium supplement to patients, we always strongly encourage the majority of calcium to be obtained via food sources. Oddly enough, this is almost always accomplished from non dairy sources! Did you know that 1cup of cows milk contains 305 mg of calcium and 1 cup of collard greens has 357mg? Nice!

Iron– Along with B12 deficiency, Iron deficiency can be common in vegans. However, with a strong focus on incorporating dark leafy greens, it is less of a concern. There was a reason Popeye ate his spinach! If the vegan athlete embraces a plant based diet and avoids the vegetarian trap, iron deficiency would be less likely than that of a lacto/ova vegetarian. Some of our favorite vegan Iron sources include spinach, quinoa and lentils.

A vegan lifestyle will require frequent shopping to assure fresh foods. Below is an example of a vegan menu for a day that contains balanced nutrients to fit an athlete training for one to two hours a day:

Breakfast: (Steel cut)Oatmeal with ground flax

Snack: Trail mix/ nuts and fruit

Lunch: Salad including a Spinach and Kale base, garbanzo beans, shredded carrots, broccoli, oil and vinegar

Snack: Homemade granola bar

Dinner: Tempeh “steak” on a bed of lentils with edamame and chard

Pre Training- Apple with almond butter 30 minutes before workout

Post Training- Protein shake (pea and rice protein mix) and a banana within 30 minutes after exercise

                Of course this only an example and it can easily be modified to suit individual tastes. The vegan athlete definitely needs to do a great deal of research or seek out a health care practitioner that can help to provide a diet that helps achieve an optimal diet. The above only briefly covers some of the considerations for a sports diet.

If you have any questions please feel free to post in the comment section or contact us. Thank you for reading!

 

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