Why Useless Surgery is Still Popular

A patient sent me a great article from the New York Times this summer about why useless surgery is still so popular.

The upshot is that it is popular because 1) surgeries are not subjected to the same clinical trials and testing that medications are and 2) people want an easy fix.

For example, spinal fusion continues to be a popular surgery, even though research shows that non-surgical methods of treatment are just as effective.

Another example is meniscus surgery–more than 400,000 Americans have surgery to trim this sliver of cartilage that acts as a cushion in the knee. But it turns out there isn’t even a clear relationship between knee pain and meniscus tears–MRIs show plenty of people without pain have tears, and plenty of people who do have pain also have osteoarthritis, which could be the source of the pain.

Extensive research into this meniscus surgery produced the following scathing conclusion: The surgery is “a highly questionable practice without supporting evidence of even moderate quality,” adding, “Good evidence has been widely ignored.”

Where does this leave you if you have back or knee or hip or shoulder or foot pain and your doctor has suggested surgery? I highly recommend that before you agree to any surgery, you go see a sports medicine specialist with expertise in Dynamic Neuromuscular Stabilization (whether or not it’s me, I don’t care–just find someone who can evaluate you using the DNS paradigm, which has high rates of success for treating pain).

It is very possible that with manipulations and exercises aimed at improving the body’s alignment and getting body movements into an ideal pattern, you can avoid surgery altogether. Sometimes you will still need surgery, but at least explore your options before scheduling that surgery date.

Call the office today to schedule an evaluation, and we will be able to tell you in one visit whether we can help you or whether you should go ahead with the surgery.

Natural Relief for GERD

Millions of people suffer from some version of heartburn or gastro-esophageal reflux disease (GERD), and those numbers are rising. According to a recent study from Norway, in just one decade, the number of people experiencing any GERD symptoms is up 30%, the number of people with GERD symptoms once a week is up 47%, and the severe GERD is up 24%. Moreover, 20% of Americans with GERD don’t respond to standard medical treatment.

GERD is currently a $9-billion industry in America.

It turns out that you can relieve and alleviate GERD symptoms with proper breathing. I know, it sounds weird. With so many over-the-counter medications available, how could breathing possibly make a difference?

Did you read our post earlier this month on why the diaphragm is so important for good posture and movement patterns? The diaphragm stereotype (the program in our brain) has a huge effect on all body functions. Including the way all the other muscles in our abdomens act and respond.

It turns out that a strong diaphragm can address reflux symptoms. Here’s a paper on how it works: Science!!!
http://www.rehabps.com/REHABILITATION/Poster_GR.html

This paper’s conclusion: “As the diaphragm is a striated voluntary muscle, its function and strength can be targeted and systematically trained. In our opinion, this may represent a new approach in the treatment of GERD”.

Now in plain English: Not only does a stronger diaphragm help treat GERD, you can actually train your diaphragm to get stronger with specific exercises.

Voila! The famous Capitol Rehab “breathing exercise.” It will help you not only recover from chronic and recurrent pain and loss of mobility but can even help with acid reflux! The reflexes that are stimulated during your therapy in our office activates the diaphragm immediately, so that the diaphragm breathing exercise you do at home creates a quicker response in your brain, making the new pattern automatic and permanent.

Call us today to schedule an appointment, and we’ll teach you some techniques that could help you reduce or even eliminate GERD medication.

Protecting Your Back While You’re Raking Leaves

Preventing injuries and backache while raking leaves is both the easiest and the hardest thing to do. The trick is, if your body is well aligned and moving properly, you won’t hurt yourself.

In fact, the patients I see don’t have injuries from raking leaves or shoveling snow or any of those big, seasonal jobs that seem to leave so many Americans in pain each year. The reason they don’t is that if they’ve been seeing me for any amount of time, they have strengthened their core muscles (including, most importantly, the diaphragm), and have better posture and more ideal movement patterns. Once you have good breathing, strong core muscles, good posture, and good movement patterns, you won’t get injured from heavy labor–you’ll get stronger and you’ll actually hurt less.

That’s why our grandfathers (who may have been a laborers, factory workers or construction workers), didn’t miss a day of work due to a “backache.” That’s why our great-grandmothers had six kids and did laundry without a machine didn’t seem to have hip pain and incontinence during their thirties and forties. They didn’t have the pain we modern workers have because lifting bricks, hauling logs, and maintaining a household without modern conveniences is exercise in itself. And actually, it’s exercise that keeps the body in much better alignment and in much better shape than going to the gym and working out on cardio and weight machines. The human body is intended to lift heavy things, pick up children. When I am treating a patient either for pain or to improve performance, we do functional exercise that improve posture, alignment, and ideal body movement.

The folks who have been doing functional exercises in my office as part of their treatment plan always tell me that raking leaves, spreading mulch, shoveling snow makes them feel better than ever. Exercise properly done with a “functional body” provides training, not injury. Exercise with a less-than-functioning body…strain! Makes sense, no? Isn’t that why athletes train? So they can perform better?

At Capitol Rehab of Richmond, our approach for everyone from office workers to elite athletes, and from infants to seniors is that we want to help you get relief of your discomfort, regain mobility and improve your performance. We look at it as if you were in the “Life Olympics.” This doesn’t mean working out in a gym all year to get in shape so you won’t throw your back out once or twice a fall or winter when you’re raking leaves or shoveling snow. It means getting your body into proper alignment and well trained so that you can handle LOTS of things without getting hurt—playing with kids or grandkids, cleaning, doing part of a home renovation project, raking leaves, carrying heavy shopping bags, stretching up to get something off a high shelf, and yes, routine yard maintenance in the fall and winter.

Call us today to schedule a functional evaluation if you’re a new patient, or if you’ve seen us before, call us to schedule a fall tune-up!

How to Breathe

If you’re a patient of ours, you know proper breathing technique is a big deal in our practice. In fact, one of the foundational exercises we use in both therapy and training here at Capitol Rehab of Richmond is what we call “diaphragm calisthenics”–what many of the patients and athletes we work with call “the breathing exercise”.

Just last week, a patient asked me, “I have one friend seeing you for a shoulder injury, another for a bad knee, and a third for improving athletic performance, and you have us all doing the breathing exercise? Why do you have us all doing the same thing?”

The cornerstone of most training and exercise regimens is strengthening the so-called “core muscles”. It’s just that most trainers consider the abdominals the most important core muscles, when in fact, the diaphragm is absolutely critical for good posture and ideal movement patterns.

In the 1980’s, a group of Australian physical therapists discovered that before any other movement can occur (eg. shoulder movement, hip movement, knee movement), these core muscles must activate (or “turn on”) first.♦

Of all the “core muscles”, the diaphragm is the most important. It attaches across the lower ribcage and has a dual function: breathing and support. The diaphragm activates first (along with the “transverse abdominis” muscle), even before the rest of the core muscles do.

While your trainer might be telling you to do more planks to strengthen and activate your core, you will see far more success if you strengthen the diaphragm before anything else. According to the late professor emeritus Karel Lewit, M.D. and many other experts, no other movement or posture can be ideal until the diaphragm stereotype (program in the brain) is ideal.

So whether you have shoulder pain, knee pain, arthritis, restless leg syndrome, back pain, or Parkinson’s, we’re going to start you off learning how to really breathe with your diaphragm and then create a customized treatment program with that foundation. Proper breathing technique is necessary for ideal posture and movement patterns, which is in turn crucial for reducing pain, improving mobility, and achieving peak performance.

The reflexes that are stimulated during your therapy in our office activates the diaphragm immediately, so that the diaphragm breathing exercise you do at home creates a quicker response in your brain, making the new pattern automatic and permanent.

Therein lies the foundation for the DNS approach, which is the basis of Capitol Rehab’s Functional Integrated Therapy and Training.

How DNS Helps Improve Baseball Performance: By Dr. Len Mayer

I’ve been using Dynamic Neuromuscular Stabilization (DNS) as a core foundation of my practice for 14 years. While DNS may not be a household name, it is a practice that is in regular use by some of the most elite athletes in the world.

Dynamic Neuromuscular Stabilization (DNS) is a method of rehabilitating the way humans move, either to improve athletic performance or to help rehabilitate people bodies after an injury.

The brainchild of professor Dr. Pavel Kolar, Czech rehabilitation expert and team physician for the Czech national hockey, soccer and tennis (Davis Cup) teams, DNS is breaking new ground in physicians offices and rehabilitation clinics; as well as with athletes in virtually every sport, all over the world.

DNS is not a technique. It is a system, an approach, to therapy and training that uses normal baby development as the “functional norm”, as described by world-renowned pediatric neurologist, Vaclav Vojta, M.D., and used in the treatment (Vojta’s Method) of babies with neurological disorders such as cerebral palsy (see: Reflex Locomotion).

Watch how Ken Crenshaw uses it with the Arizona Diamondbacks:

The “Fall Tune-Up”

Have you a heard of a seasonal tune-up for your car, your heating system, your air conditioner or even your lawn?

Your body needs one too!

For many of us, summer, takes it’s toll, whether it’s because you’ve been doing less activity because of the insane heat or more or different activity because of fun summer vacations and adventure.

I have one patient who has been experiencing knee pain in the last few weeks (her knee pain is actually stemming from back issues resulting throwing her kids in the pool all summer!). Another patient has been running less because of the heat and is feeling a little stiff. A third is looking at optimizing her performance in the Richmond Marathon this fall after a long season of training, ramping up to the big event. A fourth pulled a muscle in his hamstring while water skiing and

My question for you as we near Autumn : Are you doing all the things you would like to, or is discomfort and lack of mobility holding you back?

Maybe you have severe pain that you’ve seen multiple practitioners about, and now you’re just living with it, getting cortisone shots, taking pain meds. I can probably help you, and if you come in for a Free functional evaluation, I’ll be able to tell you if I can help you or not.

Maybe you have mild, nagging pain that you’ve just decided to live with. Maybe it’s an old injury and it’s better enough that you deal with it. Maybe you got busy over the summer and hoped it would work itself out. I’d love to see you this Fall and help you feel better so you can really enjoy the change of seasons.

If you’re an athlete and not in pain, the approach we use can help you optimize your performance in Fall sports or competitions. We use dynamic neuromuscular stabilization which helps elite athletes all over the world improve their performance (watch this video on how the Arizona Diamondbacks use DNS)

We are taking appointments for “Fall Tune-Ups” now and would love to see you. Call the office at 804-285-4400 and speak to Casey or Gina to schedule your appointment.

Exciting Changes at Cap Rehab

We are going through some exciting changes here at Capitol Rehab of Richmond. As most of you know, Diego and Paige, trusted assistants and trainers for some time, have moved on to other things. Diego and his wife moved to Hawaii and Paige will be working with another organization.

We always knew this would happen—Capitol Rehab was always intended to be a short step on their professional journeys, but we wish them the best of luck in their future careers. We know they will both be excellent additions to their new practices as they increase their knowledge and attain the goals they have set for themselves.

Meanwhile, I am very excited about our new staff!

Casey Boxall, my new “right hand”, comes to Capitol Rehab with a skill set I have not had the pleasure of having in the 33 years I have been in practice. Casey is well versed in the workings of a healthcare clinic and is also a licensed massage therapist.

In addition, Casey had a knee injury almost six years ago in which she tore the anterior cruciate, medial collateral and lateral collateral ligaments. The only ligament left intact in her knee was the posterior cruciate. She was given a knee brace which “made things worse” and was told she needed immediate surgery. As fate would have it, Casey was living in the Czech Republic at the time which, as you know, is where the DNS approach we use here at Capitol Rehab originated. When she went back to the Czech Republic, she saw a doctor there who told her to get rid of the knee brace and that she would not need surgery if she was compliant with her rehabilitation exercises. Being a very active person and wanting to avoid surgery, Casey was a model patient. Six months later she was back to all her activities of daily living, including in-line skating, and twelve months later she was skiing in the Alps. So, Casey understands our approach first hand, which is incredibly unusual to find in an assistant!

Gina Kihnley is coming on to assist us as a trainer. She plays rugby and is currently entering her junior year at VCU in exercise science. I look forward to her enthusiastic approach to exercise and learning our approach.
In the meantime, come say hello if you haven’t been here in awhile and meet our new staff! We’re excited to start the fall strong!

What’s This Blog About?

Dr. Mayer headshot

I’ve been in practice for just over thirty years now. I have seen and heard of almost every health and fitness fad, and all the so-called “accepted knowledge” and “current wisdom” come and go. From blood –letting to mega doses of beta- carotene, both “orthodox” and “alternative” medicine have given us rules-to-live-by (sic) that can literally kill us or, at the very least, cost us considerable time and expense with little to show for it.
This column will deal with many of these issues but the take-home lesson is simple. When in doubt as it pertains to health and fitness, common sense and a “back-to-basics” approach is almost always right.
For instance, when it comes to exercise just look at the human body and what tasks it has to perform. Do our exercises, the ones the so-called experts told us to do (eg. crunches, upright rows) look like anything humans do in the course of a typical day? Doesn’t it make sense to exercise to develop more power and mobility for the things we actually do like athletes (and babies) do?
When it comes to diet, all the things we’ve been told to eat a lot of, or not so much of, has changed umpteen times over the last thirty years. Just think of how things were a long time ago NO, not the 70’s but hundreds of years ago. We ate meat, but only what we caught or killed. A lot of calories were burned hunting, fishing and preparation. And, fish don’t always get caught and animals don’t always show up to the hunt.
The vegetable, fruits, herbs, and roots we ate grew wild and they were full of phytonutrients that our farm-grown ones are lacking. In fact, the animals we hunted grazed on natural grasses and plants, not corn and feed.
So should we climb trees and forage for berries, roots, and wild herbs? Should we chop wood or row a boat? In a word . . . Yes! But when that’s not possible in this modern world, a good substitute will suffice. Following articles will offer some of these substitutes. But in the meantime, go fly a kite… or row a boat… or climb a tree…….

 

How to Avoid Snow Shoveling Injuries: Train Don’t Strain

By Dr. Len Mayer

Did you ever wonder why your grandfather or great-grandfather, who may have been a laborer, factory worker or construction worker, didn’t miss a day of work due to a “backache”; or, why your great-grandmother had six kids and didn’t complain of hip pain and incontinence during her thirties, forties and fifties? That’s because lifting bricks and taking care of household duties without time and effort-saving devices, are a form of exercise. Better yet, they are a very natural form of exercise that keeps the body in alignment.

Last week, the Richmond area had a pretty good snowfall—about 16. Someone suggested I write a blog about snow shoveling and back injuries and how I treat them—she’d been hearing people complaining of back pain all over Facebook for days.

But a funny thing happened when I thought about what I would say on the topic. I’m not actually treating anyone for back pain related to snow shoveling, because all the patients I have who have been in treatment for chronic pain in their back and/or sciatica or hip pain in our clinic said the snow shoveling didn’t cause any problems at all. In fact, these folks who have been doing functional exercises in my office as part of their treatment plan said snow shoveling made them feel better! Even the patient who reported shoveling “what seemed like fourteen tons of snow” said they were better than ever.

At first, one patient said he thought it was “counterintuitive” that he did all that shoveling and felt better for it, but then said that it was counterintuitive before we started working together. Now, he realizes that instead of being “strained” by the shoveling, he was “trained”. Exercise properly done with a “functional body” provides training, not injury. Exercise with a less-than-functioning body…strain! Makes sense, no? Isn’t that why athletes train? So they can perform better?

But, what if they trained incorrectly? Can you see why that could lead to “overuse” (actually “misuse”) and/or micro-injuries?

At Capitol Rehab of Richmond, our approach for everyone from office workers to elite athletes, and from infants to seniors is that we want to help you get relief of your discomfort, regain mobility and improve your performance. We look at it as if you were in the “Life Olympics.” This doesn’t mean working out in a gym all year to get in shape so you won’t throw your back out once or twice a winter when you’re shoveling snow. It means getting your body into proper alignment and well trained so that you can handle LOTS of things without getting hurt—playing with kids or grandkids, cleaning, doing part of a home renovation project, raking leaves, carrying heavy shopping backs, stretching up to get something off a high shelf, and yes, shoveling snow.

Hope and Relief for Restless Leg Syndrome

By Dr. Len Mayer

Summary: Restless Legs Syndrome (RLS) is caused by disruptions in the brain pathways that when working properly, cause smooth, purposeful muscle activity. The DNS model of recovery addresses the core issues causing RLS by teaching your brain’s neuroplasticity to work for you instead of against you.

If you are among the 10% of Americans who suffer from Restless Legs Syndrome (RLS), you know exactly what its symptoms are. For those that aren’t familiar with the condition, it is a neurological disorder characterized by unpleasant sensations in the legs often describes as throbbing, creeping, pulling, and an uncontrollable and often overwhelming urge to move the legs. Sufferers usually experience symptoms at night or while at rest, and the severity of the discomfort can range from mild to excruciating.

RLS is one of the most confounding of modern illnesses because experts disagree on its roots and causes, and in fact its causes may vary from one person to another. For some, the cause may be related to another underlying condition (kidney failure, diabetes, Parkinson’s); for others, medications, alcohol usage, and sleep deprivation may exacerbate symptoms.

Many sufferers don’t seek treatment, worrying that their symptoms aren’t bad enough, that they won’t be taken seriously, or that there is no treatment. Those that do seek treatment often find themselves chasing down solutions on a trial-and-error basis, often including one or more of the following:
-Dietary changes (reducing caffeine and alcohol; nutritional supplements to correct iron, magnesium, and folate deficiencies)
-Lifestyle changes (moderate exercise, changing sleep patterns)
-Manual stimulation (massage and chiropractic care)
-Temperature therapy (hot baths, ice packs, heat packs)
-Medication

Relief is typically temporary or incomplete at best, because we don’t really know what causes RLS. And as with many of the other conditions I see, patients come to see me after playing whack-a-mole with symptoms and side effects, often for years.

Here’s what we DO know, according to the National Institutes of Health: “considerable evidence suggests that RLS is related to a dysfunction in the brain’s basal ganglia circuits that use the neurotransmitter dopamine, which is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements.”

I have been treating patients with RLS for thirty years (though the syndrome wasn’t widely called RLS until the late 1980’s), and in the last ten years, I’ve seen my success rate drastically increase with the introduction of a highly effective, integrated approach to recovery called Dynamic Neuromuscular Stabilization (DNS). I was trained in DNS 12 years ago by its creator, Pavel Kolar, in Prague. DNS is a treatment approach based on the neurophysiological aspects of movement as a child matures from birth to age four.

It makes perfect sense that DNS would help alleviate the core issues causing RLS. We know RLS has its origins in the brain even if the effects are seen in the legs. By using the neuroplasticity in your brain to work for you instead of against you, DNS can change the motor programs in your brain that control your movement and muscular activity so the changes can become automatic and permanent.

I’ve worked with dozens of RLS sufferers in Richmond, helping them find relief. Often the relief is total, and they no longer suffer from any symptoms. Even when we can’t cure RLS, we can usually provide those who suffer from it considerable relief. Our process starts with what we call a Functional Evaluation (FE), where we meet with you to assess your condition and determine whether or not our treatment can help.

To schedule your Functional Evaluation, please call our office at 804-285-4400 or email us at capitalrehabrva@gmail.com. Restless Legs Syndrome is a pernicious and exhausting condition, and we’d love to do our best to help you find some relief from it.