Z Health/ Mike T Nelson Testmionial

Testimonial Time!
Outstanding! Professional! Amiable! Thoughtful! Intelligent! Those are just a few words to describe my experience with Mike T. Nelson.

I arrived at Mike’s place hoping to be educated and find relief from some nagging injuries and poor movement habits to include a tight lower back, lack of movement in the hips and plantar fasciitis in my both my feet. My right foot being much worse than my left.

I left Mike’s place using hip muscles that I have not effectively used in, well maybe forever.

Within 2 weeks of performing the drills Mike provided for me my back pain disappeared and within 4 weeks the pain in my feet subsided dramatically. Only 5 days after working with Mike I did a marathon. I marched 17 miles and ran 9 miles with hiking boots and a backpack. Without Mike’s help I would not have been able to walk across the finish line, it would have been a crawl. A few times during the race the pain in my hips, due to poor movement, became very intense. When this happened I would stop marching/running and perform the Z-drills. This provided for instant relief and more efficient, fluent movement!

It’s been 5 weeks since my experience with Mike and I can play 2 hours of basketball with minimal pain in my feet! This was not possible pre Mike. Along with the Z-Health drills Mike provided for me he also gave me advice on footwear and he gave me a book on weight training. I left Mike’s place an improved man.

Thank you Mike for your first class service and I’ll be seeing you again.

Lucas Guili, Michigan
B.S. in Health/Fitness Management, Veteran of U.S.A.F.

Thanks again to Lucas for making the long drive and doing his exercises! Excellent work!
It is not always this easy, but about 70% of the time it is!
Drop me a line and book your session today.

Email Mike T Nelson by clicking here

Rock on
Mike T Nelson
PS
To see more testimonials check out the links below
Z Health MN

Testimonials

Z Health Testimonial from Joe Pavel and More Nervous System Research

Testimonial Time, Blogs, Fat Loss and Bone Health Connection?

Z Health Testimonial: Endurance Athlete

Testimonial Time, TSC 2009 Training and Lessons Learned

Pain is Bad for Performance: New Study on Shoulder Pain

I am sure everyone is tired of hearing me yack about how bad pain is for performance and proper muscle coordination. If you have missed my tyrants in the past, see the following by clicking on them

Biomechanics of Musculoskeletal Pain and A Shot to the Nuts

Pain and Performance

In this study, they created pain in healthy people and then saw that it decreased shoulder muscle activity. The researchers stated,

"During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles."

The body is showing an arthrokinetic reflex where it is working to protect the joint by starting to shut down the muscles around it. Makes sense since your body is survival based, not performance based. You can get an increase in performance by increasing the ability of it to survive. This is a basic concept taught in Z Health R Phase.

Mobility drills (like Z Health) can be used to correct the joints and thus muscular function.

For maximal performance, get out of pain. A vast majority of the time, better movement = less pain.

Below is the full study

The influence of experimentally induced pain on shoulder muscle activity

Louise Pyndt Diederichsen1, 4, 5 Contact Information, Annika Winther1, Poul Dyhre-Poulsen2, Michael R. Krogsgaard3 and Jesper Nørregaard1
(1) Institute of Sports Medicine-Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
(2) Department for Medical Physiology, Panum Institute, University of Copenhagen, Copenhagen, Denmark
(3) Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
(4) Division of Rheumatology, Department of Medicine, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
(5) Lodsvej 25A, 5270 Odense N, Denmark

Abstract
Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function.

Eleven healthy men (range 22–27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0°–105°) at a speed of approximately 120°/s, controlled by a metronome.

During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles.

EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles.

In conclusion, this study shows that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure.

Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load on the painful structures.

Z Health, Pain, and Limb Shaking?

Here is a thought for you Mike, A friend of mine shakes her hands, vigorously flapping them around, and claims it helps her hands. What effect would that vigorous joint mobility have from a Z health perspective? Steve Hendrickson


Similar idea. When you touch a hot stove, after pulling your finger away, what do you do next? Flap that finger around! Why? Because your body is friggin' smart, that is why! You are trying to increase motor function and potentially "drown out" the pain sensation.

Z Health does something similar, as it uses all ACTIVE mobility drills, so there is a motor component being sent from the brain to the joint/muscles.

The downside is that limb shaking works, but the body does not learn much from it; so it will probably need to be repeated often in the future for the same effect. Limb shaking may have some other temporary benefits like blood flow and lymph movement also. Active mobility drills (like Z Health) since they are done by actively moving the joint/limb in an INTENDED position will "stick" better; so you don't need to keep doing the exact same movements forever.

Good question!
Mike T Nelson

Biomechanics of Musculoskeletal Pain and A Shot to the Nuts

Here is a very interesting view of muscloskeletal pain based off the Neuromatrix of Pain.

Special thanks to Scott Perry, Z Health MT(p) for sending this study to me.

Biomechanics of Musculoskeletal Pain:
Dynamics of the Neuromatrix
Partap S. Khalsa, D.C., Ph.D.

And just to keep your attention, watch this and then continue reading



Understanding pain is very important for athletic performance since it is virtually impossible to achieve the highest level of performance while in pain.

If you don't believe me, go run 100 meters as fast as you can. Rest completely. Now before you run again I am going to kick you in the nuts really hard. Any bets on which time will be faster?

See older related posts (just click on them)
Pre-emptive Analgescis--what is he talking about now?

Pain Perception and the Neuromatrix--Guest Blog by Katelin Bigelow

Pain and Performance

Nerve Flossing Z Health Style: I Can Rotate My Neck!

Z Health Level 4 Work
I've had some questions about what the advanced (level 4) Z Health work entails lately, so I thought I would use an example from an athlete last night. This is just one item that is covered and is not the whole course. This material has existed before and was not invented by Dr. Cobb or Z Health, but it is an amazing tool.

I had the athlete rotate his head to the left and right and found that it was less than ideal. Actually it would only turn to about a 45 degree angle (which is not ideal, but relatively common). I remember Kent Johnson saying at the Z Health Master Trainer eval in CA last week to "not confuse common with normal" and I am going to steal that one!

I noticed that his sternocleidomastoid muscle (SCM) on each side would "pop" out when he turned his head. The SCM is a longer, strap like muscle that runs from under the ear lobe to the sterum (top part of the chest) /clavicle area (mastoid process of the temporal bone and superior nuchal lin for all you anatomy geeks--you know who you are).

The main motor nerve is the accessory nerve so we did some nerve glide work (nerve flossing) for it, had him walk and retested. He gained about 2Xs as much rotation and was able to go almost to 90 degrees on each side. Welcome to the Owl club! Whooooooo whhhooo (you know, that noise owls make)
Nerve Flossing?
Nerve glides or nerve flossing is a technique where an exercise is performed while a nerve is SLIGHTY tensioned. Just like flossing your teeth, the nerve is moved a little bit through various tissue to allow better movement of the nerve itself.

Nerves are a HUGE priority for the body and since the body is survival orientated, it will go to great lengthens to protect the nerves. This includes shutting down muscular function and force production along with range of motion (ROM). Result--not good for athletic performance!

How Can I Do It If I am Fitness Professional?
Anyone interested in can sign up for the Z Health Level 4 cert, but you must do R Phase then I Phase first (which are both amazing). Drop me a line and I am more than happy to chat with you about it or call the Z Health office directly by clicking HERE for more info and be sure to tell them Mike T Nelson sent ya.

Full disclosure: I am not currently an employee of Z Health, nor do I make any money off of referring people to their certs. I do get a few bucks off future certifications that I take though.
What If I Just Want To Get Better Myself?
Keep in mind that any active joint mobility drill (like the Z Health R Phase exercises) also work to slightly move the nerves, lymph, blood, and active muscle etc by themselves! That is another reason why precise, active joint mobility work is so important. As always, make sure it is done in a relaxed state and NO pain!

You can purchase the R Phase manual and 2 DVD set on the link from the upper right.
Full disclosure: the price here is the same as anywhere else, and I do make a few bucks off each one. Again, I never recommend anything that I don't 100% believe in.

If there is a Z Health trainer in your area, that would be your best bet. You can never replace custom work for YOUR body.

Summary
Nerve glide work can have amazing effects very fast when it is the bottleneck. As with anything else, it is not always this easy, but about 50-70% of the time with the correct knowledge it can be!

Any comments/thoughts, let me know.

Selected References
A great review is
"Improving application of neurodynamic (neural tension) testing and treatments: a message to researchers and clinicians".Shacklock M.

His book "Clinical Neurodynamics: A New System of Neuromusculoskeletal Treatment" is one I own and is quite good.


The ones listed below are a good place to start and are taken from "Neurodynamics in a broader perspective". By Butler DS, Coppieters MW


Butler DS. Mobilisation of the nervous system. Melbourne: Churchill
Livingstone; 1991.

Butler DS. The sensitive nervous system. Unley: Noigroup Publications;
2000.

Butler D, Gifford L. The concept of adverse mechanical tension in the
nervous system. Part 2: examination and treatment. Physiotherapy
1989;75(11):629–36.

Coppieters MW, Butler DS. Do ‘sliders’ slide and ‘tensioners’ tension?
An analysis of neurodynamic techniques and considerations
regarding their application. Manual Therapy, 2007, accepted
pending minor changes, in press [Epub ahead of print; doi:10.
1016/j.math.2006.12.008].

Erel E, Dilley A, Greening J, Morris V, Cohen B, Lynn B.
Longitudinal sliding of the median nerve in patients with carpal
tunnel syndrome. Journal of Hand Surgery [Br] 2003;28(5):439–43.

Gifford LS. Factors influencing movement—neurodynamics. In: Pitt-

Brooke J, Reid H, Lockwood J, Kerr K, editors. Rehabilitation of
movement. London: WB Saunders; 1998. p. 159–95.

Greening J, Leary R. Letter-to-the-editor in response to the editorial
by Shacklock (doi:10.1016/j.math.2005.03.001). Manual Therapy,
2006 [Epub ahead of print; doi:10.1016/j.math.2006.01.004].

Hough A, Moore A, Jones M. Restricted excursion of the median
nerve in carpal tunnel syndrome. In: Proceedings of the second
international conference on movement dysfunction, Edinburgh,
2005.

Maitland G. The slump test: examination and treatment. The
Australian Journal of Physiotherapy 1985;31(6):215–9.

Moseley GL, Nicholas MK, Hodges PW. A randomized controlled
trial of intensive neurophysiology education in chronic low back
pain. Clinical Journal of Pain 2004;20(5):324–30.

Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM,
Bartko JJ. Nerve and tendon gliding exercises and the conservative
management of carpal tunnel syndrome. Journal of Hand Therapy
1998;11(3):171–9.

Shacklock M. Improving application of neurodynamic (neural tension)
testing and treatments: a message to researchers and clinicians.
Manual Therapy 2005a;10(3):175–9.

Shacklock MO. Clinical neurodynamics: a new system of musculoskeletal
treatment. Edinburgh: Elsevier Butterworth-Heinemann;
2005b.

Shacklock M. Author’s reply to the letter-to-the-editor by Greening
and Leary (doi:10.1016/j.math.2006.01.004). Manual Therapy,
2006 [Epub ahead of print; doi:10.1016/j.math.2006.01.005].

Tuzuner S, Ozkaynak S, Acikbas C, Yildirim A. Median nerve
excursion during endoscopic carpal tunnel release. Neurosurgery
2004;54(5):1155–60.

Valls-Sole J, Alvarez R, Nunez M. Limited longitudinal sliding of the
median nerve in patients with carpal tunnel syndrome. Muscle &
Nerve 1995;18(7):761–7.

Neuroplasticity and Human Athletic Performance

It is all in your head?

The future is upon us and my crystal ball prediction for 2009 is that neuroplasticity (the ability of the brain to change) will gain popularity and for good reasons.

I find the science in this area amazing. Just a few years ago we thought that the brain would not change and now we know this is not true at all. The brain actually has an amazing ability to adapt and change (just like everything in human physiology). Most probably seen the PBS special "The Brain Fitness Program" which is fantastic.

The key to this idea is that learning new movements can have a huge effect on neuroplasticity. While hardcore research studies in this area are a bit lacking currently, there is enough data to show that when we learn movements there are concrete changes in the brain. The keys to enhanced athletic performance are findings ways to harness this neuroplasticity as the brain and nervous system control movement. The flip side is also true, for optimal health, we need to learn more athletic movements and challenge the brain in new ways.

Survival vs Performance
The human body is wired for survival instead of performance. This really bums me out personally, but once we realize this we can optimize it for survival and see an increase in performance! I have a whole presentation I did at the Z Health Master Trainer Eval in California recently on this topic. The short version is that we need to first look how we get information.

Primarily it is from
1) Eyes (visual and eye muscle movements)
2) Vestibular (inner ear "balance")
3) Proprioceptive (info from the joints)

In order to optimize the body for performance (and pain reduction), we need to optimize each one of these systems. This is what I really love about the Z Health system, as it works to optimze each system and then combine them in a meaningful way. The result is superior athletic performance for virtually ANYONE. Everyone can learn to move more athletically and do things that they thought were not possible with the correct approach.

Below is a great article in Outside magzine on neuroplasticity. While I don't agree with their exercises and would do it a different way; there is some great information.

Timeto exercise your mind AND body! See these related posts

Movement and Brain Deterioration? New Study

Stroke of Insight

Z Health S Phase Wrap Up

Z Health Level 4 Wrap Up and Good vs Bad Calories

Neuroscience Research Updates for October

Z Health and Biomechanical vs Neurological Approach

Total Life Fitness
Clear Your Head
Wellness 2009 from

Outside Magazine, January 2009
By Nick Heil

Brain training is suddenly big business. But can you get smarter without geriatric video games or wildly expensive lab tests? As our Lab Rat learned, yes.

The mental calisthenics were pretty simple at first: Could I pick up an envelope off the floor? Did I know where I was? Then came the stumper: What day was it? "Wednesday … wait a minute." I glanced around the room for clues. Nothing. "It's Tuesday. No, Monday!" I blurted to Tonya Kydland, a psychologist who works at Cognitive Fitness and Innovative Therapies (CFIT), a brain-fitness facility in a leafy section of Santa Barbara, California. Kydland nodded and, wearing a serious expression, jotted something in her notebook.

TAKE ACTION: Sharpen Up

Think you don't need to work your noggin? Try this simple test: Have a friend read two random four-digit sequences to you (for instance, 5-3-8-9 and 2-5-3-8). As soon as they finish, repeat the numbers out loud, but in reverse order (9-8-3-5 and 8-3-5-2). Next, try it with two six-digit sequences, then two eight-digit sequences. If you failed to nail it, your short-term memory could use work. Try any (or all) of the following brain-building tools—which also promote long-term mental health—20 minutes a day, three times a week. 1. CogniFit (cognifit.com). Their MindFit DVDs are loaded with brain-benders such as the Stroop Test, which trains reaction time and memory. The program customizes difficulty levels according to each user's ability and has been shown to improve everything from general health to driving. 2. HappyNeuron (happy-neuron.com). These online entertainment-oriented games improve attention, language, and memory. Try "Heraldry," which requires you to memorize various coats of arms. 3. Nintendo Brain Age (brainage.com). This game for the pocket-size Nintendo DS features numerous brain-building challenges, from simple math problems to mega-popular games like Sudoku. 4. Six-string guitar. Buy a beater on eBay and commit yourself to practicing three times a week. And play scales, not just the three chords you need to hack through "Free Fallin'. " You'll improve your memory, keep your mind in top shape—and impress at the next cookout.

CFIT is a new kind of mental-health outfit. Unlike the exploding number of commercial enterprises that purport to sharpen the mind using various electronic games and gizmos, CFIT addresses the whole picture: physical fitness, diet, mental activities, personal relationships, and medical history. "The idea here is to provide a thorough baseline assessment, then set you up on a program that will optimize your lifestyle to promote cognitive health," says Ken Kosik, CFIT's founder and a professor of neuroscience research at the University of California at Santa Barbara. In other words, CFIT is an everyman's brain gym: You pay an annual membership fee of about $4,000 and make twice-weekly visits to the place, à la Equinox.

Brain fitness has become big business over the past few years. Cerebral-exercise computer games from companies like CogniFit and HappyNeuron generated $80 million in 2007, up from $2 million just three years earlier. An increasing number of high-end labs, such as Los Angeles–based Elite Sports Performance, help wealthy clients tweak attention-honing brain waves using EEGs and other state-of-the-art technology. CFIT, which is scheduled to be fully open for business by late 2008, offers something entirely different: an accessible, one-stop mind shop that promises to transcend the realm of the wonky and geriatric. For now, half of CFIT's pilot group consists of retirees with looming cognitive trouble—the most ready and willing clients of the brain-training world—but Kosik's vision is far bigger.

"I can see this sort of facility all over the country, for all kinds of people," he says. (There's talk of opening a second CFIT facility in San Diego, with more on the horizon.) "The time to focus on brain health is when there is no disease at all."

Until about 15 years ago, many experts believed the brain was hardwired, and that once mental deterioration set in, it was irreversible. But recent neuroscience research has convinced the scientific community that the brain is malleable into old age. This principle, called neuroplasticity, has neurologists racing to tweak the mind in order to improve sports and job performance—and even stave off or reverse problems like Alz­heimer's and Parkinson's. CFIT aims to prevent these illnesses, but also to teach people how to maintain their intelligence and mindfulness over the long term. And that pro­cess begins with the rest of the body. "People forget that the brain is an organ, like the heart and lungs," Kosik says, "and that it benefits from exercise and sound nutrition."

My first step was to come clean on how often I floss (only in that pre-dental-exam panic), whether I do drugs (uh—cough, cough—no), and how much red wine and chocolate I consume (plenty). Once the staff reviewed my general health, it was time for a little mind fitness. The exercises—involving a stationary machine called the NuStep, a cross between an elliptical trainer and a stationary bike, and a widescreen TV set up with Nintendo's Wii—were pretty basic at first. I experienced minor guilt pangs when, during a round of Wii boxing, I knocked out CFIT's petite director, Hether Briggs (well, her avatar, anyway).

I got my comeuppance during the neuropsychological evaluation. I aced a few of the initial tests, then struggled to remember what day of the week it was. I could repeat from memory a string of eight numbers in reverse, but for some strange reason I messed up while attempting the same exercise with just four numbers. At the end of our hourlong session, Kydland asked me if I could recall the questions she'd asked when I first entered the room (Do I wear glasses or use a hearing aid? How old am I?). I drew a blank. And then I felt a sudden chill. Was this a warning sign of bigger problems?

Before I mustered the nerve to ask this question, CFIT set me up with some mental exercises on a brain-training computer program called MindFit that involved various memory and hand-eye-coordination games. At first, it was about as challenging as desktop solitaire, but it got progressively harder, until I was floundering again. Clearly, I could use some more brain push-ups.

The next day I sat down with the CFIT team to review my performance and discuss a long-term DIY program. This is the most innovative and impressive aspect of CFIT: They put all the components of mental fitness together in a practical, manageable training program. In lieu of cool-but-mostly-useless brain scans that might show my frontal lobe lighting up like a Christmas tree (or not), I got smart advice that I could take home and apply immediately.

To wit: My physical fitness is fine; keep it up, Kosik told me. He offered nutrition suggestions, like adopting the olive-oil-and-fruit-rich Mediterranean diet, which, according to a 2008 study in the British Medical Journal, promotes a 13 percent reduction in the occurrence of Parkinson's and Alzheimer's. Kosik also advocated a few supplements, like calcium, high-quality fish oil, and folate (a B vitamin that may prevent Alzheimer's). My team prescribed three 20-minute CogniFit sessions a week; though, to be honest, I'm more likely to commit my time to other equally effective brain-benders, like the Sunday crossword puzzle, Sudoku, learning guitar, or tackling another language—anything, basically, that presents fresh challenges. "The better you get at a given activity," said Kosik, "the less brain you use."

One of the most compelling things I came away with is also the simplest: the vital importance of friendships. "A healthy and active social network is probably one of the best predictors of long-term mental health," Kosik said.

"So I should keep playing soccer and going on ski trips with friends?"

"Absolutely," he said.

Before I left, I had to ask Kydland about my quirky performance during the neuropsych tests. Was this, as I feared, a sign that I'm on the road to senility? "Don't worry," she said reassuringly. "You scored completely within the normal range. You just weren't paying attention."

TAKE ACTION:
Reprogram Your System
Know that feeling when you want to keel over at mile five on your run? That's your brain playing mother hen. Sports scientists are realizing that everything from how fast you can run a 10K to how long you can bike at 20 mph is determined by the brain's understanding of the body's limits—a protective mechanism known as "anticipatory regulation."
"Job number one for your brain during exercise is to prevent you from working yourself to death," says Ross Tucker, an exercise physiologist and consultant to the Sports Science Institute of South Africa. This subconscious safety net is usually more conservative than it needs to be, unless you're an elite athlete. And research suggests that amateurs can boost their performance with workouts that safely recalibrate the brain's protective mechanism. Here's how.

1. Wear a stopwatch or heart-rate monitor and warm up with ten minutes of easy swimming, jogging, or pedaling. Increase your effort to the fastest speed you think you can sustain for 20 minutes. But don't look at your watch—hold your pace until you think you're near exhaustion. Stop and cool down.

2. Jot down your average pace (for example, 7:30 mile for a run) and the amount of time you held that pace (don't feel bad when it's not even close to 20 minutes). Repeat the workout once a week and try to sustain the same pace for a slightly longer duration each time. Again, don't look at the clock—push yourself by feel. Expect some improvement in your second try at the workout—not because you're more fit, but because your brain is comfortable letting you work harder.

3. In each subsequent workout, you should be able to go farther, thanks to improving fitness and a slightly less conservative brain.

—MATT FITZGERALD

Body Image and Pain-New Study

Twitter!
Just a heads up that I am on Twitter now. I will be posting some training, nutrition and neurology tips, cool studies I find, what I've been up to, etc. The longer updates will still be by my newsletter (sign up in the upper right of this blog) and blog updates of course! I will have tips and tricks on Twitter that I won't have in other places.

Look for the twitter updates on the right hand side of my blog or you can chose to follow me by clicking this button HERE and then the "follow" button under my pic.

Anything you want to see, feel free to let me know!

New Neurology Study Time
Below is an amazing study showing once again the power of the brain!

The researchers had the subjects view their limb through binoculars to make it appear bigger or smaller. When the limb appeared bigger, the pain was increased. When it was made to look smaller, the pain decreased!

That alone is cool enough, but here is the really amazing part. In this study, they used an objective measure to verify the participants' reports of the pain they experienced. Most of the time Visual Analog Scale (VAS) is used which is simply a rating of pain from 1-10. This has been shown to be repeatable, but it will always be subject to the participant's "feeling"of pain and it is not a direct method.

In this study, they measured the swelling of the fingers in the "pain hand" and compared it with the unaffected hand. They found more inflammation when the participants saw a magnified view of their hands!! So we have a DIRECT measure showing a direct correlation of how they "see" their hand appearing to control inflammation.

Not to beat a dead horse, but once again it shows how we even PERCEIVE an event has a DIRECT effect on inflammation and most likely healing. Wow, that makes your head spin.

Z Health uses these principles also since at a base level it works to correct any bad "maps"in the brain. Remember that the brain is always creating various maps and it primarily gets its information from 1) proprioception (information from the joints) 2) eyes (both vision and eye muscle movements) and 3) vestibular (inner ear "balance"). If any of these systems are sending "bad" information to the brain, them map created is also bad.

If I want to drive to Chicago from Minneapolis and I follow a bad map, how long will it take me? Well, that depends on how fast I drive and how bad my map is! We need a good map or else we are screwed for starters.

Better maps = better movement
Better movement = less pain.

See these related posts
Dopamine, Mood, Movement and Exercise

Mobility Work Is the Missing Link for Fat Loss

Myth Busters: Painful Soft Tissue Work

Pre-emptive Analgesics

Invasion of the Body Snatching Scientists?

Pain Perception and the Neuromatrix of Pain

Overload and Muscle Soreness (DOMS)

Here the abstract and another version of it form Scienficific Amercian.
Thoughts?


Current Biology, Volume 18, Issue 22, R1047-R1048, 25 November 2008

Visual distortion of a limb modulates the pain and swelling evoked by movement

G. Lorimer Moseley1,2,,Timothy J. Parsons1andCharles Spence3

1 Department of Physiology, Anatomy & Genetics, University of Oxford, UK
2 Prince of Wales Medical Research Institute, Sydney, Australia
3 Crossmodal Research Laboratory, Department of Experimental Psychology, University of Oxford, UK

Summary

The feeling that our body is ours, and is constantly there, is a fundamental aspect of self-awareness [[1]]. Although it is often taken for granted, our physical self-awareness, or body image, is disrupted in many clinical conditions [[2]] (see also [[3]] for a list of such conditions). One common disturbance of body image, in which one limb feels bigger than it really is, can also be induced in healthy volunteers by using local anaesthesia or cutaneous stimulation [[4]]. Here we report that, in patients with chronic hand pain, magnifying their view of their own limb during movement significantly increases the pain and swelling evoked by movement. By contrast, minifying their view of the limb significantly decreases the pain and swelling evoked by movement. These results show a top-down effect of body image on body tissues, thus demonstrating that the link between body image and the tissues is bi-directional.

Source: Scientific America Mind Matters Dec 23, 2008

Distorted Body Images: A Quick and Easy Way to Reduce Pain

As it turns out, size also matters when it comes to pain perception.

By Moheb Costandi

The body image is a mental representation of one's physical appearance, constructed by the brain from past experiences and present sensations. It is an essential component of self-identity, which, when altered, can have dramatic effects on how one perceives oneself. For example, a small proportion of migraine sufferers experience visual hallucinations just before the onset of a headache, in which the body parts appear larger or smaller than they actually are. Lewis Carroll, who is known to have suffered from migraines, documented such hallucinations in Alice in Wonderland.



These body image distortions can have bizarre consequences. Otherwise healthy people report that they have always percived a part of their body as feeling "wrong," and opt to have it removed by amputation; some brain-damaged or psychiatric patients experience alien hand syndrome, in which they deny ownership of a limb, and insist that it is under the control of external forces.

Our perception of our own body can, of course, be easily manipulated. As we walk through a house of mirrors at a fair, for example, we may view ourselves as being very short and fat one minute, and then very tall and thin the next. By looking through a pair of binoculars, a limb can be made to appear disproportionately large or small.
One might think that such temporary manipulations would be of little consequence. After all, we know that our body doesn’t really look like that. However, a study published recently in the journal Current Biology shows that a simple manipulation of the visual image of one's body can significantly alter the perception of pain. These findings have important implications for how clinicians manage the treatment of pain.

Binoculars as Pain Killers
For the study, Lorimer Moseley of Oxford University and his colleagues recruited 10 participants, all of whom suffer from chronic pain in their right arm. The participants were asked to perform a set of movements with their right arm, under different conditions. In one condition, they observed their limb through a pair of binoculars, which magnified their hand to twice its normal size; in another, the binoculars were inverted so that their hands appeared smaller than they actually were.

As they performed the arm movements, the participants were asked to rate the amount of pain they experienced. Each one reported that the pain they felt became markedly worse when they moved their limb. Surprisingly though, every participant also reported that the extent to which their pain increased depended on how their vision had been manipulated. They reported the greatest increase in pain when they saw a magnified view of their hand, and the smallest increase when their hands were minified.

The researchers used an objective measure to verify the participants' reports of the pain they experienced—they measured the swelling of the fingers induced by the movements, and compared it with the unaffected hand. Sure enough, there was more inflammation following the movements when the participants saw a magnified view of their hands. By contrast, the researchers measured less swelling of the fingers following the movements performed with a minified view, in line with the participants' subjective reports of experiencing less pain under that condition.

Furthermore, the visual manipulations also affected the time taken for the participants' pain to return to the level it was at before the movements were performed: recovery to the pre-movement level of pain was quickest in the "minified" condition and slowest in the "magnified" condition.

Top-Down Perception
These findings clearly demonstrate that the mere appearance of a limb—making it appear larger or smaller than normal—can directly modulate our experience of bodily pain. Exactly how distorting the body image in this way affects the perception of pain remains unclear.

One possibility is that magnifying the view of the hand enhances the sense of touch, whereas minifying it has the opposite effect. Some evidence for this comes from a 2001 study, which showed that magnifying subjects' arms improved their ability to discriminate between needle points placed close to each other.

Alternatively, the authors suggest that manipulating the image of the hand may have altered the participants' sense of "ownership" of their painful limb. Viewing magnified images of their hands may have made the participants more aware that the limb belonged to them, thus increasing their sensitivity to the painful sensations originating from it. Conversely, the minifying condition may have "alienated" the participants' arms, reducing their sense of ownership of their limb and thus desensitizing them to the pain felt in them.

Regardless of the mechanism, these findings could lead to new methods for improving the rehabilitation regimes administered to patients with a wide variety of conditions. Most obviously, they point to a simple way for the effective management of chronic pain. They may also prove to be useful in helping patients with alien hand syndrome and related conditions to regain ownership of their limbs.

It is now well known that physical changes to the body alter the brain's representation of it. In the case of amputation, for example, the changes that take place in the brain lead to phenomena such as phantom pain, in which painful sensations are felt from the missing limb. This relationship between body and brain is referred to as "bottom-up"; this study, however, suggests a "top-down" relationship—it seems that the visual inputs (the participants' views of their hands) were sufficient to override the tactile sensations (the felt pain), by fooling the brain into modulating them.

Are you a scientist? Have you recently read a peer-reviewed paper that you want to write about? Then contact Mind Matters editor Jonah Lehrer, the science writer behind the blog The Frontal Cortex and the book Proust Was a Neuroscientist. His next book, How We Decide, will be available in February 2009.

Research Update: December: Ergogenics-Caffeine and Asprin

Here is a video of a bunch of crazy Minnesota kiteboarders from the last trip to South Padre Texas at the end of Nov and early Dec. If you look closely around 2:22 you will see yours truly and Jodie enjoy a great post session beer (Shiner Bock, the local brew is great). The live action kicks in around 4 minute mark.

Special thanks to Randy for the video! Nothing better than a great day on the beach, some kiteboarding in great winds, sunlight and lots of great friends. Excellent times!



More research!
I am behind on getting some cool studies out to all of you. If you have any questions at all, feel free to post them in the comments and I will try to get to them as soon as I can. I know many smart people read this blog, so I am interested in your thoughts or even just basic questions so that all of us can learn more.

Very cool study since caffeine in higher doses may have an analgesic (pain killing) effect. Adding aspirin may work via a similar mechanism also.

I remember "back in the day" some strength coaches promoting a baby aspirin before lifting for this effect and also so that it may thin your blood a bit for better oxygen delivery. I have not see any research on the latter and personally I am not a fan of blunting the pain response for strength training at all since pain is vital feedback--you want to know if you did something wrong!

The only time it may be worth trying is for very long distance events (tris, marathons) if you are doing it as a professional and your income depends on upon it. Even then I would highly recommend those athletes to try a higher dose of caffeine first IN TRAINING. Do NOT make ANY changes before a big race!

We know that pain negatively affects performance, so the theory behind the study is sound. The tricky part is that caffeine has many different physiologic effects in the body.

Interestingly, caffeine, aspirin (or acetaminophen aka Tylenol) is commonly found in over the counter headache medicine.

Effects of caffeine and aspirin on light resistance training performance, perceived exertion, and pain perception.

Hudson GM, Green JM, Bishop PA, Richardson MT.

Department of Health, Human Performance, & Recreation, Baylor University, Waco, Texas, USA. Geoffrey_Hudson@baylor.edu

This study compared independent effects of caffeine and aspirin on muscular endurance (repetitions), heart rate (HR), perceived exertion (RPE), and perceived pain index (PPI) during light resistance training bouts performed to volitional failure. It was hypothesized that the hypoalgesic properties of these ergogenic aids would decrease pain perception and potentially result in enhanced performance.

College-aged men (n = 15) participated in a within-subjects, double-blind study with three independent, counterbalanced sessions wherein aspirin (10 mg x kg(-1)), caffeine (6 mg x kg(-1)), or matched placebo were ingested 1 hour before exercise, and RPE, HR, PPI, and repetitions (per set and total per exercise) were recorded at 100% of individual, predetermined, 12-repetition maximum for leg extensions (LE) and seated arm curls (AC). Repeated-measures analyses of variance were used for between-trial comparisons.

Caffeine resulted in significantly greater (p <>or= 5 repetitions) for total repetitions, with 53% exceeding the effect size (>or= 2 repetitions) for repetitions in set 1 with caffeine (vs. placebo). In AC, 53% (total repetitions) and 47% (set 1 repetitions) of participants exceeded effect sizes with caffeine (vs. placebo), with only 13% experiencing decrements in performance (total repetitions). Aspirin also produced a higher PPI and RPE overall and in set 1 (vs. placebo).

Conclusion: This study demonstrates that caffeine significantly enhanced resistance training performance in leg extensions and arm curls, whereas aspirin did not. Athletes may improve their resistance training performance by acute ingestion of caffeine. As with most ergogenic aids, our analyses indicate that individual responses vary greatly.

My notes:
The caffeine dose used here is on the higher end and comes out to be about 600 mg for an adult male around my size (about 21o lbs), which is about 3-4 standard cups of coffee.

It showed that caffeine at this dose for this protocol did help performance.

Ironically, asprin INCREASED the percieved pain and RPE (rating of percieved effort--the weights felt heavier) which is an odd finding.

See related posts below

More Caffeine!!

Caffeine and Testosterone--Is There a Connection?

Another Coffee Study and Caffeine Speeds Recovery?

Red Bull Will Give You a Stroke! What?

Update on Energy Drinks--Caffeine experts call for warning labels for energy drinks

Any Thoughts on Accupunture and Pain?

Question: Is there any new data to support the use of acupuncture for pain?

Answer: Yes, there are some new data on the use of pain and acupuncture.

Note, for a review on my thoughts on pain, see the following posts

Myth Busters: Painful Soft Tissue Work
Pain Perception and the Neuromatrix of Pain
Pre-emptive Analgesics
Overload and Muscle Soreness (DOMS)

Recently there are 2 newer reviews on acupuncture and its effect upon pain.

The first one (below) is a review of 31 studies using acupuncture and sham acupuncture. Sham acupuncture is where they still poke you with a needle, but they are not putting it in the correct location. This is very important when reading studies (especially on acupuncture) since the placebo effect can be huge! Take one group and poke them with needles (acupuncture group) and don't do anything to the control group and many times you will see that the acupuncture group was better! Well, most in the treatment (acupuncture) group quickly figured out that they were in the treatment group and those that had nothing done quickly realized they were in the control group.

Many times it possible to have a control group. If you are doing a study on a new implantable medical device, it is considered unethical to implant the device in a group of patients that have NO medical need for it just to lessen the placebo effect. This can also make enrollment in some trials more difficult if the patients already believe the device will help them and may drop out if they are randomized to the control arm (no device).

So in our first acupuncture study they used only studies that had a comparison to the sham acupuncture group. They concluded "Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate."

In the second study, they looked at post operative pain. While it does appear that they only took studies using acupuncture and a sham control procedure, it appears that there may be some benefit to acupuncture post surgery. Now this may be a placebo (not sure what they used for a sham control), but if by inserting a small needle into you allows your body to need fewer drugs for the same effect on pain--sign me up!

How does this relate to training?
1) Be sure to read studies closely and think about the placebo effect.
2) The mind is very powerful. You will achieve what you believe

Thoughts?


Acupuncture for the Management of Chronic Headache: A Systematic Review. Sun Y, Gan TJ. Duke University Medical Center, Department of Anesthesiology, Box 3094, Durham, NC 27710.

Anesth Analg. 2008 Dec;107(6):2038-2047.

OBJECTIVE: The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache.

METHODS: We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods.

RESULTS: Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17).

CONCLUSION: Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.

Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials.
Sun Y, Gan TJ, Dubose JW, Habib AS.

Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA.

Br J Anaesth. 2008 Aug;101(2):151-60. Epub 2008 Jun 2.

Postoperative pain management remains a significant challenge for all healthcare providers. The objective of this systematic review was to quantitatively evaluate the efficacy of acupuncture and related techniques as adjunct analgesics for acute postoperative pain management. We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials (RCTs) using acupuncture for postoperative pain management. We extracted data about postoperative opioid consumption, postoperative pain intensity, and opioid-related side-effects. Combined data were analysed using a random effects model.

Fifteen RCTs comparing acupuncture with sham control in the management of acute postoperative pain were included. Weighted mean difference for cumulative opioid analgesic consumption was -3.14 mg (95% confidence interval, CI: -5.15, -1.14), -8.33 mg (95% CI: -11.06, -5.61), and -9.14 mg (95% CI: -16.07, -2.22) at 8, 24, and 72 h, respectively. Postoperative pain intensity (visual analogue scale, 0-100 mm) was also significantly decreased in the acupuncture group at 8 and 72 h compared with the control group.

The acupuncture treatment group was associated with a lower incidence of opioid-related side-effects such as nausea (relative risk, RR: 0.67; 95% CI: 0.53, 0.86), dizziness (RR: 0.65; 95% CI: 0.52, 0.81), sedation (RR: 0.78; 95% CI: 0.61, 0.99), pruritus (RR: 0.75; 95% CI: 0.59, 0.96), and urinary retention (RR: 0.29; 95% CI: 0.12, 0.74).

Perioperative acupuncture may be a useful adjunct for acute postoperative pain management.

Pain and Performance

Pain and Performance

Melzack defined the Neuromatrix of pain as “pain is a multidimensional experience produced by characteristic ‘neurosignature’ patterns of nerve impulses generated by a widely distributed neural network-the ‘body-self neuromatrix’-in the brain (3).”

Anyone still there? Wow, that does sound like something right out of the movie the Matrix with big fancy words like “multidimensional” “neurosignature” “neural network” are we still talking about physiology today or in 2050? The above quote was actually from 2001, so coming up on seven years ago now, but you would be hard pressed to find a ton of acceptance to the theory
(although momentum for it gaining steam).

But how does this relate to me? I just want to perform at a higher level?
A brief tangent about pain

The old school view of pain was that when you stuff that hot cream cheese puff from the Chin Young buffet in your cake hole, the signal travels from your tongue into the pain center in your brain. The hunt was on as scientist spent years trying to find this elusive, Bigfoot like creature in the brain. Let’s try the cortex, maybe that is it? Nope. Thalamus? Not it again (10). On the search went, but to no avail (9). The thought was that once we find the pain center, we can cut it out, ablate it, drug it and bammmm-o, no more pain. While this fantasy sounds awesome, it is just that---a fantasy as physiology is not quite that simple. We now know that there is no pain center. Drat, so much for the trying the easy stuff first. We know that pain does live in the brain, but it is multidimensial (there is that word again); most likely stored away in the nooks and crinkles just like a squirrel hiding nuts for the winter in your lawn.

Pain is produced when the brain perceives that danger to body tissues exists and that action is required as a survival response. Back to our friend at the buffet with the hot cheese puff in his mouth. What happens next? He either tries to dump the said cheese puff on to the plate in a very non conspicuous way (can you give me a “good luck buddy” shout), or add some cold water perhaps. Either way, it is highly unlikely he will sit there as it smolders into his tongue and pollutes the room with the smell of burning flesh. Pain is an action signal-do something!
The brain and the nervous system control ALL muscle movements. When pain occurs it inhibits the nervous system as a protective mechanism. Remember that the body only cares about survival and does not give a hairy rat’s butt about performance. If I injure my elbow, my nervous system will start to shut down the muscles around that joint as a protective mechanism to try to prevent further damage (ala arthrokinetic reflex).

The Neurosignature
Pain is a specific interpretation of the brain, or as Melzack calls it a “neurosignature” (no that is not how Neo from the Matrix signs his name, that would be the neosignature). This neurosignature is dependent on many imputs (multidimensional). The main inputs into the brain are proprioceptive, visual, and vestibular. Remember that proprioception is the body’s 3D map of itself and allows you (ok your friend) to touch their nose with their eyes closed when they get pulled over by the Smokey along the road. Everyone is familiar with vision, as we are highly visual creatures (some would argue males more so than females, but I won’t go there). Vestibular refers to the function of the inner ear and balance. With every step we take (yes even with every breath you take for all you Police fans), the brain is receiving inputs from each of these systems and combines them to form a neurosignature. I hear some academics in the back shouting “where is the data” so here you go.

Phantom Limb Pain
Many times those who have lost a limb, will complain of pain coming from their lost limb! At first blush, the thought “they must be insane” runs through my head, but several studies have shown this to be true in very sane people; and the pain is real (5). How can this happen? So the very same inputs that provide the brain with signals interpreted as pain, can run amok in the brain and actually produce pain!(4) So it is not just a one way system, as the brain it seems can produce pain that feels like it was coming from the lost limb-kind of like working for a double agent. Imagine you are a super top secret agent (inputs from the body) hired by Emilio the Shark (the brain) to get info on those sneaky Russians (lost limb). Yeah those Russians are sneaky, so watch out Pavel, But you then learn that Emilio the Shark has sold you out and is just creating information for the Russians! Dang it. So the brain appears to create pain from the lost limb.

The pain can many times be induced by a conflict between visual feedback and proprioceptive representations of the amputated limb (8). If this is true, it should be fixed by reversing this and presenting a “working limb” to the brain, right? By using a mirror box, you can create an image (from the good limb) to appear where the lost limb would normally be in space. This can “trick” the brain into believing there is a limb there, and many times the pain will diminish (1).

Placebo Effect
Everyone has heard of the placebo effect by now. While there are many different flavors of it, it is believed that the brain (and perhaps the spinal cord) play a key role! Obvious I know. Pain depends on both biological and psychological factors (2). Matre et al. (2) did an experiment where they heated up a small patch of skin on volunteers (always read the fine print) and the only difference was that one group was told that this special magnet (which was not even a magnet, just a lump of iron to look like a magnet) would reduce the pain. Sure as heck, it did just as predicted with the placebo group reporting less pain! Other studies have shown similar results (6), and it is common place to include a placebo group in almost any experiment.

Seriously man, how does ANY of this help me?
Ok, so we know that changing the inputs to the brain via proprioception, visual, and even vestibular inputs can alter the perception of pain. Even the context of the event (placebo effect) can even alter it (7). So how goes this help you increase performance?

Pain and Performance
Pain becomes a huge priority in the body and if you are not sure, then ask anyone in pain! Remember that we are a survival based organism and while pain works great to keep us alive at certain times, if you are dealing with pain you will not have peak performance. Still don’t believe me? Go out and run your fastest 100 meters. Now have Emilio the Shark kick you square in the nut sack and try it again. I can guarantee your second performance will not be as stellar.
Just as in the mirror box example, we can alter the brain’s perception of pain via proprioceptive, visual, and vestibular input! Injury is a big event and it carries a pretty hefty neurosignature. I worked with a client that had sprained his left ankle pretty bad at a fun house and we used these principals. As he was walking through the fun house, minding his own business, a super scary dude jumped out at him as he turned his head to catch a glance of him. Unfortunately at the same time, he stepped wrong with his left foot and rolled his ankle. So I set out to use some Z Health “voodoo” on him. Actually Z Health is a system based on the principals discussed here for altering the inputs into the brain to reduce pain and increase performance (Z Health in MN ); so I need to credit Dr. Cobb the creator of Z Health for all of his efforts.

Back to our fun house friend and I had him do a specific Z Health joint mobility drill to increase the proprioceptive input (this was a wrist up and down motion), with his eyes up and to the right (visual input) and in his case also with his head rotated to the right and up (vestibular input); and within a few motions we were able to get his pain from a 6/7 on a 1-10 scale to less than a 1. I was in essence recreating this event for his brain, but in a safe environment this time (I left my clown suit in the closet). Another way to explain it is that we just gave the brain the correct inputs to alter its perception of pain. Amazing.

Conclusion (aka read this part for sure)
In conclusion, from our good buddy Melzack (who also had help from Patrick Wall) defined the Neuromatrix of pain as “pain is a multidimensional experience produced by characteristic ‘neurosignature’ patterns of nerve impulses generated by a widely distributed neural network-the ‘body-self neuromatrix’-in the brain (3).” Definitely a mouth of futuristic Matrix-like words, but we know that pain lives in the brain and it can be modified by changing proprioceptive, visual, and vestibular inputs. Decreasing pain will have you on the fast track to enhanced performance!

References
1. Chan BL, R Witt, AP Charrow, et al. Mirror therapy for phantom limb pain. N Engl J Med. . 2007; 357(21):2206-7.
2. Matre D, KL Casey, S Knardahl. Placebo-induced changes in spinal cord pain processing. J Neurosci. . 2006; 26(2):559-63.
3. Melzack R. Pain and the neuromatrix in the brain. J Dent Educ. . 2001; 65(12):1378-82.
4. Melzack R. From the gate to the neuromatrix. Pain. . 1999; Suppl 6:S121-6.
5. Melzack R. Labat lecture. Phantom limbs. Reg Anesth. . 1989; 14(5):208-11.
6. Oken BS. Placebo effects: clinical aspects and neurobiology. Brain. . 2008.
7. Quevedo AS, RC Coghill. Attentional modulation of spatial integration of pain: evidence for dynamic spatial tuning. J Neurosci. . 2007; 27(43):11635-40.
8. Ramachandran VS, D Rogers-Ramachandran. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. . 1996; 263(1369):377-86.
9. Shaw KA, VK Srikanth, JL Fryer, L Blizzard, T Dwyer, AJ Venn. Dual energy X-ray absorptiometry body composition and aging in a population-based older cohort. Int J Obes (Lond). . 2007; 31(2):279-84.
10. Spiegel EA, HT Wycis. Present status of stereoencephalotomies for pain relief. Confin Neurol. . 1966; 27(1):7-17.

Z Health, Kettlebells and Kiteboarding?

I had an amazing time this past weekend kiteboarding up on Mille Lacs here in Minnesota. It is probably one of the biggest lakes in MN and the wind was cranking! I am not sure of the exact wind speed, but easily mid 20s and gusting up to mid 30s mph at times! Huge whitecaps all across the lake and waves knee to almost waist high at times! Yeah, for you ocean riders this is nothing, but keep in mind this is MN! Credits to Denis for the pics and Steve Blaine in the top pic.

Check out the video below from Dr. Knap and Denis showing all the amazing moves! If you do a "where's Waldo" you can see pass by in the background around the 2:42 and 3:18 mark with a bright yellow Cabrinha kite (Switchblade II 2007 8meter--LOVE that kite). Some amazing riders were out rocking it--both kiteboarding and windsurfers alike.

Z Health and Movement
I credit a recent discussion with Frankie Faires about sensory information during high "flow" times. I will save you a long discussion, but I am sure everyone has had times were they felt "in the zone." At that time, did you experience more or less sensory information? Think of the reverse--poor movement and even painful movement; more or less sensory?

I have noticed a DECREASE in sensory information when movement is better or my skill level is higher. Pain tends to make you highly aware of certain movements, but overall movement quality is less. When I pulled both my hip flexors and groin area a few years ago, I was very aware of all movement! For the record I really don't recommend this as it was the most PAINFUL injury ever! Way worse than busting my ankle snowboarding and ripping my right shoulder completely out playing broomball. I had lots of sensory information, but Penguins had a much better gait (walking) pattern than I did for a long time!

Kiteboarding!!!
The conditions were not ideal for those who were new to the sport, but after drinking tons of water for first 45 minutes on my first session I started to figure it out a bit more and had an absolute BLAST. Easily in the top 5 best kiteboarding moments ever for me. A huge breakthrough was that I was able to ride only looking at the waves with only an occasional glance at the kite; even though I was still constantly moving the kite to keep my power/speed up.

The even cooler part was the change in my thoughts. For those new to kiting, in order to keep a constant pull from the kite, you need to move it around to keep pushing air over the kite in order to create force (or go fast enough to force more air over the kite); so you pull in on the control bar on the right or left side to cause the kite to move in the sky and keep it at a constant pull. Similar to the same ides to fly a Snoopy kite, but imagine one that is 24 to 50 feet across with enough power to yank you off the water at times!

This past weekend my thoughts were OUTCOME based---instead of thinking "pull my right arm in more, let out more, etc" they changed to "I need more speed, less speed, higher angle to change the line of pull, etc" again without constantly looking at the kite. So my body (movement) became more autonomous (auto pilot) in regards to the kite and also LESS sensory-- more movement based.

In the past I tried to really focus on feeling the kite move in my hands without looking at it, when maybe I should have focused on what OUTCOME (via movement) I wanted to achieve to short cut the learning process. Perhaps we should teach what we want the outcome to be and let our body figure it out. This applies to other areas too, esp. education, projects, etc--assign the outcome and few rules and let the participants figure it out. Randy Pausch illustrates this idea in his book "The Last Lecture" also (almost done with it, but so far I HIGHLY recommend it).

KBs and Z Health and Riding Long Hours
I was also very grateful for the weight training sessions with KBs and other forms since my legs were great the whole time! For those of you who have ridden waves or even moguls in the winter on a snowboard or skis, you are familiar with the constant motion of your legs as you go up and over the waves. I only had a little groin soreness and right hip flexor that cleared up within 2 days. So if you are looking to maximize your time on water, drop me a line!

Life is short, so enjoy the ride

Z Health and Marathon Running

Another Z Health story!

I had the opportunity to work with an Olympic level marathon competitor who was having some left hip pain of about a 6/7 on a 1-10 scale and some pain in her right big toe that was preventing her from rolling up on to the ball of her foot (she could only get her heal about 1/2 to 1 inch off the ground before pain). The toe pain had been ongoing for over a year.

We did some simple range of motion and a gait analysis in addition to muscle tests for rectus femoris, psoas, glutes and hamstrings. Her left rectus femoris, psoas and glutes tested a bit weak and that was reflected in her gait (walking motion). We tried some Z Health drills on her left and right foot/ankle and were able to get her hip pain to less than a 1 and no "clicking" in the hip motion. Whooo ha.

Being able to roll threw your bit toe is important for running, so we went to the opposite joint of the right big toe which is the left thumb. Remember that your body is a big "X" in regards to force transfer via the back force transmission system.

When I step with my right foot, the force goes up my leg into my right glute/hip area and at my SI (middle of hips) crosses to the other side of my body and on up to my scapula where it begins to split into my LEFT hand and my LEFT jaw/side of my face. So if you have TMJ issues and the clinician is ONLY ever looking at your jaw, you may want to look elsewhere. Remember, the SITE of PAIN is RARELY EVER the SOURCE! It just means you have pain and something is not right. The pain can be very real of course and where you have pain can test very poor, but you many want to look at the entire body for the actual SOURCE.

So we went to her LEFT thumb to work on the RIGHT big toe and it turns out she had a very hard time moving the joint in the middle of the thumb at all! Hmmmmm. With some work over a few minutes she was able to move it on her own and the pain in her big toe went to less than a 1 and she was able to roll up much much further on her big toe for the first time in years. Whoo ha and behold the power of the nervous system!

So if you are interested in your own custom Z Health session, check out the information HERE and drop me a line to get on the schedule.

Any other comments on crazy mobility work?

NEW RKC!

Wanted to send a shout out to Brad Ellingson for passing the RKC test!! Brad also recently completed the Z Health R Phase certification in addition to the NSCA CSCS cert in the past. Brad contacted me to help him out on the RKC snatch test due to some past injuries. It took a few months, but he was diligent on doing all the work and was rewarded. Congrats to Brad!! Check him out at Top Notch Fitness if you are here in MN.

Pre-emptive Analgescis--what is he talking about now?

Z Health R Phase Certification in MN this weekend!
Just a heads up for anyone that is one the fence, that the R Phase Cert is here this weekend! There is currently an awesome group of people signed up and it will be a blast! I will be there all day Sat and Sun and I am sure I will learn new stuff again even though this will be my third time through the first 3 days. Basics are best!

The Pain Train Continues
If you missed the last post on pain, see the one before this and check it out. Below is another guest post from Nicole Nelson in relation to pain. Ok, so I am biased since she is my sister, but the information is great and there is a bit about how it relates to Z Health and movement towards the end also. She is currently at the U of MN working on her advanced degree to be a certified registered nurse anesthetists (CRNA)--those people that put you as close to death as possible during a procedure and make sure you come back too!

Pre-Emptive Analgescis

by Nicole Nelson, RN

Chronic pain affects millions of people in the world today. As an anesthesia provider it is crucial to know how to adequately treat pain in a multi dimensional approach. One way anesthesia providers may decrease post operative pain is by giving pre-emptive analgesics. Decreasing pain at the spinal level is a good approach to both acute and chronic pain. Research of the pain pathways is complex and new thinking has shown that it is a multi sensory system according to the neuromatrix of pain (Mosely, G. 2003).

Pain can be difficult to define since everyone perceives and experiences pain differently. According to the definition by Morgan, Mikhail and Murray, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage (Morgan, Mikhail, & Murray 2006). Pain is categorized as either acute or chronic. Post operative pain is considered acute pain and is usually due to nociceptive stimulus. Chronic pain on the other hand is when acute pain fails to be resolved from either abnormal healing or inadequate treatment. Chronic pain may be nociceptive, neuropathic or mixed (Morgan, Mikhail and Murray 2006). A recent article by Weiss, Vanderlin and Hietpas states that chronic pain is the nation's leading cause in adult disability (Weiss, M., Vanderlin, D., Hietpas, J. 2007).

Physiologic pain pathways can be very complex and only a brief overview will be provided here. When a pain receptor is stimulated it travels to the CNS by two neurons known as either A-delta or C nerve fibers. The A-delta fibers are large in diameter, fast conducting myelinated fibers which transmit "first" pain experienced as sharp, prickling and injurious ( Kelly, D., Ahmad, M., Brull, S. 2001). The C fibers are small in diameter, slower conducting unmyelinated fibers that are responsible for "second" pain experienced as dull, aching and visceral type ( Kelly, D., Ahmad, M., Brull, S. 2001). The sensory neurons then travel to the spinal cord and synapse with second order neurons located in the dorsal horn. The second order neurons then travel either up the spinothalamic tract or ipsilateral spinal pathway to the thalamus. Once the impulse arrives in the thalamus it is sent to other CNS centers such as the somatosensory cortex. These higher centers are responsible for the perception of pain and the emotional components that accompany it (Kelly, D., Ahmad, M., Brull, S. 2001). In the sensory pathway there are four distinct steps in the transmission of painful stimulus known as: transduction, transmission, modulation and perception. It important to understand each area since each step is a potential target for analgesic therapy. Transduction is a process where nociceptors respond selectively to noxious stimuli and convert chemical, mechanical or thermal energy at the site of the stimulus into neural impulses (Kelly, D., Ahmad, M., Brull, S. 2001). The intensity of the impulse arriving in the dorsal horn depends on how much excitatory or inhibitory transmitter is released. Transmission occurs once the signal has arrived in the dorsal horn and where it synapses depends if the signal is coming from an A-delta or C nerve fiber. The A-delta neurons synapse in laminae I, II and V, and the C fibers in laminae I and II (Widmaier, E., Raff, H., Strang, K. 2006). Neurotransmitters are released and can cause changes in the excitability of the cell. In addition to causing increased excitability to the cells, repeated noxious stimulation of the dorsal horn may result in an increase in the number of neurons in laminae I and II whose nuclei express C-fos protein, a protein thought to be involved in the memory of pain ( Kelly, D., Ahmad, M., Brull, S. 2001). This is one area in which preemptive analgesic such as morphine could decrease the number of cells expressing C fos protein. The next step in the sensory pathway is known as perception. This step involves the impulse leaving the dorsal horn and traveling up to the thalamus then on to the somatosensory cortex. Analgesic therapy has traditionally targeted the pain perception component of the analgesic pathway (Kelly, D., Ahmad, M., Brull, S. 2001). By understanding each concept in the pain pathway it allows providers to use several different analgesic agents which each act on a specific area in the pain pathway.

As stated earlier, treatment of either acute or chronic pain involves a multi-dimensional approach. Preemptive analgesic may be one way to treat acute pain before it can trigger long-term neuronal changes leading to chronic pain. Some of the neuronal changes in chronic pain involve a term known as "wind up" that occurs when the initial pain stimulus goes on too long and the NMDA receptors become sensitized (Kelly, D., Ahmad, M., Brull, S., 2001). This then triggers a cascade of events that leads to CNS hypersensitization. This process can lead to a long line of complications from pain such as hyperalgesia, non-pain nerves begin to fire and carry pain messages, the threshold of opiod receptors is increased, sensitivity to catecholamines is lowered and the pain fields spread to adjacent neurons in the spinal cord (Copstead, L,. Banasik, J. 2005). The long line of complications and neural changes that occur from chronic pain only reinforces why acute pain should be treated aggressively. As researchers develop a better understanding of acute pain mechanisms it has been shown in clinical trials that preemptive analgesic could benefit the patient with decreased postoperative pain, decreased hospital stays and improved overall satisfaction of care (Turan, A.,White, P., Karamanlioglu, B., Pamukcu, Z. 2007). Preemptive analgesia is defined as analgesia given before the initiation of nociceptive stimulus (Pyati & Gan, 2007). There still remains a lot of controversy over preemptive analgesia. A recent review of literature by Pyati and Gan in 2007 demonstrated that around 40% of studies showed a beneficial effect (reduction in pain and analgesic consumption) of pre-incision analgesia as opposed to analgesic administration after surgical incision ( Pyati & Gan, 2007). There are many factors that play a role in preemptive analgesia such as which drug is given, dosage and duration of medication and the exact time that the medication was given preoperatively. Gabapentin is just one of many medications a provider could give as a preemptive analgesic. Gabapentin has primarily been given as an anticonvulsant but it is also used extensively in the treatment of neuropathic pain. It works primarily on voltage dependent calcium channels, resulting in postsynaptic inhibition of calcium influx and which will reduce presynaptic excitatory neurotransmitter release (Pyati & Gan, 2007). Research has now shown gabapentin is helpful in reducing the central neuronal sensitization that occurs in postoperative pain (Turan, A., White, P., Karamanlioglu, B., Pamukcu, Z. 2007). In one particular study by Pyati and Gan in 2007 demonstrated a reduction in morphine consumption post operatively by 32% when 3 grams gabapentin was administered before and during the first 24 hours after abdominal hysterectomy (Pyati & Gan, 2007). In another study with inflammatory pain, gabapentin was shown to reduce hyperalgesia and inhibit C-fiber response to noxious stimuli by modulating both central and peripheral nociceptive response (Turan, A., White, P., Karamanlioglu, B., Pamukcu, Z. 2007). Lastly in a study by Turan, White, Karamanlioglu and Pamukcu in 2007 it showed the effects of tourniquet pain from a total knee surgery. Gabapentin decreased postoperative pain as much as 50% in the controlled group (Turan, A., White, P., Karamanlioglu, B., Pamukcu, Z. 2007).

Preemptive analgesic is the first step in controlling acute post surgical pain and including ideas evolved from the pain neuromatrix may be an insight into controlling chronic pain. The pain neuromatrix was developed over a decade ago by Melzack and Wall (Moseley, 2003). Melzack and Wall developed the ideas in the pain neuromatrix on the bases that pain is produced by the brain when it receives neuronal signals that danger to body tissues exists and that there needs to be an action (Mosely, 2003). There are four basic concepts within the neuromatrix. The first concept is that pain is produced by the brain (Mosely, 2003). The second concept is that pain is produced when the brain perceives that danger to body tissues exists and action is required (Mosely, 2003). Third concept consists that pain is part of the survival system, any threat, can be interpreted as pain (Mosely, 2003). The last concept is that pain is individual (Mosely, 2003). In traditional ideas of pain it is perceive that pain is caused by a physical injury. The main difference between traditional ideas and the neuromatrix is that pain can be caused by a physical injury but pain can also be stimulated within the body by either a noxious or non-noxious threat. Acute pain is generally well understood but chronic pain syndromes, which are often characterized by severe pain associated with little or no discernible injury or pathology, remain a mystery (Melzack 2003). Melzack states, "chronic pain is produced by the output of a widely distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology. A great study by Onodera, Shirai, Miyamoto and Genbun in 2003 looked at the density and distribution of neural endings in rabbit lumbar facet joints after anterior spinal fusion and to evaluate the effects of intervertebral immobilization. The author states, "These results suggest that immobilization of the intervertebral segment causes a reduction in the number of mechanoreceptors in the facet joint capsules because of the reduction in mechanical stimulation. Moreover, in the upper adjacent facet joint there may be neural sprouting caused by nociceptive stimulation" (Onodera, Shirai, Miyamoto and Genbun 2003). One simple way to apply this idea is to think about when you accidentally burn your finger on a hot stove. According to the ideas in the neuromatrix the actual pain is considered an action signal so you pull your hand away to decrease the threat, then you might franticly wave your hand around to decrease the pain by increasing mechanoreceptor stimulation. Another example is to apply other systems such as the Z Health Performance System to the neuromatrix. Z Health uses joint mobility exercises to increase mechanoreceptor stimulation and therefore potentially reduce chronic or acute pain.

The ideas involving pain physiology are very complex. Preemptive analgesic may be just one way of many to help prevent acute postoperative pain. Using a multi sensory system such as the neuromatrix of pain could be another way to treat chronic pain and trigger new non-painful neural pathways. Including all the concepts in pain physiology and add the ideas of the neuromatrix may lead to a new way of thinking on how to treat acute and chronic pain in the near future.

References

Copstead, L., Banasik, J. (2005). Pathophysiology 3^rd edition. St. Louis: Elsevier Saunders

Kelly, D., Ahmad, M., Brull, S. (2001). Preemptive analgesia I: physiological pathways and pharmacological modalities. Regional Anesthesia and Pain, 48(10), 1000-1010.

Melzack, R. Pain and the neuromatrix in the brain. Department of Psychology, McGrill University, Montreal, Canada. rmelzack@ego.psych.mcgill.ca

Morgan, E., Mikhail, M., Murray, M. (2006). Clinical Anesthesiology. New York: Lange Medical Books/McGraw hill.

Moseley, G. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy

Onodera, T., Shirai, Y., Miyamoto, M., Genbun, Y. (2003). Effects of anterior lumbar spinal fusion on the distribution of nerve endings and mechanoreceptors in the rabbit facet joint. Journal Orthopedic Science, 8(4), 567-576.

Pyati, S., Gan, T. (2007). Perioperative Pain Management. CNS Drugs, 21(3), 185-211.

Turan, A., White, P., Karamanlioglu, B., Pamukcu, Z. (2006). Premedication with Gabapentin: The Effect on Tourniquet Pain and Quality of Intravenous Regional Anesthesia. Brief Report-International Anesthesia Research Society, 104(1), 97-101.

Weiss, M., Vanderlin, D., Hietpas, J. (2007). Controlling Chronic Pain in the Workplace- Nerve Stimulation and Intrathecal Drug Delivery Systems. Continuing Education, 55(11), 463-467.

Widmaier, E., Raff, H., Strang, K. (2006). Vander's Human Physiology. New York: McGraw Hill.