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Structural Care for Pregnancy

by Dr. Willemin 0 Comments

My wife is amazing. No questions, no debates. While there are a plethora of reasons why I say this, I am currently referring specifically to her giving birth to both of our wonderful children. I will avoid straying too far down memory lane, but I want to take a minute to discuss my wife’s experience with pregnancy. For our first child, our daughter, my wife had an uneventful (relatively speaking) pregnancy. She had a lot of the norms – nausea, fatigue, etc, but on the whole things marched along pretty smoothly.

For our son, pregnancy marched along fairly smoothly until we found out that at 38 weeks our son was in the breech position. We had a conversation with our OB that included her telling us that my wife would need a cesarean section, and me informing the OB that before we just agreed to that, there was some structural chiropractic work that I wanted to do with my wife. While the OB agreed, she clearly didn’t understand the purpose or even the goal. For the next week my wife and I employed a rigorous structural correction plan. I addressed shifts in the bony structures and spent a lot of time working on the soft tissues as well. The goal of the structural care was focused on allowing my wife’s pelvis to achieve a normal position which would remove a secondary condition known as intrauterine constraint, and allow our son to achieve the normal position for delivery. At our follow-up appointment ultrasound confirmed that our son was no longer breech, and could be delivered without a cesarean section, which for us was terrific news.

Now let me make a few quick, but essential, points here. First, I did not, do not, will not ever treat to turn a breech baby. There is a medical maneuver for that called an External Cephalic Version (ECV). It is where a medical doctor attempts to turn the baby manually into a head down position.(1) The goal of structural care is to create normal structure which facilitates normal function. Second, I am in no way criticizing or disparaging any woman who has had, or will have, a cesarean section. The procedure can be a life saving intervention for the mother, for the baby, or for both. For my wife, she wanted to avoid a cesarean section if possible and was happy to be able to do that.

So now that you have our backstory, let me dive further into why structural chiropractic care during pregnancy is so effective.

Ultimately the main reason we chose to utilize structural chiropractic care for my wife’s scenario is that the Webster Technique has been shown to be much more successful than ECV. With structural chiropractic care demonstrating an 82% effective rate in research (2) and ECV showing less than a 56% success rate in 2016 according to statistics from the CDC. Additionally, there are some drawbacks to ECV which made my wife uncomfortable. While the risk associated with ECV is small, 1 in 286 results in the need for emergency delivery, typically via cesarean section. Other complications such as cord prolapse, vaginal bleeding, and water breaking are infrequent, but associated with the maneuver. (3)

Using structural care during pregnancy is not just for a breech presentation of the baby either. Common complaints like low back pain and sciatica are also associated with the structural shifts that naturally occur during pregnancy. The mechanism of structural shifts is pretty simple. In basic terms the fetus grows in the woman’s uterus it expands, which in turn pushes and strains everything in that area. These shifts result in changes to normal movements – think of things like the late pregnancy “waddle”. All of this is occurring while the woman is carrying the additional weight of pregnancy. This is why structural focused care during pregnancy can be so helpful – it helps to compensate for the inevitable changes of pregnancy. Research also supports that chiropractic care is very safe during pregnancy. (4) In fact evidence exists which shows that getting manipulative therapy during pregnancy is associated with improved labor and delivery outcomes. (5) This indicates that structural care can be beneficial during pregnancy even without a secondary complaint.

At Align Chiropractic, we have specialized equipment to help pregnant women – tables with drop away abdominal pieces, tables that raise and lower to make getting on and off the table easier, gentle adjusting equipment for women that do not want or cannot physically handle manual adjustments, soft tissue tools used to address tight ligaments and muscles. If you have questions, I would be happy to sit down and have a consultation with you. As always, at our office a consultation is a conversation, not a commitment.

1. https://www.acog.org/Patients/FAQs/If-Your-Baby-Is-Breech

2. https://www.ncbi.nlm.nih.gov/pubmed/12183701

3. https://evidencebasedbirth.com/what-is-the-evidence-for-using-an-external-cephalic-version-to-turn-a-breech-baby/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647084/

5. King H.H., Tettambel M.A., Lockwood M.D., Johnson K.H., Arsenault D.A., Quist R. Osteopathic manipulative treatment in prenatal care: a retrospective case control design study. J Am Osteopath Assoc. 2003;103(12):577–582.

Quick Fitness Test – Plank

by Dr. Willemin 0 Comments

TL;DR: You should be able to hold a spine neutral plank position for 2 minutes. Train by a combination of short intervals and longer holds.

We are going to spend a few blogs going over some basic fitness tests to see where you fall on the spectrum and help identify how you can improve. Today’s blog will discuss plank.

There is a lot of debate and discussion regarding the risks and benefits of plank. In order to dive into the topic we first have to have a baseline understanding of what the plank exercise actually is. The basic plank is when your toes and forearms are on the floor and you are supporting your body and head in a neutral spine (straight line) looking down at the floor.

What’s not to like?

I’ve read articles that discuss the pressure put on the lumbar spine (low back) and the risk of costochondritis (inflammation of the cartilage between the ribs). In one article, Dr. Michael Durtnall, a chiropractor in London, was even quoted saying, “Planks are for the super-fit and athletes, not for soft, desk types to go bananas with once a week.” (1) I don’t agree. While I would agree with the sentiment that it is not a good approach to go wild with plank once a week; I would say the same is true for almost any exercise, especially when first starting. The statement implies though that working at a desk is mutually exclusive of being fit or an athlete. I know a lot of people who are active athletes in a variety of sports that work desk jobs. I myself play pickup basketball when I can. I have participated in flag football leagues, kickball leagues, and play tennis regularly when the weather permits. The goal with any exercise is to work up gradually. The risk of injury with plank is substantially lower than with many exercises since there is no motion and there are no additional weights being used. I do agree with the sentiment out there that just trying to exercise to overcome low back pain is not a good approach. Having said that, not doing an exercise because of a current injury doesn’t make the exercise inherently bad. If I had a broken leg I wouldn’t be doing squats, but that doesn’t mean squats are bad (in fact I Love Squats)

What’s the good news then?

The good news is that there is good evidence that planks are pretty beneficial. You see it isn’t actual strength that seems to be important with your core, but rather your core endurance. In the research article, “Core Stability Training for Injury Prevention” by Bliven et al. (2) Planks can help train core endurance which may help reduce certain injury risk. Stuart McGill published in the June 2015 issue of the Journal of Strength and Conditioning Research “…an isometric training approach was superior in terms of enhancing core stiffness. This is important since increased core stiffness enhances load bearing ability, arrests painful vertebral micromovements, and enhances ballistic distal limb movement.” (3) Think of it like this – if you compared it to holding a weight at arm’s length in front of you, it isn’t about how heavy the weight is, but how long you can hold it. Also, one of my favorite things about plank is it is NOT a massive time consuming exercise. This means it is easy to incorporate on a daily basis. Now there is a bit of debate regarding how much is enough/too much. Top End Sports lays out a guide in which they state that excellent core strength is the ability to hold the plank position for over 6 minutes! (4) If you’ve ever tried plank you know that is a LONG time, and fortunately, most exercise experts would disagree. An article published in Women’s Health reads, “Albert Matheny, R.D., C.S.C.S, co-founder of SoHo Strength Lab and advisor to Promix Nutrition, says you can plank daily, but the length you should hold a plank can vary from 10 seconds to one minute.” (5) Men’s Health contributor and strength coach Dan Johns feels strongly that anything over two minutes is a waste of time, but not being able to hold a plank for two minutes is a problem.

The Test

I agree with Johns, the benchmark is two minutes. To perform the test get into the plank position with a time directly in front of your face, or with a partner timing you. If you have appropriate core endurance then you should be able to hold a perfect form plank for 2 minutes. This doesn’t mean it won’t be hard. You might shake, you might hate every second, but if you can hold a neutral spine while in the plank position for 2 minutes then your core endurance should be adequate. If you can’t then you need to get better. Going over 2 minutes doesn’t really indicate anything better in terms of injury prevention or overall fitness.

How to Train

McGill recommends training in repetitions of 10 seconds (6), while Matheny recommends simply holding the position until your form breaks down. I recommend both. To give an analogy to running, if you’re training for a marathon, don’t only run sprints. If you’re trying to make your body as fit as possible, don’t only run long distances. All of the exercises we discuss are designed to promote healthy and normal function. Our goal isn’t just to be able to hold a plank for two minutes but to actually improve the function of our core so that we reduce injury risk and promote wellness. If you alternate days between training intervals and longer holds, or want to mix both together on the same day, you will make positive steps with either approach. If you really want to maximize your training though try using plank variations like side bridge or one foot planks. Your body is dynamic and your training should reflect that by challenging your body in a controlled manner to improve overall fitness.

1. http://www.dailymail.co.uk/femail/article-3030983/The-ultra-competitive-exercise-fad-ruin-health-called-planking-suddenly-sweeping-gyms-Pilates-classes.html

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/

3. http://journals.lww.com/nsca-jscr/Abstract/2015/06000/Effect_of_Long_term_Isometric_Training_on.8.aspx

4. http://www.topendsports.com/testing/tests/plank.htm

5. https://www.womenshealthmag.com/fitness/how-long-to-hold-plank

6. https://www.menshealth.com/fitness/truth-about-extreme-planking

Quick Fitness Test – Sit Rising Test

by Dr. Willemin 0 Comments

TL;DR – You should be able to go from standing to sitting on the floor and back to standing without using anything to help you up or down. The older you are, the more it matters.

The Test

Okay, I’m sure you are all masters of the 2 minute plank now. If not, maybe it’s because you didn’t read this. It is time to take a look at our second quick fitness test. The Sit Rising Test (SRT). The test is very simple. Go from standing to sitting cross legged, and then from sitting back to standing. The goal is to perform the movements WITHOUT losing your balance or using anything to stabilize yourself (i.e. putting your hand or knee on the ground). If you can’t picture what I’m saying watch this https://youtu.be/1tdtHWURId0 video. Remember I said simple, not easy. Scoring is straightforward as well, for every body part you need to use to brace yourself, you lose a point, and if you’re wobbly you lose a half point. A perfect score is 10 (5 points for the standing-to-sitting portion and 5 points for the sitting-to-standing portion). The benchmark is a score of 8 or better. Some voices in health and fitness feel there are some concerns that pre-existing injuries to the hips, knees, and ankles, or bone fragility are good cause to avoid performing this test. While I certainly encourage everyone to exercise caution, I don’t believe that this test has to be avoided. I encourage people to aim for an honest assessment. What that means is that if you need to use your hand on the ground, then use it. You can test your hip, knee, and ankle flexibility simply by trying to get into a cross legged position from an already seated position. If you have bone fragility issues to the point that just sitting down might break them, then you should be addressing this with a doctor.

Uh-Oh, I didn’t score an 8 or higher

Being able to do the SRT with a score of 8 or better is an indicator of good musculoskeletal health. If your score was less than this, it means you need to improve. This movement series will test hip, knee, and ankle flexibility, lower body strength, and core stability. A great way to start improving those things are with squats. Read this earlier post about why I love squats and really recommend adding them to your routine. At Align Chiropractic we are focused on improving the underlying structural issues that may be occuring in your musculoskeletal system – a low score is an indicator that you might have a structural problem holding you back. Also, don’t try and rush into a perfect score. Take your time making small, but steady, improvements, and then try the test again after giving yourself adequate time to improve. Note where you have difficulties and look for specific improvements in those areas.

Why Do We Care?

While the Sit Rising Test has some detractors, according to a study in the European Journal of Preventive Cardiology, the test is a good predictor of musculoskeletal fitness. The study showed SRT actually was a good predictor of all-cause mortality in 51-80 year olds. The study did a 6 year follow up on participants and found that there was a strong relationship for death and a lower score. The higher your score the lower the risk of death. (1) This means that at the 6 year follow up people with lower scores were more likely to have died than those with higher scores regardless of the specific cause of death. Now further study is certainly warranted, but this isn’t the first study to associate musculoskeletal health and mortality rates. The Journal of the American Geriatrics Society found that a hyperkyphotic posture (anterior head posture) was also a significant predictor of mortality in older persons. (2) Clearly your musculoskeletal health matters, and it isn’t just about aches and pains.

http://journals.sagepub.com/doi/abs/10.1177/2047487312471759

http://cdn2.perfectpatients.com/childsites/uploads/219/files/PosturePredictsMortalityinOlderCommunity.pdf