It's Alive - IT'S ALIVE: Fascia, More Than Just A Cover Surrounding Your Muscles

By Miami Beach Chiropractic Sports Physician, Dr. Todd Narson

Most of us grew up in our sports injury profession, albeit sports chiropractic, physical therapy, orthopedics, athletic training or the like thinking that fascia was simply a covering that surrounded various structures in the body. Kind of an envelope that surrounded the stuff inside and kept is separate from it's neighbors and allowing for the sliding and gliding of the individual parts.

However original research by Stecco et.al., Histological Characteristics Of The Deep Fascia Of The Upper Limb show that what we once thought of as a kind of a sock or wallpaper type tissue covering on the inside is more like that of a proprioceptive information superhighway interwoven into the fascial weave. This proprioceptive information superhighway relays information throughout the musculo-skeletal system allowing the coordination of movement throughout a kinetic chain.


Imagine having an injury such as a contusion, muscle or tendon strain or having surgery that interrupts or cuts through the fascial planes and no real consideration is given to the condition of it's state of healing. No longer can we think it's just incidental connective tissue keeping things compartmentalized. We must now think about fascia as an integral part of our neuro-musculo-skeletal system as it gives afferent information into the system that that helps to provide for our movement, balance and coordination.

This information now places more importance on treatment modalities like Instrument Assisted Soft Tissue Mobilization (Graston Technique(r), AYSTM, SASTM, FAKTR) as well as manual hands on mobilization systems like ART(r), Fascial Manipulation (Stecco & Hammer) & NIMMO.

For surgeons, you need to think more about the post surgical rehabilitative process to account not only the proper healing of the target structures of your surgery, but the supportive systems of muscle, tendon, joint capsules AND fascial planes.

Fascia my friends is alive and well...AND loaded with proprioceptive organs: Ruffini and Pacini corpuscles and woven around the muscle fibers, muscle spindles reside in the fascia surrounding them.

If you want to learn more, go to www.pubmed.gov and in the search screen type only two words: stecco facia. They (brother and sister) have written over 40 articles on this very subject.

Quite interesting and enlightening information indeed. A big thank you to Warren Hammer, DC, DABCO for his lecture on the subject at the ACBSP Sports Science Symposium, Boston MA, April 2011.

'nuff said

Dr. T

Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

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Dr. T

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Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

#chiropractormiamibeach #MiamiBeachChiropractor #SportsInjuriesFixedHere #DrNarson #ToddNarson #Narson #TriDoc #TriathlonDoc #ChiropracticSportsMedicine #ACASC #SportsMedicine #SportsChiropractor #MiamiBeachSportsMedicine #SportsMedicineMiami #MiamiSportsMedicine #MiamiChiropractor #Triathlon #Running #Ironman #IFixPeopleInPain #TrainWithoutPain #MiamiBeachChiropractor #GrastonTechnique #FAKTR #IASTM #Chiropractor #FootPain #Narson #NarsonBodyMechanic #NarsonTool #DACBSP #CCSP #ACBSP #BackPain #NeckPain #ShoulderPain #RotatorCuff #ITBandSyndrome #runnersKnee #PlantarFasciitis #Plantarfascitis #AchillesTendonitis #AchillesTendonosis #GettingAthletesBackInTheGame  #MiamiBeachChiropractor #MiamiSportsMedicine #MiamiBeachSportsMedicine #WeFixPeopleInPain #TrainWithoutPain #ChiropracticSportsMedicine #ACASC #ProSportChiropractic #FunctionalMedicineMiami #DrNarson #BackPainRelief #NeckPainRelief #SportsInjuriesFixedHere #LaserTherapy #RockTape #KinesioTape #KTTape #Nutrition #21DayPurificationProgram #DetoxProgram #PaleoDiet #PaleoDoc #FunctionalNutrition #Chirooractor #Chiropractic #ChiropracticPhysician #DoctorOfChiropractic #USATriathlon #USAT #TeamUSA

Rotator Cuff (Shoulder) Injuries & An Interesting Email: Food For Thought(s)...

By Miami Beach Chiropractic Sports Physician - Todd M. Narson, DC, DACBSP

I received this email below that I'm not going to comment on...I just want you to read it, sit back and think about it. I'll add a little color & some bold for emphasis, but as FoxNews says, we report-you decide.....................

From the OrthoSuperSite:

The American Academy of Orthopaedic Surgeons Board of Directors recently released a clinical practice guideline for the treatment of rotator cuff tears and related problems, according to a press release from the organization.

A work group chaired by Robert A. Pedowitz, MD, of Los Angeles, and co-chaired by Ken Yamaguchi, MD, of St. Louis, developed the guideline after a review of 74 studies on rotator cuff treatment published through 2008.

“Although there is a tremendous amount of research on the rotator cuff, much of it does not reach the quality levels necessary to be considered definitive,”“Thus, we cannot say there were recommendations that could be unequivocally supported.” Yamaguchi stated in the American Academy of Orthopaedic Surgeons (AAOS) press release.

.....................................

You know.. I just can't resist; I will make this comment..

If you're going to a physician that is going to give you some type of treatment to your rotator cuff/shoulder (or any other part for that matter), ASK A LOT OF QUESTIONS AS TO (1) What's specifically wrong with you(2) How does that contribute to my symptoms (3) exactly how is your recommended treatment going to help(4) What outcome can I expect (5) what you can do at home to help yourself.

Oh, those question should be posed to the physician AFTER an examination which should include:

1. A full history of how the problem came about
2. Reflexes
3. Range of motion
4. Orthopedic tests of the injured areas and related areas
5. Palpation of the area and adjacent areas
6. Motion palpation of association joint structures
7. Imaging studies if necessary AFTER the physical exam

If you can't get a good and thorough explanation.....walk out.

'nuff said

Dr. T



Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

Does Knuckle Cracking Cause Arthritis?

By Miami Beach Chiropractic Sports Physician - Dr. Todd Narson

So ever since I've become a chiropractic physician one of the most popular questions has always been does cracking my knuckles cause arthritis?

You would think that popping and popping your knuckles would eventually cause so much repetitive trauma that it would lead to arthritis. Arthritis being an inflammation of the joints caused by overuse (actually caused by abuse or mis-use). There's also a genetic version of arthritis known as Rheumatoid arthritis, but that's not a concern here.

In a recent edition of the Journal of the American Board of Family Medicine, Kevin deWeber, MD, FAAFP, Mariusz Olszewski, MD and Rebecca Ortolano, MD put this old wives tale to the test. In an article based on original research-entitled Knuckle Cracking and Hand Osteoarthritis, their conclusions were somewhat surprising to some, but not to me.

It's not too technical and very interesting to find out that there is actually no correlation between cracking your knuckles and getting arthritis.

For those that also ask about why your joints make that cracking sound, you'll also find your answer in this report of their original research.

Read the article and let me know your thoughts.

'nuff said

Dr. T




Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

Icy-Hot Patches Do Not Replace Ice Packs or Hot Packs

By Miami Beach Florida Chiropractic Sports Physician - Dr. Todd Narson

I'm really getting tired of people listening to TV commercials and "interpreting" my advice. I'm sure I'm not the only doctor this happens to either.

So someone comes into my office here in Miami Beach with a particular complaint. Shoulder (rotator cuff) pain, back pain, neck pain, knee pain, I.T. band pain, plantar fascitis, carpal tunnel syndrome, tennis elbow, golfer's elbow...you get the idea. I do an exam and then make my recommendations for treatment in the office and what they need to do at home to help.

I will recommend applying an ice pack for 15 to 20 minutes for 3, 4, 5, or more times per day. Or, if the condition requires heat, the recommendation is a moist heating pad for 20 minutes several times throughout the day as well. Then, on their next visit when I ask how they're doing? - they say they aren't getting any better. I question them about following my home recommendations and invariably find out they are using some type of "pain patch" or topical pain relief cream that "feels" cold or "feels" hot.

The problem with these pain patches that people Like Shaq and others are paid to sell on TV is that their one and only purpose is to mask your pain. They are very simply skin irritants that will distract you from feeling pain by a chemical perception of heating or cooling. some of them may have some interesting ingredients to help it "get down deep" but they don't get into the muscles, they don't go into the joints. They sit on the surface, smell horribly and don't do anything to reduce inflammation or spasm.

When I make a recommendation for using ice or moist heat, I mean apply an actual ice pack or an actual moist heating pad. Both of these have specific physiological effects that will help inflammation, spasm and pain. They have specific effects that will help your condition heal.

So, when I or your physician, therapist or trainer tells you to apple ice or apply heat, we're talking about the real thing. Save the topical stuff for when you leave your home. Yes, they will make you "feel" better but they don't help you actually get better.

I your bicycle is broken you can certainly paint it to make it look better, but unless you fix it, you still have a broken bicycle. Stop listening to Shaq and his TV commercial with his pain patches and take the advice from a real doctor. Afterall, when Shaquille O'Neal gets hurt, he goes to his team physicians and trainers, not the box of pain patches.

'nuff said

Dr. T

PS, if you're a physician, PT or ATC, please chime in here. I'd love to hear your thoughts on this.



Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

Graston Technique(r), FAKTR & Narson Body Mechanic

I've been certified in Graston Technique(r) since 2002/2003. It's a phenomenal method at treating chronic sports injuries and some acute injuries as well. The technique uses 6 stainless steel instruments (pictured to the right) that are used to treat scar tissue and adhesions that prevent the function of normal tissue dynamics typically seen after an improperly healed injury.

Since becoming certified and practicing this technique on thousands of patients over the years I began to notice that I would get the best results when I treated patients in a position of provocation. In other words, when a patient said, "it hurts when I do this" I would treat the condition with my Graston Technique(r) instruments while they were in the position where they complained provoked their pain. My rate of success increased even more.

I began having people hold dumbbell weights, pull on resistance bands or exercise tubing or simply go through the motions of their sport while I administered the treatment. I would follow this more active/function version of Graston Technique(r) with stretching, ice and electric stimulation and pulsed ultrasound. The results were outstanding. You should also know that Graston Technique(r) isn't just treating patients with their instruments. It also involved evaluation of the patient and the administration of treatment afterward (stretching, therapies and home instructions for patient self care).

In 2006 I was picked to travel with a team of sports chiropractors to treat athletes at the 20th Central American & All Caribbean Sport Games. It's basically a mini-Olympics where the winners of these events go on to the Pan American Games and then onto the Olympics.

In most circumstances, all I had was my reflex hammer, some athletic tape & and ACE bandage, my adjusting table and my set of Graston instruments. If I was lucky, there was some ice and plastic bags. I used both the standard Graston Technique(r) and also the more functional version I was slowly discovering. Being in an environment where you often didn't have electricity and certainly didn't have all the comforts of a modern chiropractic sports injury office, you had to so the best with what you had. I found that I was able to use these more functional treating techniques were extremely effective, more so than when treating statically. I helped quite a few athletes get back into their event pain free. I continued to use my modified methods when I finally returned home.

It wasn't too long after that I learned one of my sports medicine mentors, Dr. Tom Hyde along with one of my original Graston Technique (r) instructors, Dr. Greg Doerr had been developing a lot of this "functional" Instrument Soft Tissue Mobilization stuff. I believe they had been doing it for about 4 years at the point when I first caught onto it but had already taken it a lot further. Both being instructors & friends, they they continued to collaborate and add more and more to it. Dr. Hyde and Dr. Doerr continue to develop and add to this functional instrument based soft tissue technique and began teaching and adding to it. I took their class which was called FAKTR-PM (Functional And Kinetic Treatment with Rehab Provocation and Motion (...now shortened to just FAKTR). It was outstanding. The physicians, trainers and therapist that were in the classes were certainly the cream of the crop. I think people knew that they were on to something big.

The technique really developed and advanced, now getting the input of the many of the leading physicians, trainers and therapists from around the world. This FAKTR thing had developed into a very advanced Instrument Assisted Soft Tissue Mobilization method. It continues to evolve to this day and I'm sure will be better tomorrow than it was yesterday.

I think the Graston Technique(r) is an excellent base of knowledge and represents the foundation for this work. If you want to get into this kind of treatment, Graston Technique(r) is definitely the place to start. It represents the foundation of instrument based soft tissue treatment. In my opinion, you can't get very far without a good foundation. However, as you get more experienced with your technique, FAKTR is where you go from there. FAKTR is an ever evolving technique that incorporates current trends and research. I've seen where one seminar to the next will be different based on information that was published in a recent research journal. It's ever evolving for the right reasons.

What has made performing FAKTR so much easier was the N6 Narson Body Mechanic that I developed. I found that when treating a patient, I changed instruments at least twice, sometimes more. Now, I currently use only 1 stainless steel instrument that has the functionality of my 5 main GT instruments as well as other Gua Sha instruments on the market. It's like a Swiss Army Knife of Soft Tissue instruments. I've added a gripping surface to reduce finger and hand fatigue and now I only need to carry 1 instrument from patient to patient. I only clean 1 instrument and it's much easier to transport when traveling. That's probably considered a shameless plug, but it kind of like talking about baseball without mentioning the glove, ball or bat.

So combine your FAKTR Functional and Kinetic Treatment with Rehab Provocation and Motion with your Narson Body Mechanic N6 and you have a winning combination to treat athletes, difficult chronic sports injuries and more.

For more information on the techniques and instruments discussed above, please click on the following links:

FAKTR www.faktr.com
Narson Body Mechanic N6: www.NarsonBodyMechanic.com
Graston Technique: www.GrastonTechnique.com

Graston Technique(r), FAKTR and Narson Body Mechanic are separate and distinct companies. None of these companies endorses the other. The Narson Body Mechanic instrument should not be confused with Graston Technique(r) instruments. The Narson Body Mechanic is for use with Instrument Assisted Soft Tissue Mobilization while only Graston Technique(r) tools are for use with Graston Technique(r). Graston Technique(r) is owned by Therapy Care Resources, Inc.

Healthfully yours

DocT



Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

How To Be A Good Sports Parent...

By Miami Beach Sports Chiropractor - Dr. Todd Narson

I remember one of my first experiences in taking care of younger athletes was at a high school soccer game back in my home town of Coral Springs, FL. A young athlete wearing an $800 orthopedic knee brace to protect a partially town ACL hurt their knee. I instructed the coach to pull the athlete from the game and the parent told me to go to hell. The parent said their child was going for a college soccer scholarship and they needed to get back in and play.

I asked the parent one question. If they wanted their child to walk into college or to limp into college unable to play soccer again. Just so happens the knee gave out during the game and that was it. The dad ate some humble pie followed by his left foot and I was upset to see a kids dreams go down in flames.

Sometimes it's difficult to be a good sports parent. You want only the very best for your child and have hopes of their future as an athlete. Sometimes we try to relive our old glory years through our children and it really doesn't work so well for the child.

Here's a great article and guide I ran across today that can help us all (yes...me included) be a better sports parent so our kids get everything out of their athletic experiences they can.

http://sportsmedicine.about.com/od/children/a/SportParentTips.htm?nl=1

'nuff said

Dr. T
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Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

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