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You’ve just been injured or started feeling a weird pain in one of your joints. You get online and start googling things like “knee pain,” “elbow pain” or “sprained ankle.” Immediately, you’re hit with search results and ads advocating for the use of a “brace.” It’s an attractive solution, because it seems easy and low risk. What’s a couple bucks? If it doesn’t help, no biggy. If it does help, you’ve found a solution that will allow you to keep going about your normal day to day life – that’s great! Right? Well… potentially.  It is definitely great that you’ve found a temporary solution to relieve pain and keep you moving, but there are a few important questions you must ask yourself before calling the problem solved. Before we dive in to the questions, let’s start with the basics of the function of a brace. A brace decreases pain by restricting mobility and limiting range of motion in the affected joint. By restricting mobility, a brace may cause a couple of long term problems for the joint, as well as other joints in the body.
 With those thoughts in mind, it may start to seem like a brace isn’t such a great idea.
However, they aren’t completely bad. It just means that they aren’t always the long term solution people think they are. Here’s 3 questions to ask yourself before jumping at that opportunity to throw on a brace and see how it feels. 1) Is my safety at risk if I don’t wear the brace? In some cases, an injury or movement disorder may be so bad that a brace is needed to stabilize the joint. Without a brace, it’s possible that simple movements like walking or standing up would cause more damage to the joint. If that’s the case, it’s likely a brace needs to be a part of your solution. 2) Do I want to wear the brace long term? If you’re perfectly ok with wearing a brace long term, maybe it can be a solution for you. Just remember that the longer you wear it, the more you’ll increase the risk of developing dependence on it and other injuries down the road. 3) Do I have a brace exit plan? If you do not want to wear the brace long term, you need a brace exit plan. There must be a plan in place to address the underlying causes of the injury or condition – a qualified strength coach, physical therapist, or neuro therapist may be able to help develop this plan. My take? Braces aren’t all bad – they play an important role in the recovery process if the affected joint is in legitimate risk of additional harm. However, I would not recommend using a brace (other than for safety reasons) if you don’t have a parallel plan in place to address the underlying cause of injured joint.
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Our local community partner, the Arthritis Foundation, is hosting their annual Baltimore Walk to Cure Arthritis on Sunday, June 9th! We see clients from all walks of life, and I’ve seen first-hand the impact arthritis can have on someone’s life.  At the end of 2018, we had the pleasure of working with one of the most well known Baltimore area members of the Arthritis Foundation. He grew up with Juvenile Arthritis and continues to live with Rheumatoid Arthritis. When he came to us, his goal was to walk the entire Jingle Bell Run For Arthritis (a 5K). It was a lofty goal, given that the arthritic pain and fatigue had never allowed him to complete the 5K, and we only had 1 month to help him prepare. However, using Neuro Therapy, we were able to help him pull it off. He continued to work with us in to the first few months of 2019 to manage the inflammation around his joints, prevent muscle atrophy, and improve his overall quality of life, and has since accomplished his second goal of being able to work 30 hours/week!   Arthritis is the nation’s #1 cause of disability, and it is the mission of the Arthritis Foundation to fight for a cure, while providing educational tools and resources, along with community connections, for the 54 million Americans who are diagnosed. The Walk to Cure Arthritis is a FREE wellness event where the Arthritis Foundation raises awareness and funds to support their mission. At the event, we will hear from Young Adult Honoree, Nia Phipps, who has been living with Juvenile Arthritis since she was 5 years old. Nia credits the Arthritis Foundation’s Juvenile Arthritis Camps for helping her make friends and learn to live life beyond her diagnosis. It costs the Arthritis Foundation $1,000 for a child to attend a Junveile Arthritis Camp each summer. Our goal is to raise $1,000, and send a child like Nia to one of the 42 Juvenile Arthritis Camps across the US so they finally have a chance to be a kid.  We have a team for the Walk and would love to walk with you on June 9th.
Visit https://events.arthritis.org/team/premier to register, or create your own team to walk with your family and friends! If you’re able to donate, even just $5, it will make a difference. Thank you in advance for all your support. To learn more about the Arthritis Foundation and how you can get involved, contact Lexi Evans, aevans@arthritis.org, 443-948-6657. One of the toughest parts of the recovery journey that we see day in and day out is day 1 of what we call “force absorption testing.” I would imagine this concept isn’t unique to Neuro Therapy – there are similar moments during the recovery process for everyone, whether they are just “resting” their injury until it gets better, going through traditional physical therapy, or have recently undergone a surgery. It’s that moment when you get to test the activity that’s most important to you and see how the injury feels. Whether it’s just going for a walk, jogging, biking, or getting back on the field, you finally get to see how you’ll feel going at a little higher intensity than what you’ve been allowed to do in therapy so far. So what makes it so tough? Surely, this is a joyous occasion. All the hard work and time you put in to therapy is about to pay off! Except when it doesn’t (at least not on day 1…)  In 90% of cases, that first day of testing isn’t about being 100% pain free or to feel like you’re performing at your best again. Day 1 of testing is about starting to acclimate your body and more specifically the nervous system, to the forces that are required to do that activity again without any hesitancy or guarding. Because it’s been so long since you last performed that activity without pain, it’s extremely likely the nervous system will still be guarding. And when the nervous system is guarding, it causes the brain to send off signals like pain, stiffness, and “this feels weird.” It takes repeated exposure to the activity over the course of several days in order for the body to “take the guards off” and realize the activity can be completed without any resistance. When the nervous system realizes this, it eventually allows the activity to be performed without pain, stiffness and the feeling of “this feels weird.” In other words, to put it shortly: You should expect there to be pain or some level of discomfort on Day 1 of testing – do not let it discourage you!  The goal of day 1 of testing is to establish a baseline. How much activity can you do before feeling discomfort? If you’re a runner, maybe its ¼ mile and you start to feel that nagging pull in your hamstring at a 2/10 pain level.
In general, we look at pain levels of 1s and 2s out of 10 as a warning signal sent by the nervous system. They aren’t there to indicate you’re doing harm – just to let you know “hey, we’ve been down this road before, and past experience tells me we might be doing an activity that can cause damage.” We’ll encourage you to keep running through that 1 or 2 out of 10 until one of two things happen: 1) The discomfort goes from a 1 or 2 out of 10 to a lesser value (maybe none at all). That’s fantastic – it means the nervous system has realized there isn’t actually a threat present and has started to ease up on the guarding mechanism. 2) The discomfort goes from a 1 or 2 out of 10 to a greater value. That’s great as well, because now we know and can start gauging progress as you continue with the recovery process. Our goal will be to continue working at it to extend the amount of work you can do without discomfort levels elevating to a more alarming level. Primary message of this post? Don’t get discouraged on day 1 of testing your body with your favorite activity! It’s only purpose is to establish a baseline for where you’re at in the recovery process. The recovery process is a journey with ups and downs along the way, but you will reach the end goal! If you’ve been through the Neuro Therapy process, you’re well accustomed to the following send-off after sessions (perhaps even as you’re walking out the door). “Don’t forget your protein, water, and sleep!” Whether you are recovering from a sport/exercise related injury or doing what you can to put years of persistent pain behind you, all 3 play a vital role in the recovery process. Out of these 3 recovery factors (protein, water, sleep), the protein is the one we get the most questions about. “Do I have to eat protein?” (Yes!) “It makes me so full!” (That’s a good thing!) “Won’t I gain weight?” (No!) We know – Optimizing your lifestyle to increase the body’s ability to repair isn’t easy. But as anyone who’s experienced it knows, the point of Neuro Therapy isn’t to be easy. It’s to get better.  So why do we constantly preach protein when clients offer so much resistance to the idea? Here’s 4 reasons hitting your protein target is crucial to reaching your Neuro Therapy goals: 1) Protein is the essential building block required to repair muscles, bones, and nerves. If you’re injured, your body is damaged, or suffer from nerve pain, your body literally cannot repair itself without sufficient amounts of protein. Hoping that Neuro Therapy can help you recover without hitting your protein targets is like trying to build a house without wood or brick (ask the 3 Little Pigs how that worked out…). It just won’t happen! After writing this, I’m starting to think just this reason alone should be sufficient to convince you protein is needed…but we’ll continue with the other 3. 2) Protein helps to prevent muscle atrophy associated with injury. Injuries often cause a state of anabolic resistance in the affected muscle, which decreases the ability of the muscle to create protein. This causes immediate losses (atrophy) in muscle size and strength, sometimes in as little as 5-7 days. Hitting your daily protein targets will decrease the effects of anabolic resistance, and thus decrease the chance of muscle atrophy in the affected area (boosting your ability to recover quickly). 3) Protein helps to decrease muscle soreness between Neuro Therapy sessions. One of the reasons Neuro Therapy is so effective is because it directly targets muscles and ranges of motion that the body is not accessing properly. Often times, re-introducing the body to correct muscle activation and movement patterns causes muscle soreness – something we keep an eye on throughout the Neuro Therapy process. While muscle soreness is expected (and generally is a good sign of progress), if the muscle soreness becomes too intense, it may limit our ability to be as effective in Neuro Therapy. So how can we prevent the onset of soreness and optimize the Neuro Therapy process? Hit your protein targets! Protein will help to repair and re-vitalize muscles between sessions so you can arrive at your next session ready to get to work!  4) Protein increases your capacity to do work during Neuro Therapy sessions. In order for Neuro Therapy to be the most effective, you must arrive every single day ready to get to work. If you’re coming in hungry or malnourished, your body will start to reserve energy for vital functions, meaning you won’t have as much energy to put into your session. There’s nothing worse than having to deal with a growling stomach and a max tolerance set of Neuro Therapy. Hunger will limit your ability to push yourself to higher output powers, meaning your results will be limited. Hit your protein targets, and I can promise you, hunger will not be on your mind during sessions, allowing you to put all of your energy into pushing yourself and driving results.
What is Neuropathy?
Neuropathy is characterized by decreased or improper neurological communication to the peripheral nerves. The peripheral nerves are responsible for neurological communication throughout the body. The brain uses them to communicate with the muscles to make them move and also to receive sensory information from the environment, like the sense of touch. When these nerves are damaged, it can affect either (or both) functions of the peripheral nerves. If communication with the muscles is disrupted, you may find it more difficult to move and experience decreased coordination, decreased balance, muscle weakness, and/or stiffness. If neuropathy affects the nerves responsible for the sense of touch, you may also start to experience numbness, tingling, and/or burning. When the brain senses it has lost communication with the peripheral nerves, neuropathy often starts to become painful. Why does it occur? Neuropathy occurs for a number of reasons, but the primary reason is that the brain has a lost the ability to communicate with the nerves in the affected area. Whether it is because of a previous trauma to the area, head/neck injury, nutrition deficiency, or biochemical imbalance (like Diabetes Mellitus), the nervous system has a diminished ability to communicate effectively, resulting in the symptoms listed above. In order for the problem to be addressed, the nerves need appropriate resources (oxygen, nutrients) to repair themselves and re-establish appropriate communication. However, often times, the problem is compounded over time. Because neuropathy causes people to use the symptomatic area less, the brain starts sending less resources that way. The nerves become inflamed, scar tissue can develop, and blood supply is restricted, meaning the nerves receive less oxygen and nutrients to repair themselves. Additionally, muscles in the area become weaker, so the nerve becomes likely to become even more damaged. How can Neuro Therapy be a part of the solution? Neuro Therapy was designed to re-establish proper neurological communication throughout the body. When proper communication is established, the brain can start to communicate with the damaged nerves appropriately again and symptoms may start to decrease. Through its unique, targeted approach, Neuro Therapy also helps to bring needed resources (blood flow, nutrients, oxygen, etc). back to the affected area, so the nerves can begin to repair themselves. During the process, clients also work to re-educate the nervous system and muscles around the affected area to work properly, to improve movement patterns, increase range of motion, and limit the chances of future damage to the nerve. If you or a friend are experiencing symptoms consistent with Neuropathy, it's possible Neuro Therapy can help. We've designed a 3 step assessment process to determine whether or not Neuro Therapy can help relieve your Neuropathy symptoms... and for a limited time, it's 100% free. If you're interested, just click the blue button below to apply for the free assessment. Once you've completed the form, a member of our team will reach out to learn more about your problem and determine if you are a good candidate for the assessment: This week’s post is short, but sweet, and may be one of the most valuable techniques I can share with you. It’s about re-programming the script that runs through your head. When the script is tuned improperly, it drives negativity and unhappiness. It turns stress into anxiety, opportunity into dread, and gratitude into apathy. I call it the “I have to” script.
It’s when we think things like “Today, I have to do x” or “Why do I have to do y?”. Because when we tell ourselves we HAVE to do something… we’re telling ourselves we have no control over our lives. We’re telling ourselves that we don’t have a choice to do what we want to do. In some ways, we’re training ourselves to be victims in our own lives. But life is about creation! And we get to choose every single minute who we want to become and what life we want to live. You literally don’t “have to” do anything, as long as you understand the consequences of your actions. You get to educate yourself enough to weigh the pros and cons of every decision in your life before taking action – a liberating thought. So how do we re-program the script? We’ve got to be guardians of our mind and teach it discipline. Every time you think of all the things you “have to” do, simply pause…. And re-frame it.  Let’s take a look at a common one. I have to go to work on a Monday morning.
Pause…. No…. I choose to go to work this morning. It’s not always the easiest to get out of bed, but work gives me a sense of pride. It gives me the ability to make a difference every day (no matter how big or small), provide for my family, who I am very lucky to have, and do many of the things I enjoy doing outside of work. If this job was affecting my life negatively more than it does positively, I would make the choice to find a different opportunity. That’s just one example, but I’m sure if you pay attention to how you speak to yourself throughout the day, you’ll find many more opportunities to start the re-programming process. It will feel extremely forced at first, and it’s not easy, but given time, commitment, and discipline, you’ll start to see your mind naturally starts thinking this way. When the mind naturally starts thinking this way, you’ll find yourself feeling more fulfilled, gracious, and ready to take on the opportunities that come your way. A lot has been made over the last decade about the hazards of concussions (and rightfully so). When the brain smacks into the skull with force, it should be obvious that this isn’t a good thing and it needs to be taken seriously. Most of the attention around concussions has been dedicated to chronic traumatic encephalopathy (CTE). If you’ve watched Will Smith’s movie “Concussion” or followed the NFL over the past few years, you’ve definitely heard of it, (that's not what this article is about).  In CTE a protein called Tau slowly builds clusters in the brain, killing brain cells. It’s been linked to cognitive problems, personality changes, and behavioral changes like aggression and depression. But the development of CTE is a long term process. And for us human beings, it’s harder to make decisions that are best for our long term health and well-being (just think about how much discipline it takes to routinely put money aside in retirement savings, knowing you could go on a tropical vacation with it instead…) So let’s talk about the short term risks with concussions - the ones that haven’t been featured in a movie or talked about on Sportscenter. If you’re only focused on the here and now versus what your brain looks like 30 years from now (what’s wrong with you anyways?? Take your brain health seriously!), these are the risks that will matter to you. Even though they can completely DERAIL an athletic career or workout regimen, they aren’t getting the same attention as CTE. So what is it? Those who suffer a concussion are at least 38% more likely to suffer a lower extremity injury within the next year [1]. And some studies have concluded the risk is even higher (up to nearly 3x more likely to suffer a lower extremity injury! [2,3]).
What’s this mean? That a concussion can have lingering effects LONG AFTER the initial symptoms are gone and you’ve been cleared by your physician or athletic training staff for return to activity.
And that these effects can keep you off the field or out of the gym for significant lengths of time. In many cases, those who return to activity after concussions continue to have decreased dynamic postural control, motor control, balance, and ability to effectively coordinate movement [2]. The differences are so subtle that often times it’s not even noticeable, but they are there, and pose a risk for future injury. We see this retrospectively all the time at Premier. A client comes in reporting an extensive history of injuries (they just keep getting hurt time and time again…) or chronic pain that won’t go away no matter what they do. After thoroughly talking through the client's injury history, this question is eventually asked: “Have you ever experienced a head or neck injury?” In many cases, the answer is something along the lines of: “Well, there was this one time that caused a lot of concussion symptoms, but it wasn’t that serious and went away after a few days.” When the client compares the date of the concussion with when the string of injuries or chronic pain started, it becomes clear that the concussion may have been much more significant than originally thought. From there, our unique neurological communication assessments reveal that the significance of the concussion is even more apparent – those who have suffered a concussion often fail to pass the most basic assessments. So what does all this mean? 1. Take concussions seriously! They not only impact your long term brain health, but short term ability to stay on the field and in the gym. 2. A proper concussion rehabilitation program needs to go beyond just rest and passing a cognitive test. It should incorporate functional movement and dynamic postural control testing as well. 3. If you’re someone who keeps getting hurt, has an injury that won’t go away, or suffers from chronic pain AND have a history of head/neck trauma, it’s likely neurological communication issues will need to be addressed to put an end to your cycle of frustration. . If you have questions regarding concussion rehabilitation protocol or how a previous head/neck injury may be affecting your life, feel free to shoot me an email at: support@premierneurotherapy.com References:
There’s a common misconception out there that a person experiencing lower back pain must have a core that is “unstable.” It’s a thought process that intuitively makes a little bit of sense, but if you dig a bit deeper below the surface, you’ll find it’s rarely the case. Study after study has shown that core exercises are no more effective than general exercise when it comes to addressing lower back pain. Before we get into several reasons why lower back pain doesn’t always equal an unstable core, let’s look at the theory behind it. When most people refer to “core stability,” they are referring to the muscles that lie deep within the torso (think the muscles around the abdomen). Muscles generally accepted in this group are: the diaphragm, lumbar mutlifidus, transverse abdominis and the muscles of the pelvic floor, which link most closely to the spine.  Because these muscles act most immediately on the spine, the surface level thought is that they must not be working properly in people with lower back pain… or they must not be providing the proper stability to the spine. This is a far too oversimplified way of thinking about the body, and would be similar to assuming the wheels on your car don’t turn because the axel isn’t strong enough. Yes, it’s possible, but there are hundreds or even thousands of other variables that may be going on that contribute to the wheels on the car not turning. The same can be said about lower back pain and core stability. Pain is complex. Movement is complex – we need to go deeper than the surface to find meaningful (and productive) solutions. Unfortunately, this means that we can’t just point to the simplest possible answer (core instability) and say it’s why you’re having lower back issues. Let’s look at the assumption a little more closely, and we’ll see how wrong it can be…
The core stabilizers are meant to do just that, provide stability. In a general sense, they’re meant to absorb tiny forces around the spine to maintain balance. Just think about the exercises and tools we use to isolate these muscles… bosu balls, physioballs, and balance boards.
We’re not moving tremendous amounts of weight or moving with high velocities when we’re isolating these muscles, because that’s not what they’re designed to do. Now, let’s think about the muscles that we DO train with heavy weight and high velocities. These would be ‘mover’ muscles like the calves, hamstrings, quads, and glutes. They help to create and absorb tremendous amounts of force – not only in the gym, but in our day to day lives. They are the main drivers for movements like bending over to pick something up, walking, jumping, and climbing the stairs. Looking at it this way, if either of these types of muscles (the smaller core muscles or larger ‘mover’ muscles) were unable to absorb force properly throughout the day, which do you think would contribute more to additional stresses on the spine (and possibly lower back pain). I think the answer’s obvious – you would expect any dysfunction in the larger ‘mover’ muscles to play a much larger role in keeping stresses off the spine.. and it matches what we find with nearly all of our clients with lower back pain. Rarely does our assessment process indicate any need to improve core strength. This is just one great example of the many myths out there about lower back pain (and rehabilitation in general). If we look at problems within the body at the surface, you’ll get surface level solutions. I encourage you to take a step back, whether you’re dealing with back pain or another issue, and dig at least 1 level deeper to find more meaningful (and hopefully productive) solutions. This week's post highlights the story of a Premier Family member, Kelly. I share these stories with hopes that you can relate - it's likely that you know someone who's living with pain and would jump at the opportunity to find out if Neuro Therapy can help live life without limitation. (Click here to refer a friend or family member).
Kelly came to us after hearing about her husband's positive experience working with Premier Neuro Therapy. She had lived with chronic sciatic pain for all of her adult life, over 20 years. Secondary to the sciatic pain, she was experiencing 1-3 migraine headaches/week. The sciatic problem was bothering her throughout everyday life, including when she sat for long periods of time at work, in the car, or in restaurants. Like many people who come to Premier, she had tried a number of other options first, including seeing multiple specialists, chiropractors, and physical therapists. No one was able to offer her a direct solution. Her goal was to have pain free days, and we're happy to say that through several weeks of hard work (as you'll see in the video below) and dedication, Kelly has achieved that goal! If you're interested in finding out if there's a chance Neuro Therapy can help you, click the blue button below to schedule a time to chat with a member of our team. For a sneak peek of one of Kelly's Neuro Therapy sessions, check out the video below:
There are between 150,000 – 200,000 ACL tears every year in the US, and nearly 100,000 ACL reconstruction surgeries performed. Out of all the data available with regards to these surgeries, there is one piece of information that is most telling about the future health of the affected knee. This data point is so telling that one group of researchers drew the conclusion that people who don’t hit this target would have been better off if they hadn't gone through the ACL reconstruction surgery at all. So what is it? After ACL reconstruction surgery, one of the primary focuses of rehabilitation is restoring full extension of the knee (or being able to completely straighten the knee). If full extension is not restored to within 5 degrees of being straight, those who undergo ACL reconstruction surgery will be 2x more likely to develop osteoarthritis in the knee. A loss of 5 degrees of extension is also tied to:
All of these consequences make it very unlikely that the patient will be able to return to a high activity lifestyle. Without full extension, even every day activities like walking, climbing the stairs, and bending over to pick things up can become difficult. It goes without saying that restoring full knee extension range of motion after surgery must be one of the top priorities in a successful ACL reconstruction rehabilitation. And the sooner the better. One research group found that range of motion in the knee at 4 weeks was strongly correlated with range of motion in the knee at 12 weeks. In other words, if you’re behind in restoring range of motion 4 weeks after surgery, it’s likely you will still be behind 8 weeks later. When you hit the 12 week mark, the likelihood of restoring ROM becomes less and less. In a recent case study with one of our clients, Bobbie, she started Neuro Therapy protocols 4 weeks after surgery. At the time she started, her knee lacked 5 degrees in extension, which could have been problematic if it remained that way. In many cases, it takes months to restore the range of motion with traditional therapy. However, within just 1 week of work, Bobbie’s knee extension range of motion was restored, drastically decreasing her chances of developing osteoarthritis in the affected knee. Neuro Therapy protocols have consistently delivered these types of results for ACL Reconstruction Rehab, as is evidenced by Cameron and Naja’s words on the rehab process below (both returned to their sports at a high level).
Neuro Therapy can yield these types for a variety of ACL reconstruction clients, including the following:
Just click the link below, fill out the form, and we’ll have someone get in touch as soon as we can. go.premierneurotherapy.com/talk
Sources:
Noll S, Garrison JC, Bothwell J, Conway JE. Knee Extension Range of Motion at 4 Weeks Is Related to Knee Extension Loss at 12 Weeks After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2015;3(5):2325967115583632. Published 2015 May 4. doi:10.1177/2325967115583632 Shelbourne KD, Urch SE, Gray T, Freeman H. Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery. Am J Sports Med. 2012;40:108–113 |
About the AuthorEvan Lewis is a nationwide leader in Neuro Therapy and founded the Baltimore area's only specialist Neuro Therapy facility. 
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Premier Neuro Therapy LLC
support@premierneurotherapy.com
(410) 929-0642
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