KIMA Wellness

Tracey and her husband Health Chef Galen Foulois attend the Food4Me one day conference in Brussels on Feb 26.

Hannelore is Professor and Chair in Physiology of Human Nutrition and a director of the Center Institute of Nutrition and Food science (ZIEL) at the Technische Universität München (TUM).

Her background is in Human Nutrition with a specialisation in biochemistry and physiology. Throughout her career she has been conducting basic research on the functions of individual proteins in human nutrition with emphasis on nutrient transporters which were cloned, expressed and functionally analysed in her lab.

New EU-funded project changing the way we eat

When the human genome sequence was launched in 2000, it introduced the possibility of personalization in health care. Such personalization can be applied to nutrition, a key health determinant, to create a diet tailored specifically for an individual, according to their individual physical and genetic make-up.

Personalized Nutrition

Studies have shown that individuals respond differently to various nutrients. For example, omega-3 polyunsaturated fatty acids, the ‘healthy fats’ found in oily fish that are believed to protect against cardiovascular disease, have been found to be more beneficial in individuals with a particular genetic make-up (Ferguson et al., 2010). The point is, we are all different, and so the way we respond to our diet is also different. Such research suggests that blanket public dietary advice is not the most effective technique for improving public health.

Rather than applying overarching dietary guidance to the whole population, personalised nutrition sets the individual apart to consider their specific physical and genetic characteristics. This practice has been touted as the future of nutrition with significant potential to improve public health. The early promise has not quite lived up to this expectation however, and despite the efforts of numerous companies there has been limited success.

Food4Me will investigate the possibility of designing better diets based on a person’s genetic make-up. A renowned group of experts will examine the application of nutrigenomic research (studies of the effect of food on gene expression) to personalised nutrition. How can we use our understanding of food and our genes to design a better, healthier and more individual diet?

Food4Me project

Food4Me, a 4 year project coordinated by Professor Mike Gibney of the Institute of Food and Health, University College Dublin (UCD), will consider all aspects of personalised nutrition; from investigating consumer understanding to producing technologies for implementation and investigating gene expression in response to diet.  “In employing this holistic approach we hope to draw together cutting-edge research and instigate a significant step forward in the field of personalised nutrition” said Gibney.

A major component of the study is a large multi-centre human intervention study investigating the effectiveness of personalised nutrition. The study will offer participants differing levels of dietary advice; tailored to individual physical characteristics, individual genetic make-up, as well as advice with no personalisation. Over a thousand subjects will be recruited from eight EU countries to take part in the study. Research to determine the effectiveness of personalised nutrition and develop appropriate technologies for its implementation will be supported by investigation of the public’s needs and perceptions.

All results will be consolidated in the design of business and value creation models for the development, production and distribution of personalised foods. These will be tested throughout the project in order to consider the feasibility of future personalised nutrition approaches. Ethical and legal issues will also be assessed and will help shape the framework for the outcomes of the consumer studies, business models and human intervention research.

The data gathered in the project will feed into the development of services to deliver personalised advice on food choice.

The website www.food4me.org will stay up for the next 5 years to deliver the results of the project.

The Tour de France is under way again, and for some of us that might be enough to prompt us to brush the dust off the old bike and go for a ride. So consider this scenario for a moment, if you will: suppose you did something repetitively, like, really, really often: using the subway stairs could be a good example. It’s fair enough to expect that if your technique was sound, any equipment you used (eg. shoes) were in good shape and your body was up to the task, then you ought to be able to perform this activity almost ad infinitum. Conversely, if you performed this activity and something was out of kilter, be it either with your body or the equipment, it might not be long before something went awry.

Riding a bike, particularly for fitness, is like this. If you rode a few laps of Central Park, say twice a week, then headed up 9W on the weekend, as many of us do, you’d expect to be turning the pedals in the vicinity of 25,000 times a week! Even if you’re simply scooting the wrong way up a one-way street on a Citibike a couple of times a week, you’d still perform a few thousand pedal revolutions.

So getting the bike set up right is important. More important obviously if racking up the miles, but a consideration even for Citibike commutes to the pub (most people, at an absolute minimum, would adjust the seat height of the Citibike being heading off). Optimal bike setup means different things to different people. Racing, triathlon, mountain biking and commuting all have very different requirements. The relative strengths and weakness of the rider, minimizing resistive forces (the main one is drag from wind resistance) & maximizing propulsive forces are some of the things to be considered. Optimal bike setup also minimizes risk of injury.

Not considering injury due to crashes and falls, cyclists most commonly have problems with their backs, knees, necks, and also where they come into contact with the bike – hands/wrists, foot/ankle & the saddle region. This may be due to a problem, pre-existing or not, with the rider, or it could be due to the bike setup, especially if the problem only manifests while riding. Sometimes it’s a combination of both.
Fitting a rider to a bike means working out the attributes of the individual rider, then adjusting the bike to suit those traits. A comprehensive musculoskeletal screening from a physical therapist can not only filter out many of these traits, but can also take previous or current injury history into consideration when adjusting relevant parts of the bike. Out of this process can come the opportunity to commence a rehabilitation or corrective exercise program, should deficits be discovered during the screen.

There’s a bit of both Art and Science in fitting a bike. The science is in the measuring of both bike and rider and the application of a number of previously published formulae to come up with a ballpark approximation of where things ought to be. Thereafter follows the art – fine tuning adjustments based on feel & experience. Sometimes a recommended adjustment may not be appropriate given an individual’s injury history, for example.

There are a number of certified systems available to bike fitters – Retul, Serrotta, FitKit, F.I.S.T. Slowtwitch, and so forth – all of which have their strengths and weaknesses

Depending on the rider’s needs, adjustments can subsequently be gradually made to the bike to make things more streamlined and aerodynamic

The best way to ascertain what’s causing what is to get a professional bike fitting. If you’re serious about your riding

If you’ve just discovered cycling and looking to take things up a notch, and particularly if you have an injury history, then it’s worth considering get a professional bike fitting. The advantage of getting it done by a physical therapist is the ability to incorporate a musculoskeletal screening

NOTES:
Number of common presentations can be directly attributed to improper bike setup
Importance of musculoskeletal screening to determine strengths and weaknesses
Art vs science… Development of principles/guidelines/preferences (LeMond, Hamley, Holmes, etc) but ultimately about feel
Number of variables able to manipulated to achieve good fit body/bike interfaces – pedal/cleat/crank, saddle position (tilt/fore/aft/up/dn), handlebar (stem length/height/tilt)

One of the top 10 trends highlighted for SpaFinder Wellness 2015 Wellness Report is Forest Bathing.

“In the world overwhelmed by technology, there has emerged a search for simplicity and return to the lost, healthier ways of living. This can be seen in the growing popularity of meditative forest bathing as well as the definition of high luxury to encompass experiences in which nature, space and silence are prized above all.”

Since I was in Japan and seeking nature, space and silence … I discovered a hidden gem, Yakushima island. Yakushima is a subtropical island covered by an extensive cedar forest that contains some of Japan‘s oldest living trees. Trees more than 1000 years old are affectionately called yakusugi (a combination of Yakushima and sugi, the Japanese word for cedar), the most ancient of which may be over 7000 years old. I couldn’t think of a better place to do forest bathing.

“The term for this bathing has nothing to do with water. The Japanese government coined the term in 1982, a translation of shinrin -yoku, which literally means ‘taking in the forest atmosphere’. More than just a poetic way of describing a walk in the woods, The concept revolves around a deceptively simple practice quietly walking and exploring with a mind deliberately intend on – and all senses only open to – every sound, send, color and feel of the forest, in all it’s buzzing biodiversity”.

“With forest bathing, as well as the increasingly expert lead ‘forest therapy’ the goal is the bathe every cell of your entire psyche in the forest’s essence. No power hiking needed here; just a wander through nature, breathing deeply and mindfully, and stopping to experience whatever catches your soul” – be it a wildflower fragrances, moss covered ancient roots or the texture of a 3000 year old tree’s bark.

“Both poetic and pleasurable, it’s the science behind the practice that is taking forest bathing global, as a growing mountain of evidence indicates there is strong medicine for human bodies and brains within any forest setting. Studies indicate that forest bathing significantly lowers blood pressure, heart rate, cortisol levels and sympathetic nerve activity compared with city walks, while also alleviating stress and depression” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793347/).

“Forest Bathing is now a pillar of preventative medicine in Japan, with millions visiting more than 50 official forest therapy trails annually, and there are plans to designate an additional 50 such sites within 10 years.” In Yakushima island I discovered 2 such trails in Yaku-Sugi Ceder Land http://www.japan-guide.com/e/e4655.html

and Shirataji Unsuikyo http://www.japan-guide.com/e/e4654.html

As you sit in front of you computer screen or on your phone reading this, I thought you might enjoy a few highlights from the trails:

Yayoisugi is a 3000 year old tree that is 8.1 meters in circumference and 26.1 meters high. The Yayoi period in Japanese history was between 500 BC and 300 AD hence the trees name. If you look closely it has 10 different species growing from the surface of its trunk including Rhododendron, Japanese Rowan and Japanese Wood Oil

“In an era of precedented urbanization and digitisation, with the average person now ‘bathing’ their face seven hours a day in the glow of a screen, we humans are in the throes of a forest-deprivation crisis. The convergence of these two trends – growing awareness of the medical benefits of time spent in forests and alienation from this essential, yet increasingly exotic, human experience – will drive demand for forest bathing experiences in the years ahead.

The Role of Foods in TMJ (Jaw) Dysfunction and Chronic Headaches.

Headaches can come from various sources. One cause could be dysfunction of your Temporomandibular joint (TMJ).  TMJ Dysfunction (TMD) is a catch-all term for anything wrong with your TM Joint, including pathology within the joint itself or more commonly the muscles around the joint. Chewing very crunchy, hard, or chewy foods increase the amount of work the muscles of the jaw (muscles involved in mastication) need to do to prepare the food to be swallowed. The main muscles of mastication are the Masseter and Temporalis muscles, the cheek and the temple muscle respectively. Like any muscle in your body they can be overworked if they are suddenly doing more than they normally do.

The excess tension created in these muscles could be a culprit in causing headaches. Examples of common hard to chew foods are:  Bagels, hard crusty breads, steak, pretzels, nuts, salads, raw carrots, caramels, licorice.

If you suffer from regular headaches and a cause has not been determined perhaps you have a TMJ dysfunction.

SELF-ASSESSMENT TO DETERMINE IF YOUR HEADACHES MAY BE CAUSED BY EXCESSIVE JAW MUSCLE TENSION:

1. Press firmly around your temples, the area lateral to your eye socket and up into your hairline (Is this area tender? does it reproduce your headaches?)

2. Place your pinky finger into your ear with the pad facing your eye, press firmly and open your mouth (do you feel popping? Pain? Tenderness?)

TREATMENT

1. USE MOIST HEAT OVER YOUR TEMPLES AND CHEEKS
Do this for 10-15 minutes, If the heat does not work try ice for 10-15 minutes over the same area. The question of whether to use heat, or ice on an injured or painful area is a perennial question that does not always have a clear cut answer. The rule of thumb is usually use ice on an acute injury and heat on an injury or painful area that is chronic but in actual practice the lines are blurred, so use whichever one works best for you.

2. SELF-MASSAGE
A) The first 2 images show a practitioner performing a cheek (Masseter muscle) and temple (Temporalis muscle) trigger point release massage but you can do the same thing for yourself. Find a tender point and then gently press and hold until the tenderness diminishes.

B) To release tension in your Temporalis gently press your fingers into your temples (start just lateral to your eyes), maintain that pressure as you fan your fingers out and slide your hands up into your hairline. Let your jaw drop open as you slide your hands upward.

3. SELF-STRETCHING
Pinch your cheek between your thumb (outside your mouth) and your pointer (inside your mouth) then press your pointer out and pull down at the same time on the cheek muscle (Masseter).

4. AVOID CHEWY, CRUNCHY HARD FOODS FOR 3-4 WEEKS
This will give your muscles a chance to relax and return to baseline. Then slowly add those foods back into your diet and limit them in general, to one chewy/crunchy/hard food a day.

If headaches persist you might need a full evaluation and treatment from a TMD specialist. You may be a night clencher or teeth grinder and may need to see a dentist who specializes in TMD, to be fitted for a night guard, or you may have a very “forward head posture” which will inhibit the jaw muscles from relaxing. If your head and neck posture is contributing to your symptoms you will need to address that either prior to, or at the same time as addressing the masticatory muscles. Faulty posture can be corrected with stretching, soft tissue and/or joint release techniques, core muscle strengthening and corrective postural exercises.

Having a baby is a life-changing event. It’s filled with wonder, excitement, nervousness, and many unknowns. If you have just had a baby… CONGRATULATIONS! If you are a post-partum Mom or pregnant, and suspect a diastasis please continue to read this blog for more information on how to get effective help.

It is so important to support your body properly during this special time in your life. Taking care of yourself specifically during this transition is essential to preventing injury in the years to come.

New Moms, especially those who are breastfeeding have a pelvis that still is relatively lax (loose) post-partum for longer than you think. Tension in your ligaments doesn’t return to previous (pre-pregnancy) strength until TEN MONTHS AFTER you stop breastfeeding. This can lead to feeling vulnerable and lead to mechanics that are inefficient as you over-compensate for the lack of tensile ligamentous strength. This is why it is imperative that you are careful with how you lift and handle your baby, especially with car seats, strollers, etc.

*BONUS TIP: See pictures above on how to properly lift and handle your infant for car seats / strollers.

Whether you have or don’t have a diastasis, very often women feel they should brace and contract their abdominals pretty vigorously to get support. This is often not an effective strategy and can lead to more pressure and abdominal separation/tearing.

Diastasis recti is when the central seam of your abdominals (the linea alba) stretches and thins to the point of gapping/tearing. A thinning and minor separation can be normal and can heal on its own by 8 weeks post-partum. If the separation is too large or it doesn’t heal for various reasons, like doing the wrong exercises too early, then it can stay that way 12 months later and beyond. Good posture, avoiding the wrong exercises like planks/push-ups/press ups/crunches, limiting excess pregnancy weight gain are key to PREVENTING diastasis.

If you suspect a diastasis recti, please contact a Physical Therapist who specializes in women’s health issues.

Here at KIMA, we have a specific way to retrain this area utilizing real-time ultrasound to image your muscles. We use ultrasound, similar to the one your Obstetrician uses, but keep the view superficial to image your muscles (not organs or baby). We then observe which facilitation cue is best to close the abdominal gap and retrain your core, specific to what YOUR body responds to and needs.

After a thorough and careful examination, with you performing exercises, we determine the correct cues that resonate with your body to produce the best contraction. We identify which exercises are right for you, as well as the ones that are pulling at your seam – essentially keeping you from gaining that flat tummy again.

Often our patients are stunned that a contraction of less effort, along with an appropriate breathing strategy can “close the gap” more efficiently and help them feel supported.

Using these methods, Physical Therapists here at KIMA have been able to help women who were previously debating surgery for their 4-finger diastasis.

Once you can access the correct muscles, begin closing the diastasis and feel better, we continue to use the real-time ultrasound as biofeedback to help you refine your techniques. Enabling you to perform safely and independently at home. Let’s face it, life as a new Mom is BUSY. We understand fitting appointments into your schedule is hard, that’s why we work efficiently to progress you safely, until the point where you can return to your former exercise program (At home, Gym, Yoga, Pilates etc.)

Come in for your evaluation with one of our Women’s Health Physical Therapists to find out what YOUR individualized program should be.

By Patricia Ladis, PT
KIMA Co-founder & Mom of 3

In the previous two posts in this series, we learned how research over the past 20 years into tendon pain and injury had led to fundamental changes to how we understand what’s going on when someone experiences tendon pain. We discussed the change in terminology used in light of the discovery that inflammation was not a factor in tendon damage, and more recently how tendon injury can be divided into stages along a continuum. This system, increasingly embraced in the contemporary sports medicine community, has also served to simplify treatment choices, as selection is now guided by tendinopathy stage. Importantly, the realization that treatment choice is driven by stage of tendinopathy also tells us why and when a particular treatment may be inappropriate. These are discussed below.

Best practice management of tendinopathy, according to stage:

1. Reactive

From the previous post, we learned that acute, or reactive tendon pain can occur before actual damage is caused to the tendon, and as such, is reversible. It is a time of high metabolic activity, and so it is not considered a good idea to be using treatment techniques that would stimulate this further, such as friction massage or injections. Optimal treatments during either the reactive or acute-on-chronic stage include:

• Tendon unloading or rest – this is the only stage when you might consider resting a tendon
• Isometric or static hold exercises – known to have a pain-relieving effect on acutely painful tendons, can be progressed to very slow, heavy repetitions within specific ranges
• Ibuprofen – not because of its anti-inflammatory actions (since tendinopathy isn’t an inflammatory condition), but rather because of its effect on a compound called Aggrecan. Aggrecan isn’t welcome in tendons, but starts to accumulate in the reactive stage. Ibuprofen, and to a lesser extent other anti-inflammatories like Indomethacin and Naproxen, have a helpful side effect of being aggrecan inhibitors.
• Green tea, fish oil – these compounds are known as anti-oxidants, but additionally they inhibit the formation of another undesirable protein found in reactive tendons called TNFα (tumor necrosis factor alpha if you must know!)
• Doxycycline – primarily used as an antibiotic and anti-malarial, Doxy is also an effective TNFα inhibitor. Requires a prescription. Taking this and Ibuprofen together increases the potency of Doxycyline’s TNFα inhibition effect.

2. Dysrepair

Dysrepair, being an intermediate stage, takes some of its management priniciples from both acute and chronic classifications. Structural changes have started to occur in the tendon, such as a change in the collagen/ground substance mix and the ingrowth of small blood vessels. This is a progression of the ‘failed healing response’

• Exercise therapy during the dysrepair phase, like that in chronic tendinopathy, requires a more formal structure and progression, allowing time for the injured tendon to adjust to the demands that are being placed upon it. Progression from very slow, heavy resistance exercise to eccentric exercise protocols (see below) and alternating high/medium/low loading days
• Medications (see below for more information)
  • Green tea, fish oil and Ibuprofen (the triple cocktail) may still provide symptomatic relief
  • Polidocanol injections, designed to sclerose the new blood vessels growing into the tendon, are often employed during this stage
  • Platelet-rich plasma (PRP) injections are sometimes used during this stage
  • GTN (glyceryl trinitrate) patches, used in the treatment of angina, are sometimes cut into quarters and applied over the area of tendon damage with the aim of increasing local blood flow to the area.
• Massage and manual therapy – applied to the muscle belly, rather than the tendon itself, may play a supplementary role in managing local tightness and tenderness.

Fig. 1 – An example of the graduated progression of loading (strengthening) exercises for the Achilles tendon

3. Degenerative

Tendon metabolism during the chronic or degenerative stage has slowed down quite a lot – there’s not much going on in the tendon by this stage, unless an acute-on-chronic reaction is provoked. Structural damage is nevertheless present, and therefore therapies at this stage are directed more at stimulating repair and remodeling of the tendon.

• Injections – depending on the school of thought, injection therapy may comprise an effort to get the tendon to heal, initiate a scarring response, or to selectively ablate small blood vessels growing into the tendon.
• Platelet-Rich Plasma (PRP) – increasingly popular in the US, this involves taking a patient’s own blood and spinning it in a centrifuge to extract all the good bits like growth factors and healing promotors, then injected back into the tendon, with the aim of stimulating healing
• Prolotherapy – involves the injection of something like dextrose into the tendon, essentially to irritate it and generate a scarring response. Also used in the treatment of damaged or lax ligaments.
• Polidocanol – has the effect of killing off the additional blood vessels that are known to grow into the tendon during this stage. These vessels are considered by some to be a source of pain within the tendon.
• Cortisone – the use of steroid anti-inflammatories is no longer recommended, as they have been shown to weaken the tendon structure (predisposing to rupture) and also since tendinopathy is no longer considered an inflammatory condition.
• Extracorporeal Shock Wave Therapy (ESWT) is currently more popular in Europe and Australia than it is here, but there is a growing body of research that suggests it is helpful in treating chronic, recalcitrant cases of tendon pain that have proven resistant to other conservative therapies. The device used emits an acoustic pulse that stimulates tenocyte (the cell that drives tendon metabolism) activity in the damaged tendon. The treatment is mildly unpleasant but takes only several minutes.
• Massage and manual therapy – not considered to play a significant role in the management of tendinopathy, but may provide some symptomatic relief of local tightness and tenderness.
• Exercise is the most potent stimulus for tendon remodeling. Since the rate of change in tendons is much slower than that of muscles, it is critical that any therapeutic exercise program be progressed carefully and structured so that the tendon has enough time between loading efforts to adapt (sets, repetitions, frequency)
• A popular program is the eccentric exercise protocol developed by the Swedish researcher Hakan Alfredsson. It seems to be more effective with damage to the middle of the tendon as opposed to where it joins with the bone.
• Often sufferers of chronic tendinopathy have developed strength deficits or muscle wasting, which needs to be addressed through appropriate strengthening exercise programs
• Once a patient has progressed to impact loading activities – jumping, hopping, running – the exercise program can be progressed to include alternating high/low or high/medium/low load days
• A final, important component of exercise therapy with degenerative tendinopathy is the appreciation and correction of any biomechanical or movement pattern anomalies that may be contributing to the onset or maintenance of the problem. An experienced physical therapist, with their understanding of biomechanics, tissue pathology and exercise is ideally placed to deal with these kinds of issues.

Indeed, alongside the medical doctor, the sports physical therapist plays a major role in the effective management of all the different stages of tendinopathy. Occasionally some tendons may require surgical intervention, but the majority of cases can be effectively treated with a combination of the correct type and progression of exercise and prudent use of medication.