Acetaminophen—the main ingredient in medications
such as Tylenol®—is the most widely used pain
reliever. While generally considered safe when taken
occasionally and in small doses, acute overdoses and
chronic consumption of acetaminophen can cause
liver toxicity.
According to research, 50 percent of all acute liver
failure in the United States is attributed to acetaminophen
consumption.1 While many of these cases result
from an overdose, even “correct dosage” may cause
liver damage, liver failure and death.1 In the United
States alone, approximately 56,000 liver injuries
requiring emergency treatment, 26,000 hospitalizations
and 458 deaths per year are attributed to aceta
minophen consumption.2 The Food and Drug
Administration (FDA) is currently considering measures
to decrease the number of cases of unintentional
and intentional overdose leading to liver injury,
including limiting the maximum adult daily dose in
both prescription and over-the-counter medications
and improving labeling.3
Initial signs and symptoms of acetaminophen toxicity
are nausea and vomiting, so it’s hard to identify it
immediately. In some cases, liver toxicity may develop
without symptoms.
Drug-Free Pain Relief
Patients often rely on medications to treat acute and
chronic pain, Talk to your doctor of chiropractic about
conservative, medication-free pain relief. Depending
on your individual needs, your doctor of chiropractic
will develop a program of care that may combine
more than one type of treatment instead of using
drugs and surgery. The treatment plan may include
spinal manipulation, mobilization, or massage, as
well as procedures such as electric stimulation, rehabilitative
exercises, advice on nutrition, and suggestions
for posture modification. Doctors of chiropractic
are committed to wellness and avoiding the unnecessary
use of medications.
Be well!

History:
A professional racing cyclist
presented with low back
pain after finishing stage
two of a 17-day stage race.
Earlier in the stage, the
cyclist crashed into a
concrete barricade while
attempting to maneuver
around a crash in the
peloton (group of cyclists).
The cyclist collided with
another bike and was
thrown into the barricade.
He struck the barricade with his low
back first, mostly on the right side,
hyperextended over the barricade
and fell onto his knees.
Initial evaluation after the
stage revealed a large
hematoma forming on the
athlete’s right paraspinal
muscles at the level of
the 4th lumbar vertebra,
which was roughly 5 cm in
diameter. After a 30-minute
bus ride, he could barely
stand to exit the bus.
Upon re-evaluation of his
condition, the hematoma
remained the same size.
The athlete had a difficult
time sitting and lying on his back, as well
as getting into any position that would
assist in making a quality diagnosis.

Limited ROM/Pain:
Every range of motion in the lumbar spine was limited
and was accompanied by pain. In a side lying position,
the iliac compression test was performed as well as a
modified straight leg raise. Both were positive. Upon
palpation of the lumbar spinous processes, there was
tenderness at levels L3, L4, and L5. At this time, the
athlete was referred for X-rays of the lumbar spine and
pelvis. The X-rays were negative for any fracture, but
showed a significant amount of soft tissue swelling in
the lumbar and sacral regions.

Treatment:
The athlete’s lower extremities and low back were
massaged for 90 minutes in an attempt to break up
forming adhesions. Afterwards, noticeable swelling
remained in the lower lumbar region, specifically in
the right flank region around the iliac crest. The
athlete was informed of the Graston Technique® (GT)
and how it would promote healing in his low back.
GT2 was used to assist in edema removal by gently
gliding over the visual hematoma from the iliac crest
up the right paraspinal to the min-thoracic level. A
moderate fluid wave was caught numerous times
during the gliding strokes.
After approximately a dozen strokes, GT4 was used with
a fanning stroke along the right flank to assist in the
removal of edema. Overall, the hematoma was reduced
by 50 percent. The athlete was instructed to ice for 20
minutes every hour for the rest of the day and he
received laser treatments in-between ice applications.

Inflammation Subsides
The athlete was in considerable pain the next day, but
rode and finished the stage. The inflammation in the
lumbar region was considerably less and he was able
to walk without an antalgic gait. The cyclist was having
a difficult time flexing at the waist, as well as laterally
flexing to the right. He had no radiating pain into his
extremities, but moderate pain in the lumbar region.
GT4 was used in a static mode to scan the right and
left flank areas, focusing specifically on the thoracolumbar
fascia and latissimus dorsi origin. GT3 was
used around the hematoma to continue breaking down
the adhesive tissues forming in the area. After
treatment, the athlete was able to flex at the waist and almost touch his toes. The next day, the cyclist was in pain and barely finished the stage. He attributed the pain and
soreness to too much treatment the previous day.
(The previous stage was a very hard climbing stage
as well.) At his request, we did not treat him. The
cyclist received roughly 90 minutes of massage
therapy and ice treatments and called it a day. The
next day, he raced and felt more comfortable on the
bike, but complained of moderate to severe amounts
of pain in his lower back when in the saddle and even
more when he stood up to climb or gain extra speed.

Static/Slowly Flexing Treatment:
We continued GT treatments after this stage by
scanning the area with GT4 in a static position, then
slowly having the athlete flex at the waist with the
transverse abdominus (TA) activated. A fanning
stroke was used in a superior and lateral motion with
GT4 along the fibers of the latissimus dorsi while
the athlete laterally flexed and rotated to the left.
Significant fascial restrictions were felt throughout the
posterior compartment. Upon completion of this
treatment, the cyclist had improved range of motion
in flexion and lateral flexion at the waist, as well as
decreased pain. The next day, the cyclist felt improvement, but still complained of soreness in his lower back while on the bike. He finished in the middle of the peloton and was
pleased with his ongoing recovery. He said a fall like
the one he had after the start of the race would
usually have removed him from the race for its
entirety. We continued the same treatments, but
added GT3 and GT6 in a more specific nature on the
origin of the lats at the iliac crest and the iliocostalis
muscles where these areas were quite defined on
him. (This is a common characteristic in elite cyclists
because these muscles are used in and out of the
saddle to stabilize the sacrum and pelvic structure.)
During the next few stages, it seemed as though
we were reaching a plateau. The athlete was continuing
to have a moderate amount of soreness in his low back,
but more than anything, he was not getting the power
output he normally had. He was also complaining of a
specific spot in his lower back that we later pin pointed
to be just below the origin of the hematoma. This spot
was just above the base of the sacrum at the level of
the right mammillary process of L5. After stage 10, we treated the cyclist on his bike aboard rollers. The next day was an off day for the event so it was a perfect opportunity to try a new technique. The cyclist armed up for 10 minutes at a
power output of 100 watts (computer-aided device).
We scanned the thoracolumbar fascia with GT4 and
evaluated how his muscle system responded. The
cyclist increased his output to 200W and held for four
2-minute bursts. During these bursts, we treated at
the base of the sacrum, mostly on the right side with
GT3 and GT6.

Cyclist Stronger
Finally, we had the cyclist come out of the saddle and
hold for 2-minute bursts at an output of 250 W. We again
treated the specific area the cyclist was complaining of,
as well as into the paraspinals of the lumbar spine.
The next day, the cyclist did a light 2-hour ride and felt
he had more power in his train. No treatment was
performed on this day. At stage 11, the cyclist felt even
stronger in his race, but was hindered by several flat
tires. After this stage, he received another treatment,
but the intensity and duration were decreased.

Result:
Stage 12 deemed to be the time where everything
came together for the cyclist. He was ahead for most
of the stage, but fell back at the very end, finishing
fourth. The cyclist continued to ride strong through the
last four stages and complained of minimal pain in the
affected area. Continued treatments were done with
the cyclist on his rollers and again the treatments
were modified to reflect how the athlete was feeling
after the respected stage. One month later in a prestigious stage race in China,
the cyclist complained of no pain in his low back,
only soreness after the big climbing stages. The
cyclist ended up winning the overall race and another
major race back in the states a few weeks later. This
is a classic example of learning how to listen to an
athlete’s body and knowing when is too much and
when is not enough. Most importantly, after fascial
restrictions are removed with GT and proper
remodeling of tissues are completed, it is amazing
what the human body can do.
Great article, hope you all enjoyed it!

What about those “Finger Shoes”?

The natural or ‘barefoot’ running trend has received much attention over the last two years. The foot is a machine. It is designed for the planet Earth where ground softness varies between rock and beach sand with a constantly varying terrain. With each step the foot handles huge forces with 26 tiny bones, managing to balance, maneuver, and take a horrific beating and yet spring back for the next step. It is truly an engineering marvel and continues to amaze us. The majority of runners train and race on asphalt, pavement, and concrete: unforgiving, hard and un-natural. Over time, the elongation of the arch supportive ligaments is likely. For the most part, in a practical clinical environment support is required as part of the treatment protocol. While you will have those rare patients that can achieve complete nirvana with only running form alteration, this will likely be the exception rather than the rule. There may be some psychological benefits to being barefoot, but since the mechanical integrity and long-term health of the foot is so much more important, we recommend a full contact ‘isomorphic’ calibrated orthotic to support the majority of patient’s feet and ensure their continued health and happiness in this concrete jungle.

What about those “ROCKER” shoes?

Rocker sole shoes have long been known for their therapeutic benefits. They can protect the feet from repetitive impact with concrete and hard surfaces. They can also help those patients suffering from hallux rigidus to restore a more normal heel to toe gait. But rocker sole shoes are not for everyone. Many of the brands on the market are considered “unstable” shoes, promoted to induce instability to recruit the muscles you use for balance. They will have medial and lateral shoe instability. They also have a negative heel effect. At heel strike, the heel will be slightly lower that the forefoot which tenses the posterior compartment musculature. Since calf tightness is so common, increased calf tension from a lower heel could cause more compensatory pronation. Depending on the clinical situation of each patient, these may not be desirable conditions.

I wish there was a quick answer to foot pain/problems, but there are only simple ones. We have had great success with Graston technique for foot pain, plantar fasciitis, ankle pain and chronic sprains, as well as various achilles tendonopathies. We are now thrilled with the results we’ve had from Sole supports, and it is the only orthotic I will now cast patients with.
If you are suffering with foot pain or problems, you really don’t have to, and you owe it to yourself to come in and at least have you feet scanned (no charge!) and let us discuss your options. Relief is just phone call away.
Be well!

All parents want their kids to be the best athletes they can be. Chiropractic care can help your child be a better athlete while improving their performance and helping to prevent some injuries. In this article we are going to take a look at some strategies for optimizing your child’s performance through solid preparation, prevention of injuries and recovery.

Prepare for Sports Performance -

Proper nutrition: Make sure your athlete always eats a good, healthy breakfast. Avoid sugar-laden cereals that give a sudden burst of energy but then leave them feeling drained. Opt instead for a bowl of oatmeal with fresh fruit, or a whole grain muffin.

Kids need a varied, healthy diet rich in all kinds of vegetables, fresh fruits, whole grains and lean proteins. Hydration is vitally important. Offer your kids lots of water with lemon rather than those sugary, salty sports drinks.

Provide healthy snacks after each game or performance such as, a healthy trail mix that you make yourself, granola bars, carrots, apples, low fat cheese and whole grain crackers.

Adequate rest: When trying to balance both sports and schoolwork, sometimes kids end up staying up too late to do homework. Help your child to manage their time among all of their obligations so that they can be sure to get at least eight hours of sleep each night. Good sleep and nutrition habits lay the foundation for peak athletic performance.

Prevention of Sports Injuries -

Working with a chiropractor is an effective adjunct to proper preparation for athletic performance. A Chiropractor can provide adjustments, therapeutic exercises and stretches along with nutritional counseling to help support your child’s increased performance and reduced incidence of injuries.

Proper training:
Are your kids getting proper training for their sport? Without solid preparation from a coach who is knowledgeable about the sport and about physical developmental issues with children, kids can end up getting unnecessary injuries.

Warm-ups:
Kids need to warm up and stretch using appropriate exercises for their sport. A proper warm-up and stretching regimen can prepare them to play and help protect them from injury.

Proper equipment:
Children need the right equipment that fits them and is appropriate for their sport such as helmets, shoes, protective pads, etc.

Cool-downs:
After a game or performance, make sure that your child gets a chance to do long, slow cool-down stretches and cool-down exercises.

Recovery from Injuries -

If your child somehow ends up getting injured, a chiropractor can help them to properly recover from injury so that they can resume their sport safely.

While your young athlete might think that they are impervious to injuries, taking a few preventative steps can set them up for a much more rewarding and successful career and can teach them solid practices that will last their entire lives.

In a retrospective study of 39 patients treated in one physician’s office, Cox® Technic provided statistically significant relief of pain. The Visual Analog Scale (”On a scale of 1 to 10 with one be no pain and 10 being the worst pain, what is your pain today?”) reports by the patients showed reduction in pain. The mean number of treatments was 13 (+/- 8 treatments). The treatment protocol was Cox® Technic and physical therapy modality (ex: ice or electrical stimulation or other).

This study of cervical spine radiculopathy patients with pain down the arm below the elbow is a stepping stone to larger studies of its kind to document the relief attainable with Cox® Technic. Cox® Technic and its physicians and researchers strive to document the protocols, outcomes and biomechanics for the best clinical outcomes.

For more information on Cox® Technic flexion-distraction for cervical spine pain and cervical spine pain radiculopathy, please visit techniques we use on our website, or call for a complimentary consultation!

Be Well!

Dr. Joseph Hayes