Diagnosis Detective Case File: Osteoporosis

diagnosis-dectectiveOsteoporosis has many different causes and because of this, needs diagnostic work comparable to a detective searching for a killer who wants to remain hidden.

First let’s talk about what osteoporosis is because many people confuse it with another bone issue that has a very different cause and treatment plan.  Then let’s briefly describe some of the different mechanism that can lead to osteoporosis.

Osteoporosis vs. Osteomalacia

By derivative work: Chaldor (talk)Illu_bone_growth.jpg: Fuelbottle - Illu_bone_growth.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4353671

Before I describe the difference between these two diseases, it is important to understand one key concept in bone production.  In the normal state of bone growth with youngsters or later on in life with bone remodeling, oocytes (bone building cells) first produce and secrete a layer of protein called ‘Osteoid’ that looks very much like cartilage.  Once this soft, bendable protein scaffolding is laid down, calcium and other minerals will bind to this cartilage substance to stiffen it into hard bone.

Osteomalacia

osteomalaciaOsteomalacia is a somewhat common condition, particularly with children, that is also known as ‘rickets’. This issue is the result of a vitamin D deficiency that leads to problems absorbing dietary calcium.  When you don’t absorb enough calcium, your osteocytes will still be very capable of laying down the protein cartilage scaffolding, but there will not be enough calcium to stiffen it into hard bone.  In this situation, the bones will be too soft and bendable.  People with rickets frequently become bow legged from their long bones bending too much.

With x-rays, calcium and other minerals will stop the radiation from penetrating through to the film. Because there is too little calcium saturating the protein cartilage, the pictures of the bone will show low density which is called osteopenia, or too little bone mass.  Under a microscope, bones with osteomalacia will look like cartilage that is only partly mineralized.

Osteomalacia is helped very rapidly by increasing your vitamin D and calcium supplements or occasionally by correcting issues with your thyroid/parathyroid glands.

Osteoporosis

osteoporosisOsteoporosis is a very different disease that typically affects seniors.  In this condition, the body is laying down too little of the bone protein scaffolding. The bone cartilage that is there will be calcified perfectly, it is just that there are too many large holes in the bone where the protein scaffolding has not be laid down.

Unfortunately, using an x-ray or bone density study, it will look identical to osteomalacia.  The total amount of x-ray stopping minerals will be deficient in both cases, showing a low bone density.  In osteomalacia, the minerals are evenly dispersed through a nice homogeneous cartilage matrix, but with the minerals at a low density.  In osteoporosis, the bone that is there will have a high mineral content, it is just that there are too many holes in the bone.  If we add the normal density bone to the holes in the bone with no minerals at all, we get an average bone density that is low.

If we look at both of these bones under a microscope, the appearance is very different.   Under a microscope, the osteoporotic bone looks like hard, swiss cheese and the osteomalacia bone looks like bendable, lightly mineralized cartilage.

Osteoporosis typically gets very poor results from treating it with vitamin D and/or calcium.  The reason is because there is no scaffolding for the calcium and other minerals to attach too.  Successful treatments of osteoporosis are targeted towards increasing the amount of protein scaffolding in the bone which then will typically mineralize without any additional treatment.

Causes of Osteoporosis

protein-rich-foodsThis is a partial list of the causes of osteoporosis.  Some of these can easily branch off into multiple sub-mechanisms of causes.  The key thing to remember about osteoporosis mechanisms is that it is not the result of too little calcium or vitamin D.  It is because there are too many holes in the protein scaffolding where the calcium cannot attach to!

  • Low Protein Status – This can be from too little protein intake, too little protein digestion, too little absorption, increased rates of protein utilization, and increased rates of excretion.  Factors that can cause these sub-mechanisms include: excess antacids; proton pump inhibitors; lax attention to amino acid balancing in vegetarian diets; food allergies; pancreas, kidney or liver problems; protein depletion during child-bearing; excess stimulation of adrenal grands from caffeine.
  • Hypo-active Osteocytes – These are the cells that lay down the protein scaffolding in the bones.  They may be under active because they don’t have the protein raw materials to work with or because of protein deposition regulation problems.
  • Weight Bearing Exercises – The shock wave that travels up the body from the heel to the head when you take every step is a stimulus to laying down new bone scaffolding.  Insufficient activity leads to bones getting weaker.  (Think of astronauts and how their bones get extremely fragile after extended stays in microgravity.)
  •  Estrogen Decrease – Estrogen fluctuations in women during childbearing years is a slight stress to bone building contributing to women getting weaker bones than men. At menopause, there is an approximately 3 year window when bones will get rapidly weaker due to the decreased estrogen.  Once the body adapts to the new estrogen status, osteoporosis progression due to this mechanism abates.
  • Liver Status – Toxins, drugs and alcohol all put major strains on the capabilities of the liver.  This organ is responsible for many internal physiological processes that contribute to bone production rates.
  • General Health Issues – Production of the bone protein scaffolding is impacted by many more factors.  Everything from blood distribution to the osteocytes being influenced by tobacco to, every one of the 42 essential nutrients will have a role to play in slowing down bone production from optimal levels.
Wrap Up

From the above list, it is hopefully easy to see that slowing down or reversing osteoporosis is going to take a broad approach to finding the causes and potential cures.  There is no simple, single remedy that is going to work for all or even most people.  It requires detective work, and a determination to seeking out the causes.

While it is not a simple “One Disease, One Cause” type of issue, it is also not impossible to find the culprit. And it is critically important to undertake the venture.  Leaving most of these potential causes of osteoporosis undiscovered and unaddressed will lead to more problems, some of them much worse than osteoporosis.

On the good side, not only are most of these issues relatively easy to find once you start to look for them, most of them are also fairly easy to fix once you know they are involved.  The key to success is having a mind-set that is determined to seek out and optimize your health.

Stand Tall, Stand Strong!

By Dr. John M. Wallman

This article is not intended to offer a diagnosis or medical advice.  It is offered strictly for educational purposes.  Please consult members of your health care team directly to explore these or any other health care concepts.

Nutritional Support of Low Handicap Golfers

Golfer with back pain“Higher handicap players typically experience injuries that result from swing mechanics, whereas lower handicap and professional players have overuse as the major cause of their injuries.” (1)

On a fundamental basis, overuse injuries indicate that the mechanical stresses & damage to an area of the body is outstripping the body’s ability to heal this damage.  While traumas of a certain severity can easily overwhelm every body’s ability to immediately contain the damage, the nature of overuse injuries implies small, repetitive traumas.  Many of these overuse injuries can be eliminated by reducing the amount of damage, or accelerating the rate of repair. Both sides of this equation should be considered, looked for and corrected when found.  Let’s not put up with overuse injuries unnecessarily when potential cures are not being considered.

Potential Causes of Excess Overuse Injuries

This sounds kind of redundant, but there are some subtle, yet important distinctions.  We’ll just touch on this briefly before moving on to nutrition. This ‘Excess Overuse’ concept considers, “is the damage causing the overuse injury greater than it needs to be?”

Excess mechanical damage – Professional golfers get very good at their swing mechanics.  They become very efficient with their swing and utilize proper sequencing of muscle groups that contribute to their power and control. So by this ‘excess mechanical damage’ I am not referring to poor technique or inefficient strokes.  I am referring to a combination of: managing old injuries; accumulated muscle imbalances from an inherently one-sided sport and; prime movers that become stronger than the associated antagonists, synergists and stabilizer muscles.

This topic is covered in part with other posts. (see Golf: Training Driven By Diagnosis: Exercise Your Stabilizers  and Improving Your Golf: Balance Your Agonists and Antagonists and Are My Muscles Balanced )  The bottom line is, can corrections be made to reduce the amount of damage that occurs from a high volume of mechanical activity?

The Repair Side of the Equation

golfers-elbow-wcNutritional Sufficiency for Rate of Tissue Damage – The golf swing place stresses on certain tissues that accelerate the rate of tissue damage beyond the wear and tear experienced through normal daily activities.  This accelerated damage requires accelerated repair to keep the tissues healthy or preferably, to get stronger over time.

While all 42 essential nutrients will be utilized at an accelerated rate to repair this type of damage, certain key nutrients are very frequently deficient from repetitive mechanical use, at least on a local basis.  By local basis, I am referring to the nutrient levels within the damage zone of the affected tissue.  Total body levels of some essential nutrients may be adequate, but within the damage zone, you may be experiencing local deficiencies because of the accelerated repair work.

Common key nutrients utilized at an accelerated rate during physical exertion that damages biomechanical tissues include: Essential amino acids, vitamin C, zinc, magnesium, manganese and to some degree the non-essential glucosamine and chondroitin.

The final issue I want to cover on the topic can contribute to both accelerating damage and accelerating repair with overuse activities.

Non-biomechanical health issues – Every organ and tissue in the body can contribute to or detract from your ability to deal with increased mechanical stress.  Let’s look at a few examples.

  • thyroid-wcIodine deficiency – This essential nutrient is utilized extensively in the thyroid gland and the number 1 cause of hypothyroidism.  A low functioning thyroid gland will result in a number of abnormal physical effects including decreased energy and a slower rate of repair.  This slower repair can make the difference between ‘losing ground’ during an intensely physical lifestyle or ‘getting stronger’.
  • adrenal-fatigue-2Phenylalanine deficiency – This essential nutrient is converted into adrenalin (released from the adrenal gland as well as certain nerves) and thyroxine (the primary thyroid hormone). People who live high stress lifestyles produce these hormones at an accelerated rate and can become depleted in the raw materials used in the manufacturing process. Unless phenylalanine is replenished at a rate to match the elevated stress hormone production, deficiency will result along with a host of affiliated symptoms such as slow repair, low energy and loss of mental focus.
  • Glutathione deficiency – This chemical is critically important for detoxifying the body from a wide range of medications and alcohol.  If the body becomes depleted of this important chemical from a history of drug and alcohol intake, the body will not be able to eliminate these toxins from the body.  They will then accumulate in the liver where they can eventually cause many symptoms including: loss of energy, slow repair and, digestive disturbances.
Summary

To get to the top of your field and stay there requires that you do more than the average person.  Mastery of demanding physical skills requires much more than additional time of practice.  The additional practice and playing time brings along a host of new problems that the amateur athlete doesn’t experience.

The low handicap golfer now needs to pay much more attention to balancing their agonists, antagonists and stabilizer muscles in order to diminish the amount of damage to their tissues. In addition, physically demanding activities require replenishing essential and non-essential nutrients at an accelerated rate as well as paying more attention to the nutritional requirements of the entire body.

By Dr. John Wallman

www.DoctorWallman.com

  1. – Bayes, MC, Wadsworth, LT, Upper extremity injuries in golf, Phys Sportsmed, 2009 Apr;37(1):92-6. doi:10.3810/psm.2009.04.1687

This article is not intended to offer a diagnosis or medical advice.  It is offered strictly for educational purposes.  Please consult members of your health care team directly to explore these or any other health care concepts.

What is NOT a potential cause of depression?

Thinking - MSa) A deficiency of the nutritional precursor to a neurotransmitter used in the brain – i.e. tryptophan or phenylalanine

b) A deficiency of Omega 3 fatty acids that make up 25% of the brain, primarily used in making myelin sheaths that ‘insulate’ nerves.

c) A vitamin A deficiency which can cause the histamine packets within White Blood Cells to be too fragile, releasing excess histamine causing an ‘allergic’ type reaction which can affect the brain.

d) A chromium deficiency which leads to hypoglycemia, neurological inflammation and hyperexcitability of the depression brain centers.

e) A Fluoxetine (i.e. Prozac) deficiency which leads to insufficient Selective Serotonin Reuptake Inhibitors (SSRI).

All of the above are essential nutrients that must be eaten on a regular basis in order to: 1) live, 2) grow, 3) repair or 4) reproduce and potential causes of depression except e) Fluoxetine (i.e. Prozac).  Fluoxetine is a synthetic compound which was patented for many years.  There is no normal occurrence of this substance in humans and by definition, no deficiency state.

While many doctors recommend Fluoxetine and other similar SSRI medications to treat depression, these treatments do not address potential causes of the condition.  Finding out why somebody is depressed requires detective work to uncover which of the potential causes have abnormal laboratory test results.  Correction requires not only eliminating  whichever essential nutrient abnormalities you find, but may also involve neurological retraining.

Neurological Retraining: Why & How

Man Meditating on a Rock at the BeachNerves that fire excessively will tend to get larger, similar to the way an exercised muscle gets larger and hypertrophies.  When you correct an essential nutrient deficiency that was causing a nerve to fire excessively, the larger and stronger nerve will still remain hypertrophied. Until this nerve atrophies (gets smaller from lack of excess stimulation), it will still be capable of contributing imbalanced signals into the nervous system.

Retraining is a way to redirect behaviour patterns away from the hypertrophied nerves.  It may require behaviour modification, cognitive exercises, emotional patterning, meditation, etc.

This article is not intended to be medical advice and is not advising you to stop taking any medications you may currently be on.  Many SSRI medications have substantial side effects when discontinuing their use.  Please consult members of your health care provider team directly to explore the concepts in this article.

This article is not intended to be medical advice and is not advising you to stop taking any medications you may currently be on.  Many SSRI medications have substantial side effects when discontinuing their use.  Please consult members of your health care provider team directly to explore the concepts in this article.

Golf: Most likely injuries for professionals?

golf-swing-injury-sitesWhat body parts are most likely to get an injury for:
a) male professional golfers?
b) female professional golfers?
Another interesting question is what percentage of professional golfers get injured because of their sport?  In one study, 66% of all professional golfers (teaching & touring) had a significant golf injury during their career, while 31% had an injury during the past year. (2)
What makes these numbers even more significant is that these are people who exercise extensively with some of the best trainers in the world and they use excellent technique.  Keep in mind that this study was completed in the post Tiger Woods era when physical conditioning for professional golfers was elevated to new heights.
What does this tell us about the likelihood of injuries and the importance of high quality training for amateurs?
Answers to the original questions (1)
a) Male professional golfers – The low back is the most likely area to be injured.
b) Female professional golfers – The wrist is the most injured area.
Excerpt from Dr. Wallman’s upcoming book “Golf: Training Driven By Diagnosis”
1) Clin Sports Med. 1996 Jan;15(1):1-7.
2) Br J Sports Med 2011;45:e1 doi:10.1136/bjsm.2010.081554.12
This article is not intended to offer a diagnosis or medical advice.  It is offered strictly for educational purposes.  Please consult members of your health care team directly to explore these or any other health care concepts.

Histamine – “I’m not an evil chemical”

woman-with-an-allergy-public-domainHistamine is a chemical that is normally found in the body.  The actions of histamine include being a part of the immune system’s defense.  Histamine acts a chemical messenger in the early alert system that detects chemical intruders into the body.  The early alert system which utilizes histamine messengers includes mast cells (found in lymph nodes) and basophiles, one type of white basophil-wcblood cell (see blue histamine packets within the cells in the photo).  When foreign proteins get into the body the mast cells and basophiles swallow and destroy them and release histamine.  Histamine then diffuses into the surrounding tissues where it will dilate local blood vessels.

allergic-conjunctivitis-wikipediaThe dilated vessels will result in the blood flowing slower in the surrounding tissue.  Slower moving blood through arteries that are larger than normal will tend to allow an increased amount of blood to leak out.  This leaking blood contains additional chemical and white blood cells to help contain and eliminate any additional foreign proteins that have gotten through the body’s walls.  This redness (from dilated blood vessels) and swelling (from increased fluid leakage out of the blood vessels) is inflammation.  So histamine is one of the chemical messenger that initiates inflammation and protects your body from foreign ‘invaders’.

hives-wikiIf histamine is released in larger amounts, it will spread further through the body causing increasing inflammation at more distant sites.  Remote sites could include the eyes, nose and brain. In these situations, you might get watery eyes, runny nose, hives and neurological symptoms such as brain inflammation.  An inflamed brain can give a wide range of symptoms depending on which nerves are weakest and most vulnerable (i.e. depression, anxiety, compulsions, etc.).  If severe enough, anaphylactic shock will be the result as too many arteries throughout the body dilate and blood pressure drops to lethal levels.

At certain points, the inflammation process is opposed by the bodies inflammatory chemical such as cortisone.  These anti-inflammatory chemicals will stop the inflammation process from spreading too far.
child-eating-peanuts

Combating excess histamine release or control with ‘anti-histamines’ will stop the symptoms of allergies but will not fix the cause.  Why is the body releasing too many histamines? Are the histamine packets in the immune cells to fragile? Is the body producing too little cortisone? Why?  If you cover up excess allergy symptoms with anti-histamines instead of finding and fixing the cause(s), the original problem continues to wreak havoc on your body, and the next problem from this cause might have much more severe consequences on your health! In addition, you are crippling your immune system from containing and eliminating foreign proteins that have gotten into your body.

Regulating histamine releases, as well as containing the duration of its effect, is a vitally important component of the body’s defenses.  It will help attract your body’s defenses to deal with foreign substances that get inside of you.  When histamine is excessively released or unopposed sufficiently by regulating chemical, inflammation can spread too far, and can cause mild to severe symptoms including anaphylactic reactions and death.  The key is finding out: 1) if the right amount of histamines are being released upon normal stimulation (such as eating a normal food) and then 2) are you turning off the inflammation process at the right time.  Once you determine these factors, it will be much easier to find the causes and hopefully permanent cures to prevent excessive histamine reactions in the future.

By Dr. John M. Wallman, DC

This article is not intended to offer a diagnosis or medical advice.  It is offered strictly for educational purposes.  Please consult members of your health care team directly to explore these or any other health care concepts.

Stability Testing – For Seniors

senior-doing-tai-chi“Unintentional falls are a common occurrence among older adults, affecting approximately 30% of persons aged >65 years each year.” (1)

In the US, in 2003, a total of 13,700 persons aged >65 years died from falls, and 1.8 million were treated in emergency departments (EDs) for nonfatal injuries from falls.

Why do seniors fall?  tree-pose-yoga

Falls can happen for a lot of reasons.  Here are some of the more significant reasons (2)

  • Muscle weakness and asymmetry, particularly in the ankles and hips.
  • Too many medications
  • Unsafe home environment
  • Decreased sensitivity of the body and joint positions.
  • Vision issues

Perhaps surprisingly, inner ear issues were not as big an issue as is frequently thought.

How to Prevent Falls?  seniors-dancing

  • Get tested for muscle imbalances and do corrective exercises.
  • Do you really need that many medications? Talk to a doctor about cutting back.
  • Make sure your home has clear walkways, inside and out.
  • Move more often, take Tai Chi, yoga and balance development classes.
  • Get your essential nutrient status checked and take care of any deficiencies.
  • Change your multi-focal glasses for single focus lenses.

Am I at risk?  Get tested!  

cmi-in-actionThere are different ways to test for susceptibility to falls available through the Diagnosis Foundation.  These include:

  1. Fall Assessments – These include a wide range of quick and easy physical and written questionnaires. Checking your fall history, evaluating how well you rise from a chair, timing how quickly you can maneuver through a series of standing, turning and walking activities.
  2. Computerized Movement Imaging (CMI) – A computer analysis is done of you performing a few specific maneuvers.
  3. Stability Testing – A sensitive piece of technology measures how much you ‘wobble’ while doing a series of activities with your eyes open and closed.
  4. Muscle Imbalance Testing – Muscles commonly involved in fall prevention and measured for strength and symmetry.

Contact The Diagnosis Foundation  

liim-exercise-roomThe DxF is focused on improving human safety, health and performance by promoting diagnosis which seeks underlying causes using objective and holistic methods.  We do this through diagnostic programs of: testing, education and R&D which will ultimately result in a new system of human care.

As part of our testing program, you can contact the DxF so that we can put you in touch with a physician in the Suffolk or Nassau County, NY region who is certified to perform a Fall Prevention Exam using Muscle Imbalance Testing, Force Plate Stability Testing & Computerized Movement Imaging.  Your doctor will then prescribe and if appropriate, supervise a nutrition or exercise program to decrease your fall risk. These tests may be performed at our state of the art headquarters in Ronkonkoma, NY on Veterans Highway near Islip McArthur Airport.  For additional information or to schedule an exam, contact: Info@DxFoundation.org

1 – Hausdorff et.al.  Gait variability and fall risk in community-living older adults, Arch Phys Med Rehabil 2001;82:1050–6.

2 – Gillespie et.al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep

This article is not intended to offer a diagnosis or medical advice.  It is offered strictly for educational purposes.  Please consult members of your health care team directly to explore these or any other health care concepts.

CrossFit – Top Box Program

hand-stand-crossfitThe Diagnosis Foundation (DxF) has established a program to work with CrossFit boxes in order to: prevent injuries; accelerate the rate of fitness development and help fine tune exercise programs.  For this program, the DxF will provide a certified physician to do the following free services for you at your box:

  • Pre-Training MaxFit Exam – For new members who enlist in membership at a specified level, the DxF will supply a 30 minute MaxFit Exam at our state of the art facility in Ronkonkoma, NY.
  • Computerized Movement Imaging (CMI) Screen – Semi-annually, the DxF will come to your box and do a ½ hour talk on CMI and screen all attendees.
  • Max Fit Re-Exam – For anybody who receives a Pre-Training Exam at our office, we will do a re-exam at your facility.

Pre-Training MaxFit Exam weight-lifter

  • Designed to decrease injuries and improve client retention
  • For new clients who sign up at a membership level you decide on
  • 30 minute exam includes:
    • Computerized Movement Screen
    • 40 Muscle Imbalance Tests
    • Stability Exam
    • Vitals – Height Weight, Blood Pressure, Max Expiration Volume
  • Max Fit Exam available to other member at a discounted price

MaxFit Re-Exam athlete-crossfit

  • Twice a year, a DxF physician will come to your box and re-examine anybody who had received a MaxFit Exam.
  • Re-exams are the critical component to maximizing improvement with muscle imbalances.
  • Clients will be reexamined on tests with abnormal findings in their original MaxFit Exam.
  • MaxFit Re-Exams start with a half hour informal talk regarding: corrective exercises

Computerized Movement Imaging 

  • cmi-in-actionThis cutting edge system records clients performing a set of physical activities. It then measures and analyzes the biomechanics of more than 35 key body movements using infrared, video and computer technologies.
  • Ranges of Motion are measured for hyper and hypo mobility, dyskinesias, symmetry and potential muscle imbalances.
  • CMI analyzes the sequence and timing of joint movements for proper kinematics
  • Graphic data is synchronized with video recordings for immediate viewing to assist patient comprehension and training.
  • DxF certified physicians mine the data obtained to aid in diagnosing specific body regions and joints.

Diagnosis Foundation liim-exercise-room

The DxF is focused on improving human safety, health and performance by promoting diagnosis which seeks underlying causes using objective and holistic methods.  We do this through diagnostic programs of: testing, education and R&D which will ultimately result in a new system of human care.

All health care providers for the CrossFit Top Box Program will be certified by the DxF in Muscle Strength & Balance testing and CMI procedures.  Examinations not performed at your CrossFit box will be performed at the DxF state of the art facilities in Ronkonkoma.  For more information or to schedule a TopBox program for your CrossFit facility, contact: Info@DxFoundation.org .

© Diagnosis Foundation 2016

This article is not intended to offer a diagnosis or medical advice.  It is offered strictly for educational purposes.  Please consult members of your health care team directly to explore these or any other health care concepts.

Training Driven By Diagnosis – Program Handbook

The following materials are being used at DxF affiliated facilities in Suffolk County, NY.  Contact us at Info@DxFoundation.org for more information.

Program Handbook

What is the Training Driven By Diagnosis (TxDx) Program?

GOlf Exercise with CablesIt is a supervised group exercise program where each person receives their own personalized training plan that is developed through extensive examinations. Testing determines which muscles need exercise and which should be avoided to achieve the best performance for your particular sport or lifestyle.

The program format is based on research showing how to achieve optimal rates of physical development.  It is offered as a series of quarterly training ‘Courses’ with each focused on different types of physical skill (i.e. SPRITE – Speed, Power, Range, Independence, Technique, Endurance). Each physical skill course is available in 5 different ‘Tracks’ targeting different body regions (1. Scapula, Shoulder & Elbow   2. Knee & Ankle   3. Pelvis & Hips   4. Spine: Cervical, Thoracic & Lumbar   5. Wrist & Hand).

Your path through the program is individualized to make it as focused or diversified as you wish.  You can focus on a specific problem area and take the same course in the same body region every quarter.  At the other end of the spectrum, you can work on total body development and take 2-3 different courses each quarter and repeat them in every body region.

Current & Future Coursesguymnastics-uneven-bars-wiki
  • Individual Muscle Strength & Joint Balance – Available NOW
  • Individual Joint Range: Flexibility & Stability – Winter 2017
  • Sport Technique: Deconstruction & Reconstruction – Spring 2017
  • Sport Technique: Speed – Fall 2017
  • Regional & Whole Body Strength – Winter 2018
  • Sport Specific Flexibility & Stability – Spring 2018
Each Course Includes…
  • Workshop – 1 hr. presentation & discussion
  • Exam – ½ hr. exam with Computerized Movement Imaging (CMI) & Muscle Strength Testing
  • Re-exam – ¼ hr. re-exam includes retesting of abnormal findings to track progress
  • Supervised Group Training – ½ hr. sessions with 1-4 students / doctor
  • Individual Training Plan (ITP) – updated every 4 training sessions
Age Groups

As the first classes fill up, they will be split by age groups.

  • Primary School (1st – 6th grades)
  • Secondary School (7th – 12th grades)
  • Adult, College & Professional
General Schedule
  • TxDx Programs Are
    • 10 weeks long
    • Fall, Winter & Spring terms
    • Summer Term: Customized by arrangement
Program Includes
  • test-glut-med-positioningWorkshops – are held the first week of each term (i.e. September, January, April)
  • Exams – By appointment during 1st week
  • Re-Exams – By appointment the last week, additional re-exams by appointment during term
  • Supervised Group Training
    • 1, 2 or 3 x’s / week depending on Development Rate schedule desired
    • Time slots are: _________, __________,  & _________
    • Groups of 4 can create their own supervised training time slots with doctor

Development Rate                                                  Hours / Term                     

  • 1 / Week
    • Workshop:                                                          1 hr
    • Exam:                                                                 0.5 hr
    • Re-Exam:                                                           0.25 hr
    • Supervised Training: ½ hour / week                5.0 hr
    • Individual Training Plan & Log Book
    • Total contact time                                             6.75 hrs. / term
  • 2 / Week
    • Everything in TxDx-1 PLUS
    • 1 additional re-exam                                        0.25 hr
    • 1 additional supervised training / week          5.0 hr
    • Total contact time                                          12.00 hrs. / term
    • 3 / Week – Note: Research shows that this is the optimal rate for physical development
      • Everything in TxDx-1 PLUS
      • 2 additional re-exams                                  0.5 hr
      • 2 additional supervised training / week     10.0 hr
      • Total contact time                                        17.25 hrs. / term
Prices
  • A La Carte prices
    • Workshop: $40
    • Half Hour Exam: $240
    • 15 minute re-ex: $120
    • Half hour group training session: $40 / session
  • Prices       A la carte                   Package (40% off a la carte prices)
    • TxDx – 1: $800                            $480
    • TxDx – 2: $1320                          $792
    • TxDx – 3: $1840                          $1104
  • Drop Ins – You can participate in any component of the program as oftenliim-exercise-room as you like on a space available basis (i.e. no more than 4 people / training session). A La Carte pricing applies.
  • Late Start – No workshop, but still receive exam, re-exams, & group training until end of term
    • 5% off package price for each week missed
  • Early Termination/Refunds – Participants may stop at any time and will be refunded any unused portion of their tuition based on A La Carte pricing.
  • Referral Program
    • Form a group with 3 new people & you attend free – or –
    • Get a discount off of your fee equal to 20% of the paid enrollment of each New Participant you refer in.
    • Referred: 5% off when referred by current or previous TxDx student
  • Payments
    • Full program fee due at first visit – or –
    • Payment Plan:
      • Total fee + $30 book keeping fee
      • 3 monthly installments
      • 1st payment due first visit. Subsequent payments at beginning of 2nd & 3rd months

Departments & Course Descriptions

Departmentsvolleyball-serve

There are 4 departments in the TxDx Program.  They are: I.C.T.E. (pronounced Ice Tea)

  • Individual Muscles & Joints
  • Complete Body Development
  • Technique for Sports
  • Extent of Performance

Individual Muscles & JointsAre each of your body pieces working properly? Athletes will be evaluated for joint integrity & strength of individual muscles for the anatomical track they have enrolled in. Previous injuries or imbalanced muscle development can lead to abnormal mechanics which need to be corrected before progressing to more advanced training methods.  Athletes who skip this stage of training and progress directly to sport specific techniques, put abnormal strains on an imbalanced body.  This limits their athletic performance and increases the potential for injuries with long term implications.  Proper training sequencing that starts with correcting joint integrity and muscle balance greatly increases the efficiency of exercise time by eliminating the need to reestablish new motor patterns after bio-mechanics have been corrected.

Complete Body DevelopmentIs your whole body working efficiently together?  Athletes will be evaluated and trained for complete body performance in Speed, Power, Range of motion, Independence, Technique & Endurance (SPRITE).  These courses focus on mastering basic athletic abilities (i.e. running, jumping, climbing, pushing, pulling, twisting, etc.) by deconstructing the motions into individual components, training each component in the SPRITE skill and reconstructing the activity in a series of steps.  This method of training the entire kinesthetic chain involved in basic physical activities identifies and corrects weak links & improper transfers of power that limit an athlete’s potential.

TechniqueAre the kinesthetic chains involved in each of your sport motions utilizing: all the muscles they can; in proper sequence; with good timing?  This series of courses focuses on the same procedures used in Complete Body Development described above, but applies them to sport specific activities (i.e. golf swing, throwing, catching, agility, etc.).  Participants choose which sports and techniques they wish to develop.  These courses do not recommend which techniques the athlete should use. Those decisions are left to the athlete and their coaches.  The TxDx program focuses on ensuring each body component that can be involved in the technique is contributing to the motion and that each component is transferring power properly to the entire activity.

ExtentAre you performing each of your sport activities at their maximum potential? Attention will focus on maximizing the extent to which you can perform all your athletic skills.  This is what most athletes think of when they envision physical conditioning for their sport but done at an advanced level.  Examples in this department include: faster golf swings, throwing balls more accurately, hitting further, spiking balls with more power, better triathlon times.  It is important to emphasize that these training methods will achieve optimal results when they are undertaken AFTER the athlete has corrected abnormal biomechanics, has establish basic physical condition and mastered their techniques at sub-maximal levels.

Athletes are evaluated for each of the appropriate SPRITE capabilities for their sport activities and receive advanced, custom programs to optimize their performance (i.e. muscle fiber size; muscle fiber recruitment; preferential development of fast & slow twitch muscle fiber types; neurological firing thresholds; etc.).

Courses

In the Individual Muscle & Joint Department there is:

  • Muscle Strength & Joint Balance – Fall & Winter
  • Individual Joint Range: Flexibility & Stability – Winter

Muscle Strength & Joint Balance – There are many thousands of exercises possible to do, but which ones should you do to improve your performance? The weaker ones!  Exercising the muscles which are already stronger will have limited or even detrimental effects by imbalancing a joint.  The more imbalanced a joint becomes, the more the fulcrum moves from the optimal position, decreasing efficiency and increasing the rate of tissue damage.  How can you tell which are the weak muscles?  You need to test them on an individual basis.  If instead, you measure full body strength on some maneuver, it will not tell you which muscles are the ‘weak links’ that limit your ability.  Continually exercising whole body activities typically do not cross the threshold necessary to stimulate growth of all the weaker muscles.

This course will test all the muscles in the body region of the track(s) you selected and come up with a customized set of exercises to improve your weak links.

Individual Joint Range: Flexibility & Stability – A joint with too much flexibility is as big a problem as a joint with too little.  Too loose and the joint shifts in the middle of a motion, throwing off your accuracy or damaging tissue.  Too tight and you lose some of the range of motion needed to accelerate and power decreases.  How can you tell which joints are too tight, too loose or just right?  You have to test them individually!  Doing stretches that lengthen 2 or more joints at the same time may improve your total flexibility but it runs the risk of making your performance worse by obtaining some joints too loose while other remain too contracted.  This course will not only target which joints to stretch and which to tighten, but will also cover which stretching techniques to use for what goals.  Techniques such as active vs. passive stretching, focal vs. whole muscle techniques and static vs. intermittent.

Calendarcalendar
  • Fall 2016
    • Start 10/3/16, Last day 12/9/16
    • No classes 10/10/16 (Columbus), 11/25/16 (Thanksgiving)
    • Classes are held on 11/11/16 (Veterans Day)
    • Workshop – Saturday 10/8/16 12:00 pm
    • Supervised Group Training
      • 1/week – Fridays 5:00 pm
      • 2/week – Monday & Wednesday 5:00 pm
      • 3/week – Monday, Wednesday, Friday 5:30 pm
    • Exams – Schedule week of 10/3/16
    • Re-Exams
      • 1/week – Schedule during week 10 (starting 12/5/16)
      • 2/week – Schedule week 5 & 10 (starting 10/31 & 12/5)
      • 3/week – Schedule week 4, 7 & 10 (starting 10/24, 11/14, 12/5)
  • Winter 2017
    • Start 1/9/17, Last day 3/24/17
    • No classes 2/20/17 through 2/24/17 (Winter recess)
    • Classes are held on 1/16/17 (Martin Luther King Day)
    • Workshop – Saturday 1/14/17    12:00 pm
    • Supervised Group Training
      • 1/week – Fridays 4 & 5:00 pm
      • 2/week – Monday & Wednesday 4 & 5:00 pm
      • 3/week – Monday, Wednesday, Friday 4:30 & 5:30 pm
    • Exams – Schedule week of 1/9/17
    • Re-Exams
      • 1/week – Schedule during week 10 (starting 3/20/17)
      • 2/week – Schedule week 5 & 10 (starting 2/13, 3/20)
      • 3/week – Schedule week 4, 7 & 10 (2/6, 2/27, 3/20)
  • Spring 2017
    • Start 3/27/17, Last day 6/9/17
    • No classes 4/10/17 through 4/14/17 (Spring recess) & 5/29/17 (Memorial Day)
    • Workshop – Saturday 4/1/17     12:00 pm
    • Supervised Group Training
      • 1/week – Fridays
      • 2/week – Monday & Wednesday
      • 3/week – Monday, Wednesday, Friday
    • Exams – Schedule week of 1/9/17
    • Re-Exams
      • 1/week – Schedule during week 10 (starting 6/5/17)
      • 2/week – Schedule week 5 & 10 (starting 5/1, 6/5)
      • 3/week – Schedule week 4, 7 & 10 (4/24, 2/27, 6/5)

Training Driven By Diagnosis: Exercise Your Stabilizers

Pec Major stabilizes abduction
Public Domain

Stabilizers are a group of muscles that offer the possibility to obtain large increases in power and accuracy as well as prevent injuries.  Many people overlook this important group of muscles in their athletic training.  Let’s look at:

  • What are stabilizer muscles
  • Why are they important to train
  • Why they don’t develop adequately from practice
  • How to improve them
What Are Stabilizer Muscles?

These are muscles that contribute to an agonist or prime mover muscle’s function via reducing movement of some related bone. The ‘stabilizer muscle’ term is most often used in the context of action on the same joint(s) as the agonist but the term can also be applied on distal, functionally related joints. In either case, stabilizers do not directly contribute to the agonist’s movement of a bone, but they do contribute to the total power output and control of a movement.  Every joint involved in golfing uses multiple stabilizer muscles. Let’s see some examples.

Deltoid - BP3d
By Anatomography

Example: Same Joint Stabilization

When you do your arm back, your right arm is using the middle / posterior fibers of the deltoid muscle (the blue fibers in the graphic) to lift your arm up and back.  If the humerus were not constrained within the shallow socket  (note the shallow socket on the left scapula in the skeleton graphic) of the scapula by other muscles, it would dislocate superiorly every

Public Domain
Public Domain

time you did a backswing.  Fibers of the lower portion of the pectoralis major and to a lesser degree, the teres minor muscle work to pull the head of the humerus down, keeping it in the shallow socket, at the same time as the deltoid is pulling the arm backward. In this example, the pectoralis major is a stabilizer muscle.

Humerus Stabilization with Pec Major
By Dr. Wallman

Example: Distant Stabilization

“For every action, there is an equal and opposite reaction.”

Newtons Third Law

By Jeffrey Beall CC 3.0
By Jeffrey Beall CC 3.0

How does this manifest in sports?  For a football quarterback throwing a ball, they straighten their arm rapidly to push the ball forward off of their hand.  The shoulder end of their humerus is also pushing in the opposite direction as the arm straightens.  It is only by having a relatively stable scapula attached to a fixed torso which allows all the force to go forward into the ball.

If the muscles holding the scapula to their torso are weaker than the forces being exerted on it by the arm straightening muscles, some of the force will cause their scapula to stretch backward.  This results in some percentage of the force being generated by straightening their arm going into scapula movement rather than propelling the ball forward.  In other words, weak scapula stabilizer muscles result in the ball traveling slower over a shorter distance.

By Ducky2315 CC 3.0
By Ducky2315 CC 3.0

This loss of effective power being delivered to the target in golf (the club and ball) because of weakness in a stabilizer muscle of a related joint can happen anywhere along the kinetic chain of a movement.  For golfers, power starts at the points where cleats push against the ground. Some force can be lost by not having cleats and being on slippery ground.  In this case, the rear foot would slip backward during the swing.  In a similar manner, weak ankle stabilizers will results in the foot bowing outward instead of that force being transferred up the chain.  The same for knees that bow, hips that wobble, each and every vertebra that stretches the wrong way, robbing power rather than contributing power to the drive.  Stabilizer muscles at every joint along the kinetic chain stop unnecessary movement so that there is a potential to maximize force being transferred to the club head.

Why Are They Important To Train?

These are some of the outcomes achieved by gaining better control and power from your stabilizer muscles:

  • Local Power – They keep the fulcrum of each individual joint ‘centered’ properly during movement to optimize biomechanics and power of that joint.
  • Combined Power – Having adequate strength and control of each stabilizer in your body allows you to add more cumulative power to your shots rather than robbing power from your stronger muscles.
  • Consistent Shots – Clicking joints are a prominent sign that your joints are not being stabilized properly and could be moving unpredictably during a stroke.   Loose joints are less noticeable than clicks, but have the same impact of decreased accuracy.  This makes it very difficult to hit the same shot time after time.  Even half a mm of extra play in a dozen joints throughout the body accumulates so that body movements are difficult to control with precision and consistency.
  • Health – Weak stabilizers allow local joints or other parts of the body to move excessively, stretching tissues abnormally, causing damage and eventually pain.
  • Career Longevity – Accumulated stretching of soft tissues by poorly stabilized joints leads to accelerated damage and joint degeneration that results in prematurely ending athletic careers and yoga practices.
Why don’t they develop adequately during practice

Increasing effective control and strength in a muscle is a combination of many factors including: increased muscle mass; elimination of intramuscular fibrosis & trigger points; recruitment of more muscle fibers during contraction, enhancing neurological control and coordinated timing.  Prime movers will experience some improvement of these parameters through playing golf, particularly enhancing nerve control and coordination.  Stabilizers rarely get conscious attention during play and typically do not get enough usage to result in significant improvement.

Let’s look at a couple of the factors in muscle strength development so you can see why training stabilizer muscles in isolation and reintegrating them back into your swing can be so much more effective.

Increasing Muscle Mass

Increasing muscle mass requires introducing micro-tears into the muscle so that it stimulates the body to repair the damage and make it just a little bit stronger to prevent future damage.  This is done by exceeding the muscle’s capacity through repetitive use of the muscle or increasing the amount of weight that the muscle is pulling against.

Muscle developmentFor example, in golfing, the swing muscles are typically used only once every 3-10 minutes.  This pattern does not lead to the repetitions that are conducive to obtaining micro tears that stimulate growth.  Increasing resistance on the stabilizer muscles through contractions of stabilizers near their maximum output during a swing are also very unlikely to happen.  The majority of force in a swing is exerted by the agonist muscles and stabilizers typically only use a percentage of their maximum potential force which doesn’t stimulate growth.

Neurological Control

Control of stabilizer muscles are frequently far from a golfers thoughts during their shot routines.  It is often difficult to determine if a stabilizer is working or not, unless you isolate the movement and the muscle involved.

Internal and external rotation of tibia - yiss-anatomy2010-11.wikispaces.comOne knee stabilizer that I frequently check involves control of rotation of the tibia at the knee.  Try this on yourself.  Sit with your hips and knees bent at 90 degrees.  Lift one foot off the ground a few inches and dorsi flex your foot (pull your toes and foot upwards using your ankle muscles).  Keep your foot in this position and without moving your thigh at all, rotate your lower leg around the axis of the tibia (i.e. if you placed your heel on a nail sticking out of the floor and twist your lower leg so the heel stays in place and your forefoot rotates from pointing to the outside and pointing to the inside).

80% of the people I test for this stabilizer muscle have no control over the motion at all. The bend their ankle but do not rotate their tibia.  They do not have neurological control over the muscles that perform this motion. It usually takes 2-4 weeks to gain minimal control overs this motion and another 2-3 months to gain power and speed of movement.

Without control of this movement, your knees will not be stabilized properly, will not contribute to the total power of your sport and leave you vulnerable to injury.

How to improve stabilizer muscles
Dr. John Wallman
Dr. John Wallman

First…..diagnose which stabilizers are too weak, which too strong and which are normal.  This requires testing individual muscles.  You can do this by focusing on one specific joint and testing all the muscles there and comparing them to other muscles around that joint and against the paired muscle on the opposite side. Alternatively, you can do more disseminated testing, possibly testing all the muscles in the body.  Testing may be done by a number of different muscle strength testing techniques including: manual; isokinetic; tensitometry; computerized movement imaging, etc.

Second….make sure that the cause of the weakness of the stabilizers is amenable to treatment by exercise.  You don’t necessarily want to be exercising a muscle where the weakness is caused by a nerve, bone or other pathological problem.

Exercise band - peroneus brevisThird…..exercise the muscles that are weak from lack of sufficient exercise or minor traumas with exercises that target only the individual weak muscle.  You don’t want to be exercise multiple muscles simultaneously, particularly if you end up increasing the strength of muscles that are already normal or too strong.    Which specific exercise you do can be further refined by what aspect of the muscle you want to address. I.E. increase muscle mass, break up trigger points, recruitment, etc.

Fourth….A muscle that has recently achieved significant improvements of strength may cause some shifting of stress points, neurological control and even technique requirements. Because of this step, you may need to reintegrate the muscle back into your stroke.  This step is not always required.

Reintegration is begun by initially deconstructing the golf swing into small components (i.e. on the downswing, a deconstructed swing might be broken into: a) push down or back on the right foot; b) rotate the knee; c) rotate the hip; d) rotate lumbars; rotate the thoracic region; drive the lead arm down; etc.).  Then start reconstructing the stroke by combining the newly strengthened muscle with one of its neighbors in a subset of the swing that just includes those two joints.  Exercise just those two components of the swing using proper timing, motion and then speed. Once remastered, combine the ‘new’ muscle with two neighbors.  Continue in this manner, adding one new neighbor at a time, until the entire swing is reconstructed.

Excerpt from upcoming book by Dr. John Wallman “Golf: Training Driven By Diagnosis”

DoctorWallman.com