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  • Terminology about a herniated disc can be confusing. There are many different terms to describe a herniated disc, such as a pinched nervebulging disc, ruptured disc or slipped disc. These terms tend to be used somewhat differently among health professionals because there are no generally agreed upon definitions for many disc problems. Interchangeable terminology can be confusing and frustrating for patients who hear their condition referred to in different terms by different practitioners, causing the patients to remain unclear as to the real diagnosis.
 
  • The extent of disc problem or disc herniation does not necessarily correlate to the patient’s level of pain. Although it may seem contrary to common sense, the severity of pain from a herniated disc does not always correlate to the amount of physical damage to the disc. Additionally, less serious back problems may cause more pain than a herniated disc. For example, a large herniated disc can be completely painless, while a muscle spasm from a simple back strain may cause excruciating pain. This means that the severity of pain is not a determining factor for identifying a herniated disc.
 
  • Many herniated discs do not cause any pain. Imaging of a disc herniation are common (such as from an MRI or CT scan), but oftentimes the herniated disc is not associated with any pain or symptoms. While there may be an association between trauma to the disc and the onset of the patient’s symptoms, a herniated disc also may occur without a specific, recalled event.  I often tell patients that a plain xray does not show the disc or any other soft tissue.
 
  • It is difficult to distinguish a herniated disc from other spinal problems. The nerves and anatomical structures—such as discs, muscles and ligaments in the spine—have a great deal of overlap. This makes it difficult for the brain to distinguish between problems with one structure in the back versus problems with another. For example, a herniated disc can feel similar to a bruised muscle or ligament damage.
 
  • Pain from a herniated disc is a complex personal experience. Physical and psychological factors are constantly changing and can contribute to a patient’s experience of pain. A herniated disc may not be painful at all times, or it may become even more painful because of psychological and other factors in the patient’s life. For example, many studies have established a correlation between back pain and depression.  The pain from a disc herniation also may become more severe when compounded with other physical problems in the spine, or situational factors (such as poor posture, sitting for a long period, etc).
 
Because of the complexities of understanding pain from a herniated disc, patients should not attempt to make their own diagnosis. An inaccurate self-diagnosis may lead to further damage to spinal structures or to more severe episodes of back pain or leg pain if the condition is left untreated or treated incorrectly. Working with a spine specialist helps ensure that the correct location of a herniated disc, extent of the problem and source of pain are identified early on.  
If any of you have any questions on what the neck or back problem might be or looking for suggestions or care feel free to call me!  Or ask me at CF!! 
 
Dr. Meghan

Anyone else finding themselves extra hungry from the workouts lately?? Maybe it’s the heavy lifting we’ve been doing or the longer WODs that crush us but the hunger that coincides with Crossfit can be fierce! Doesn’t matter if you’re paleo, count macros, or stuff your face with whatever because you’re on the see food diet . . . chances are you’ve experienced what it’s like to feel hangry. I know I can’t be the only one who’s part way done with one meal and already thinking about their next. What can I say . . . . I genuinely love food. Heck, I love food and cooking just about as much as I love lifting, thankfully the two marry together great!

For those of you not enjoying an amazing Box Bistro meal or who are looking for something different to make for dinner some nights, here’s my favorite recipe from the “Well Fed Weeknights” cookbook (I’m even making this tonight for dinner and I’m so excited lol . . . there will be no survivors). Yes it is Paleo. Yes it is easy to make. Yes you will have quite a few dishes BUT it’s an amazing dish that doesn’t take long to make.

Dan Dan Noodles from Well Fed Weeknights

wfweeknights_dandannoodles-w750

Dan Dan Noodles are one of the most popular street foods in Sichuan (a.k.a. Szechuan) province of southwestern China. The cuisine of the region is known for its bold flavors, with lots of garlic, chiles, and Sichuan pepper. The name “dan dan” refers to the pole that noodle vendors used to sell their wares. It was carried across their shoulders, a basket of noodles on one end and the spicy sauce on the other. Traditionally, the noodles swim in a face-tingling broth and are topped with minced pork and preserved vegetables. This fast, paleo version uses zucchini noodles for slurping, cornichons for an acidic tang, and a separate chili oil so you can customize the heat.

Total time: approx. 40 minutes

Ingredients: (Serves 2-4 people)

For the noodles:

  • 2 pounds zucchini
  • 2 teaspoons salt

For the chili oil:

  • ½ cup light-tasting olive or avocado oil
  • 1 tablespoon whole black peppercorns
  • ½-inch piece of cinnamon stick
  • 2 tablespoons crushed red pepper flakes

For the pork:

  • 1 tablespoon extra-virgin olive oil
  • 2-inch piece fresh ginger
  • 1 jalapeño
  • 3 cloves garlic
  • 1½ pounds ground pork
  • 1 teaspoon salt
  • ½ teaspoon ground black pepper

For the sauce:

  • 2 tablespoons tahini or almond butter (I prefer almond butter)
  • 2 teaspoons toasted sesame oil
  • ½ teaspoon Chinese five-spice powder
  • ¼ teaspoon ground black pepper
  • ¼ cup coconut aminos
  • 2 tablespoons unseasoned rice vinegar
  • pinch coconut sugar (optional – I omit)
  • ⅓ cup cornichons (optional – I also omit)

garnish: a handful cashews or sunflower seeds, 2–3 scallions

Directions:

Make the noodles. Julienne the zucchini with the spiralizer. Place the noodles in a colander and toss them with the salt until the strands are lightly coated. Set the colander in the sink to drain while you prep the other ingredients.

Make the chili oil. In a small saucepan, combine the oil, peppercorns, cinnamon, and red pepper flakes. Warm the oil over medium-low heat while you cook.

Cook the pork. Warm the oil in a large skillet over medium-high heat, 2 minutes. While the oil heats, peel and grate the ginger, mince the jalapeño, and peel and crush the garlic. Add the aromatics to the oil and cook until fragrant, about 1 minute. Crumble the pork into the pan, season with the salt and pepper, and cook, breaking up the meat with a wooden spoon, until it’s browned, 7–10 minutes.

Make the sauce. While the pork cooks, place the tahini, sesame oil, Chinese five-spice, and black pepper in a small bowl and mix with a fork. Add the coconut aminos, vinegar, and sugar; stir until combined. Chop the cornichons and set them aside.

Put it together. Add the sauce to the meat in the skillet and stir to coat the meat. Add the cornichons to the skillet, toss to combine, and transfer the meat mixture to a large bowl. Reheat the skillet over medium-high heat. Rinse the zucchini noodles under running water, drain well, and squeeze them dry in a clean dish towel. Add the noodles to the heated pan and stir-fry for 2–3 minutes until hot. Return the meat to the pan and toss with two wooden spoons to combine; allow it to heat through. Use a slotted spoon to remove the cinnamon stick from the chili oil and discard it. Set the oil aside to cool. Chop the cashews and scallions.

To serve, divide the noodles among individual bowls and top with a drizzle of chili oil, then sprinkle with cashews and scallions.

Cookup Tips

Spiralize the zucchini, make the chili oil, and prep the sauce in advance; store everything in separate airtight containers in the fridge. When it’s time to eat, cook the pork and put it all together according to the directions.

5 Reasons to Drink More Water

By William Imbo

When astronomers look for life in our solar system and beyond, the unifying factor that generates the most interest and excitement is the potential presence of water. Where there is water, there might just be life. Every organism we know of needs water to survive, and scientists have said that there’s no better substance better at sustaining life. So, if you didn’t already know, water is incredibly important to prolonging your life—given that our bodies are composed of roughly 60% of the stuff. For this reason, water consumption—or lack thereof—can have a profound impact on your athletic performance.

Here are 5 reasons why drinking water is crucial to your health and your gains.

1. Improves recovery time
During exercise, the body’s electrolyte balance can begin to shift. Electrolytes are minerals that break into small, electrically-charged particles called ions when they dissolve in water. Found in blood and cells, electrolytes are essential to physical activity because they regulate bodily fluids. During exercise, the body’s electrolyte balance can begin to shift. As the body loses electrolytes through sweat, the imbalance can result in symptoms like muscle cramps, fatigue, nausea, and mental confusion. And if the electrolyte supply stays low, muscles may continue to feel weak during your next WOD. So if you want to make sure your body is at full fighting force the next day, grab the H20 post-workout. Add a pinch of salt for a boost in electrolytes.

2. Helps to avoid dehydration
The American Council on Exercise states, “For regular exercisers, maintaining a constant supply of water in the body is essential to performance.” In one hour of exercise, the body can lose more than a quart of water, depending on exercise intensity and air temperature. If the body doesn’t have enough water to cool itself through perspiration, it enters a state of dehydration. And this is not good. The list of ailments due to dehydration is extensive, and can severely impact an athlete during a WOD. They include heat stroke, muscle fatigue, lack of coordination, increased heart rate and headaches.

3. Important for healthy muscles and performance
I bet you didn’t know that water composes 75% of all muscle tissue and about 10% of fatty tissue. As legendary strength coach Charles Poliquin says, “Hydration is the greatest determinant of strength. A drop of 1.5% in water levels translates in a drop of 10% of your maximal strength. The leaner you are, the worse it is. Make sure you weigh the same or more at the end of your training session.” Drinking water helps to prevent the breakdown of muscle proteins and increases nutrients absorbed from food—both key factors in building strength and maintaining high energy levels during a WOD.

4. Helps your mental game
Sodium chloride and potassium are the two chemicals that are needed for nerves to send electrical signals to your brain. A lack of water leads to electrolyte imbalances. If you are sending signals to your brain at a reduced speed, this means you are thinking slower and your body is reacting slower to what is going on when you train. Aside from losing track of how many reps you’ve done, this could severely affect your game plan for the WOD, your pacing and you may begin to struggle with movements that require more focus on technique.

5. Reduces joint and muscle pain and helps to increase your flexibility
Cartilage in the joint is 65 – 80% water. In fact, water is present in tendons, ligaments, and muscles, and it plays an important role in cushioning and lubricating joints and tissues so that they remain elastic. Water helps you maintain an adequate blood volume so that nutrients can move through your blood and into your joints. A helpful analogy is to think of our joints as if they were sponges. Two dry sponges are going to move against one another very well, but two wet ones will glide easily. Water also allows waste products to move out of the joints. Combined, this helps to reduce the pain you may experience in your joints and muscles during and after a workout—not to mention helping increase your range of motion when you work on your mobility.

Drinking too much water isn’t good either
Hyponatremia is a rare condition that occurs when there is not enough sodium in the body and usually comes about when athletes (particularly endurance athletes) drink too much water. If your sodium levels in your body are too low, your cells begin to swell with water, expanding your brain tissue and putting pressure on the brain. On top of that, it may also cause your lungs to fill with fluid. Symptoms of hyponatremia can include headaches, vomiting, and swelling of the hands and feet.

Not sure how much water to drink? The American Council on Exercise advises:

  • Drink 17-20 ounces of water two to three hours before the start of exercise.
  • Drink 8 ounces of fluid 20 to 30 minutes prior to exercise or during warm-up.
  • Drink 7-10 ounces of fluid every 10 to 20 minutes during exercise.
  • Drink an additional 8 ounces of fluid within 30 minutes after exercising.
  • Drink 16-24 ounces of fluid for every pound of body weight lost after exercise.

For everyday consumption, the Institute of Medicine determined that an adequate intake (AI) for men is roughly 3 liters (about 13 cups) of total beverages a day. The AI for women is 2.2 liters (about 9 cups) of total beverages a day.

SHIN SPLINTS

Shin splints, the catch-all term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints), are the bane of many athletes. They often plague beginning runners who do not build their mileage gradually enough or seasoned runners who abruptly change their workout regimen, suddenly adding too much mileage, for example, or switching from running on flat surfaces to hills.
The nature of shin splints, also known as medial tibial stress syndrome (MTSS), most often can be captured in four words: too much, too soon.
Common causes of shin splints
There can be a number of factors at work, such as overpronation (a frequent cause of medial shin splints), inadequate stretching, worn shoes, or excessive stress placed on one leg or one hip from running on cambered roads or always running in the same direction on a track. Typically, one leg is involved and it is almost always the runner’s dominant one. If you’re right-handed, you’re usually right-footed as well, and that’s the leg that’s going to hurt.
The most common site for shin splints is the medial area (the inside of the shin). Anterior shin splints (toward the outside of the leg) usually result from an imbalance between the calf muscles and the muscles in the front of your leg, and often afflict beginners who either have not yet adjusted to the stresses of running or are not stretching enough.
But what exactly is a shin splint? There’s no end-all consensus among sports scientists, and theories have included small tears in the muscle that’s pulled off the bone, an inflammation of the periosteum [a thin sheath of tissue that wraps around the tibia, or shin bone], an inflammation of the muscle, or some combination of these. Fortunately, medical experts agree on how to treat them.
Treatment of shin splints
Experts agree that when shin splints strike you should stop running completely or decrease your training depending on the extent and duration of pain. Then, as a first step, ice your shin to reduce inflammation. Here are some other treatments you can try:
Gently stretch your Achilles if you have medial shin splints, and your calves if you have anterior shin splints. Also, try this stretch for your shins: Kneel on a carpeted floor, legs and feet together and toes pointed directly back. Then slowly sit back onto your calves and heels, pushing your ankles into the floor until you feel tension in the muscles of your shin. Hold for 10 to 12 seconds, relax and repeat.
In a sitting position, trace the alphabet on the floor with your toes. Do this with each leg. Or alternate walking on your heels for 30 seconds with 30 seconds of regular walking. Repeat four times. These exercises are good for both recovery and prevention. Try to do them three times a day.
If you continue running, wrap your leg before you go out. Use either tape or an Ace bandage, starting just above the ankle and continuing to just below the knee. Keep wrapping your leg until the pain goes away, which usually takes three to six weeks. “What you’re doing is binding the tendons up against the shaft of the shin to prevent stress,” Laps says.
Consider cross-training for a while to let your shin heal. Swim, run in the pool or ride a bike.
When you return to running, increase your mileage slowly, no more than 10 percent weekly.
Make sure you wear the correct running shoes for your foot type specifically, overpronators should wear motion-control shoes. Severe overpronators may need orthotics.
Have two pairs of shoes and alternate wearing them to vary the stresses on your legs.
Avoid hills and excessively hard surfaces until shin pain goes away completely, then re-introduce them gradually to prevent a recurrence.
If you frequently run on roads with an obvious camber, run out and back on the same side of the road. Likewise, when running on a track, switch directions.
If you are prone to developing shin splints, stretch your calves and Achilles regularly as a preventive measure.  Always take the time to warm up, roll out, stretch, ice.  And rest if your body is asking you too.
Hydrate in this heat and take care of you!
Dr. Meghan

The Athletic Benefits of Caffeine

By William Imbo

Caffeine is the most popular drug in the world. It’s found in coffee beans, tea leaves, cocoa beans, chocolate and cola nuts, and its use is incredibly widespread. In the U.S. alone, over 100 million Americans consume 400 million cups of coffee per day, equivalent to 146 billion cups of coffee per year, making the United States the leading consumer of coffee in the world. In fact, coffee is the most commonly consumed beverage in the world. Starbucks thanks you.

Because just about everyone is ingesting caffeine in one way or another, and it is so readily available (coffee, tea, energy drinks, etc.) caffeine is no longer on the banned substance list of the International Olympic Committee. It is now listed as a “controlled or restricted substance”.

Caffeine is mainly popular because it functions as a mild stimulant—more on that later. As such, it helps wake us up and keeps us going when we feel like throwing in the towel. Therefore, it comes as no surprise that athletes are interested in those very same effects as it is applied to their sport. So, can caffeine help to enhance your athletic performance?

How does caffeine work?
To understand how caffeine might help you during a WOD, we need a quick biology lesson on how the drug works in the first place. Throughout the day, neurons (an electrically excitable cell that processes and transmits information through electrical and chemical signals) are firing in your body, which leads to the build-up of a neurochemical called adenosine. The nervous system uses special receptors to monitor your body’s adenosine levels. As the day wears on, more and more adenosine (a neuromodulator that plays a role in promoting sleep and suppressing arousal) passes through those receptors—and it makes you sleepy. It’s one of the reasons you get tired at night. Caffeine is believed to work by blocking adenosine receptors in the brain and other organs. This reduces the ability of adenosine to bind to the receptors, which would slow down cellular activity, and helps to keep you from getting tired.

But that’s not where coffee’s kick comes from. With the adenosine receptor clogged, neurotransmitters like dopamine and glutamate can get a head start. Adenosine has a calming effect because it slows the activity of nerve cells, whereas caffeine speeds up the activity of cells. Nerve cells that are stimulated by caffeine release the hormone epinephrine (adrenaline), which increases heart rate, blood pressure, and blood flow to muscles, decreases blood flow to the skin and organs, and causes the liver to release glucose.

But the effects of caffeine can only last so long. It takes about four cups of coffee to block half of the brain’s adenosine receptors, so caffeine is quickly removed from the brain. However, continued exposure to caffeine leads to developing a tolerance to it. Tolerance causes the body to become sensitized to adenosine, so withdrawal causes blood pressure to drop, which can result in headaches and other symptoms. Too much caffeine can result in caffeine intoxication, which is characterized by nervousness, excitement, increased urination, insomnia, intestinal complaints, and sometimes hallucinations.

Caffeine and athletic performance
Caffeine works to reduce fatigue and increases our heart rate and blood flow to our muscles. It’s no surprise therefore that there have been numerous studies to examine how the effects of caffeine can be tailored to improve an athlete’s performance. Even the U.S. Military has researched the physiological effects of caffeine on hydration and performance, concluding that it “improves cognitive abilities, marksmanship, physical performance and overall vigilance, while preventing fatigue-related injuries and deaths.” From this research, the military actually developed a caffeine chewing gum called Stay Alert, with each piece containing 100 milligrams of caffeine, equivalent to a 6-ounce cup of coffee.

Starting as long ago as 1978, researchers have been publishing caffeine studies. And in study after study, they concluded that caffeine actually does improve performance. But in what ways?

Enhances endurance levels
Glycogen (a type of sugar in the body) is the principal fuel for muscles and exhaustion occurs when it is depleted. A secondary fuel, which is much more abundantly found in the body, is stored fat. As long as there is still glycogen available, working muscles can utilize fat. Caffeine mobilizes fat stores and encourages working muscles to use fat as a fuel. This delays the depletion of muscle glycogen and allows for a prolongation of exercise. The critical time period in glycogen sparing appears to occur during the first 15 minutes of exercise, where caffeine has been shown to decrease glycogen utilization by as much as 50%. Muscle glycogen is therefore preserved for longer, and is available for use as energy during the later stages of exercise, thus increasing endurance levels and delaying the onset of fatigue. In addition, because caffeine promotes the use of stored fat for energy rather than glycogen, you’ll also benefit from increased fat burning.

May reduces the effect of delayed onset muscle soreness (DOMS)
Remember how caffeine blocks the body’s receptors for adenosine, which helps us feel more energized? As it turns out, adenosine is also released by the body in response to inflammation, such as the type that occurs in our muscles after a grueling WOD. So if caffeine is acting to block adenosine, then not only are we going to feel more alert, we’re going to feel less sore after a workout, too. A 2013 study published in the Journal of Strength and Conditioning Research appears to support this. Nine “low caffeine consuming males” were blindly given either caffeine or a placebo one hour prior to completing sets of bicep curls. They received caffeine in proportion to their weight, with the average dose around 385mg. That’s about 2.5 cups of coffee. Then they performed a lot of bicep curls, finishing with a one max-effort set. Over the next few days the participants returned to the lab each day and reported their levels of soreness. Starting on day two, the caffeine group reported significantly lower levels of soreness compared to the placebo group. This difference continued each subsequent day, but was most drastic on days two and three. Soreness to the touch was also drastically different. The placebo group experienced significantly more pain when their biceps were touched up to two days after the test. There are of course some caveats to these findings, namely the fact that all the subjects were males (females may respond differently to caffeine), and they were all low caffeine consumers. The results may not be applicable to regular caffeine users, since they may be less sensitive to caffeine’s effect.

Considerations with caffeine
It is important to remember that despite the apparent benefits of using caffeine, it is still a drug and too much of it can actually have a negative impact on your health and performance. Over-consumption of caffeine can lead to insomnia, indigestion, headaches, irregular or fast heartbeat and dehydration.

Moderate caffeine intake is considered to be 250 mg (milligrams) per day. In research studies, the amount of caffeine that enhances performance ranges from 1.5 to 4 mg per pound of bodyweight taken one hour before exercise.

Recommendations for Athletes 
If you choose to use caffeine on competition day, here are a few tips that may help you maximize the benefits.

1. Take caffeine about 3 – 4 hours before the competition. Although blood levels of caffeine peak much sooner, the maximum caffeine effect on fat stores appears to occur several hours after peak blood levels.

2. Consider decreasing or abstaining from caffeine for 3 – 4 days prior to competition. This allows for any tolerance to caffeine to decrease and helps to ensure the maximum effect of the drug. Be careful though, because this may also lead to caffeine withdrawal.

3. Make sure you have used caffeine extensively under a variety of training conditions and are thoroughly familiar with how your body reacts to this drug. Never try anything new on competition day.

 

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