Did you just sprain your ankle? I did recently. It hurts! Ankle sprains occur so often that sometimes it can be easy to overlook helpful treatment strategies to accelerate the healing because, well, they will heal on their own, right?

Ankle sprains are the most common lower extremity injury in sport. The most common is an inversion sprain where the foot rolls under the inside portion of the ankle. There are eversion sprains and diastasis (aka "high ankle") sprains, but these are less common. ​

Now more than ever it seems the world wants effective means by which to naturally boost the immune system. We've already learned a lot about what strengthen our immunity before this pandemic and even more afterwards.

What we know is that functional impairment of antigen-specific T cells is a hallmark of chronic infections and viral disease. 

There are many considerations for boosting immunity and T cell function. Supplements most notable for this are:

• Vitamin D3 with K2
• magnesium
• zinc
• selenium
• melatonin

In addition to supplementation, staying hydrated and eating well are usually the first things people think about when wanting to boost their immune system. I mean, you are what you eat right. But what ways naturally boost the immune system that goes beyond what you put in your mouth? Here are 4 ways to boost the immune system naturally that doesn't involve diet and nutrition:

1. Reduce stress - when your mental health is attacked, inflammation is seen throughout the body because of your hormonal response to cortisol. Chronic inflammation causes an imbalance in cell function and can lead to illness and disease. Managing your stress levels by practicing mindfulness techniques, speaking to a licensed counselor, journaling your thoughts, socializing with friends, receiving a massage, reading a book, reducing screen time,  or enjoying a favorite activity can all help keep your immune system functioning properly.(1,2,3)
2. Restful sleep - most of us have experienced a time in our life when we consistently got less and less sleep and were more prone to getting sick. Adequate rest will significantly impact the ability to fight illness and infections. Our bodies need sleep to recover from everyday stressors, whether that be mental or physical. Aim for 7 hours of actual sleep time if you are an adult, 8-10 hours for adolescents, and 14 hours for young children and infants. (4,5,6)
3. Exercise - moderate intensity exercise will place a healthy amount of oxidative stress on your body that causing your immune system to adapt over time to this stress and slowly strength immune cellular function. It can be tricky because chronic high-intensity exercise can also cause enough stress to the immune system resulting in an unfavorable outcome of suppressing the immune system. Brisk walking regularly is one of the most often studied forms of exercise that shows consistent results for boosting the immune system. (7,8,9)
4. Chiropractic adjustments - okay this one I'm certain I will need research to support. Last thing I need is someone saying I said Chiropractic adjustments cure COVID-19. I am not saying that. In no way shape or form am I suggesting that chiropractic can cure, treat, prevent, or mitigate COVID-19 because the evidence to substantiate such a claim does not exist. The practice of chiropractic however focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health.  There is a growing body of evidence showing a positive relationship between the chiropractic adjustments, the nervous system and the immune system. (10,11,12,13,14,15)

​Want more tips and tricks on keeping your body healthy and strong? Hit us up at Gaitway Chiropractic @ Spokane Wellness in Spokane, Wa. 509-466-1366

References:

1. ​​Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res. 2014 May;58(2-3):193-210. doi: 10.1007/s12026-014-8517-0. PMID: 24798553.
2. Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, Turner RB. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci U S A. 2012 Apr 17;109(16):5995-9. doi: 10.1073/pnas.1118355109. Epub 2012 Apr 2. PMID: 22474371; PMCID: PMC3341031.
3. ​Carlsson E, Frostell A, Ludvigsson J, Faresjö M. Psychological stress in children may alter the immune response. J Immunol. 2014 Mar 1;192(5):2071-81. doi: 10.4049/jimmunol.1301713. Epub 2014 Feb 5. PMID: 24501202.
4. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015 Sep 1;38(9):1353-9. doi: 10.5665/sleep.4968. PMID: 26118561; PMCID: PMC4531403.
5. Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev. 2019 Jul 1;99(3):1325-1380. doi: 10.1152/physrev.00010.2018. PMID: 30920354; PMCID: PMC6689741.
6. Nagai N, Ayaki M, Yanagawa T, Hattori A, Negishi K, Mori T, Nakamura TJ, Tsubota K. Suppression of Blue Light at Night Ameliorates Metabolic Abnormalities by Controlling Circadian Rhythms. Invest Ophthalmol Vis Sci. 2019 Sep 3;60(12):3786-3793. doi: 10.1167/iovs.19-27195. PMID: 31504080.
7. ​Simpson RJ, Kunz H, Agha N, Graff R. Exercise and the Regulation of Immune Functions. Prog Mol Biol Transl Sci. 2015;135:355-80. doi: 10.1016/bs.pmbts.2015.08.001. Epub 2015 Sep 5. PMID: 26477922.
8. Abd El-Kader SM, Al-Shreef FM. Inflammatory cytokines and immune system modulation by aerobic versus resisted exercise training for elderly. Afr Health Sci. 2018 Mar;18(1):120-131. doi: 10.4314/ahs.v18i1.16. PMID: 29977265; PMCID: PMC6016983.
9. ​Khosravi N, Stoner L, Farajivafa V, Hanson ED. Exercise training, circulating cytokine levels and immune function in cancer survivors: A meta-analysis. Brain Behav Immun. 2019 Oct;81:92-104. doi: 10.1016/j.bbi.2019.08.187. Epub 2019 Aug 24. PMID: 31454519.
10. Fidelibus, J.C., An overview of neuroimmunomodulation and a possible correlation with musculoskeletal system function. J Manipulative Physiol Ther, 1989. 12(4): p. 289-92.
11. Teodorczyk-Injeyan, J.A., H.S. Injeyan, and R. Ruegg, Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther, 2006. 29(1): p. 14-21.
12. Lohman, E.B., et al., The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial. J Man Manip Ther, 2019. 27(4): p. 186-196.
13. Teodorczyk-Injeyan, J.A., et al., Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation: A Nonrandomized Clinical Trial. Clin J Pain, 2018. 34(1): p. 68-75.
14. Kovanur-Sampath, K., et al., Changes in biochemical markers following spinal manipulation-a systematic review and meta-analysis. Musculoskelet Sci Pract, 2017. 29: p. 120-131.
15. Teodorczyk-Injeyan, J.A., et al., Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat, 2008. 16: p. 5. 

​Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Of course, there exists other conservative treatment options like nutritional needs analysis, topical analgesics, acupuncture, brain based therapy, hypobaric oxygen therapy, etc. However, the list above is what most often what a Chiropractor or physical therapist might recommend to you. Before you decide which treatment or combination of treatments you decide to go with, it is important for you to be an equal team member in the decision making process of your own health.

Want tips and tricks on getting rid of headaches, back pain, neck pain, shoulder pain, hip pain, knee pain for good?
​
Hit us up at Gaitway Chiropractic at Spokane Wellness in Spokane, Wa.
509-466-1366

​This New Blog post from Dr. Jared Wilson, DC, MS at Gaitway Chiropractic in Spokane, Washington discusses the mortality effects of being either unfit or fat. Dr. Jared Wilson blogs about chiropractic health and other relevant health news. He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters of Exercise and Sports Science degree.

Last year I posted this information to the Gaitway Chiropractic facebook page and I wanted to bring it up again in this health blog.

In a recent meta-analysis (Barry et al 2014) researchers asked the question, " Which is a better predictor for death by all causes, cardiorespiratory fitness or fatness measured by one's BMI?" A meta-analysis is a study looking at a collection of other studies asking the same question in order to give a weighted average of the total effect.

They determined that:

1. a normal weight, unfit person is 2.42 times more likely to die than a normal weight, fit person;
2. an overweight, unfit person is 2.14 times more likely to die than a normal weight, fit person;
3. an overweight, fit person is ONLY 1.13 times more likely to die than a normal weight, fit person;
4. an obese, unfit person is 2.46 times more likely to die than a normal weight, fit person;
5. and an obese, fit person is ONLY 1.21 times more likely to die than a normal weight, fit person.

Bottom line conclusion from this article I think is we should be focused more on lifestyle modifications which include an increase in physical activity to be fit. This would improve a person's cardiorespiratory fitness and perhaps we should not be focusing too much on weight loss driven approaches to health.

But let us not get carried away here. We know that being overweight and obese does increase your risk for disease. In another recent study (Vistisen et al 2014) of 6705 people, 35 to 55 years old, and an average follow up of 14 years, the researchers saw that 645 of those people developed diabetes. Of those 645 people, 94% were actually in the staying overweight group, 2% were in the progressively gaining weight group, and 4% were in the persistently obese group. The 6060 participants who remained free of diabetes were characterized by a mean BMI of just below 25 that rose only gradually over the follow-up period.

At first glance it would appear that this second study possibly contradicts the first one and that being overweight and obese should be areas of concern. However, without knowing more information about the typical eating and exercise habits of the people in the second study it is difficult to correlate the two. Perhaps those who didn't get diabetes in the second study was due to the GRADUAL rise in BMI over the 14 years. It makes me wonder if these people were engaging in regular physical activity and if the people who got diabetes were mostly sedentary people. 

Hopefully you will find this information to be informative and most importantly motivating to live a healthy life by staying active and eating well. If you have any questions about how Dr. Wilson's expertise in Chiropractic, health, or sports medicine, please call Gaitway Chiropractic in north Spokane at (509) 466-1366, request an appointment online, or come by the clinic at 8611 N Division St, Ste A, Spokane, WA 99208.

REFERENCES
Barry, Vaughn W., Meghan Baruth, Michael W. Beets, J. Larry Durstine, Jihong Liu, and Steven N. Blair. "Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis." Progress in Cardiovascular Diseases 56.4 (2014): 382-90.

Vistisen, Dorte, Daniel Witte, Adam Tabak, Christian Herder, Eric Brunner, Mika Kivimaki, and Kristine Faerch. "Patterns of Obesity Development before the Diagnosis of Type 2 Diabetes: The Whitehall II Cohort Study." PLoS Medicine 11.2 (2014): E1001602

This New Blog post from Dr. Jared Wilson, DC, MS at Gaitway Chiropractic in Spokane, Washington focuses on answering the question of how much protein should an athlete intake depending on the type of exercise, their state of training, and their gender. Dr. Jared Wilson blogs about chiropractic health and other relevant health news.  He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters of Exercise and Sports Science degree.

Dating back as far as Ancient Greece and the Olympics, athletes have added protein to their diets to modify the effects of training on physique and performance. Conventional thought held by many athletes and coaches is that very high dietary protein intakes are needed to maximize protein metabolism within a muscle leading to faster repair and hypertrophy, the increase in cell size. But what does the current research suggest is the adequate amount of dietary protein intake for differing forms of exercise as well as the gender and performance level of the athlete?

In this blog I will try to provide the answer in a comprehensive yet simple review on this hotly debated topic.

Generally speaking, most athletes engaging in resistance exercise desire to increase their muscle mass, strength, and power. Whereas, endurance athletes are looking to augment longer duration output, such as increased maximal oxygen consumption, or reduce body fat.

Now before I jump right into discussing adequate protein intakes for resistance exercise, I want to address endurance athletes first because even these athletes need to pay attention. Multiple studies have shown that endurance exercise increases the breakdown and utilization of protein for energy as you increase the intensity of the exercise and depending on the state of training of the athlete. A recent study by McKenzie et al evaluated protein usage in both male and female athletes during a 38-day high intensity endurance training program. They found that:

• the body used more protein at the beginning of the 38-day training compared to the end indicating the importance of knowing an athlete’s training status, 
• the body used more protein when there was a depletion of carbohydrate availability, 
• the body used more protein when the athletes pushed themselves to higher intensities during the workouts, 
• on average the protein usage accounted for 1-6% of the total energy cost for the endurance workouts, and
• women tended to use less protein then men during the workouts.
  

Other studies looking at athletes engaging in low to moderate intensity endurance exercise programs indicate that these athletes need the same amount of dietary protein intake or only slightly above that of a sedentary individual.

So how much protein should an athlete consume given the intensity of their endurance workouts?

Recreational endurance athletes who are exercising 4 to 5 times per week for 30 minutes below moderate to high intensities need about 0.80-1.0 grams of protein per kilogram of body weight per day. This is the same for sedentary men and women.

Moderate intensity endurance athletes who are exercising 4 to 5 times per week for 45 to 60 minutes need about 1.2 grams of protein per kilogram of body weight per day.

Elite high intensity endurance athletes (regular marathon runners and triathletes) need about 1.4-1.6 grams of protein per kilogram of body weight per day.

And in general, dietary protein recommendations for female endurance athletes may be 10-20% lower than males.

Surprisingly, these recommended values are much lower than the average protein intakes of most male and female endurance athletes. The typical male and female endurance athlete today consumes about 1.8 and 1.3 grams of protein per kilogram of body weight per day, respectively.

So now that I’ve summarized the adequate protein intakes for endurance athletes let’s switch to protein requirements for resistance training athletes. First off, resistance exercise is different than endurance training in that a primary end goal is muscle hypertrophy or the increase in muscle size. Therefore it would only make sense that protein intake will need to be in excess that of basic sedentary requirements to provide the building blocks for muscle repair and growth, right? Well what does the research say?

A study way back in 1988 by Tarnopolsky et al calculated how much protein intake it would take to match protein metabolism in 6 well-trained bodybuilders compared to 6 sedentary people. Surprisingly, they found that only 12% more protein intake was needed for the bodybuilders. Even more surprisingly, the bodybuilders were regularly consuming protein amounts of 2.7 grams of protein per kilogram of body weight per day which if you look back above you’ll find that this is 170% more the recommendations for sedentary people of 1.0 grams. (Also remember that recreational endurance athletes and sedentary individuals are at the same recommendation.)

Now this study was looking at resistance athletes at steady state given the bodybuilders had at least 2 years of consistent training. The recommended protein intake for steady state resistance athletes is 1.0-1.2 grams of protein per kilogram of body weight per day.

What about people in the early stages of resistance training? Do they need more or less protein intake?

4 years later Lemon et al answered this question by calculating the estimated protein requirement during the early stages of resistance training. They had 12 young men participate in 2 months of resistance training and split them into two groups having them intake either 1.4 or 2.6 grams of protein per kilogram of body weight per day. The men exercised 6 days per week for 2 hours each day. The weights were set to 70-85% the maximum weight that they could only do 1 repetition of. They found that the estimated protein requirement during this early stage of resistance training was 1.6 grams of protein per kilogram of body weight per day.

Would you be surprised if I told you that the average resistance athlete today is consuming far more their needed protein requirements regardless of their stage of training in resistance exercise? Probably not since I’ve already told you this is true for two other situations above. The average resistance athlete today consumes 2.0 grams of protein per kilogram of body weight per day. This is 25% more than the amount needed for early resistance training athletes (1.6 grams) and about 80% more for steady stage resistance training athletes (1.1 grams).

At this point I might be hearing a pour of outrage from some athletes believing they still need more protein to meet the demands of their resistance training, usually from the intense football or rugby player. So let’s look at the protein requirements for football and rugby athletes involved in weight-training and high-intensity sprinting and power activities as evaluated by the research of Tarnopolsky et al in 1992. They found that the protein requirement for this group at the highest was only 1.7 grams of protein per kilogram of body weight per day. This is only slightly higher than those athletes who are early on in their resistance training.

So to recap, see below the listed protein requirements for the various athlete type measured in grams of protein per kilogram of body weight per day.

• Sedentary people: 0.80-1.0
• Recreational endurance: 0.80-1.0 
• Moderate intensity endurance: 1.2 
• Elite high intensity endurance: 1.4-1.6
• Early stage resistance training: 1.5-1.7
• Steady state resistance training: 1.0-1.2
• Power sports like football or rugby: 1.4-1.7
• Female athletes: on average need only 10-20% lower than male athletes
  

I know this is a lot of information but I hope you found this blog to be informative. Perhaps you will save some money on protein supplements or foods by knowing these recommendations. If you have any questions about how Dr. Wilson’s expertise in sports medicine could help you or have other Chiropractic questions, please call Gaitway Chiropractic in north Spokane at (509) 466-1366, request an appointment online, or come by the clinic at 8611 N Division St, Ste A, Spokane, WA 99208.

REFERENCES

Lemon PW, Tarnopolsky MA, MacDougall JD, Atkinson SA. Protein requirements and muscle mass/strength changes during intensive training in novice bodybuilders. J Appl Physiol 1992;73:767-75.

McKenzie S, Phillips SM, Carter Sl, Lowther S, Gibala MJ, Tarnopolsky MA. Endurance exercise training attenuates leucine oxidation and BCOAD activation during exercise in humans. Am J Physiol endocrinol Metab 2000; 278:E580-7.

Tarnopolsky MA, MacDougall JD, Atkinson SA. Influence of protein intake and training status on nitrogen balance and lean body mass. J Appl Physiol 1988;64:187-93.

Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP. Evaluation of protein requirements for trained strength athletes. J Apply Physiol 1992;73:1986-95.

This New Blog post from Dr. Jared Wilson, DC, MS at Gaitway Chiropractic in Spokane, Washington looks to the research to answer if the posture or position taken when performing the resisted side-stepping exercise matters when trying to maximize gluteus medius activity and minimize tensor fascia lata (TFL) activity. Dr. Jared Wilson blogs about chiropractic health and other relevant health news.  He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters of Exercise and Sports Science degree.

Hip abductor weakness is a common problem with people suffering from a variety of hip conditions such as femoroacetabular impingement, iliotibial band syndrome, and patellofemoral pain. It can even contribute to chronic ankle sprains. Weakness of the gluteus medius muscle will usually cause excess compensation from the TFL. Allowing the TFL to be recruited continually can lead to gluteus medius atrophy.

Corrective exercises can increase gluteus medius strength and improve muscle firing patterns. Usually exercises involving a variation of resisted hip abduction are given. However, it is important for clinicians prescribing these exercises to be aware of excessive firing from the TFL when their patient is performing them.

A recent study by Selkowitz et al (2013) looked at gluteus medius and TFL activation during 11 different exercises. The researchers used fine-wire electromyography (EMG) to determine the maximum voluntary isometric contraction (MVIC) of both the gluteus medius and TFL with each exercise. Their report showcased 5 exercises that activated the gluteus maximus and medius muscles without getting as much unwanted TFL activation. Those exercises included the clam exercise, single-leg bridge, hip extension (quadruped) with knee straight and knee bent, and the resisted side-stepping exercise. Specifically regarding the resisted side-stepping exercise, they found significantly lower TFL activation (13.1% MVIC) compared to gluteus medius activation (32.2% MVIC).

Bottom line is resisted side-stepping should be included in any corrective exercise program designed to strengthen the hip abductors. But does the position or posture you take when performing the resisted side-stepping exercise matter?

A study by Berry et al (2015) addressed this question. They had all 24 participants perform the exercise with an elastic resistance band around their ankles in both standing and squatting postures. Like the Selkowitz et al study, these researchers also used fine-wire EMG to determine the MVIC of the gluteus medius and TFL. Interestingly, they found that the EMG activity of the muscles being tested were actually higher in the stance leg rather than the moving one. They also saw that the EMG activity in the gluteus medius was significantly higher in the squat position than the upright position while activity in the TFL was lower in the squat position compared to the upright position.

So to answer the question…yes! It does matter what position or posture you take when performing the resisted side-stepping exercise. Performing the resisted side-stepping exercise should be done in a squat position rather than an upright one.

But how does this happen? Willcox and Burden (2013) gave a biomechanical explanation for the decreased TFL activity in the squat position. In the squat position the center of mass of the trunk is forward compared to the hip. This creates a hip flexion position and thus reduces the need to activate more muscles involved in hip flexion. Since the TFL acts also as a hip flexor in addition to being a hip abductor, the squat position would reduce the need to activate the TFL in order to stabilize the hip and pelvis. Increased TFL activation would be counterproductive.

I hope you found this blog to be informative. If you have any questions about how chiropractic care could help you, please call Gaitway Chiropractic in north Spokane at (509) 466-1366, request an appointment online, or come by the clinic at 8611 N Division St, Ste A, Spokane, WA 99208.

REFERENCES

Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther. 2013;43(2):54-64.

Berry, Justin W., Theresa S. Lee, Hanna D. Foley, and Cara L. Lewis. "Resisted Side-Stepping: The Effect of Posture on Hip Abductor Muscle Activation." J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy (2015): 1-30.

Willcox EL, Burden AM. The influence of varying hip angle and pelvis position on 531 muscle recruitment patterns of the hip abductor muscles during the clam exercise. J 532 Orthop Sports Phys Ther. 2013;43(5):325-31.

Image: Photographer unknown. (2015, August 6). Participant side-stepping to the right in the squat posture [digital image]. Retrieved from http://www.jospt.org/doi/pdfplus/10.2519/jospt.2015.5888