Author Archives: Sharon Rose

About Sharon Rose

Acupuncturist, medical massage specialist, scientist, roadtripper, historian, cat herder, gamer, belly-laugher.

Posture: It does a body good!

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Posture does more than make you look good: It’s important for your health! Being bent over creates tremendous stress on our muscles, squishes our organs, and blocks blood flow. I also affects our mood and digestion. Besides pleasing Grandma, there are a lot of terrific reasons to pay attention to posture.

Modern-evolution

We all sit too much. And that tends to lead to slumping. At work, at home, in the car… it’s actually gotten worse as technology has gotten better. We’re not even staring at computer screens over a desk anymore – we’re looking down at laptops and phones, and as a result, our collective necks are becoming permanently bent!

Posture2

There’s a funny sort of cascade that happens when you are out of whack. A forward head posture, for example, is very common. In that position, the muscles that flex the neck forward are underworked. The muscles on the back of the neck are overstretched and cranky. The hips tend to shift to compensate, and you get a similar pattern at the pelvis.

 

 

Picture a string running from the base of your spine, up through the top of your head. Imagine yourself pulled up by that string. You will naturally straighten, and your shoulders will relax into their proper position. I like this much better than the rigid shoulders that can happen from just trying to “stand up straight.”

Note that her chin is not pointing up – lift the top of your head, not your face.

Of course in about 5 minutes you may find yourself back in the familiar slouch. Pull up on that string again! It takes practice, but like any habit, it gets easier the more you do it, and eventually it’ll be automatic. Yes, your postural muscles will be weak at first, but they’ll get stronger. Stick with it!

Top 8 reasons to use good posture:

Superman has excellent, confident posture!

1) Create confidence and elevate your mood. The link between mind and body goes both ways… you can literally lift your spirits by lifting your head! Did you know your self-talk is linked with your posture? You know how faking a smile can actually make you feel better?  It’s the same thing with your entire body. Career coaches recommend taking on the “Superman pose” (ideally in an empty elevator or bathroom) before an interview, to go in feeling confident.

2) Reduce pain in the neck and shoulders. Your trapezious muscles get pulled tight when you slump forward, which causes all sorts of inappropriate tension.  And as you can see, keeping your head aligned is the best way to distribute the weight of your skull. A forward neck posture creates leverage that works against your body. This graphic below shows the pounds of pressure at various positions.

Good posture helps avoid muscle strain.

3) The individual bones of your spine – both neck and back – will be able to move more freely. This means less chance of spinal injuries or pinched nerves, and can prevent fusion between bones as you age.

4) You’ll look slimmer! Most of those “before and after” weight loss poses can be achieved with nothing more than good posture and different lighting.

5) Increase the flow of blood and cerebrospinal fluid. If you’re a collapsed beanbag, various pathways can be cut off, preventing your body from working as it should. Even cortisol (stress hormone) levels decrease with better posture!

6) Give your digestive organs room to move. Remember, they have to push food around, from the stomach on down, to mix it with the different stages of digestive enzymes and extract nutrients and water.

7) Make a better impression on the people you meet.

8) Look up and see the beautiful world around you! The sidewalk isn’t nearly as attractive as the people, architecture, and nature around you.

Good posture is a HABIT that you need to build. Put up visual flags (sticky notes, or draw an arrow on your hand) to remind yourself to relax your shoulders and lift your head. Just keep doing it, and eventually it will become your new default!

 

Damp (a Chinese medicine concept)

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I’ve talked briefly before about Fall in the Pacific Northwest, but let’s get into some more details about how the weather here literally leads to Damp in our bodies. I was out playing in our great outdoors, and on the way back, a fellow adventurer asked me if the soggy Portland climate affected how I practiced. It was an interesting question, so I figured I’d share my response.

In Chinese medicine, you can be “invaded” by EPIs – External Pernicious Influences:  Heat, Cold, Damp, Dryness, and Wind (There are actually two types of Heat, but I’m simplifying here). Damp Heat infection examples include yeast and urinary tract infections. Damp Heat in the Gall Bladder* can cause jaundice.

Damp can also start internally. Remember that in this system we have energetic organs* with special duties. The Spleen transforms food into energy (I think they actually meant the pancreas!), and is important in fluid management. If the Spleen fails, or if there is an invasion, fluids accumulate into Damp. A classically Damp body is overweight. Other symptoms include heavy limbs, stiffness, and edema (fluid retention). Damp left unchecked can further consolidate into Phlegm. This may be literal mucus or lipomas (fatty tumors), or “invisible Phlegm” like brain fog or even depression.

Oregon is, of course, a very wet place! Whether the rain itself penetrates us, or the fact that hiking isn’t as much fun when you have to slosh through the mud… either way, living here can definitely contribute to obesity. Be sure to get off the couch and enjoy the sun when you can. I don’t think getting your skin soaked has an effect in terms of Damp, but a light rain jacket and hat can make a real difference in your comfort level, so gear up and go have some fun outside!

Sugar, alcohol, and dairy are the biggest Damp culprits in our diet. Microbrew and local cheese, anyone? Nourish your Spleen with protein and hearty cooked vegetables. This is especially important going into Fall and Winter, but don’t neglect them in favor of a completely raw diet even in the Summer.

Acupuncture is a great way to drain Damp, clear Heat, and restore balance to your system. Please ask if you have any questions!

* Energetic organs are typically capitalized to emphasize their distinct nature from our literal, anatomical organs.

 

 

Sp-9 – “Damp,” blood sugar, infections, edema

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The Spleen* likes to be warm and dry. With our wet weather here, lots of Portland people have Damp issues.  Sp-9  (Yin Ling Quan) will drain damp, usually through urination. It can be used to treat bladder & urinary tract infections, chronic yeast infections, hepatitis, jaundice, and leg edema. It’s also a good long term treatment point for diabetes.

Sp-9Sp-9 lies in the depression posterior and inferior to the medial condyle of the tibia. The easiest way to find it is to run your thumb up the edge of the bone on the inside of your lower leg until it falls into a hole. It will drain damp, usually through urination. It can be used to treat bladder & urinary tract infections, chronic yeast infections, hepatitis, jaundice, and leg edema. If this Sp-9 is active (meaning, it needs some attention!), it’ll be quite sore.

Press gently for 10-20 seconds, with healing intention.

* Remember that in Chinese medicine, the Spleen is an energetic concept and should not be confused with your anatomical organ, the spleen.

 

Arnica for bruises, sprains, strains

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I generally don’t use topical stuff or supplements. Even when I have a good remedy, I have a bad tendency to forget to use it. Arnica is my big exception. Arnica montana is an herb that has natural anti-inflammatory properties. It makes a terrific topical oil for bruises, sprains, and strains. It’s fantastic for reducing inflammation in the area and speeding up healing.

arnicaoilI have a source for organic, locally-grown, hand-picked, hand-processed Arnica oil. It also contains a little St. Johns Wort for antibacterial and anti-inflammatory effects, and olive oil so it soaks into the skin. I prefer topical application to the pills, because it puts the medication where you need it, rather than spreading it out over the entire body, and because in high doses, taken internally, it can be toxic.

In all my years of martial arts, personal training, and running an acupuncture clinic (not to mention my own boo-boos), this is easily the best preparation I have found. It’s far superior to the multitude of diluted oils, creams and homeopathic pills generally available (most contain only small amounts of arnica), and that’s why it’s the only product I carry. I have bottles for $15 – swing by and pick one up! Use on unbroken skin only, please, and of course discontinue if your skin is irritated.

 

“Dry Needling” vs. Acupuncture

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I had a gentleman ask me last week if I had heard of “dry needling” and if I ever did it. I was flabbergasted… Dry needling is what acupuncture is called when non-acupuncturists do it. Wait – that’s not quite right. It’s what using acupuncture needles is called when someone else does it… but that doesn’t make it acupuncture. True acupuncture requires an understanding of a complex system, while most “dry needling” courses are surprisingly brief.

When comparing acupuncturists vs other practitioners as providers of therapeutic needling, some interesting things come to light. I feel very strongly that the various types of medical providers each have their areas of expertise. A bad injury, a serious infection, and organ failure are just a few of the problems that would send me running to “Western” modern medicine. But in some cases – chronic pain, healing after an injury, neurological repair, anxiety, etc. – acupuncture is highly effective. So….Why not just have your doctor do it?

There are some advantages to doctors doing acupuncture. First, they have a more extensive knowledge of anatomy than the average acupuncturist. I was very lucky to get to work with cadavers when I was at chiropractic school – most don’t. Secondly, the procedure is more likely to be covered by health insurance.

Unfortunately, there are also some disadvantages. Doctors are usually MDs first, and have taken a seminar on acupuncture. This course is a few weekends of instruction. They learn a handful of “recipe” points that are based on symptoms. Some people doing “dry needling” are physical therapists or chiropractors. As a comparison, I have a Master’s degree from OCOM, which consisted of 3,344.5 total hours, including 996 clinical hours. I learned about the Zang Fu organs, the channels, and the 1000 points and how they interact.

Doctors usually don’t spend much time getting to know every detail of your medical history. They tend to have 10 minutes for the whole appointment, and focus purely on your “chief complaint” as we call it in medicine: the main reason you came in. Traditional Chinese Medicine (TCM) is holistic. I prefer to take an hour with my patients. We examine the entire body, not just an isolated part, and our diagnosis is dependent upon that global perspective. For example, you may have a headache due to Liver* Yang Rising, or Qi deficiency, or a Wind Invasion. Or look at it from the other direction: A single diagnosis, such as Kidney Yin Deficiency, can cause varied symptoms like menstrual irregularity, anxiety, vertigo, night sweats… you see the problem. This is why I ask all those rude questions (sorry) in a 10 page form when you come in. What your menstrual cycle is like can actually help me determine how to treat your digestive disorder.

When doctors, chiropractors, and physical therapists use dry needling, especially for internal medicine, their results are not as strong as when a TCM trained practitioner wields the needles. I see this in a lot of research studies that “prove” acupuncture “doesn’t work.” It’s roughly equivalent to testing antibiotics for a runny nose, without separating out bacterial infections from viruses and allergies, then claiming that pharmaceutical drugs aren’t effective.

In this article, a doctor writes about needling. The myofascial part is spot on, but he’s missing the energetic component. Some of the points work on areas far away from where the needle goes! LI-4 and LV-3 are beautiful examples of powerful points that don’t really make sense with the Western understanding of anatomy. If distal points like the hands, feet, scalp and ears are neglected, the treatment may be weaker than ideal. It’s something to think about when comparing someone offering dry needling vs a true acupuncturist.

People with only basic anatomy training like massage therapists, and physical therapists doing dry needling? Super bad idea – and the reason there are so many news stories about dry needling pneumothorax (collapsed lung) problems created by physical therapists. Acupuncture needles are controlled as a medical device, because they really shouldn’t be used by amateurs.

Dry needling is a bad idea, m'kay?

Dr. Andrew Weil, M.D., agrees that TCM training should be comprehensive.

*Remember that in Chinese medicine, capitalized organs are energetic concepts and should not be confused with your anatomical organs.

Before and After #2

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I usually forget to take Before and After shots but will try to make more of an effort in the future. They are so much fun! Here, we are looking along the patient’s back, from the head towards the feet. She came in with upper and mid-back tension. I found a series of 4 ribs out of place on the right side. After some gentle acupuncture and medical massage, everything was back where it should be and she was thrilled to find that she could take a deeper breath than before.

Before Acupuncture - note the slope of her asymmetrical posterior ribcage.

BEFORE – note the slope of her asymmetrical posterior ribcage.

After Acupuncture - now her ribs are properly positioned, her back is even, and she can breathe more deeply!

AFTER – now her ribs are properly positioned, her back is even, and she can breathe more deeply!

GB-21 (neck / shoulder tension, rebellious Qi)

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Jian Jing (Shoulder Well) is a place many people tend to store their stress. Every day, people come into my office and complain about neck and “shoulder tension.” They really mean the trapezius and levator scapula muscles, not the shoulder joint. I’ve been saying for years that we need a better name for this part of the body, but “noulder” isn’t catching on (for obvious reasons!).

Referred pain and trigger points for the trapezius.

Referred pain and trigger points for the trapezius.

The trapezius is a big muscle, and it does a lot. Carrying heavy loads (especially unbalanced ones – so carry a small purse and use both straps of your backback!), working with your arms up (I’m talking to you, hair stylists!), or just general hunchiness over a computer… all are common causes of tension. The traps refer pain over the head to the eyebrow area, so shoulder tension can give you a severe frontal headache.

GB-21 also descends energy, so it’s good for rebellious rising Qi causing headaches, dizziness, heartburn, or vomiting.

GB-21 for relieving neck and shoulder tension.

 

Find GB-21 at the top of the upper thoracic area (aka “noulder”), halfway between the shoulder joint and the spine. Press firmly for 10-15 seconds with a healing intention. NOTE: Do not use GB-21 on pregnant women.

Also – look into some better ways to release your stress!

FYI…

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UPDATE 6/13/13: The recovery went well and I am back at work! It’s terrific to be out of pain! Feel free to book an appointment or give me a call. :)

Most of you know I’ve been battling with De Quervain’s tenosynovitis. This is a chronic inflammation of a tendon in my left wrist that controls the thumb. Actually it’s the sheath that the tendon passes though.

I have been using conservative treatments for about a year, including ice, rest, PT, bracing, lots of natural topical and systemic stuff, a cortisone shot, and of course myofascial release and acupuncture. If I were not so relentlessly active with my hands, that would have been sufficient. I’ve helped patients avoid surgery with similar conditions in the past, which made my situation that much more frustrating. In the end, though, this was a case where a quick surgical procedure to release the tendon was my best long-term option. Rest helped only while I rested… as soon as I resumed my usual crafty/weightlifting/combat/massage activities it came back. I had the double-sheath construction that pre-disposed me to the problem.

I had the procedure this morning and it went well. I’m so happy to finally have the issue resolved! I’ll be available for acupuncture starting Thursday, 5/9 (my right hand is unaffected). It will be a few weeks at least before I can do massage. During this recovery period, I am booking people manually rather than with the online system, so give me a call at 503-964-3422. :)
Sharon

 

Foot Pain, Foot Function, & Shoes

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My personal health issues, combined with frustration with lack of results using the current common answers, continually take me to new and interesting places. In the past year most of what I know about metabolism, nutrition, and now feet (and foot pain) has shifted drastically. It all comes back to evolution.

I’ve had intermittent stabbing pain for about 7 years, focused at the 1st MP joint (where the big toe joins the foot). I walk a lot, and the more I walked, the more it hurt. It had been diagnosed as a stress fracture years ago, and and for years I would wear Danskos* (hard soles, so my feet didn’t flex) when the pain got bad. Basically the Danskos acted as a walking boot. I am heavy (180lbs, due to muscle and bone from my bodybuilding days, plus all the extra padding I’m currently carrying) and have small feet and a stompy gait… It just refused to heal.

The foot pain had been interfering with my workouts, but it was getting worse and now messing with my weekend fun, too … that’s no good! So I started investigating and it turns out the solution was simple. I didn’t have a stress fracture at all.

diabetes_foot_problems_s13_hammertoesWearing tight shoes, especially heels, can cause bunions (angled big toe), neuromas, and hammertoes (bent toes), too. Fortunately my problem was easier to fix than the poor feet in this stock photo!

I had to change my shoes.

That wasn’t all of it, of course – I also needed some fascial adhesions stripped out. Acupuncture reduced the pain and swelling, and the minimal shoes I transitioned into have had the cool side-effect of forcing me to soften my gait. I wear CorrectToes spacers when I remember. Still, changing the shoes was key . Shopping guide here.

Rolfer Karin Edwards-Wagner does a lot of work with feet, and she pointed me towards the brilliant Dr. Ray McClanahan. He’s got a bunch of videos and articles on his site, so rather than reinventing the wheel I’ll just let you look at his stuff.

Here’s the deal: See those bones on the top of your foot? Your toes should extend in a straight line from them. For centuries we have crammed our feet into shoes that gathered the toes together, creating a sleeker pointed look instead of the spread “duck-foot” that nature intended.

Available here in the office, Correct Toes spacers help separate and flatten your toes into a natural spread for better stability. Use them along with changing your shoes, and getting some acupuncture and medical massage to break up fascial adhesions and relax the muscles of your feet. Your knees, hips, and even lower back will be happier once your gait is correct!

ct-before-during-after__smCorrectToesLogo_small

Under your big toes are tiny floating bones called sesamoid bones, which provide leverage and assist in tracking as a tendon moves over bone. The knee cap is a sesamoid, too – in fact you can imagine a miniature knee cap under that joint in your foot. The bones have grooves that the sesamoids are supposed to follow. If the toe angles inwards, the bone is pulled off track. Ouch!

The funny thing here is that my feet look pretty “normal.” I don’t have bunions or any obvious deformation… just a few degrees was enough to cause that foot pain for me. I haven’t worn heels for years. Even so, I had a huge pile of shoes and boots (some of them practically new) that I had to sell, donate, or toss. The trick is finding shoes that:

1)   Have flexible soles across the ball of the foot and also longitudinally, for twisting.

2)   Have the heel at the same level as the toe. Now that I’m used to “zero-drop” shoes, even a half-inch heel feels weird.

3)   Fit well in the heel and instep, but have lots of room in the toebox. This is why regular “wide” shoes don’t work for me – the rest of my foot isn’t wide. See the pic below.

4)   Don’t have a lot of  “toe spring” – that’s when the toe of the shoe comes up off the ground. It pushes you into an unnatural position all the time.

When buying shoes, remember to check for fit with the shoe liner test. Take out the inserts and stand on them (with all of your weight). If your toes drip off the edge, they are too small. Standing  on the bottoms of the soles of shoes is another good way to assess how much room you’ll have. If your favorite shoes are just a smidge too tight in the toe box, you can remove the inserts, which gives you a few more millimeters of room to stretch out.  If they are lace-up shoes, skipping the first set of holes can also let the toe box open up.

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn't enough - that big toe needs to be able to move and spread outwards. These are my new favorites, Clark's "Faraway Field," available in other colors if you aren't into blue suede shoes. :)

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn’t enough – that big toe needs to be able to move and spread outwards. These are my new favorites, Clark’s “Faraway Field,” available in other colors if you aren’t into blue suede shoes. :)

The sad truth is that most of the anatomically correct footwear out there is hideous, but I have found some cute options! Shopping info here. My winter boot review is here.

In addition to going shoe shopping, I also got some socks! The regular “mitten” sock can encourage toes to gather together, especially if they get pulled tight as you slip into your shoe.  When I wear those, I stretch out the toe seam to give myself some room. Sock Dreams is a fun local company that carries a variety of toe socks, and they ship for free.

Can’t give up the heels due to work or your fashionista status? Check out this article on ways to mitigate the effects of high heels. 

So… the real question is, did it work? My emphatic answer is YES! A week after switching, for the first time I finished a LARPing weekend without being in agony. My foot and knee may have grumbled a few times (I run for miles during these weekends) but that searing pain was gone. At the end, instead of waiting miserably for Robert to be done cleaning, I was out doing extra trash sweeps, because I felt that good!  Plus, at my next workout, I had to ask Brandie to throw extra weights on for the leg extensions and squat press, because the weight we were doing before suddenly felt ridiculously easy. Correcting my foot function helped my knee normalize, too, which is a bonus I hadn’t expected. It makes sense, though. If the toes can spread out and do their job creating stability, it takes a lot of pressure off the knees.

The next adventure is the perfect intersection of SCA / LARP / craftiness, and healthcare: I’m going to try making my own shoes!

*Setting aside the issue of the heel height for the moment, it’s true that Danskos and other hard clogs make it easier on your feet. The trouble is, they make it too easy. It was obvious once I thought about it…

When a patient comes in with a brace (on the wrist, knee, back, whatever), we always have this discussion: “Immediately after an injury, a little support is very helpful. As you heal, though, you need to wean off the brace. It’s good to wear it for sports, or challenging events, but not all the time. If you baby the muscles, they won’t work and get stronger, which is what you really need to heal. Eventually you should be brace-free.”

I’d been over-bracing my feet. *headdesk*

Wearing softer, more flexible shoes that allow / force my feet to get to work makes them stronger. Here’s a cool exercise you can do to strengthen your arch. I still prefer some shock absorption when walking on man-made surfaces like concrete, but for dirt and carpet I like to go more minimal. More exercises! And even more!

What about arch support? Modern shoes actually give us TOO much support, so our foot and leg muscles don’t work, and get weak. Remember we evolved without shoes. Our feet are designed to support us, given the chance. By doing foot exercises and gradually transitioning to more minimal shoes, your arch will support itself. This is awesome because it means your feet take a lot of the load back from the ankles, knees, and hips in terms of balancing. The whole body works better when strong and supple. Specifically for the arches, you want the “short foot” exercise.

Now that I have spent some time opening my feet up, I love the thin toe-separated shoes like Vibram 5 fingers. Just ease into them… minimal footwear takes some transition if your feet have been over-supported in regular shoes. I have a pair of Filas that are similar (just have shorter toes, so they fit me better) and I adore them! They are phenomenal for running around in the woods.

NOTE: If you are carrying a lot of extra weight, some squishy support is better than a purely minimal shoe, to offset the extra impact on your joints.

EDIT 7/1/13: Here’s an awesome article on another reason to wear good shoes – neurological challenge! Also – I get asked about foot pain due to Morton’s neuromas and plantar fasciitis (inflamed fascia) a lot. YES, I can treat them! The good news is that the treatment is immediately and highly effective. The bad news is that it’s the only treatment I do that hurts… Sorry. But only briefly, and it’s worth it, speaking personally!

Toenail Fungus: Prevention and Treatment

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Mild case of toenail fungus.

Mild case of toenail fungus.

Severe case of toenail fungus.

Severe case of toenail fungus.

Thanks to the warm weather, more people are letting their feet breathe by wearing comfortable sandals and flip-flips. And with all these toes out for a walk, I’m seeing a lot of toenail fungus. Some sources claim as many as 12% of us are affected. You might have it, too! Are your nails thick? Yellowed? Crumbly? What starts as a mild case on one big toe can spread to all ten digits, and eventually deform your nails. I see it on hands, too, but not as frequently.

To prevent an infection of toenail fungus,

  1. Thoroughly wash and dry your feet daily.
  2. Use only clean cotton socks.
  3. Don’t wear the same pair of shoes two days in a row (this lets the insides dry completely). If you have an entrenched case, your favorite shoes are probably also infected. You can try to treat them with anti-fungal spray and letting them dry thoroughly a few times, but you might have to say goodbye. :( Shoes worn every day are a major carrier for stinky bacteria, too
  4. In wet common-use areas like a sauna or gym shower, use shower shoes to prevent exposure. Definitely treat your feet to an extra scrub after your dip in a public pool or hot tub.
  5. If you go for professional pedicures, you should bring your own tools (running them in the dishwasher before and after to keep them clean) to prevent picking up an infection from another client. Or you can go to Frenchie’s, a salon in Beaverton that autoclaves their tools, so they are safe. If you are prone to toenail fungus, you should forgo polish. Fungus actually lives on the dye of the polish, according to a podiatrist friend, so use a clear coat as a base.

If you are already infected, don’t worry. Just follow the above hygiene rules, and add in a twice-daily anti-fungal treatment. Over-the-counter sprays containing Clotrimazole will help. Vicks Vap-O-Rub works well, too, because toenail fungus dislikes an acidic environment, and the vaseline base makes it stick to the area. Apply it morning and evening, after a thorough wash and dry, then cover with clean white socks. In 6-8 weeks you should see healthy nail growth.

People who prefer the “natural” route can use tea-tree oil or vinegar, but be aware that the treatment can take months. Severe cases should ask their doctor for prescription medication. And of course, acupuncture to help boost your immune system is a great idea, too. :)