Proper Weight Selection For Rapid Muscle Building Progress

by Dana McDaniel, Strength & Conditioning Coach at Performance Sport-Care
 If I was to ask people who lift weights what key factor is required to make the most progress toward building a strong, well developed body, most people might reply by saying things like “dedication,” “hard training,” “high protein intake,” “balanced nutrition,” and so forth. But my personal experience as well as my experience training injured people and athletes at Performance Sport-Care has convinced me that the biggest factor preventing most people from making maximum gains from their training program is training with weights or resistance that is too heavy.

To be sure, every successful strength athlete or bodybuilder on this planet attained championship level by constantly attempting to use increasing poundage/resistance in their workouts. This is concept is called “Progressive Resistance Training.” The training principle is a simple one: as we became stronger, our muscles also become firmer or larger as a result of our muscles adaptation to the greater resistance or exercise challenge placed a upon them.

Unfortunately, problems arise when trainees insist on using weights they can’t handle in proper form, or by performing weight training exercises in rep ranges that do little to stimulate growth. This also raises the probability of injury in the former case and slower training progress in either case.

Walk into any busy gym. Look around. Let’s see what we find. Oh, here’s a guy on the bench press. He says his goal is to develop larger pectoral muscles like a competitive bodybuilder. But every time he comes in to the gym he is always attempting to increase his one-rep max on the bench press exercise. Why? Is it to put himself on a fast track to a shoulder or chest injury? Ego gratification for this guy is all I can think of. If he was a powerlifter, performing such maximum lifts might be better understood. Powerlifters need to be able to bench press a lot of weight for one rep. Bodybuilders, or even the ordinary person starting an exercise program usually seeks a larger, more aesthetically shaped chest. Training like a powerlifter will not make you look like a bodybuilder!  Yet you see guys attempting to use so much weight that their spotter has to risk back injury in order to assist them from the very first rep. More often than not, this constitutes a waste of time and effort.

Many studies have been done to determine the optimal rep ranges for building strength vs. muscle mass. Training for pure strength requires that you handle very heavy loads, usually in the 1-5 rep range. To stimulate muscle growth, however, the reps need to be higher: 8-12 in general. In the bodybuilding world, many have found success with even higher reps for legs, as in 12-20. The key thing to remember is that optimal growth stimulation from exercise requires that you keep the muscles under the right amount of tension/load for the right amount of time. Going too low on the reps means you are stimulating the nervous system more than the muscles, not to mention greater stress on joints and structural components. Going too high on the reps means you are building muscular endurance. That’s fantastic for sports like triathlons, not optimal for those seeking bigger or more shapely muscles.

But even after selecting the optimal repetition range for their exercises we still find some misguided people that insist on using so much weight that they have to heave, swing, and use momentum to perform their exercises, thus recruiting a variety of muscle groups unrelated to the target muscle group they are supposedly trying to develop. Again, you can see it in the busy gyms, especially the CrossFit gyms: the people using such a heavy barbell or pair of dumbbells for curls that what they are doing more closely resembles a clean and jerk. Others using so much weight that they need to cut the range of motion short. Every gym has at least one guy who loads up the bar with 405 or more for squats, then proceeds to “bust out” 3-inch reps, going down nowhere near parallel, grunting and screaming all the while. And usually what you find is that most of them have very little leg development to show for the big weights and theatrics on display.

There is one very important concept from the bodybuilding world that anyone can benefit from…..and it is the critical difference between bodybuilders and the other 95% of people who train with weights. When performing weight training exercises most people simply move a weight from point A to point B, whereas a bodybuilder strives to feel the target muscle forcefully contract and stretch with each rep. The very best exercise results come from an understanding that we are ‘training the muscles,’ not just lifting weights!

Getting stronger is certainly important. And increased strength will inevitably come from faithfully following a properly performed exercise routine. So, remember this above all else: only increase your exercise weights IF you are using good form, getting enough reps, AND you are feeling the target muscle do the work. The muscle(s) that you are exercising should get pumped after just a few good sets. But, if you’ve just done a marathon workout of 12 sets of 3 different types of curls and your biceps aren’t pumped, tight, and burning with lactic acid, then something is wrong….(and probably not with your body) and is likely related to over/improper training!

Every gym has dozens of guys who train very heavy, yet aren’t particularly impressive to look at. Far more rare is the man or woman with an impressive physique that immediately identifies them as something beyond ordinary. Watch them train, and you’ll usually find some things that are very different. They train with more precision, better focus, and typically with somewhat higher reps than the average person. You can see their target muscle working when they are performing an exercise because they know how to isolate that muscle and make it do the work, regardless of the weight used or the particular exercise being performed. They are in tune with their bodies and what their muscles are doing when they exercise. Strangely enough, in the big commercial gyms sometimes populated by “haters,” these correct exercisers will sometimes be criticized for being ‘weak’ by the smaller gym members who don’t understand how and why muscles grow. They operate under the myth that heavier weights at all costs mean bigger muscles, without understanding all the other factors involved that we have been discussed above.

In conclusion, never hesitate to go a little lighter if that’s what it takes to improve your exercise form and allow you to feel your muscles working. If your goal is to build a body that sets you apart not only from the general public but also from the herds of “knucklehead” weight lifters in commercial gyms everywhere, ignore your ego, select weights that you can handle properly, and work like heck on those movements/exercises. You will be well rewarded.

Big commercial gyms and health clubs are not always the best places to obtain information or instruction on proper exercise program design or performance.

One final thought. Big commercial gyms and health clubs are not always the best places to obtain information or instruction on proper exercise program design or performance. Very often, people receive misinformation or acquire bad exercise techniques in such environments. We provide expert exercise instruction and design for beginners as well as competitive athletes. We provide close, individual attention in a safe, private, distraction-free, positive environment. Health histories and personal goals are carefully reviewed by a licensed health care professional in order to provide a customized exercise program designed to achieve your physical performance goals. Feel free to contact me directly, if you would like an improved and more effective exercise experience at

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

“POLICE”: New Management Guidelines For Ankle Sprains


Ankle sprains may not seem like such a big deal, but in the United States, alone, an estimated 28,000 ankle injuries occur every day. Most people assume that these injuries are destined to resolve with rest, alone, and minimal self management. However, this is certainly not the case for everyone. In fact, at least one systematic review, published in the American Journal Of Medicine, reported that only 35 to 85% of sprain ankles heal in three years.

Recently, there has been increasing suspicions among clinicians and researchers that the failure of some ankle sprains to fully resolve is attributable to outdated or incorrect advice given to patients and/or the general public with respect to the care and management of ankle sprains.

The Common Ankle Sprain (Inversion Type)


If there is a severe in-turning of the foot relative to the ankle, the forces imposed upon the ankle cause the ligaments (that hold the bones together) to stretch beyond their normal length.  This is known as a ‘sprain.’ If the force is very strong, the ligaments can tear. You may lose your balance when your foot is placed unevenly on the ground. You may fall and be unable to stand on that foot. When excessive force is applied to the ankle’s soft tissue structures, you may even hear a “pop”. Pain and swelling result. A black and blue discoloration may soon also appear.


The amount of force imposed upon the affected ankle ligaments determines the grade of the sprain. A mild sprain is a Grade 1. A moderate sprain is a Grade 2. A severe strain is a Grade 3.

Grade 1 sprain:

Slight stretching and some damage to the fibers (fibrils) of the ligament.

Grade 2 sprain:

Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.

Grade 3 sprain:

Complete tear of the ligament. If an examiner pulls or pushes on the ankle joint in certain movements, gross instability (excessive and/or inappropriate movement) occurs.

The acronym ‘RICE’ appears all over the Internet and in various self-care books, pamphlets, and resources in regard to advice about ankle sprains. This acronym represents the traditional management prescription of Rest, Ice, Compression, and Elevation.

As noted earlier, an increasing number of clinicians and researchers believe that the ‘RICE’ paradigm is outdated and does not necessarily reflect modern science or current clinical experience, certainly in the sports injury setting. A 2012 editorial published in the ‘British Journal Of Sports Medicine’ has called for the replacement of ‘RICE’ with a different set of guidelines with the acronym ‘POLICE.‘ These guidelines are organized as follows:

P = Protection

OL = Optimal Loading

I = Ice

C = Compression

E = Elevation

The fundamental difference with these new guidelines, particularly in regard to grade 1 and grade 2 sprains, is the de-emphasis on rest. Instead, patients are advised to start moving most sprained and strain joints soon after the injury.

Rest should be of limited duration and restricted to a brief window of time immediately after the inciting injury/trauma. An increasing body of scientific evidence suggests that longer periods of rest/unloading are actually harmful and produce soft tissue changes that are not optimal for the restoration of full strength and desired biomechanics.

Of course, no one is suggesting that people be forced to walk or certainly run on their sprained ankles right away. But some randomized controlled trials have shown that beginning range of motion exercises within a couple of days, followed by gradually increased loading, can get patients back on their feet more quickly. Joint manipulation by trained health care providers has also shown success in these trials.

For grade 3 ankle sprains (complete ligament tear), a study published by the National Athletic Trainers Association advises initial immobilization of the joint for 10 days. After that, they recommend that patients should begin moving the injured joint.

Skrecenia i niestabilnosci stawu skokowego

Braces and supports, like the type shown above, can provide protection that can enable an early return to weight bearing and walking, as well as protecting the joint from unexpected/undesired movements, or losses of balance.

The use of canes, crutches, and walkers can reduce effective body weight. This can help provide optimum loading so that an early return to walking and standing can be achieved more comfortably and to make sure that the load bearing capabilities of the injured ankle are not exceeded so that healing can progress.

The use of ice, cold packs, or cold water immersion can reduce the sensation of pain for many people and can also help control swelling. Cold application should not be prolonged in order to prevent thermal injury or vascular responses that are counter to the intended purpose of cold application.

The use of wraps, tape, or various bandages can provide compression that can reduce the leaking of fluids from capillaries into tissue spaces. This can also help reduce swelling.

Elevation of the legs can keep blood from pooling in the injured foot/ankle. This, too, can help reduce or control swelling.

There remains a general consensus among clinicians and researchers that extreme swelling adds days, if not weeks, to the healing process. The general belief remains that if one can control swelling, a faster return to sports or normal activities will transpire.


As a side note, an emerging controversy over the use of Non-steroidal Ant-inflammatory Drugs (NSAIDS), such as the one shown above, is worth mentioning. Some researchers point out benefits to injured body parts that occur during the initial stages of inflammation. NSAIDs, some believe, might interfere with those benefits. As a result, there are some clinicians and researchers that now recommend that NSAIDs not be consumed during the first 48 hours after injury.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Disclaimer: The images, text, video, or other media displayed above are intended  for informational purposes only and are not considered specific medical or chiropractic advice. Transmission of this information is not intended to create, and receipt does not constitute, any form of doctor-patient  relationship. Internet subscribers and online readers should not act upon this information without seeking their own professional  consultation. The information contained in this web site is provided only as general information, which may or may not reflect the most current health care/scientific developments. This information is not provided in the course of a doctor-patient relationship and is not intended to constitute medical or chiropractic advice or to substitute for obtaining health care advice from a duly licensed health care provider in your state.









“Kipping” Handstand Pushups – An Injury Awaits


A “kipping” handstand push-up is a handstand that employs an explosive hip and leg thrust (kipping) that is intended to generate momentum to more rapidly launch the handstand. It is an exercise activity frequently observed in CrossFit training and competitions. It enables this community of exercisers to perform more repetitions, with more speed than would be otherwise possible by performing conventional handstand pushups in strict form.

The following instructional video link was produced by a California CrossFit facility and describes what is considered to be the proper technique for performing a kipping handstand pushup:

This instructional video clearly indicates that it is acceptable for the trainee to rest or make contact with the head (on a mat/ or directly on the floor) at the bottom position of this handstand push-up. Thus, the kipping handstand push-up involves a headstand as well as an explosive handstand. Therefore, the injury risks from both of these components warrant serious consideration.

A strong upper body and plenty of practice is necessary to perform a headstand posture, alone, in a safe fashion. The shoulder, arm, chest, and upper back muscles should support your body weight when performing a headstand. If they are not strong enough to hold you in a stable posture, there is risk of damaging the cervical spine because most people’s necks are not designed to bear all or even a portion of the body weight . This damage could involve bones, discs, facet joints, muscles, ligaments, nerves, or some combination thereof. Needless to say, if you have an existing neck injury, doing a headstand or handstand pushups is unwise.

The following is an image of a normal neck x-ray:


The following is a flexion x-ray image of a normally healthy person, experienced in the performance of headstands, who sustained significant neck injury and instability from performing the simple headstand:

headstand_neck injury

Of course, one would expect that many CrossFit aficionados will vociferously take issue with this presentation and respond with the general argument that the described risks are overstated and that kipping handstand push-ups are completely “safe” when performed with “correct form.” Unfortunately, the reality is that CrossFit participants often perform exercises rapidly, in increasingly higher repetitions, and to a point of exhaustion, or momentary muscular failure. Even under the best of circumstances, musculoskeletal training injuries are certainly possible under such demanding conditions. Moreover, training form is almost always compromised when exercises are performed rapidly or to the point of exhaustion. Repetition speed up or, particularly, down may not remain under control.  Under these conditions the likelihood of situations ranging from a simple strain type injury to landing out of position, or coming down too fast or too hard onto the head and neck is a very real possibility. And, unfortunately, it doesn’t take a full-on crash onto the head and neck to cause a serious injury. Much lesser forces can certainly accomplish this.

But the risks of injury do not end here. Additional risk factors include high blood pressure and glaucoma. The inversion associated with headstands and handstands can increase intracranial blood pressure significantly. A person with high blood pressure can experience increased pressure in the blood vessels supplying the brain and eyes. This can lead to ruptured  blood vessels in the eyes, retinal tears or, in very rare instances, stroke. In glaucoma, pressure builds up within the eye, impairing vision. Inversion of the body exacerbates this pressure. Also, if the blood vessels in your eyes have burst or if you have ever seen “floaters” then headstands, handstands, or handstand push-ups are not for you. The consumption of anti-inflammatory medications may also be an added risk factor, in regard to strenuous activities involving inversion.

Therefore, when everything is taken into consideration kipping handstand push-ups are  not advisable for most people other than, perhaps, the “genetic elites.” They certainly cannot be endorsed for the general population seeking to pursue an exercise activity.

For those seeking to engage in kipping handstand push-ups anyway, the following opinions and recommendations are in order:

  1. Do not engage in any strenuous activity involving inversion of the body (i.e. headstands, handstands) if you have high blood pressure, glaucoma, ruptured blood vessels in the eye(s), an active neck injury, or a past history of significant neck injury.
  2. Avoid taking anti-inflammatory medications immediately prior to performing strenuous activities involving inversion of the body.
  3. Make sure you have an adequate strength base in the shoulders, arms, chest, upper back, and neck before attempting any handstands, or even a headstand.
  4. A minimum  strength “benchmark” of 15 strict handstands pushups or 10 strict overhead barbell presses with 1.25 times bodyweight  should be demonstrated before proceeding with kipping handstand pushups.
  5. Do not perform kipping handstand pushups alone or without someone nearby to assist you if you experience an injury.
  6. Direct strengthening exercises for the neck are strongly recommended. Exercises such as those depicted in the following link are suitable, if carefully performed:

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Growing Concerns About The Abuse/Misuse of ‘Plyometrics’


Plyometrics represent a form of exercise that has been employed over the last 30 years by elite athletes in order to promote speed, explosiveness, and faster reaction times. But more recently, plyometrics have found their way into the mainstream as a result of the wildly increasing popularity of jump filled workouts such as high intensity interval training, CrossFit, and Boot Camp classes. What has followed is an increase in injuries, particularly for the everyday exerciser.

Plyometrics is defined as any exercise in which muscles are repeatedly and rapidly stretched and then explosively contracted. Examples of this include jumping high off the ground or doing push-ups with a clap between each repetition. Playing catch with a medicine ball can also be considered plyometrics, along with skipping, bounding, and jumping. Plyometrics is believed to teach muscles to react faster. Plyometrics are believed to produce more power because the faster a muscle can contract, the more powerful it becomes. As a result, it has been a part of training for elite and professional athletes in a variety of sports, particularly those who engage in rapid stop /starts like basketball and tennis players.

Unfortunately, there is an increasing body of evidence that demonstrates that plyometrics is associated with pain and accelerated aging/degeneration of tendons, particularly when performed too frequently or improperly. The clinically painful tendons that can be produced by plyometric performance are now characterized at the microscopic level by collagen fragmentation, increased ground substance, and neovascularization of the affected tendon(s). These tissue abnormalities are believed to develop from an ineffectual healing response to the repetitive microtears within a tendon(s) that can be produced by plyometrics. The natural healing process may not be sufficiently capable of healing the repetitively strained tissue once these abnormal tendon changes develop.

Proper instruction and guidance is essential to the safe performance of plyometrics. It appears that most injuries occur when people attempt plyometrics without proper supervision and instruction. Also, a good strength base is essential before proceeding with any plyometric training programs. Because they can be so hard on the tendons even well-trained athletes are well advised to limit plyometric drills to no more than twice a week.

An increasing risk group for plyometric induced injury is the CrossFit crowd. This represents a younger population of exercisers who are willing to expend a lot of energy in the pursuit of high-end goals by following a high intensity, constantly varied exercise activity schedule that is performed several times per week.

There has been an increasing and worrisome misconception that plyometric training is somehow beneficial for weight loss. This simply is not so. Those exercise novices and overweight individuals who incorporate substantial amounts of plyometric training will encounter injury far sooner than any appreciable loss of body fat. It is far better to accomplish weight loss with other exercise/nutritional strategies before embarking on a plyometric program. Certainly, the load on muscles and tendons will be less…..and less likely to produce injury.

For the beginning to intermediate level exerciser, some guidelines for incorporating plyometrics is in order: Beginners should perform plyometrics no more than once a week, for five minutes, at low intensity. Certainly not every day. Plyometric jumps should not be performed until the exerciser is capable of performing squats in proper fashion with his/her own body weight. Whenever possible, or whenever in doubt, one should seek proper instruction before performing plyometric drills and techniques. Moreover, instruction on proper landing techniques is essential in order to avoid lower extremity, hip, and spine injuries. Activities like jumping over cones, skipping, and ladder hopping on the ground do train the neuromuscular system. They seem deceivingly simple and easy to perform. However, when performed repetitiously and at high intensity these activities have the potential to produce significant pain and injury.

In short, plyometrics can provide definite training benefits to athletes, but should be carefully integrated and performed in order to avoid potentially painful and costly problems.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Statin Drugs And Musculoskeletal Injury Risk


Statins are a class of medicines that are frequently used to lower blood cholesterol levels. These drugs are able to block the action of a chemical in the liver that is necessary for making cholesterol. Specifically, statins inhibit an enzyme called HMG-CoA reductase. Although cholesterol is necessary for normal cell and body function, very high levels of it can lead to atherosclerosis, a condition where cholesterol-containing plaques build up in arteries and block blood flow. By reducing blood cholesterol levels and the formation of plaques, statins may lower the risk of chest pain (angina), heart attack, and stroke.

Many people who begin statin treatment do so in order to lower their cholesterol level to less than 5mmol/l, or by 25-30%. Physicians may opt to increase the dosage if this target is not achieved. Treatment with statins usually continues even after the target is reached in an attempt to prevent atherosclerosis.

It is well known that statin drug consumption can sometimes cause side effects including nausea and muscle/joint pain. Infrequently, statins may even cause liver damage and muscle break-down (rhabdomyolysis) in some individuals.

However, a new study now suggests that the use of statins appears to be associated with an increased risk of musculoskeletal injuries, including an increased risk of dislocations, strains, and sprains. Researchers suggest the full range of musculoskeletal adverse events might not be fully known and that further studies are needed, especially in active individuals.

“These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated,” says Dr Ishak Mansi  and colleagues in a study published last month in the Journal of the American Medical Association: Internal Medicine.

This study included 6967 statin users “propensity-matched” with 6967 nonusers. Of the statin users, the majority were treated with simvastatin (73.5%) and approximately one-third had been prescribed maximum doses of the drugs, including simvastatin (“Zocor”) 80 mg, atorvastatin (“Lipitor”) 80 mg, or rosuvastatin (“Crestor”) 40 mg. Simvastatin 80 mg is currently restricted on the US market because of concerns about muscle damage.

In the propensity-matched analysis, treatment with a statin was associated with a 19% increased risk of any type of musculoskeletal injury, a 13% increased risk of dislocations, strains, and sprains, and a 9% increased risk of musculoskeletal pain. The study authors also reported a trend toward a 7% higher risk of osteoarthritis/arthropathies, but the association was not statistically significant in the propensity-matched analysis.

In addition, researchers observed no association between the number of years an individual took simvastatin and the risk of musculoskeletal injuries.

The study authors suggest that musculoskeletal adverse events with statins may represent a lesser known side effect of the drug class and should be studied further, especially in individuals who continue to be physically active. A better understanding of the full risks of statins will also “provide more complete data for cost/benefit and cost-effectiveness analyses of statin use,” they advise.

In conclusion, if you are taking any statin medication and experience any kind of muscle/joint pain, strain/sprain, or musculoskeletal injury, please report this to your prescribing physician for evaluation of your status and for data collection on this emerging area of concern.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Painkiller-Related Deaths Among Women Are Skyrocketing


The number of women dying from overdoses of opioid painkillers increased 5-fold between 1999 and 2010, according to new data released on July 2, 2013 by the US Centers for Disease Control and Prevention (CDC).

CDC director Tom Frieden, MD, MPH, said the following during a media briefing:

  • The problem of prescription opioid drug overdoses in women is “getting worse and getting worse quickly.”
  • Deaths due to opioid drugs have “skyrocketed in women.”
  • “Mothers, wives, sisters, and daughters are dying from overdoses at rates we have never seen before.”
  • “The increase in opioid overdoses and opioid overdose deaths is directly proportional to the increase in prescribing of painkillers.”
  • Opioid prescriptions are “increasing to an extent that we would not have anticipated and that could not possibly be clinically indicated.”

The CDC now says that since 1999, the percentage increase in painkiller-related deaths was actually greater among women than men (400% in women vs 265% in men). Prescription painkiller overdoses killed nearly 48,000 women between 1999 and 2010. More than 6600 women, or 18 women every day, died from a prescription painkiller overdose in 2010

There were 4 times more deaths among women from prescription painkiller overdose than for cocaine and heroin deaths combined in 2010. In 2010, there were more than 200,000 emergency department visits for opioid misuse or abuse among women — about 1 every 3 minutes.

Previous research has shown that women are more likely to have chronic pain, be prescribed prescription painkillers, be given higher doses, and use them for longer periods than men. The higher doses in women are “something we don’t really understand,” Dr. Frieden said, “given that, on average, women weigh less than men, and at the same or higher dose, they are more likely to have adverse events than men.”

Studies have also shown that women may become dependent on prescription painkillers more quickly than men and may be more likely than men to engage in “doctor shopping” (obtaining prescriptions from multiple prescribers).

“These are dangerous medications,” Dr. Frieden said. “They should be reserved for situations like severe cancer pain, where they can provide extremely important and essential palliation, but in many other situations, the risks far outweigh the benefits. Prescribing an opioid may be condemning a patient to lifelong addiction and life-threatening complications.”

The CDC is now encouraging medical doctors to take the following steps when treating women for pain:

  • Follow guidelines for responsible opioid prescribing, including screening and monitoring for substance abuse and mental health problems.
  •  Use their states’ prescription drug monitoring program; this can help identify patients who may be improperly using opioids and other drugs.
  • Discuss pain treatment options, including ones that do not involve prescription drugs.
  • Discuss the risks and benefits of taking prescription painkillers, including situations in which painkillers are taken for chronic conditions, and especially during pregnancy.
  • Avoid prescribing combinations of prescription painkillers and benzodiazepines unless there is a specific medical indication.

Consider Drug-Free Treatment Alternatives

Our office utilizes a wide spectrum of drug-free treatment and management strategies for musculoskeletal pain and injuries including rehabilitative exercise, applied nutrition, Chiropractic, and manual therapies.

Problems we successfully treat include, but are not limited to, the following:

  • Headaches of muscular/mechanical origin
  • Neck pain/stiffness
  • Shoulder pain: rotator cuff or other functional problems involving muscles/tendons
  • Tennis/Golfers Elbow
  • Back pain
  • Hip flexor tendonitis, bursitis, and/or myofascitis
  • Groin injuries
  • Hamstring and quadricep injuries
  • Knee pain: patellofemoral pain/stress syndrome, iliotibial band syndrome
  • Shin splints
  • Achilles tendonitis
  • Plantar fascitis
  • Other overuse injuries arising from exercise or sports

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Knee Osteoarthritis and the New AAOS Treatment Guidelines

knee_ OA2

The newly revised 2013 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines for knee osteoarthritis (OA) has become a focus for discussion in both the orthopedic and general health care community..

The most significant changes from the 2008 clinical practice guideline is a strong recommendation AGAINST  the use of  the following treatments/procedures:

  1.  Intraarticular Hyaluronic Acid (HA) injections a.k.a. “viscosupplementation.”
  2.   the use of Acupuncture.
  3.   the use of Glucosamine and Chondroitin sulfate.
  4. Arthroscopy with lavage for primary knee OA.  (simply “scoping” the joint and washing/sucking out particulate matter, absent any actual repair/reconstruction)

The new guidelines also reduced the maximum dosage for acetaminophen from 4000 to 3000 mg/day.  Interestingly, it does not recommend for or against the use of acetaminophen, opioids, or pain patches because evidence of effectiveness remains inconclusive.

The AAOS Committee on Evidence-Based Quality and Value, which oversees the development of clinical practice guidelines. reviewed 14 studies assessing the effectiveness of injections of Hyaluronic Acid (HA) into the knee joint. Although a few individual studies found statistically significant treatment effects, when combined together in a meta-analysis, the evidence did NOT meet the minimum clinically important improvement thresholds for recommendation.

The new AAOS guidelines do recommend non-steroidal anti-inflammatory drugs (NSAIDs) and Tramadol (a semi-synthetic pain medicine) for patients with symptomatic OA of the knee. Again, the AAOS guidelines were “unable to recommend for or against the use of acetaminophen, opioids, or pain patches” because of inconclusive evidence. (Of the 15 areas addressed by the AAOS work group, 7 were judged to have inconclusive evidence for or against the specific treatment considered.)

In regard to acetaminophen, some critics of the new guidelines point out that none of the published studies look at combination acetaminophen therapy, which is often how the drug is used in actual practice. For example, acetaminophen in combination with tramadol is said by some to be more effective than tramadol alone for joint pain.

Other key recommendations in the new guidelines include:

  1. Patients who only display symptoms of osteoarthritis and no other problems, such as loose bodies or meniscus tears, should NOT be treated with arthroscopic lavage.
  2. Patients with a Body Mass Index (or BMI) greater than 25 should lose a minimum of five percent of their body weight.
  3. Patients should begin or increase their participation in low-impact aerobic exercise.

It should be kept in mind that virtually all guidelines include a caveat that the practice of medicine involves the individual patient and that, for the practitioner, guidelines are only suggestions. The problem with guidelines usually arise when third-party payers (insurance companies) decide to use the guidelines simply to justify what are basically economic decisions. It remains to be seen to what extent the insurance industry will use these new guidelines to assert itself in treatment decisions between patient and doctor.

The information above is provided for general information purposes only and should not be construed, under any circumstances, as treatment advice. The reader is advised to seek the counsel of his/her personal health care provider for specific treatment advice.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or