The Doc’s Perspective

Chia seeds are gaining popularity as a dietary superfood, but are they really special?

Chia is an ancient grain, cultivated by cultures such as the Aztec thousands of years ago, and a significant portion of their diet. More recently in the 1980′s, these are also the same seeds grown to sprouts on Chia Pets.

Nutritional Analysis of 1 ounce (28 grams):

Calories 137
Total Fat 9g (1g saturated)
Cholesterol 0mg
Sodium 5mg
Total Carbohydrate 12g
Dietary Fiber 11g
Protein 4g

Minerals of note:

Calcium 177mg (18% DV)
Phosphorus 265mg (27% DV)
Manganese 0.6mg (30% DV)
Zinc 1.0mg (7% DV)

Touted superfood benefits which we will analyze one by one:

Weight loss: Chia seeds swell and form a gel when added to water. This effect may be filling and blunt the appetite. However there isn’t any research to back up claims of direct weight loss. It’s also worth noting that an ounce of seeds packs the same number of calories as a thick slice of bread, and a tablespoon of chia is worth 70 calories.

Reduction of cholesterol: Chia seeds contain fiber, fiber helps to reduce blood cholesterol levels. So, yes they are helpful to reduce cholesterol.

Control of blood sugar: again, it’s about the fiber. So, yes chia’s fiber slows absorption of sugar into the bloodstream during and after a meal.

It’s worth noting that chia is a complete protein and has an excellent omega-3 fatty acid profile (57% alpha linolenic).

My analysis finds that chia really isn’t extraordinary or a superfood. However it is a healthy, good quality food. It lends the same heart health benefits of many other seeds and legumes. Flax, chick peas, oatmeal, quinoa, black beans come to mind.

What you may want to do is a cost analysis. How much is a half pound of chia? You may be paying a premium for hype, Chia has been around for thousands of years and there is precious little research to back up any claims that it’s better than widely available healthy grains and legumes.

I was going through my 2011 shoe demos here at the end of the year when I found this pair of New Balance 650′s in the back of the training room closet.

I put around 45 miles on these and two 5K races around mid-summer, one of which was the Minnesota Heart Institute road race on the streets circling the Braemar Golf Course in Edina, MN.

What characterizes these shoes are a rather firm sole and little by the way of external foam or shock absorption. The outsole is attached directly to the shoe body with any shock absorption thus coming from the internal sole structure.

In use, the shoes are very firm with little shock absorption, not quite on the order of track flats/cleats but nearly so. Combined with the hard rubber outsole, they were quite noisy, too.

At the same time they are not outstandingly lightweight.

Around the 2 mile mark the shoes tended to build up internal friction and the sole became somewhat uncomfortably warm on most every run.

Overall these would be reasonably fair short distance racing shoes at moderate cost, but I would not recommend them.

New Balance 650 “Pulse” @ 40 miles:

We are firmly into the winter/indoor running season and I’ve put 60 miles on a pair of Asics Gel Nimbus 13 over the last three weeks. This is 100% treadmill mileage and the results have been spectacular in terms of comfort.

Granted, a large component of indoor running comfort belongs to the treadmill platform itself, but the Gel Nimbus 13′s are excellent all the way around. Highly stable and all mileage thus far with zero hip, knee or foot pain. They have been comfortable on my ACL injury as well.

They run neutral with good forefoot landing comfort and a very comfortable stride. The laces have good bite, I’m running them a bit loose but they’ve not come undone during a run. Internal friction is mild with little heat build up and no foot numbness noticed at distances up to 6 miles.

Quite light for a training shoe. These aren’t ultralight or minimalist by any stretch, but for a serious mid distance training shoe, look no further.

Asics Gel Nimbus 13 @ 60 miles:

Recently a 23-year-old female patient with no prior history of trauma or related medical conditions presented to the clinic with primary complaint of persistent neck pain and stiffness, headaches and upper-mid back pain, recurring over the last 3-4 years.  She was self-employed, and spent the majority of her day in front of a computer. 

 She had tried PT and massage which were ineffective.  She was working with her family MD on an ongoing basis, had been prescribed a low dose of Flexeril to be taken on the ‘bad’ days.  The MD had recommended an MRI scan of the neck, then referral to a chronic pain center.  However the patient has a large insurance deductible, so could not afford this route.

Examination revealed an otherwise healthy appearing young adult female of normal weight, but with very chronic-appearing, ropy, nodular muscle tissues palpated bilaterally from the upper neck down to the mid-back between the shoulder blades.  The tissues were particular rigid and tender along the lateral and posterior neck, yet the neck range of motion was entirely normal.  Misalignments of the spine were identified, particularly in the upper back, yet the bony segments of the neck were found to be somewhat hypermobile. 

Radiographs obtained from the MD were essentially normal.

Summary:  This patient’s situation is seen with uncommon frequency.  An otherwise young, healthy, non-traumatic patient, but with chronic pain and stiffness.  Further history revealed that the patient had an ‘addiction’ to frequently stretching and pulling on her head and neck to get the bones to ‘pop’.  In fact, the patient reported that as she sat in front of the computer working, it was not uncommon for her to pull on her head and neck every 5-10 minutes.

She was diagnosed with self-induced cervical strain/sprain.  In essence the patient gave herself a mild form of whiplash and was suffering from chonic inflammation and low grade spasm of the muscles, tendons and ligament.

I recommended that the patient immediately decrease the frequency of her self-treatments over time, with a goal of stopping entirely, by explaining that she was damaging her neck tissues by the repeated yanking on her neck.  I advised her that she will likely go through a withdrawal period, of sorts, during which her neck will be even more symptomatic.  To heal her injuries, we initiated her on electical muscle stimulation treatments, along with adjustments of the upper back to the segments that were misaligned.  I briefly considered placing her in a neck brace, but the patient declined.  She was given strengthing exercises.  The outcome of treatment is pending, and much depends upon her own compliance.

The Kinvara 2, released in 2011 by Saucony, is best described as a semi-minimalist running shoe. If moving from a high-end standard shoe such as a Ride 4 or Gel Nimbus 13, the first thing you will notice is that the Kinvara 2′s are, by comparison, feather light. Second will be the low heel to toe ratio, which will move the foot strike toward the forefoot from the heel, which is generally a good thing to neutralize hip and knee gait related pain. Technically, it’s classified as a neutral shoe, for those with under/over pronation problems, keep that in mind.

The upper is entirely a screened mesh, extremely breathable. The screen mesh keeps rocks and sand out, but not dust/dirt. The sole is nearly 100% foam, without a continuous hardened rubber outsole. The fit is spot-on, the heel fits nicely in the cup, the inner sole is balanced, and the laces firm up the support comfortably.

They run “nice”. I’ve put 80 miles on this pair, give or take, maximum of 5 miles per outing. There is a decent foot strike, neutral handling, comfortable inners, good energy return on push-off, traction is perfectly adequate, and of course the weight, or lack thereof, should improve your mile times. It’s quite close to running barefoot, without the bruises and cuts. I suppose one could forget your are wearing shoes, they are that light.

As “nice” as they are, I’m not convinced this is the best everyday training shoe. Barefooters and minimalists will likely disagree, but the Kinvara’s minimal structure and weight may work against being an everyday running shoe for those with stuctural or injury issues. Right off, these are not highly durable, with a primarily foam sole, so with mileages above 20 per week, expect to replace these a lot more often. Secondly, heavier or taller folks, or those with joint injuries may not get enough impact absorption from the shoe.

I’m 175-lbs with a ‘bad’ (ACL) knee. The Kinvara 2′s are acceptable for training, although I did have a bit more anterior knee pain than usual; so there are better daily training shoes out there, such as the aforementioned Gel Nimbus 13, or Grid Raiders, etc. Where the Kinvara 2′s have found their niche for me are competition shoes. There is nothing like a featherweight shoe if you’re trying to trim seconds off your mile time.

Overall, the Kinvara 2′s are surprisingly stable, absorbtive, lightweight (~7 oz) minimalist shoes. They run really great on road, gravel and mixed surfaces, too. Go get your own pair!

Coming soon will be my thoughts on the Saucony Exodus 2.0 trail running shoes, and if there is enough time left in the outdoor running season we’ll analyze the outcome of Lisa’s experience with Asics Lady Gel Nimbus 13′s as it pertains to her moderate chondromalacia patellae (knee cap cartilage degeneration).

Saucily Kinvara 2 @ 80 miles (about 30 of that on gravel trails):

55-year-old male patient presents with significant numbness of the outside of the left lower leg and foot, history of falls, mild lower back pain.  Surgical history notable for a disc surgery 20 years in the past, due to lower back and left leg pain. 

MRI and X-rays find severe degenerative arthritis and disc space loss at the two lowest levels in the patient’s lower back, as well as degenerative arthritis in the left knee. 

Physical examination is notable for a man who walks with a very pronounced hitch in his left leg gait.  Also notable for loss of sensation to pin prick and light touch over much of the lateral calf, the outside of the foot and the big toe.  Knee and ankle reflexes are both diminished.  Measurements of the left calf girth confirm loss of mass comparative to right (atrophy).

Referrals are made to neurology for further work-up.  In the meantime it is decided to embark upon a course of conservative care with the stated goal of potentially slowing the progression of the lumbar degenerative disc disease, the resulting atrophy and loss of sensation.

Six visits are scheduled with treatment measures including mild manual (doctor-assisted) traction, massage, mechanical chiropractic adjustments, along with instruction in exercises, diet and stretching.  The patient was advised to lose 10-15 pounds.

Current progress: Now into the third week of care, four visits, the patient has reported feeling intermittent pain in a formerly numb area of his left foot.  His left leg continues to feel week, but he has been able to ride an exercise cycle and is walking 3-4 blocks daily without falling.  These are positive signs. 

 The patient will consult with neurology as recommended, to see what they suggest, but in the meanwhile is gaining strength in his weak, atrophied leg, appearas to be maintaining his health, as well as showing a glimmer of restored sensation, even if it is ‘pain’.

Will add time to your 5K!  Large wheels are key to a smooth ride for the kids and runner.  Getting used to running without pumping the arms is required, but not at all difficult.  Use a tether so the stroller doesn’t lose control if you do.  Some models offer hand brakes, which may be helpful should an emergent stop be necessary, otherwise I think the feet work well enough.

There is debate in the jogging-stroller-running community whether a jog stroller’s front wheel should swivel/turn.  In fact, if it swivels it will be easier to take sharp corners.  Turning a non-swivel requires you lift the front wheel up, typically by pushing down on the handlebar.  The reasoning against swiveling front wheels are most all safety concerns, they say should a swivling type wheel strike a rock, it may veer sideways.  I’ve never seen or had it happen, but it seems plausible.

Maintenance: Jogging strollers or those strollers with larger diameter wheels typically use pneumatic tires with air inflated tubes, exactly like a bicycle.  But they can be harder to fix than on a bike.  As an avid mountain and road biker, I’ve changed dozens of flat tires.  I had the opportunity recently to fix a flat on a 12″ stroller wheel.  I don’t mind admitting it took quite a bit of muscle finesse, and wouldn’t have been easy for an inexperienced person to do, especially without the proper tools.

Changes to the Workout:  You’ll gain a bit of momentum on declines, but the real work comes when going uphill.  My personal experience is with a double-wide Bumbleride.   My kids + stroller + miscellaneous = 100+ lbs.  Moving this sort of weight uphill at a run adds an anaerobic/strengthening segment to your otherwise purely aerobic session.  Quite obviously.

Injury potential:  Adding weight resistance to running increases the risk of stress/strain injury to the running muscles as well as the lower back.  The degree of risk is somewhat nebulous, as with any exercise, the greater the effort the greater the risk.  Long runs down inclines, slowing the stroller, may put additional stress on the hamstrings, mid back and lower back.  There is an increased risk of injuries related to crashes and accidents, should they occur.  Overall, the added impact/shock strain on the feet and knee joints would be minimal, in my opinion.

Runner’s World recently rated the Saucony ProGrid Ride 4, a “best update” for 2011.  It’s a running shoe I was well familiar with prior to the magazine’s accolade.  I’m a mid-short distance runner, weekly milage in the range of 14-20.  Right knee ACL is gone. 

Since part of my practice is running injuries, I trial *a lot* of shoes to see how they behave.  These ProGrids are among my own regulars as they provide great neutral cushioning, a plush ride, and are light weight.  Ideal for the 4-6 mile runs I typically take.  Even boasts such a comfortable interior fit that you could get away without wearing socks, so I was told…which I don’t recommended.

Saucony Pro Grid - Excellent neutral handling, shock absorbing, and overall comfort, for mid to high distance training.

IT BAND SYNDROME 

CASE: 26-year-old female who developed outside knee pain two weeks prior to her presentation at the clinic for examination.

HISTORY: Recently increased mileage, ran through pain, added bicycling to routine, ran with dog who pulled on lead.  Replaced her high-quality running shoes regularly every 250 miles. 

PHYSICAL: Pronated feet, scoliosis of the lower back.  Tenderness outside of knee.  Tenderness lateral hip and buttock.  Sore when sitting in office chair.

DIAGNOSES: IT-Band syndrome [ITBS], Tensor fascia lata syndrome [TFL], Scoliosis (congenital curved spine), pronated feet, flattened arches.

TREATMENT PLAN: Ultrasound and cross friction massage 3x week for 2 weeks.  Stop all running and bicycling.  Check alignment of foot, ankle, knee, hip and lower back.  Home treatment ice/heat/stretching/strengthening.

OUTCOME: We determined that the patient sustained the ITB injury by increasing her mileage too quickly as well as from running off-balance from a dog pulling on a lead.  She had pre-existing scoliosis as a complicating factor.  We determined that she had a secondary case of TFL syndrome in the same leg, caused by compensating for the ITBS pain and climbing/descending her 2 flights of steps often at home.  Her high quality shoes mitigated the flat feet and pronation problem, so this wasn’t a significant factor. 

With treatment and rest, the ITBS pain resolved in 14 days, along with the TFL which we simultaneously approached with electrical muscle stimulation and restrictions on climbing/descending stairs.  We reintroduced run/walks on a trial basis on day 15 with a 5 minute run/walk.  Progressively adding minutes over the next two weeks, 5 at a time until she reached her goal.

DISCUSSION

Situated as we are on Lake Calhoun, surrounded by miles of running and biking trails, we have the opportunity to see a large number of exercise-related injuries, including what is primarily a running-related injury, IT Band Syndrome. 

Iliotibial Band Syndrome typically is noticed by the runner/walker/hiker as outside or lateral knee pain that occurs during or after running.  While many factors can predispose and/or cause a runner to come down with the syndrome, some of the more common causes we see in the clinic are a sharp increase in mileage, running on uneven surfaces, worn out or improper foot wear and biomechanical issues with the knees, hips and/or the lower back.

Treatment options are many.  Here, we utilize a conservative approach to care, tailoring non-invasive treatment to each individual presentation.

Our typical assessment of the running injury may include:

1) Review of running/training history.

2) Physical examination of the spine, hips and lower extremities to assess for biomechanical problems.

3) Assessment of flexibility, mobility and movement patterns.

Treatment may include:

1) Assessment of foot, ankle, knee, hip and lower back alignment.

2) Ultrasound, massage, cross friction massage, ice, heat and/or additional local therapy measures on the injury.

3) A stretching and strengthening program.

4) Reduced mileage, alternate exercises, cross-training, rest, and a step-wise return to activity.

5) Education.  We make it a priority for our patients to understand the injury and underlying causes of injury.

With our competent assessment and diagnosis, our patients have enjoyed good success with our conservative approach to treating their IT Band, and other exercise-related, injuries.  In most cases we are able to resolve injuries to avoid sending a patient on to more aggressive and potentially difficult treatments including prescription medications, cortisone injections and beyond.  If you think you have IT Band syndrome, or any other injury and you would like an opinion, please contact our office for an appointment.

Remember, this is a case history and general discussion of injury conditions we see here.  It is not to be considered specific advice to follow without proper medical or chiropractic evaluation.

I have been an avid scuba diver for over 25 years since getting ‘the diving bug’ from my father, who provided my initial training in an Iowa lake in the early 80′s. 

Back then, we breathed undewater using a long hose attached to an air compressor motor floating on an inner tube.  Many years and many dives later, I still enjoy the freedom of underwater weightlessness.  Matter of fact, my father, now in his late 60′s, and I have completed several dives together this summer.

It was only relatively recently that I decided to transition from recreational diving toward instructional-level certification.  Why?  Not for any great desire to start a new career as a scuba diving teacher, but rather in a quest for knowledge and training in advanced techniques. 

On the pathway toward this goal was a Rescue Diver course which included techniques and in-water training scenarios for preventing emergencies and saving lives involving in-water rescue of scuba divers, swimmers, or anyone involved in an in-water emergency.

Given my background in healthcare and emergency response, the course work and written examination were simple, yet the in-water training scenarios were totally new to me, including coordinating a search and then actually searching underwater for drowning victims, providing CPR and other First Aid while simultaneously swimming a victim toward safety.

All in all, well worth the time and highly recommended for aspiring scuba divers.