Rethinking Hydration: Water Alone Isn't Enough!

Hydration is commonly misunderstood, with many people under the impression that drinking more water is always better. Take for example, the widely accepted 8×8 rule (8 glasses of 8 ounces of water per day) which lacks scientific evidence and was held onto for the ease of memorizing and prescribing. This misconception has led to over-hydration and the neglect of electrolytes, resulting in conditions like exercise-associated hyponatremia. Understanding the role of electrolytes is crucial for optimal hydration and helping you form your why as to the importance of consuming them.

The Importance of Electrolytes:

Hydration involves two essential components: water and electrolytes. While our body's thirst mechanism helps regulate water intake (very accurately, actually!) we must consciously ensure sufficient electrolyte consumption. Electrolytes, especially sodium, play a vital role in fluid balance and overall hydration. Sodium regulates fluid outside cells, while potassium maintains fluid balance inside cells.

Why Fluid Balance Matters:

Fluid balance is crucial for various bodily functions, including blood circulation, skin moisture, and toxin elimination through sweat, urine, and feces. Electrolytes, along with water, are fundamental in maintaining fluid balance. Drinking excessive water without adequate electrolytes or consuming too few electrolytes can lead to imbalances and even electrolyte deficiency, despite normal blood levels.

Benefits of Proper Hydration:

1. Increased Energy: Sodium deficiency often leads to low energy levels, especially in athletes and low-carb dieters. Addressing electrolyte imbalances can boost energy and overall performance.

2. Improved Brain Function: Sodium and potassium conduct electrical signals between brain cells, supporting optimal brain function. Proper fluid balance, aided by electrolyte consumption, is crucial for brain health.

3. Reduced Muscle Cramps: Electrolyte deficiency, rather than dehydration, is often responsible for muscle cramps. Adequate sodium and magnesium intake can help prevent cramping.

4. Headache Relief: Dehydration and electrolyte imbalances can contribute to headaches, particularly in individuals following low-carb diets. Replenishing electrolytes can alleviate these symptoms.

5. Enhanced Athletic Performance: Replacing both water and sodium lost through sweat is crucial for endurance athletes, as insufficient electrolytes can lead to medical complications especially during endurance based athletics. 

6. Support for Fasting and Keto Diets: Low insulin levels during fasting or ketogenic diets increase fluid and electrolyte excretion. Proper electrolyte intake helps alleviate symptoms such as headaches, low energy, and cramps.

7. Healthy Blood Pressure: Potassium intake is associated with lower blood pressure levels, while sodium restriction may not necessarily lower blood pressure.

8. Smooth Digestion: Adequate hydration is essential for maintaining proper digestive function, magnesium can even help alleviate constipation.

9. Improved Skin Health: Hydration status affects skin health, and adequate water intake and retention helps prevent dry skin and cracked lips.

10. Better Sleep: Magnesium supplementation promotes better sleep quality, while sodium restriction can negatively impact sleep patterns.

How to Stay Hydrated:

While our body signals thirst for water, it lacks a similar mechanism for electrolyte intake. It's recommended to consume 4–6 grams of sodium, 3.5–5 grams of potassium, 400–600 mg of magnesium, and 1 gram of calcium daily. Sodium deficiency is common, and individuals with high sweat rates or specific dietary patterns may require higher sodium intake. Adjusting electrolyte consumption based on personal factors such as energy levels, muscle cramps, and sleep quality is crucial for optimal hydration.

Hydration is not just about water; it's about how your body uses and maintains proper fluid balance to improve its overall functionality. Understanding the importance of electrolyte balance can lead to better overall health and performance. By prioritizing proper hydration with adequate water and electrolyte intake, individuals can experience increased energy, improved brain function, reduced muscle cramps, headache relief, better athletic performance, and various other benefits.

Our office is a proud provider of LMNT - they have a wide variety of flavors and supply top quality electrolytes in easy to transport packets. If you’ve never had one, this summer is the perfect time for you to feel the difference of being hydrated, especially if you plan on spending time while being active in the Nashville heat! Questions? Reach out to us and we’d be happy to help.

3 Benefits of a Functional Range Assessment (FRA)

What is an FRA?

The Functional Range Assessment (FRA) is a system that provides objective measures of an athlete’s movement capacity for each and every joint articulation.

Concise programming can be designed based on FRA measurements to reach specific goals for an athlete’s performance.

3 ways Functional Range Assessment can assist you:

1. Heightened Awareness - Most athletes are hyper-aware of the way their body feels and where it is limited. The FRA assist in identifying areas that may be lacking in dexterity and proprioception and provides a clear plan to improve them. A great example is the big toe. Can you move just your big toe on both feet without using any other toes or altering your ankle position? Tougher than you think!

2. Reprioritizing - FRA highlights the need for sufficient joint capsule space and the ability to rotate our joints - even our knees! Are your training priorities optimal for controlled joint movement? Do you account for your joint’s fundamental need to rotate with control and power?

3. More Data - These days a lot of us are collecting data on our Whoop, Oura, Apple Watch etc. Data is a powerful tool especially when it guides how you move forward. You can not manage, if you do not measure. Measurements allow for objective non-biased metrics for us to check back against. Lacking internal rotation of your right shoulder? Let’s measure it and see how much more rotation you have in 4 weeks. Clear-cut and defined - to compare the results of all your hard work. 

“As a professional athlete, my body is my job…The (FR) assessment gives me a specific baseline that I plan to use before, during and after my season to see what deficiencies I may have. That way I always stay progressing and improving - overall a great experience.”

- Tre T.

FUNCTIONAL RANGE ASSESSMENT

Call to book an FRA session with Ronnie Grant, LMT at Nashville Chiropractic + Sports Therapy

Are You Meeting Baseline Recommendations For Your Running Goals?

1 minute read

Recommendations for running can be overwhelming. The good news is there are many ways to address concerns for runners trying to meet new challenges or work their way back from injury. 

At Nashville Chiropractic + Sports Therapy we offer running assessments for athletes looking to recover from injury, maximize a running season, or prevent onset of concerns. 

There are functional tests that have been studied to identify if an athlete should return to running or when it is appropriate to run through recovery. 

Some key tests we address include:

• Single Leg Balance Control

• Two Leg Jumping Endurance

• Single Leg Hopping Endurance

• Side Plank Endurance

• Gluteal Bridge Endurance

• Lateral Step Down Control

• Calf Cadence Activation

The running assessment helps shed light on areas of concern and design a focused strengthening program. (1, 2, 3)

Our goal is to help you get to your race goal. If you would like to address concerns or see if you meet researched baseline recommendations we would be grateful to support you with a scheduled running assessment.

References:

1. Anderson LM, Martin JF, Barton CJ, Bonanno DR. What is the Effect of Changing Running Step Rate on Injury, Performance and Biomechanics? A Systematic Review and Meta-analysis. Sports Medicine-Open. 2022 Dec;8(1):1-41.

2. Bonacci J, Fox A, Hall M, Fuller JT, Vicenzino B. Effect of gait retraining on segment coordination and joint variability in individuals with patellofemoral pain. Clinical Biomechanics. 2020 Sep 20:105179.

3. Chris Johnson, PT. (2023 March). Lesson 23 – Physical Performance Tests & Clearance Considerations for Distance Runners Following a Running-Related Injury (RRI).chrisjohnsonpt.com/runnerszone

Evidence Based Approach to Understanding the Diagnosis and Treatment of Plantar Fasciitis (cont.)

PART II:

TREATMENT AND MANAGEMENT OPTIONS

DIFFERENTIAL DIAGNOSIS: There are other conditions to rule out before assuming plantar fasciitis is the correct diagnosis for the symptoms presenting. Potential issues to rule out include, not limited to-  fat pad bruising, Baxter’s Neuropathy, stress fractures, and various tendon strains. It is advised that you do not assume plantar fasciitis treatment with out confirmation of the diagnosis from a physician. 

MANAGEMENT: Traditionally, anti-inflammatory medications were prescribed for plantar fasciitis symptoms. The recent research would not support this process due to the nature of the injury not being in acute inflammation. Corticosteroid injections were shown to be no more effective than placebo for pain control and function improvements. NSAIDs are at times utilized for palliative relief but will not help tissue heal for long term relief or proper function.

Multi-modal approaches have repeatedly been supported by evidence-based research and systemic reviews. Exercise, mobilization, and palliative therapies have been shown in combination to have the best outcomes. 

Exercises: Strengthening weak musculature related to plantar fascia irritation can help modify agitating mechanics. Exercises can be considered for the gastrocnemius, soleus, posterior tibialis, flexor digitorum brevis, and intrinsic muscles of the foot. 

Mobilizations: Checking ankle mobility, big toe dorsiflexion, and working through muscle trigger points can help improve ranges of motion for the lower extremity. Stretching tighter tissues such as hamstrings and the plantar fascia itself have supported significant outcomes and help stress tissue at the histological level for healthy organized repair. 

Palliative Therapies: Orthotic supports and bracing in stretched positions can be relieving. Arch wraps can also be considered for support. 

Rest: In some cases rest may be necessary for runners. At least modifying the physical activity to find a tolerable level of load is ideal. Once the level is defined, activity should increase by increments no more than 10% per week.

Biomechanics: Cadence modifications can be considered and trained for to minimize overloading the plantar fascia and contribute to minimize reoccurrence. 

If you feel you are concerned about symptoms you are experiencing, be sure to connect with a movement specialist physician.  There are a list of possible diagnoses to rule out before moving forward with treatment for plantar fasciitis. We hope to be of help for questions, concerns, diagnostics and recovery! 

References: 

Cobden A, Camurcu Y, Sofu H, Ucpunar H, Duman S, Kocabiyik A. Evaluation of the Association Between Plantar Fasciitis and Hallux Valgus. Journal of the American Podiatric Medical Association. 2019 Nov 12. 

Steele, B., & Bertelsman, T. (n.d.). ChiroUp: Conditions Reference- Plantar Fasciitis. Retrieved April 20, 2020, from https://appsv2.chiroup.com/treatment/conditions/53 

Michaud, Thomas C., Differential Diagnosis of Heel Pain Dynamic Chiropractic – January 15, 2013, Vol. 31, Issue 02. 

Michaud, Thomas C., Injury Free Running: How to Build Strength, Improve Form and Treat/Prevent Injuries. Newton Biomechanics. 2013.

Quillen WS, Magee DJ, Zachazewski JE. The process of athletic injury and rehabilitation. Athletic Injuries and Rehabilitation. Philadelphia: WB Saunders. 1996:4-8.

Evidence Based Approach to Understanding the Diagnosis and Treatment of Plantar Fasciitis

PART I: UNDERSTANDING THE PROBLEM

DEFINITION : Recently plantar fasciitis has been better defined as a non-inflammatory fibrotic degeneration of the type 1 collagen fibers of the plantar fascia (1). Sounds complicated- so let’s simplify. Due to excessive load, the plantar fascia tissue starts to have micro tears in it. Typically, an injured tissue would follow an inflammation process for repair. The plantar fascia however is vulnerable to overuse/overload mechanics and minimal rest, both of which limit the acute inflammation process. The tissue accelerates into a disorganized healing process, laying down less than ideal fiber repair. It is advised that you do not assume plantar fasciitis treatment with out confirmation of the diagnosis from a physician.

ANATOMY AND PHYSIOLOGY: The plantar fascia is a fibrous tissue, ligament, on the bottom of the foot attaching from the medial calcaneal tuberosity extending to all 5 toes. The ligament protects the intrinsic muscles of the foot, nerves, and vasculature. Biomechanic responsibility of the plantar fascia includes the “windlass mechanism” in the gait cycle. The ligament at rest, or heel strike, is relaxed and absorbs ground forces and body weight. As the heel raises and center of gravity moves toward the forefoot, the tissue winds up around the first metatarsophalangeal joint, or big toe, draws the tissue taught - shortening the arch distance and increasing the arch height, creating a stiff lever for forward propulsion.

ETIOLOGY/CAUSE: Plantar fasciitis, or possibly better termed fibrosis, occurs when the ligament has been irritated from overuse or overloading- causing microtears to the ligament fibers. The windlass mechanism can be compromised due to plantar fascia pain and degeneration. Limitation in proper mechanics could have lead to the overuse/overloading errors in the first place- example of a positive feedback loop.

POPULATION: Majority of cases are among people over the age of 40. Other populations that are shown to have plantar fascia irritations are middle aged females, runners, soldiers, and person’s with BMI over 35, especially if weight change was rapid. All populations are at risk of plantar fascia irritation if they increase physical activity too quickly or with high load. 

WHOLE BODY APPROACH: Other regions of the body should be evaluated to fully determine the biomechanical influences on the plantar fascia. The following regions have been noted in congruence with plantar fasciitis symptoms. 

• Pes Planus (Flat Arch) - decreases stability for toe off phase

• Pes Cavus (High Arch)- decreases absorption at heel strike

• Hallux Valgus (Big Toe curving to midline, Bunion Formation) - compromises toe off phase

• Tight and Weak Gastrocnemius and Soleus (Calf Muscles)

• Weak Flexor Digitorum Brevis Muscle (Foot Muscles)

• Tight Hamstrings 

There are a number of differential diagnoses that can share similar symptoms as plantar fasciitis. Be sure to consult a movement specialist physician before assuming your diagnosis.

Check back later this week for PART II: TREATMENT AND MANAGEMENT OPTIONS.