Tag: health

Shannon Clinic – Melbourne Chiropractic and Sports Care Blog

Chronic Traumatic Encephalopathy (CTE) is a complex, evolving area of neurology and sports medicine. In one corner we have experts who definitively state that CTE is a delayed and progressive neurodegenerative disease directly linked to repeated head impacts with onset of symptoms later in life; while in the other there are those who suggest the evidence is currently insufficient to provide such a definitive statement.

High levels of post-mortem histology neurodegenerative change where first described in boxers in 1928 and termed ‘dementia pugilistica’ which, by 1949 would give rise to the term chronic traumatic encephalopathy. These neurodegenerative changes visible in the brain at autopsy are thought to occur from repetitive head impacts and include axonal disruption/injury, myelin degeneration, white matter loss, the presence of p-tau proteins (p-tau pathology), neurofibrillary tangles (NFT), astrocytic tangles (AT), beta-amyloid plaques (Aβ) among others. The distribution of these deposits is in clusters around small blood vessels of the cortex, typically at the sulci depths. Such changes are proposed to result in mood, behaviour, cognitive changes and dementia. Theories regarding the pathogenesis include disruption to the blood brain-barrier resulting in ischaemia within the brain and the presence of neuroinflammation following head impacts.

Head impacts such as sports related concussion can be disturbing to witness; the acute, delayed and prolonged symptoms can be distressing and challenging for an individual to work through. This has created space for the media to leverage clicks and views off through movies and stories using the narrative that sport related concussion is directly linked to CTE.

The first assumption in such a narrative this is that we definitively know that sport related concussion is exclusively a head impact injury, where symptoms are directly associated with injury to certain areas of the brain. For if this statement were not true how could we confidently link repeated head impacts to long term neurodegenerative change?

Our current understanding of sport related concussion is improving however, it is based on animal and motor vehicle occupant studies which are not representative of sports related concussion; head impact sensors are not as consistently accurate as required and, although blood biomarkers look increasingly promising their presence is nowhere near definitive. Furthermore, many symptoms of sport related concussion may not be directly associated with the brain and can be seen in whiplash patients leading to the plausible theory that sport related concussion may potentially include involvement of the upper cervical spine and area with Melbourne sports chiropractor Dr. Shannon has published work. There is no doubting that direct impacts to the head, such as a head-to-head contact results in a brain injury however, our understanding and ability to accurately diagnose sports related concussion is still limited and evolving.

The second assumption is that we can definitively identify the symptoms of CTE to make an accurate diagnosis. Presently there is no way to diagnose a living person with CTE, all diagnoses have been made via autopsy. Although recently there have been attempts to establish research diagnostic criteria for diagnosing traumatic encephalopathy syndrome, the clinical disorder suggestive of CTE. Moreover, there have been a series of pathohistological diagnostic criteria put forth by Omalu in 2011 which were broad and non-specific for CTE, nor did it include specific characteristics of p-tau pathology, a key feature of CTE; By McKee in 2013 which was based on a comparison study of 68 cases aged match to 18 control cases without a known history of mild traumatic head injuries and although they identified unique patterns and distributions of tau pathology in CTE; the criteria has not been statistically tested, there are blurring between stages, as well as overlaps with other comorbid conditions.

In 2016, a consensus panel of neuropathologists established a preliminary criteria for diagnosing CTE which as they stated, is limited and requires further research; additionally the methodology they used was at risk of selection bias nor were any epidemiologists were involved in developing that methodology. Furthermore, a key issue at present is that many of the histopathological findings seen in those with suspected CTE can also be present in other neurodegenerative conditions, and have been present in those who have not participated in contact sports.

This is not to say that neurodegenerative changes do not occur in those exposed to repetitive head trauma; there is evidence that shows athletes involved in contact sports have a higher risk of developing neurodegenerative diseases such as Dementia, Alzheimer’s, Parkinson’s and Motor Neuron Disease. Furthermore, the consensus panel found potentially distinctive p-tau pathologies unique to individuals with CTE. However, there is still much that needs to be learned about sports related concussion and CTE, as well as the relationship between the two.

Currently, there are too many unanswered questions to support a definitive link between sports related concussion and CTE. Further research including longitudinal studies are needed to develop and evaluate blood biomarkers and imaging to help identify, diagnose and monitor sports related concussion and CTE, as well as determining what histopathological findings are specific to CTE, is CTE a specific disease entity or is it related to other neurodegenerative diseases like Alzheimer’s disease and is there a dose-effect, ie. a number or size of head impacts that are required before neurodegenerative change occurs.

The next time a headline splashes across the news linking contact sports to long term neurodegenerative changes in the brain, it is important that we take a step back for a moment and appreciate that our awareness and ability to identify those who have had a suspected sport related concussion has improved greatly, with immediate removal from play, and no return to play on the same day rules in place; sport governing bodies are continuously evolving rules to protect the heads of athletes; although more work needs to be done in junior sport, awareness among the community is improving. Additionally, we need to be look at ways we can encourage people to participate in sports safely, as opposed to frightening people off sport, with evidence supporting longer life expectancies in elite athletes including those in team sports. As we can continue to advance how we protect our athletes’ heads, we further mitigate the risk of any longer term changes that may occur in the brain.

With thanks to Dr. Jon Patricios

If you are suffering post-concussion symptoms or have suffered a whiplash injury Melbourne city chiropractor Dr. Shannon at the Shannon Clinic Melbourne Chiropractic and Sports Care is well placed to assess whether your upper cervical spine may be playing a role in your symptoms. If you would like to read more about neck pain our blog post has some insightful information. You can book below and will find our Collins Street practice in the Melbourne CBD is easily accessible by trains, trams and car.

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Shannon Clinic – Melbourne Chiropractic and Sports Care Blog

We are often asked by patients which exercise approach is best for them, should it be a high intensity approach either through their own training or part of a group or lower pace longer workouts. The Shannon Clinic Melbourne Chiropractic and Sports Care is here to educate you on what the literature tells us about high intensity interval training (HIIT) and moderate continuous training (MCT) so you can determine what works best for you.

The Benefits of Exercise

There is a wealth of research available today showing the benefits of exercise on health resulting in a raft improvements including;

  • Improved sleep
  • Improved bone health
  • Improved quality of life

The current physical activity guidelines for good health recommend at a minimum 150 mins per week of moderate to vigorous exercise or 75 mins per week of vigorous exercise. The question then becomes what type of exercise is better, high intensity interval training (HIIT) or moderate continuous training (MCT)?

What is HIIT and MCT?

True HIIT is often a variation of what is known as a Wingate test where an individual is asked to go “all out” in a 30 second sprint and then has a 3 to 4 minute slow recovery before going all out again for 30 seconds. This is usually repeated 4 to 6 times. During the “all out” sprint the individual needs to keep their heart rate (HR) above 85% of their maximum. This entire workout might take 12 to 15 minutes to complete and is performed 2 to 3 times per week.

MCT involves an individual operating at a lower level of intensity around 60-70% of their maximum heart rate however, they need to continue to exercise for longer, usually around 60 to 90 minutes. An example of this would be to go for a steady ride on a push bike. Unlike HIIT, MCT needs to be undertaken 4 to 5 times per week.

Purely on face value there are pros and cons to both; HIIT although very time efficient can be very unpleasant for those who don’t like working at such high intensities. Whereas MCT is more comfortable in terms of the effort required however, it is more time consuming.

What Are the Benefits of HIIT and MCT?

Overall the consistent findings within the literature indicate HIIT is as good and probably superior to MCT in terms of improving cardiovascular fitness, especially V02max in a variety of cohorts including young athletes, adults, obese and diabetic individuals. For body composition, reduction in blood lipids (fats) and % of body fat, HIIT and MCT achieve similar results. In respect to weight loss, exercise is important however, diet is the key to long term sustainable weight loss. For long term glucose metabolism MCT appears superior to HIIT.

What Exercise is Right for You?

On the face of the findings it could be argued that MCT is as effective overall as HIIT, therefore we should all be training at moderate intensities for longer; however, time is a factor that is omitted in this argument. Similar health benefits can be achieved through HIIT to MCT in a fraction of the time. This means for athletes they can focus more on sports specific skills training, while for those who are busy or do not enjoy exercising can still gain meaningful health benefits without needing to dedicate hours a week exercising.

The important message to take away is that neither HIIT nor MCT are vastly superior to the other; both provide meaningful health benefits in terms of body composition, cardiovascular fitness, blood lipids, glucose metabolism. At the end of the day, it is about making sure you find an exercise approach that works for you which allows you to achieve at least 150 mins of moderate to vigorous exercise or 75 mins of vigorous exercise per week of to improve you overall health and life expectancy. This is something melbourne sports chiropractor Dr. Shannon advocates and discusses with all of his patients. It is also an area that alarmingly too many people fall well below this mark and often are not doing any exercise at all.

For more sports and exercise medicine related information from the Shannon Clinic head over here to our blogs.

If you are interested in ways to improve your athletic performance we highly recommend having a read of our blog on NMN supplementation, as well as mental imagery. To book an appointment to see our melbourne city chiropractor or massage therapist you can below Our sports chiropractic clinic is located on Collins Street in the Melbourne CBD and is easily accessible by trams on Collins Street, Swanston Street, Bourke Street and Elizabeth Street, by train via Flinders Street Station and parking at Federation Square.

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Shannon Clinic – Melbourne Chiropractic and Sports Care Blog

The COVID-19 pandemic created global disruption, uncertainty and with many countries enforced society into lockdowns, which made physical activity and exercise more onerous and challenging. However, one of the few exceptions to the lockdown rules was exercise, so Melbourne city chiropractor Dr. Shannon examines the evidence on exercise and immune function.

Does Acute Bouts of Intense Exercise Help or Hinder Immunity?

It is well known that regular bouts of exercise lasting up to 45 minutes of moderate to vigorous exercise is beneficial for immune defence, particularly in older adults and those with chronic diseases. This type of exercise is beneficial for the normal functioning of the immune system and is likely to help lower the risk of respiratory infections/illnesses. However, there is debate within the scientific community whether acute bouts of vigorous intensity exercise leads to a period of immune suppression post exercise.

There has been a long held concept in exercise immunology developed in the 1980s and 1990s called the “open window” hypothesis which proposes a J curve relationship between exercise intensity and infection risk. Which is supported by the belief that athletes who engage in high volume endurance training experience a greater incidence of Upper Respiratory Tract Infections (URTI) compared to those who are less active. Until recently this concept has remained relatively unchallenged.

The “open window” Hypothesis

The “open window” hypothesis suggests that following a prolonged (>1.5hr) and vigorous acute bout of exercise or following chronic intense training (>1.5hr on most days) there is an “open window” which results in an increased risk of opportunistic infections such as URTI’s. The three principles underpinning this concept are:

1). Infection risk increases after prolonged vigorous aerobic exercise

2). Acute bouts of vigorous exercise can lead to temporary reductions in salivary immunoglobulins resulting in higher risk of opportunistic infections

3). A period of post exercise reduction in peripheral blood immune cells resulting in a period of immune suppression.

J Curve – relationship between the risk of infection and level of exercise intensity

Is The “open window” Hypothesis Still Relevant Today?

Recently though there has been emerging evidence suggesting this concept may be outdated. There is evidence, albeit small that indicates international athletes suffer from less URTI than national athletes. This raises the likelihood that infection susceptibility is more likely multifactorial including genetics, sleep, stress, nutrition, travel, circadian misalignment and increased exposure risks due to close proximity of crowds rather than being directly attributed to acute or chronic bouts of vigorous training. This also indicates that international athletes are potentially better supported, have access to better education helping them to improve their life-style behaviours over national athletes resulting in lower risks of infection.

Secondary to this, evidence supports the opposite of the three principles upholding the “open window” concept. With no changes seen in mucosal immunity which has previously been flagged as an indication of immune suppression. The reduction in blood immune cells (primarily lymphocytes) 1 to 2 hours post exercise reflects a transient and time dependent redistribution of immune cells to peripheral tissues resulting in a heighten state of immune surveillance and regulation leading to enhanced antibacterial and antiviral immunity, not suppression of the immune system.

Moderate to Vigorous Exercise Is Beneficial for Immunity

Further research is needed to confirm or refute the “open window” concept however, it currently appears that the infection risk post vigorous exercise is more likely to be associated with a multitude of other factors rather than purely post exercise immune suppression. So for athletes and non-athletes the message remain the same, regular moderate to vigorous exercise is beneficial to enhance immune function to reduce the risk of bacterial and viral infections including URTI’s. And remember that good hygiene practices (washing hands regularly, not touching your face), physical distancing, getting good quality sleep, reducing stress levels and eating healthy wholefoods are the keys keeping your immune system in peak condition. To read more on the importance of sleep you can find the Shannon Clinic Melbourne Chiropractic and Sports Care blog on sleep and performance here.

As a Melbourne city sports chiropractor Dr. Shannon advocates to all his patients the important of regularly exercise and utilizes exercise therapy with all patients. To work out what exercise is best, moderate continuouse or high intensity interval training check out our blog. If you are looking for an active way to rehabilitate your musculoskeletal injury book an appointment today at our Melbourne CBD chiropractic clinic on Collins Street in the Manchester Unity building opposite the Melbourne Town Hall and City Square.

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Shannon Clinic – Melbourne Chiropractic and Sports Care Blog

Pain is a complex subjective, sensory and emotional experience occurring as a result of damage or potential damage to tissue (skin, ligaments, muscles, bones). Pain is most commonly caused by a specific injury however, in some cases an injury mechanism is absent.

Types of Pain (Simplified)

There are three different types of generalised pain:

Nociceptive Pain

Nociceptive pain occurs when there is damage to a tissue (like burning your finger). This pain can be local or it can be referred (ie. the pain is felt away from where the tissue is damaged). An example of referred pain is, “sciatic” leg pain which is associated with tissue damage in the lower back.

Neurogenic Pain

Neurogenic pain occurs when the nerves behave abnormally by conducting nociceptive pain where there is no apparent tissue damage or pain source.

Psychogenic Pain

Psychogenic pain arises from the mind (such as the memory of a bad past experience).

Nociceptive Pain (Peripheral Pain)

Nociceptors are sensors found in the body which detect the possible threat of injury or actual injury to tissues such as bone, ligaments, skin etc. They then relay this information to the central nervous system (CNS) – spinal cord.

There are two types of nociceptive fibers, C fibers and A delta fibers which respond to different sorts of pain stimulation.

  • A delta fibers carry signals from the body’s periphery (such as the fingers or feet) back to the CNS very quickly and are responsible for the acute pain experienced when a tissue has been injured.
  • C fibers carry signals more slowly from the periphery to the CNS and are responsible for sub-acute/chronic pain.

Sensitisation

When a tissue has been injured, the nociceptive fibers become sensitised. As a result, the nociceptives threshold for activation and subsequently sending pain signals back to the CNS is much lower. For example, following a bump on the head a light touch to the injured area will be painful. In the case of chronic pain, abnormal sensitisation of nociceptors contributes to why pain is easily triggered, why the pain is often disproportionate to the trigger and why pain is felt long after the initial injury stimulus has gone.

Spinal Cord and Brain Involvement

The information carried by the A delta and C fibers is then transmitted back into the CNS where it is processed in a part of the spinal cord called the “dorsal horn”. The dorsal then determines whether the information needs to be relayed up the CNS to a higher brain centre for processing and response. Or, it may determine the response can occur locally from the dorsal horn, called a “spinal reflex response”. An example of this would be the inflammatory reponse following an injury involving muscle spasm and increased blood flow.

Managing Pain

Non-pharmaceutical Interventions

Chiropractic adjustments are postulated to manage spinal pain by affecting the higher brain centre, the nocipetive fibers in the periphery of your body and through the spinal cord reflex response.

Acupuncture or dry needling is another treatment intervention for managing pain. Needling affects pain at the periphery by desensitizing the nociceptive fibers so they are not stimulated as easily, while also triggering a local muscle relaxation response.

Exercise therapy and physical activity is another intervention that is beneficial in the management of pain, including pain associated with musculoskeletal conditions like osteoarthritis and low back pain.

These are all interventions Melbourne city chiropractor Dr. Shannon utilizes at The Shannon Clinic Melbourne Chiropractic and Sports Care use as a part of our holistic approach to patient care.

Read more about Melbourne sports chiropractor Dr Nicholas Shannon. [Click through to About the Shannon Clinic page]

Pharmaceutical Interventions

Pain medication (analgesics) such as paracetamol (Panadol), ibuprofen (Nurofen) and diclofenac (Voltaren) work on desensitising the A delta and C fibers and hence reducing pain at the source (in the periphery). Pain medications which are codeine based (Opioids) like Panadeine work by affecting how the body interprets pain in the higher brain centres (centrally, rather than peripherally).

It is important to remember when taking pain medication that long term use of analgesics can have harmful side effects like gastric ulcers, renal disease and cardiovascular disease. In addition to this there is strong evidence indicating paracetamol and NSAID’s are ineffective in the treatment of low back pain.

If you are interested to learn more about the different types of regional pain such as the common causes of neck pain or hip pain, you should find our blog on these topics of interest. If you would like to make an appointment to see Melbourne city chiropractor Dr. Nicholas Shannon or remedial massage therapist Paula Espinoza you can book below. Our Melbourne city chiropractic clinic is located on Collins Street in the Melbourne CBD, with easy access via trains at Flinders Street Station, trams via Collins, Swanston, Bourke and Elizabeth Streets and parking at Federation Square.

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Shannon Clinic – Melbourne Chiropractic and Sports Care Blog

The Benefits of HIT/HIIT Training

Exercise and physical activity are extremely important for our overall health and wellbeing. With evidence showing physical activity improves; quality of life, sleep, cognition, physical function, insulin sensitivity, while reducing the risks of; clinical depression, dementia, a raft of cancers and chronic preventable diseases, as well as anxiety, blood pressure, weight gain and falls. You can read more about the benefits of physical activity in Melbourne city chiropractor Dr. Shannon’s article on Exercise Medicine.

The current recommendations for physical activity are for 150 minutess per week of moderate to vigorous exercise, this means exercising to an intensity where it is still possible to maintain a conversation but with difficulty. High intensity (with/without intervals) training is a great way of efficiently reaching that 150 minutes per week mark with a host of added benefits.

High Intensity Training (HIT) / High Intensity Interval Training (HIIT)

HIIT refers to exercise that occurs in frequent short burst or “sprints” of high intensity exercise, with recovery periods. The sprints can last from 30 seconds to 4 minutes, with recovery periods lasting anywhere from 1 to 4 minutes and repeated sprints of 2 to 6 cycles per session. For true HIIT to be achieved, heart rate (HR) needs to reach 85-90%+ of max HR during the sprint effort. This is the key difference with moderate continuous training (MCT) where HR will only reach 60-70% of max HR.

Why HIT/HIIT?

In healthy individuals HIT/HIIT programs have been clearly shown enhanced exercise capacity, muscle strength and muscle oxidation compared to MCT. It may also improve cardiovascular fitness and function, as well as anxiety and depression severity. It has been associated with improvements in these same variable in individuals with cardiovascular disease, spinal arthritis and multiple sclerosis, in addition to reducing the disability associated with these diseases.

In obese and overweight individuals it is as effective in the short-term as MCT at modest reductions in body fat and waist circumference, which suggests it may be a more time efficient way to exercise. Additionally there is also evidence showing it is well tolerated and has greater improvements in disability and exercise capacity in individuals with nonspecific low back pain when compared to MCT.

What Type of HIT/HIIT Program?

One of the appealing features of HIIT programs are how time efficient they are, especially when compared to MCT. In addition to this, HIIT programs appear to result in similar or greater endurance performances and VO2max (a measure of fitness) when compared to MCT.

Cardiovascular protocols utilizing short intervals (30 seconds or less), for 5 minutes or less, performed 4 or fewer times per week will assist in developing VO2max in the general population. However, the greatest improvements come from longer sprint intervals (2 minutes or longer), higher volume (15 minutes or longer) over a longer duration (4-12 weeks). Resistance training HIT protocols are typically defined as more than 70-80% of a 1 repetition maximum, performed at a maximum of 1 set of 12 repetitions.

Finally, for anyone considering a HIIT program it is important to note that even though HIIT appears to be safe for most individuals, consulting a health/medical practitioner to determine if a HIIT program is safe for you is extremely important before you start any HIIT program.

To book an appointment with Melbourne city sports chiropractor Dr. Shannon or remedial massage therapist Paula Pena you can book below. You will find our Melbourne chiropractic clinic located on Collins Street in the Melbourne CBD opposite the Melbourne Town Hall.

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Shannon Clinic – Melbourne Chiropractic and Sports Care Blog

When people talk about the keys to living a healthy life and performing at your best, exercise and diet are always front and centre. Rightly so, as exercising at least 150 mins per week at moderate to vigorous intensity and eating a well-balanced diet rich in green leafy vegetables, fruits, grains and seafood and low in red meats and saturated fats are essential for longevity and a healthy life. But there is a third pillar that is regularly overlooked that is just as important as diet and exercise and that is sleep. In this blog Melbourne city chiropractor Dr. Shannon discusses the importance of sleep on athletic performance.

Sleep Deprivation

Sleep deprivation can be due to sleep disorders like insomnia and sleep apnoea. These disorders are often associated with symptoms such as difficulty falling asleep or maintaining sleep and require further clinical investigation. However, most sleep deprivation occurs due to poor sleep quality and duration. The average adult requires 7-9h of sleep per night yet those with sleep deprivation will get less than 5-6h of sleep per night. Some people pride themselves on their ability to work with very little sleep yet sleep deprivation has been shown to affect human (and athletic) performance in a myriad of ways including:

  • Impaired cognition effecting decision-making, judgment, mood, and reaction times
  • Metabolic disruption including diabetes and obesity
  • Weight gain to due craving more unhealthy and high carbohydrate foods and in larger portions
  • Immunological resulting in increased proinflammatory cytokines which impair immune function and impede muscle recovery and repair from damage
  • Cardiovascular dysfunction
  • An increased risk of injury

There is also a dose-dependent relationship between sleep and performance; the greater the sleep loss the greater the performance loss, with performance loss occurring with as little as 2-4h of sleep loss. And for those who believe they are able to recoup the sleep they lose during the week on the weekends, the evidence says the contrary.

Improving Sleep Quality and Duration

The two sleep interventions that have received most research are sleep extension and sleep hygiene. Sleep extension and napping involves extra sleeping time to make sure the 7-9h daily limit is being met; this is especially useful when one knows they have a day of potential sleep deficit ahead. Sleep extension might involve going to sleep earlier or utilization day time naps that are more than 20 mins but less than 60 minutes and occur before 3pm. Sleep hygiene helps to improve sleep quality and duration and essentially involves a healthy sleep routine such as:

  • Don’t go to bed if you aren’t sleepy
  • Rise at the same time every morning, including on the weekends
  • The bed is for sleeping only, don’t watch TV or use electronic devices in bed
  • Avoid caffeine after lunch
  • Avoid alcohol, especially before bed
  • Avoid high intensity interval training before bed
  • Try to create a dark, quiet and cool space to sleep (ambient temperature is 19+/-2 degrees)

Improvements in sleep extension can lead to improved skill specific execution in sports, improved cognition including reaction times. mood, alertness and vigor. While improved sleep hygiene results in less fatigue and sleepiness.

Final Thoughts on Sleep and Performance

Whether the goal is optimizing performance at work, in sport or about doing all you can to live a healthy life, sleep needs to be given as much attention as diet and exercise. By improving the quality and duration of sleep through better sleep hygiene and sleep extension one will yield benefits such as, reducing the risks of preventable disease like diabetes, obesity, cardiovascular disease, improved judgment and decision-making and optimized athletic performance and recovery.

If you are looking for other blogs on ways to improve performance check out Melbourne city chiropractor Dr. Shannon’s blog on how to improve your athletic performance in just 15 minutes with mental imagery or on the promising results seen with NMN supplementation in middle and older aged adults. To make an appointment with Melbourne city sports chiropractor Dr. Shannon or remedials massage therapist Paula Pena you can book below. Our Melbourne CBD chiropractic clinic is located on Collins Street, opposite the Melbourne Town Hall.

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