Archive for May, 2008


Where is it written? How does it work? What is IMT (Integrative Manual Therapy)?

May 26, 2008

Some interesting questions come up when we use Integrative Manual Therapy to help our patients.  Most times people just want to get rid of their pain and get on with their life; doing the things they had been unable to do or were limited in doing, due to pain and other limitations.  But, at times, patients want to know how Integrative Manual Therapy (IMT) works, and if it is scientific.

When observing an IMT session or having one yourself, the practitioner usually places his or her hands lightly on the client and leaves them in one place for a while, a few seconds or up to a few minutes.  To most people it looks like nothing much is happening.  What could possibly be the benefit of something so light and seemingly innocuous. This is understandable when most times, when someone thinks of bodywork, hard massage, chiropractic adjustments or some other form of deep hands on work comes to mind.

To fully understand what is happening and the science and the theory of what is happening and why it works, one would have to be familiar with scientific findings and principles found in cell biology, cell transport (membrane wall integrity), biochemistry, epigenetics (cell membrane work and DNA), quantum physics and psychoneuroimmunology; even the study of fractals and frequencies (tensegrity) and architecture would be useful . So for the truly inquisitive, study in these areas would be the place to look for answers.  But, I will give some basics.  Before I begin though let me start with a quote from Arthur Clarke, who recently passed this March 2008.  Arthur Clarke was the author of 2001 A Space Odyssey.

His quote:

Any sufficiently advanced technology is indistinguishable from magic.
Arthur C. Clarke, “Profiles of The Future”, 1961 (Clarke’s third law)
English physicist & science fiction author (1917 – 2008 )
I bring up this quote so that if you find what I am about to write impossible think about it and see if you can open up your mind to the possibilities.  First off let’s remember that in our school physics classes, we learned that everything and every body is composed of atoms and the atoms are composed of little sub atomic particles (neutrons, protons and electrons) but what is the atom mostly comprised of?  Space, lots of space.  In fact almost all of the atom is space and an impossibly small part of any atom is the actual matter.  And from a physics point of view even the physical matter, the protons and neutrons are really more like information rather than a physical thing.  So most everything in the physical universe including us is comprised of space and some packets of information.  Another principle in physics is that the observer matters.  What this means is that one cannot look at a sub atomic particle without changing it.  By merely looking at it, you change it.
And depending on how you look at it and what you are looking for will change what you see.  For example if you study sub atomic particles and you look for them as wave forms, you will find wave forms and if you look for solid particles you will find them as solid particles.  You are basically sending information out to them and they are responding to that ‘intention’ and presenting themselves as either particles or wave forms.
Now if we change gears and look at this phenomena from another science, Epigenetics, we see how it looks to a bigger organism like a living cell.  In his book “The Biology of Belief” Bruce Lipton, PhD discusses some of these findings.  In experiments, researches have found that the cell membrane is more a “brain” to the cell than the DNA.  A cell will survive for some time without DNA but without a cell membrane in dies quickly.  The DNA is the machinery to make proteins and what the cell needs to live but the cell membrane is what tells the DNA which protein to make; or how to express itself.  And how does the cell membrane decide which part of the DNA to activate?  It does it depending on what is in the environment and how it perceives the substance; is it toxic or food?  In the field of epigenetics and quantum physics, researches have even been able to show that the cell membrane is looking at information from the environment.  And they have been able to show that even thoughts and emotions are information to a cell; and depending what the cell membrane comes in contact with will determine what happens even on a DNA level.  How the DNA is expressed is determined by what is in the environment and whether the cell perceives it as toxic or useful.
Now in the study of tensegrity and fractals/frequencies we find that most of nature is set up on angles of 60 and 120 degrees; like geodesic dome or a spider web.  It is much stronger than something built at right angles and interestingly enough a small pressure on one part of a spider web or a geodesic dome will impart a force on all parts of the structure.
So let’s combine these sciences.  By treating the body like an information processing organism or structure we can impart an intention; some information to a specific part; a light touch with information and because of the tensgrity principle, the force will be transmitted to the cells and the cell membrane can take this information and process it.
In the study of the Collective Unconscious, which is in the field of quantum physics, as well as philosophy and spiritual traditions, one finds the theory that all is connected.  That because we are all mostly space and packets of information, we are all connected to past, present, future and to each other and every living and non-living organism.  In this way, we already know the answers to many of the questions.  Some of the questions we would be talking about in this article would be why is someone in pain; why is someone not healing for 5, 10, 20 years or more; what does it mean?; what is the story?  In a book called “The Art of Dowsing” Richard Webster writes about the sticks some people use to find water.  He states that it is not like the sticks move themselves; I paraphrase his work; but the important thing to know is that these water dowsers’ hands move little bits and direct them to the water.  The hands do so because on some level the person already knows the answer.  Is this the collective unconscious directing the water dowser?  When we search for the reasons someone is not healing and do this light touch hands on diagnostics and treatment are we tapping into the collective unconscious; an intelligence we don’t yet fully understand.  This could be part of the reason IMT and other subtle light touch therapies work.
This is basically and very simplistically how a light touch method like IMT can have huge effects and help a body change it’s condition.  If you treat the body like a mechanical bag of bones and muscles, it will behave as such; if however you look at the body as a complex information processing organism connected to space and time in an exceedingly complex and elegant system of consciousness and you interface with it as such, quantum effects are possible.
Ralph Havens, PT, OCS, IMTC

A Safer Alternative to NSAIDs (non-steroidal anti-inflammatory drugs)

May 23, 2008

by: Sally Skurdahl, MPT

Most people have heard the term “inflammation” and associate this phenomenon with pain and injury. Inflammation is the human body’s reaction to injury or infection. This involves an influx of chemicals/ specific cells to the area which in turn may be reflected by swelling, redness, warmth, and /or pain or in some cases only pain may be felt with no visible changes. Failure to completely resolve an acute inflammatory response can lead to chronic inflammation, scarring, and
eventual loss of tissue function.

So what do we do to combat inflammation? One of the most common remedies is oral NSAIDs (non-steroidal anti-inflammatory drugs) which can be purchased over-the-counter. Common name brand versions are Advil, Aleve, Motrin, and Bayer. Unfortunately this group of anti-inflammatory drugs is commonly associated with gastro-intestinal distress, nausea, and even bleeding in the stomach.

Many of my patients choose to avoid medications all together or suffer from the unpleasant side effects of NSAIDs and are looking for a safer, more natural way to fight inflammation and therefore pain. One option is supplementing their diet with Omega 3 fatty acids. The past 10 years+ have provided ample research evidence of Omega-3’s anti-inflammatory properties. It is now known that resolvins and lipoxins derived from Omega 3 and 6 fatty acids, -are active anti-inflammatory and proresolution mediators, acting in part by reducing neutrophil entry to the inflammation site and stimulating the uptake of apoptotic polymorphonuclear leukocytes by macrophages.
Two examples of such research include the following:
1) A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain; Pain. 2007 May;129(1-2):210-23
The results suggest that omega-3 PUFAs are an attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.
2) Omega-3 fatty acids (fish oil) as an anti-inflammatory; an alternative to non-steroidal anti-inflammatory drugs for discogenic pain; Surg Neurol, 2006; 65(4)

Fish Oil, Omega-3 Fatty OilJoints
The results that suggested the safety and effectiveness of omega-3 fatty acids in the treatment of non-surgical neck or back pain. Over half (60%) of the subjects reported an overall improvement in their pain and 59% reported discontinuing their NSAID with 80% continuing the fish oil supplementation beyond the study. Average dose for subjects was 1,200 mg/day.

In summary, there are safe and effective alternatives to NSAIDs out there and Omega-3 fatty acid (fish oil) supplementation has been shown in research to be useful to decrease pain and inflammation without side effects. It is recommended that the fish oil supplement be “purity guaranteed” and from a reputable company examples: Metagenics, Pharmax, or Biogenesis.
*Be sure to consult your physician first!

P.S. Healthiness Grows Happiness!


Living a Detox Lifestyle *Part II* Guide to Organic Produce

May 9, 2008

Veggies and Fruits that are Highest in Pesticides

  • Apples
  • Bell Peppers
  • Celery
  • Cherries
  • Grapes (imported)
  • Nectarines
  • Peaches
  • Pears
  • Potatoes
  • Red Raspberries
  • Spinach
  • Strawberries
  • Fruits and Veggies that are Lowest in Pesticides.
    If organic varieties are not available, these fresh fruits and vegetables consistently have the lowest levels of pesticides. These are the safest choices for conventionally grown produce.

  • Asparagus
  • Avocado
  • Bananas
  • Broccoli
  • Cauliflower
  • Corn (sweet)
  • Kiwi
  • Mangos
  • Onions
  • Papaya
  • Pineapple
  • Peas (sweet)
  • h1

    Common Causes of Knee Pain ? and an Integrative Manual Therapy viewpoint on Knee Pain.

    May 7, 2008

    With a diagnosis of knee pain there are many things to consider. I?m going to go over some of the more basic things first and expand from there to a more detailed and whole-body assessment in looking at the knee.

    One of the basic ideas in physical therapy in general and Integrative Manual Therapy in particular is that the knee is usually the ?victim.? It is not usually the actual cause of the problem, but merely the area that took the big hit or injury. Even in a traumatic injury, the knee is rarely the primary problem, but instead is the location of the patient?s pain. The reason the knee expresses the pain is that it takes so much of the stress, being at the end of two long levers, the thigh bone and the lower leg bone. Forces are accentuated where they meet, and in this case they meet at the knee.

    How does this translate clinically? Say someone comes in with a recent onset of knee pain. Maybe they have started a new exercise routine, or they have been doing some extra walking or standing. Maybe they actually ?blew out? the knee with a traumatic sporting injury. Maybe they have no idea how it started, but they have a few-month history of knee pain that is not clearing up on its own. When I see this type of patient, I may find tenderness to touch in a tendon or a ligament or along the joint line of the knee. As I have found that knee pain is usually caused by a hip problem and/or a foot problem, I will usually also see one or more of the following: an asymmetry in the pelvis, a lack of motion in the back and hip more on one side than the other, a foot that lacks motion in the ankle, or a foot that has too much motion in subtalar joint pronation (a rolling-in causing a flat foot).

    The problems at the hip, back, and foot are placing undue stress at the knee and making it more vulnerable to injury. The imbalances are also not allowing healing to occur in the knee. These are common findings when looking at a knee patient from an orthopedic physical therapy model. The forces need to be balanced above and below the knee to allow good mobility and stability at the knee. Specifically, treatment to correct the imbalances at the knee and allow healing of the tendon, ligament, or joint of the knee would involve balancing the pelvis, hip, and foot through manual therapy, exercises, and orthotics.

    From a more whole-body, Integrative Manual Therapy approach, we can take this idea of balanced forces a step further and find ways to help even the more chronic problems at the knee. Say someone comes in with a knee pain that has been problematic for 10 years or more. We have seen patients with long standing problems, who have findings on an MRI of degenerative problems, patients who have been un-helped with standard good quality physical therapy, orthotics, and anti-inflammatory medications. We?ve been able to help these people by looking further into the cause of the problem, the ?why? of the injury. Why would a person?s body keep a pain or problem for 10 or more years, despite resting it and despite good treatment?

    What I?ve found is that, especially in difficult or chronic cases, the body is protecting something very important, and this is why the knee is not healing. Let me give a brief explanation. In standard physical therapy treatments, we look at muscles, connective tissue like ligaments and tendons, joints, and even nerves. We look at strength and flexibility. But there is so much more in the body. There are organs, lymph vessels, veins, and arteries. There are also toxins affecting the body. The body will use ?less important? structures like muscles, ligaments, tendons, and even joints to protect ?more important? structures like organs or vessels. It will also do the same to protect itself from toxins.

    There are common patterns when you look at the body from this more whole-body approach. If the body has toxins from a leaky gut syndrome, which is very common, the pelvic organs can be affected. The body will then lock down the joints of the pelvis and hip, which in turn affects the way the leg works. If the body has infection and inflammation in arteries, also very common, the body can lock down the spine, pelvis, and legs. If the body has infection and inflammation in the urogenital areas (uterus for women, prostate for men, or bladder for both), the pelvis can lock down, causing more compression in the knee and leg. In all of these cases, the knee will have a hard time healing because of all of these protective restrictions in the spine, pelvis, and legs. The body is more protected from infection and inflammation, but the spine, pelvis, and legs are tight and causing stress on the vulnerable knee.

    In this approach correcting the actual cause of the locked-down pelvis or leg would bring faster and longer-lasting changes. Specific Integrative Manual Therapy techniques to help the body fix up the restrictions in the pelvic organs or vessels can be used to balance the pelvis and legs to allow better mobility and balance. Specific Pilates and pelvic floor exercises can help strengthen and balance the pelvic floor muscles. This is important to retrain the pelvis and allow better function in all activities. A detox diet could be useful to turn things around if toxicity is causing the problem. A gluten-free diet is especially useful for correcting a leaky gut problem affecting the pelvis and knee. Additionally, the gluten molecule is very similar to hyaline cartilage in the knee, and research has shown a direct correlation between eliminating gluten and eliminating the inflammation and pain of both rheumatoid arthritis and osteoarthritis.

    As you can see, there is much to consider when looking at why someone with knee pain, especially chronic knee pain; but there is also so much we can do to help someone with this problem and help them return to walking, running, and living life they?ve been missing.

    Ralph Havens, PT, OCS, IMTC


    Living a Detox Lifestyle *Part I*

    May 5, 2008

    The following suggestions will help you keep your body less toxic:

    Notes on Plastic

    Heating foods in plastic releases harmful chemicals. You should never heat food in plastic…use glass or ceramic instead.

    Skin Brushing

    To aid in lymphatic drainage, use a dry, natural fiber shower brush or loofa to massage your entire body before you shower or bathe. Start at the toes and gently scrub using circular motions toward your heart.

    Clean Water

    Public tap water is often contaminated. Drink and cook with only pure filtered water and consider adding a filter to your shower.


    One of the best ways to increase your metabolic activity is to simply use your body. Daily exercise has innumerable benefits including building lean muscle mass, which helps you burn more calories at rest. Consider jumping on a mini trampoline for 3-5 mins a day to give a boost to your health and vitality. Sweating also releases toxins, consider using sauna at your local gym.

    P.S. Part II of Living a Detox Lifestyle is coming soon! We’d love to hear your suggestions and comments!

    Viva Detox!
    Your friends at Mission Hills Physical Therapy


    Gluten and Inflammation

    May 2, 2008

    Over the 22 years I have been treating people with chronic pain, I have noticed an interesting phenomenon. About 2 years ago I noticed an alarming trend. More and more of our patients were showing signs of gluten sensitivity. Where as in the past some people needed to avoid gluten ( true celiac disease ) long term, and a small percentage of people had to eliminate gluten from their diets for 3 to 6 months while we fixed up their gut through integrative manual therapy; now we were finding that almost all of our clients were showing significant signs of gluten sensitivity. It has come to the point that it is very hard to help chronic pains and other problems if the patient does not eliminate gluten. This is different than even 2 years ago. What has happened? Why are so many of our clients showing this intolerance to gluten? Why do the patients who get off gluten heal; and why do the ones who don’t get off gluten have so many relapses? I think other practitioners must be finding similar things in their patients. Why else would Whole Foods and others have so many gluten free products. The market is paying attention. Others must be telling their patients to get off gluten. Why? What’s going on? Is the world changing? Why is it that to date we personally have over 18,000 scientific references about the links between gluten and diseases, pain and disabilities. Please feel free to ask us and we can get you information on this.

    Here are some of the ideas I have seen from a variety of practitioners. I’ve studied with Integrative Manual Therapy practitioners, Functional Medicine practitioners and others and here are some ideas that I see that account for these findings and phenomena.

    First off gluten in our foods now is not the same as gluten in our food even 10 years ago. It is preserved with formaldehyde a known carcinogen. Gluten has been genetically modified and the most common carrier to move DNA from one organism to another is e. coli bacteria. Gluten has been added to many food items and now it is nearly impossible to eat the standard american diet without getting a significant amount of gluten. So were getting more gluten in our diets than ever before and it is treated with formaldehyde and it’s been modified using e. coli to move DNA around.

    It is know in the field of epigenetics that if you introduce a certain type of toxin to a rat, you will cause the rat to become obese. In this way scientists can study obesity. If these obese rats reproduce they will reproduce rats that are obese. Even the offspring from these rats will be obese and on down the line, the DNA will be expressed in such a way that the rats are all obese.

    Well toxins such as genetically modified, formaldehyde laced gluten has been added to our diets over the years. These toxins could be starting to show a long term effect on us and could be at least part of the reason everyone is showing up in our clinic as intolerant to gluten.

    Also, gluten is inflammatory and inflammation has been linked to most chronic illnesses and pain syndromes.  If you look at the gluten molecule from a biochemistry standpoint what you see is that the gluten molecule is very similar to the cartilage in joints.  So, if someone has an allergic type reaction to gluten or if they have an auto-immune problem they could be making it worse by eating gluten. The body is attacking the gluten but then attacking itself too.  The biochemistry pathways for anti-inflammation are used when the diet is high in alkaline producing foods such as fruits, vegetables and omega 3’s (fish oils) and the pathways for inflammation are used by the body when the diet is high in processed foods and grains, especially gluten.  Inflammation has been linked to most chronic illness including heart disease, diabetes, multiple sclerosis, macular degeneration, systemic lupus, arthritis and many others.

    Clinically what we see is that if we get a patient off gluten 100%, they heal at a predictable rate; they stay well and they can get on with their lives in a painfree way. Clinically what we see is that the clients who take in gluten don’t heal very well; they have significant ups and downs; they don’t have good outcomes.

    Like I said this is different than even 2 years ago. Something is going on. Other practitioners and people must see this. Whole Foods has big gluten free sections now. Something is going on. I think part of the reason is due to the way gluten has been modified and the way we have so much gluten in almost all processed foods.

    If you want a quick read with alot of scientific references, a good source is Shari Lieberman, PhD’s book “The Gluten Connection”. Check it out and let me know what you think. Health care practitioners, let me know what you are finding. We are picking up alot of cecum and iliocecal valve problems with dysbiosis ( leaky gut) which resolves with gluten free diet and Integrative Manual Therapy. Like I said something is going on here; let me know what you are finding.

    Ralph Havens, PT, OCS, IMTC


    The pelvis is connected to everything!

    May 1, 2008

    As a PT I have been finding more and more that almost every patient I treat has some dysfunction in his or her pelvis. Whether the symptom is headaches, back pain, or shoulder pain, I always look at the pelvis and more often than not find that the pelvis is out of alignment. This makes so much sense to me because the pelvis is really the “base” of the body. Everything is connected to it in one way or another. If the pelvis is not lined up, the body must compensate somewhere, and that is often where the symptoms manifest!

    It is pretty amazing the changes I have seen by treating the pelvis first. Huge changes in range of motion all over the body, and often significant pain reduction. I highly recommend to any body worker that you investigate the pelvis first, and to all people having body pain, suggest to your therapist or body worker that they look at your pelvic alignment!

    Signing off _______Danielle Emhof, MPT
    san diego physical therapy, physical therapy san diego, mission hills pt