SMI Newsletter — March, 2014

Healthy Start 2014

Olympic Inspiration 

Greetings from SMI,
We’ve recently had a number of clients come into SMI saying they “over did it” in the mountains after watching Julia Mancuso or Bode Miller carve the slopes at Sochi.  While it is great to find motivation and inspiration from watching our Olympic heroes, it is important to remember one’s individual limits and long term goals. An SMI client recently said “once you hit 40, the objective is to put yourself in a position to still be active and working out in your 70’s and 80’s!”  While we do treat a number of Olympians and Olympic hopefuls, we see even more clients who simply want to continue doing the activities they love for as long as possible. Keep that in mind as you hit the slopes, the track, the golf course or whatever your favorite activity may be.
So stay active and stay healthy. And if you need some help along the way, let us know.  That is what we are here for!

~The SMI Team   


SMI in San Francisco!

Just a reminder that SMI therapist Eva Popper is now working in San Francisco a few days a month! She is working in the Alamo Square district at 425 Divisadero St,Suite 209. You can schedule by calling the Palo Alto office at 650­-322­-2809.

Acupuncture — Dry Needling, What is it?


Dry Needling, What is it?   

We’ve recently received a number of inquires about “Dry Needling” and whether or not this is a service SMI offers. The short answer is YES.

Dry needling developed as a derivation of Trigger Point Injection’s (TPI’s) were pioneered by doctors Janet Travell and David Simons as a way to treat Trigger Points (TrP’s). A trigger point is defined as “a hyperirritable spot in skeletal muscle that is associated with a palpable nodule in a taut band of muscle fiber.”[1] Trigger points can result in a decrease in flexibility, a decrease in strength and pain both locally and referred to other areas. As many of you know, treating TrP’s is one of the things that we specialize in here at SMI. Some of you are intimately familiar with the pain caused by an SMI therapist pressing down with a thumb or elbow into a knotted band of tight muscle tissue. The manual therapy techniques practiced at SMI are often times very effective for treating TrP’s. TPI’s, including dry needling, are another effective form of treatment.

Originally, Trigger Point Injection’s were performed by injecting a substance such as saline, lidocaine, cortisone or botox via a hypodermic syringe directly into a painful trigger point. Dry needling was a derivation of a TPI where a syringe would be inserted into a trigger point but nothing would actually be injected. Eventually, acupuncture needles began to be substituted for the syringe altogether.

We have discovered that sometimes people respond better to manual therapy and sometimes they respond better to alternate methods such as TPI’s. When a client is hypersensitive, in a more acute state or the trigger point is particularly stubborn, TPI’s can be very effective.

It turns out, 92% of the 255 Trigger Points documented by Travell and Simons actually correspond to classical acupuncture points that were identified over 4000 years ago. Pretty fascinating! Acupuncturists are particularly skilled at finding TrP’s. And combining traditional acupuncture techniques with the treatment of TrP’s can offer a very effective treatment protocol. Here at SMI our staff acupuncturist, Colleen Burke, L.Ac., works directly with our orthopedic massage therapists to offer the best possible treatment options.

If you have questions about dry needling, acupuncture or Trigger Points in general please don’t hesitate to contact us!

1. Travell, Janet; Simons David; Simons Lois (1999). Myofascial Pain and Dysfunction:The Trigger Point Manual (2 vol. set, 2nd Ed.). USA: Lippincott 
Williams & Williams. ISBN 0­683­08363­5. 

Nutrition — Just One Thing!


Just One Thing!

All of us have weaknesses for certain foods. Some of us crave sweet things such as chocolate, cookies and ice cream. Others crave savory foods like potato chips, pizza and just plain old bread. Everyone knows these foods are “unhealthy” and yet most of us continue to give in to these cravings just the same. What if I were to tell you that you could continue to eat the things that you crave and love AND be much healthier at the same time. Recent research has found that you can. You do need to make a change, BUT unlike the fad diets and starvation techniques of the past, instead of taking away the foods you love, you simply make one small change, add one thing… VEGETABLES,VEGETABLES and more
Research has shown that adding vegetables to your diet, particularly raw leafy greens and eating lots of those vegetables before the “unhealthy” foods has a profound impact on your overall health. We all know that vegetables are high in nutrients. We also know that if you eat a lot of vegetables you will probably eat less of other foods, but something much more important has recently been discovered. Vegetables can make the rest of your meal healthier by slowing down the digestion rate of the entire meal and therefore significantly increasing your metabolic rate. A faster metabolic rate reduces body weight, body fat, and waist circumference significantly in both the short and long term. Digestion rate is how quickly foods break down in your stomach and intestines. Metabolic rate is the amount of calories you burn throughout the day while at rest. The simple act of slowing down the digestion rate of our meals allows our calories to enter the bloodstream more slowly, giving our lean tissues more time to absorb and use those calories. When our lean tissues absorb and use more calories, fewer calories go to fat, we burn more calories throughout the day, and our metabolic rate is higher. This also means our brain and body are more active, so we think and move with more energy and we become leaner. Protein, fiber, and dietary fats also slow digestion to provide some benefits, but not nearly as much as vegetables do.
On to the research…
In 2011 it was shown that eating vegetables before other carbs leads to dramatically better metabolism (insulin sensitivity) in type 2 diabetics at 6, 12, 18 and 24 months compared to “healthy eating” (a food exchange system which is the standard of care for diabetics) [1]. This is not to say that eating vegetables along with junk food is better than eating vegetables without the the junk. Changing more things has the potential for greater benefits, but that might become overwhelming and therefore lead to less benefit. Change is generally easiest if it is done one step at a time, and if only one step is actually ever needed for the effect you are after, even better.
In 2012 it was shown that it takes about 200 grams of vegetables (8 oz, which is 3 cups of lightly cooked veggies or double that in leafy greens) to significantly raise metabolic rate in diabetics [2]. If the vegetables were green then there was also a drop in body weight, body fat, and waist circumference. The more vegetables are cooked, the softer they become and the impact on metabolic rate diminishes.
In 2013 it was shown that having the vegetables 10 min before the carb resulted in dramatically slower meal digestion than when the vegetables were eaten 10 min after the carb [3]. This means having a lot of vegetables won’t help you slow digestion very much if you have already digested much of your meal before you eat them. Presumably eating vegetables together WITH the rest of your meal would be as helpful as eating them right before the meal, since either way the vegetables are in your stomach with the rest of the food, but this has not yet been tested.
Although adding a lot of vegetables to your diet might be challenging for a variety of reasons, it can be incredibly comforting to know that you can keep eating all the things you love and actually make physiological, medical, and quality­ of ­life headway without ever going on a diet. In fact, the effects are profoundly stronger than if you had gone on a diet. The only thing you have to focus on, and make sure it happens every day, is vegetables.
1. “A simple meal plan of ‘eating vegetables before carbohydrate’ was more effective for achieving glycemic control than an exchange-based meal plan in Japanese patients with type 2 diabetes” by S Imai et al., Asia Pac J Clin Nutr 20 2011 161
2. “Effects of total and green vegetable intakes on glycated hemoglobin A1c and triglycerides in elderly patients with type 2 diabetes mellitus” by K Takahashi et al., Geriatr Gerontol 12 2012 50
3. “Eating vegetables before carbohydrates improves postprandial glucose excursions” by S Imai et al., Diabet Med 30 2013 370
4. “Postchallenge Glucose, A1C, and Fasting Glucose as Predictors of Type 2 Diabetes and Cardiovascular Disease” by H Cederberg et al., Diabetes Care 33 2010 2077

Active Release Technique — ART and injury

ART and injury

 Many “injuries” can be classified as cumulative or repetitive stress injuries. Many of our daily activities involve repetitive motions, whether it is working at a computer, running, or playing tennis. These activities by themselves are usually not problematic. However, when combined with poor posture, previous injury, or asymmetry in movement, the repetitive motion can lead to microtrauma in the tissue causing pain and/or limited range of motion. The defining line between pain, tightness, and more serious injury can be difficult. But being aware of problematic areas and/or changes in how we are feeling can be very useful in preventing further injury/pain. ART can be used to manage both the daily wear and tear on our body as well as treating injury when it becomes symptomatic. 

For example, a common injury in runners is pain on the outside of the knee, or Iliotibial band (ITB) pain. People will often complain of a sharp onset of pain during a run followed by prolonged soreness. Stairs and walking downhill can aggravate the symptoms. After evaluation, treatment consists of various massage techniques including ART to the tissue surrounding the iliotibial band from the hip to the knee and sometimes the lower leg. This breaks up the adhesions between muscles and other soft tissue while increasing range of motion and reducing/eliminating pain. Additionally, at-home exercises are prescribed to address stability, strength and/or flexibility problems that may have contributed to the injury.


How does ART work?

Active Release Technique is a unique massage technique that involves movement. Although the treatment can at times be painful, it is less about depth of treatment and more about specificity and motion. When tissue is injured or damaged, the body lays down scar tissue or adhesions which are shorter than normal, healthy tissue. This can lead to limited range of motion and pain. ART is used to “release” this scar tissue, lengthening the restricted tissue, and improving the overall movement.

ART is effective in treating traumatic injuries such as a sprained ankle or a strained hamstring and in repetitive use injuries such as low back pain, Achilles tendinopathy, iliotibial band (ITB) syndrome or carpal tunnel. Regardless of the cause of the injury, ART is most effective when combined with a home treatment routine including stretching and strengthening exercises.


Can ART help prevent injury? 

While many people seek ART providers to treat specific injury, it can also be used as a preventative treatment tool to maintain elasticity and range of motion. Often, athletes and active individuals use ART to manage the regular stress to the tissue and help prevent injuries from starting. Someone who truly understands the importance of ART is Krys Kolanos. Playing in the NHL, he has struggled with a number of injuries. Using ART, Krys has learned how to optimize recovery in between games so he isn’t limited by tension/pain and can play his best.


“ART has been a key avenue for keeping my body in an ideal performing state in the NHL. It’s effective in priming my body to move properly right before and during my skating and training sessions. It’s also effective after training and on “off” days to maintain the proper tone in muscles and balance throughout my body. ART is an intricate part of my daily routine. For every hour of training or skating, I make a goal of doing 20 minutes of bodywork including ART. Needless to say, I spend a lot of time doing ART. Using this modality has given me a great edge in my daily performance. The more I have ART done on my body it learns and remembers and is more responsive and inclined to get to the ideal state quicker. I’m a huge advocate of ART for any athlete and making it a part of his/her lifestyle.” Krys Kolanos

If you have questions regarding Active Release Technique, you can email:




or call our office at 650-322-2809.   

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