Autumn News

At SMI, we are constantly striving to make our treatments more effective and more efficient. We have a set of guiding principles that help direct how we approach a particular problem, but we also realize that every client and every problem is unique. Sometimes we need to make changes such as modifying the frequency of appointments, altering the depth of the pressure we use, changing the technique or adjusting a clients’ home routine. We may even recommend working with a different therapist at SMI as all of our therapists have developed their own strengths and specialties.

We continue to improve our treatment approach by regularly reviewing research that is being published in the areas of fitness, rehabilitation, and musculoskeletal injuries. Combining our own experiences as therapists with information provided by peer-reviewed research, we have come up with a solid foundation of guiding principles.

Below, you will find a synopsis of several articles we recently discussed in our SMI staff meetings. We hope you enjoy them. If you have any questions or concerns, please don’t hesitate to contact us!

~ The SMI Team

SMI in San Francisco!

Just a reminder that SMI therapist, Eva Popper, is now working in San Francisco every Wednesday in addition to a few Sundays per month. She is located in the Alamo Square district at: 425 Divisadero Street Suite 209. You can schedule by calling the Palo Alto office at 650­-322­-2809.

Keep On Rolling


One of the things we have pioneered at SMI is the use of the foam roller for self massage. For over 17 years we have encouraged all of our clients to make foam rolling part of their regular daily stretching routine. Anecdotally, there has been a tremendous amount of positive feedback for the foam roller, but very little research to confirm these benefits until recently.

In March of last year, there was a decent study on foam rolling published in the Journal of Strength and Conditioning (1). It examined quadriceps strength and knee flexion after 2 – one minute bouts of rolling just the quadriceps muscles. It found that knee flexion increased by 10 degrees post rolling and was still 8 degrees better 10 minutes later. Furthermore, the foam rolling had no impact on quadriceps strength and power output!

What Should You Do?

Clearly more research needs to be done to look at ways to optimize foam rolling and the combination of foam rolling and stretching. In the meantime, we recommend you experiment with a combination of foam rolling and dynamic stretching prior to activity. Find out how your body responds to varying combinations of rolling and dynamic stretching so that you can optimize the approach that works best for you. You should also continue to use the foam roller as part of your post exercise routine as well.

Here are a few resources for foam rolling:

A Guide to the Foam Roller
Foam Roller Techniques

Keep an eye out for the new PHLX method foam rolling system due to come out at the end of 2014.

(1) MacDonald GZ, Penney MD, Mullaley ME, Cuconato AL, Drake CD, Behm DG, Button DC. “An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force.” Journal of Strength and Conditioning Research March 2013: 812-21.

A Real Pain in the Neck

This past spring, an interesting piece of research on massage and neck pain was published in the Annals of Family Medicine (1). It examined different massage protocols for treating chronic, nonspecific neck pain.

The 228 participants were randomly separated into five groups. The individuals in the first group were simply put on a “wait list” but never actually received any massage. The other four groups all received massage but the length and frequency of the sessions varied for each group. One group received two or three 30 minute sessions per week. The other groups all received 60 minute treatment sessions either once, twice or three times per week. All of the massage groups received treatments for 4 weeks and all sessions focused solely on the thoracic spine and neck regions.

According to the study, both the length and frequency of the sessions can impact the outcome. After four weeks, the 30 minute treatment group did not report any statistically significant improvements in either pain or dysfunction. Neither did the group that received one session per week for 60 minutes. Participants who received treatments at least twice a week for one hour were much more likely to experience improvement with both neck pain and dysfunction.

The massage utilized in this study was most likely different than the type of treatments we have developed at SMI. However, it does help to illustrate a very important point. Relatively small changes in the treatment approach can have a substantial impact on the outcome.

At SMI, we realize that the difference between a successful outcome and something less, can often times be a fine line. By combining our extensive experience as therapists with the results from meaningful research studies, we are able to provide approaches that maximize the potential for success for each one of our clients.

If you have any further questions about neck pain, please don’t hesitate to contact us!


(1) Karen Sherman, Andrea Cook, Robert Wellman, Rene Hawkes, Janet Kahn, Richard Deyo, Daniel Cherkin. “Five Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain.” Annals of Family Medicine March/April 2014: 112-120

More Bad News for Supplements

A New York Times article this past December outlined how the lack of regulation and oversight of vitamin supplements can result in significant problems. (1) Contaminants and impurities regularly find their way into vitamins and the amounts listed on the labels can be different from what’s actually in the supplement. Obviously, this can be very dangerous and pose serious health risks. It turns out, that even if the ingredients are pure and the label is accurate, you may be better off avoiding some supplements altogether.

A recent study out of Norway found that individuals training for an endurance event were negatively impacted by supplementing with moderate doses of vitamin C and vitamin E (2). The study separated 54 participants, all in their mid-twenties, into two groups. The test group was given 1000 mg of vitamin C and 350 IU of vitamin E a day for 11 weeks. The control group was given a placebo.

At the end of the study, the supplement group had a statistically significant smaller increase in markers for the production of new muscle mitochondria, indicating a reduction in the beneficial cellular adaptions to exercise. Despite doing the same training, simply taking a Vitamin C and E supplement resulted in less of a training benefit when compared to the placebo group.

Previous studies have found that multivitamin supplements can dampen other beneficial effects of exercise such as improved insulin sensitivity and boosting the body’s natural antioxidant system (3).

The take home message here is that, before taking any vitamin supplements, it is important to understand the potential adverse effects. If you have any questions or concerns, please feel free to contact us.

(1)Paul Offit and Sarah Erush.”Skip the supplements”. The New York Times December 15, 2013:SR7

(2) Goran Paulsen, Kristoffer Cumming, Geir Holden, Jostein Hallen, Bent Ronney Ronnestad, Ole Sveen, Arne Skaug, Ingvild Paur, Nasser Bastani, Hege Nymo Ostgaard, Charlotte Buer, Magnus Midttun, Fredrik Freuchen, Havard Wiig, Elisabeth Tallaksen Ulseth, Ina Garthe, Rune Blomhoff, Haakon Benestad, Truls Raastad. “Vitamin C and E supplementation hampers cellular adaptation to endurance training in humans: a double-blind randomized controlled trial.” The Journal of Physiology February 3, 2014.

(3) Peterneli TT, Coombes JS. “Antioxidant supplementation during exercise training: beneficial or detrimental?” Sports Medicine December 1, 2011: 1043-1069.