Muscle Medicine The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints

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  • Edition: 1st
  • Format: Paperback
  • Copyright: 2009-09-15
  • Publisher: Touchstone

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Muscle and joint injuries are not just for sports superstars anymore. Back, shoulder, hip, and knee problems impact more of us than ever before, sometimes making even routine activities seem impossible. Now, two of America's top experts on muscle and joint health have teamed up to create a program that anyone can easily follow to feel great. Muscle Medicine offers: A SELF-TREATMENT, STRETCH, AND STRENGTH REGIMEN FOR THE BODY'S MAJOR TROUBLE SPOTS; A NUTRITION PROGRAM TO GIVE MUSCLES AND JOINTS THE HEALTHY FUEL THEY NEED FOR TOP PERFORMANCE; DOZENS OF ILLUSTRATED EXERCISES FOR FITNESS, INJURY PREVENTION, AND RECOVERY; ADVICE ABOUT WHEN SURGERY IS NECESSARY AND WHAT TO ASK A DOCTOR IN ANY CONSULTATION. Care for your body and enjoy a pain-free, active life, no matter what your age or activity level!

Author Biography

Rob DeStefano, D.C., is a sports chiropractor, a national leader in the field of manual muscle therapies, and an avid triathlete.

Bryan Kelly, M.D., is an orthopedic surgeon, specializing in sports medicine and arthroscopic surgery of the shoulder, hip, and knee at the Hospital for Special Surgery in New York City.

Joseph Hooper is contributing editor/writer at Elle and Popular Science magazines who has been covering health and fitness since 1985.



Weserve on the medical staff
of the New York Giants and treat athletes at all skill levels, so it?s fair to
say we know something about the punishment the human body can take and dish out. But
in our private practices, too much of the pain and suffering we see in our patients
has no rationale whatsoever. It stems from a big and preventable cause: muscles are
overlooked as an important piece of the treatment puzzle. A sore shoulder, a tight
lower back, an achy knee? in virtually everyone over the age of thirty, these
problems are so common, they?re taken for granted as the near inevitable
consequence of getting older. But that?s just not true. Whether tight or
injured muscle is the primary cause of pain and restriction or whether the main
culprit is inside the joints, the tools exist to get to the root of the

In the pages that follow, you will learn advanced
muscle self-treatment techniques as well as stretching and strength exercises, all
pegged to the most common body breakdowns. Merging our expertise as an orthopedic
surgeon working in academic medicine and a sports chiropractor specializing in
?hands-on? muscle therapies, we?ll also show you how we treat more
serious muscle and joint problems. Our aim is to put the tools of ?muscle
medicine? in your hands in the service of a pain-free life.

That our own backgrounds are so different has helped us appreciate how all
the parts fit together. One of us, Dr. Bryan Kelly, is an orthopedic surgeon at the
nation?s premier orthopedic hospital, Manhattan?s Hospital for Special
Surgery, specializing in sports injuries to the hip, knee, and shoulder. He is also
an assistant professor at Weill Cornell Medical College and is involved in a wide
variety of research in sports medicine. The other of us, Dr. Robert DeStefano, was
trained in chiropractic and, while developing busy practices in New Jersey and
Manhattan, expanded his approach by teaching and developing hands-on muscle
therapies. We have collaborated on both clinical and research protocols to improve
the treatment strategies for patients with sports injuries.

What?s different about our approach from others you may come across is that
we look at the body the way nature made it, as an integrated system of bone, joint,
and muscle. When there is pain or restriction, our job is to tease out the
relationship among these three elements, so we can accurately diagnose and treat a
musculoskeletal problem and, whenever possible, teach you how to treat



What do you do when you go to an orthopedic
surgeon and he says there?s no structural problem, nothing to fix? We say,
there may be nothing wrong with you from his perspective, but it doesn?t
mean there?s nothing wrong with you. It just means you can?t see it
on an MRI or X-ray. In this case the problem may be mostly

That doesn?tsoundradical, does it? But as the medical establishment evolved,
different parts of the body became the territory of different specialists. Physical
therapists work on muscle conditioning, trauma surgeons set bones and save lives,
and sports medicine orthopedists repair joints. They all do valuable work, but what
sometimes gets lost is an appreciation for how the whole system?bones, joints,
and muscles?must be brought back into sync when everyday wear and tear knocks
it out of kilter. (When we discuss specific injuries, you?ll see how nerves
can also interact with all three of these elements to contribute to pain and


In our experience, the approximately six
hundred muscles in the body that keep humans upright and moving are often the
most overlooked element of the system. Muscle is soft tissue that can?t
hold a surgeon?s stitch?it basically heals itself?so it
doesn?t have its own branch of medical specialists to diagnose and treat
it. Sure, any doctor will tell you muscles play a role in pain and dysfunction,
but typically a supporting role?the stars of the show are supposed to be
the joints, cartilage, and ligaments, in other words, the structures that show
up damaged on an MRI. Minor muscle damage that may be seen on an MRI is often
overlooked or viewed as clinically irrelevant. In addition, it?s
subjective?we don?t yet have a numerical scale that measures muscle
tightness. Yet experience has shown us that tight, damaged muscle can often be
the primary cause of your problems. Even when muscle damage is the result of
joint injury, it?s often the factor that holds you back from complete

Take the example of a patient we treated not
long ago. A former college soccer player turned business executive, he blew out
the ACL (anterior cruciate ligament) in his knee playing club soccer. The
surgery Dr. Kelly performed was a textbook reconstruction of the ligament, which
restored stability to the knee joint. This patient seemed to have everything
going for him?he was young, fit, and motivated?and yet after months
of postsurgical physical therapy, he could still barely lift his leg. Dr. Kelly
sent him to Dr. DeStefano, who broke up some scar tissue that had built up
around the surgical site and lengthened the muscles that had tightened up after
being immobilized postsurgery.

Our soccer player went back
to physical therapy to strengthen the muscles and was running in weeks. The
point is not that something is wrong with surgery or with physical therapy (both
were absolutely necessary in this case) or magical about manual muscle therapy.
The point is, the body returns to health in a sequence. First, tight or inflamed
or scarred-down muscles have to heal before they can be conditioned to become
stronger and more flexible. Exercise an injured muscle, even in a physical
therapy setting, and it might not respond and you may just injure it some


Your musculoskeletal system takes a beating, whether from big traumas such as a
torn ACL or simply from muscle and connective tissue in the joints growing
inflexible and weaker with age. But some of the decline that is often written
off as ?normal aging? has less to do with the built-in deterioration
of the cells themselves than with an accumulation of treatable muscular dinks
and tweaks that were never addressed. Maybe your knees are achy and you
can?t jog or play basketball the way you used to, or your wrist is sore
from working at the computer all day. Over time even the ?small
stuff? has a way of adding up to permanent pain, a lost range of motion,
and a less active life. Which is not a small thing at all. In this book, we will
briefly explain how the musculoskeletal system works, and sometimes falls apart,
how the lifestyle choices you make affect the system, and ultimately, what you
can do to recognize problems and often fix them yourself.



It happens all the time. The patient comes in
needing joint surgery, but their muscles are so weak, they can?t lift
their leg off the bed. I tell them, if we do surgery now, it?s going
to be a disaster. I send them to Rob for ?prehab? to decrease
the pain and improve the function of the muscles. Other patients don?t
necessarily need that, but if, after surgery, their muscles are shutting
down or they?ve got a buildup of scar tissue, I send them for manual
therapy on the muscles and it turns their rehab around. Now it?s
almost routine. Two or three months out from surgery, if I have any inkling
at all that the muscles are getting into trouble or I want them better
faster, I?ll send patients for hands-on therapy. The muscle is
ultimately what gets people back to normal. If you treat the bone and the
joint and the muscle isn?t functioning well, the patient is just not

approach to musculoskeletal health begins with a
two-chapter look at the biology of muscles, joints, and bones, and at the events
and forces that can do them harm. In Part Two, we move on to the choices you make in your everyday life
that affect the system. A lot affects your body that?s out of your hands,
such as genetics (do both of your parents have surgically replaced hips?) and
luck (did you suffer a serious knee injury playing high school sports?). In
these chapters, we target three important areas where you can exert some

In chapter 4, ?Mind-Body,? you?ll learn how
psychological stress can wreak havoc on the musculoskeletal system and how you can contain the
damage by developing a measure of control over your thoughts and emotions. In
chapter 5,
?Nutrition,? you?ll learn how smart food choices can support
bone growth and possibly reduce joint inflammation. We?ll explain why
maintaining a healthy weight will lessen the physical stress that wears down the
joints. You get moving in chapter
6, with an all-around fitness plan that develops muscle and bone
strength and cardio endurance, reducing the odds of injury.

In Part Three, we
tour the body?s seven ?hot spots?: neck; shoulder; elbow/
wrist/hand; lower back; hip; knee; ankle/foot. We focus on the most common
sources of pain and the decisions that people make, or don?t make, about
how to deal with it. Do you ignore it? Do you stop running or swimming or
playing your favorite sport? Do you explore self-treatment or seek out treatment
from a muscle therapist, a physical therapist, an orthopedist? Not to be too
dramatic about it, but by the time you hit your sixties, the answers to some of
these questions could determine whether you?re getting ready for tennis
season or another physical therapy session.

In each hot
spot, we?ll describe the most common problems, how Dr. DeStefano frees up
tight and scarred-down tissues with ?hands-on? manual techniques,
and how, when the joint is seriously damaged, Dr. Kelly provides the orthopedic
expertise. At the end of each of these chapters, you?ll learn how to work
on yourself, to protect against injury or to come back from it. We describe a
series of self-treatment techniques tailored to each of the body?s hot
spots, based on the principles of Dr. DeStefano?s muscle therapy. Using
your hands and a few simple items such as a treatment stick and a physio ball,
you?ll learn to work directly on painfully contracted muscles to release
the tissue and speed healing. Only when the area is no longer sore or inflamed
will you progress to hot-spot-specific stretches to develop or maintain a
healthy range of motion, and then strength exercises to build up resilience and
protect against reinjury.

As you?ll see, this book
isn?t a laundry list or an encyclopedia of musculoskeletal injuries. (If
you?re interested, plenty of books out there will give you the details of
orthopedic procedures.) We?ve organized our information the same way
we?ve taught ourselves to diagnose and treat problems, into three
categories: Mostly Muscular; Muscle or Joint?; and Joint/Orthopedic. In the
first group, which includes most problems, most of the time, injured muscle is
generating the pain; any joint damage that shows up on an X-ray or an MRI is
incidental. The standard medical prescription for this group is rest and a
couple of Advil. Our approach is to get at the underlying causes and then to lay
out a program to treat and strengthen all the important muscles in the hot

With the problems that fall into our second
category, Muscle or Joint?, neither the muscles nor the joint are working the
way they?re supposed to, and it?s not clear who the most important
bad actor is. Is the torn meniscus cartilage inside the knee the real issue, or
can we bring the patient back to health just by working on the muscles that
stabilize the joint? By putting these problems under a diagnostic microscope and
always treating conservatively first, our goal is to eliminate avoidable

Patients in the third group, Joint/Orthopedic,
have serious damage inside the joint that must be addressed, medically or
surgically. Here, we work on the muscles before (prehab) and after surgery
(rehab) to shorten recovery times and improve the outcome. Mostly Muscular,
Muscle or Joint?, Joint/Orthopedic?this isn?t the standard approach
to musculoskeletal injury, but in time we hope it will be.

The good news about these injuries is that the necessary expertise is out there
to fix them, even if it?s rarely collected under one
roof?orthopedics to diagnose and repair joints; hands-on muscle therapy to
promote muscle healing; and physical therapy/training to build up muscle and
joint strength and flexibility. It?s the team approach. Working with the
New York Giants for the past six years, we?ve seen the results when
players have access to the best talent from these different schools of
treatment. We believe readers should have access to the same expertise, even if
they?re not (we hope) taking the same physical pounding as the Giants


Wouldn?t it be nice if
all-around healthy living were all that was needed to ward off muscle and joint
problems? But no matter how you live your life, it?s a near certainty that
sooner or later you?ll have to deal with musculoskeletal ills?they
account for almost a quarter of the visits to primary-care physicians in this
country. Young people playing competitive sports put their frames under
tremendous pressure, from contact-sports body blows to the grinding repetition
in the endurance-sports world. Adults find themselves in office jobs that have
become hothouses for
nagging aches and pains: lower-back pain from sitting glued to a desk; sore
necks from improperly positioned computer screens; and overuse syndromes of the
forearm?commonly if not always accurately labeled carpal tunnel
syndrome?from all that typing and ?mouse?

The lowest blow of all is that aging
recreational athletes who maintain their cardiovascular fitness on the running
trail, the tennis court, or in the gym are probably more susceptible to
musculoskeletal damage than their couch-potato counterparts. (Ever notice how
many social gatherings and dinner parties turn into a litany of ?war

is a manual about fighting back: how to make the right
choices to address both healthy and damaged muscle, whether it?s on your
own or with professional care. It lays out the first truly integrative approach
to the care and repair of muscle and joint problems. Whether you?re an
accomplished athlete, you want to maintain your regular tennis routine, or you
just want to be able to play with your kids, or your grandkids, without back
pain after a long day at the office, we want to be on your



Every day, I treat patients who are
convinced that the source of their pain is the damage inside their joint
that shows up on an X-ray or MRI. A patient will come in and say, ?Can
you help me with my meniscus tear in my knee?? I?ll say,
?No, I can?t help you with the meniscus tear, but I may be able
to help you with the pain in your knee.? What people don?t
usually understand is that in many cases, if we can get the muscles around
the joint to move properly, the joint itself doesn?t have to be in
perfect shape for the system to work without pain. That?s something I
can appreciate. I?ve been in two serious accidents?once when a
car hit me while I was training for the Ironman World Championships and once
in a Manhattan cab crash?and I?ve got the chipped vertebrae and
herniated disks to show for it. A year ago, the pain in my back and neck
flared up so badly, my orthopedist was ready to bring in a neurosurgeon to
work me up for disk surgery. I kept exercising, getting manual therapy, and
applying self-treatment. Slowly, over a month, the contracted muscles in my
cervical and lumbar spine let go their grip, and the pain went away.
I?m not cured; I still have damaged disks. I may need surgery down the
line, but as long as I?m symptom-free and maintain the health of my
muscles, I?m fine.

? 2009 Rob DeStefano, Bryan Kelly, and Joseph Hooper

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