arsenic exposure

Our Toxic World: Arsenic

Arsenic is a natural component of the earth’s crust and is widely distributed throughout the environment in the air, water and land. It is highly toxic in its inorganic form.

Long-term exposure to inorganic arsenic, mainly through drinking-water and food, can lead to chronic arsenic poisoning. Skin lesions and skin cancer are the most characteristic effects.

Arsenic Toxicity

arsenic exposure

Since arsenic is found naturally in the environment, you will be exposed to some arsenic by eating food, drinking water, or breathing air.

Mechanisms of Arsenic Exposure

People are exposed to elevated levels of inorganic arsenic through drinking contaminated water, using contaminated water in food preparation and irrigation of food crops, industrial processes, through exposure to arsenic treated woods, eating contaminated food and smoking tobacco.

Water Contamination in the US:  In a national study of groundwater quality, the USGS found that arsenic was detected in nearly half of the wells sampled in parts of aquifers used for drinking-water supply at a concentration of 1 µg/L or greater. Detections were more common and concentrations generally were higher in the west than in the east. About 7 percent of the wells sampled contained arsenic at a concentration that exceeded the MCL of 10 µg/L, indicating a potential health risk. The greatest concern was in the Southwest, where concentrations of arsenic exceeded the MCL in about 16 percent of drinking-water wells sampled.

Food Contamination:  Arsenic occurs naturally in a variety of foods such as fruits, vegetables, grains and fish.  Most recently, low levels of arsenic have been detected in rice and juice products.

Health Effects from Arsenic

Acute Effects:  The immediate symptoms of acute arsenic poisoning include vomiting, abdominal pain and diarrhoea. These are followed by numbness and tingling of the extremities, muscle cramping and death, in extreme cases.

Long-term Effects:  The first symptoms of long-term exposure to high levels of inorganic arsenic (for example, through drinking-water and food) are usually observed in the skin, and include pigmentation changes, skin lesions and hard patches on the palms and soles of the feet (hyperkeratosis). These occur after a minimum exposure of approximately five years and may be a precursor to skin cancer.

In addition to skin cancer, long-term exposure to arsenic may also cause cancers of the bladder and lungs. The International Agency for Research on Cancer (IARC) has classified arsenic and arsenic compounds as carcinogenic to humans, and has also stated that arsenic in drinking-water is carcinogenic to humans.

Other adverse health effects that may be associated with long-term ingestion of inorganic arsenic include developmental effects, diabetes, pulmonary disease, and cardiovascular disease. Arsenic-induced myocardial infarction, in particular, can be a significant cause of excess mortality.

Treatment for Arsenic Exposure

The first step to treating arsenic exposure is to eliminate the source of the exposure.  Clean drinking water, uncontaminated food, and clean air are a must.

No treatment of proven benefit is currently available to treat chronic arsenic toxicity. Treatment options advocated are vitamin and mineral supplements and antioxidant therapy (especially increasing glutathione levels). The benefits of these treatment measures need to be evidence based to receive endorsement and wider application.

Read about other common environmental exposures.

Environmental Exposure

Our Toxic World

I really do try to stay upbeat in most situations.  Take a deep breath and carry on right?  But what if that deep breath is killing you?  What if instead of qi you get environmental toxins? 

American culture used to be baseball and apple pie.  So wholesome…  Nowadays, it’s instant gratification and disposable trinkets.  When was the last time you cart abandoned because prime wasn’t an option?

Come down the rabbit hole with me as we explore the Environmental working group‘s (EWG) list of top environmental toxins.  Learn a few tips and tricks to help reduce your exposure, protect your family, and support your body in the process.

Let’s start by simply naming what it is that’s killing us.

A Toxic Home

Environmental Exposure

I’m not sure if you’ve ever tried to actually read something on the EWG website, but it’s an awful user experience.

They offer several really nice guides on specific topics, but click on any given link and you will get research overload.

Let’s start with something simple…a list.

1) Arsenic

A known human carcinogen, arsenic is a common contaminant in food and water. It was also used in virtually all pressure-treated wood products before EWG helped get it off the market.

2) Asbestos

EWG research showed that 10,000 people die each year of asbestos-related diseases and unearthed documents showing that corporate executives concealed for decades the dangers of making or handling asbestos-containing materials.

3) BPA

BPA  leaches from can linings and plastic water bottles/containers into foods, beverages and infant formula – and ends up in the bodies of 93 percent of Americans.

4) Chromium-6

Nearly 200 million Americans across all 50 states have been exposed through their tap water to higher-than-recommended levels of chromium-6, a cancer-causing chemical. Chromium-6 was made famous in the 2000 biographical film “Erin Brockovich.” 

5) Dioxin

EWG found cancer-causing dioxin and related chemicals in the blood of every American it tested, including cord blood from 20 newborns that came into the world “pre-polluted.”

6) Flame Retardants

For decades, foam furniture, baby products and electronics have been loaded with needless flame retardants that migrate out of products and into our bodies. These chemicals have been linked to cancer and hormone disruption, as well as deficits in motor skills, attention and IQ in children.

7) Lead

Chronic exposure to lead is a well-known threat to health, especially for children, but it’s still a persistent problem.  Flint Michigan is not unique.

8) Mercury

Mercury exposure from eating fish carries serious health risks, especially for developing fetuses.  Every worry about those old amalgam fillings?

9) Nanomaterials & Microplastics

These vanishingly small particles are turning up in thousands of new products, including cosmetics and are bioaccumulating.

10)  Perchlorate

This component of rocket fuel, which can affect thyroid hormone levels currently has no national drinking water standard.

11)  Pesticides

Pesticides are designed to kill “pests”, but some pesticides can also cause health effects in people. The likelihood of developing health effects depends on the type of pesticide.  Some health effects from pesticide exposure may occur right away, as you are being exposed. Some symptoms may occur several hours after exposure. Other effects may not be noticed for years, for example cancer.

12) Phthalates

These endocrine-disrupting “plasticizer” chemicals are everywhere in modern society.  Several have been banned in children’s toys, but they are still widely used chemicals that  pollute almost everyone’s bodies.

13) PFA’s

In 1946, DuPont introduced Teflon to the world, changing millions of people’s lives – and polluting their bodies. Today, the family of compounds including Teflon, commonly called PFAS, is found not only in pots and pans but also in the blood of people around the world, including 99 percent of Americans. PFAS chemicals pollute water, do not break down, and remain in the environment and people for decades. Some scientists call them “forever chemicals.”

14) Triclosan

Consumer products containing this antibacterial pesticide don’t protect you from germs or disease, but they do expose you to a hormone-disrupting chemical. 

15) 2,4-D

2,4-D (2,4-dichlorophenoxy) is a systemic phenoxy herbicide developed in the 1940s and still in use today (think Agent Orange).  ,4-D is reported to have negative effects on the endocrine system (specifically the thyroid and gonads) and immune system.

16) Gyphosate

Glyphosate is a toxic pesticide widely used on crops. The active ingredient in Monsanto’s Roundup, it is sprayed on oats right before harvest to dry them out, so it ends up in many oat-based products, like cereals and breakfast bars.

On March 28, 2017, the California Environmental Protection Agency’s Office of Environmental Health Hazard Assessment confirmed that it would add glyphosate to California’s Proposition 65 list of chemicals known to cause cancer. 

Joint Hypermobility

Joint Hypermobility Syndrome

Hypermobility means that your joints are more flexible than other people’s (you may think of yourself as being double jointed). When this causes pain, it might be joint hypermobility syndrome.

People with high levels of flexibility often gravitate towards activities where flexibility is a goal or even rewarded.  Think of activities such as dance, yoga, performance art, and the circus arts.  This increased level of flexibility, however, comes at a price.  If you are one of those amazingly flexible few, you need to consider how to age well and protect yourself from injury.

Intrigued?  Read on!

The Nuts and Bolts of Hypermobility

Joint Hypermobility

Hypermobility usually comes up when I’m initially working on a patient.  It may be really hard to get their joints to tension, or when I do an ankle adjustment their knee and hip come along for the ride.  They may not have that classic “double jointed” presentation, but it is distinctly noticeable.  Your connective tissues don’t lie.


Bare with me for a minute while we go down a scientific rabbit hole.  It’s worth the trip.

Your ligaments are comprised primarily of two types of protein, the aforementioned collagen and elastin.  Collagen provides structural integrity while the Elastin is responsible for a ligament’s ability to stretch and deform.  Without Collagen you would be a rubbery mess, and without Elastin you would be as stiff and the tin man.  

Your specific mix of Collagen and Elastin is dictated by a dozen or so genes.  Thanks mom!  

Collagen and Elastin make up most of what we think of as being our soft and connective tissues: skin, fascia, ligaments, tendons, etc.  Muscles are different because they also contain contractile elements.

Ligaments, specifically, provide a supportive role.  They hold your joints together, your organs in place, your teeth in their sockets…you get the idea.  You can think of the texture of a ligament as being somewhat akin to that of saltwater taffy?  It’s pretty darn tough, but if you keep at it you can get it to stretch.  This quality is known as a ligament’s “creep.”  The fibers are slow to lengthen, but under sustained stress they do.  They don’t really snap back…a good analogy is when you overstretch the elastic in your sock.  It does the job, but that sucker is going to sag.


From the direction of the conversation, you may have already guessed what is coming next.  If you are already more flexible than the average bear, and you continue to stretch your ligaments…at some point you may find yourself with an unstable joint.  This means that your ligaments are not able to hold their respective bones in a proper alignment.

Now, you may be looking down at yourself and noticing that your joints are not flopping around like raggedy ann or andy despite the fact that you are very flexible.  Well, our bodies are good at their jobs.  We have redundant systems in place.

If you are overly flexible, you make up for that lack of ligamentous stability with muscular strength.  Your muscles also attach to the bones, kind of necessary for movement to occur.  Since muscles have contractile fibers, they are able to shorten and don’t stay stretched out.  “So what’s the problem?” you may ask.

In a nutshell, your muscles are doing two jobs instead of one.  They aren’t just moving you through space, they are also holding you together.  This makes repetitive activities especially trying on the muscles around the joints.  You may have noticed that you are more likely to get tendinitis, plantar fasciitis, shin splints…any one of those pesky inflammatory connective tissue injuries.  This common inflammatory theme also means that you are more likely to build up scar tissue in your fascia (ouch!).

On a more serious note, when you are in an accident your joints usually have two lines of defense: muscles and ligaments.  You are pretty much flying with one engine.  You may be more likely to dislocate a joint when a stiffer soul would only sprain a ligament.  Also, you are more prone to recurring injuries such as ankle sprains and shoulder dislocations.

The makeup of your connective tissue also affects the valves in your veins and heart.  Those with excessive flexibility may be more prone to varicose veins and swelling of the legs.  In more extreme inherited genetic connective tissue syndromes, such as Ehler Danlos, the heart may be more profoundly affected.



Play to your strengths, literally!

If you happen to be in San Francisco,  I’d love to help!  You can see my schedule and make an appointment online.

Stress & Your Body

Stress & Your Body

Stress has both benefits and downfalls. It is an adaptive energy needed for growth and strengthening. We have evolved through the fight or flight response, which provides the physical energy and mental focus to remove us from dangerous situations (Segerstrom, 2006).

Examples of good stress include physical stress on muscles or the vasculature system to further strengthen, alertness as a psychological stress needed to take an exam, or pay attention driving during bad weather. (Cleveland Clinic, 2017)

When stress becomes chronic and mismanaged it is a detriment to our health and well-being.

Examples of unhealthy stress include inadequate recovery from physical, mental and emotional stress of any kind. This could be related to exercise, constant worrying and repetitive thoughts of a negative nature, and even emotions such as depression and anxiety (Cleveland Clinic, 2017).

Prolonged stress leads to hyper physiological levels of cortisol. This alters the effectiveness of cortisol to regulate both the inflammatory and immune response because it decreases tissue sensitivity to cortisol (Segerstrom, 2006).

As the human body heals, inflammation becomes a response to stress. Like stress, inflammation is beneficial, although when inflammation becomes chronic, it can lead to constant tissue breakdown and impairment of the immune system.

“Stressed people’s immune cells become less sensitive to cortisol. They’re unable to regulate the inflammatory response, and therefore, when they’re exposed to a virus, they’re more likely to develop a cold” (Cohen, 2004).


Stress management can be complicated and confusing because there are different types — acute, episodic acute stress, and chronic — each with its own characteristics, symptoms, duration and treatment approaches. Let’s look at each.


This is the most common form. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. It is thrilling and exciting in small doses, but too much is exhausting. A fast run down a challenging ski slope, for example, is exhilarating early in the day. That same ski run late in the day is taxing and wearing. Skiing beyond your limits can lead to falls and broken bones. By the same token, overdoing on short-term stress can lead to psychological distress, tension headaches, upset stomach and other symptoms.

Fortunately, these symptoms are recognized by most people. It’s a laundry list of what has gone awry in their lives: the auto accident that crumpled the car fender, the loss of an important contract, a deadline they’re rushing to meet, their child’s occasional problems at school and so on.

Because it is short term, acute stress doesn’t have enough time to do the extensive damage associated with long-term stress. The most common symptoms are:

Emotional distress — some combination of anger or irritability, anxiety and depression, the three stress emotions.

Muscular problems including tension headache, low back pain, jaw pain and the muscular tensions that lead to pulled muscles and tendon and ligament problems.

Stomach, gut and bowel problems such as heartburn, acid stomach, flatulence, diarrhea, constipation and irritable bowel syndrome.

Transient over-arousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath and chest pain. 

Acute stress can crop up in anyone’s life and is more or less inevitable.


There are those who suffer acute stress frequently. They’re always in a rush, but always late. If something can go wrong, it does. They take on too much, have too many irons in the fire, and can’t organize the slew of self-inflicted demands and pressures clamoring for their attention. 

It is common for such people to be over aroused, short-tempered, irritable, anxious and tense. Often, they describe themselves as having “a lot of nervous energy.” Always in a hurry, they tend to be abrupt, and sometimes their irritability comes across as hostility.

The symptoms of episodic acute stress are the symptoms of extended over arousal: persistent tension headaches, migraines, hypertension, chest pain and heart disease. Treating episodic acute stress requires intervention on a number of levels, at times requiring professional help, which may take many months.


While acute stress can be thrilling and exciting, chronic stress is not. This is the grinding stress that wears people away day after day, year after year. 

Chronic stress comes when a person never sees a way out of a miserable situation. It’s the stress of unrelenting demands and pressures for seemingly interminable periods of time. With no hope, the individual gives up searching for solutions.

The worst aspect of chronic stress is that people get used to it. They forget it’s there. People are immediately aware of acute stress because it is new; they ignore chronic stress because it is old, familiar, and sometimes, almost comfortable.

Chronic stress kills through suicide, violence, heart attack, stroke and, perhaps, even cancer.  Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat.


  • Try to keep a positive attitude.
  • Accept that there are events that you cannot control.
  • Be assertive instead of aggressive. Assert your feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.
  • Learn and practice relaxation techniques; try meditation, yoga, or tai-chi for stress management.
  • Exercise regularly. Your body can fight stress better when it is fit.
  • Eat healthy, well-balanced meals.
  • Learn to manage your time more effectively.
  • Set limits appropriately and learn to say no to requests that would create excessive stress in your life.
  • Make time for friends, hobbies, interests, and relaxation.
  • Get enough rest and sleep. Your body needs time to recover from stressful events.
  • Don’t rely on alcohol, drugs, or compulsive behaviors to reduce stress.
  • Seek out social support. Spend enough time with those you enjoy.
  • Seek treatment with a psychologist or other mental health professional trained in stress management or biofeedback techniques to learn healthy ways of dealing with the stress in your life.

Dr. Smith encourages his clients to seek mental health care when appropriate and helps his patients manage their physical symptoms through a combination of Chiropractic, Massage, Reiki, Craniosacral, Improved Nutrition & a host of other services. 

For more information, please call us at 415-496-0992 or book an appointment online.


Cleveland Clinic (2017) Stress. Retrieved from:

Cohen, S., (2004) 5 Studies of behavior, biology, and the common cold: A data repository. The Common Cold Project. Retrieved from:

Segerstrom, S., Miller, G., (2006) Psychological stress and the human immune system: A meta-analytic study of 30 years inquiry. Psychological Bulletin, 130(4), 601-630. Retrieved from:

Leaky Gut Syndrome SF

Leaky Gut Syndrome

Leaky gut, or “intestinal permeability” is a condition in which the lining of the small intestine becomes damaged, causing undigested food particles, toxic waste products and bacteria to “leak” through the intestines and flood the bloodstream. The foreign substances entering the blood can cause an autoimmune response in the body including inflammatory and allergic reactions such as migraines, irritable bowel, eczema, chronic fatigue, food allergies, rheumatoid arthritis and more.

With leaky gut, damaged cells in your intestines don’t produce the enzymes needed for proper digestion. As a result, your body cannot absorb essential nutrients, which can lead to hormone imbalances and a weakened immune system. 

The Causes of Leaky Gut

In many cases, leaky gut is caused by your diet.  Certain foods that you consume every day, including gluten, soy and dairy, may be treated by your body as foreign invaders that have to be fought off. When you eat these foods, your body may be going to war, producing antibodies, which trigger an immune response that included diarrhea, headaches, fatigue and joint pain.

Leaky gut can also be caused by medications including antibiotics, steroids or over-the-counter pain relievers like aspirin and acetaminophen, which can irritate the intestinal lining and damage protective mucus layers. This irritation can start or continue the inflammation cycle that leads to intestinal permeability.  Ongoing high levels of stress are often a contributing factor to leaky gut syndrome.

  1. Chronic diarrhea, constipation, gas or bloating
  2. Nutritional deficiencies
  3. Poor immune system
  4. Headaches, brain fog, memory loss
  5. Excessive fatigue

6.  Skin rashes and problems such as acne, eczema or rosacea

7.  Cravings for sugar or carbs

8.  Arthritis or joint pain

9.  Depression, anxiety, ADD, ADHD

10.  Autoimmune diseases such as rheumatoid arthritis, lupus, celiac disease or Crohn’s

Healing a Leaky Gut

The key to healing a leaky gut is changing your diet and eliminating the foods that your body treats as toxic. This often requires eliminating gluten, dairy, soy, refined sugar, caffeine and alcohol.   An Elimination Diet is the key first step.

In addition to eliminating certain foods, you will need to add a few things to help repair your leaky gut. These included healthy fats such as fish, coconut and olive oils; avocados and flax; probiotics to restore the healthy bacteria in yourgastrointestinal tract; and L-glutamine, an amino acid that rejuvenates the lining of the intestinal wall.  You will also need digestive enzymes to help your body more fully break down the protein in your meals.  Also, aloe can help to coat the GI tract while the underlying lining heals.

Dr. Smith addresses Leaky Gut Syndrome with many of his patients as an underlying cause of their inflammation and pain.  For more information, please call us at 415-496-0992 or book an appointment online.

Acute Pain

Acute vs. Chronic Pain/Inflammation

What was the mechanism of injury?  When did it start?  What have you done at home to address it?

When you ask someone for advice about pain, you tend to get a slew of questions rather than anything constructive.  A good first step is to understand the difference between acute pain and chronic pain and how the approach to treating them differs.

Pain is almost inevitably related to and associated with inflammation.  Treating pain, in large part, requires managing and resolving inflammation.  So what’s inflammation?

Inflammation is the body’s generic, first line of defense against any type of injury.  It helps to rally the body’s resources and bring factors necessary for healing to the area.  It increases circulation to the area and is classically described as having 5 cardinal signs (pardon the latin): rubor (redness), dolor (pain),  calor (heat), tumor (swelling), and functio laesa (loss of function).

Acute Injuries & Inflammation

Maybe you woke up in a wonky position and you have a sharp pain in the neck.  You might have been bending down to tie your shoes and your low back went out.  Towards the end of your run your knee started to hurt, but you were too close to home to stop.  Whatever the circumstances, you are having a sudden onset of pain.

Acute inflammation is a healthy response that serves to protect and repair the body.  It occurs from something damaging, whether that be an infection in a cut or a strained muscle. The key here is that it is the body’s expected and necessary response to an injury.

Managing Acute Inflammation: 

While a certain amount of inflammation is necessary for the body to heal, sometimes the body gets a little over-enthusiastic with the inflammation.  Reducing the level of inflammation can help to manage the pain, stiffness, and loss of function associated with an injury.  However, a certain amount of inflammation is necessary and appropriate.  So what do we do? 

Well there are two schools of thought.  One is to use the RICE method.  The other is to actively engage the damaged structures (albeit carefully). Joint movement and muscle contraction are how your body naturally processes inflammation and keep it from becoming stagnant around the injury.  It seems a bit counterproductive to cut them out of the equation.

Since there is no consensus, I recommend a hybrid of the two approaches.  Let’s call it RICEM.    

  • Rest
  • Ice
  • Compression
  • Elevation
  • Movement

I find that the first four are appropriate in the earliest stages of an acute injury (first 1-4 days-ish).  After that, try replacing the compression with something more dynamic (such as kinesio tape) and gently get your body back into motion.

Chronic Injuries & Inflammation

Maybe you hurt yourself years ago, and over time you progressively got worse.  Your whole body hurts for no apparent reason.  Maybe the foods that you eat are secretly plotting to kill you.  Whatever the case may be, you hurt on the regular and quite often nothing seems to help.

Unlike acute inflammation, chronic inflammation is not a part of the body’s natural healing process.  What was supposed to be a useful healing mechanism has spun out of control and is instead causing damage.  There is a wrench in the machine. 

Chronic inflammation is a condition where dilated blood vessels and a hyped up immune system become the new norm. The human body isn’t designed to cope with this unfocused immune activity, and eventually chronic inflammation will cause organ damage. White blood cells usually protect the body from disease, but the unchecked white cell activity of chronic inflammation can make you more prone to non-infectious conditions such as cancer, asthma, allergies, arthritis, and autoimmune disorders.

Managing Chronic Inflammation

So what do you do? 

It all comes down to lifestyle.  Let’s consider triggers for chronic inflammation.

  • Being Overweight
  • High Glycemic Index Foods
  • High Levels of Stress
  • Smoking
  • Pollution (Air & Otherwise)
  • Poor Diet in General
  1. Improve what you eat.  If you don’t know what that means, try an anti-inflammatory diet.
  2. Get some movement into your body.  Be it through yoga, stretching & exercise, chiropractic or massage movement helps to decrease inflammation.  It may be uncomfortable at first, but it will get better with consistency.
  3. Learn to manage your stress!  But don’t let the fact that you’re stressed stress you out.  Meditation and other mindfulness practices will not only help you feel better, they may even help you live longer while feeling better. 

Managing inflammation can seem like a daunting proposition, but take it one step at a time.  If you are in the San Francisco area and need some help, look us up.

For more information, please call us at 415-496-0992 or book an appointment online.

Tennis Elbow SF

Golfer’s Elbow and Tennis Elbow

While many people are familiar with the names of these conditions, there is less widespread understanding about how they differ. Both tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are injuries to the tendons attaching your forearm muscles to the bone at your elbow. The “epicondyle” part of epicondylitis refers to the bony bumps or protrusions at your elbow.

The anatomical structures involved in tennis elbow and golfer’s elbow are very similar and the symptoms are also similar, but they appear on opposite sides of the elbow and arm.

Golfer's Elbow vs Tennis Elbow

Lateral Epicondylitis (Tennis Elbow)

Common symptoms of tennis elbow include:

  • Pain that radiates from the outside of your elbow and down your forearm
  • Tenderness on the outside of your elbow
  • Weakness in your forearm or a weak grip
  • Pain when you grip things, twist something or, if you play tennis, especially with backhand strokes

Medial Epicondylitis (Golfer’s Elbow)

Golfer’s elbow symptoms are similar, but occur on the inside of your arm and include:

  • Pain and tenderness on the inside of your elbow
  • Pain that radiates down your arm from the inside of your elbow
  • Weakness in your hand or wrist
  • Numbness or tingling in your ring and little fingers
  • Pain when you grip or twist things
  • Pain when you flex your wrist

Both tennis elbow and golfer’s elbow symptoms usually start gradually and get worse over time.

Causes of Golfer’s Elbow and Tennis Elbow

Both conditions are types of tendonitis, or inflammation of a tendon, and both are commonly caused by overuse. This may be due to excessive force on a regular basis (like hitting a tennis or golf ball) or due to other repetitive activities that involve the forearm muscles. The tendons over time can progress from inflammation, to partial thickness tears, and finally full thickness tears. Painters, plumbers, and carpenters or anyone performing repetitive gripping and lifting activities are also prone to both tennis and golfer’s elbow.

Treatment of Tennis Elbow and Golfer’s Elbow

Fortunately, most cases of tennis elbow and golfer’s elbow respond well to conservative treatments. Dr. Smith incorporates home stretching routines, muscle scraping, microcurrent point stimulation, myofascial release techniques, deep tissue massage, and extremity adjustments to address both painful syndromes. 

Surgery is usually not necessary, although complete recovery can take weeks or even months, depending on the severity of the condition. As with other forms of tendonitis, one of the most important aspect of treatment is to reduce the amount of strain on the affected tendons. This may include resting the arm, using a brace or athletic taping, wrist splints, and once healed, correcting improper technique/form to prevent the recurrence of the injury.

For more information, please call us at 415-496-0992 or book an appointment online.

Stretching, Foam Rolling, and Myofascial Release

Foam Rolling, Myofascial Release and Stretching: What’s the Difference?

Foam Rolling, Myofascial Release, Stretching…What’s the difference really?  Most of us will instinctively try to loosen a tight muscle.  This is especially true when it causes pain.  Many different techniques have been developed to fulfill this need.  They fall into two broad categories: things that we can do to ourselves and things that are done to us by someone else (such as massage).  Let’s focus on things that we can do for ourselves.

Stretching and self-care are ubiquitous in the Animal Kingdom.  You don’t have to look beyond your favorite four-legged friend to see an example.

People love to bandy about terms as though we know what they are talking about.  Let’s get into some of the specifics.



Most people, when they refer to stretching, are thinking of a static stretch.  This basically means that you put your body into a certain position which forces a muscle to lengthen.  Muscles get tight from overuse, underuse, repetitive stress, and injury.  Needless to say, at some point you have most likely experienced a tight muscle. 

Tight muscles often result in pain.  In the neck tight muscles can result in tension headaches.  Tight muscles in the low back can contribute to low back pain.  The list is long, but you get the idea.

When we perform a static stretch, the force of the activity is distributed across the length of the muscle, tendons included.  This makes it hard to isolate a specific section of a muscle, especially if the muscle is long. 

The hamstrings are a great example.  They run from the very top of the back of the leg down past the knee.  Not only are they long, but they are also bulky.  The hamstrings are comprised of three large muscle bellies and their associated tendons.  You may have noticed that bending down to touch your toes doesn’t always do the best job to stretch the hamstrings. 

One option is to rotate the leg so that you isolate a single aspect of the hamstrings.  This is known as doing the stretch “with isolation.”  Now the stretch is spread across a smaller section of the muscle, but it still doesn’t single out a specific part.

Need some ideas on how to stretch? Learn more…

What if you have a knot in a specific section of the muscle.  Doing a static stretch is like stretching a rubber band that has a knot tied in it.  This is where myofascial release comes in.


Myofascial release is the application of direct force to a specific section of muscle fibers (or tendon) to address the myofascial tightness or scar tissue in that area.  You can use your hands, a massage tool, a shoe horn, or whatever happens to be within grasp.  The idea is that you are working on a small section of the muscle rather than the whole thing.  Many different myofascial techniques exist, but at the end of the day they all have the same goal: to release tension in the muscles, tendons, and fascia.  You also wind up getting improved flexibility, decreased pain, and improved circulation in the area.  This is also known as a good thing.


Foam rolling is a type of myofascial release that uses a specific tool…you guessed it!  A foam roller is a cylindrical piece of dense material.  You lay your body across it and use your weight to apply pressure to specific areas of muscle.  It is very effective for longer, more expansive structures such as the IT Band.  However, if the area is cramped or far from your center of gravity the effectiveness is diminished.  People often overcome this limitation by augmenting such areas with a smaller stretching prop such as a tennis or lacrosse ball.

Simple Right?!



Frozen Shoulder

Frozen shoulder is a condition that affects your shoulder joint. It usually involves pain and stiffness that develops gradually, gets worse and then finally goes away. This can take anywhere from a year to 3 years.  If you are suffering from Frozen Shoulder in San Francisco, help is just a phone call away.

Your shoulder is made up of three bones that form a ball-and-socket joint. They are your upper arm (humerus), shoulder blade (scapula), and collarbone (clavicle). There’s also tissue surrounding your shoulder joint that holds everything together. This is called the shoulder capsule.

With frozen shoulder, the capsule becomes so thick and tight that it’s hard to move. Bands of scar tissue form and there’s less of a liquid called synovial fluid to keep the joint lubricated. These things limit motion even more.


The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move it.

If you have frozen shoulder, you’ll likely feel a dull or achy pain in one shoulder. You might also feel the pain in the shoulder muscles that wrap around the top of your arm. You might feel the same sensation in your upper arm. Your pain could get worse at night, which can make it hard to sleep.

You’ll typically go through three phases with a frozen shoulder. Each has its own unique symptoms and timeline.


  • You develop a pain (sometimes severe) in your shoulder any time you move it.
  • It slowly gets worse over time and may hurt more at night.
  • This can last anywhere from 6 to 9 months.
  • You’re limited in how far you can move your shoulder.


  • Your pain might get better but your stiffness gets worse.
  • Moving your shoulder becomes more difficult and it becomes harder to get through daily activities.
  • This stage can last 4-12 months.


  • Your range of motion starts to go back to normal.
  • This can take anywhere from 6 months to 2 years.


It’s not clear why some people develop it, but some groups are more at risk.

Frozen shoulder happens more often in women than men, and you’re more likely to get it if you’re between the ages of 40 and 60. Your risk might also go up if you’re in the process of recovering from a medical condition like a stroke, or surgery like a mastectomy that keeps you from moving your arm.

Certain medical conditions can increase your risk too. You may also be more likely to get frozen shoulder if you have diabetes. About 10% to 20% of people with diabetes get frozen shoulder. Other medical problems like heart disease, thyroid disease, or Parkinson’s disease are linked to frozen shoulder, too.

A physical exam is usually enough to diagnose frozen shoulder, but your doctor may also order imaging tests such as X-rays, ultrasound, or MRI to rule out other problems like arthritis or a torn rotator cuff that can also cause pain and limit how far it moves.

A Doctor of Chiropractic can help with the pain and stiffness related to frozen shoulder through a combination of joint manipulation, fascial stretching, massage, and by addressing inflammation in the area.  Sometimes dietary changes are necessary to help your body minimize inflammation.

sf elimination diet

The Elimination Diet

An elimination diet is an eating plan that “eliminates” a food or group of foods believed to cause an adverse food reaction, often referred to as a “food intolerance.” By removing these foods for a period of time and then reintroducing them during a “challenge” period, you can deduce which foods are causing symptoms or making them worse. We often think of reactions to food as being a rapid and dramatic allergic reaction, such as when a person has an anaphylactic reaction to eating peanuts or shellfish and their throat swells up.  However, there are other ways our bodies can react to foods that may not be so immediate, and may or may not be tied to an immediate immune system response. 

Food intolerances may be triggered by various natural compounds found in foods (natural sugars or proteins) or common food additives (such as natural and artificial colors, preservatives, antioxidants, and flavor enhancers) that can cause reactions through various mechanisms in the body. 

There is no consensus on the specific mechanisms involved in different reactions to foods, and many tests to identify the suspected culprit(s) can be unreliable. Clinical experience holds that an elimination diet is one of the best tools for identifying such foods and is very safe, as long a variety of foods are still eaten supplying all of the body’s essential nutrients.

 1. Symptoms

Symptoms of food intolerance can vary widely. They can include stomach and bowel irritation, headaches, hives, itching, and even vague feelings of being unwell, such as flu-like aches and pains, unusual tiredness, or concentration problems. Certain foods and food groups also exacerbate symptoms in people with specific conditions such as autoimmune disorders, migraines, IBS, gastroesophageal reflux (GERD) and others.

Symptoms and their severity are unique to the individual. They are influenced by specific compounds in the food, a person’s sensitivity level, and how much of certain foods are eaten. If the same food is eaten
repeatedly, or different foods with the same compound are eaten together or often, the body may reach a threshold, or a tipping point where symptoms begin to occur.

2. Food Substances

Even “healthy” foods contain many different naturally occurring chemicals that can be a problem for some people. Substances common to many different foods, such as salicylates, amines, and glutamate, may cause different symptoms in different individuals. 

3. Individual Variation

Because people are unique genetically, and because we each have different eating patterns, elimination diets have to be based on each unique individual. Eliminating the most offending food or multiple foods and substances all at one time is the most reliable way to find out which foods may be contributing to symptoms. A healthcare practitioner may recommend a specific plan to follow based on symptoms, typical dietary choices, and food cravings.


The Modified Elimination Diet

The most common food proteins that can cause intolerance are cow’s milk protein and gluten from wheat. A modified elimination diet removes
dairy and gluten and any other specific foods that may be craved or eaten a lot.

• Eliminate all dairy products, including milk, cream, cheese, cottage cheese, yogurt, butter, ice cream, and frozen yogurt.
• Eliminate gluten, avoiding any foods that contain wheat, spelt, kamut, oats, rye, barley, or malt. 

This is the most important part of the diet. Substitute with brown rice, millet, buckwheat, quinoa, gluten-free flour products, or potatoes, tapioca and arrowroot

Other foods to Eliminate

• Eliminate fatty meats like beef, pork, or veal.  

It is OK to eat the following unless you know  that you are allergic or sensitive to them:  chicken, turkey, lamb, and cold-water fish such as salmon, mackerel, sardines and halibut. Choose organic/free-range sources where available.

• Avoid alcohol and caffeine and all products that may contain these ingredients (including sodas, cold preparations, herbal tinctures).

• Refrain from eating foods containing yeast or foods that promote yeast overgrowth, including processed foods, refined sugars, cheeses, commercially prepared condiments, peanuts, vinegar and alcoholic beverages.

• Avoid simple sugars such as candy, sweets and processed foods.

• Drink at least 2 quarts of water per day.