What is Adrenal Fatigue Syndrome?


We all get run-down now and then due to the stresses of everyday life and the demands of our busy schedules. Over extended periods of time this can overburden our bodies, creating a situation that’s not so easy to bounce back from. In particular the adrenal glands, being in charge of the release of various stress hormones, can become exhausted and unable to effectively do their job. This is referred to as “adrenal fatigue.” When this happens, our fatigue can become chronic and be joined by other symptoms such as pain and inflammation.

The underlying signs of adrenal fatigue as seen through diurnal cortisol testing.  

Understanding and Treating Adrenal Fatigue

1. About Adrenal Fatigue

The adrenal glands have many functions, including the secretion of cortisol and other hormones in response to stress. Stress comes in many forms: physical, psychological, emotional, mechanical, chemical, environmental, etc. It can come from an emotional trigger like a fight with a loved one or trouble at work. It can also come from a physical trigger like an injury or motor vehicle accident. 

When prompted by pain or inflammation cortisol is released from the adrenal glands into the blood. Cortisol modifies the inflammatory pathways resulting in a decrease in inflammation and pain. When a drop in blood sugar occurs cortisol is secreted to help balance the levels of sugar in the blood. Cortisol is also released from the adrenal glands in a 24-hour daily rhythm with a burst in the morning to help us awake and a decrease in the evening to help us sleep. 

When adrenal glands are required to secrete at high levels for extended periods of time due to prolonged stress, pain, or blood sugar imbalances, they can become fatigued or begin to secrete cortisol at lower levels. When this occurs it is common to see an increase in fatigue, pain and/or inflammation.

2. Symptoms of Adrenal Fatigue

The list of possible symptoms is quite long (75+). Below are a few of the more common that you may find relatable.

  • Insomnia
  • Low Blood Pressure
  • Low libido and lack of sex drive
  • Feeling hypoglycemic despite normal lab values (getting hangry a lot)
  • Depression
  • Anxiety, often accompanied by panic attacks
  • Brittle hair and thinning skin/fingernails
  • Not feeling rested despite a full night of sleep
  • Feeling “wired” and unable to relax
  • Feeling tired in the afternoon between 3 and 5.
  • Needing coffee to get going in the morning.
  • Feeling tired between 9 and 10 pm.
  •  Craving for salty food such as potato chips
  • Cold hands and feet; general sensitivity to cold.
  • Abdominal fat accumulation.
  • Generalized pain and inflammation.
  • Weight loss with more advanced cases

3. The Adrenal Fatigue Controversy

Adrenal Fatigue is increasingly common, yet there still remains an unwillingness among medical doctors to diagnose it. There are essentially three reasons for this:

1. Lab Tests are Inconclusive.
2. It is not yet formally recognized as a diagnosis.
3. There is no pharmacological solution.

“Adrenal fatigue is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms.” 

– Hormone Foundation

“Any doctor worth his/her salt understands that the term “adrenal fatigue” means mild adrenal insufficiency. The Hormone Foundation statement readily admits that adrenal insufficiency IS a real diagnosis. To me, they seem to be denying the possibility that some people might have a mild form of a real diagnosis. That’s short-sighted and excessively arbitrary.” – Richard Shames, MD

In time this will change, but what does that mean for you in the meantime?
If you suspect that you are suffering from adrenal fatigue, taking an adrenal fatigue assessment quiz is a good first step. If you answer yes to more than 10 questions may indicate that you have been under sustained stress. In the case that you have been experiencing a number of physical and/or psychological symptoms a deeper assessment of your Diurnal Cortisol levels may be appropriate.

4. Recovering From Adrenal Fatigue

The Approach to Adrenal Fatigue in short:

Diet Modification: Eating a diet rich in fruits, vegetables, whole grains and legumes that provides antioxidants and nutrients is essential for adrenal health (i.e. an anti-inflammatory diet).  The adrenal glands need a good diet rich in B vitamins, vitamin C, zinc and magnesium. Eating quality protein at each meal allows the body to maintain healthy levels of blood sugar without taxing the adrenals. Eliminating caffeine and alcohol is also crucial.
Lifestyle Modification: In a word, Stress Management. With adrenal issues stress management is vital to any treatment. Proper sleep, stress reduction techniques such as deep breathing or meditation and exercise can all increase the body’s ability to handle stress.
Supplementation: providing extra nutrition through a multivitamin, increasing minerals available to our system through the use of raw sea salt, and using adaptogens to help balance your hormones and manage your stress response.

Be gentle with yourself.  Give your body the permission and time that it needs to heal. 

What is Rotator Cuff Syndrome?


 The rotator cuff is a group of muscles and tendons that surround the shoulder joint.  It keeps the head of the humerus firmly within the shallow socket of the shoulder. A rotator cuff injury often causes a dull ache in the shoulder.  This often worsens when you try to sleep on the involved side.

A wide variety of techniques can be used to address Rotator Cuff Syndrome. These include sports massage, myofascial release, assisted stretching, extremity adjustments, and appropriate home care.

Understanding Rotator Cuff Syndrome

1. Common Causes of Rotator Cuff Injuries

Rotator cuff injuries occur most often in people who repeatedly perform overhead motions in their jobs or sports. Examples include painters, carpenters, and people who play baseball or tennis. The risk of rotator cuff injury increases with age.

Many people recover from rotator cuff injuries with physical therapy exercises.  These attempt to improve the flexibility and strength of the muscles surrounding the shoulder joint.

Sometimes, rotator cuff tears occur as a result of a single injury. In those circumstances, medical care should be provided as soon as possible. Extensive rotator cuff tears may require surgical repair, transfer of alternative tendons, or eventual joint replacement.

2. Symptoms of Rotator Cuff Syndrome

The pain associated with a rotator cuff injury may:

  • Be described as a dull ache deep in the shoulder.
  • Disturb sleep, particularly if you lie on the affected shoulder.
  • Make it difficult to comb your hair or reach behind your back.
  • Be accompanied by arm weakness.
Many types of Shoulder Pain begin with a rotator cuff imbalance.  Frozen shoulder, impingement syndrome, and rotator cuff syndrome all often harken back to a rotator cuff muscular imbalance.  

3. Risk Factors for Rotator Cuff Syndrome

  • Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears most often affect people older than 40.
  • Certain sports. Athletes who regularly use repetitive arm motions, such as baseball pitchers, archers and tennis players, have a greater risk of having a rotator cuff injury.
  • Construction jobs. Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that damage the rotator cuff over time.
  • Family history. There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.

4. Complications & Prevention

Without treatment, rotator cuff problems have the potential to cause permanent loss of motion or weakness.  They may also result in progressive degeneration of the shoulder joint. Although resting your shoulder is necessary for your recovery, keeping your shoulder immobilized for a prolonged time can cause the connective tissue enclosing the joint to become thickened and tight (frozen shoulder).

If you are at risk of rotator cuff injuries or if you’ve had a rotator cuff injury in the past, daily shoulder stretches and strengthening exercises can help prevent future injury.

What is Runner’s Knee?


Runner’s knee hurts, limits your mobility, makes it hard to get comfortable, and takes forever to heal.  The term runner’s knee is sometimes used a bit loosely.  It may be used to describe either tendinitis of the Ilio-tibial Band (ITB) tendon where it attaches on the lateral side of the knee.  More often it is used to describe patello-femoral syndrome which describes tendinitis and pain related to the patella and its surrounding/supportive structures.  Both are caused by repetitive overuse and what may be described as inappropriate stress on the knee.  

A wide variety of techniques can be used to address Runner’s Knee including: sports massage, myofascial release technique, assisted stretching, extremity adjustments, orthotics, and  appropriate home care.

What Do you Do about Runner's Knee?

1. Running Surface Matters

As we run there is a fair amount of force generated by the impact of our feet striking the ground.  Depending of the firmness of the ground, more or less of that force is transmitted up through and absorbed into our bodies.  That force is absorbed into our ligaments, tendons, muscles, and ultimately the discs in our backs.

You can think of there being a hierarchy of stress.  

  • Concrete:  Concrete is the worst.  It does not have any give.  If you are trying to aggravate your back or give yourself shin-splints, go run on concrete. 
  • Asphalt:  Asphalt is better than concrete.  There is some space between the particulates and there is a bit of give under your weight, especially when it is warm outside.
  • Track:  It was made for running.
  • Turf/Trail:  These are ideal as long as you have good balance & coordination.  The natural springiness of the earth is what we were made to run on, and it will absorb a fair amount of force.  If your balance is questionable, you may sprain an ankle.
  • Sand:  This is heaven if you can stand it.  It absorbs force, provides resistance, and the shifting surface is great for proprioceptive stimulation (improving balance).

2. Arch Support for Runner’s Knee

Poor arch support is the root of many of the problems that we suffer in the legs, knees, ankles, and feet.  You can think of the entire lower extremity as being one big sheet of connective tissue.  Inadequate medial arch support causes most people to pronate (feet roll in when walking/running) which rotates the hips and knees putting excess stress on many soft-tissues including the ITB.  Excess stress leads to inflammation.  Tendinitis literally means inflammation of the tendons.

3. Stretching for ITB Syndrome

The IT Band is the great human design flaw.  It crosses too many joints for us to stretch it effectively, and it gets tight from just about everything that you do.  The list of activities that aggravate the IT Band is extensive:  sitting, standing, walking, running, crouching, you get the idea.  If you are breathing and not in a half-fetal position, your IT Band is probably getting tight.

The ITB is very hard to stretch (but here’s a good one), but the combination of foam rolling and using a lacrosse ball on the TFL and Glut Minimus is quite effective.  If your tendon is already inflamed ice, rest, and kinesio tape go a long way.  For chronic ITB issues, you might consider arch support and an ITB strap.