Dr. Brian Fuller is a Chiropractor and Kinesiologist practicing in Chicago and Oak Park, Illinois. What follows is the story of one of his more amazing patients.
Kris Lenzo asked for my help to solve a shoulder pain problem he had while dancing with a professional company here in Oak Park. He asked me if I could reduce his pain and keep him away from the surgeon–he had a chronic rotator cuff tear from eight years ago. “I’m having sleep trouble too,” he told me.
The thing is, Kris is not a typical patient. He lost both his legs when he was 19 years old–the result of goofing around with a box compactor in the factory where he worked. A bilateral leg amputation above the knees saved his life.
He’s led an astounding life since.
A former member of Team USA in both wheelchair basketball and track, Lenzo is now an accomplished dancer. In digging deeper into his current passion for dance, he told me his story of how he fell in love with movement.
“There’s a school, the Academy of Movement and Music, in Oak Park. My daughter was a preschool student there,” he said. “At my request, they built a ramp and made other renovations to make the building more wheelchair accessible. They got a grant to hire a composer to create an original piece with a dance company the school was affiliated with. They wanted a dance featuring students and family members with and without disabilities to commemorate the school becoming wheelchair accessible. I was not enthused when they asked me. But I felt obligated, and my youngest daughter, who was five at the time, wanted to do it.”
To Kris’ surprise, he ended up thoroughly enjoying it: “The experience with my daughter was great, she was so focussed and attentive. I loved how the piece came together. The composer came to all the rehearsals and played the piano and watched the dance, it was amazing to see how it evolved from nothing into a performance piece.”
Dance has been his obsession ever since.
Kris is a big guy, very athletic and works out three times a day, if not more. His heart rate, blood pressure and resting heart rate are all high, not what I want to see in my patients. I introduced him to the WHOOP Strap after digging deeper into what seemed to be a straightforward musculoskeletal issue. As with many patients, the pain is usually just the tip of the iceberg and the deeper we go into his history the more complex the picture becomes. I decided I needed more data to answer some important questions about his ability to regulate his autonomic nervous system. I felt that the WHOOP Strap would do just that.
Discoveries: Monitoring Patient’s Strain
As soon as Kris wore the WHOOP for two weeks I could start seeing that his Strain was extremely high in comparison to his Recovery and the amount of sleep that he got. The big thing that I wondered was why does his Strain get so high so quickly? Why does his heart rate variability take a hit from just a trip to the office and not longer workouts on the bike?
The first idea that I am exploring is that as a bilateral amputee, his circulation volume is different than yours and mine. The heart is designed to help circulate blood through your body every 16 seconds. But for him, because he has no legs, it’s maybe every 7 seconds. Thermodynamically, if he generates a little bit of heat, he can’t blow it off as fast as you or I can. His heart has to work twice as hard to pump the blood through his trunk to benefit from any cool down effect of circulation. This delayed cool down effect from less circulatory volume may result in a heart that has to work longer and harder to achieve proper temperature regulation.
I believe reducing the strain on Lenzo’s heart can also help alleviate the pain in his shoulder. In Applied Kinesiology, the heart is related to the Subscapularis muscle. This is a key shoulder stabilizer and if there is any heart stress it is safe to say shoulder stability will be compromised.
Solution: Cooling the Body?
As a result of analyzing the WHOOP data, I suggested that Kris start taking cold showers to lower his body temperature after working out and to follow the advice that the WHOOP algorithm had for him on when to push and when to rest. To date, I am seeing a positive effect. It is helping him reduce his overall Strain, and in turn assisting in his Recovery.
Additionally, one of Kris’ complaints was that after he danced all day he couldn’t sleep the next night. It took him two days to return to his normal sleep level. I wondered how much of his sleep is also related to the way his body regulates temperature? I’m kind of on new ground here in terms of understanding the connection between sleep, temperature, heart rate variability, and rehabilitating his shoulder. However, I do think it is linked to Kris’s core issue of how hard his heart is working and how his temperature management, via his autonomic system, is compromised.
Results: Improved Behavior Change
“I’ve been working on my sleep, it’s getting better. Overall I’m trending in the right way,” Kris told me. However, he admits he doesn’t always follow what his WHOOP Strap suggests: “You wake up red, do very little that day. Yellow, maybe this kind of workout is OK, but avoid this kind. Green, all systems go. I wake up and I hope my Recovery is green. I listen to it as much as I can, but if I’ve got a rehearsal, or if I’ve got to do something I’m like ‘well… I’m doing it anyway.’” On those days, I tell Kris to try to at least make an effort to get more rest afterwards.
Changing people’s behavior outside of my office is the most difficult thing to do. People are in my office because of the small choices they make that add up over time. Sometimes my job is a slam dunk. After 15 years of private practice, I get to see each patient more and more as an expression of how their nervous system functions under increasing strain and challengers. That’s the reason why I recommend WHOOP to all of my patients. It’s extremely useful in communicating the big movers of health; sleep, exercise and energy metabolism or diet. Having the ability to see their data before they come in is really, really helpful.
Takeaways for WHOOP Users
We like to think of injuries as isolated issues and we hope to see direct correlations between actions like rehab and outcomes like decreased pain. Unfortunately, It can be tough to understand cause and effect, particularly when there are so many variables in play. Many WHOOP athletes partake in behavioral micro-experiments, particularly around Recovery modalities such as cold showers, massages, and supplements. Monitoring how they impact your metrics on the WHOOP system can be helpful to gain a better understanding of your own unique physiology.
It’s also important to look at your overall trends versus your daily stats. For example, has your HRV been consistently low for an extended period of time? Has you Deep Sleep diminished ever since you moved into a noisy apartment?
When you identify a positive or negative trend in your WHOOP data, you can then search for concrete factors that are influencing this trend, and experiment with behavior change to improve your performance results.
For Kris, we identified a specific time and place that significantly spikes his Strain to then ask questions about his physiology moving in a wheelchair. Ultimately, WHOOP enables the user to see further into your physical life and conditions like never before.