Are You In The Right Office?

A common question I frequently ask my patients is:  Are the people you’re trusting with your healthcare decisions really a ‘healthcare’ provider?  Seems like a pretty simple question, right?  The problem is that we’re living in a day and age where the lines between ‘healthcare’ and ‘disease management’ are terribly blurred.

For example, on my case history form, I have a section that asks:

What medications(s) are you currently taking?

Then, it asks about their vitamins and is followed by a question that asks:

How would you describe your overall health?     Excellent     Good     Fair     Poor

I’ve been in practice for nearly two decades and it still surprises me to see patients who may take a half dozen or more medications (and no vitamins btw) but describe their health as “Excellent.”  Why?  Because the commercials on TV tell them that if they want to be healthy, they have to take this or that medication.  Because the people that they trust tell them that if they don’t take the medication, they won’t stay healthy.  The problem with both scenarios is that medications are not vitamins.  Whether helping to marginalize your symptoms or not, they’re still toxic and have side effects.  Further, I propose that if you are taking medications, prescription or otherwise, to manage a chronic illness, you’re definitely not in “Excellent” health.  A healthy person doesn’t need medication.

Nowadays, advertising has sold you on the notion that medicine is health.  It’s not.  Medicine is disease management and disease management is not the same thing as healthcare.  Now, I’ll be clear.  Modern medicine is a marvel of crisis care and intervention saving countless lives every year.  But you have to understand that it really stinks for chronic illness.  That’s why so many chronic illnesses are on the rise like cancer, heart disease, and diabetes, despite miraculous advances in medicine and technology.  The interventions we turn to in these illnesses just aren’t helping us to become healthier.

So, how do you know the difference between the two?  Here are a few clues:

You develop some sort of symptom and go to your doctor.  Your doctor performs all the tests, as appropriate, to determine the nature of your issue.  If he/she then:

 

  1. Gives you a pill (Disease Management). This is symptom control.  The pill does nothing to necessarily improve your health but it does at least manage your symptoms enough to make you comfortable and/or prevent you from becoming sicker or even dying.  That being said, all medications are toxic and have variability of side effects.  So, while you’re directly managing the symptoms of your disease, you may actually be compromising your general health in the long run.  So many meds are tough on your liver, kidneys, digestive system, heart, nervous system…etc.  Not only that, many medications breed dependency, meaning that if you take it long enough your own body chemistry may never recover.
  2. Hooks you up to some sort of gadget or gizmo (Disease Management). I run a chiropractic office and we routinely use passive therapies like electrical muscle stimulation and ultrasound to help decrease a patient’s pain.  But this type of intervention is also not healthcare.  It’s pain control.  It’s disease management.  A TENS unit, on its own, does nothing to improve your general health.  It just temporarily covers up your symptoms.  The same can be said for back braces, orthotics, and even hot packs.
  3. Tells you it’s “normal” for your age (Disease Management). Now, this is a total cop-out.  Not only is it false in too many cases, it steals a patients hope and gives them a crutch to justify their illness.  Your body is designed to be healthy.  It will fight with every fiber and molecule of your being to resist disease and stay alive.  So, at what point does “dis-ease” become normal?  Always be wary of anyone who tells you that.  In many cases, what it really means is:
    1. “I see this a lot but don’t have much experience with helping people with it.”
    2. “I don’t know what’s wrong with you. (Here’s an antidepressant.)”
    3. “I don’t know if a referral will help.”
    4. “I’m too busy to help you fix it.”
  4. “Pops” your back when you’re in pain (Disease Management). As a chiropractor, this one also strikes particularly close to home and so many of my peers operate their offices this way:  “Just give me a call when you’re have problems again.”  Seriously?  I thought as chiropractic physicians, our mission was to educate and keep the patient healthy, not just pick up the pieces after everything falls apart.  We should not be mimicking a failing model of disease management and you should expect more from your chiropractor.
  5. “Pops” your back when you’re doing well (Healthcare). Chiropractic care has been shown to help improve a patient’s health above and beyond just pain management.  The problem is that most patients who see a chiropractor for pain don’t maintain their alignment and functionality after the pain subsides.  How can you expect to be at maximum health when your pain levels are never truly stable?  You can’t have consistent health when your pain is in flux.  My experience has shown me that the patient gets the most health benefits from adjusting once they are out of pain.  And, ironically, it’s much easier to keep a person well than get them well.
  6. Tries to help you make meaningful lifestyle changes (Healthcare). Maintaining and restoring health is not mystery.  It’s largely about the choices you make, good or bad.  Truthfully, most people know what they need to do to stay healthy, but they still fail.  Why?  Because becoming sick is easy.  Anyone can do it.  But not everyone will stay healthy.  Additionally, most people don’t have a support system and they’re turning to the wrong people for healthcare advice.  Too many people turn to a disease management provider for healthcare advice.  That’s like asking an electrician about why your sink is backed up.  Listen, I’ve said it before.  Maintaining optimum health is about 6 things: Proper Diet, Exercise, Stress Management, Proper Sleep Habits, Limiting Toxic Exposure, and Healthy Nervous System Function.  But, you may not know how to do those things well.  You need a healthcare provider.  You need a coach.

If all you’re getting from your doctor is a pill or procedure and you’re trying to get your health back, I hate to break it to you: you’re in the wrong office.  If, however, your provider is spending time with you to council you on better nutrition, help you with exercising better, and work with you to better your lifestyle, then you’re on the right track and in the right place.  Think about it.  Almost all of us have a disease management provider, but how many of us have a healthcare provider?  If you can find a good one, you may even surprise yourself at how healthy you can become.

Pregnancy Related Back Pain: Real Solutions

This is the most amazing thing to happen to you!  Congratulations!  Few things will change your life more than having a child.  It’s a joyful time for you, filled with anxious excitement and planning.   While you relish this 9 months and the anticipation of your baby, there was one thing you weren’t planing on: pregnancy back pain!  Ugh!

Pregnancy related back pain is an extremely common complication of pregnancy. Some estimates place as many as 61% of women as experiencing low back pain while carrying their child.  That being said, there are many practical conservative solutions to the stress on the low back that occurs while pregnant.

So, why does a woman develop low back pain? Well there is the obvious answer that with added weight, comes added pressure on the joints. True, the average woman, in a healthy pregnancy, gains 25-35 pounds on average. However, there is more the back pain it than a simply weight gain.

Many women describe pregnancy related low back pain as back pressure, pain across the back, or pain in the hips. Additionally, they may report achiness, stabbing, burning, or instability in the low back.   Regardless of the description, the causes of pregnancy related low back pain are many and include:

  1. Increased weight gain – as your body increases in weight, increased stress is applied to the joints. Gaining the typical 25-35 pounds in a period of 9 months is a relative rapid weight gain, and change your body may have difficulty adapting to. Generally, the impact of weight gain will be affected by general health going into the pregnancy and other factors such as core strength and exercise levels. While healthy weight gain should not generally be discouraged, there are ways to get the body to adapt better to the increased weight, minimizing stress to the joints and maintaining full function of the back through the duration of your pregnancy.
  2. Changes in weight bearing – Generally, most of the weight gain during pregnancy is in the stomach causing the center of gravity to shift forward. While non-pregnant individuals will generally have a center of gravity that is somewhere over the mid-pelvis, pregnancy causes trunk weight to shift forward. This forward weight bearing can cause an increase in the curvature of the low back leading to cramping as the back muscles struggle to support the weight of the abdomen. Additionally, forward weight bearing stress the sacroiliac joints, those tailbone joints that work with the pelvis, to cause sacroiliitis.
  3. Changes in hormones – As your body approaches its due date, your body will start to produce hormones which will increase flexibility. While the hormones do allow for increased motion in the pelvis to allow for birthing, they also make it more difficult for the pelvis and low back to stay in proper alignment, leading to increased instability and pain. Pain may come and go as the pelvis and low back shift and move more easily, resulting in low back irritation and pain.

So, you have low back pain from your pregnancy, what can you do? There are a lot of conservative interventions available to help your deal with your back pain. Some can be accomplished on your own, others require the help and intervention of others. Here are a few suggestions:

  1. Weight bearing exercise – A moderate amount of walking will help keep postural muscles strong and improve circulation to affected tissues. Additionally, walking will help improve motion in the pelvis which should, in turn, decrease the likelihood of joint instability, asymmetry, and misalignment of the pelvis.
  2. Stretching – Later in pregnancy, your body does produce hormones that increase joint flexibility and make birthing possible. However the degree to which flexibility improves often depends on pre-pregnancy range of motion. It’s been my experience that many women have developed such muscle tightness before pregnancy that the relaxing hormones can’t even get those individuals to normal ranges of motion. Your body is designed to have a certain level of flexibility that we lose due to life circumstances. Maintaining and improving that flexibility will help decrease the stress on your low back and pelvis. Often, stretching areas you would not associate with your back can even help, such as hamstrings, upper back, and hips. Sitting on an exercise ball and rolling the hips or laying on your back and using the ball to roll the hips back and forth are great exercises for improving your back pain. There are also yoga programs for pregnancy that are available. True, you may not be able to do every pose, but working on your range of motion is generally a good idea.
  3. Improved diet – Of, course, it should go without saying that you should be eating well during your pregnancy, and I’m not talking about volume but quality. After all, you are eating for two now. You should be eating whole foods free of artificial ingredients. Not only will you be healthier for it but your baby will thank you. Improved nutrition will increase nutrient supply for the muscles, ligaments, and tendons of the back. Good food will decrease the likelihood of muscle spasms due to nutritional deficiency.   Avoid excessive carbs/sugars because they can be pro-inflammatory and contribute to inflammation in the joints. Also, watch your water intake. Dehydration can also lead to muscle spasming and soreness in the soft tissues. Finally, a whole food pre-natal vitamin should be part of any regimen to help fill the holes in your diet, not to mention prevent possible birth defects.
  4. Stress management – Mental stress causes physical distress. True, your low back pain is most likely due to the physiologic changes you’re experiencing with your pregnancy but mental stress can take a physical problem and make it that much worse. Pregnancy in and of itself can be a trying time mentally, especially for single or first time mothers. Finding an outlet or your stress, such as exercise or even counseling will help your body adapt better.
  5. Improve your body positioning – Being conscious of your posture and taking active steps to alleviate the stresses on your back may improve your pain symptoms. This may include everything from sleeping on your side with a pillow between your legs to using pillows to support the back and legs while you’re sitting. Back supports may also help.   Avoid standing or sitting in one position for too long and try to get moving as much as possible.
  6. Massage Therapy – Because much of the pain experienced during pregnancy is due to tension and stress on the muscles, soft tissue mobilization may help alleviate a portion of the pain. Massage therapy will help relax tightened muscles, improve circulation to the tissues, and promote a general sense of well-being.
  7. Heat or ice – While many sources will include hot baths for relieving pain, I will generally discourage that for my patients. In fact, many physiotherapy resources discourage the application of heat over the abdomen as a contraindication during pregnancy. I generally tell patients to use a regional warm pack over the back for no more than 15-20 minutes. It can be repeated but allow about an hour or so for re-application. I want the patient to avoid increasing their resting metabolize temperature and the goal isn’t to cook the tissues. A warm pack can often provide just as much effect as a hot pack, with less risk. A microwaveable heat pack or hot water bottle will generally suffice to ease tension in the low back without the danger of overheating the area. As a general rule, avoid placing heat or ice over the abdomen while you’re pregnant.
  8. Kinesiotaping – This is an athletic taping technique that has been gaining popularity in recent years. Kinesiotape is being increasingly used by professional and amateur athletes to help alleviate pain and improve tissue healing. It’s safe to use during pregnancy because it does not use any drugs and is strictly a cloth tape with a skin adhesive.  In fact, there are specific taping regimens for pregnancy, to not only alleviate low back pain, but possible abdominal pain associated with carrying your baby. To be effective, though, the tape should be applied by an individual with training and experience in kinesiotaping. There is a certain art form to its application. It can, however, offer notable decrease in pain and improved stability in the back, hips, and abdomen.
  9. Proper spinal alignment – Arguably one of the most important aspects of decreasing pain in your back, I saved this for last. Proper alignment of the low back will decrease pressure on pain sensitive nerves, improve motion of the joints of the low back, decrease stress on the soft tissues, and improve overall function of the low back. Chiropractic care has been routinely shown to be safe and effective for relieving the back pain associated with pregnancy. Spinal adjusting has also been linked to improved labor and delivery. There are certain medical conditions that may be a contraindication to chiropractic care but, for most women, chiropractic care can be very effectively incorporated into a pain management regimen. In my office, I will frequently see pregnant patients on a weekly or biweekly basis for their pain and most women will see decreased pain immediately following their adjustment. They also will report improved ability to sleep, decrease generalized soreness, and an improved ability to function. In my opinion, chiropractic adjusting should be incorporated for most women with pregnancy related low back pain.

If you are struggling with pregnancy related low back pain, there are solutions out there for you. Perhaps the best place to consult about your back pain is with someone who sees a lot of back pain patients, like a chiropractor. Besides adjusting your spine, they can provide you with additional tips and tricks to alleviate your pain.

Has your doctor suggested pain medication to you? Always ask better questions. The decision to take pain medication while pregnant should be a thoughtful one made with your medical doctor.  You need to know what research has been done on that medication and its effect on a developing fetus. Certain conditions like asthma and autism have risen to alarming rates, with little research done on the effects of oral medications on an undeveloped fetus. While there is little overt evidence to explain the remarkable rise in childhood illness, that is mostly the result of a lack of research. Just because there is not an established 1 to 1 relationship between a specific cause and disease does not discount an overall trend toward increasing illness due to an accumulation of exposures. I don’t think it’s an accident that autism rates have risen to 1 in 88 kids. Too much of the research focuses on, and debunks, a single specific cause like vaccination and I fear conditions like autism are not due to a solitary cause but a series of toxic exposures over time. Unfortunately, there is very little research on the effects of pre-pregnancy, intra-pregnancy, and post-pregnancy toxic exposure on the developing child. However, it reasons that the rises in childhood illness rates may be linked to the fact that our environment is as toxic as it’s ever been. Anything you put in your body that is not food is a potential toxin. That toxin can affect you and your baby. Pain medication is not food. Anything you feed your body while pregnant, your baby will respond to, either for good or bad. Try to remove as many toxins as possible from your diet and lifestyle. Turning to natural means for alleviation of your pain may make you and your baby a whole lot healthier and happier for a lifetime of wellness.

Sources:

http://en.wikipedia.org/wiki/Symptoms_and_discomforts_of_pregnancy

www.webmd.com/baby/guide/back-pain-in-pregnancy

http://icpa4kids.org/Chiropractic-Research/Pregnancy-and-Adjustments/

New Year, New You – Increasing Success With Your Resolution

As I write this blog, the New Year is just a couple of days away.  Like many people, you probably have resolutions to improve your health and your life.  So, what’s your plan?

Why do people create a New Year’s resolution in the first place?  I don’t think it’s only because it’s a new year.  I think it also has to do with the fact that so many people let themselves go over the season between Thanksgiving and Christmas that they have a burning need to reverse all the damage they’ve done in that single month’s time.

Having practiced for a decade and a half, I’ve worked with thousands of patients.  My experience has shown me that most people’s resolution generally don’t last long into the New Year.  Many either never get started with their resolution or give up on them before they experience any measureable success.   Generally, this can be traceable to a series of flaws in the implementation of their own resolution, including:

1.       Not having a plan

2.       Being unrealistic with their expectations

3.       Creating to broad sweeping of a change too quickly

4.       Not having a start date

5.       Not sticking with it

6.       Not outlining realistic goals

7.       Not working with a healthcare provider or coach

While many people claim to have resolutions they plan to implement on January 1st, most of these changes turn out to be only ‘pot-shots’ in the dark with no direction or end in mind.  Sure, you want to eat better.  Sure, you want to get more exercise.  But, in order to be truly successful in your lifestyle change, you have to be crystal clear about your goals and have a bullet-proof plan detailing how to accomplish them.  Here are some suggestions to help you become more successful at realizing your resolutions:

1.       You need a plan

You know the saying, “No plan is a plan to fail.”  You have to have a plan.  An architect doesn’t build a house without a plan.  A CEO doesn’t grow a company without a plan.  The Marines don’t invade a beachhead without a plan.

I would argue that most people who say they will eat better really have no idea what that means or how to really accomplish it.  They say they will get more exercise but don’t know or understand the types of exercises, the frequencies they should exercise, and how to exercise safely.  To just say you’re going to change this or that is not a plan. You need to write it down.  You need to write down where you are starting, where you would like to be, and how you are going to get there.  You need to set realistic goals and create benchmarks along the way in order to get to your target.

2.        Be realistic with your expectations

Unfortunately, many people either give up or never even get started with their resolutions because their expectations are not based on reality.  A 50lb. weight loss in 4 weeks is not healthy or realistic.  Going from a couch potato to running marathon in a month is not realistic.  Going immediately from eating nothing but junk food to eating only fresh foods is also not realistic.  Your ability to be realistic with your expectations can determine your success or failure with your plan.

If you haven’t exercises in years, an hour on an elliptical right away may be too much for you.  If you only eat junk, a dramatic change to a whole food vegetarian diet is not realistic.  If you are under a lot of stress, completely withdrawing is not in the cards.  You need to implement the changes you are about to make with slow measurable steps.  After all, the saying goes, “The journey of a thousand miles begins with a single step,” not a jump off a cliff.  Step by step, steady but sure, you can reach your goals in time, but not all at once.

3.        Don’t try to change too much too fast

Creating too drastic of a change in too short of a time breeds resentment and will sabotage your success.  For example, if you are the type or person who starts the day out with an energy drink and a couple of donuts, an immediate drastic change to healthy foods, while good for you, will create a mental barrier and sabotage your success.  You can’t expect to set up something that you may perceive as a ‘punishment’ and expect to develop success from that.  Further, the withdrawals from a junk-food lifestyle will make you irritable and lethargic, jeopardizing your success.  Instead, from the outset, have a realistic expectation that you can’t just quit your addiction to junk food cold turkey.  You’ll have to wean yourself off of them and wean yourself on to healthy food.

Perhaps a good place for you is to start adding rather than taking away.  Instead of stopping the donuts right away, add some celery.  Add a salad.  Start increasing you consumption of good stuff before you get rid of the bad.  You’ll definitely be boosting your nutrition, while easing your transition to a healthy lifestyle.

4.        You need a start date

Not having a start date is like not having a plan.  It will increase your risk for failure.  Instead of saying I’ll eat better tomorrow or after the holidays, you need to say “on this date I will start my change.”  You also can’t say I’m going to start this when “I get the time.”  If you do, you’ll never have the time.  Being health isn’t about having the time it’s about making the time.  That being said, the time to start isn’t now.  It’s on the date that you set for yourself.  January 1st is generally a good day to begin.

5.        Never give up

Have you ever regretted giving up on something before your success was realized?  Have you ever said to yourself, “Maybe I should have given it more time?”  Well, being successful with any change requires a small investment of time but a realistic one.  In my experience, it generally takes a person about 3 weeks for a lifestyle change to become a habit.  In other words, if you decide to take up walking, as an example, it will take about 21 days for that change to become a habit.  Have you ever quite on day 3, day 10, or even day 20?  You have to stick with it.  Just because the results are slow does not mean it’s not working.

6.        You have to have clear goals

Not having crystal clear goals is like not knowing where you’re going when you’re traveling.  You’ll spend an awful lot of time getting lost and hitting dead ends.  Another analogy is playing a sport and not keeping score.  You won’t know whether you’re winning or losing.

If you don’t have a clear goal, how will you know whether you achieve it or not?  For example, “I’m going to lose weight after the New Year” is not a clear cut goal.  “I’m going to lose 20 pounds in 30 days” is far more clear.  Here is an example of clear cut goals:

“In 6 months, I would like to run my first half marathon (end goal).  To accomplish this, I must hit several benchmarks along the way.  To begin, I will move away from my sedentary lifestyle and begin walking daily starting at 20 minutes.  As walking becomes easier, I will transition to running but I will set a benchmark to be able to run 1 mile within the next 30 days.  I will slowly increase the distance over the subsequent month to set my next benchmark of 3 miles.  By month 3, I would like to be running 5 miles.  By 6 months, I will have worked my way to my goal of 13 miles.”

You see, setting a clearer goal makes it much more achievable.  By setting intermediate benchmarks, you have also established a plan.  And remember, no plan is a plan to fail.  So, begin with the end in mind.  Set your goals and achieve them.

7.        You need guidance

I know you think you may have the answers you need.  To be true, everyone knows they need to eat better and get more exercise.  The problem is, how do you do that safely and effectively and will you stick to the plan?  You need a coach.  Whether it’s a personal trainer, nutritionist, or chiropractor, a coach adds two critical components to your lifestyle change:  accountability and direction.

A coach will make sure you are dong what you’re supposed to do so that you succeed.   If you only have to answer to your own conscience, you are more likely to fail.  By adding a coach, you are making yourself accountable to someone else.  Now, you will not only let yourself down if you quit, you’ll let your coach down.  The impact of accountability can be huge.

A coach will also offer guidance.  Sure, everyone knows to eat better and get more exercise, but what types of food?  What types of exercise?  How often should you eat or exercise?  What should you avoid?  Are you doing something that may be unsafe or unhealthy and not even know it?  Adding a coach adds an objective third party that can evaluate your routine an increase your odds for success.

Now, make sure that the person you are taking your health advice from is a reliable health source.  Unfortunately, many of the people we turn to for health advice are either unhealthy themselves or really specialize in disease management.   Being healthy is not the same as symptom control.  Everyone has a provider they turn to when they are sick.  Who do you rely on to help you stay healthy?

Stop taking ‘pot-shots’ in the dark, hoping you’ll accidentally find health.  Rather, outline a clear cut plan, with realistic goals, and stick with it.  You can be healthier than you know but you need to make the decision to be healthier and outline a definitive plan with crystal clear goals you can realistically achieve.  To be sure, health is a journey not a destination, but without a map, how will you know how to get there?   Use this New Year to finally realize the truly amazing innate health potential being suppressed inside you.  Make this the year of a new you.  Healthy New Year!

Fat and Happy or Fit and Healthy

There is an old expression that describes contentment as “sitting fat and happy.”  Our modern lifestyle seems geared toward having both, often at the expense of your health and longevity.  While the United States has one of the most sophisticated healthcare delivery systems in the world, we rank 37th in overall health according to the World Health Organization.  Why is that?

Look around you.  We live in an age that is designed to sabotage our health.  Cheap, poor quality food is readily available at every turn.  Our jobs are slowly moving away from physical labor toward a computer driven economy that inhibits exercise.  We even have moving sidewalks.  So, the question becomes is “sitting fat and happy” the picture you had for your life?

Let’s look at the results of a sedentary lifestyle.  There are endless known effects of lack of exercise and poor diet, including:

1.        Increased risk of heart disease

2.       Increased risk of diabetes

3.       Increased risk of cancer

4.       Increased risk of stroke

5.       Decreases immune system

6.       Sleep difficulty

7.       Depression

8.       Digestive problems

9.       Decreased life expectancy

10.   General decline in health

The “fat and happy” lifestyle is a recipe for disaster.  While you may enjoy temporary satisfaction, you are setting yourself up for long-term failure.

Unfortunately, many people are led to believe that being healthy is out of their reach.  They’ve been told that illness is just inevitable and they are destined to suffer the rest of their life with some form of chronic infirmity.  Worse, many of the people telling them this are the very people they trust with their health decisions.

The truth is exactly the opposite and you have more power than you know.  Being healthy is a choice as much as being sick is your decision.  Your body is a self healing machine and functions optimally with adequate fuel and proper maintenance.  Further, where you are in your health right now is more likely a reflection of the decisions you have made up to that point rather than an accident of genetics or fate.  The biggest detriment to being healthy may be you.  Lack of exercise, poor diet, high amounts of stress, and poor nervous system health all contribute to a decline in your overall well being.

If we’re told that as we age getting sick is normal, does that make the 90 year old healthy individual on no medications abnormal?  When did sick become the new normal?  Where you are in your health is a product of the choices you make, a cause and effect.  If you choose to exercise or not, there will be an effect.  If you choose to eat junk food or vegetables, there will be an effect.  If you are able to manage your stress or not, there will be an effect…and so on.

Disease does not occur in a vacuum.  It’s the deliberate result of years of poor decisions and neglect…years of “sitting fat and happy.”  You need to understand that the decisions you make now about your health may determine whether you spend the later years of your life sick and tired or fit and healthy.  The decisions you make now may even shorten or prolong your life.

Even if you are sick, there are ways to restore your health.  No, taking ibuprofen for pain, an acid reducer for acid reflux, or an antibiotic for a sinus infection does not make you healthy.  You can’t get health from chemicals in a bottle.  Medications are only designed to alter body functions in order to manage a disease process…cause and effect.  They are not vital nutrients.  In other words, you’re still “fat” (or, more appropriately, sick) but at least you’re happy.  Health can only come from one place…from inside you.  The decision you have to make is whether you are willing to make the good decisions to take care of yourself as an insurance policy for your future.

The ironic thing about health is that most people know what they need to do to be healthy.  They know they need to stop eating the junk.  They know they need to eat more fruits and vegetables.  They know they need to get more exercise.  They know they should take care of their spines.  Many of the patients I talk to even know that the medications they take are not the solution they are looking for.  Still, they choose not to do anything about being well and prefer to live “fat and happy.”

Each day is a new cross-road in your life.  Each day, you have the option to take care of yourself or not.  Keep in mind that every day you choose not to act builds upon the next.  Ultimately, you need to decide for yourself whether you are going to live each day “fat and happy” or fit and healthy.

Limitless Choices: Finding The Exercise That’s Right For You

When it comes to exercise there are almost limitless options available.  With so many choices, people are often left guessing which type of exercise is right for them.  Facing this decision, there is a lot to consider, including:

1.        What are your goals?

2.       What are you physically able to do?

3.       What form of exercise will fit in your time constraints?

4.       What do you enjoy?

5.       What can you afford?

What are your goals?

This question is probably one of the most neglected when starting a successful exercise regimen.  To truly succeed and be consistent with your exercises, you must begin your goals in mind.   Which of the following is most important to you?

1.        Flexibility

2.       General Muscle Strength

3.       Endurance

4.       Overall muscle definition

5.       Core muscle strength

6.       Weight loss

Becoming clear on your goals will help point you in the direction of the exercise or exercises that will most allow you to accomplish those goals.  So, you have to consider what’s possible given the following primary exercise forms:

1.        Range of motion exercise – This form of exercise can include yoga, pilates, generalized muscle stretching, Tai Chi, or Qi Kung.  Range of motion exercises are ideal for that person who is looking to regain flexibility and decrease stiffness.  Generally, a person who suffers from stiffness or generalized soreness should include some form of range of motion exercise, though this form of motion is ideally suited for anyone.  Flexibility exercises will help lengthen tight muscles, decrease stiffness, and improve overall range of motion.  A weakness with this form of exercise is that it generally does very little to improve cardiovascular tone and may only minimally improve muscle strength.  Weight loss is also nearly impossible with range of motion exercises alone.

2.       Strengthening exercise – Building muscle strength is an extremely popular form of exercise.  Generally, this includes lifting weights (free weights or machines) and any other exercise that is done against resistance.  This form of movement is extremely effective for the person looking to boost muscle strength, produce definition in their muscles, and increase muscle mass.  Weaknesses with this form of exercise are that it produces very little cardiovascular workout unless resistance is produced with ballistic repetition (quick reps with a higher risk of injury).  Additionally, if weight loss is your goal, and it is for some, visual body changes will be a more reliable method of tracking progress than measuring weight.  Generally, resistance exercise will produce a bulky muscle mass rather than the leaner look which accompanies cardiovascular exercise.

3.       Endurance Exercise (Cardiovascular) – Probably the most important requirement for staying well is a healthy cardiovascular system.  Endurance exercises can include walking, but biking, running, elliptical, pool laps, or even calisthenics to help elevate your heart rate while boosting your exercise endurance.   This type of exercise helps to build lean muscle tone and can help to boost your metabolism, leading to increased energy.  Calorie burning is also relatively high, which can lead to rapid weight loss and generally results in a slimmed physique.  While cardiovascular exercise will help to boost your endurance, it will be more difficult to build muscle mass and short resistance to heavy load (found in strength training).  That being said, cardiovascular exercise should be a critical component of any exercise regimen as it helps to strengthen the heart and improves circulation to the extremities.  Keeping that in perspective, no one ever died of muscle weakness, but a weakened heart and circulation can kill you.

Generally a combination of all three is most ideal.  Having worked with thousands of patients over the years, I can say that flexibility exercises are the most neglected of the three major forms of exercise.  All, however, are important to improving and maintaining optimum health.   Many newer forms of exercise are emerging that incorporate aspects of all three such as cross-training, plyometrics, cardio kick-boxing, or boot camps.  There is an exercise regimen out there for you.  You just have to do it.

What Are You Physically Able To Do?

When beginning a new exercise regimen, you have to consider your own physical ability and limitations.  Not every exercise is meant for every person.  For example, a deconditioned person, not used to regular exercise, may not want to begin with a rigorous plyometric exercise.  Likewise, a person who is unable to bear weight for very long may benefit from starting with pool exercises before beginning a walking regimen.

Injuries while exercising are extremely common, usually the result of exercising beyond a person’s ability.  Two popular exercises I would also generally recommend against for most individuals are squats and dead-lifts.  Both have a very high risk of injury, usually because they’re done incorrectly, and have alternative exercises that will produce the same result with much lower risk of damage.

Exercising within a comfortable pain free range of motion is also key to preventing injury.  While the desire is to tax the tissue so as to produce a desired effect, that has to be weighed against the risk of tissue damage if you cross that line.  Exercising with proper form and being proactive about safety will give you a better workout and decrease the likelihood of having to stop your regimen due to an injury.

What  Form Of Exercise Will Fit In Your Time Constraints?

We live in a day and age where time is limited and valuable.  So, then, is your health.  With more and more people becoming more sedentary than ever before, it becomes ever more critical to incorporate an exercise regimen into your daily routine.  Simply put, you have to get moving.

The excuse I always hear is “I don’t have time to exercise.”  I need you to understand that statement is a total cop-out.  What it really means is “exercise is not important to me.”  Incorporating exercise into your regiment is a matter of priorities.  It’s always interesting how the person who “doesn’t have time to exercise” has plenty of time to watch TV, go out to dinner, sleep in on the weekends, or hang out with friends.  It’s never a matter of time.  It’s a matter of priorities. If it were important, you would make the time.

For those looking to be healthy, exercise becomes something that other commitments are scheduled around, not the reverse.  Ultimately, you will have to find an exercise that not only works for you but you can schedule your lifestyle to accomodate.

What Form Of Exercise Do You Enjoy?

It can truly be said that the best exercise in the world is the one you will actually do and do consistently.  With limitless possibilities for exercise, there is an exercise for just about anyone and there is some form of exercise that everyone will enjoy.  You just have to find it.

Whether, you have a knee replacement, back pain, or are just generally ill, there is an exercise for you.  So, what do you like to do?  Some like to hike while others prefer lifting weights.  Still others enjoy an evening run or a morning swim.  Finding what you love doing and sticking with it is a critical key to be successful at any exercise regimen you choose to pursue.

What Can You Afford?

This section should almost be a non-issue, because exercising is basically free.  You don’t need a fancy gym membership or home equipment to exercise.  You can go walking or running outside for no charge.  You can also make a ‘poor-man’s weight set’ out of some empty milk jugs.  Stretching can be performed in your living room and you can do calisthenics with no additional equipment.   You need to change your perspective on what it takes to get moving.  Unfortunately, many people use expense as an excuse not to exercise.  True, there are many amazing gyms and facilities where you can get a great workout, but don’t let the lack of a membership deter you from getting the movement you need to stay healthy.

Joining a gym does offer several benefits, however.  Exercising with your peers adds motivation and being away from home may decrease the likelihood that some form of distraction will take you off task.  Further, the classes offered in a gym may also guide you toward specific forms of exercise and help you exercise more safely.  The equipment available may further open options for specific exercises not possible at home.  A personal trainer may also add accountability and ensure that you exercise safely.

If you are fortunate enough to afford a trainer, choose one that most matches your fitness ideal and seems to represent your own goals.  So, a person working toward larger bulk muscle mass and definition should not necessarily choose a fairly slim, slender trainer, and a person looking to build a more feminine physique may not want a male body builder to train them.

Ultimately, the most successful form of exercise for you is the one you will actually do and continue with.  Oftentimes, people will give up on regular exercise because they feel like they don’t enjoy it.  Well with so many possibilities, find what you do enjoy and stick with it.  Only consistency will give you the desired results you are looking for.  Becoming healthy takes time and you have to invest in yourself to get the results you expect.

The Exercise Paradox: Movement Is Not An Option

Movement is not an option.  It’s a requirement.  A common conundrum that I see on a regular basis in my office is whether or not to exercise when you have chronic pain.  The correct answer is you should always be exercising.  Now, that doesn’t mean that every exercise is meant for every person and doing the wrong ones, based on your condition, may even have a negative effect on your health.  That being said, incorporating some form of exercise into your regimen is critical to maintaining your health and there is always some for of activity you can do regardless of your current health status.

Unfortunately, many people make the mistake of assuming they cannot exercise because of some form of ailment.  Generally they report that exercise “aggravates my knees” or “hurts my back.”  The problem is that the ‘no exercise’ solution really does nothing to improve that person’s health and may even be making it worse.  Your body is designed to move and the ‘use it or lose it’ rule really is directly tied to your health,

The World Health Organization has said that “sedentary lifestyle is more harmful than smoking.”  This is a fact that often does not occur to those stricken by pain or where exercise is more of a burden than a benefit.  To be honest, we’ve become a sedentary society where convenience is the rule.   It seems that every aspect of our lifestyle from computers to mobile phones is designed for convenience.  Of the thousands of patients I’ve seen in my office, I’ve noticed that being sedentary for large portions of the day can do more to aggravate a chronic pain issue than even some traumas.  Further, most exercise physiology research confirms that the sooner you can return a person to exercise, the better the long term recovery.

The reasoning for lack of exercise that many patients make is “the more I exercise, the more it hurts.”  The paradox is that the less you exercise, the more it will continue to hurt.  Worse, the less exercise you get, the more deconditioned you will become and the more your condition will advance.  You have to understand that your body is a sensory input and motor output machine.  It requires constant sensory and motor stimulation to stay healthy.  While it may “feel good” to not exercise, it is well known and accepted that prolonged immobility leads to muscle weakness, poor circulation in the extremities, increased risk of cardiovascular disease, respiratory problems, and can contribute to neurological symptoms.

For most people, a better solution is not that they can’t exercise, it’s that they need to exercise smartly.  For example, you can’t expect a person with severe arthritis in the knees to begin a walking regimen.  However, pool exercises may be a good place to start, then transitioning to a recumbent exercise bike.   Likewise, arm exercises using weights may also be a viable option to help maintain skeletal muscle tone and improve circulation to the extremities.  Either way, not exercising is not an option.

From heart disease to degenerative arthritis, exercise is possible and even necessary to maintain or restore health.  The question becomes then, what exercise is best for you when establishing an exercise regimen?  Many people just don’t know where to start when they are in pain and looking to rehabilitate themselves.  I will generally advise my patients to begin as easily as possible, exercising in a pain free zone.  While there is a temptation to work through the soreness, exercising while in pain can often aggravate the affected area and does little to rehabilitate it because the targeted muscles are guarded, your body compensating with other muscle groups.  Begin at the beginning.  Ease into any new regimen and exercise in a pain free range of motion.

Once you find a regimen you are comfortable with, begin building on that foundation.  Avoid those motions and movements that may aggravate your condition, focusing instead on the movements you are able to do well.  Over time, increase the amount of time, reps, and resistance as the exercise becomes easier.  Ultimately, you will begin rehabilitating yourself, improving your strength and range of motion via your own physical work.

Besides pain, exercise is a fundamental requirement for the person looking to become healthy and stay healthy.  In fact, your body depends on small amounts of stress in order to more adequately heal.  Movement improves circulation to the tissues which brings in oxygen and nutrients to help keep muscles, ligaments, tendons, cartilage, and even organs healthy.  Movement also stimulates nerve firing to help improve nervous system function, decreasing pain, improving muscle tone, and improving balance and coordination.  Movement against gravity will help strengthen your core and improve your posture.  Increased heart rate will also help keep your heart, lungs, and blood vessels healthy.

There is a solution for just about anyone.  Of course, the best exercise anyone can do is the one they are actually consistent with on a regular basis.  Excellent exercise habits will produce excellent results.  If you are only hit or miss with your regimen, expect corresponding results.  If you neglect exercise all together, expect illness to be an eventuality for you.

Shoulder Pain: Is Surgery Your Only Option?

In my experience, besides back pain, shoulder injuries and pain are some of the most common reasons a patient presents to our chiropractic office.  In fact, I have observed that most of my patients who suffer from chronic neck and upper back issues have at least a minor shoulder condition complicating their case.  The biggest fear with our shoulder pain patients is the dreaded ‘rotator cuff’ injury.  Why dreaded?  Because so many people have been trained to think that he only solution for rotator cuff problems is an invasive procedure.  Generally, the race to expensive, invasive interventions, in my opinion, is largely unnecessary overkill but can include pain management injections, which are generally only temporary and don’t really fix the cause of the pain, and surgery, which has a potential for risk, and recurrence of the condition. Surgery also limits additional future conservative care options in the likely event that the surgery fails.

Your shoulder can experience pain and dysfunction just like your back can.  Acute traumas and chronic stresses can lead to wear and tear on the joint just like they would in the low back.  It reasons then, if a patient can experience an excellent recovery with conservative care of their low back, conservative care of the shoulder is also a viable method of improvement.  So why, when you go to your doctor, do they so often immediately refer you to an orthopedic surgeon?  There are several reasons for this:

1.        Your doctor may not know or understand the nature of a shoulder injury.  The shoulder joint is a complex one with multiple muscular, tendonous, and neurological involvements that can affect areas other than the shoulder.

2.       A lack of understanding of how the body heals if the obstructions to the healing process are removed.

3.       A lack of understanding of the role conservative intervention can play, including chiropractic adjusting of the extremities, in helping the patient to heal themselves.

4.       Surgery is a perceived quick fix (despite the fact that surgery is not without its potential complications and failure rates).

So, you have shoulder pain…now what?  Shoulder pain is not as simple as just ‘rotator cuff damage.’  You have to understand what the mechanism of injury is, what tissues are involved, and whether there are other areas that may be contributing to or aggravating the shoulder region.  There are countless reasons a person can develop pain in the shoulder and rarely is the pain ‘just a shoulder problem.’

Your shoulder joint mechanism is an extremely complex one.  It allows for the largest range of motion of any joint complex of the body.  It has muscular attachments not only to the shoulder joint, but to the neck, rib cage, elbow, and even the low back.  The rotator cuff musculature represents only 4 of approximately 2 dozen muscles that affect shoulder function.  Did you know that the collar bone is the only one that directly attaches the bones of the entire arm to the rest of the skeleton?

In order to adequately diagnose a shoulder problem with the greatest level of accuracy, an MRI of the shoulder may be required.  While many will rely on plain film x-rays to diagnose a shoulder condition, x-rays alone don’t generally reveal the information necessary, especially for a chronic shoulder issue.  An MRI on the other hand will reveal information about all the soft tissues in and around the joint, including the cartilage.  It can even offer information as to whether the injury is acute and whether there is an active inflammatory response currently progressing.

Understanding how the shoulder functions is a key to helping it resolve.  Most injuries to the shoulder are either acute sprains or chronic overexertion injuries.  Either way, most shoulder conditions will improve with conservative care.  Now, many will argue that physical therapy is the best solution for a shoulder issue and I would agree to an extent.  Physical therapy is extremely effective at helping a shoulder condition to resolve.  However, to limit conservative care to only pain management and exercising the shoulder joint may prevent the patient from reaching full resolution of their condition.

Ideally, these factors need to be addressed when caring for a person with a shoulder injury:

1.       Misalignments of the shoulder joints need to be identified and corrected manually.  This requires the expertise of a chiropractor.  There are 3 true joints and 1 potential joint in the shoulder that must be corrected to restore full function before additional care can be rendered.  Exercising or stressing a deranged joint may actually aggravated it and slow your recovery.  The muscles, ligaments, and tendons of the joint rely on proper alignment for their proper function. Your soft tissues cannot function correctly if the skeleton is functioning incorrectly.    Only a chiropractor or, arguably, an osteopathic physician has the training and expertise to identify and correct misalignments in the shoulder with precision.

2.       Pain must be controlled.  While rendering care, there is the temptation to jump right into exercise to rehabilitate the area.  True, studies have shown that the earlier you introduce exercise, the better the long term recovery, but this has to be done within reason.  Applying stress to a guarded and deranged joint experiencing debilitating pain may aggravate the condition.  Additionally, the person is most likely not using the damaged tissue when they are in exercising the area and are, instead, recruiting other tissues to compensate for the loss.  Getting your pain under control is a critical step to rehabilitation.

3.       Exercise is critical.  Ultimately, you will have to add active exercise to strengthen the affected soft tissue damage.  Because your body lays down new tissue and builds up existing tissue according to the stress you place upon it, stressing the joints and soft tissues within reason is a critical component to resolving a shoulder issue.  It will be very difficult to expereince a full recovery without eventually adding a structured exercise regimen.

4.       Don’t ignore other associated areas.  Often, when you feel shoulder pain, you think it is necessarily only a shoulder problem.  In fact, it may not even be a shoulder problem at all.  Neck issues, upper back problems, postural issues, elbow dysfunction, and even low back pain can contribute to derangement in the shoulder.  They can both cause pin in the shoulder and aggravate a shoulder condition.  So, it’s critical that ALL these areas that interact with the shoulder also be addressed when helping you recover.

Conservative care for most mild to moderate shoulder conditions can be extremely effective.  When cared fro properly, I generally see a 90% recovery in our office in 90-120 days, depending on the type and nature of the shoulder injury.  The biggest detriment to a person’s improvement with conservative care, though, is their own impatience.  Healing takes time.  Conservative intervention for these types of shoulder injuries should at least be attempted before any invasive medical intervention is considered.