An Interesting Take on “R.A.”, aka- Rheumatoid Arthritis!

I was just visiting at home over this past Thanksgiving break, helping out, and doing Active Release Techniques®  (ART) on the hands of my highly active grandmother of 85 years young, and chatting about her issues with Rheumatoid Arthritis, commonly called, “R.A.”.  For those of you who are not aware, R.A. is an autoimmune condition.  Unfortunately the immune system goes after and attacks its own tissues, and in regards to this condition, the joints.  The immune system recognizes the cells and tissue as an invader, and is constantly attacking certain joints of the body more then others.  In the long run this ends of triggering chronic inflammation in the body, which equals pain surrounding the joints usually.

The most common form of “standard medical treatment”, our nemesis, is prednisone, BOO…  In the short run this drug can definitely reduce pain, but acts more like a bandage.  There are also many bad side affects in regards to using prednisone for the long run as well.  Many of those side affects have been made very well aware of to the general public over the past few years, including weakening the immune system.

What if we were to think outside of the box for a little bit?  Just bare with me here… Don’t you think it would be a good idea to understand where this autoimmune condition is coming from?  Can you even guess?  What are the more advanced and validated medical researchers these days saying where many, if not most conditions are coming from?  The gut, obviously!  With all of the research out there now on R.A., it is showing a huge connection between the two.

Many of you may be familiar with “Leaky Gut Syndrome”, and if you are not, it is a condition in the digestive tract where these tiny holes are created.  Factors such as poor diet and poor environmental conditions cause these little holes where the intestines are supposed to be so tightly bound together.  Bad bacteria then can freely travel and enter into the bloodstream, not good!   There are paragraphs in much greater detail about “Leaky Gut”, but this part isn’t to bore you, or more realistically, overwhelm you.  Bottom line, these factors weaken the immune system, and this is what can also lead to a multitude of food sensitivities that everyone is now talking about, and everyone now seems to have.

In regards to the use of prednisone to treat R.A., this drug also weakens the immune system as stated above.  This drug may help control the level of pain, but doesn’t it really now seem counter intuitive to use?

I was discussing with my grandmother about eating a “whole foods” diet, and trying to stay away from processed food, which she does for the most part.  How do you think she has made it this far and remained in such amazing shape?  I was also talking to her about common food sensitivities that many people seem to have; gluten, dairy, and refined sugar!  Trying to remove these things from your diet is a huge key factor in regards to any inflammatory condition, autoimmune or not.

In regards to taking supplements, there are a few natural products that could be of great help as well.  Taking a high strain good quality probiotic (everyone and their mom should be taking this) to help increase good bacteria levels in the gut, and taking ~5,000mg of L-glutamine daily to help with healing your gut lining.  Taking in more good quality fats, like a fish oil, to help decrease inflammation through out the entire body.  Some other supplements worth mentioning and taking if contending with R.A. would be high potency curcumin, MSM, and glucosamine sulphate.

I know this a lot of information, and unfortunately there is no “quick and easy fix” when dealing with an autoimmune condition such as R.A.  That is why people are so quick to turn to prednisone for pain relief.  Unfortunately, much of the population is not well educated in regards to what an autoimmune disease is, and what terrible side affects drugs such as prednisone can have on the body.  I feel it is my job as a chiropractor to help educate my patients to the best of my ability so we can all lead a healthier and happier life.

In closing and as a side note, if you are dealing with R.A., chiropractic treatment and ART® have proven to help provide a lot of relief when dealing with chronic inflammation and pain surrounding the joints.  The goal is also to remain active.  Joints are meant to move, so KEEP MOVING!  Should you have any questions, always feel free to email me at drv@performancehealthcenter.com .  Happiest and healthiest of holidays to you all, cheers!

Stay Safe During Hot Weather Exercise

If you are a regular reader of these blogs you know that I definitely advocate exercising on a regular basis, but when the summer months turn really hot and humid, you need to be careful to avoid heat related illnesses like heat stroke or heat exhaustion.

Whether you’re running, playing tennis, working in your yard or garden, or going for a power walk, please be careful when the temperature rises. Even in your home, you should take measures to ensure the home is nice and cool. You might want to check out Allen Kelly & Company, Inc. if you need an air conditioning facility.

Exercising in hot weather puts extra stress on your body. If you don’t take care when exercising in the heat, you risk serious illness. Both the exercise itself and the air temperature and humidity can increase your core body temperature.

To help cool itself, your body sends more blood to circulate through your skin. This leaves less blood for your muscles, which in turn increases your heart rate. If the humidity also is high, your body faces added stress because sweat doesn’t readily evaporate from your skin. That pushes your body temperature even higher.

Under normal conditions, your skin, blood vessels and perspiration level adjust to the heat. But these natural cooling systems may fail if you’re exposed to high temperatures and humidity for too long, you sweat heavily, and you don’t drink enough fluids.

The result may be a heat-related illness. Heat-related illnesses occur along a spectrum, starting out mild but worsening if left untreated. Heat illnesses include:

  • Heat cramps.Heat cramps, sometimes called exercise-associated muscle cramps, are painful muscle contractions that can occur with exercise. Affected muscles may feel firm to the touch. You may feel muscle pain or spasms. Your body temperature may be normal.
  • Heat syncope and exercise-associated collapseHeat syncope is a feeling of lightheadedness or fainting caused by high temperatures, often occurring after standing for a long period of time or standing quickly after sitting for a long period of time. Exercise-associated collapse is feeling lightheaded or fainting immediately after exercising, and it can occur especially if you immediately stop running and stand still after a race or a long run.
  • Heat exhaustion.With heat exhaustion, your body temperature rises as high as 104° F, and you may experience nausea, vomiting, weakness, headache, fainting, sweating and cold, clammy skin. If left untreated, heat exhaustion can lead to heatstroke.
  • Heatstroke is a life-threatening emergency condition that occurs when your body temperature is greater than 104° F. Your skin may be dry from lack of sweat, or it may be moist.

You may develop confusion, irritability, headache, heart rhythm problems, dizziness, fainting, nausea, vomiting, visual problems and fatigue. You need immediate medical attention to prevent brain damage, organ failure or even death.

During hot-weather exercise, watch for signs and symptoms of heat-related illness. If you ignore these symptoms, your condition can worsen, resulting in a medical emergency.

WARNING SIGNS:

  • Muscle cramps
  • Nausea or vomiting
  • Weakness
  • Fatigue
  • Headache
  • Excessive sweating
  • Dizziness or lightheadedness
  • Confusion
  • Irritability
  • Low blood pressure
  • Increased heart rate
  • Visual problems

If you develop any of these symptoms, you must lower your body temperature and get hydrated right away. Stop exercising immediately and get out of the heat. If possible, have someone stay with you who can help monitor your condition.

Measuring core body temperature with a rectal thermometer is essential to accurately determine the degree of heat injury. An oral, ear or forehead thermometer doesn’t provide an accurate temperature reading for this purpose. In cases of heatstroke, due to confusion and mental status changes, you won’t be able to treat yourself and you’ll require emergency medical care. The most effective way of rapid cooling is immersion of your body in a cold- or ice-water tub.

In cases of heat exhaustion, remove extra clothing or sports equipment. Make sure you are around people who can help you and assist in your care. If possible, fan your body or wet down your body with cool water.

You may place cool, wet towels or ice packs on your neck, forehead and under your arms, spray yourself with water from a hose or shower, or sit in a tub filled with cold water. Drink fluids such as water or a sports drink. If you don’t feel better within about 20 minutes, seek emergency medical care.

IF YOU HAVE SIGNS OF HEAT STROKE- SEEK MEDICAL TREATMENT RIGHT AWAY

If your core temperature is less than 104° F, but it doesn’t come down quickly, you’ll also need urgent medical attention. In some cases, you may need fluids through intravenous (IV) tubes if you’re not able to drink fluids, or not able to drink enough fluids.

Get cleared by your doctor before you return to exercise if you’ve had heatstroke. Your doctor will likely recommend that you wait to return to exercise or sports until you’re not experiencing symptoms. If you’ve had a heatstroke, you may require many weeks before you are able to exercise at a high level. Once your doctor clears you for exercise, you may begin to exercise for short periods of time and gradually exercise for longer periods as you adjust to the heat.

When you exercise in hot weather, keep these precautions in mind:

  • Watch the temperature.Pay attention to weather forecasts and heat alerts. Know what the temperature is expected to be for the duration of your planned outdoor activity. In running events, there are “flag” warnings that correspond to the degree of heat and humidity. For example, a yellow flag requires careful monitoring, and races are canceled in black flag conditions.
  • Get acclimated.If you’re used to exercising indoors or in cooler weather, take it easy at first when you exercise in the heat. It can take at least one to two weeks to adapt to the heat. As your body adapts to the heat over time, gradually increase the length and intensity of your workouts.
  • Know your fitness level.If you’re unfit or new to exercise, be extra cautious when working out in the heat. Your body may have a lower tolerance to the heat. Reduce your exercise intensity and take frequent breaks.
  • Drink plenty of fluids.Dehydration is a key factor in heat illness. Help your body sweat and cool down by staying well-hydrated with water. Don’t wait until you’re thirsty to drink fluids. If you plan to exercise intensely, consider a sports drink instead of water. Sports drinks can replace the sodium, chloride and potassium you lose through sweating. Avoid alcoholic drinks because they can actually promote fluid loss.
  • Dress appropriately.Lightweight, loose fitting clothing helps sweat evaporate and keeps you cooler. Avoid dark colors, which can absorb heat. If possible, wear a light-colored, wide-brimmed hat.
  • Avoid midday sun.Exercise in the morning or evening, when it’s likely to be cooler outdoors. If possible, exercise in shady areas, or do a water workout in a pool.
  • Wear sunscreen.A sunburn decreases your body’s ability to cool itself and increases the risk of skin cancer.
  • Have a backup plan.If you’re concerned about the heat or humidity, stay indoors. Work out at the gym, walk laps inside the mall or climb stairs inside an air-conditioned building.
  • Understand your medical risks.Certain medical conditions or medications can increase your risk of a heat-related illness. If you plan to exercise in the heat, talk to your doctor about precautions.
  • Choose and alternative form of exercise. If you are a runner – maybe try cycling as you create your own cooling effect by moving air over your body – or maybe give swimming a go – but beware of swimming laps in a hot (> 84° F) pool – as you can quickly overheat swimming in water that warm.

I do recommend that you continue to exercise on a regular basis even through this hot month of August, just be smart about it by following these recommendations.

If you have any questions about this blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com

 

Fall Sports Season Is Here, BELIEVE IT OR NOT!!! Dynamic Stretching, the “Pre-workout”

I wouldn’t be doing my job at Performance Heatlh Center, if I wasn’t trying to educate all my athletes how to prevent injury and showing up to my office “all banged up”.  I know I have touched on this before, but I cannot stress the importance of stretching, and when training, dynamic stretching!

If you look up Wikipedia’s definition of dynamic stretching, this is what comes up, “Dynamic stretching is a form of stretching beneficial in sports utilizing momentum from form, and the momentum from static-active stretching strength, in an effort to propel the muscle into an extended range of motion not exceeding one’s static passive stretching ability”.

Performing dynamic stretches in a “pre-workout” or warmup are a series of active stretches will help move the muscles through their range of motion, help improve range of motion surrounding the joints, help elevate core body temperature, and help to stimulate the nervous system so it is better prepared for activity.

Dynamic stretching primes the muscle to be ready to contract and relax, just as they would need to be ready to function during a sprint, run or jumping motion etc.  Being dynamic stretching is an active movement, it helps to prevent over-stretching, which can also fatigue the muscles.  Fatiguing the muscles prior to a workout can provoke injury or unfavorable symptoms to the area.  That is one of the main reasons coaching have gotten away from prescribing static stretching before a workout.  In fact, many coaches suggest athletes do a dynamic warm up every day to help keep muscles limber and ready to move at all times.

Dynamic stretching also helps to mentally prepare the athlete before the workout or competition.  Static stretching can be more relaxing, and while there is definitely a place for it, static stretching can almost trick one’s body into relaxation mode and make it more difficult to transition to “competitor” or “beast mode”.

Dynamic stretches target major muscle groups when warming up.  For example, when running, dynamic stretches target hamstrings, quads, glutes, hip flexors and calves to help prime these areas for movement.  Usually a couple of minutes of light jogging is recommended first to get the blood flowing before getting into a 5-10 minutes of dynamic stretching.  Walking butt kicks (heel to butt), knee hugs (walking knee the chest), walking toe touches, walking lunges with an overhead reach, glute bridges, heel and toe walks, are just a handful of great dynamic stretches to get one warmed up and the muscle groups prepared for the intensity of the workout that follows.   It really is something so easy to work into a warm up, and would most likely replace a more static routine one is doing, so it would not add much time on to one’s routine either.    Some of you reading this may find that you are already doing some type of dynamic stretching prior to a workout without even knowing it, which is great!  Gold stars for you!

Should anyone reading this little article have any questions in regarding dynamic stretching and incorporating this into their pre-workout routine coming into the fall sports season, please feel free to contact me at: drv@performanacehealthcenter.com

Share This With Your PCP!

Unfortunately the following saga is way too typical in our office. Last month I saw a new patient who had severe low back pain (LBP) for over 2 years. The pain was so severe she was living on pain meds, going right home from work and going to bed. She was not participating in life and was extremely frustrated. She had seen her Primary Care Physician (PCP) from the onset of her pain. She was referred to multiple specialists for advanced testing, injections and more medications, none of which gave her any real relief or hope.

Finally after two (2) years, at the repeated encouragement of Lyn Rome, her hair stylist, she came into my office, explained in detail all she had been through and the frustration of living with pain. My exam ruled out all the “red flags” or pathological causes of her pain. My diagnosis was dysfunction of her left Sacro-iliac joint and sciatic nerve entrapment. Simply put, the largest joint in her body (in the butt area) was stuck and the longest and thickest nerve in the body which goes from the low back to the toes was not gliding properly. Of course she also had muscles spasms because her muscles were short and tight to protect the joint that was not moving, setting up a visors cycle of pain that kept perpetuating itself.

I felt confident I could help her, but since she was skeptical and nervous from her prior medical treatments I recommended a 2 week trial of chiropractic care to see how she would respond. I wish all of my patients responded so quickly, but after 2 treatments she had significant decrease in pain, stopped the pain meds and didn’t have to go right to bed after work. Obviously the trial of care was successful and she is on the road to recovery.

Two (2) years of her life was wasted because of ignorance (or bias) on the part of her PCP. Unfortunately this is a scenario I see all the time at our office, but it shouldn’t be that way. Any competent medical doctor who keeps up with the literature should know that chiropractic care has been well documented as an effective treatment for LBP. (It is not the only condition we treat, but the most researched). There really is no excuse for collaboration between your PCP and the chiropractic profession for the best interest of the patient, especially for the treatment of LBP.

Now there is even more proof! In the May 2018, on-line edition of the JAMA (Journal of the American Medical Association), a new studies found that “usual medical care plus chiropractic care reported a statistically significant improvement in low back pain intensity and disability at 6 weeks compared with those who received usual care alone.” In a study of 750 people, from the ages of 18-50, the addition of including chiropractic care documented statistically significant improvement included less reported pain, less disability, more patient satisfaction and less pain medications used. Across the board including chiropractic care reduced pain and suffering.The conclusion of this study states, “this trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines”. Note the words…as currently recommended in existing guidelines.

The number one cause of disability worldwide is LBP! At least 20% of Americans will have LBP lasting at least 1 day over the next 3 months. LBP is the 2nd reason why patients visit their PCP. The direct cost of LBP in 2010 was $34 billion, and adding in lost work and productivity costs the US economy up to $200 Billion. At the present time only 8-14% of the US population receives chiropractic care annually. So why aren’t PCPs referring to chiropractors. Getting historical, there have been excellent studies validating chiropractic care and multiple government reports recommend a greater utilization of chiropractic care.

As far back as 1993 the Ontario Ministry of Health published what is called the Manga Report. The Manga Report’s conclusion was to make chiropractors the gatekeepers for treating LBP for many reasons concluding: “On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate; there is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain; and there is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.”

Then in 1994, the US Agency on Health Care Policy and Research (AHCPR) released Clinical Guidelines for Management of Acute Low Back Pain. These Guidelines were created an expert panel to provide PCPs with recommendations on the assessment and treatment of LBP. Again the conclusions included:
• Conservative treatment such as spinal manipulation should be pursued in most before cases considering surgical intervention;
• Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

The benefits of chiropractic care both in human suffering level and economic savings is well documented and recommended by multiple government agencies. I still don’t understand why the chiropractic profession is not getting more referrals from the medical profession. Going back to the patient in the first paragraph, in her words she lost 2 years of her life and had lost hope of ever being able to function and doing the most basic activities like walking with her husband or sitting in a restaurant. My bias is that she should have been referred for chiropractic care after the pain lasted for 2 weeks while following her PCPs advice. When the pain persisted and multiple therapies failed, at the very least her PCP could have said I don’t know much about chiropractic health care, but since you are not feeling better why don’t you give it a try.

I don’t fault the present generation of medical doctors. Chiropractic care is not part of their educational curriculum. I have seen this first hand. For eight (8) years family practice residents first at University of Vermont and then Tufts had a one (1) day rotation at my office. I asked each resident in all your years of medical school and residency how much did they learn about chiropractic health care. The answer across the board was “nothing”. Then I’d ask how much did they learn about the musculoskeletal system? The answer across the board this time was “not much”. Then I’d ask my final question which was how many vertebrae are in the spine? In 8 years only 1 Family Practice Resident was able to rattle off the correct answer which is 24.

Then the medical resident spent the day with me watching me interact and treat my patients. At the end of the day across the residents would say how impressed they were. They didn’t realize the scope of chiropractic practice and the benefits of manipulation. My advice was always the same. When you finish your residencies and hang up your shingle to practice, meet a few chiropractors in your community, find one or two that you feel comfortable with and refer your patients to them. Unfortunately this type of rotation at a chiropractic office was and still is a rare event in the training of medical residents.

Hopefully you have read down this far. The only way your PCP is going to know about this new study (and historical guidelines) is if you share this article with them. Please email your PCP and attach this article. Ask if he/she has read the new JAMA study on the significant benefits of including chiropractic care in collaboration with “usual medical care” for patients with low back pain? If not the link is here: Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial

Sharing this article with your PCP this will help build bridges between the two professions and the winner is you, the consumer of health care.

For more information please contact me at drbradweiss@performancehealthcenter.com

It’s That Time of Year Again, Boston Marathon Time!

Calling all Boston Marathoners, it’s that time of year!  Spring is in the air, hopefully the snow is done, and the marathon is quickly approaching.  So exciting!!!

Once again, I wouldn’t be doing my job if I wasn’t offering a little advice to all my patients, family and friends on how they can better take care of themselves during this exciting time of year, and the rest of the year, as “marathon-ing” is starting to become an all year round sport.

I cannot stress how important it is that runners and athletes in general be more proactive to take care better care of themselves leading up to a marathon, and in their recovery post marathon as well.   Being proactive pre-race and post-race, whether it being seeing your chiropractor, massage therapist, physical therapist, or acupuncturist, can really help prevent injury from occurring leading up to the race, and certainly help speed up your recovery and get back on the road to training after the race.  There are so many words of advice, tips, recommendations etc., that I am going to just focus on a few things that I have found myself to fall short on after running a marathon or completing a triathlon.

One of the most commonly asked question by a runner or triathlete is, “How long should I wait to run again after the marathon?”.   After my first marathon, I had no clue, and I thought I could just jump back into running like it was nothing!  I mean, I had just completed 26.2 miles of running, I felt like I could do anything!  Boy was I wrong, and it certainly wasn’t the first question I asked.  So…for all of those who are inquiring and don’t want to be like me on the first time around, general rule of thumb seems to be 1-2 weeks depending on how one feels.

A lot of articles say 5-7 days of rest post marathon, which I am totally fine with.  More importantly though, the next few weeks after that initial week should be taken lightly with training as the body is trying to recover.  Usually within 3-4 weeks a runner can return to regular training, or harder workouts, providing there are no injuries that the runner or triathlete is dealing with from before the race, or an injury resulting from the race.  As for triatletes, usually one can get back to swimming right away, as it is not compressive to the body, but I wouldn’t be trying to “kill it” in the pool.  As for the bike, again, less compressive to the body, but listen to your legs and your body, and how you feel over all.  To go a little lighter for a few weeks post-race is not a bad thing.  You can still get some good training and exercise in without destroying your body.

Again, as I have mentioned before, ice baths for recovery post race are awesome.  Most runners inquire about the effectiveness of ice baths and when or how long to soak in the tub of ice for.  The general idea in regards to this type of cryotherapy treatment is that the exposure to cold helps the body fight the microtrauma (tiny little tears) in the muscle fibers causing soreness by the repetitive exercise that just took place.  Constricting the blood vessels for a short period of time can help to flush toxins released by the body during the event, and intern, help to decrease or reduce inflammation, swelling, and breakdown of tissue in the body. I recommend getting into the tub and filling it with cold water around you first (up to your waste), then dumping a bag or two of ice into the water after you are submerged. It is best to stay submerged in the ice bath for about 10 minutes if you can tolerate it.

As always, I am a HUGE fan of a post marathon chiropractic adjustment and Active Release Techniques® (ART) to help realign your body, and set your straight for the rest of the season, or whatever race you have coming up next.  Post-race massage within a few days’ post marathon or whatever race you have done is so important, and something I always do without fail.  Without my chiropractors and massage therapists, physical therapist, and acupuncturist, I do not think I could train the way I do, and keep going after all of these years, seriously!

I really hope some of this information helps you all in your journey to the Boston Marathon this year, or whatever race or competition you have on your calendar in 2018.  And, in particular to the month of April, Happy Boston Marathon-ing to everyone racing.  Think positive thoughts to carry you through that day, and I will be there with you all in spirit!  If you have any questions about pre and post marathon or race recovery, please feel free and contact me at drv@performancehealthcenter.com.

 

Improve Your Posture With These Exercises and Stretches

Most people feel like they could improve their posture, yet they are not quite sure where to start.  I will list some key stretches and exercises that will help improve your posture, but first we need to determine what is causing our poor posture.

Most of us spend too much time sitting. Add up all the time we spend sitting in the car, at home, and at work and it may equal more than half your waking hours. The problem stems from the way we typically sit, or slouch, hours at a time in front of a computer, or behind the wheel of a car, or slumped on the couch at home.  Typical poor sitting posture includes: neck protracted, shoulders internally rotated, hamstrings shortened, glutes and core muscles disengaged. Consistently sitting like this will inevitably lead to muscular imbalances that translate into poor posture.

When you do sit, remember to keep your back straight with your head in a neutral position. Allow your shoulder blades to sink into your back pockets. Align your ears over your shoulders, and your shoulders over your hips to avoid that forward slouch.

Better yet, sit on a stability ball, or replace the chair, even some of the time with a stand-up desk arrangement. At the least, incorporate frequent breaks into your workday to break up extended hours of sitting at a desk.

During your breaks from sitting, stand up and do some muscle activation exercises and dynamic stretches to wake up the lines of communication to underused muscles and to increase mobility in tight areas.

MUSCLE ACTIVATION EXERCISES:

Activate your core by pulling your belly button toward your spine; then raise your arms above your head and lean back slightly while balanced on one leg. Hold it for five seconds; then switch to the other leg.

Activate your hips by standing on one leg and moving your opposite leg back and to the side. Hold for five seconds; then switch legs. Or, stand on both legs and alternately squeeze one glute and then the other, as you sway side to side.

Specific stretches to improve posture:

Open up the chest with a doorway stretch.  Stand in a doorway with your hands on each side of the opening- allow your body to “enter the room” with your hands still on each side of the door opening behind you.  Hold for 30 seconds.

To stretch your back, start with a half wall hang. With your feet shoulder-width apart, place your hands against a wall. Slowly step away from the wall as you slide your hands down the wall until your hands, shoulders, and hips are aligned and parallel to the floor. Push your hands into the wall and pull your hips away from the wall as you feel a stretch in your lower back.

From the half wall hang, move into a full hang to target more of your hamstrings. Move your hands down the wall to the floor and hang with waist bent and head relaxed.

SHOULDER RETRACTION EXERCISE:

The shoulder retraction exercise helps vertically align your head and neck with your spinal column and helps your thoracic spine move into extension. The shoulder retraction exercise is designed to relax your tight neck and pectoral muscles.

Stand up straight and keep your feet about shoulder-width apart and your toes pointing straight ahead. Slowly contract your abdominal muscles to keep your hips in a stable position. With your arms dangling freely at your sides, flip your palms over to face directly ahead and then lower your shoulders down and back so that your shoulder blades move toward your spine. Push your breastbone out and up. Position your head so that it’s directly above your spinal column and then tuck your chin to your throat. Hold this stretch for 20 to 30 seconds. Perform this stretch one time per working hour.

REVERSE SHOULDER SHRUGS:

Perform reverse shoulder shrugs by standing or sitting up straight and keeping your head in a neutral position, directly above your spinal column. In one fluid motion, lift both of your shoulders toward your ears. Then roll your shoulders backward and down as your shoulder blades move toward your spine. This exercise helps extend your upper thoracic spine and opens up your chest. While you’re performing this exercise, you should feel a light stretch in your chest and shoulder muscles. Perform 20 reverse shoulder shrugs two to three times a day, five days a week or more if you’re doing a lot of computer work.

CHIN TUCK EXERCISE:

Perform the repetitive chin tuck exercise to stretch your neck muscles and promote better posture. The repetitive chin tuck exercise targets the muscles in your upper cervical spine, which are situated just below the base of your skull.

Perform the repetitive chin tuck exercise by standing tall and keeping your spine straight. This is your starting position. Keeping your gaze level, pull your head and neck straight back (without tilting your neck backward) and bring your chin to your throat. You should feel a light stretch in the back of your neck, just under the base of your skull. Hold your stretch for five to seven seconds and then return to your starting position. Repeat this exercise 10 times five days a week. To enhance your stretch, you can use your index finger to place gentle pressure on your chin.

My favorite “improve your posture exercise” involves a stability ball, also known as a Swiss ball, this passive stretch should be part of your daily routine.  Lie with your back supported by the stability ball. Plant your feet firmly in the ground, hip-distance apart.  Open your arms to the sides of the room and let them hang so you feel a stretch in your chest muscles. Hold for 20 to 30 seconds.  This exercise feels great as it unloads your spine from gravity and reverses the forward hunched posture we get from prolonged sitting.

To learn these and more Postural Restoration exercises in person, come to my next workshop, Postural Restoration.  Included in the class is a new Stability Ball pumped up for you.

If you have any questions about this blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com

The Concussion Muscle

Concussions are awful. There are close to 4 million sports related concussions in the U.S. every year. Your brain gets shaken up like an egg inside its shell. The skull doesn’t crack but the brain gets rattle around. You might lose consciousness, balance, ability to talk, have a headache and the world appears fuzzy. You go through concussion protocol testing and spend anywhere from a few days to weeks resting.
Slowly you start to feel better and eventually get on with life. 15% of concussion suffers have lingering effects which last beyond 3 months which is labeled “post-concussion syndrome. Persistent symptoms include inability to concentrate, memory issues, fatigue, dizziness, irritability, anxiousness, insomnia, blurry vision, noise and light sensitivity, and headache.

A recent study from the American Journal of Neuroradiology (AJNR) tried to determine if there was correlation between the suboccipital muscles and recovery time from post-concussion syndrome. The suboccipital muscles connect the upper neck vertebrae to the back part of the skull called the occiput. There are seven (7) muscles that make up the suboccipital muscles. An MRI of sixty-four consecutive patients with post-concussion syndrome was performed and symptoms were tested using standard concussion protocols.

Of the seven (7) suboccipital muscles only one (1) muscle’s cross-sectional diameter proved to have a direct association with post-concussion symptoms. That muscle is the Rectus Capitus Posterior Minor. (RCPMinor). There was a direct correlation with the RCPMinor and “greater symptom severity, longer recovery time, poor verbal memory performance and headache”. None of the other suboccipital muscles had a direct correlation.
What is so special about the RCPMinor muscles that it effects the recovery time ofpost-concussion syndrome? The RCPMinor is the only suboccipital muscle that has a ligament bridge that connects to the dura mater of your spinal cord right where your brain and spinal cord join. The dura mater is the outer protective membrane of the spinal cord. The theory is that the RCPMinor tugs on the spinal cord covering contributing to post-concussion symptoms.

I am only aware of one soft tissue technique that can isolate, evaluate and treat the RCPMinor muscle. That technique is called Active Release Techniques® or (ART). ART is patented and consists of over 500 specific protocols which differentiate, isolate, evaluate and treat the individual muscles in the body. The goal of ART is to release adhesions or scar tissue in muscles, ligament and nerve pathways in the body, in essence the soft tissues of the body. ART is cutting edge and is becoming the gold standard in treating soft tissue injuries. ART is done by hand. In order to become certified in ART you need to go through a certification course. Certification needs to be renewed every year. There are only 40 +/- certified ART providers in Massachusetts.

In the suboccipital region it is possible to isolate and evaluate the RCPMinor muscle using ART. If the RCPMinor is found to be short & tight, a specific tension is applied to the muscle which can normalize the tone and function. I have been an ART provider for 20 years. I have helped many patients suffering from whiplash injuries, headaches and post-concussion symptoms. Even before this study was published I have found that clinically the RCPMinor is a key muscle to treat to resolving post-concussion symptoms. As a side note, if you are suffering from whiplash injuries due to a car accident then it might be a good idea to get a lawyer involved, particularly if the accident wasn’t your fault. A lot of law firms will have a contact us page and this will help you to find the best lawyer for you and your case.

It’s not important to remember the name of the Rectus Capitus Posterior Minor muscle, but it is important to know that ART is one technique that is very effective in finding, evaluating and treating this muscle. If you, a family member or friend has been frustrated due to post-concussion syndrome, chronic headaches or whiplash injury, please get evaluated by an ART certified provider.
To find a certified ART provider anywhere in the world clink this link: http://activerelease.com/find-a-provider.asp

If you would like more information please contact me at: drbradweiss@performancehealthcenter.com

“Rest and Relax” vs “Fight or Flight”

“Rest and Relax” (PNS) vs “Fight or Flight” (SNS)…. I am writing this Blog the week before Super Bowl LII, while most sports fans are thinking AFC vs NFC and which is stronger and who will over power the other.  Well, I want you to consider in your own mind which system in your body is overpowering the other?

What do I mean by that?  Well, we all have both a Parasympathetic nervous system (PNS) and Sympathetic nervous system (SNS), both of which are regulated by our Central Nervous System (CNS).  Which ever one is dominant in you may influence your overall health.  People who are more SNS dominant may have trouble relaxing, they may have hypertension, muscle tension, irritability, and difficulty with digestion and/or elimination.  There are a host of health-related problems from being too SNS dominant, but for the sake of this blog I will highlight how it effects our overall nutritional intake and absorption.

Have you ever switched your focus from what you are eating to how you are digesting? Are you really absorbing all the nutrients from your foods?

The parasympathetic nerves come from the cranial nerves and include the vagus nerve. The PNS nerves perform the following digestive functions:

  • Stimulate the activity of the stomach
  • Inhibit the release of glucose
  • Stimulate the release of the gallbladder to release bile needed to digest fat
  • Stimulate the activity of the intestines
  • Trigger peristalsis, which helps prevent constipation
  • Trigger enzyme production in the pancreas (pancreatic enzymes to break down carbs, protein and fats)
  • Signal if satiated
  • Signal if hungry
  • Need for more stomach acid (HCL), enzymes, bile and peristalsis

The sympathetic nerves do the opposite, including:

  • Inhibit the activity of the stomach
  • Stimulate the release of glucose (increasing blood sugar levels)
  • Inhibit gallbladder function (inhibiting the release of bile for fat digestion)
  • Inhibit the activity of the intestines

Stress impairs our digestive process. Digestion is a parasympathetic nervous system process (PNS) also known as the “rest, digest and repair” nervous system. For maximum health we should be in the PNS 80 percent of the time and the other 20 percent of the day we should be in the sympathetic nervous system (SNS), also known as the “fight or flight” nervous system. Now what percentage of the day do you think you are in PNS versus SNS? What about when you are eating? Resting? Sleeping? We should be in the parasympathetic nervous system when eating but rarely do we sit, relax and focus on eating a meal as they do in most areas of Europe.

If you are a typical type-A personality, over-doer in life, then you may struggle with taking time out of your weekday for a relaxing meal and unplugging. What is the difference? Eating in the parasympathetic nervous system versus the sympathetic nervous system. Digestion is turned off when you are in the sympathetic nervous system. Many of us are living life as a race leading us to be in the sympathetic nervous system 80 percent of the day instead of 20 percent, causing a domino effect of health problems.

So, we know the vagus nerve highly influences the PNS so our vagus nerve needs to be strong in order to help in the digestion process. Remember, we get our amino acids, essential fatty acids, vitamins and minerals from the food we digest and break down, which helps build enzymes, hormones, muscles, bones, blood and our gut biome.

We need to support our vagus nerve and (PNS) to improve our digestion and gut health if we want to be healthier, since good digestion leads to a healthy gut, which results in reduced inflammation and an improved immune system (70% of our immune system is in the gut!).

Stop, pause, slow inhales, long exhales and reset. Take some deep breathes in and out, focus and unplug. Other techniques to boost your PNS: gargling, humming, singing, cold showers, meditation, mindful yoga, and connecting with loved ones.

Our digestion is as important as our diet. To nourish ourselves, we must support our digestion, but also our brain, as the brain communicates to the gut and the gut communicates back to the brain. Anti-inflammation is key to our bodies’ repair, recovery and regeneration, but it doesn’t happen if we are not in the parasympathetic nervous system more often during the day and all night.

Chiropractic adjustments can strengthen your PNS since it deals directly with your nervous system.  Every function of your body is controlled by your central nervous system, and these functions can be disrupted by misalignments in your spine. These are called subluxations. A subluxation creates interference in the function of your spinal nerves, and this can result in impaired functioning of your organs and endocrine system.

So, slow down, take some deep breaths and get regular chiropractic adjustments to keep your vagus nerve and your PNS strong and healthy.

If you have any questions about this blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com

 

Got Enough Snow Yet???

Has your back been aching after an already long winter, and it’s only the beginning of February? Did you ever stop to think that you might be doing it wrong?  Shoveling, that is.  And, if you are not using a snow blower, like many of us are not, me included, you basically have a couple choices when it comes to shoveling snow…Shoveling after every few inches of snow fall, or waiting until the storm ends, and then remove the snow in layers, are the pretty obvious choices I would say.  If shoveling snow after you have waited for it all to accumulate, the please remove only as much snow as you are comfortable lifting and moving at a time.

It is also recommended that you clear your driveway in two stages if shoveling.  First, you should push the snow to the edges of the driveway with a versatile snow shovel (there are various types of snow shovels if you didn’t know, and this is one that is good for throwing, lifting and pushing), then shovel what’s left in the way out of the way.  The more you can push the snow instead of actually lift and shovel the snow, the better! One tip, if you have an uneven pavement, an all plastic snow shovel without a steel edge would be better and less likely to catch and possibly “jar” your wrist, elbow, shoulder, or back.

Even if you have been dealing with shoveling snow on and off your whole life, the basic idea is to work smarter, not harder – avoid unnecessary work!  Clear a path on your way to your car, that way you avoid packing down the snow along the way, and packed snow is much tougher to shovel.  We all know that!  Just look at the last storm we had that packed down a lot of heavy and wet snow, ugh L

Don’t bother too much with the snow close and around your car at first.  Turn your car on to defrost and melt the snow on it, while you start shoveling elsewhere.  It is usually just easier to clear the snow close and around your car later after you have cleared off what is left on your car as well.  To be more efficient, it is better to remove that snow once towards the end as a final touch up.  Remember, every additional scoop you make is extra strain on your body!  If you are in good shape and aiming for this to be a work out, awesome, just please move carefully as well (the same rules generally apply), otherwise one should be trying to conserve movement.

Don’t worry too much about shoveling the snow where your driveway meets the road right away.  As we all know, the plows go by and always fill that area with more snow, lucky us!  If I were you, I would wait until the end to shovel that part, or when the plows have finished, or at least gone by once depending on the size of the storm.  When tackling this part of the driveway, be sure to do it in stages, as the snow will be much heavier to shovel.

Try and have a plan of attack before going out to shovel snow.  It may even be best to break up shoveling into smaller sections and rest in between if needed.  Like stated before, try and clear your driveway in stages, rather than all at once.  Try not to create huge piles of snow while shoveling either, it becomes harder to lift and throw the snow, and can put more pressure on your spine and back.  Another tip as well, make sure you know where your walkways or pathways are, and do not shovel more snow into those areas.  You will in turn have to shovel that snow, plus the snow already there.  There is NO need to move that snow twice!  Our backs are not meant for this kind of work.

 

It is still a good possibility that even following all of this advice and the tips, you could end up with a “bad back” a day or two after shoveling.  That is why you always hear, “Lift with your legs!”.  You want to avoid at all cost putting added stress on your low back, let your legs do the work.  For example, bend your knees to lower yourself to pick up the shovel off the ground, and same goes for accessing the snow.  DO NOT bend your back to reach the snow. After scooping up a shovel full of snow, use your legs to raise yourself back up.  When you are going to stand back up as well with the snow on the shovel, do not have your arms stretched out away from your body, your back will be doing much of the work that way, and in an odd and vulnerable position.  Keep the load of snow close to your body, as it will help to keep stress off your low back.  And one other thing, and I promise to be done talking about shoveling snow (how depressing), ALWAYS move your upper body and upper body together when turning to throw the snow.  NEVER twist or rotate with your upper body only, that is a recipe for a herniated disc, or a very back low back strain.  Okay, I am done ranting on, for now anyway…

Performance Health Center always sends out an email reminder to all of our patients and friends before a snow storm to help remind you all how to perform snow removal safely with a shovel.  It’s because we care, and would rather see you in our office for your monthly maintenance or wellness visit, not because you threw your back out shoveling! If you have any questions or concerns regarding any of this information, be sure to email one of the docs at PHC, or talk to us at your next office visit.  Happy shoveling you guys, and only two more months of winter, but who’s counting?  I sure am!  DrV@performancehealthcenter.com

Tips to Relieve Back Pain

Your first step should be to seek out professional help.  Whether you see your PCP, a Physical Therapist, an Orthopedic Physician, or a Chiropractic Physician, start by finding a professional trained to diagnose and treat back pain not only with cheap tramadolpills.  There are a multitude of factors that can cause back pain, and getting the proper diagnosis is the best place to start.  If you are looking for a non-invasive non-pharmacologic option, Chiropractic has shown in many studies to be statistically the best choice.

 

“Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”       

Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics

 

Keep moving.  Many PCP’s and Orthopedic Physicians recommend bed rest, but this can often make things worse.  We say every day to our patients, “Life is motion”.  We are designed to move each and every day.  Many of our patients tell us the prolonged sitting or standing they do is often their biggest contributor to their chronic back pain.  Let pain be your guide, any movement or motion that does not make your condition worse will usually help it get better sooner.  We find many times the cuase of the back pain are fixated vertebrae- that is they are not moving properly. These “fixations” can be caused by a multitude of factors, i.e. physical or emotional stress, some sort of trauma, poor posture, or even a poor diet can contribute to these vertebral “fixations”, which we refer to as “subluxations”.  Chiropractors are the only specialists that are trained specifically to locate and correct these vertebral subluxations.

If your chronic pain is related to emotional or work-related stress, try some relaxation techniques to help reduce muscle tension.  If your job or lifestyle requires lots of physical stress, make sure to use good posture and be sure to take stretch breaks often.

Exercise regularly- this helps in many ways: gets your spine moving; reduces stress; increases blood flow; and helps strengthen the muscles that support your spine.  What exercises are best for your back?  Well that may be different for each of us, but first find something you can currently do without pain, and make sure it is something you enjoy as you will be much more likely to stick with it.  My people find Yoga and/or swimming to help their chronic back pain, but as I mentioned earlier find what works best for you.  Make sure to warm up properly: including some foam rolling, then be sure to maintain good posture throughout your exercise, and be sure to stretch when you are done.

Get enough rest.  Make sure you have a good mattress to sleep on, and beware of your sleeping “posture” as well.  Avoid sleeping on your stomach as that can cause the neck and head to twist and put stress on your spine.  If you sleep on your back consider putting a pillow under your knees, and if you sleep on your side consider putting a pillow between your knees.

These are just a few more “tips” to help you improve your back pain.  If you have any questions about this Blog or about your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com